DETROIT – Children aren’t immune to COVID-19. They can get sick, just like adults do. They can be hospitalized, the same as adults. And rarely, they can even die.
That’s the message doctors at several of Michigan’s children’s hospitals want people to hear as the state confronts yet another massive surge in coronavirus cases and hospitalizations, which reached 3,953 Monday, surpassing the state’s November/December spike.
“The state is at a record high for hospitalizations for pediatrics during the entire pandemic and our hospital reflects that,” said Dr. Rudolph Valentini, a pediatric nephrologist at Children’s Hospital of Michigan and group chief medical officer for the Detroit Medical Center.
Statewide, 49 children were hospitalized Monday with either confirmed or suspected cases of COVID-19, according to state data.
With Michigan’s case rate of 515.8 per 100,000 people over the last week — the worst in the nation and four times higher than the rate in neighboring Ohio, according to data from the CDC — more people in general are going to get sick.
That includes kids, said Dr. Prashant Mahajan, an emergency medicine physician and division chief of children’s emergency medicine at the University of Michigan’s C.S. Mott Children’s Hospital.
“There is definitely an increase in the total number of patients that are coming to the ER, both on the pediatric side and the adult side,” Mahajan said. “And the reason I bring both pediatric and adult is because we see children up to 21 years of age at Mott Children’s.
“We are seeing the number of patients who are getting admitted who had a baseline illness, like say for example, asthma or Crohn’s disease, increase. Those patients are now coming in with COVID,” he said.
Among the biggest drivers of coronavirus infections in the state, health officials have said, are outbreaks among youth athletes and those associated with K-12 schools. This week, the state reported 312 ongoing or new school outbreaks, which includes infections linked to classrooms, after-school activities and sports.
Cases among kids ages 10-19 are at an all-time high, the state’s top epidemiologist, Sarah Lyon-Callo, reported last week, quadrupling from four weeks earlier.
Dr. Matthew Sims, director of infectious disease research at Beaumont Health, said Michigan’s kids might be contracting the virus at a higher rate now than they did in previous surges because they’re able to socialize, attend in-person classes and continue to play sports now — spreading the virus during these activities — in a way that wasn’t possible during previous waves.
When the first huge spike in coronavirus infections slammed the state in March and April of 2020, Gov. Gretchen Whitmer issued an executive order pushing all K-12 schools to virtual learning. Sports were stopped, restaurants closed and the opportunity for the virus to spread shrank.
In November, when the state was hit yet again with high coronavirus case rates and hospitalizations, the state health department issued a public health order mandating a temporary pause for in-person high school and college classes. High school sports were suspended and in-person dining was stopped, too.
That’s not the case this time. Although Whitmer has encouraged people to avoid in-person dining, urged schools to take a two-week pause from in-person classes following spring break, and asked youth sports teams to also suspend playing, there is no requirement shutting them down.
“In the last couple of surges, sports were closed,” Sims said. “And while they may not be getting it directly from the sporting event, there’s a lot of things that go along with sports. A lot of people go in to watch. There’s the celebration after, where people are gathering together. There have been a bunch of outbreaks linked to sporting events, and so I think that’s part of it.
“Schools have said they’re not all built to keep 6 feet of distance, or sometimes 3 feet of distance, between kids. All of these things play into it. Also, a large number of kids are asymptomatic and we’re not doing enough testing. Often, it spreads without us knowing it.”
The more contagious B.1.1.7 variant, which originated in the United Kingdom, is another factor, Valentini said.
“We know from a statewide statistics that the state of Michigan definitely has one of the highest variant rates of the U.K. variant, the B.1.1.7 variant,” Valentini said, which is 50% to 100% more transmissible than other strains of the virus. “That seems to be higher in our state, and so it could very well be that it is contributing to some of the change.”
The way the state and nation have targeted vaccines to older populations also could play a role in more kids getting sick with the virus now, Valentini said.
Nearly 60% of adults 65 and older in Michigan have been fully vaccinated, according to state data, and almost 50% of people ages 50-64 have gotten at least one dose of a coronavirus vaccine.
That leaves unvaccinated younger adults and children vulnerable to infection. Just 10.7% of 16- to 19-year-olds have been vaccinated, state data show.
Only one COVID-19 vaccine now on the market — Pfizer-BioNTech’s — is approved for use in children ages 16 and older. The company now is seeking an expansion of its emergency use authorization from federal authorities so children ages 12-15 also will be able to get immunizations, but that has yet to be approved. Moderna and Johnson & Johnson have clinical trials underway in children and have federal emergency use authorization in Americans 18 and older.
That’s why, Valentini said, “adults have to do the responsible thing and get ourselves vaccinated to protect the children because they can get it and they can spread it.”
Dr. Rosemary Olivero, a pediatric infectious diseases physician at Helen DeVos Children’s Hospital said the Grand Rapids-based hospital also is seeing an increase in pediatric hospitalizations from COVID-19, though the vast majority are found to be positive for the virus when they are screened at admission for other medical reasons.
At least 99 children hit by rare complication
State health officials also have reported at least 99 cases of the rare pediatric condition known as Multisystem Inflammatory Syndrome-Children, or MIS-C, which can develop several weeks after a coronavirus infection and can lead to organ failure and death in kids.
As many as five Michigan children have died of MIS-C and/or active COVID-19 infections, though state health officials won’t release an exact total number of deaths from either disease.
“We suppress information in order to protect the privacy of individuals who can be more readily identified in a smaller cell when information such as the age can be used along with other publicly available information to identify someone,” Bob Wheaton, a spokesperson for the state health department, told the Free Press for a previous story.
“As we’re seeing more and more (COVID-19) cases in young people, we fear that we will see more cases of MIS-C at the Children’s Hospital, so we’re very prepared for that possibility,” Olivero said.
Of the children who develop MIS-C, 99% have tested positive for SARS CoV-2 or were in close contact with someone who had COVID-19, according to the CDC.
“As we’re trying to combat this pandemic, this is one of the many, many very important consequences of COVID-19,” Olivero said. “Children, they’re not as able to communicate. They can’t express themselves quite as well in terms of how they’re feeling. It is kind of a scary thing to potentially come up against. And, of course, we know that children, especially our younger children, don’t have any access to vaccines at this point in time.”
Olivero said it’s unknown what the long-term consequences of MIS-C are on the body, particularly on the heart. Children who develop the condition will need to be monitored by cardiologists throughout childhood and adolescence.
“We would think (it) is going to affect our children with chronic medical conditions more than our healthy children, but our young healthy children seem to be the ones who get MIS-C,” Olivero said.
The CDC has reported 3,185 MIS-C cases nationally since the start of the pandemic and 36 deaths. Most cases have occurred in children ages 1-14, but MIS-C has been identified in infants and adolescents up to 20 years old.
Symptoms of MIS-C, which appear two to eight weeks after the child had COVID-19, include: fever; a rash or discoloration of the skin; red bumps or splotches on the body; redness of the whites of the eyes; swelling or red coloring of the lips, tongue or throat; puffy or red hands and feet; severe gastric pain, vomiting or a large amount of watery diarrhea.
Although a “very small number” of children who are diagnosed with COVID-19 will go on to develop MIS-C, Olivero said parents should seek medical attention for their child if they are concerned the child may have the condition.
Valentini urged all adults and children 16 and older to take the vaccines as soon as possible.
“We should all vaccinate, vaccinate, vaccinate — from the elderly to those that are 16 and over,” he said.
“Children are getting hospitalized with COVID, and we don’t know some of the long-term effects of COVID. We also know that children can get MIS-C. … These things can be prevented with the vaccine.”