Increasing child COVID hospitalizations filling pediatric ICUs, Triangle hospitals say

As COVID-19 cases and hospitalizations continue to surge in North Carolina, the coronavirus and other respiratory diseases are causing sick children to fill up pediatric intensive care units in the Triangle.

Among the three PICUs in the Triangle — WakeMed Children’s Hospital in Raleigh, Duke University Hospital in Durham and the University of North Carolina Medical Center in Chapel Hill— WakeMed and UNC were full on Friday, and Duke had just one of 32 beds available. UNC has 20 beds and WakeMed has 10.

Capacity numbers change day to day, hospital officials said.

Dr. Benny Joyner, division chief of pediatric critical care medicine at UNC Medical Center in Chapel Hill, told The News & Observer that they are no longer taking transfers from outside UNC into the PICU.

“It is exhausting to have seen what potential we would have had with the introduction of the vaccine, with careful masking,” Joyner said. “And this, to be put in a position again where we’re having to say to outside referring hospitals, ‘We cannot take your child with a new cancer diagnosis, a new trauma’ — that’s a hard thing.”

The rise in children needing intensive care is partly due to the delta variant, a mutation of the virus that’s more than three times as contagious as the original strain. Almost 94% of sequenced virus in North Carolina is delta, according to the latest data from the Centers for Disease Control and Prevention.

Delta is spreading so quickly that August is on pace to have the most cases and hospitalizations among children since the pandemic started, N.C. Department Health and Human Services data show. Currently, the highest is still January when most COVID-19 metrics peaked during the winter surge.

But the surge in children needing intensive care is not limited to COVID-19. Respiratory syncytial virus, or RSV, is a common disease in the winter months, but it has unusually spread in various parts of the country during this summer, NBC News reported.

WakeMed, which saw no cases of RSV in January, had treated 180 children in August, as of Thursday, The N&O reported.

“The thing that’s really killing our capacity right now is that we’re having this sort of perfect storm of more kids getting sick with COVID. At the same time, RSV and other typically winter-based viruses … are all circulating now,” said Dr. Karen Chilton, medical director of WakeMed Children’s Hospital.

At the beginning of last week, UNC Medical Center had six children in PICUs with RSV, plus two with COVID-19. Combined with the usual summertime surgeries and uptick in accidental traumas, Joyner said, COVID is adding a strain on the system.

Why is RSV spreading?

Joyner said he was unsure why RSV was spreading so rapidly in the summer as opposed to winter, but he thought it was likely due to fewer people masking and socially distancing than during the winter months.

“We were headed into a bad winter season, and the moment that the mask mandates and everything went into place, we really just had a complete decrease in the number of viral respiratory illnesses for the rest of the winter,” Joyner said.

He said the spread now could be due to young children being exposed to RSV, because fewer people are taking those precautions.

“What you’re seeing is that a number of children who have immune systems that were never exposed to RSV are now getting exposed,” Joyner said.

He said it’s unclear if the surge in RSV over the summer will continue into the winter, causing capacity problems if COVID-19 hospitalizations stay high.

“I think that’s yet an unanswered question,” Joyner said.

Which children are more at risk?

Joyner and Chilton said most children with COVID-19 in PICUs have preexisting conditions, such as obesity. Chilton said almost all of them are unvaccinated, and most are older teenagers.

As of Friday, 32% of children age 12 to 17 in North Carolina are fully vaccinated, according to DHHS.

DHHS reported Friday that unvaccinated children in that age range were more than six times as likely to catch COVID-19 as vaccinated teens.

Children younger than 12 are not eligible to receive any COVID-19 vaccine.

Chilton said WakeMed is still able to treat children, but they may have to wait in the emergency room longer than usual. Admittance to the PICU depends on severity of symptoms.

“Every day there’s a shuffle of who’s sort of the least sick, so that we can prioritize those kids who require the most intensive care,” Chilton said.

August on pace for most cases and hospitalizations

Between the pandemic’s peak in the winter and the onset of the delta surge, all metrics were decreasing rapidly as vaccinations soared.

But when vaccinations stalled and delta hit the state in early July, cases rebounded.

“We went weeks without a pediatric patient having either COVID or RSV. Now it’s a near daily occurrence that we have somebody, a pediatric patient, with COVID,” Joyner said.

Child hospitalizations have increased rapidly since delta caused cases to spike. Among those with COVID-19 age 17 and younger, 38 were admitted to a hospital statewide in June. In July, it was 59.

In the first 20 days into August, 128 children with COVID were hospitalized. That could hit 200 by the end of the month. Children with COVID admitted to the hospital peaked in January at 141.

Cases among children have spiked, also.

DHHS reported just under 2,200 cases among children in June and 9,450 in July.

Twenty-one days into August, there were over 20,000 cases confirmed among children, on pace for nearly 30,000, higher than the pandemic peak of 27,181 reported in January.

“It certainly feels like many more children are being infected this time around,” Chilton said.

Is delta causing more deaths and more severe symptoms?

Joyner said the number of children being hospitalized is definitely higher at UNC than over the winter, but he couldn’t conclude that they were sicker than before.

“I wouldn’t necessarily say that they were sicker, but I certainly would say that the kids are coming in more frequently with respiratory symptoms is how I would characterize it,” he said.

Chilton said the number of children with COVID-19 who require intensive care is still relatively low.

“But those who do are quite sick,” she said.

Deaths among children due to COVID-19 are extremely rare statewide. Five had been reported, as of Friday.

The last child who died due to COVID-19 was on Aug. 1 in Surry County, northwest of Winston-Salem.

The last child to die before that was in mid-January in Union County, in the Charlotte area.

Hospitals concerned as children go back to school

With children starting school in-person last week in Wake County, Chilton said her staff is concerned that the close proximity indoors will increase the spread of COVID-19 and other respiratory viruses.

“We’re all pediatricians, right. We’re also pretty staunch advocates of having kids in school, and in person when possible to maximize education,” Chilton said. “The most important thing is the universal masking and adhering to as much social distancing and protective measures as we possibly can.”

As of Wednesday, 90 of 115 school districts in North Carolina, including all in the Triangle, require masking, The N&O reported.

That represents 78% of the state’s 1.5 million public school students.

“It’s unequivocal in my mind. It is clear as day what benefit masks have,” Joyner said. “They’re effective, and it’s a shame more people don’t believe that.”

Chilton also encouraged all school staff and older students to get vaccinated to protect younger children who are not eligible.

“Tool number one in our arsenal is vaccination,” she said.

Mandatory masking policies have been controversial among some parents. When the Wake County School Board voted for their mask mandate earlier this month, some residents protested the decision, The N&O reported.

“It is exhausting. It is frustrating at the level of misinformation that compels people to take the positions that they take. It’s such an emotional toll,” Joyner said. “It’s just, really just sad.”

In the Triangle, there were 13 outbreaks at schools, nine in Wake County, as of Tuesday, the N&O reported. The number is likely higher. DHHS updates its outbreak totals on Tuesdays.

Joyner said that UNC is preparing for the worst as schools fill with students for the first time since the pandemic started.

“We are concerned, and we’re actively making contingency plans to try to accommodate what we anticipate will be a surge,” Joyner said.

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