U.S. Hospitals Risk Being Overwhelmed with Child COVID-19 Cases, Warn Experts Who Estimate Over 170,000 Infected

Pediatric intensive care units in the U.S. could become overwhelmed by children sick with COVID-19, say scientists who estimate over 170,00 may already have been infected.

A team from the University of South Florida (USF) and the Women's Institute for Independent Social Enquiry set out chart the number of children who had been infected with the coronavirus in the U.S., and to estimate how many kids may fall seriously and critically ill and need hospital treatment before the end of 2020. The findings were published in the Journal of Public Health Management and Practice.

According to Johns Hopkins University, more than 2.4 million have been diagnosed with COVID-19, 165,273 have died, and almost 629,000 have recovered. As the Statista map below shows, the coronavirus has reached almost every country and territory in the world.

A report by the U.S. Centers for Disease Control and Prevention published on April 6 showed children aged 18 and under made up 2,572 of the 149,082 reported cases for which age was known. The findings suggested "relatively few children with COVID-19 are hospitalized, and fewer children than adults experience fever, cough, or shortness of breath. Severe outcomes have been reported in children, including three deaths," the agency said.

The authors of the Journal of Public Health Management and Practice study looked at figures from 166 facilities from a database of pediatric intensive care unit admissions (PICU) in the U.S. between March 18 to April 6. To model how many children may get COVID-19 in the U.S., the team looked at data and modeling from China between January and February—including from the Chinese Center for Disease Control and Prevention—as well as estimates of the child population for 2020 from the U.S. Census Bureau.

Currently, there are 5,100 PICU beds across the U.S., with 94 percent in major metropolitan areas. Of the 74 million people aged 17 and under in the U.S., 74 children had been admitted to PICUs for COVID-19 across 19 states, they found.

Using this information, coupled with data from China, the team created an estimate for the percentage of children who would need hospitalization for COVID-19. They then forecast several possible scenarios for the scale of the outbreak among children in the U.S.

The researchers believe 176,190 children across the U.S. have been infected with the coronavirus. Broken down by age, that is 52,381 infants and toddlers younger than two-years-old, 42,857 children aged between two and 11-years-old, and 80,952 12 to 17-year-olds.

If 0.5 percent—or one in 200 children—caught the coronavirus, 369,833 would be infected, of whom 991 would be severely ill and require hospitalization, the team predicted, with 109 needing treatment in a PICU.

If 60 percent of children were infected, 118,887 children would be seriously ill, 13,038 of whom would be critically ill. A total of 44 million would be infected.

Although data on past cases suggests older people are at higher risk of having serious complications and or dying of COVID-19, the authors stressed "a small proportion of children infected with SARS-CoV-2 [the COVID-19 virus] develop severe cases of COVID-19 that require hospitalization."

In one study on 2,143 children in China the team used for their models, babies were found to be at most risk of becoming seriously or critically ill, at 10.6 percent of infants, versus 7.3 percent of one to five-year-olds, and 4.2 percent of six to 15-year-olds.

"Severity and case fatality are much lower for children than for elderly persons, and this truth has created a sense of complacency that 'COVID-19 is not a major concern for children's health'," the authors of the latest study wrote.

"But the devil is in the denominator. There are 74.0 million children younger than 18 years in the United States in 2020. Every 1 percent increase in the proportion of the U.S. population infected with SARS- CoV-2 includes an additional 740,000 children who become infected. Even under moderate cumulative infection proportion scenarios, it is projected that there would be millions of children infected with SARS- CoV-2 and thousands of severely ill pediatric COVID-19 patients as the epidemic peaks across the nation."

The team urged: "Hospitals will need to plan, based on their circumstances and geographic location, for the volume of pediatric-sized equipment and supplies that will be needed and for enhanced staff complements to manage a possible surge in pediatric patients who require critical care."

Most children with COVID-19 have caught the infection in a family setting, the team said, and children in low-income families whose parents are blue-collar or service job workers who cannot work home are among those at greatest risk. Those living in crowded homes, the homeless, uninsured and undocumened families, also face a greater chance of developing COVID-19.

Co-author Jason Salemi, associate professor of epidemiology in the USF College of Public Health, commented in a statement: "Government officials and policy makers should understand the likelihood of capacity challenges, which underscores the importance of effective mitigation strategies such as frequent and thorough handwashing and persisted social distancing measures."

Elizabeth Pathak—president of the Women's Institute for Independent Social Enquiry, which co-authored the study—told Newsweek what inspired it.

"I read the article on COVID-19 among children in China (Dong et al) [mentioned above] when it first came out in mid-March, and felt kind of physically sick, because I immediately saw the implications for global child health," she said.

"Epidemiologists think about the world in a funny way. We think about populations and denominators, when most people tend to focus on case counts, death counts—in other words, numerators. To me what was scary was that there were children who ended up in intensive care with COVID-19, and the risk seemed to be higher for infants and toddlers."

Pathak said she thought most news reports were focusing on the "wrong numbers."

"Yes, it's true that most kids had asymptomatic or mild cases, and that's good. But even a low relative risk for severe disease, multiplied by millions of children at risk, will result in large numbers of very sick kids," Pathak added.

She said she realized she needed to write a paper applying the Chinese findings to the situation in the U.S.

Commenting on the drawbacks of the study, Pathak said: "The biggest limitation to all research and modeling of the COVID-19 pandemic in the U.S. is the lack of widespread testing. What is still happening, nationwide, is that only the most clinically severe cases are being tested and confirmed as COVID-19.

"We are not testing mild cases, and governments at all levels (local, state, and national) are not doing widespread contact-tracing and testing of asymptomatic persons who have likely been exposed to the virus (either through household exposure, occupational exposure, or from a large gathering). This is a huge, huge, problem, and it is going to dramatically impede our efforts to understand and control this virus."

Correction 04/21 3.27 a.m.: A previous version of this article said that if 0.5 percent of children got COVID-19, 1,099 would need treatment in a PICU. This has been corrected to 109 children.

This article has been updated with comment from Elizabeth Pathak.