Seasons of Covid 2 (in charts)

Pediatric Covid-19 hospitalizations reach all-time highs; a look at flu and the ICU

I’m a clinical instructor for Harvard Medical School, emergency physician, and director of emergency informatics for Cambridge Health Alliance.

When I first put up my surge comparison site almost two weeks ago, I remarked how Covid hospitalizations in Massachusetts had tracked those of last winter at a level about a third lower and that each day that continued we could feel better about the omicron variant. Of course, timing is everything, and hospitalizations inflected upward the very next day. They have now exceeded last year’s peak in MA, are nearing that peak in the US as a whole, and are still going up. As a reminder, solid lines in the charts below represent this year, while dashed lines are the same date the previous year.

The story of omicron has been of massive infection metrics — cases double and triple their previous highs! wastewater viral loads off the charts! — but more questionable degrees of severe illness. Using data from HealthData.gov, I added to my site options to chart Covid pediatric and ICU hospitalizations, influenza hospitalizations, and hospital/ICU occupancy — the % of beds filled by all types, not just Covid. I’ll go through some of those highlights below.

A common meme remarks, hospitals that don’t have beds are referring to serious nursing shortages: They haven’t run out of furniture!

The ICU surge that (so far) wasn’t

A year ago today as I write this, ICU hospitalizations due to Covid-19 reached their peak in Massachusetts, with the national peak just two weeks behind. Today, MA’s ICU trajectory is on a gentle upslope with possible signs of flattening, and has been consistently about 15% below last winter’s surge. This may turn upward as we saw with hospitalizations, but there is no sign of that as of today. The US numbers have been about 25% below those of last year, but have shown an uptick the past week.

Dividing the US up into its census bureau regions, we see a general drift upward in the past month, somewhat more prominent in the south, which remains about a third beneath last year’s high level. The northeast does appear set to eclipse last year’s peak, though its curve may be leveling off.

Is there room at the inn?

Looking at hospital occupancy, the picture given by the solid lines (this year’s values) is one of stability. Hospitals have been fuller this year than last, but we haven’t seen the sort of large net influx from last winter (which followed a deep summer lull), which was especially dramatic in the ICU December 2020.

On the ground, this generally means that hospitals have been replacing non-Covid patients with Covid patients without much change in the overall numbers. Of course, that stable picture belies many hospitals’ desperate straits. A popular meme remarks, when hospitals say they have no beds, they’re referring to nursing shortages: They haven’t run out of furniture!

What about the children?

One pandemic constant has been uncertainty around strategies and impact on children. Do kids spread it, can they safely go to school, who can get vaccinated when, and at what risk?

As the title image makes clear, every region of the country is seeing many more kids in the hospital than at any prior time. The absolute numbers remain small; at last count in MA hospitals, 80 kids had Covid versus about 2,500 adults.

Unfortunately, the strain of even a few sick kids can still be immense because in the best of times (spoiler: these aren’t), there are far fewer pediatric beds available.

Stop the panic around “flurona”

Finally, there’s influenza, the flu, which I saved for last because it is, currently, least. There’s been frequent speculation about hospitals being flattened by simultaneous waves of the two viruses. The term flurona was even coined, for individual patients that have both viruses simultaneously. I shared some of these concerns earlier this winter as we began seeing a high rate of flu A earlier than any prior year. Of course, we were testing about five times as often, but even accounting for that, it was a significant spike. Would it affect us in the hospital?

As of today, the answer is a firm “no.” Flu hospitalizations are higher this year than last, but still very low. In the US, if you are currently hospitalized with a viral condition, it is eighty times more likely to be Covid than flu. In fact, there are more than twice as many children hospitalized with Covid as there are patients of any age hospitalized with flu. And unlike Covid, flu hospitalizations appear to have hit a peak and are currently coming down.

What’s next

For the coming week, I’ll be watching that ICU curve most closely. The NY Times has noted the beginnings of concerning death and ICU increases in some large cities. However, in wider areas and the US as a whole, the levels have yet to reach last winter’s values. It’s hard to see that continuing if hospitalizations don’t peak soon.

Speaking of peaks, it appears from my spot on the front lines that our area’s peak transmission may actually have passed late last week. At the very least, the ED crunch appears to have stopped accelerating. But I’ll have to see convincing tops to both case and hospitalization charts to look away from all this and onto the family’s February ski trip.