Children, Covid-19 and an increase in hospital admissions: A paediatric expert tells us more

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  • There has been a rise in the number of children under five years hospitalised in South Africa.
  • Experts say this can be due to various factors, including an increase in children being tested.
  • Most paediatric cases have been mild, with short stays in hospital.

The fourth wave of Covid-19 infections in South Africa has sparked an increase in hospital admissions in children under five years, experts from the National Institute for Communicable Diseases (NICD) recently reported.

"What we normally see is a large number of [hospital] admissions in older people, but in this early resurgence in Tshwane, we're seeing most of the admissions in the zero to two years age group," Dr Waasila Jassat, a public health specialist at the NICD, said at a media briefing on 29 November. 

The majority of the admissions were initially observed in Tshwane, where there has been a sharp rise in cases amid the circulation of the new Omicron variant.

However, Jassat said they were starting to see an increase in other Gauteng districts as well.

Children have been less severely affected than adults by Covid-19 in the previous three waves and subsequently had fewer hospital admissions. The recent data, therefore, have raised alarm bells for parents and guardians. 

Increased testing

Researchers are currently monitoring the trends in admissions in younger children.

In the meantime, Jassat said the admissions should not prompt panic, adding there were a few potential reasons behind the increase in admissions in children – one of them possibly being as a result of an increase in Covid-19 testing.

She said:
There's a lot more testing in the hospitals of all people admitted, even for other … medical conditions or for elective surgeries, and so they're picking up incidentally positive patients who may not really be sick or have other symptoms of Covid.

Professor Heather Zar, Chair of the Department of Paediatrics and Child Health at Red Cross Children's Hospital, echoed Jassat’s comments: “Many of the hospital cases are incidentally found to be SARS-CoV-2 positive, e.g. a child is admitted for another reason (such as elective surgery) and tested for SARS-CoV-2 as screening."

Precautionary measure

There’s also a probability that clinicians are admitting paediatric patients as a precaution while there are beds available, and so more young patients are being admitted, whereas later in the wave they wouldn’t meet the criteria for admission, said Jassat.

Cases have mostly been mild 

While it’s early doors, it does look like there are increased numbers of children testing positive and in some areas, a small rise in hospital cases. However, out of these admissions reported, the infections have generally been mild, Zar said.

She added:

Cases are almost invariably reported as mild, with very few requiring oxygen, and having short stays in hospital.

Jassat further said that although the increase in admissions in younger children could be precautionary, the indications were they were not more severe than in the past. 

"But I think what's important for us to note is, while we do hospital surge preparedness, this time we may need to look at paediatric bed preparedness especially," she said.

Reflection of what is seen in the community

The increase in positive infections in children also seemed to be a reflection of what was happening in the community, said Zar.

"[The admissions] reflect increased infections seen in areas with increased adult cases [adult cases also seem to be milder than prior waves – possibly due to vaccination and/or prior infection in these individuals, so they have immunity against severe disease)."

Parents not vaccinated

In the briefing, Jassat said while there was a possibility the Omicron variant might be more transmissible than Delta, and made children more susceptible to getting the disease, it was worth considering there was an immunity gap regarding vaccination coverage in adults and children.

She added:
And so it's likely that as the vaccination coverage increases in adults, the children who are not vaccinated are the ones who are susceptible and they may be the ones that get sick and need to be admitted.

In children under the age of 12 (who are not eligible for vaccination) who were admitted to hospital with Covid-19, none of their parents – except for three – were vaccinated, said Jassat. 

She added all the children aged between 12 and 18 who were admitted were not vaccinated. One dose of the Pfizer vaccine is currently being offered to this age group.

Expected as coverage increases in adults

Zar said: "As more adults become vaccinated, so we can expect children to become proportionately more of the positive cases, as more adults will be protected."

She added there was no cause for panic at this stage.

"Illness seems predominantly mild, case numbers are still quite small and children are still a very small percentage of overall hospitalisations."

Do younger children need to be vaccinated?

"No. I think this speaks to the need for better vaccination coverage of our adult population and the need for booster vaccination, especially in the elderly, those with underlying comorbidities and people who have only had a single J&J [which protects against severe disease but provides poor protection against infection or mild illness]," Zar said.

Currently, around 25% of the adult population has been vaccinated. 

"Antibody levels reduce after four to six months post-vaccination – higher antibody levels may protect against infection, so boosters are urgently needed," she added.

Heterologous boosters

Heterologous boosters (a Johnson & Johnson dose followed by a Pfizer dose) have been shown to give higher antibody levels than two shots of J&J, and this should be offered as an option to everyone who had had only had a single J&J shot, which did not provide adequate protection against infection, Zar said.

Heterologous boosters have not been approved yet.

However, Professor Linda-Gail Bekker, the co-investigator of the SA Sisonke study, told Health24 last month its approval was a possibility in the future.

Booster shots may be available soon

"A booster is also needed for the elderly or those with comorbidities four to six months after their last vaccine to increase antibody levels," said Zar.

Booster doses opened up to people who are immunocompromised on 1 December.

Meanwhile, the SA Health Products Regulatory Authority on Wednesday approved Pfizer's application for a third dose for adults who have received their primary two-dose regimen.

The regulator approved a third dose of Pfizer's Comirnaty Covid-19 vaccine "in individuals aged 18 years and older, to be administered at least six months after the second dose", as well as a third dose for "individuals aged 12 years and older who are severely immunocompromised, to be administered at least 28 days after the second dose".

What parents and guardians should do

The most important thing was for parents and guardians, and eligible members of the family, to be vaccinated themselves, said Zar.

She added:
Transmission is lower in vaccinated households [at least for the prior variants, and is likely also for Omicron].

Jassat said: "I think certainly the value of vaccination in the adults protecting the children in the homes is something to be borne in mind."

Zar advised the public to follow Covid-19 public health measures.

"Avoid social gatherings [especially those that are indoors where transmission is much more likely] and shopping centres, etc. Wear masks in all public spaces. Open windows at home and be outside rather than inside whenever possible," she said.

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