30+ Children Hospitalised with COVID-19 in January, Paediatrician Shares Outlook

On Friday 4 February 2021, Chronicle.lu got the opportunity to speak with Dr Isabel de la Fuente Garcia, Paediatrician at CHL KannerKlinik (Centre Hospitalier de Luxembourg; children's hospital), regarding COVID-19 related hospitalisations among children in Luxembourg.

Dr de la Fuente also serves as an expert on the Superior Council of Infectious Diseases (Conseil supérieur des maladies infectieuses - CSMI), within Luxembourg's Ministry of Health and as a member of the Advisory Forum of the European Centre for Disease Prevention and Control (ECDC).

Dr de la Fuente confirmed: "More than 160 children aged up to 15 years old have been hospitalised with a SARS-CoV-2 infection in the national centre for paediatrics at CHL since the beginning of the pandemic". Of those, she estimated that around 115 were hospitalised due to COVID-19 while the remaining were hospitalised with other health issues but had a SARS-CoV-2 acute infection at the same time.

The hospitalisation rate of children infected with SARS-CoV-2 in Luxembourg was estimated to be between 0.3% to 0.6% of infected children in 2020 and 2021, as noted in the CSMI reports concerning vaccination in adolescents and children, Dr de la Fuente clarified. She also serves as the permanent expert in paediatric infections on these reports.

"The total number of hospitalised children has evolved in parallel to total number of infections in children in the community, with the highest number in January 2022", said Dr de la Fuente. She continued: "To these children, you need to add several cases of children hospitalised after a SARS-CoV-2 infection due to post-infectious complications. However, these cases are not in the official statistics - as at the moment of their hospitalisation, their PCR results were already negative".

Data compiled from ECDC showed that 33,353 children under 15 years of age were infected in Luxembourg as of 30 January 2022; whilst half (49.5%) of these infections occurred in the last four weeks alone (3 to 30 January 2022).

When asked if the sudden increase in infections has translated to increased hospitalisations as well, Dr de la Fuente clarified: "Yes, since the beginning of the year, paediatric hospitalisation cases have been rising in parallel to high community transmission and very high infection rates in toddlers and children. Just in January 2022, more than 30 children were hospitalised at the Kannerklinik due to SARS-CoV-2. Most of them were very young babies, less than twelve months of age".

She stated that in January 2022, an average of one to four new hospitalisations due to COVID-19 per day were witnessed: "It has therefore been a very busy month at the KannerKlinik paediatric ward!". However, children's hospitalisation stays were quite short in most cases in children when there were no other complications (48 to 72 hours).

In relation to multisystem inflammatory syndrome in children (MIS-C) or heart inflammation (myocarditis) in children in Luxembourg, Dr de la Fuente confirmed: "We detected our very first cases very soon at the beginning of the pandemic at the end of March 2020. We even published one of our first cases in an international scientific journal as at the time this type of complications / syndrome had still not been described".

She continued: "Since the beginning of the pandemic, we have had fifteen children hospitalised with MIS-C (or PIMS, another acronym for same condition). It is a syndrome arriving generally four to eight weeks after an acute COVID-19 infection where the body reacts with an important and damaging inflammatory reaction that affects different organs of the body (heart, brain, intestines, etc.). Children present themselves with several days of high fever, bad general condition and sometimes signs of heart failure / inflammation like hypotension / syncope. Children with this complication need prompt hospitalisation, sometimes in intensive care, for specific care and treatment".

She added: "Between the end of December 2021 and the beginning of 2022, we have seen an increase in the number of children with these complications, following the last Delta wave. We still don't know if infections with the Omicron variant can lead to these complications or not, and with which frequency. However, all our recent hospitalisations of children with MIS-C were secondary to infections with the Delta variant at the end of 2021".

In terms of gender bias, Dr de la Fuente said she had not witnessed any big difference in acute hospitalisations between girls and boys.

Discussing COVID-19 vaccination in children, Dr de la Fuente stressed: "As a paediatrician, putting the children's interest first, the main objective of vaccination should be to protect children themselves against SARS-CoV-2 complications".

She continued: "We have now two recent studies coming from France and the United States showing that vaccination seems to protect against development of PIMS and MIS-C. In Luxembourg, since the beginning of vaccination of those aged twelve years and over in the summer of 2021, we haven't seen any vaccinated teenager hospitalised with MIS-C. Furthermore, data shows as well (in adults) that COVID-19 vaccination protects as well from long-term sequelae and long-COVID".

Regarding long-COVID in children, Dr de la Fuente affirmed that she had encountered some children with persisting symptoms several weeks after infection, mainly at the outpatient clinic. The main symptoms were fatigue, loss of physical condition and respiratory symptoms. However, she underlined: "I must say that it doesn't seem to be frequent and, although, as you said, data is missing, studies tend to show that long-COVID in children is not as frequent as in adults. We are, however, seeing more and more children being physically and mentally affected by the whole pandemic situation".

"In that case and knowing that it is essential that children and teenagers have a normal scholarly and social life, we feel much more comfortable with children and teenagers living a 'normal' life even in times of high SARS-coV-2 transmission, if we know that they are protected against complications of COVID-19 through vaccination", she argued.

Dr de la Fuente concluded on an optimistic note: "Concerning children aged less than 5 years and babies (over 6 months old), specific vaccines might be available in the coming weeks / months. When this will be the case, specific recommendations for this age group will be elaborated taking into account on the one side the effectiveness / safety data of the vaccines in this age group and on the other the infection severity / infection rates of this age group".