Sixty Michigan children are now hospitalized with confirmed or suspected cases of COVID-19 — a 54% increase since Nov. 3, the state health department reported Wednesday.
"We are a little bit on edge at this point," said Dr. Rudolph Valentini, a pediatric nephrologist at Children's Hospital of Michigan. "We currently are managing. It's absolutely manageable, but ... it appears as though there's trouble around the corner."
The sudden rise in pediatric hospitalizations from the virus is approaching the pandemic peak of 71 set on April 20.
Children's Hospital now is caring for about 10-15 of the kids hospitalized with COVID-19 in the state, Valentini said, noting that many of them are sicker than they were in previous surges.
He estimated 30%-50% of them now are so acutely ill, they need treatment in the intensive care unit.
"A fair number of them are requiring ventilation and we have some requiring ECMO (extracorporeal membrane oxygenation), which is heart-lung bypass" device, Valentini said. "The patients that are typically getting admitted are unvaccinated."
He's concerned because pandemic trends appear to be worsening, and that is likely to affect kids, too.
The emergency room at Children's saw an uptick of 60% to 70% in COVID-19-positive patients in the past week, said Valentini, who also is the group chief medical officer for the Detroit Medical Center.
"Usually, the positive tests are a leading indicator," he said. "They precede hospitalizations and then hospitalizations usually precede ICU admissions."
After that, deaths typically rise, too. While kids are far less likely to get severely ill from the virus or die, it can happen. Since the pandemic began, 29 Michigan children have died from COVID-19, according to the state health department.
At Helen DeVos Children's Hospital in Grand Rapids, there has been at least one pediatric death from the virus in recent weeks, said Dr. Darryl Elmouchi, president of Spectrum Health West Michigan.
"I can't elaborate," Elmouchi said of the death. He could say, however, that 18 kids had been admitted with COVID-19 as of Monday to DeVos Children's.
"That is higher than any time we've seen" in the last 20 months, Elmouchi said.
Throughout the pandemic, one to five children typically have been hospitalized at one time with COVID-19 at DeVos, he said, "so that is significantly higher." It includes six children who are critically ill and being treated in intensive care.
It comes as Michigan is hit with its fourth major coronavirus surge. The statewide seven-day case rate climbed Wednesday to 536.5 per 100,000 residents — the second-worst in the nation, behind Minnesota, according data from the U.S. Centers for Disease Control and Prevention.
Spread of the virus is highest among children ages 10-19, as 566 new and ongoing outbreaks and clusters of the virus were reported in the last week in Michigan's K-12 schools.
School-age children also are the least vaccinated against COVID-19 in Michigan. State data shows just 23.3% of kids ages 5-19 are fully vaccinated, making them especially vulnerable to contracting the virus, getting sick and spreading it to others.
Part of the reason for the low vaccination rate among school-age kids is because the Pfizer vaccine wasn't granted emergency use authorization for kids ages 5-11 until late October. Statewide, about 8.2% of kids in that age range have gotten one dose of the vaccine.
"While kids may fare better than others when contracting the virus, they still are very much a vessel to pass it on to most vulnerable populations or unvaccinated family members," said Bob Riney, Henry Ford Health System's chief operating officer and president of health care operations.
"And then, just inevitably ... we're all human beings, we slowly let our guard down. We don't want to wear masks. They're inconvenient. We want our old lives back so much."
The lower vaccination rate among kids is one of the reasons why coronavirus infections are soaring in that population, but it's also because most children are now able to socialize far more than they were previously in the pandemic, attending in-person classes and playing sports without universal coronavirus mitigation measures, Valentini said.
"Clearly, the kids are mingling a lot more this time around," he said. "This is the first surge we've seen with open schools and open arenas and active sports. I don't think the kids are getting tested before athletics like they were before."
When the first huge spike in coronavirus infections slammed the state in March and April 2020, Gov. Gretchen Whitmer issued an executive order moving all K-12 schools to virtual learning. Sports were stopped, restaurants closed and the opportunity for the virus to spread shrank.
In November 2020, when the state was hit yet again with high coronavirus case rates and hospitalizations, the state health department issued a temporary pause, canceling in-person high school and college classes. High school sports were suspended and in-person dining was stopped, too. Masks were required in all indoor, public places, including schools.
In the April 2021 surge, all Michigan K-12 schools still required masks, there was a coronavirus testing requirement for student athletes, and quarantine rules were in place.
But this fall, there are no statewide requirements for masks in schools, testing, social distancing or quarantining. While some local health departments and individual school districts may require masks and quarantining of unvaccinated people who've been exposed to the virus, there are no uniform protections.
"Children are not immune to this, and so we have to respect this disease," Valentini said. "We have to protect the kids by any means possible and it starts with vaccination, but it doesn't end with vaccination.
"It still means we need to wear masks. We need to keep our distance and we need to be respectful of one another."
Sarah Rauner, the chief pediatric nurse practitioner at Beaumont Hospital in Troy, said kids also can develop a rare but serious complication of COVID-19 known as multisystem inflammatory syndrome-children, which can cause multiple organs, including the heart and blood vessels, to become inflamed. It can lead to organ failure and damage.
Since the pandemic began, 5,526 children in the U.S. have had the condition and 48 have died, according to the CDC.
In the last week, Rauner said the Troy hospital "definitely has seen an increase in COVID-positive cases, but not necessarily an increase in the sickness or the acuity of these kids.
"We're not as worried about the acute COVID with them, we're more worried about them spreading it to people that are either unvaccinated or undervaccinated," and to people with underlying health conditions that make them more vulnerable to severe disease, she said.
It can be devastating for the child to bring the virus home and infect loved ones.
"I have counseled parents through when a child brings it home and then a grandparent or a parent dies," she said. "This is preventable and that these poor children and families have to go through this, it is awful."
She also worries about kids who develop long-haul symptoms after they've been exposed to the virus or recovered from an infection that can range from rashes to heart inflammation, respiratory, gastrointestinal and neurological problems.
"It's this conglomeration of stuff that you can't predict, which is the scariest part," she said.
"We have the vaccine now. We have given enough doses to know that it's safe. Adults and kids can get the vaccine. We health care workers are begging you: Get the vaccine. We don't have much left to give."
Editor's note: This story has been updated to reflect statewide pediatric deaths from COVID-19 as of Nov. 20.
Contact Kristen Jordan Shamus: firstname.lastname@example.org. Follow her on Twitter @kristenshamus.
This article originally appeared on Detroit Free Press: Michigan kids hospitalized with COVID-19 nears pandemic peak