During the worst days of the pandemic last year, the same virus that slammed South Florida hospitals with COVID patients rendered the region’s children’s hospitals eerily quiet.
But as more and more adults have gotten vaccinated against the SARS-CoV-2 virus, the disease burden has shifted toward adolescents, and with it, the attention of many public health experts.
COVID hospitalization rates for those between 12 and 17 years old ticked back up in April after a dip in March, according to a recent study sampling 99 counties in 14 states by the U.S. Centers for Disease Control and Prevention. Adolescents get hospitalized from COVID significantly less often than adults, but more often than children, the study concluded.
In Miami-Dade and Broward counties, children’s hospital leaders say that pediatric COVID has been relatively rare in their facilities, though they stressed an urgent need for South Florida adolescents to get vaccinated. It’s not just to protect their own health, but the public health at large.
While tens of thousands of South Floridians have been hospitalized from COVID, only a fraction of them were under the age of 18. Since March last year, Holtz Children’s Hospital, part of Jackson Health System, has had 777 COVID-positive patients under the age of 18. Joe DiMaggio Children’s Hospital in Broward County has had about 174 COVID-positive patients.
Those numbers include children who arrived at the hospitals for other reasons and then tested positive for the virus.
To go along with low levels of pediatric COVID, virtually no kids have showed up at Joe DiMaggio in the last four to six weeks with the post-COVID inflammatory syndrome known as “MIS-C,” which is mainly seen in children, according to Dr. Ronald Ford, the chief medical officer there. Corresponding with that, children have been returning to the hospital for non-COVID treatment at pre-pandemic levels over the last three months, he added.
And while Ford welcomes that bounceback, he said he’s also growing concerned. Because teenagers have been less likely to get severely sick from COVID, Ford fears they’ll also be less likely to get vaccinated. About 22% of Floridians aged 12-19 have gotten at least one dose of a COVID vaccine, according to University of South Florida epidemiologist Jason Salemi’s dashboard. The Pfizer BiONTech COVID-19 vaccine was authorized for people 12 or older about a month ago.
“We’re getting back to normal in so many areas and people are starting to finally feel like things are normal again, but I want to keep it in front of people is that part of the reason we’re back to normal is because of the success of the vaccination program,” Ford said. “If we let up on that, we run the risk of going backwards with this pandemic.”
Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security, said that a mix of vaccine protection for adults, lifting of pandemic restrictions and potentially the influence of new variants is leading to increasing infections in younger Americans.
“The risk to any individual child is very small,” Toner said. “But from the standpoint of public health and looking at it from a population point of view, it’s important to get children vaccinated, not only to protect them from severe disease, but to prevent children from being a reservoir for the virus that continues the outbreak in the rest of society.”
How many kids are being hospitalized with COVID in Florida?
While adult hospitalizations from COVID have been steadily declining in Florida, the rates of admission are among the highest in the country. Meanwhile, the rate of pediatric hospitalizations has fluctuated, following similar patterns observed in the multi-state CDC study.
During the winter COVID surge, pediatric hospitalizations from COVID hit a peak of 65 confirmed and 14 suspected COVID patients on Jan. 25, a rate of about 1.9 hospitalizations per 100,000 children when looking at both confirmed and suspected admissions, according to Salemi’s dashboard. The CDC study found that pediatric COVID hospitalization rates peaked nationally at 2.1 per 100,000 children on Jan. 9.
As of June 5, there were 40 confirmed pediatric COVID patients and 5 suspected in the state, a combined rate of 1.1 hospitalizations per 100,000 children.
Nationally, Florida ranks second in the country for confirmed adult COVID admissions, and fourth for confirmed or suspected admissions, according to U.S. Health and Human Services data. For pediatric patients, Florida ranks fourth for confirmed COVID admissions, but that ranking falls to 20th when looking at confirmed and suspected.
The variation between confirmed and suspected admissions is likely caused by differences in how hospitals report the data and test for COVID, according to public health experts and hospital leaders.
Dr. Barry Gelman, chief medical officer at Holtz Women’s & Children’s Hospital, part of Miami-Dade’s Jackson Health System, said he hasn’t seen a lot of pediatric COVID lately. Earlier this week, there were about two patients in the hospital.
Of the 573 COVID-positive patients admitted under the age of 18 at Holtz, Gelman said about 204 were over the age of 12. Only one patient under 18, Gelman said, passed away, but overall, he said death is an extremely rare outcome for younger patients, even those who wind up in intensive care.
“We’re fortunate that we’re not seeing anything like the morbidity and mortality that we saw with adults,” Gelman said.
But at this stage in the pandemic, Gelman stressed that adolescents “make up a big bulk of people who don’t have immunity.” That’s part of the reason there are walk-in vaccination clinics at the children’s hospital, and patients who haven’t gotten their shot yet are often directed there.
“We’re trying to make it as easy as possible to get as many people protected so they can turn down their worry and go about enjoying their summer,” Gelman said.
Four reasons why adolescents should get vaccinated
Though severe pediatric COVID has been relatively rare in South Florida, it’s still more dangerous for adolescents than the flu, with hospitalization rates among that age group about three times as those linked to influenza over three recent flu seasons, according to the CDC study.
Of those who do get admitted to the hospital with COVID as an adolescent, about one-third end up in an intensive care unit, and 5% require mechanical ventilation, the study found.
Dr. Kartik Cherabuddi, an infectious disease expert at the University of Florida, said that the success of the adult vaccination campaign has led much of the country to be “sort of caught in a lull where we feel that kids don’t get sick with COVID.”
“When something affects kids worse, panic ensues,” Cherabuddi said. “But I think we’ve gone the other way in thinking it’s completely safe, which is not true.”
To that end, Cherabuddi proposed four reasons why adolescents should get vaccinated. The first, he said, is prevent teenagers from becoming the next “vectors of spread,” propagating the disease to older and unvaccinated people.
The second reason, according to Cherabuddi, would be to learn from other countries, such as the United Kingdom, where 12-to-18-year-olds are accounting for a substantial number of infections.
The third reason Cherabuddi identified was the emergence of dangerous new viral variants, such as the “Delta variant,” which is thought to be as much as 80% more transmissible than the super-contagious U.K. variant.
The variants that are spreading now have emerged under the pressure of increasing vaccinations in adults, Cherabuddi added, meaning that the virus is more likely to head to unvaccinated younger people, such as adolescents.
“When you have certain demographics already vaccinated and protected, [the variants] are going to start spreading in other age groups,” he said.
Lastly, Cherabuddi said it’s not just about protecting kids from severe disease, but allowing them to return to normal activities such as youth sports and summer camp without worrying about being infected with COVID and having to self-isolate until they test negative.
“That’s just as problematic as getting hospitalized,” Cherabuddi said. “Let’s not take the childhood away from our kids.”