Although serious cases of COVID-19 remain relatively rare among Israeli children, pediatric wards across the country are reporting that children admitted to the hospital for reasons unrelated to the coronavirus, such as surgery, are increasingly testing positive for the virus.
Treating these patients requires the wards to observe coronavirus regulations, including placing these children in isolation rooms in the care of teams wearing full protective clothing, to avoid putting other patients and staff at risk.
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Up until a few weeks ago, coronavirus cases were a marginal phenomenon in pediatric wards. Within a month, since early September, the number of coronavirus patients aged 19 years or younger has risen from 35,000 to 75,000. The number of cases among children younger than 9 years old has doubled from 12,000 to 24,000. Doctors say the increase is felt, but that they have been able to cope with it.
As expected, there has been a significant increase in children arriving in hospitals, as compared to the first wave of infection a few months ago. Some require hospitalization for reasons unrelated to the coronavirus and were admitted after testing positive.
“In general, only a few children are hospitalized due to the severity of COVID-19 – only about one percent of the children infected,” says the director of infectious diseases in Hillel Yaffeh Hospital in Hadera, Dr. Michal Stein.
But in recent weeks there has been an increase in inquiries regarding such cases, she said. “If during the entire month of August we had four such cases, in the three weeks of September there have already been 15. That is a result of the general increase in illness, which in recent weeks has also been reflected in an additional tens of thousands of children who have been infected.”
A mitigating factor has been the fact that children tend to have a lower risk of suffering a serious case of COVID-19, but even mild cases merit attention.
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“We’ve been feeling the effects of COVID-19 for several months, but recently there’s been an increase in the hospitalization of children with the virus. Just because they are barely ill, or are asymptomatic, there’s a need for extra attention. It’s very complex, not medically speaking, but in terms of the efforts to provide an area safe from the coronavirus, for the children, the parents and the staff,” said the director of Schneider Children’s Medical Center, Dr. Efrat Bron-Harlev.
“All the children who arrive are tested for the virus, we also test one of the parents, prevent the entry of families and try to have only one parent accompanying the child,” Bron-Harlev said.
The Dana-Dwek Children’s Hospital at the Tel Aviv Sourasky Medical Center, also known as Ichilov, has also noted an increase in the number of children being hospitalized and tested. Some came in for elective surgery, tested positive for the virus, and were sent home, their procedures rescheduled.
“But in medical terms, we have no serious cases of coronavirus,” among children, says the director of the unit for Pediatric Infectious Diseases at Ichilov, Prof. Galia Grisaru-Soen. She says that children generally have less a chance of being hospitalized for COVID-19 than adults.
A report published last week by the Medical Barometer team, a group of experts that tracks the situation in the hospitals, states: “The numbers of children testing positive who require hospitalization are increasing, and the inventory of beds for such children is small and not centrally organized. The small hospitals and those in outlying areas, which lack good solutions for hospitalizing children who test positive, have difficulty transferring such children for treatment in the large centers.”
The team recommended finding a centralized solution for hospitalizing children with COVID-19. “We should consider defining one of the children’s hospitals as a super-center and creating a solution for hospitalizing children who are evacuated from the small hospitals,” they wrote.
However, hospital directors and medical staff disagree with the idea of designating specific centers for treating children with the virus. “I don’t think it’s a correct or necessary solution,” says the director of Schneider hospital. “We should learn from the experience of the first wave. Sharon Hospital in Petah Tikva was defined as a designated hospital for coronavirus patients only, and that turned out to be a bad idea that hurt both the hospital and the patients."
“The moment you gather coronavirus patients in a single designated center, you both prevent them from receiving necessary treatment in another place, and seriously harm the work of the hospital, which stops all its other activity. I think that the focus should be on precise thinking as to how to create safe treatment,” she says.
Prof. Moti Ravid, medical director of Mayanei Hayeshua Medical Center in Bnei Brak, concurs.
“There are always children who test positive. Most are in good shape and are sent home. A minority are hospitalized in the children’s section in the coronavirus complex and are treated by the staff of the children’s ward. I don’t think it’s practical to concentrate the children in specific hospitals, because then they’ll be far from their families, and the logistics of transfer are also superfluous.”