The winter Omicron surge has sent more kids with COVID-19 to Ontario hospitals than previous pandemic waves, and now some hospitals are starting to plan for a new uptick in children admitted with the virus.
Doctors say they anticipate a rise in pediatric hospitalizations following the swell of COVID infections seen since March break, fuelled by the new highly transmissible subvariant of Omicron and the removal of most public health measures in the province, including mandatory mask wearing.
While kids admitted to hospital with Omicron infections are not experiencing more severe symptoms compared to previous COVID variants, the province’s pediatric hospitals are again reviewing their capacity plans in case of a spring surge of patients, said Dr. Upton Allen, division head of infectious disease at the Hospital for Sick Children.
“We are watching very carefully,” he said, noting the hospital experienced a slight increase in hospitalizations for COVID this past week.
“This newer subvariant, BA.2, it’s even more easily transmitted. We are expecting, in this period following March break, more kids coming to the emergency department (with COVID) and more kids coming who need to be admitted” with COVID.
Since Jan. 1, SickKids has admitted more than 255 kids with COVID. This includes 96 patients — about 40 per cent — who tested positive for the virus but received care for another illness or condition.
SickKids data shows children under five, not yet eligible for COVID vaccines, are being admitted in higher numbers than older kids, mirroring a provincial trend. Of the 159 children admitted since Jan. 1 with COVID as the primary diagnosis, 85 have been four and younger.
Allen said young children admitted with COVID have symptoms similar to another respiratory infection called respiratory syncytial virus, or RSV, that can cause breathing problems and be serious in infants. Most need supportive care, such as some oxygen support and IV fluids to help with dehydration caused by vomiting and diarrhea, he said.
Children with the virus who go to the ICU are “given a bit of extra support to take them over the hump before being sent back to ward,” Allen said. Between Jan. 1 and March 20, 44 children with COVID were admitted to SickKids’ pediatric intensive care unit. Of those patients, 26 were under five.
Allen said the majority of those in the specialized unit above age five were unvaccinated, despite being eligible.
At CHEO (the Children’s Hospital of Eastern Ontario) in Ottawa, since the beginning of the Omicron wave, “about 10 per cent of all of our admissions to hospital are kids testing positive for COVID,” said Dr. Lindy Samson, the hospital’s chief of staff.
“For about a third of those kids, that’s the sole reason for admission to hospital. And for about two-thirds, something else brought them in, which may or may not have been triggered by COVID,” she said. “We believe that in many of those children, COVID exacerbated an underlying condition and they may not have needed to come into hospital if they didn’t have” COVID.
While CHEO experienced an uptick in kids being admitted with the virus during the first two weeks of March, the trend did not continue through the rest of the month. Samson said with COVID wastewater readings going up, it’s critical to ensure eligible kids are vaccinated and maintain masking in indoor places, including schools.
Dr. Ram Singh, director of the pediatric critical care unit at the Children’s Hospital at London Health Sciences Centre, said he and his colleagues are watching the numbers carefully and co-ordinating with others in the province to ramp up capacity as needed this spring.
During the peak of the winter Omicron wave, Singh said the hospital faced a dual surge of COVID and RSV patients, forcing them to open additional pediatric ICU beds in surgical recovery areas that were empty following the cancellation of some pediatric surgeries.
“We looked for any extra space we could find,” he said. “If we start to see more cases coming in (this spring) we will need to activate those plans.”
According to Public Health Ontario, 73 kids 19 and younger were admitted to hospital for COVID between March 16 and March 30, including 46 children under five.
In January, as the Omicron wave was rising, 137 children were hospitalized with COVID from Jan. 6-20. During that time, the youngest kids were being admitted at a higher rate, with 77 kids under five hospitalized.
So far in the pandemic in Ontario, 1,385 children have been admitted to hospital with COVID, including 769 under the age five.
Dr. Steve Flindall, an emergency medicine physician in York Region, said while he hasn’t had to admit many children severely sick with COVID to hospital this spring, he is struck by the volume of young kids testing positive in the ER.
On a recent shift, Flindall said he spent about half his time seeing patients with COVID-like symptoms. And of those patients, half were children under five, many with high fevers. One had a fever so high it triggered a febrile seizure, he said.
“They can’t be vaccinated and with public health restrictions essentially being removed, they aren’t being protected in the community in any way.”
Data from Public Health Ontario shows a person with COVID under age 19 died during the last two weeks of March. To date, 15 children have died of COVID, according to provincial data.
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