Pediatric COVID-19 Cases on the Rise Again in Houston

Memorial Hermann's hospitalizations are rising amid new and existing variants of COVID-19. Doctors and nurses prepare for the worse as they gear up to care for patients who have the virus.
Memorial Hermann's hospitalizations are rising amid new and existing variants of COVID-19. Doctors and nurses prepare for the worse as they gear up to care for patients who have the virus.

Doctors and nurses in Houston hospitals are facing increases in pediatric COVID-19 cases that could lead to a rise in hospitalizations akin to the amount brought in by one of the worst spikes of Respiratory Syncytial Virus last November and December.

Hospitalizations of RSV overwhelmed pediatric wards then, and have only recently decreased in the last week, said Dr. Michael Chang, a pediatric infectious disease specialist at UTHealth affiliated with Children’s Memorial Hermann Hospital.

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The entrance to Memorial Hermann's pediatric wing, which was full of patients seeking initial diagnoses this RSV and flu season.
Photo by Memorial Hermann

Now COVID-19 hospitalizations are set to potentially replace these even though the RSV season is not over, as the new omicron variant, XBB1.5 is creating an uptick in cases of the virus.

As of Monday afternoon, there were 32 current pediatric hospitalizations combined in the city of Houston and Harris County and 103 active pediatric cases of COVID-19 in Harris County, according to the SouthEast Texas Regional Advisory Council.

Though it is too early to tell if it will become the country’s dominant variant, this new variant combined with the existing omicron variants are at the center of this recent spike in hospitalizations, said Chang.

These hospitalizations began two weeks ago, and are already increasing significantly, said Chang. “In the last few weeks, we’ve seen an increase in the number of patients hospitalized and in this initial increase in admissions, the majority of kids were actually here for COVID-19 and not just with COVID-19,” said Chang.

According to Chang, in past waves, pediatric cases of COVID-19 were usually accompanied by other illnesses, however in the recent hospitalizations, children are being admitted to hospitals solely for their COVID-19 related symptoms.

Even though initial reporting of XBB1.5 does not indicate worsening of symptoms, hospitalizations are occurring due to the rate of infection of this new variant as well as first-time exposures to the virus, as some patients are as young as six months old.

“They are potentially facing their first big surge of COVID-19, so we are seeing an increased number of patients that are hospitalized for their symptoms,” said Chang.

In these younger patients, symptoms include fever, dehydration, trouble breathing, and some respiratory problems –including lower respiratory tract diseases and viral pneumonia.

Children over the age of five have similar symptoms, however, they can also be affected by underlying conditions like seizures, asthma, or heart diseases that may be exacerbated when accompanied by the patient's COVID-19 infection, said Chang.

As XBB1.5 takes center stage, RSV hospitalizations noticeably dropped off in the last week, said Chang. This RSV season came unusually early and was the one of the worst seasons of RSV with around 40 to 50 percent of RSV patients admitted into the Intensive Care Unit, said Chang.

“In our experience, we actually had a higher percentage of patients needing ICU care than in previous RSV seasons,” said Chang. “So not only did this RSV season start unusually early, it lasted a pretty long time, and it was also more severe.”

Coupled with the RSV season was influenza season, but flu by itself never had as much of an impact on hospitalizations as cases of RSV, said Chang.

“We've had a few patients here and there hospitalized for flu and fortunately, that hasn’t increased,” said Chang.“

Though hospitalizations for RSV have decreased, it does not mean RSV is not still an issue, as Chang said RSV is still treated at a higher-than-normal rate at clinics. “Patients with RSV still represent a burden on our system and they’re still representing a significant volume to emergency departments, pediatricians and urgent cares,” said Chang.

Because of the lack of change in severity of XBB1.5, Chang hopes that though the number of COVID-19 hospitalizations has the chance to parallel the number of hospitalizations of RSV, they won’t have as drastic an impact on local hospitals as RSV did.

“I hope that the overall peak and burden of this particular variant is not going to be as impactful as how it was with RSV a few weeks ago,” said Chang. “I think this could be true, even with XBB1.5 seeming more contagious and more infectious, because the disease severity doesn't seem to be worse.”