Hospitalisations in Children with Confirmed SARS-CoV-2 Infection During December 2020 to January 2022: Retrospective Single-Centre Cohort, London, England

Abstract

Hospitalisations are often used as proxies for severe disease and to measure the impact of variants and vaccination during the COVID-19 pandemic. Unlike adults, children and young people (CYP) usually remain asymptomatic or have mild, transient infection when exposed to SARS-CoV-2. Hospitalisation for severe COVID-19 is rare in CYP but, two years into the pandemic, there are limited data on COVID-19 hospitalisations in CYP. We, therefore, undertook a retrospective case-note review of CYP admitted to a large paediatric hospital in London, England, with PCR-confirmed SARS-CoV-2 infection over a 14-month period covering the alpha, delta and omicron variant waves. During the 14-month period, there were 33,775 CYP A&E attendances and 3,593 hospitalisations at St. George’s Hospital. Of these, 147 were hospitalised with a positive SARS-CoV-2 PCR-test. Of these, only 15 (10%) were hospitalised with severe COVID-19 presenting as pneumonitis, mainly during the alpha variant wave (10/15, 67%), and in older CYP (9/15 [60%] were aged 12-18 years) with comorbidities (11/15, including 8 with immunosuppression). In a further third (49/147, 33%), SARS-CoV-2 likely contributed to hospitalisation, with had clinical presentations that were typical of other childhood viral illnesses, including fever in young infants and in immunocompromised children that required in-patient investigation and antibiotic treatment, until bacterial infections could be excluded. In the remaining 83 cases (56%), SARS-CoV-2 PCR-positivity was an incidental finding in CYP admitted for other non-infectious medical conditions. In conclusion, unlike adults, hospitalisation with a positive SARS-CoV-2 PCR-test is not a useful marker of severe COVID-19 in children. Our findings demonstrate that not only do CYP have a very low risk of hospitalisation with SARS-CoV-2 infection, but the vast majority of hospitalised CYP (especially healthy CYP) with confirmed SARS-CoV-2 infection do not have severe COVID-19, irrespective of SARS-CoV-2 variant, while the minority with severe COVID-19 recovered without complications. The very low rate of severe COVID-19 during the omicron variant wave is also reassuring.

Note:
Funding Information: None.

Conflict of Interests: None.

Ethical Approval: Anonymised patient data were used for the paper; hence ethical approval statement is not required.

Keywords: sars-cov-2, omicron variant, severe covid-19, hospitalisation, immunosupression