Hospital Pediatrics,” a journal of medicine for pediatric care, published two research papers Wednesday that found child hospitalizations for COVID-19 were over-counted by at least 40% in the state
“Hospital Pediatrics,” a journal of medicine for pediatric care, published two research papers Wednesday that found child hospitalizations for COVID-19 were over-counted by at least 40% in the state, and researchers believe it’s likely national numbers were similarly inflated. New York magazine reported commentary from Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, and her colleague Amy Beck, an associate professor of pediatrics, that explained the studies’ findings.
“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,” they wrote. The reported hospitalization rates “greatly overestimate the true burden of COVID-19 disease in children.” In an interview, Gandhi told New York magazine “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.”
New York magazine summarized the key findings from the two studies:
In one study, conducted at a children’s hospital in Northern California, among the 117 pediatric SARS-CoV2-positive patients hospitalized between May 10, 2020, and February 10, 2021, the authors concluded that 53 of them (or 45 percent) “were unlikely to be caused by SARS-CoV-2.” The reasons for hospital admission for these “unlikely” patients included surgeries, cancer treatment, a psychiatric episode, urologic issues, and various infections such as cellulitis, among other diagnoses. The study also found that 46 (or 39.3 percent) of patients coded as SARS-CoV2 positive were asymptomatic. In other words, despite patients’ testing positive for the virus as part of the hospital’s universal screening, COVID-19 symptoms were absent, therefore it was not the reason for the hospitalization. Any instance where the link between a positive SARS-CoV2 test and cause of admission was uncertain the authors erred toward giving a “likely” categorization.
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 September 30, 2020, the authors classified 58 (40 percent) as having “incidental” diagnosis, meaning there was no documentation of COVID-19 symptoms prior to hospitalization. Like the first study, and as has been typical around the nation, this hospital implemented universal testing of inpatients for SARS-CoV-2. An example of incidentally SARS-CoV-2-positive patients are those who came to the hospital because of fractures. Patients who may have had COVID-19 symptoms but who had a clearly documented alternative reason for them, such as a child with abdominal pain and fever found to be related to an abdominal abscess, were also deemed to have incidental diagnosis. The study categorized 68 patients, or 47 percent, 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 these patients were those with acute appendicitis, since that condition includes gastrointestinal symptoms that may also present in COVID-19.