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Are Pediatric Hospitalizations Rising?
AAP and CNN raise alarm about pediatric hospitalizations
My apologies for my Substack being a bit quiet lately. I had some personal matters that I’ve been dealing with over the past couple of months, but I have lots of good stuff on the horizon. I’m currently working on an investigation about the US government’s continued investment in rapid Covid testing that should be out soon!
On Friday, September 22, CNN ran a surprising piece about rising Covid hospitalizations, particularly concerning children. I shouldn’t have been that surprised, considering the hype around the current Covid “surge” has been ridiculous. It’s much less significant than our last two waves, but I feel like those didn’t seem to cause nearly as much hand-wringing. The CNN article was based in part on recent report from the American Academy of Pediatrics (AAP) — COVID-19 hospital admissions among children rising again. This panic over pediatric hospitalizations was especially frustrating because several reliable indicators (test positivity, wastewater data, and percent of ER visits) were already showing that we were at or past the peak for this wave.
Pediatric ER Visits Declining
My focus has primarily been children, so one of the key indicators I’ve been watching is the percentage of pediatric ER visits with Covid. This metric has been declining for weeks. (It’s not data lag, as this is a surveillance system based on “electronic diagnostic codes transmitted automatically in near real-time.”) ER visits are typically a leading indicator and hospital admissions follow shortly after.
For those who are surprised to see the 0-1 age group so much higher than other age groups, it’s important to note that babies and toddlers are more affected by any respiratory illness due in part to their smaller airways and lower levels of immunity. There is also a lower threshold for visiting the ER or being hospitalized with a baby or young toddler (parents and doctors are more willing to wait and see with older children, who are less vulnerable and can communicate better). For context, last winter, ER visits for influenza and RSV were higher for children under 2 than they were for Covid.
Timing of Prior Summer Waves
Comparing the current wave to prior years would also suggest that we are past the peak this year, with numbers heading down into fall. (And yes, they’ll most likely go up again in the winter with a January peak.)
The CDC publishes a graph of hospital admissions with Covid that you can filter by age. Based on that graph for ages 0-17 (pediatrics), the peak in 2021 was Sept. 4 (at 0.47/100K) and the peak in 2022 was July 31 (at 0.46/100K), with a second slightly lower peak on Aug. 27 (at 0.44/100K). Based on this graph, the 2023 pediatric hospital admissions peak looks like it will be the same time frame (late Aug. - early Sept.) at ~0.2/100K — less than half of the last two summer waves. So why the panic over the current wave? (Note that this is the latest data as of 9/25, which now shows the decline, but the data from 9/18 reflected a plateau beginning late August, inconsistent with CNN’s claim that pediatric hospitalizations “are rising fast.”)
“From Covid” or “With Covid”?
Of course I couldn’t write about Covid hospital admissions without addressing this topic. Incidental hospital admissions have always been an issue, because the data collected by HHS/CDC is hospital admissions with a positive Covid test — without accounting for why the patient was being hospitalized. Some people have tried to downplay this weakness with the data from the beginning, despite significant evidence that this was a big contributor to the numbers. Now some people, including Dr. Jerome Adams, are falsely claiming that the distinction doesn’t exist at all anymore and that hospitals are no longer testing asymptomatic people.
The truth is, we don’t have good data now to know how many hospitals are still testing asymptomatic people before surgery or upon admission. It’s certainly plausible that there are fewer incidental admissions now, but we know some people are still being admitted with incidental Covid diagnoses, so it’s not accurate to say the problem has gone away entirely. Data from Massachusetts shows that a majority of current Covid hospitalizations aren’t getting treated with dexamethasone for Covid breathing issues, but that’s just from one state and is almost all adults. Unfortunately, we just don’t know the extent of this issue in the national pediatric hospital admissions data at this point.
Hospitalizations in Children <5
One of the issues that the AAP focused on was that children under 5 were affected more seriously. This is primarily due to hospitalizations in infants, as I mentioned earlier when showing the ER visit data.
This data from the COVID-NET hospital surveillance network confirms that the rate of hospitalization is highest for infants under 6 months old, and then it drops significantly. I used cumulative rates in this graph so you can see the dramatic difference between each of the under 5 age groups as well as the 5-11 and 12-17 age groups over the 2022-23 season.
The AAP stated that “While children ages 0-4 are one-quarter of the overall U.S. child population, they comprise roughly half of recent COVID-19 hospital admissions.” This is presented as if it is a new concerning trend, but it has been true since June 2022. The 5-11 age group has always had the lowest hospitalization rates, and now that teens have widespread immunity, the 0-4 age group makes up a disproportionate amount of pediatric hospitalizations.
Using the same hospital dataset the AAP is using, the latest data for ages 0-4 shows that it reached a plateau on August 28 when viewed as a rolling 7-day average. AAP’s report uses weekly totals each Saturday, which showed a small increase for the weeks ending Sept. 2 and Sept. 9, and then drops in the latest file for the week ending Sept. 16 (not available at the time of their report).
The AAP managed to time their report right at the peak of weekly totals just before a significant — 18% — drop for hospital admissions in children ages 0-4 for the week ending Sept. 16.
Data Error for Teen Hospitalizations
What stood out to me in the AAP report was the sharp spike in hospital admissions of children ages 12-17 shown in their (blurry) graph. You can also see that spike in the 12-17 line in the graph from my website above. That huge jump in teen hospitalizations seemed unnatural, and I found it strange that the AAP didn’t mention it in their report. I guess they either knew it was faulty data and didn’t want to draw attention to it, or they believed the data, but it didn’t fit with the messaging they had planned.
I wanted to find the cause of this data artifact, so I looked at the source file from healthdata.gov and found some unusual data from Texas for this age group. Specifically daily hospital admissions for ages 12-17 in Texas went from single digits to over 30 overnight. These numbers would have been at or near record highs for daily teen hospital admits in Texas, which is entirely implausible, especially out of the blue — it’s clearly a data entry error. (I documented several similar errors with this dataset in this preprint.) From the latest data file, we can see that the typo persisted for 5 days before being fixed going forward. Unfortunately, the prior erroneous data was not corrected, so it’s impossible to know the correct values, but this faulty data appears to have inflated the cited number of total pediatric hospital admissions for the week ending Sept. 9 by ~120, or 10%.
Why the fear-mongering now?
The point of news stories about pediatric hospital admissions “rising fast” or being “very concerning” is to scare parents into action. In the past, reports like this were attempts to close schools or mask students. Now the push is to vaccinate young children in the US. The quote in the AAP report from the AAP President makes it clear that making the case for vaccinating young kids is the primary goal of this report. The AAP probably knew they only had a week after the latest Covid vaccines came out to publish a report of pediatric hospital increases, and they jumped on it.
“This increase in hospitalizations, especially for the youngest children, is very concerning,” said AAP President Sandy L. Chung, M.D., FAAP. “We know this is the age group with the lowest vaccination rates. Right now, we have updated COVID vaccines that can help children's immune systems learn to detect and resist the virus, including the strain that is circulating now. The virus is still here, and I'd urge parents to talk with their pediatricians about how they can protect their family.”
It’s hard to trust these “experts” when the US recommendations when these reports and media panic seem timed perfectly to push the narrative they want.
Will the AAP release another report soon to show that pediatric hospitalizations are declining? If so, would CNN cover it? Would it get shared by the same people on social media?
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