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Pediatric COVID-19 hospitalizations rose by 84%, and mechanical ventilation among children more than quadrupled during summer 2021 when the Delta variant was predominant, a researcher said.

There was a statistically significant difference in both hospitalizations among children in August 2021 versus the last peak of pediatric cases in December 2020, whereas the difference in mechanical ventilator use among kids from January 2021 to July 2021 was 350%, reported Michael Cima, PhD, of the Arkansas Department of Health (ADH).

Both cases and ICU admissions also increased from the winter to summer peaks, though the difference between the two was not statistically significant, he said in a presentation at the virtual IDWeek.

"Your data really suggest there is an increase of the proportion of Delta cases that result in severe outcomes," said IDWeek session moderator, Andrew Pavia, MD, of the University of Utah in Salt Lake City. "As a clinician, seeing a lot of kids with Delta, our gut feel is there is a clinical difference."

Cima said that while Delta became the dominant circulating virus in Arkansas during June and July, cases in children ages 18 years and younger began to increase in early May "as restrictions started to ease." He noted the statewide mask mandate, which had been in effect since July 2020, expired in March 2021.

"Growing evidence suggests the Delta variant is not only far more infectious ... but also potentially more virulent," Cima said, adding that his group wanted to see if that applied to pediatric populations in Arkansas, which had so far been less affected by COVID.

They examined public health surveillance data from the ADH for confirmed and probable cases of COVID-19 in children ages 0-18. They compared outcomes across the two peak periods for cases in winter and summer 2021.

Notably, this analysis did not include pediatric deaths, which Cima said are "still very rare" in the state.

"While there have been more pediatric deaths reported recently during the Delta surge, they are still in the process of being reviewed," he said.

Cima noted that when comparing COVID cases across age groups, the case rate among kids ages 12-18 peaked at a different point than other age groups. Notably, the peak rate for this age group "exceeded that of all other age groups" in August, the first time during the pandemic when this happened, he noted.

This peak coincided with the start of school in Arkansas, where school districts are allowed mask mandates, but only half of districts have them in place, Cima added.

Cases experienced "dramatic, exponential growth" in summer 2021, beginning in June and peaking in August, with a 49.5% increase in cases versus the winter peak. There was also a 63.6% increase in mechanical ventilator usage among children in July versus January.

Cima said that while neither of these increases were statistically significant, he would argue they were "practically important."

"At multiple periods during our summer surge, PICU bed availability was critically low" and "reached single-digit availability throughout the entire state," he stated.

Interestingly, the one anomaly in this data was fewer cases of multi-system inflammatory syndrome in children (MIS-C) during the summer, though Cima noted since this tends to present after COVID infection, perhaps not enough time has passed to account for potential MIS-C cases.

He added that these are public health surveillance data, not a prospective cohort study, so the numbers are unadjusted, though the predominant age group who were hospitalized were less age 12 years. Pavia said this begs the question that age may be important when doing an adjusted analysis of these data.

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