Children’s hospitals are seeing record numbers of COVID patients. Most are being sent home

As COVID-19 cases soared to new highs in Florida and the nation on Wednesday, South Florida children’s hospitals reported record numbers of pediatric patients visiting emergency rooms and urgent care centers — with the vast majority of those children being sent home with mild to moderate symptoms, doctors say.

The surge in cases, much of it driven by the highly contagious omicron variant, is producing a rise in hospitalizations among children and adults. A total of 3,836 people, including 109 pediatric inpatients, were in a Florida hospital with COVID-19 as of Wednesday morning, according to hospital capacity data reported by the Department of Health and Human Services.

Few of those inpatients are severely ill or progressing to the intensive care unit, and many are finding out that they’re positive for COVID-19 after being admitted to the hospital for other medical reasons, such as appendicitis or a broken bone, doctors say.

ERs are not testing sites, hospitals say

Yet despite what appears to be less severe illness, there has been a crush of pediatric patients at emergency rooms, accompanied by parents who want their children to be screened for COVID-19. The demand is stretching hospitals thin and leading physicians to plead with the community to stop going to the ER to get tested.

“Emphatically, our message is that our pediatric emergency departments are not testing sites,” said Dr. Ron Ford, chief medical officer for Joe DiMaggio Children’s Hospital, which is part of the Memorial Healthcare System, in Hollywood. “It’s actually not a place you want to come right now just to have a test if you don’t need medical care.”

At Holtz Children’s Hospital in Miami, part of Jackson Health System, Miami-Dade’s public hospital network, doctors and nurses are also seeing many patients asking to get tested in the pediatric emergency room, said Dr. Barry Gelman, chief medical officer.

“It may have something to do with the fact that it’s holiday time and families are trying to decide, ‘Is it OK to go to a family gathering?’” Gelman said. “Most of them are coming with some kind of symptoms but they’re mild symptoms. Many of the kids who are testing positive are being discharged home.”

Gelman said there were 17 pediatric inpatients at Holtz Children’s on Wednesday with COVID-19, and that about two-thirds of them had been admitted to the hospital for a reason other than the disease. He said that’s a fourfold increase from a few weeks ago, when there were about four patients hospitalized with COVID-19.

Mild COVID symptoms for kids

“Even with kids who have COVID-related symptoms,” Gelman said, “we’re still seeing relatively mild symptoms and a relatively mild course.”

Ford said patient visits to Joe DiMaggio’s emergency room in December have been primarily for complaints of respiratory symptoms or exposure to someone with COVID-19. The number of visits this month, he said, is about to surpass the volume that doctors and nurses saw at the peak of the hospital’s delta wave in August, when there were 429 pediatric ER visits.

The majority of Joe DiMaggio’s ER visits for December have occurred in the last seven to 10 days, Ford said, adding stress to Memorial Healthcare, South Broward County’s public hospital system, which like other hospitals in Florida has seen a significant number of doctors, nurses and other healthcare workers contract COVID-19 and miss work.

But while ER visits are reaching new highs, the number of pediatric inpatients with COVID-19 at Joe DiMaggio has hovered at 10 to 15 a day over the last week, Ford said.

“While the numbers are similar to what we saw during delta, what we’re seeing is that the number of patients who are sick enough with COVID to be hospitalized is less than what we saw with delta,” he said.

Most of the patients being admitted to Joe DiMaggio with severe COVID-19 are younger and unvaccinated, some because they’re younger than 5 years old and not eligible.

At Nicklaus Children’s Hospital in Miami, Dr. Marcos Mestre said doctors and nurses are also seeing record numbers of patients with COVID-19 in the emergency room and at its network of pediatric urgent care centers.

“We’re seeing definitely more, significantly more cases,” Mestre said. “We’re unfortunately seeing it kind of clog up our emergency rooms and our urgent care centers with folks that are coming there partly because they have symptoms, partly because they want to get tested.”

As omicron spreads, Florida hospitals see more patients. Some are unaware they had COVID

Record number of pediatric cases at Nicklaus

Mestre said that on Tuesday, Nicklaus Children’s emergency rooms and urgent care centers identified 331 patients who tested positive for COVID-19, a record for the pandemic.

“At the peak of delta infection,” he said, “we had about 140. That was the max.”

The number of pediatric inpatients with COVID-19 at Nicklaus Children’s is also rising past delta wave levels. A total of 24 pediatric inpatients were hospitalized at the medical center on Wednesday, Mestre said.

“Those that unfortunately can’t get vaccinated because they’re under 5 years of age or if they’re above and didn’t get vaccinated, those tend to be the ones we’re seeing in the hospital,” he said. “The good news is we’re not seeing as much severity.”

Mestre noted how fewer patients were testing positive during the delta wave than they are now and yet many more needed hospital treatment for their symptoms. With omicron, he said, there are more cases but fewer need intense care.

“It’s definitely less virulent,” he said of the omicron variant. “The only thing is there’s a lot more of it so it takes up more resources when dealing with it.”

Florida children have low vaccine rates

Children in general are at less risk than adults of developing severe illness from COVID-19, but as a group they are also the least vaccinated in Florida. About 14% of children ages 5 to 11 years old, who became eligible for vaccination in November, have received at least one dose of vaccine compared with 58% of those 12 to 19 years old. Children younger than 5 are not eligible for vaccination.

Despite their lower risk of severe illness, though, children can contract and spread the coronavirus to others, including those who have underlying medical conditions and a higher risk of severe illness from COVID-19.

“That’s an important factor in the rationale for vaccinating children,” said Ford at Joe DiMaggio hospital.

Gelman noted that vaccines are still effective even if the omicron variant is leading to more breakthrough cases in those who are vaccinated.

“The real benefit of the vaccine is that you’re not going to get very sick, which is the most important thing,” he said, “because if you have some mild symptoms, you can get through it. ... But you’re not going to land in the emergency room.”

For adolescent children and young adults, the rise in cases presents another concern for doctors: Previous case surges have led to a rise in cases of Multisystem inflammatory syndrome in children (MIS-C), a serious condition associated with COVID-19 where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs.

“Anytime we have a surge in COVID-positive cases, we always look a few weeks down the road to see if that translates into a higher incidence of MIS-C cases,” Ford said.

Staffing strains at hospitals

Even with fewer severely ill patients with COVID-19, hospital administrators emphasize that they still have to take extra precautions to prevent the disease from spreading to others. Infection control protocols typically require COVID-positive patients to be held in negative pressure rooms that prevent the airborne virus from leaving an area. And healthcare workers, whose ranks are increasingly getting infected, too, must don more protective gear when caring for infected patients.

“Our staff is getting infected at a high rate just because the general population is getting infected at a high rate,” Mestre said. “They do need to be out for a certain period of time, even if they’re mild symptoms. So that puts a strain on our staff.”

Though Nicklaus Children’s has an employee vaccine mandate, and a staff vaccination rate of about 92%, the omicron variant is evading immunity for many and creating more breakthrough cases in vaccinated persons and reinfections in those who had a prior case. The Florida Department of Health tracks breakthrough cases but does not provide that information to the public.

Mestre said the rush of ER visits, and the absence of some staff due to COVID-19, is leading to longer wait times, not just at Nicklaus Health but all hospitals.

“It’s leading to those children that have serious illness with something else that’s not COVID to also have to wait, or maybe they don’t get that attention as we’d like to sometimes because of the sheer volume of patients we’re seeing” he said.

For now, Mestre said, parents who are concerned about their children getting infected with the omicron variant should consider visiting an emergency room only in the case of difficulty breathing or other severe symptoms.

“If you have mild symptoms,” he said, “there’s not really anything to do in terms of treatment. It’s more about isolation. Going to a testing center, communicating with your primary care physician over the phone, then isolating is probably the only thing that needs to be done.”