COVID-19 Nurses at Vanderbilt University Medical Center in protective gear, in 2020. (Photo: John Partipilo)
The pediatricians at Niswonger Children’s Hospital had an urgent message for the community they serve in the northeastern-most corner of Tennessee, where 46 new COVID cases in one day this week — 22% of all positive tests — were among kids under the age of 18.
“It hurts me to say that in the past week we’ve seen an uptick in positive rates for children, as well as hospitalizations and very severe illness in children in our region,” said Dr. Patricia Chambers, the hospital’s chief medical officer. “We’ve hospitalized children as young as three and we’ve hospitalized teenagers. This is astonishing because this is not what we all hoped and thought for COVID.”
“This is real and this is happening and we have to move as a community to do something to protect our children.” she said, urging vaccinations for all eligible children and adults.
Her colleague, Dr. Josh Henry, the pediatric ICU’s medical director, stepped in to describe the step-by-step process of sedating, immobilizing then inserting an intubation tube through a child’s mouth to reach the lungs. It was a procedure he had just performed on two children who are now fighting for their lives in the ICU, he said. “We are seeing the disease severity that mimics what we saw in adults in the ICU last winter.”
The number of new daily cases of school-aged children testing positive for COVID-19 in Tennessee has jumped from 70 on July 1 to 411 on Aug. 2, as the state experiences yet another surge driven by the low vaccination rates and the delta variant of the virus.
Most children are not hospitalized. Of the 527 Tennesseans hospitalized since July 1, six were children under the age of 10, and 12 hospitalizations were for children between the age of 11 and 20, according to state department of health data, which does not provide a specific breakdown for hospitalizations for children 18 and younger.
Pediatricians across the state are sounding the alarm about the risks to unvaccinated children posed by the current surge, still assumed to be in its early stages in Tennessee. If the virus follows its predictable pattern, new cases will lead to hospitalizations in the weeks to come.
At Monroe Carrell Jr. Children’s Hospital at Vanderbilt, Dr. Ritu Banerjee, associate professor of pediatrics and pediatrics infectious diseases, has been treating COVID patients since the pandemic began last year.
It's disheartening. . . We're now having the same conversations about hospital operations as in March 2020.
– Dr. Ritu Banerjee, Monroe Carrell, Jr. Children's Hospital at Vanderbilt.
The big surge last fall and winter subsided, she said. Then, in just the past two weeks, doctors began seeing far more pediatric patients. Vanderbilt does not disclose the number of children currently hospitalized with COVID. The vast majority of pediatric COVID patients Dr. Banerjee and her colleagues are seeing are not hospitalized. They have mild symptoms and are sent home to be cared for by parents with symptoms that mimic the common cold, including fever, cough, GI problems and headaches, she said.
But, Dr. Banerjee said, of children who are hospitalized, the majority are under 12 who are not yet eligible get a vaccine.
Doctors and hospital administrators at Vanderbilt are once again preparing for surge capacity at the Children’s Hospital, which has in recent weeks also admitted patients with RSV, a common respiratory virus among young children and infants.
“It’s disheartening,” Dr. Banerjee said. “I, like everybody else, was hopeful we were seeing the light at the end of the tunnel, but we’re now having the same conversations about hospital operations as in March 2020.”
Whats different now, and frustrating, Dr. Banerjee said, is that there is now a vaccine available to all adults who could potentially expose a child to the virus and one that can protect adolescents, 12 and older.
Dr. Banerjee’s other worry is MISC, or multisystem inflammatory syndrome in children, which can flare up in some children after a COVID infection and cause a small percentage of kids to become very ill and require hospitalization.
In Knoxville, four children remain in the intensive care unit at East Tennessee Children’s Hospital.
“Hospitalizations for children are increasing,” Dr. Joe Childs, the hospital’s chief medical officer, said. “We strongly encourage vaccination against COVID-19 for children who are eligible to receive the vaccine.”
Childs noted that most of the children his physicians have treated in the hospital have had underlying conditions before they contracted COVID.
In Memphis, Le Bonheur Children’s Hospital reported that two children died last weekend from COVID-19, one in the hospital and another while being transported to the hospital. The hospital declined to share further details about the children, including their ages or underlying conditions.
Deaths among children sick with COVID are exceedingly rare in Tennessee. Of the 12,783 individuals who lost their lives to COVID, just six have been children under the age of 10 and 5 among children and young people under the age of 21, according to health department data.
But the timing of latest surge in COVID cases across the state — just as children are returning to classrooms, or are poised to — has pediatricians across the state redoubling their messaging to urge masking and vaccines for eligible kids and for the adults in their orbit.
“It is false to believe that children don’t get COVID. They do,” read a statement released Wednesday from the Tennessee Chapter of the American Academy of Pediatrics urging vaccination among all eligible children and adults, and universal masking while indoors and in school.
“We support the rights of parents to make decisions for their children, but we also support the rights of children and school staff not to be harmed by decisions that go against science and current public health needs.”
The messages from physicians, including pediatricians, however, continue to remain at odds with some political leaders and public health officials who set public policy.
Gov. Bill Lee recently encouraged vaccinations for eligible Tennesseans, but has remained firm that mask mandates in schools are unnecessary. Tennessee House Speaker Cameron Sexton, R-Crossville, earlier this week threatened school districts with legislative action should they decide to require masks or close as a result of the virus. Lt. Gov. Randy McNally, R-Oak Ridge, subsequently weighed in, saying he trusts local schools to make their own decisions.
Tennessee Department of Health Commissioner Lisa Piercey last month fired the state’s top vaccine official, Dr. Michelle Fiscus, after pushback from Republican lawmakers over the department’s efforts to educate adolescents about the vaccine.
Meanwhile, Tennessee pediatricians continue to try to educate the public about what they are seeing at local hospitals and in their practices.
“Even though most children will recover — most — not all children will recover and even those who do not succumb to COVID-19 can have long-term consequences even with mild disease,” said Dr. Chambers, the chief medical officer at Niswonger. “I cannot emphasize enough to get your child vaccinated if your child is eligible. If you’re not vaccinated, please go get yourself vaccinated. If you need more proof, feel free to reach out to any of us at Ballad or at Niswonger and ask us what it was like working with these kids this last week.”
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