City, county return to mask mandates

Washington University's Dr. Clay Dunagan speaks as St. Louis Mayor Tishaura O. Jones and County Executive Sam Page hold a news conference at City Hall to announce a return to a mask mandate indoors in public spaces on Monday, July 26, 2021. Photo by Robert Cohen, rcohen@post-dispatch.com

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ST. LOUIS — Area hospital leaders are raising the alarm about an increase in the number of children hospitalized with COVID-19 and asking adults to protect children by getting vaccinated and wearing a mask.

In just one week, the major hospital systems across the St. Louis area have gone from having 13 children hospitalized with COVID to 20, Dr. Clay Dunagan said Tuesday, speaking on behalf of the St. Louis Metropolitan Pandemic Task Force.

Ten were younger than 12 and too young to get vaccinated, while the rest were ages 12 to 18. Three in the youngest age group and four in the oldest were in intensive care “fighting for their lives,” said Dunagan, chief clinical officer for BJC HealthCare.

Dr. Clay Dunagan speaks during about an alarming rise in children hospitalized with COVID-19 during a St. Louis Metropolitan Pandemic Task Force briefing on Tuesday, Aug. 3, 2021. 

The more infectious delta variant began spreading across Missouri in late May and has quickly become the culprit behind most cases, leading to a sharp increases in cases and hospitalizations among the unvaccinated.

Dunagan pointed to data from other countries showing that compared with earlier strains of the coronavirus, the delta variant is two to three times more likely to put an unvaccinated person in the hospital and twice as likely to result in death.

St. Louis task force hospitals have seen a daily average of 420 patients hospitalized with COVID over the past week — four times the average number recorded six weeks ago, Dunagan said.

The latest snapshot shows 84% of those patients were unvaccinated, he said. Fully vaccinated patients tended to have compromised immune systems or other illnesses.

Kids are also getting caught up in the dangerous trends.

“It’s true that children typically don’t have a very rough time with COVID. Many weather it with minor symptoms, not that much worse than a cold, but not all of them do,” Dunagan said.

Cardinal Glennon Children’s Hospital in St. Louis started the summer with fewer than eight children testing positive for COVID-19 in the emergency department and one or two children hospitalized with COVID-19 at any given time.

“Since the delta variant has been rearing itself, we are seeing double digits in the emergency department, and we have typically between eight and 12 kids in the hospital with COVID,” said the hospital’s chief medical officer, Dr. Marya Strand.

Kids not protected

Among CoxHealth hospitals serving southwest Missouri, where the delta variant hit first, doctors cared for two children hospitalized with COVID in May, 10 in June and 18 in July, officials said.

The children seen at Cardinal Glennon are either unvaccinated or too young for the vaccine, Strand said. “So, these children rely on their families and their community to be vaccinated to protect them, which we haven’t done.”

Statewide, 48% of residents have received at least one dose of the vaccine and 42% have been fully vaccinated, according the Department of Health and Senior Services.

Dunagan said in order to halt spread, vaccination levels now need to reach 80% to 90% because of how contagious the delta variant is.

St. Louis and St. Louis County reinstated mask requirements indoors on July 26, but the move prompted a large protest by an unmasked crowd at last week’s county council meeting.

State Attorney General Eric Schmitt also filed suit against the local mandate. A temporary halt of enforcement of the order was granted Tuesday.

The mask mandate was prompted by evidence showing that while vaccines remain highly effective at preventing severe illness and death, the fully vaccinated are sometimes still able to spread the virus.

“Masking is an easy way to protect kids and for kids to protect themselves and for adults to protect the children around them,” Strand said.

Young kids wear a mask when they see their parents do so, she added. “Parents have to be thoughtful and set a good example.”

Hospitals to the south see surge

Doctors with children’s hospitals in surrounding states such as Oklahoma, Texas and Arkansas have also reported caring for more severely ill pediatric patients with COVID-19.

Arkansas Children’s Hospital in Little Rock issued a news release last week saying it was caring for a record number of 24 children hospitalized with COVID-19 — a 50% increase over its winter peak.

Of the 24, seven were in intensive care and four were on ventilators, according to the release.

On Friday, in a series of posts on Twitter, Dr. Heather Haq, a pediatrician at Texas Children’s Hospital in Houston, said COVID admissions there were up 500% over recent months.

“After many months of zero or few pediatric COVID cases, we are seeing infants, children and teens with COVID pouring back into the hospital, more and more each day,” she wrote.

Haq is also concerned the delta variant is not only highly contagious but could cause more severe disease.

“This time around I’m seeing more COVID pneumonia in younger children (previously was seeing COVID pneumonia mainly in tweens and up), now seeing in neonates to preschoolers,” Haq wrote.

Strand said she is seeing kids admitted with COVID who are otherwise healthy.

“We are not seeing that they have other comorbidities that make them more at risk, these are kids who just happen to have COVID, and it happens to be of a degree that they need hospital-level support,” she said.

“There’s no predictive model for who is going to be hospitalized and who is going to be able to go home.”

She said it’s too early to tell for certain if the delta variant is making kids more sick. While she is seeing more children being admitted, that may be because more kids are getting infected, she said. Most children coming to the emergency department end up having mild enough symptoms to recover at home.

But she expects that could likely change based on what other regional hospitals are experiencing.

“We are seeing a lot more volume of kids testing positive for COVID, but we are not yet seeing the high acuity, which is great,” she said. “I think it’s coming, but we haven’t seen it yet.”

Unexpected surge in RSV

Making the situation more dire, Strand said, is that the increase in COVID patients is happening at the same time children’s hospitals are seeing an increase in respiratory syncytial virus (RSV), a highly contagious flulike virus which typically peaks in the winter months.

RSV was nearly nonexistent last winter as people were more strict about wearing masks, washing hands and social distancing; but cases began to increase in southern states in June.

Cases have also increased in Missouri, prompting DHSS to issue an advisory on July 6 warning providers of the unexpected off-season surge.

Each year in the U.S., RSV leads to about 58,000 hospitalizations and 100 to 500 deaths among children younger than 5.

“I’m extremely concerned because not only do we see that increased acuity (in pediatric COVID patients) south of us and moving into Arkansas, but when you add that on top of all of our winter viruses peaking right now, our hospitals across the region are already full,” Strand said.

“So, if we have increased admissions and increased acuity, we are going to really be strapped for resources and space for pediatric patients.”

Michele Munz • 314-340-8263

@michelemunz on Twitter

mmunz@post-dispatch.com

This article originally ran on stltoday.com.