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The reported number of COVID hospitalizations — one of the primary metrics for tracking the severity of the COVID pandemic — was grossly inflated for children in California hospitals, according to two research papers published May 19.
Both papers, published in the journal of Hospital Pediatrics, found pediatric hospitalizations for COVID were overcounted by at least 40%, carrying potential implications for nationwide figures used to justify vaccinating children.
Dr. Monica Gandhi, infectious-diseases specialist at the University of California, San Francisco (UCSF), and Amy Beck, associate professor of pediatrics at UCSF, in a commentary for the two studies wrote:
“Taken together, these studies underscore the importance of clearly distinguishing between children hospitalized with SARS-CoV-2 found on universal testing versus those hospitalized for COVID-19 disease.”
The studies demonstrate that reported hospitalization rates “greatly overestimate the true burden of COVID-19 disease in children,” Gandhi and Beck added.
One study by researchers at the Stanford University School of Medicine found that counting SARS-CoV-2 infections in hospitalized children overestimated the impact of COVID in pediatric populations because the numbers included many asymptomatic patients.
As part of the study, researchers reviewed the medical charts of children between May 10, 2020 and Feb. 10, 2021, to determine which of the 117 hospital admissions were unlikely to have been caused by SARS-CoV-2. The authors concluded 53 patients (45%) were admitted for reasons unrelated to the virus.
The reasons for hospital admission included surgeries, cancer treatment, a psychiatric episode, urologic issues and various infections such as cellulitis, among other diagnoses.
The study also found 39.3% (or 46 patients) coded as SARS-CoV-2 were actually asymptomatic.
Dr. Roshni Mathew, the study’s senior author and clinical associate professor of pediatric infectious diseases, noted the percentage of positive tests is a better measure of SARS-CoV-2’s prevalence in the community than the rate at which kids fall ill with COVID.
“The higher the prevalence, the higher the likelihood that anyone who has to come to the hospital is going to test positive,” Mathew said. “Just knowing that a child is hospitalized and has the virus is not enough information to determine if they are actually sick with COVID-19.”
“It’s really important that we distinguish between children who are hospitalized with asymptomatic SARS-CoV-2 infections and those hospitalized for COVID-19 disease,” said study co-author Dr. Alan Schroeder, a clinical professor of pediatric critical care and of pediatric hospital medicine.
“Our goal is to make sure we have accurate data on how sick children are getting,” Shroeder said in a Stanford news release. “If we rely on hospitals’ positive SARS-CoV-2 test results, we are inflating by about twofold the actual risk of hospitalization from the disease in kids.”
In the second study, at the fifth-largest children’s hospital in the country, out of 146 records listing patients as positive for SARS-CoV-2 from May 1, 2020, to Sept. 30, 2020, the authors classified 58 patients (40%) as having “incidental” diagnosis — meaning there was no documentation of COVID symptoms prior to hospitalization.
The same study categorized 68 patients, or 47%, as “potentially symptomatic,” which was defined as when “COVID-19 was not the primary reason for admission for these patients, and COVID-19 alone did not directly require hospitalization without the concomitant condition.” Examples of patients were those with acute appendicitis, since that condition includes gastrointestinal symptoms that may also present in COVID.
Gandhi, in an interview with Intelligencer, said while the studies were both conducted with data from California hospitals, “there is no reason to think these findings would be exclusive to California. This sort of retrospective chart review will likely reveal the same findings across the country.”