Infant Covid Hospitalizations
CDC's COVID-NET data lacks context
Hospitalization Data Presented at VRBPAC
Today in the FDA’s VRBPAC meeting, they presented a slide on cumulative hospitalizations during the Omicron period, a period slightly more than a year: January 2, 2022 through January 14, 2023. (Note: The date in their slide has a typo that says 2002.) Heather Scobie of the CDC presented about Covid data, including these hospitalization rates, and called out the high rate of hospitalizations among infants under 6 months.
I quickly tweeted out a couple of important caveats to help people interpret these numbers:
CDC is intentionally including incidental hospitalizations (hospital admission for reasons other than Covid) in these rates.
The Covid hospitalization rates for infants <6 months are lower than typical annual RSV hospitalizations.
Incidental Hospitalizations (with vs. from)
As Jessica Adams, who has worked in pharmaceutical regulatory affairs tweeted to noted that VRBPAC member Dr. Cody Meissner (Chief of Pediatric Infectious Diseases at Tufts Children’s Hospital) asked if the hospitalization rates being presented incorporated hospitalizations with versus from Covid, and was told they do not. He rightfully requested that the CDC incorporate this information.
As I discussed in my earlier article about Covid versus influenza hospitalizations, the CDC has data available in COVID-NET on the primary reason for admission as well as the percent of admissions that are asymptomatic. With this data, they could easily exclude at least the most obvious incidental hospitalizations, but yet they routinely refuse to do so. Why do they continue to intentionally provide deceptive and misleading data, when they have more accurate data readily available?
This issue of incidental hospitalizations affects all age groups, and it’s important to keep in mind whenever the CDC presents hospitalization data that by design, it includes all hospitalizations with Covid, regardless of the reason for the hospitalization. This factor is especially important to consider if you want to compare with influenza hospitalizations, where incidental admissions have been historically rare, due to limited influenza testing. There’s also data to show that the rate of incidental hospitalizations has increased over time for a variety of reasons. When prevalence of the virus increases as it did with Omicron, incidental hospitalizations make up a larger percentage of admissions.
Typical RSV Hospitalization Rates
When discussing infant hospitalizations, it’s important to note that infants are hospitalized at higher rates than other age groups. Most infants are born in hospitals for one, and may be admitted for reasons related to birth, such as low birth weight, jaundice, etc. Newborns are also much more likely than older children to be hospitalized for fever out of an abundance of caution. So the higher rate of Covid hospitalizations among infants needs to be put in context with infant hospitalizations for other diseases. Looking at RSV hospitalization rates for infants under 6 months helps put the risk of Covid for this age group in perspective.
When comparing the Covid hospitalization rates during Omicron to RSV hospitalization rates for recent seasons, the difference is striking. RSV-NET reports a cumulative rate for infants 0-6 month between 698-1896 per 100K. Four out of the five most recent seasons have RSV hospitalizations higher than Covid during the Omicron period so far (902 per 100K).
Oct 2018 - May 2019: 1143
Oct 2019 - May 2020: 1435
Oct 2020 - Sept 2021: 698 (Winter ’20-’21 wave was mostly skipped)
Oct 2021 - Sept 2022: 1288
Oct 2022 - Jan 2023: 1896
In fact, according to the latest COVID-NET data, for infants under 6 months, the cumulative Covid hospitalization rate, including incidentals, for the entire pandemic so far (almost 3 years, from March 2020-January 2023), was 1524, which is less than RSV hospitalizations from just the past few months for the same age group. And about 20% of those Covid hospitalizations came during the January 2022 Omicron wave, when Sars-Cov-2 prevalence was extremely high across the US (and the world).
Understanding Risk Factors
Having said all that, it would be nice to know more about infants and young children who have been hospitalized with Covid to better understand risks and other contributing factors. Are there significant comorbidities or other risk factors involved? Are these infections acquired prior to birth or while hospitalized for another issue? Are there other details that would add important context to the hospitalization? Unfortunately, we are never provided with this kind of information. I have a theory as to why that is that I’m planning to write about soon. For now, suffice it to say, the CDC doesn’t seem interested in providing that kind of data. They prefer to focus on inflated numbers of hospitalizations with Covid and act as if everyone is at equal risk within each age group, and sometimes even across age groups.
In summary, the CDC continues to push flawed data, like hospitalizations “with” Covid instead of “from” Covid, even when that data is available, and they present the data in way that is designed to alarm their advisory committees and the public, in order to further their goal of annual vaccinations for all. It’s absolutely impossible to trust the CDC when they do things like continue to share misleading data and leave out important context required to understand the data that they are presenting.