Dr. John M. Cunningham, Sept. 22

The unprecedented social distancing and mask-wearing last winter prevented many children from coming into contact with normal childhood viruses. 

Now that those non-pharmacological interventions have decreased, children are contracting respiratory viruses again, at double the rate as normal in Chicago. And all their caregivers, still enduring the worst public health crisis in a century and lacking professional-level degrees of medical literacy, are bringing them to the emergency room in unprecedented numbers.

Children's hospital and public health officials held a press conference on Sept. 22 to ask families to take sick, but not life-threateningly sick, kids to their pediatricians or urgent care clinics instead of ERs to reduce the strain on emergency departments. 

"Parents are justifiably nervous, and so they want to hear from a clinician about what they should do," said Dr. John M. Cunningham, chair of the Department of Pediatrics at UChicago Medicine, in an interview afterwards. "We're recommending that instead of going to the emergency room, they contact their primary care pediatrician."

Severely ill children are being treated at an emergency room before non-severely ill children, and non-seriously ill children are waiting up to eight hours in Chicagoland ERs for care, he said.

The pediatric surge is not due to COVID-19, but because of the respiratory syncytial virus (RSV) that typically comes in the winter but is instead hitting in the late summer and early fall.

"All of that masking and social-distancing and hand-washing that we were doing meant that last year we didn't see the normal number of so many of these childhood infections," said Commissioner Dr. Allison Arwady of the Chicago Department of Public Health. "Well now that we're more open, they're back. And so in effect, we're seeing two years of these chronic childhood illnesses presenting at the same time."

Dr. Ngozi Ezike, head of the Illinois Department of Public Health, encouraged people to first talk to their primary care providers in order to ascertain what kind of care their sick kids need. 

Dr. Frank Belmonte, Chief Medical Officer at Advocate Children's Hospital, specified that newborns experiencing fevers greater than 100.4 degrees as well as children experiencing severe chest pain or trouble breathing (e.g. asthma attacks), severe dehydration or allergic reactions, injuries like "large and complex burns, cuts and bone fractures," sudden changes in mental status or seizures, high fevers with a stiff back, sudden changes in the ability to move or speak, and self-harm or ideation.

Cunningham said the emergency department at Comer Children's Hospital, 5721 S. Maryland Ave., is seeing between a three- and five-fold increase in the number of children seeking care. 

COVID-19 can appear similar to the flu or RSV, he said: all three have fevers, runny noses and coughs as symptoms. But COVID-19 has body and headaches, loss of taste and/or smell, nausea and diarrhea as symptoms as well — with fussiness and diarrhea telltale signs in children too young to articulate symptoms. If children have those symptoms, they should be tested for COVID-19. 

RSV has wheezing, difficulty breathing and, in younger children, earache, fussiness and decreased appetite as symptoms on top fever, runny nose and cough as symptoms.

All three diseases, as well as the common cold, can be treated the same and typically at home, with rest, hydration and appropriate fever medication. Sick people should stay home. 

Cunningham said the surge is presenting Comer's emergency room with "a very severe challenge" but that the hospital is dealing with it. Every child who is critically ill is being effectively cared for, he said, and there are no staffing shortages.

"We're seeing a doubling to a tripling in the number of children with critical illnesses," he said. "We're very proud of our emergency room staff. They're really working hard at this stressful moment. And we're hiring more staff to work in our emergency room, because this was not an anticipated change. We typically see this kind of illness in January or February, not in August or September." 

Dr. Tom Shanley, president and CEO of Lurie Children's Hospital, which hosted the press conference, noted that avoiding the emergency room is cheaper both for the healthcare system and for patients.

"With the resources that are used to keep emergency departments open and running 24/7 to see children, it's more expensive to take a child to the emergency department than it is urgent or primary care," he said. "Families, if you can get the appropriate advice and it directs you to a site that is appropriate for taking care, you may also save some money at the same time."

Ezike also encouraged families to get their children vaccinated against COVID-19: nearly 57% of Illinois 12- to 17-year-olds have gotten a first dose of the COVID-19 vaccine, and a little more than 62% of Chicago 12- to 17-year-olds have gotten a first dose. Everyone eligible to get vaccinated getting their shots will protect those who have not or cannot, including those who are too young to get immunized.

Arwady said the city's COVID-19 outbreak continues to be driven by those in their 20s and 30s and especially unvaccinated people. Less than one child in Chicago per day is being hospitalized. Some children are being hospitalized with COVID-19, but she stressed that COVID-19 is largely a non-serious disease for children. Chicago's lack of a huge surge in children hospitalized with COVID-19 is largely due to the city's relatively successful vaccination campaign; severity largely depends on preexisting conditions.

Arwady said the city is ready to vaccinate younger children against COVID-19 if and when a vaccine is approved for them. In the meantime, everyone 6 months old and older needs to get a flu shot.

People seeking COVID-19 testing for their children, or who are able to connect with their primary care providers or outpatient practices, should not go to the hospital, Arwady said.

NPR reports that nine mathematical models combined by the COVID-19 Scenario Modeling Hub, which is advising the Centers for Disease Control and Prevention, finds that the delta surge is peaking across the United States and that deaths and cases may continue to decline through the winter and into the spring without another winter surge. 

The forecasters model that children get vaccinated and that no new variant that spreads more quickly than delta emerges.

Chicago's delta surge is also peaking and showing signs of decline; Arwady noted that it bears a resemblance to the alpha variant-driven surge this spring.

She said models are helpful from a planning perspective, but public health planning involves eventualities that are not a part of the models. Without the delta variant, she expected Chicago would have had "a very calm summer."

"I feel very confident predicting what will happen in the next week for COVID. I feel quite confident for two weeks. I feel reasonably confident for four weeks," Arwady said. "Once we start to get beyond four weeks, there is a lot of variability in that."

CDPH is optimistic, based on how the city has managed the delta surge, Arwady said, but there are questions based on how the city manages the fall and winter, when people move indoors. She does not expect huge spikes in cases unless the coronavirus mutates so that the vaccines are not effective against it, but the more people who get vaccinated, the better.

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