Severe pediatric COVID cases on the rise

By , Daily Memphian Updated: August 04, 2021 2:37 PM CT | Published: August 04, 2021 4:00 AM CT

Serious cases of COVID-19 have doubled at Le Bonheur Children’s Hospital in 10 days, a worrisome barometer as pediatric cases tick up across the region.

“It’s both increased and sustained,” said Dr. Nick Hysmith, medical director of infection prevention at Le Bonheur and associate professor at the University of Tennessee Health Science Center.


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Eight children are hospitalized at Le Bonheur with COVID; two are in critical care.

Two others died over the weekend. One was a resident of Shelby County. The other was to be transferred to Le Bonheur but died before leaving a rural hospital.

Hysmith did not say how old they were or where the child had been hospitalized.

“What we’ve seen in the last week and half is that children are in critical care for COVID-19 illness requiring significant intervention. And that number is being sustained,” Hysmith said.

“Once they stabilize and are transferred out of critical care, we very quickly have another patient that is there.”

Every pediatric hospital in the nation is feeling the weight as the Delta variant bears down.

Nationwide, nearly 72,000 pediatric cases were added last week, up from 39,000 the week before.

Shelby County had 1,051 active pediatric cases as of Tuesday, Aug. 3. The largest contingent is among ages 15-17, who account for more than a fifth of cases, or 626 per 100,000 people.

The Centers for Disease Control considers 300-400 cases per 100,000 people high transmission.

“The Health Department is monitoring pediatric COVID-19 cases closely,” said Dr. Michelle Taylor, the Shelby County Health Department’s new director. She is a pediatrician.


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“The recent increase in pediatric cases in Shelby County and adjoining states should serve as a wake-up call to Shelby County parents that children can and do get and transmit the COVID-19 virus,” Taylor said.

At Christ Community Health Services, a network of clinics serving primarily the poor in the Memphis area, the rise in symptomatic pediatric cases is startling.

“Before the Delta variant came, the children who tested positive were usually healthy members of the family in which there were one or two adult cases,” said pediatrician Andrew Nearn.

“In the last month, I have seen children come in with coughs, fever, malaise – just ill-appearing – and testing positive. I’d never seen kids this symptomatic until the Delta variant came out,” he said.

So far, none of his patients have required hospitalization, he said.

This strain of the virus is as contagious as chicken pox, which means one person can infect nine people instead of two to three.

“The Health Department is now looking at how to best protect children as the new school year and a return to in-person learning draws near,” Taylor said.

Le Bonheur staff have been watching the escalation in surrounding states for weeks and bracing for the onslaught.

“Since we were in between Mississippi, Louisiana and Arkansas, we felt like we were going to see this coming soon,” Hysmith said.

The hospital on Tuesday did not have the specific number of children admitted from outside the city, but was watching a rise in the number needing supplemental oxygen and ventilators.

“In the past, the children haven’t been particularly ill and most often were admitted for some other reason and then were found to have COVID,” Hysmith said.

“This is considerably different than that. These kids, for the most part, were all admitted to our hospital due to COVID-19 symptoms.”

The number of pediatric cases at Church Health Center is also up. But just as noticeable, says Dr. Scott Morris, is how young they are.

“I had a 4-month-old test positive,” he said.

The infant came in with a runny nose early this week. Morris didn’t order a COVID test.

The next day, the girl’s family brought her back. She was sicker. “One of my partners tested her. To me, that is the change,” Morris said. “Having a 4-month-old test positive has not been what we’ve seen over the last year and half.”

Le Bonheur has had patients with severe COVID throughout the pandemic. What it is seeing now is larger numbers with no lulls in between.

“That’s important for everyone to understand with this new variant,” Hysmith said.

Complicating the situation is the rapid rise in patients with RSV – respiratory syncytial virus – an infection that looks like the common cold and is usually prevalent in the winter.

This year, it has showed up out of season and is deluging physicians in a sea of extra tests and questions.

“Any other time, we would just have said that’s RSV. It’s a respiratory disease children get that’s not that big of a deal,” Morris said.

“Now, you have to start thinking, ‘Is this COVID rather than RSV?”

The CDC issued a health advisory in June, warning doctors of the uptick in Southern states and that they should increase testing in people who test negative for COVID.

It now has spread across the nation, but the most severe cases are in children.

In June, 60 children tested positive for RSV at Le Bonheur. In July, there were more than 400 positives.

“We have had a really sharp rise in RSV in the last two and a half weeks,” Hysmith said.

Their best remedy is a shot of Synagis, to help prevent serious lung infection, usually given once a month during the RSV season, typically November to April.

“Since we are starting to see it now, TennCare has made the shot available year around,” Nearn said.

Tuesday, Aug. 3, two children were hospitalized at Le Bonheur with RSV.

The infection spreads through respiratory droplets and contact with contaminated surfaces. It is the most common cause of bronchiolitis and pneumonia in children under the age of 1 in the United States. Elderly people with chronic medical conditions are also at risk.

The best explanation for why the numbers are up, Hysmith says, is that masking and social distancing kept the season at bay last winter.

“Once the summer hit, and we relaxed the mask mandates and the kids started to play with each other again, it came back,” he said.

The big question no one can answer yet, Hysmith says, is what the winter will look like.

“Is this going to come up and come down with another season in the winter or are we going to have slow positivity or peak and stay plateaued for a few months?”

In the meantime, RSV is a dull backdrop to the raging Delta variant, which in the last week has returned Shelby County hospitals to the pace of the peak last winter.

“We are absolutely in a full-blown surge, at least at Methodist University,” Dr. John Eick said Tuesday.

The hospital reopened its COVID floor in July and has now expanded to peak size.

A week ago, Methodist University had 119 COVID patients. Tuesday, there were 206.

At Christ Community, positive cases jumped from 11% the week of July 4 to more than 32% the week of July 18.

At the current rate of growth, Methodist expects to surpass its peak hospitalization level within the week, Eick said.

“So, despite thinking the most dire times were behind us, we are now seeing them in front of us.”

The look of dismay among the staff – nurses, respiratory therapists and doctors – as they pick the load back up again is telling, Eick said.

“We have to be talking about how we are going to take care of all these patients if we reach capacity at some point,” he said.

“It’s tough, and particularly in light of the fact that we have something to stop this. We have the vaccine.”

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Topics

Dr. Nick Hysmith Dr. Scott Morris Dr. John Eick Dr. Andrew Nearn Christ Community Health Services Methodist Le Bonheur Healthcare Dr. Michelle Taylor
Jane Roberts

Jane Roberts

Longtime journalist Jane Roberts is a Minnesotan by birth and a Memphian by choice. She's lived and reported in the city more than two decades. She covers healthcare and higher education for The Daily Memphian.


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