Nearly half of the Canadian children who have been in hospital with coronavirus infections since the start of the pandemic were admitted for reasons unrelated to COVID-19, according to new research from the country’s pediatricians.
The findings from a surveillance effort involving 2,800 pediatricians and all of Canada’s major pediatric hospitals show the virus is even gentler on children than previously thought – a fact that doctors hope will buoy parents as schools reopen.
“There have been children hospitalized for COVID, but really far, far, far less than adults," said Fatima Kakkar, a pediatric infectious-diseases doctor at Montreal’s Sainte-Justine Hospital. "The most interesting thing of all is that, yes, we’ve had about 100 or so hospitalizations [of children with a positive test], but when we look across the country, almost half of those have not been for COVID.”
In many instances, Dr. Kakkar said, children are being tested for the coronavirus as an infection-control precaution when they are admitted to hospital for a broken leg or surgery. If the test comes back positive, they count as a hospitalized COVID-19 case, even if they never experience symptoms.
“Overall, I think this is good news from a public-health perspective,” said Shaun Morris, a pediatric infectious-diseases physician at the Hospital for Sick Children in Toronto and the co-lead investigator with Dr. Kakkar of the Canadian Paediatric Surveillance Program’s COVID-19 project, which gathered the data.
Dr. Morris and Dr. Kakkar cautioned that the data were collected while most schools were closed and children were less likely to be exposed to SARS-CoV-2, the virus that causes COVID-19. They said public-health officials and doctors will need to keep a close eye on what happens as classroom learning resumes, giving the virus more opportunity to spread among the young.
Since the start of the pandemic, the Public Health Agency of Canada (PHAC) has been reporting by age category the number of patients admitted to hospitals and intensive-care units who have tested positive for the virus.
As of Aug. 26, PHAC had logged 149 COVID-related hospitalizations among Canadians 19 and under, including 29 admissions to the ICU. Those figures, which account for a little over 1 per cent of all COVID-19 hospital admissions, are for patients with lab-confirmed coronavirus infections, regardless of why they were in a hospital.
The Canadian Paediatric Surveillance Program (CPSP), a long-standing disease-tracking effort led by the Canadian Paediatric Society and PHAC, pivoted in early April to begin collecting detailed information about children with lab-confirmed SARS-CoV-2 infections.
The project surveyed 2,800 pediatricians every week, including specialists at major pediatric hospitals, to see if any of their patients had tested positive for COVID-19 and had been in hospital or deemed high-risk.
If a case fit the bill, the pediatrician filled out a long report for the surveillance project.
The preliminary results, released on Thursday, showed that 111 coronavirus-positive patients under the age of 18 were admitted to Canadian hospitals, 13 of them to the ICU. (Unlike the public-health agency, the CPSP doesn’t include 18- and 19-year-olds in its data for children.)
Of the 89 cases for which the cause of the hospital admission was known, the treating pediatrician identified COVID-19 51 per cent of the time. In many of the other cases, the coronavirus infection was caught as part of routine testing, often before surgery.
The report released on Thursday does not include suspected cases of multisystem inflammatory syndrome in children, or MIS-C, a complication that is believed to be linked to past SARS-CoV-2 infections.
Several dozen potential cases of MIS-C – a syndrome with the overlapping features of toxic-shock and Kawasaki disease, a rare and dangerous hyper-inflammation of blood vessels – have been investigated in Canada, but the role of the coronavirus in many of those cases remains unclear, according to Rae Yeung, a senior scientist and rheumatologist at SickKids.
Fortunately, she said, all the patients with suspected MIS-C admitted to SickKids have recovered.
Dr. Yeung and her colleagues described the story of a 10-year-old boy with MIS-C in detail in a recent article in the Canadian Medical Association Journal. The patient turned up at the emergency department with a prolonged fever, a high heart rate, diarrhea, red eyes, cracked lips and symptoms of shock about a month after he and his family had tested positive for the coronavirus.
He was treated with anti-inflammatory medication in the ICU and is doing well.
“It’s incredibly gratifying that somebody so very sick can come out with no long-term effects at all,” Dr. Yeung said. “Kids are so resilient.”
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