COVID-19: Israel needs to prepare for surge in sick children - Ash

Health Ministry instructs medical centers to prepare for a high number of young patients.

A HEALTH worker administers a COVID test to a child at a Maccabi HMO clinic.  (photo credit: MICHAEL GILADI/FLASH90)
A HEALTH worker administers a COVID test to a child at a Maccabi HMO clinic.
(photo credit: MICHAEL GILADI/FLASH90)

Hospitals should make preparations to accommodate a high number of children with coronavirus, Health Ministry Director-General Nachman Ash said Tuesday. Earlier in the day, Sheba Medical Center in Tel Hashomer reopened the Coronavirus Unit at Safra Children’s Hospital. Shaare Zedek Medical Center in Jerusalem held discussions on preparing an area of its Wilf Children’s Hospital to accommodate COVID patients.

As of Tuesday, 44 children were hospitalized with coronavirus, 10 more than on Monday, the Health Ministry reported. Fewer than five were in serious condition, it said. Health officials and professionals said they were concerned the numbers might surge in the coming days. As hospitals make preparations, there is also an awareness that a lot remains unknown about how Omicron affects the young.
Omicron is thought to be less violent than Delta, but if we consider the high number of infected, we could get a lot of hospitalizations,” said Dr. Moshe Ashkenazi, deputy director of Safra Children’s Hospital. “If we look at the numbers from New York, they’re quite scary. They have seen a 500% increase in the hospitalization rate among children.”
Children can be seriously affected by coronavirus on three different levels. Some develop serious symptoms due to the infection itself, mostly related to respiratory problems. Some experience a mild or asymptomatic infection, but a few weeks later they develop pediatric inflammatory multisystem syndrome (PIMS), which is a serious condition that can include fever, inflammation, acute abdominal pain, and other symptoms. There is also so-called long COVID, which involves fatigue, confusion, difficulty breathing, and other symptoms. Usually, long COVID does not require hospitalization.
In previous waves, most Israeli children who were severely sick as a consequence of COVID had PIMS. About 300 children have been hospitalized with PIMS in Israel, Ashkenazi said. However, looking at what is happening in New York, the surge is due to the symptoms connected with the infections, and this might be worrisome, he said.It is too early to understand the degree to which Omicron is connected to PIMS, Ashkenazi said.
 Children receive their dose of Covid-19 vaccine, at a Clallit vaccine center in Jerusalem on December16, 2021. (credit: OLIVIER FITOUSSI/FLASH90) Children receive their dose of Covid-19 vaccine, at a Clallit vaccine center in Jerusalem on December16, 2021. (credit: OLIVIER FITOUSSI/FLASH90)
“So far, most of the children who presented serious symptoms because of the infection had underlying conditions, while those who developed PIMS were healthy,” he said. “At the moment, the number of patients in Israel is small, and we are not noticing differences between Omicron and Delta. But we do not have enough experience. Unfortunately, I believe that in a month we will have more information.”

THE CURRENT burden on Israeli hospitals is also complicated because children are hospitalized due to the flu or other respiratory diseases, which last winter basically disappeared. “We are entering the Omicron season with a very high hospitalization rate from other winter viruses,” said Prof. Yechiel Schlesinger, director-general of Wilf Children’s Hospital. “The situation is already very tense.”

“As far as the new variant is concerned, I believe that every day we will know more,” he said. “At the moment, it looks like the disease is milder. But we are seeing more coronavirus patients than in the past, and, unfortunately, I expect that it is going to get worse.” Currently, there do not appear to be specific differences between age groups, other than that older children can be vaccinated and therefore tend to show up at the hospitals less frequently. Among the patients, there are some newborns.
“Most babies are born from vaccinated mothers, and they receive antibodies through the placenta that give them some protection, but some develop a fever,” Ashkenazi said. “It usually passes in a few days, but because they are so small, they need to be hospitalized. When they arrive, we do not even know what caused the fever.”
In terms of the symptoms doctors have been seeing, Schlesinger said there are children with fever, difficulty breathing, and low levels of oxygen in the blood. “We also have children hospitalized for other reasons, such as appendicitis, who also happen to be infected, and this creates a tremendous stress because of the logistical arrangements that are needed in such cases,” he said.
Ashkenazi said he was somewhat worried. “I would say that I’m concerned,” he said. “We still do not know the reason behind the high numbers of hospitalizations we are seeing in the US. The Israeli healthcare system is excellent, and we are ready to treat these children, but we need the tools.”
Parents should vaccinate their children and all those who surround them who can be inoculated, Ashkenazi said. For the youngest, he recommended maintaining their routine but avoiding unessential gatherings, especially indoors. Schlesinger also recommended that all children who can receive the vaccine should get vaccinated.“I do not want to say that I am worried, but I do think it is essential that we are prepared for much higher numbers, including of severely ill children,” he said.