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With COVID-19 cases increasing sharply in the islands in recent months, the incidence of serious illnesses in children, among other things, has been one of the most closely monitored metrics used to assess whether schools should remain open for personal learning.
However, government data on child hospital admissions seem excessive because of the way they are collected, making it difficult to get a clear picture of how children are doing.
The Centers for Disease Control and Prevention has said the risk of complications or serious illness in children infected with COVID-19 is actually lower than with the flu, which provides some comfort to anxious parents and health professionals.
But when the highly contagious Delta variant caught on across the country this summer, doctors in other states reported an alarming increase in pediatric hospital admissions.
Children under 12 are still not eligible for the vaccines, and with older children planning to go back to school this fall, only half of 12-17 year olds had at least one vaccination, according to national figures.
At the New Orleans Children’s Hospital, doctors and nurses have reported a worrying increase in the number of children who are hospitalized for COVID-19 and have difficulty breathing. In some extreme cases, ventilators were put on to save their lives.
Other cities across the south where vaccination rates are lower have also reported worrying increases in pediatric patients.
In Hawaii, it’s clear that cases in children have skyrocketed since early July, when the Delta variant spread aggressively. In the last week of August, cases in children aged 17 and younger were 17 times higher than in early July.
In the week ending August 29, more than 800 new cases in children were reported on the islands. But when it comes to figuring out how many of these kids get so sick they end up in the hospital, the picture is much bleaker.
Prior to the rapid spread of the Delta variant, 47 children with COVID-19 had been hospitalized in Hawaii since the pandemic began in early 2020, according to data published on the Hawaii Department of Health website. In the last two months alone, this number has more than tripled to 147.
One hundred pediatric hospital stays in just two months is a worrying number. However, health officials at Kapiolani Medical Center for Women and Children, the state’s only hospital specializing in childcare, say these numbers seem high and do not reflect what they are seeing.
On August 27, hospital officials said they had admitted fewer than a dozen children for COVID-19 in the past month and a half.
Kaiser Permanente has only treated three pediatric COVID-19 cases since July, none of which required ventilators, according to Laura Lott, a health system spokeswoman.
State data shows that only one child has died of COVID-19 since the Hawaiian pandemic began.
Hospital stays
The Healthcare Association of Hawaii, a trade group for the state’s hospitals, reports statewide hospitalization data to the Department of Health, which it publishes under Case Results on its COVID-19 website. The data will be used to estimate the percentage of COVID-19 cases that will require hospitalization and will be broken down by age group.
Amidst what is in the data, a hospital association spokeswoman said the numbers include children admitted due to COVID-19 as well as children who tested positive for the virus but may have been admitted for other reasons .
“The data is currently reported in an aggregated form, and this may create the false impression that more children are hospitalized primarily for COVID-19 than they actually are,” said Stacy Wong, a spokeswoman for the Healthcare Association of Hawaii email. “Some pediatric patients will be admitted primarily for COVID treatment, while others will be admitted for other reasons and found to be COVID positive.”
Such an aggregation of data can boost COVID-19 outcomes numbers significantly, according to a study published in May by researchers at Stanford University School of Medicine.
Amid the pandemic, hospitals across the country, including Hawaii, began screening all inpatients for COVID-19, regardless of whether the virus was suspected. For pediatric patients, they may have been admitted for a variety of conditions unrelated to COVID-19, such as broken bones or appendicitis.
This screening was an important safety measure in hospitals, but the number of positive tests can be misleading if the data is reported in such a way that the virus is the cause of all hospital stays.
The study analyzed COVID-19 data from Lucile Packard Children’s Hospital Stanford between May 2020 and February 2021 and found that 117 hospitalized children tested positive for COVID-19 or were admitted to MIS-C, a serious multisystem inflammatory disease in children who develop weeks after a COVID-19 infection.
The study found that of the 117 patients, 39% had asymptomatic COVID-19 infections and 28% had mild to moderate illness. Only 20% of the patients were seriously or severely ill with COVID-19, while 12% had MIS-C.
The study’s authors concluded that 45% of pediatric patients were admitted for non-COVID-19 reasons, which explains the importance of distinguishing between patients admitted for COVID-19 and those who tested positive during screening but were included asymptomatically and for other reasons, underscoring reasons for doing so.
The Honolulu Star Advertiser has been trying unsuccessfully for several weeks to break down the details of only those children hospitalized for COVID-19. On Wednesday, Wong said the Healthcare Association of Hawaii and health care leaders were discussing whether the data could be modified to give a more accurate picture of how COVID-19 is affecting children. But she said this could conflict with patient confidentiality.
“Patient confidentiality needs to be considered before any final steps can be taken,” she said via email.
Wong didn’t respond to a follow-up question about why reporting the number of patients hospitalized for COVID-19 might compromise patient privacy.
Kristen Bonilla, a spokeswoman for Hawaii Pacific Health, which oversees Kapiolani Medical Center for Women and Children, said hospital officials are discussing the issue with the Healthcare Association of Hawaii and “in the hope that either they or DOH can make that distinction, when they continue to present these numbers to give the public a clearer picture. “
The Healthcare Association of Hawaii didn’t respond when asked if all of their hospitalization data, which covers all age groups, is aggregated the same way. These numbers are also being watched closely as the state’s health resources, including oxygen supply and intensive care capacity, remain tight.
Observe the data
Heads of government stand ready to put more public restrictions in place, such as curfews and more restrictions on social gatherings, as hospital admissions increase.
On Friday, Lt. Gov. Josh Green 320 patients hospitalized with COVID-19 nationwide, with numbers falling in recent days.
But on July 7, the number of hospital admissions jumped to 473, according to state data, dangerously nearing the 500 mark that Green has cited as a turning point. If the numbers get this high, Green, who also works as an ambulance, has said he would recommend Governor David Ige to impose bans.
“When we get anywhere near 500, you have to take very strong measures, life-saving measures, and that would likely come in the form of at least a temporary shutdown by some standards,” Green told star advertiser Spotlight on Hawaii Live online program August 30th. Green said hospitals could be so strained by this point that they would have to start rationing critical care.
Later asked if he was concerned that the hospitalization data could be inflated due to the way they are collected, Green said there were cases that could skew the numbers. For example, he said that three or four months after contracting the disease, people can test positive for COVID-19 even though they have no symptoms and have been hospitalized for a non-COVID-19 disease.
But Green said he didn’t think it was a big problem.
“Occasionally, they may be chasing a slightly higher number. But that’s basically the numbers, â€he said.
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