BOISE, Idaho – Adult intensive care unit beds at many hospitals in Idaho have exceeded capacity, following a COVID-19 outbreak that has led to the implementation of crisis care standards statewide.
What could complicate this already delicate situation is that infections in children have skyrocketed, meaning pediatric wards are filling up too – and doctors and officials fear the pinched resources will end up affecting. the care available for adolescents and even the youngest.
“I worry every day about the possibility of seeing a child’s obituary,” Elke Shaw-Tulloch, administrator of the Idaho public health division, said tearfully at a conference state press release Tuesday.
Although 10 Idahoans between the ages of 18 and 29 have suffered COVID-19-related deaths, so far no child in the state has died, according to data from the Department of Health and Welfare of Idaho.
But cases of COVID-19 in children are increasing much faster than in adults, having doubled since mid-August. Infection in children now accounts for about 20% of new cases, according to Kathryn Turner, the state’s deputy epidemiologist.
Turner noted on Tuesday that childhood infections had recently “skyrocketed”, with nearly 1,700 new cases reported the week starting September 20. The peak in mid-December of last year was just over 1,100 cases in a single week.
The increase in cases corresponds to a more recent increase in hospitalizations, which worries doctors.
“We are seeing a spike, a further increase in the number of pediatric patients admitted to hospital who test positive for COVID,” said Dr Elizabeth Kleweno, medical director of the pediatric hospital team at the hospital for Children of St. Luke, Idaho Statesman in September.
Symptoms that children experience can vary, but often manifest as fever and congestion in infants, or – more often in adolescents – the severe respiratory illness that many adults experience, Kleweno said. Children with chronic illnesses, such as diabetes or metabolic diseases, are particularly at risk.
Compared to adults, the number of hospitalized pediatric patients with COVID-19 is still low. At the beginning of September, there were only two in hospitals in Idaho. As of Friday, they were 11, according to data from Health and Wellness. As of September 24, 25 COVID-19 pediatric patients have been admitted to hospitals in Idaho, according to data from the US Department of Health and Human Services.
At St. Luke’s Children’s in Boise, the number of pediatric patients has fallen from an average of about five patients per month to about 20 in September, according to Dr. Kenny Bramwell, medical director of the system at the hospital.
Since the start of the pandemic, 225 Idaho children have been hospitalized with COVID-19, and 32 have developed a post-infection illness called multisystem inflammatory syndrome, according to data from Health and Welfare. The mysterious disease has infected children across the country and typically appears around four weeks after a child is infected with the coronavirus.
Two of those cases were reported to Idaho’s Health and Welfare this week.
“What worries me is that we have children who may be asymptomatic or have very mild symptoms right now, but we may see more cases of MIS-C (in the near future),” said Turner in an interview with the Statesman in September. “This is what is scary.”
In more than half of those cases, Turner said, children never get tested for COVID-19 when they actually have it. It is only after they have the syndrome that they are tested and the doctors find out that they have developed natural antibodies against the virus, which means they had an asymptomatic case or simply have symptoms. very mild symptoms and did not know it was the coronavirus.
Risk to pregnant women and babies in Idaho
Doctors say COVID-19 has been found to be very dangerous for pregnant women, and some babies are born prematurely or with serious complications, due to a mother’s illness.
Nationwide, 161 pregnant people have died from COVID-19, including 22 in August, according to data from the Centers for Disease Control and Prevention.
In Idaho, Health and Welfare reports that there have been two pregnancy-related deaths, including women who die within a year of giving birth.
“We are seeing an increase in the number of babies born prematurely solely because of mothers … having complications with their COVID disease,” said Dr Nikolai Shalygin, neonatologist at Mountain States Neonatology, at a press conference with doctors from Treasure Valley Wednesday. He said these babies are sicker than he would have imagined, although most have not tested positive for COVID-19.
Doctors are also starting to see more stillbirths associated with infected mothers, according to Dr. Lauren Miller, director of perinatal health at St. Luke’s, who also spoke on Wednesday.
“It’s very scary,” Miller said.
She said her hospital was focusing on vaccinating as many eligible family members as possible to help protect children.
“We just beg and implore our mothers and families to trust us and trust the information we give them,” Miller said. “All we have, in terms of the data, indicates very good information on the safety of vaccination during pregnancy, as well as during the postpartum and lactation period.”
With the increase in cases of COVID-19 in children and hospitalizations, doctors are simultaneously concerned about the annual decline in the increase in other respiratory diseases, which could affect the capacity for care. What some people don’t envision, Miller said, is that masks can also help reduce the spread of diseases other than COVID-19.
Cold and flu season has already arrived in Idaho, and doctors are also seeing an unusually early rise in a common illness in children called respiratory syncytial virus, or RSV. This exacerbates the problems caused by COVID-19.
“Now that everyone’s back, the youngest ones – 2 and under – are exposed to RSV and they’re catching it now,” Kleweno said. And when you get a spike in several respiratory viruses at the same time, “it puts a strain on the hospital (pediatric) systems.”
Low vaccination rate among children, few masks in schools
Few of the state’s school boards require students to wear masks to school, despite evidence that face coverings reduce viral spread and recommendations from doctors and the Centers for Disease Control and Prevention.
In the Twin Falls area, the number of cases in children is now three times the level seen in September 2020, according to a press release Friday from the South Central Public Health District, which covers Blaine, Camas, Cassia, Gooding, Jerome , Lincoln. , Minidoka and Twin Falls counties. Among children ages 6 to 17, rates have almost quadrupled and schools in the area are also experiencing high levels of impetigo, a highly contagious skin infection and RSV, officials said.
“A little more back-to-school illness is expected,” Heather Park, the district school liaison, said in the statement. “But what we are seeing now is far from normal. Our community is grappling with a wave of illnesses that continues to engulf our hospitals and begin to affect the ability of our local schools to keep children in class.
“Some local schools have been forced to temporarily close because so many staff are sick, others are scrambling to find enough COVID-19 testing supplies because so many children are coming to school sick. “
Crowds of parents stormed recent school board meetings over possible mask mandates, prompting the Coeur d’Alene and Pocatello / Chubbuck school districts this week to call off a discussion on a mask policy and return optional masks, respectively. In the West Ada School District, a group of parents are trying to recall the board chairperson in part because of her focus on school health safety measures.
In the Treasure Valley, the Districts of Boise and West Ada both have mask mandates in place, as does the Caldwell School District. West Ada started the school year by allowing parents to refuse their children to wear a mask, and about a third did so, but as the crisis worsened, the district instituted a no-option requirement to withdrawal.
“I can’t find any kind words to describe the way school boards have responded to this problem,” Bramwell said Wednesday. “They don’t seem to understand the importance of masks in public places. … Due to the inactivity of our president and governor, we have left public health decisions to school boards, which they really have no interest in doing.
Dr David Peterman, pediatrician and CEO of Primary Health Medical Group, called the behavior of some school boards “shameful” on Wednesday and pointed to data from Primary Health which indicates fewer children test positive in the few school districts. of Idaho who have mandatory face masks.
Vaccinations among eligible children (12 and older) have been slow to take hold in the state, with just 28% of 12 to 15 year olds and 35% of 16 to 17 year olds fully immunized, according to Health and Well- to be.
“These are patients who I have looked after their children for 15 years,” said Peterman. “I’ve given them advice, which they’ve taken on flu shots, several other childhood vaccines, and sometimes antibiotics and so on, and they’re very comfortable with that advice. And yet, with so much misinformation about this particular vaccine, they are unwilling to listen. “
Bramwell pointed out that the situation in the pediatric units is not yet the “catastrophe” of the “panic-level admissions” currently seen in adult floors in hospitals, but because of its number of patients and the constraints. of space, St. Luke’s plans to admit some younger adult COVID-19 patients – 18 to 21 – to its children’s hospital.
The health care system had 264 adult COVID-19 patients hospitalized on Thursday, according to its data dashboard.
“We are short of real estate,” he said.
And if the number of patients continues to rise, it could affect the care available for children, Bramwell added.
“Our biggest concern is that these cases will continue to increase,” he said.
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