Virus hospitalizing more Arizona kids
‘It has increased exponentially since October’: Pediatric patients filling health care facilities during the latest surge
The number of children hospitalized with COVID-19 has been rising as Arizona hospitals have treated unprecedented levels of COVID-19 patients during the latest surge.
Banner Health, Arizona’s largest health care delivery system, has admitted 795 children ages 18 and younger with confirmed COVID-19 to its hospitals since Oct. 1, with the numbers steadily rising each month.
December’s pediatric COVID-19 admissions in Banner’s Arizona facilities were more than four times higher than the October numbers, according to data provided by the Phoenix-based nonprofit company.
More kids with COVID-19 are being admitted to hospitals in Banner Health’s Arizona facilities than during the first surge, said Dr. David Moromisato, a pediatric critical care medicine specialist and chief medical officer for Banner Desert and Cardon Children’s medical centers in Mesa.
That makes sense, he said, since the volume of adults hospitalized in Arizona for COVID-19 also has been higher during the second surge.
“It has increased exponentially since October,” Moromisato said of the pediatric patients. “Starting in November it just really ramped up ... We want to make the community aware that children are affected and that they can get very sick from it. Even if they don’t, they can also be spreaders.”
In December, Banner admitted 342 pediatric patients with COVID-19-related illness to its Arizona hospitals. In January, Banner officials project that number will increase by 16% to 396. The peak of Arizona’s summer surge occurred in the month of July, when 196 pediatric COVID-19 patients ages 18 and younger were admitted to Banner’s Arizona hospitals, the Banner data shows.
Even before the second surge, Arizona’s rate of pediatric COVID-19 hospitalizations appeared to be relatively high, according to a University of Minnesota study that looked at pediatric COVID-19 hospitalizations in a “geographically representative” sample of 22 states representing more than 29 million children. The study period went from May 15 through Nov. 15, and researchers found Arizona’s pediatric hospitalization rate increased by 4,000% during that time.
That study found Arizona and South Dakota had the highest rates per 100,000 children, according to a research letter published in the medical journal JAMA Pediatrics this month.
“Our results present concerning
“We want to make the community aware that children are affected and that they can get very sick from it.”
Dr. David Moromisato
A pediatric critical care medicine specialist and chief medical officer for Banner Desert and Cardon Children’s medical centers in Mesa
trends in pediatric hospitalizations,” the researchers wrote “Adult, and especially geriatric, incidence of COVID-19 continues to dominate the national picture, but pediatric populations may require resources that are not readily available across the country.”
The numbers may be small compared with COVID-19 infections of all ages, but they underscore the fact that Arizonans need to do better when it comes to protecting children and families from COVID-19, he said.
“We’re going to get to a better place in the next few months. I know people are COVID-weary, but we need to hang on a bit longer,” Moromisato said.
“Please adhere to CDC guidelines with the masking, social distancing and other measures regarding keeping children physically separated and protected.”
Phoenix Children’s: We are seeing a spike
“Typically the pediatric patients, the children who are at high risk for having a severe type of infection, are the patients who have a preexisting condition. Those are patients with heart and lung diseases, they are immunocompromised for whatever reason, they have obesity — similar to the other risk factors that put adults at high risk of complications.”
Dr. Wassim Ballan
A pediatric infectious disease specialist at Phoenix Children’s Hospital
In addition to treating those with COVID-19, Banner Health’s Moromisato said he’s treated more children than he’d anticipated for what appears to be a condition associated with COVID-19 known as multisystem inflammatory syndrome in children. In children with MIS-C, different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs.
Children with MIS-C who also have tested positive for the SARS-CoV-2 virus, which causes COVID-19, would be included in the Banner pediatric COVID-19 data, Moromisato said.
He stressed that a majority of children in the COVID-19 hospital data had acute COVID infections, but that Banner alone has seen at least two dozen children with MIS-C, which is many more than Moromisato had expected.
It is still uncommon for children to have severe COVID-19 infection, said Dr. Wassim Ballan, a pediatric infectious disease specialist at Phoenix Children’s Hospital. The 433-bed hospital would not share specific numbers of pediatric COVID-19 hospitalizations but confirmed there has been a spike reflective of what’s happening at Banner Health and statewide with patients of all ages.
Hospitalizations for the disease in Arizona have been dropping slightly but remain at very high levels.
Arizona has had the highest rate of new daily overall COVID-19 infections in the country, according to the Centers for Disease Control and Prevention’s COVID Tracker.
“We are seeing a spike, but that is not surprising to us because it’s following the same trend we are seeing in the community. Even though I’m saying it’s a small percentage of children that needs hospitalization, when you are looking at the whole state and how widespread the virus is, that percentage is going to translate into a higher absolute number of pediatric patients that are needing admission,” Ballan said.
Families should not be panicked by the reported spikes, but it’s important to be aware and to continue with prevention measures, Ballan said. When a COVID-19 vaccine is approved for younger patients, families should get one for their child, he said.
The Moderna vaccine is not approved for patients under the age of 18, and the Pfizer-BioNTech vaccine is only approved for patients 16 and older. Approval for younger people is expected after trials in pediatric patients are completed.
8-year-old had appendicitis and COVID-19
Suspected and confirmed pediatric COVID-19 hospitalization numbers would include patients hospitalized for a different reason like surgery, who also happened to test positive for COVID-19 as part of the admission process.
Juliet Hernandez, a normally healthy 8-year-old who lives with her family in Buckeye, was hospitalized Nov. 16 for appendicitis but tested positive for COVID-19 when she was admitted. What was originally predicted to be a three- to five-day stay at Banner Thunderbird
Medical Center in Glendale turned into 15 days, her family said.
Before surgery, the third grader complained that her chest hurt, said her mother, Mayra Hernandez, who was able to stay with her daughter throughout her hospitalization. Mayra tested positive for COVID-19 in July, but she isolated immediately and none of her three children or her husband contracted it at that time.
After the first of Juliet’s two appendix surgeries, she had a fever and cough, her parents said. And though her recovery included walking, she was not allowed to leave her hospital room because of her positive test result. The family doesn’t know whether Juliet’s illness was a result of COVID-19, or if it just added another complication to her appendicitis.
“There’s so much the doctors still don’t know about COVID,” said Juliet’s father, Erick Hernandez Sr., an audio engineer whose job necessitates working outside their home. “She might have already had COVID and it caused inflammation that affected her appendix.”
Mayra graduated from Arizona State University last year and wants to apply to law school. She’s grateful that she delayed returning to school or working during the pandemic, as her family has needed her, particularly because the
children home.
Erick Sr. tested positive for the virus and for influenza on Nov. 7. He’s not sure where he got it and said he’s always extremely careful about social distancing and wearing masks. His son, Erick Jr., who is 11, began showing symptoms and tested positive for COVID-19, and Mayra tested negative. Neither Juliet nor her 4year-old sister showed any symptoms and were not immediately tested.
Erick Sr. and his son immediately isolated in the home once they knew they were positive. Erick Sr. said Juliet must have begun developing COVID-19 before she was admitted to the hospital with severe stomach pains, even though she wasn’t exhibiting telltale symptoms of COVID-19 like a shortness of breath or a fever. She was fatigued, but it seemed to be connected with her stomach issues.
“She was scared,” Mayra said of Juliet. “It was overwhelming for us to know she had COVID and that she needed surgery ... I got really nervous.”
Juliet and her mother were in the hospital over Thanksgiving and had to put off any celebrating. By the time Juliet was discharged on Nov. 30, she had tested negative for COVID-19.
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Some children with COVID-19 require ventilators, external lungs
Moromisato said children with COVID-19 are being treated with steroids, and some of the older children get Remdesivir. Children who have MIS-C are often treated with IVIG, which stands for intravenous immunoglobulin. A small number need more aggressive interventions.
“If they are in the hospital, it’s because they can’t eat or drink, or they need IV fluids or they need certain therapies that can only be given IV,” Moromisato said. “Some you could say are mild because they are going to be in and out within a few days, but the severity goes all the way through requiring a ventilator, and some have required what we call ECMO. Banner Children’s has seen several reach that stage, where they either need a ventilator or ECMO.”
ECMO stands for extracorporeal lung membrane oxygenation. It is a lastditch high-level treatment that works like an out-of-the-body, artificial lung by adding oxygen to the blood and removing carbon dioxide. It buys time for extremely ill patients whose lungs need to heal.
“There have been some deaths in the
state for children as well,” Moromisato said. “Children with risk factors like chronic diseases are at higher risk for getting sick with COVID. It affects children with chronic disease at a higher rate, but because it still affects all children, most of the children who come in — probably two-thirds — actually are previously healthy.”
Statewide, there had been 1,323 patients under the age of 20 hospitalized with COVID-19 since the onset of the pandemic, and 19 have died.
The percentages for the under-20 age group remain extremely low in proportion to overall hospitalizations and deaths from COVID-19 in Arizona. Patients younger than 20 comprise 2.7% of all patients who have been hospitalized
for confirmed and suspected COVID-19 in Arizona since the pandemic began, and only 0.16% of all Arizona known COVID-19 deaths, state data shows.
Children in general are healthier than adults, and while they have the same susceptibilities to COVID-19 infection, they are less likely to have symptoms or have severe symptoms from the infection, said Ballan, who is the associate medical director for infection prevention and control at Phoenix Children’s.
“Yes, we are admitting patients and some of the pediatric patients need to be hospitalized for COVID-19 management, but that is still not the majority of patients that we are seeing at the hospital,” Ballan said.
“Typically the pediatric patients, the children who are at high risk for having a severe type of infection, are the patients who have a preexisting condition. Those are patients with heart and lung diseases, they are immunocompromised for whatever reason, they have obesity — similar to the other risk factors that put adults at high risk of complications.”
Data on childhood COVID-19 illness is still being researched, Ballan said.
“The older the child, sometimes the more risk of developing pre-existing factors ... hence, why we are seeing the patients needing a higher level of care in the pediatric population are in their teenage years compared to the younger kids,” he said.
“There are no specific data looking at the severity of illness broken down by small age groups within the pediatric population,” he said. “Within the pediatric population, we are still gathering data. Not just Phoenix Children’s, but the whole pediatric infectious disease community.”
The good news is that the vast majority of pediatric patients who are hospitalized for acute COVID-19 and MIS-C have positive outcomes, he said. It’s likely that older kids are more apt to get severe COVID-19 infection than younger children, but the evidence is still under review, he said.
Juliet Hernandez has made a full recovery and said she’s thankful for the nurses and doctors who took care of her, and for her parents. Her dad dropped off care packages while she was hospitalized.
The medical staff at Banner Thunderbird had to wear masks and suits and face shields when they treated her, but they still took the time to sit on her bed and talk, Juliet said. Other hospital employees brought her toys and games, she said. In appreciation, she made friendship bracelets with dangling silver hearts and festive red and green key chains for the staff members who took care of her.
“My family and I thank you from the bottom of our hearts. Happy Holidays!” said the note accompanying the gifts.
Juliet’s father is now coping with another fallout of the pandemic — his back surgery has been canceled twice because of a pause in elective surgeries. He acknowledges having some pain, but says he’s grateful for the health system and extremely proud of his daughter.
“She’s a champ,” her father said. “She’s a strong girl, and she’s just doing wonderful.”