Kids and COVID: NJ hospitalizations are up, pediatricians are swamped, but most kids do OK

The omicron surge has sent more children to the hospital in New Jersey in recent weeks than at any time in the 22 months of the COVID-19 pandemic. And two children recently died of COVID-19, including a North Jersey child who developed multi-system inflammatory syndrome, a rare condition that occurs about a month after coronavirus infection.

On Tuesday, 95 children were hospitalized with COVID, 24 of them due to severe symptoms and the rest of them testing positive after admission for another medical reason. That was a reduction from the 102 children hospitalized a week earlier, but up from 82 on Monday.

Meanwhile, COVID cases among kids have reached unprecedented heights, as school outbreaks and community spread mount.

“Most children appear not to get sick enough to be hospitalized,” state Health Commissioner Judy Persichilli said. But the record numbers admitted to the hospital are cause for concern, she added, and reason to urge children and those who spend time with them to be vaccinated.

Unvaccinated kids are far more likely to experience severe symptoms and require hospitalization. More than 90% of the children in the hospital “have not received a single shot,” the commissioner said. Only 3% are fully vaccinated.

However, 520,000 children in the state are too young to be inoculated against COVID, because the Pfizer vaccine — the only one authorized for people younger than 18 — is not yet authorized for those younger than 5.

“They are all at risk,” said Persichilli.

COVID can affect learning

School districts are struggling to curtail the spread of COVID as they try to maintain in-person instruction. The rate of infection among students — 25 per 1,000 in the last week of December — was five times what it had been four weeks earlier.

In one Morris County school district, Mountain Lakes, school officials said over the weekend that 131 students and 31 staff members had tested positive since Christmas. That amounts to about one in 10 children and close to one in five employees, based on district data. Statewide, nearly 1,900 students have been infected through in-school outbreaks since the opening of schools in September.

The virus’ long aftereffects, experienced by a small but significant share of those who test positive, are expected to affect some children’s learning ability and activities for months to come.

Up to 15% “will have longer term symptoms” a month or more after infection, said Dr. Katherine Clouser, a pediatric infectious disease specialist at Hackensack University Medical Center and co-medical director of the Hackensack Meridian Children’s Health Pediatric COVID-19 Recovery Center.

One of the most significant symptoms for children is brain fog, or the inability to concentrate.

“They will tell you they try to read a paragraph and read it 10 times and still don’t comprehend it,” said Dr. Margaret Fisher, a pediatric infectious disease specialist at Monmouth Medical Center and adviser to the state Department of Health. “Some children lose their ability to do math. That obviously interferes with their learning."

A lot is still unknown about “long COVID,” including which children will be affected and what makes it worse. Rutgers Robert Wood Johnson Medical School is projected to receive $30 million in federal funds as part of a study by the National Institutes of Health about COVID’s delayed and long-term effects on children.

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Pediatricians are swamped

Pediatricians’ offices are swamped. Parents are anxious.

Valley Pediatrics, a Ho-Ho-Kus practice with six physicians, saw 10 times its usual number of patients over the weekend. Doctors and nurses who typically spend three to four hours on a Saturday or Sunday worked 12- and 14-hour shifts.

The practice’s last patients left the office at 11 p.m. or 11:30 p.m. most days last week, said Dr. Stefani Birnhak. The surge has meant three times the average number of patient visits on weekdays — hundreds of additional appointments — with fewer staff to handle them, as half the doctors and nurses have their own COVID infections.

Parents are confused by the lack of consistent requirements for tests and isolation or quarantine periods.

“Each school district is doing its own thing,” said Dr. Jeffrey Bienstock, managing partner of PediatriCare Associates, a practice with five offices in North Jersey. “That’s what’s making it very hard for families.

“I wish the state Department of Health would come up with mandated regulations for how long to quarantine, how long to take kids out of school,” Bienstock said. Some districts require all the children in a family to be tested when one has been exposed to COVID, while others don’t, he said.

At Riverside Medical Group, Dr. Sheeba Ben, a pediatrician who practices in Hoboken, said the vast majority of patients she sees each day are for COVID-related appointments. It’s hard to walk into the exam room to tell a parent their child has just tested positive for the virus, she said — especially those with infants.

Sometimes the parents burst into tears.

“Parents have a lot of questions,” she said. “The pandemic is changing. There are a lot of unknowns. The tough part is not knowing everything.”

Silver lining: Kids don't get as sick

Despite the grim statistics, the good news is that most kids do not get seriously ill with COVID-19, pediatricians said.

“It tends to be upper airway symptoms — a little scratchy throat, a little croupy cough,” Bienstock said. “They’re not running 103-degree or 104-degree fevers. They don’t look sick or act sick.”

If it wasn’t a pandemic, he said, most parents would not bring their children to the doctor’s office, treating them instead as if they had a cold. But by getting tested at the doctor’s office, families know for certain whether COVID precautions are necessary.

Parents should definitely take a child to the pediatrician if they’ve had a known exposure to the flu, Fisher said. A rapid test can identify whether the infection is influenza or COVID, and effective medicine is available for flu.

Among the patients who test positive for COVID, Ben sees a difference between her vaccinated and unvaccinated patients.

“The children who are vaccinated seem to have milder symptoms,” she said. A majority feel better by the time the office calls for a telemedicine follow-up 24 hours after their initial visit. And after three or four days, most have recovered.

But the symptoms of unvaccinated children last longer, and can include a cough, body aches, and tiredness that keeps them from their usual activities, Ben said.

Unvaccinated adolescents are 10 times more likely to test positive for COVID, the federal Centers for Disease Control said last week.

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More patients hospitalized

The vast majority of children will never get sick enough to be hospitalized with the omicron variant, said Fisher. “However, some of them will get sick — and we can’t always predict who's going to get into trouble.”

So far, none of Valley Pediatrics’ young patients has required hospitalization.

“It is still rare for kids to be hospitalized, though we are seeing an increase,” said Clouser, of Hackensack University Medical Center. None of the 24 pediatric patients there last week was in intensive care, she said. Their average stay in the hospital was two or three days.

“Kids are recovering. The disease is not as severe,” Clouser said. And doctors know more about how to treat it.

So far in the pandemic, 270,000 children in New Jersey have tested positive for COVID, according to state data — likely a vast undercount because so many were not tested. Some 7,182 have been hospitalized. Ten have died.

Those who are admitted generally need help to breathe or are dehydrated, doctors said. They may have underlying conditions such as asthma that worsen with the respiratory infection.

Signs that warrant a visit to the ER for babies include a “weak suck” that causes them to become dehydrated because they get less nourishment. An older child who is too listless to eat may also become dehydrated. Other red flags, said Ben, include a high fever that can’t be managed at home; a worsening cough with a fever; changes in color, such as a blue tinge around the lips or a child who looks “off," with pale or patchy skin.

Inflammatory syndrome

While many parents are concerned about multi-system inflammatory syndrome, or MIS-C, it is extremely rare “and not a top-line concern for most patients,” said Birnhak of Valley Pediatrics. It occurs a month or so after the initial COVID infection.

Its symptoms are hard to miss, said Fisher.

“Your immune system simply goes berserk,” she said. “Instead of fighting the virus, it starts fighting itself.” Children affected “come in with high fevers, incredibly ill, in shock, and requiring intensive-care management.”

Every system of the body can be affected. With aggressive therapy, the vast majority of patients survive.

It is slightly more common in boys than girls, and more common among Hispanic and Black children than in white or Asian children. In some cases, the child may not even have realized they were infected with COVID initially.

New Jersey has recorded 156 cases of the syndrome in children over the past two years, with two deaths.

Prevention

The best tool to prevent COVID and its complications remains vaccination, health officials say. The Pfizer vaccine is the only one currently authorized for those under 18 years old. It’s a two-dose vaccine, and boosters are recommended five months after the second dose.

Yet fewer than a third of 5- to 11-year-olds have received one dose of the Pfizer vaccine, which was authorized for that age group on Nov. 1. Slightly less than two-thirds of 12- to 15-year-olds have received one dose, and three-quarters of 16- and 17-year-olds have.

“Clearly, we’d like it to be a lot higher,” said Fisher.

Those in the youngest age group — aged 6 months to 5 years old — must wait a little longer.

Additional studies to determine the best dosage have been undertaken. “Hopefully, toward the earlier part of the first half [of the year], we may have some information so that we can vaccinate children of that age,” Dr. Anthony Fauci, the top medical adviser to the White House, said last week.

To protect the youngest, medical experts recommend vaccinating everyone around them — cocooning or encircling them with a layer of people who are more likely to remain uninfected. That includes older siblings, parents and grandparents.

Demand for vaccines has increased among the families she sees, said Ben. “Fewer parents are on the fence now.”

Lindy Washburn is a senior health care reporter for NorthJersey.com. To keep up-to-date about how changes in health care affect you and your family, please subscribe or activate your digital account today.

Email: washburn@northjersey.com

Twitter: @lindywa

This article originally appeared on NorthJersey.com: Kids and COVID: Symptoms usually not severe, cases are up