Results of COVID-19 Surveillance in a Large United States Pediatric Healthcare System over One Year

Abstract

Background: The lack of SARS-CoV-2 antigen surveillance testing in the pediatric population has inhibited accurate infection and hospitalization prevalence estimates. We aim to report the estimated prevalence of and risk factors for COVID-19 infection, hospitalization, and intensive care unit (ICU) admission across the three United States (US) waves in one of the largest pediatric healthcare systems in the nation. Methods: Retrospective electronic health record (EHR) review of all COVID-19 surveillance data among children aged 0–19 years seeking healthcare at one pediatric healthcare system that serves predominantly Medicaid-dependent families from 1 March 2020 to 31 March 2021. COVID-19 infection status (Y/N), hospital admission (Y/N), and ICU admission (Y/N) are the main outcomes. Results: Of 22,377 children aged ≤ 19 years tested for SARS-CoV-2 infection from March 2020–March 2021, 3126 were positive (14.0%), and out of those positive, 53.7% were hospitalized and 2.9% were admitted to the ICU. Compared to Wave 1 (1 March 2020–31 May 2020), the risk of a positive test increased from 16% (RR 1.16, 95% CI, 1.07–1.26) in Wave 2 (1 June 2020–31 October 2020) to 33% (RR 1.33, 95% CI, 1.23–1.44) in Wave 3 (1 November 2020–31 March 2021). Similarly, compared to Wave 1, the risk for hospitalization increased 86% (RR 1.86, 95% CI, 1.86–2.06) in Wave 2 and 89% in Wave 3 (RR 1.89, 95% CI, 1.70–2.08), and the risk for ICU admission increased from 10% in Wave 2 (RR 1.10, 95% CI, 0.39–3.01) to 310% in Wave 3 (RR 3.10, 95% CI, 1.21–7.80). Children with asthma, depressive disorders, type 1 or 2 diabetes, and anemia were more likely to be hospitalized while children with diabetes, obesity, cardiac malformations, and hypertension were more likely to be admitted to the ICU versus children without these conditions. Conclusions: Children were cumulatively impacted by the COVID-19 pandemic through the three US waves with more than a third hospitalized in Wave 3. Children with underlying health conditions were particularly at risk for severe illness and should be monitored for any long-term impacts.

Pathogenesis and Preventive Tactics of Immune-Mediated Non-Pulmonary COVID-19 in Children and Beyond

“…A higher hospitalization rate for children with infection of Omicron variants was initially reported from Gauteng Province, South Africa, where 462 (18%) of hospitalizations were patients less than 19 years of age, higher than those in the three previously pandemic waves [32]. In two larger cohort studies of COVID-19 in children found that hospitalized children aged < 2 years or with comorbidities were susceptible to severe COVID-19 and potential fatality [1,2,33,34]. Higher severity and fatality of non-pulmonary disease have been later found in Hong Kong and Taiwan where the Omicron BA.2 was prevalent [14,15].…”

“…Coronavirus disease 2019 (COVID-19) has evolved from initial waves of mild pulmonary diseases to the later waves of potentially fatal diseases of non-pulmonary encephalopathies, and multisystem inflammatory syndrome in children (MIS-C) [1][2][3][4]. The evolutional variants of SARS-CoV-2 have caused immune escapes of vaccines and monoclonal antibodies, resulting in incomplete herd immunity and periodic re-emergence [5,6].…”

“…The dynamic interactions among the herd immunity, virus variants, and environments such as vaccination coverage, availability of monoclonal antibodies and antiviral medications, and quarantine strategies have shaped the features of the COVID-19 pandemic in different waves, showing a change from the initial higher fatality and lower transmission to a lower fatality and more contagious [7,8]. However, the lower vaccination coverage and limitation of anti-virus medication together with evolution of viral variants and lack of pre-existing immunity of small children have made children susceptible to infection and vulnerable to higher hospitalization rate [1][2][3][4][9][10][11].…”

The antenatal psychological experiences of women during two phases of the COVID-19 pandemic: A recurrent, cross-sectional, thematic analysis

“…In the UK, shielding meant not leaving one’s home under any circumstances unless seeking urgent medical care, and whilst pregnant women were eventually declassified from this level of vulnerability, it has been found that third trimester COVID-19 infection causes worsened maternal symptomatology [ 18 ]. Subsequent evidence countered the precautionary measures given for pregnant women to shield–finding limited evidence for vertical transmission between mother and infant [ 19 ], and mild presentation of symptoms in a large proportion of infected infants [ 20 ]. Despite which, separation of infected mothers and infants was still routinely practiced in some NHS settings at this time [ 21 ].…”

SARS-CoV-2 antibody prevalence in a pediatric cohort of unvaccinated children in Mérida, Yucatán, México

“…Population prevalence of SARS-CoV-2 exposure is an important factor for understanding the effectiveness of control methods and predicting the susceptibility of a given population to future outbreaks. Lack of data on SARS-CoV-2 exposure in children has contributed to inaccurate population prevalence estimates [3]. This is due to several factors, such as the lack of testing supplies and access to a large ambulatory pediatric cohort and the fact that COVID-19 is generally mild in children.…”