Maryland hospital beds designated for children are filling up, with COVID-19 and other respiratory viruses largely to blame. As schools reopen with mask requirements that vary from county to county, the situation could escalate and cripple the health care system, hospital officials and medical professionals say.
Maryland has not experienced the devastation of some Southern states, and the number of COVID-19 cases among children has not surpassed the winter and spring peaks. But with cases of respiratory syncytial virus, called RSV, on the rise, and with more children getting inpatient treatment for COVID-19 than during previous waves of the coronavirus pandemic, Maryland officials said the capacity to care for kids could be tested this fall and winter.
“We are in a very significant planning stage for increased hospitalization,” said Dr. Jason W. Custer, director of the pediatric intensive care unit at the University of Maryland Children’s Hospital and associate professor of pediatrics at the university’s medical school. “With the delta variant, and other viruses, and kids going back to school — coupled together, that does get our attention.”
About 2% of the COVID-19 patients hospitalized over the last two months in Maryland have been children younger than 19, said Dr. Ted Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems, which coordinates and oversees emergency care in the state. That’s twice the volume of pediatric patients that needed hospital care at the beginning of the public health crisis, he said.
Delbridge said it’s unusual to see RSV detected in kids this early in the year. Its severity was largely dulled in 2020 and early 2021 with many schools operating remotely, families staying isolated and people generally covering their faces outside their homes.
There are 271 staffed beds for pediatric care in the state, Delbridge said, and as of Friday, 204 were occupied. Among the 61 beds available in Baltimore pediatric intensive care units, 52 were occupied.
Those figures do not include Children’s National Hospital in Washington, D.C., which treats patients from Maryland. Dr. Sarah Ash Combs, a pediatric emergency medicine specialist and the hospital’s emergency department director of outreach, said the facility had 300 cases of the disease caused by RSV in July, up from zero last winter. Also, COVID-19 cases have crept back up, she said.
“It feels like COVID is back, with the caveat that it never really went away,” Combs said.
Maryland health care providers said they have the beds and the space to expand, should the situation worsen. But they may not have the staff — especially those with expertise in pediatrics — to support a surge.
Nationally, a shortage of health care workers, particularly nurses, has made caring for COVID-19 patients especially challenging. Some have left the field altogether, while others have left the state for higher-paying, short-term jobs elsewhere.
There is no overall shortage of medical professionals, said Bob Atlas, president and CEO of the Maryland Hospital Association, last week. But there are “mismatches,” with some hospitals having too few workers.
The health care system generally has more resources available for the adult population than for children, Custer said, which could pose a challenge in the weeks and months to come.
Medical experts said it’s too early to say for sure that the new COVID-19 delta variant causes more serious infections in young people than previous strains. The U.S. Centers for Disease Control and Prevention considers it more contagious and more adept at breaking through the protective shields afforded by vaccinations.
So long as pockets of Maryland and the U.S. remain unvaccinated, the coronavirus can continue to mutate and cause damage and disruption among those who have not been immunized and their families, said Dr. Gabe Kelen, director of the emergency medicine department at The Johns Hopkins Hospital.
Kelen said while children may not have been more susceptible to contracting severe cases of the previous strains, they might be more vulnerable now.
“Kids who are unvaccinated are going to be vulnerable to something more infectious,” said Kelen, who also directs Johns Hopkins’ Office of Critical Event Preparedness and Response. “Some of it is also the relaxation of restrictions, and summer camps, and parents and others not masking.”
Half of Maryland’s 24 public school systems will not require masks in the fall, which Kelen and others said could have dire consequences, especially for those who remain unvaccinated.
“If you’re infected, you’re going to be spewing viral bullets, and you could kill someone, or maim them, or prevent someone else from going to school,” he said. “It means someone isn’t getting cancer surgery or treatment because there’s one less hospital bed.”
As of Tuesday, more than 28,000 cases of COVID-19 had been reported among children younger than 9 since March 2020, and over 50,000 had been confirmed among kids aged 10 to 19, according to state data. There have been 10 deaths among the under-19 age group in Maryland since the pandemic began. Scores more have developed prolonged symptoms of the disease, known as long-haul COVID, and other complications.
There is a huge demand from parents for vaccine for kids under age 12, who are not yet eligible, said Dr. Kathy Neuzil, director of the Center for Vaccine Development and Global Health in the University of Maryland School of Medicine.
She said studies of using the vaccine in younger children are ongoing, including at Maryland, and it’s likely to be late in the year before the U.S. Food and Drug Administration authorizes vaccines for those aged 5 to 11. Those 12 and older are eligible for the Pfizer vaccine now.
“Trials are going well,” said Neuzil, also a professor in vaccinology, medicine and pediatrics. “Adolescents did well and there is no reason to believe younger kids won’t.”
She added that the FDA recently called on those studying vaccines to add more young kids to trials, which quashed hope of getting vaccines an emergency authorization for the elementary school age group before classes started.
She understands the urgency for expanding vaccine use to younger kids, but said officials need to know first if there are any rare but dangerous side effects. There were a small number of cases of heart inflammation in adolescents after their vaccinations, though most were not serious and federal officials determined the benefits outweigh the risks. By expanding the number of subjects included and the timeline, researchers can be more sure to catch any rare occurrences.
Neuzil said everyone should be vaccinated as soon as they are eligible and use other interventions — such as masking, improving ventilation and staying outside — as much as possible.
“It would be great to have a vaccine before it got really cold and everyone has to be indoors all the time,” she said.
Even in the summer months, kids — many rejoining peers for the first time in more than a year — have contracted the coronavirus, with many passing it on to their household contacts.
Margaret Hergenroeder of Glen Arm, mom to Shelby, 12, and grandma to Teddy Mead, 9, had both kids in her care when their summer camp notified them of a possible exposure in her grandson’s group.
A few days later, Teddy started showing symptoms, Hergenroeder said. She kept him at her house through the isolation period so his parents could avoid exposure.
“Teddy was very sick,” she said. “Like, oh my God, heartbreakingly sick. And he just wanted to cuddle up with me. There was no way I could have separated from him.”
Shelby, who was already vaccinated, complained of a headache but showed no other symptoms. Hergenroeder and her wife, Rebecca, who also were vaccinated, had symptoms, too, but have not required hospitalization.
“I do thank God I’ve been vaccinated, as awful as this past weekend was,” Hergenroeder, 65, said Monday. “If people would just get vaccinated, take care of it and isolate themselves, then they don’t have to impact other people’s lives.”
Without more widespread masking, vaccination and sufficient ventilation, the full return of children to classrooms could have hugely dangerous and disruptive consequences for kids, teachers, parents and school support staffers, said Dr. David Marcozzi, COVID-19 incident commander for the 13-hospital University of Maryland Medical System.
He said he recommends even children wear KN95 masks, which are more protective than cloth masks. That could protect children even if they sit next to another student infected with COVID-19.
He also said kids should get the vaccine as soon as they are eligible.
Marcozzi said showing proof of COVID vaccination shouldn’t be political, but something that’s expected, as it is for measles, mumps and rubella and a host of other infectious diseases.
“The challenge is that this virus is changing, and children could be affected more,” Marcozzi said. “And in the fall, if we don’t have mitigation steps in place, a multilayered approach, we’ll see more cases and maybe more serious cases.”
Baltimore Sun reporter Meredith Cohn contributed to this article.