As Illinois enters a new school year, more children are being hospitalized for COVID-19 than last time around — though such admissions remain relatively rare, in contrast to the chaotic scenes playing out in pediatric hospitals elsewhere.
This month, an average of more than 30 Illinois children a day have been admitted to hospitals with confirmed or suspected COVID-19, with the rolling seven-day average reaching 40 admissions last Wednesday. A year ago at this time, average daily admissions were around 20 in early August before peaking at 35.
The higher numbers come as debates linger about how best to reopen schools, most notably in Chicago. Vaccination rates remain uneven, and kids under 12 are months away from qualifying to get their shots.
Still, the increase in childhood hospitalizations in Illinois is far less severe than in states where some pediatric wards are filling up fast. In Florida, for example, admissions are running roughly triple what they were last August, at one point approaching 100 confirmed or suspected childhood cases a day, on average.
Nationally, data from the Centers for Disease Control and Prevention show the far-more-contagious delta strain has fueled all-time high rates of COVID-19 hospitalizations in all age groups under 50, spreading freely and inflicting its worst on less vaccinated groups, including those under 18. Helping Illinois, pediatricians said, are the state’s above-average vaccination rates and the greater willingness of residents to wear masks.
That’s not to say things won’t get worse here, doctors and researchers said. Already, in some Downstate regions, nearly as many residents under age 20 are testing positive now as they were during the fall surge; in one region, the rate is at a record high. Those trends are fueling increases in the number of kids ending up in hospitals, where doctors know admissions could rise even more.
“Certainly, with the rising trend in other parts of the country, we don’t want to be unprepared should we see a higher number of cases,” said Dr. Madan Kumar, a pediatric infectious disease physician at University of Chicago Medicine Comer Children’s Hospital.
“We want to be prepared for the worst,” he said.
Researchers say there is cause for concern even in places where caseloads are lower, as the U.S. battles a changing virus that is increasingly affecting younger, unvaccinated victims.
“This is a time not to pat yourselves on your back, but to double down on protecting kids,” said Josh Sharfstein, a public health professor at Johns Hopkins University in Baltimore.
Here’s what we know:
More children hospitalized
Compared with the beginning of last school year, the number of COVID-19 admissions among Illinois children is higher.
The vast majority of these admissions are suspected but unconfirmed cases. Looking at just confirmed cases, the state saw about five kids a day admitted for COVID-19 last week, on average, compared with roughly two a day at this time last year.
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With the pediatric patients spread across the state, the number in each hospital is relatively small, although some hospitals say cases are growing.
Blessing Hospital in Quincy, on the state’s western border, is now admitting about three to four children a week with COVID-19, including children as young as four months old, said spokesman Steve Felde. Before the last few weeks, the hospital rarely had child patients with the illness, he said.
A St. Louis hospital that serves many patients from western Illinois, SSM Health Cardinal Glennon Children’s Hospital, now has about six to 10 children at a time with COVID-19, said Dr. Rachel Charney, a pediatric emergency medicine physician.
That’s up from the two to six patients the hospital typically was seeing over the last year, she said. Overall, about 30% of its hospitalized COVID-19 patients this summer have been from Illinois.
In Springfield, Hospital Sisters Health System’s St. John’s Hospital has had about one or two kids at a time recently at its children’s hospital for COVID-19, said Dr. Gurpreet Mander, chief physician executive for HSHS Illinois.
In the Chicago area, in recent weeks, Advocate Children’s Hospital has typically had about one to two kids hospitalized with COVID-19 on each of its two campuses on any given day, said Dr. Frank Belmonte, the hospital’s chief medical officer. That’s a change from July, when no kids were in the hospital because of COVID-19 for several weeks, he said.
As of Thursday, two children were hospitalized with COVID-19 at University of Chicago Medicine Comer Children’s Hospital, Kumar said.
And at Lurie Children’s Hospital, about three to six children have been admitted each week with COVID-19, a number that hasn’t changed much with the rise of the delta variant, said Dr. Larry Kociolek, medical director of infection prevention and control at Lurie.
Complicating matters, doctors say, is a rise in pediatric patients being admitted across the country because of an unseasonal surge of other viral illnesses, such as RSV. Some doctors suggest that many kids weren’t exposed to those illnesses until now, because of being relatively isolated last winter.
Other states: Higher rates
Health experts say the risk to children from COVID-19 remains far lower than the risk for adults, but the risk varies depending on where people live.
CDC figures from this month show child admissions rising swiftly in the South, with Alabama, Georgia and Florida this week averaging more than 1.2 daily admissions of confirmed cases per 100,000 youths. On the other end of the spectrum, a handful of states reported childhood admission rates of less than a tenth the rate seen in those states.
Illinois’ most recent rate was 0.14 per 100,000 kids, ranking it among the healthiest states on that metric. One way to look at that: Compared to the average child in Illinois, the average Florida child was nearly nine times as likely to be admitted to a hospital with COVID-19 this past week.
That gulf illustrates how uneven the rise in hospitalizations has been across the country, with warnings of some hospitals filling up in Florida, Georgia, Mississippi and Louisiana even as Chicago-area hospitals report admitting only a few children with COVID-19 each week.
At Children’s Hospital New Orleans, beds filled up earlier this month, including in the ICU, and the hospital’s chief physician, Dr. Mark Kline, warned at a news conference that half his patients were “perfectly healthy children” before getting infected.
“I’m as worried about our children today as I’ve ever been,” Kline said.
In Illinois, however, hospitals say they are not close to running out of space because of COVID-19, and the state continues to rank far lower than the national average in the rate of kids admitted with confirmed cases. Illinois’ rate, per 100,000 kids, is even among the lowest of its neighbors. Indiana and Missouri, for example, have rates more than triple Illinois’.
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Researchers say one reason Illinois is faring better than other states is a smaller rise in overall case counts, as the level of community spread tends to dictate how many children get infected.
Mask wearing, distancing and — most importantly — higher vaccination rates all help to hold those numbers down, doctors say.
COVID-19 vaccines don’t entirely eliminate infections, but researchers say fully vaccinated people are less likely to get infected, less likely to spread the virus and far less likely to need hospitalization. (That’s despite notable exceptions, such as the Rev. Jesse Jackson being hospitalized last week even though he had been vaccinated.)
CDC data confirms that, last week, states with lower vaccination rates generally had higher rates of new cases, when adjusted for population size, than others.
With at least 50% of its population fully vaccinated, Illinois’ rate of average new daily cases was less than 30 per 100,000 residents. Compare that to Mississippi, where barely a third of residents are fully vaccinated and the state had a daily average of nearly 120 new cases per 100,000 residents. (Florida is an outlier, with an average daily case rate of nearly 100 per 100,000 residents even though its vaccination rate is close to Illinois’.)
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The CDC does not offer data that is recent and detailed enough to compare states on vaccination rates and case rates for children old enough to get the shots.
But in states with heavy caseloads, including among children, doctors worry that low vaccination rates have set the stage. Among them is Kline, with the New Orleans pediatric hospital.
“The low rate of vaccination here in Louisiana means that we are very susceptible to a truly devastating surge,” Kline told reporters this month.
In Illinois, state data allows a comparison by region, though the age groups differ for vaccination data and case data. These numbers show that the national trend holds: The higher the vaccination rate for children age 12 to 17, the lower the rate of new cases in the youngest age group, people under 20.
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Illinois concerns
Unlike many governors in the South, Illinois Gov. J.B. Pritzker has mandated masks be worn in schools, arguing they are needed to avoid spikes in infections as schools reopen. Chicago Public Schools has gone a step further, requiring teachers to get vaccinated by mid-October.
Still, the debate lingers over the best ways to protect kids while also helping them learn. Some Illinois schools are resisting the mask mandate amid claims it’s an unnecessary overreach, while some Chicago aldermen and state lawmakers question whether the city is doing enough to protect kids. And Illinois schools are reopening just as outbreaks have forced some districts — mostly in rural areas in the South — to send kids home.
Chicago’s public health commissioner, Dr. Allison Arwady, told the Tribune she believes schools, with masking and distancing, pose little risk.
“The main thing that puts kids at risk is the community-level COVID risk,” she said. “As long as we can keep the outbreak in control at the city level broadly, we will keep the child numbers in control also.”
Kociolek, with Lurie, doesn’t expect schools to be drivers of COVID-19 transmission, given the safety measures put in place. But it’s possible that the play dates, sports and after-school activities that accompany the school year could prove problematic, he said.
So far, for people under age 20, the number of infections in the Chicago area has risen but isn’t at the level of the spring surge, let alone the fall. IDPH’s most recent data for Chicago shows the city’s rate of new infections had reached about 12 cases per 100,000 residents through last week, or a little over half the spring peak and less than a fourth of the fall peak.
Downstate, the hardest-hit region is the southern 20 counties spread from roughly Mount Vernon to Illinois’ southern tip and east to the Indiana line. For residents under 20, the most recently recorded rate of new daily infections exceeded 100 per 100,000 residents. That’s the highest ever recorded for any region of the state, any time of the pandemic, for that age group.
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Sharfstein, with Johns Hopkins, warned that downstate Illinois is at risk of more COVID-19 hospitalizations, including children.
“I’d be especially worried about areas in the state that have lower vaccination rates and greater case rates,” he said.
Hospitals are bracing for more patients. “With schools opening up, we are obviously on watch to see how that plays out,” said Mander, with HSHS Illinois. “It’s so hard to predict where we’ll end up.”
And, Arwady said, Chicago also is not immune from rising case numbers, with too many people still unvaccinated and masking inconsistent indoors and in crowds.
“We will absolutely see some unnecessary COVID (cases) and some unnecessary COVID hospitalizations,” she said.
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