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Michigan critical care pediatrician details severe COVID outcomes, says her greatest wish is families don’t need her

This story appeared in MLive. Read more here.

A critical care pediatrician said she has seen children with COVID-19 develop serious and life-threatening pneumonia, myocarditis causing heart dysfunction and multisystem inflammatory syndrome, a post-infection complication resulting in swollen organs and tissues.

They often require a variety of medical treatments, including intubation and ventilation and high-flow oxygen into their noses or mouths. Some need medications to improve cardiac function and raise their blood pressure after dangerous drops. They might undergo special procedures, such as the placement of an intravenous line in their neck or groin, said Dr. Lauren Yagiela, pediatric critical care physician at Children’s Hospital of Michigan in Detroit.

“My greatest wish is that a child or family never needs medical care that I provide in the pediatric ICU.”

Yagiela spoke Tuesday, Jan. 11, at a virtual press conference with state health leaders on the recent dramatic influx in COVID-19 cases and hospitalizations as omicron rapidly moves about the state, straining an already overburdened hospital system.

There has been an especially steep rise in pediatric hospitalizations. As of Tuesday, there were 107 children with suspected or confirmed cases in Michigan hospitals, down from a pandemic record 135 late last week, but still higher than at any previous period. At the peak of the delta-fueled hospital crisis, the state saw about 60 pediatric patients.

Each day, there are 22 new pediatric admissions and admissions are 66% higher than the week of Dec. 20, said Dr. Natasha Bagdasarian, Michigan’s chief medical executive. “You can see this curve is really troubling. And we’re very concerned, especially given what we know about vaccination update in younger age groups.”

Children are far less likely to be immunized in Michigan than older people. About 37% of children and teens 5 to 19 have received a least one dose.

Pediatric intensive care units in the Detroit region are full due to both the usual winter uptick in respiratory viruses and with children who have COVID-related illnesses, Yagiela said.

Health care workers are under great pressure. “We are doing the best we can to deal with the stress and we are working to support each other and the numerous challenges that COVID has brought to health care,” she said and detailed several sets of alarming potential COVID consequences.

A few children have been so severely compromised they needed heart-lung bypass with extracorporeal membrane oxygenation, meaning their blood is pumped out of their bodies to a machine acting as the children’s heart and lungs while those organs rest and heal.

The Detroit hospital has seen healthy children develop seizures brought on by fever and children with diabetes coping with a dangerous condition known as diabetic ketoacidosis.

“The majority of children we cared for with serious and life-threatening illness due to COVID have recovered,” Yagiela said.

However, they can be in the hospital up to one or two months depending on the severity of their illnesses.

Those admitted to pediatric intensive care units are at risk of lasting impacts on their emotional and physical health, she said. They could develop new conditions, new disabilities and see their quality of life diminished.

The experience can be traumatic for parents; Some endure post-traumatic stress disorder symptoms after their children are discharged. “Many parents fear their child may die,” she said.

She encouraged parents of eligible children to get them vaccinated.

The more children inoculated against COVID-19, the fewer will be ill and require hospitalization or significant medical interventions, she said.

Children younger than 5 are not eligible for vaccines and only about 23% of children 5 to 11 are at least partially immunized in Michigan. About 49% of children 12 to 19 have received a single dose or more.

Of those 20 and older, about 71% have had at least one shot. For people 65 and older, the rate is close to 90%.

In clinical trials, the vaccine was more than 90% effective in preventing COVID-19 in children ages five through 17, Yagiela said and noted the hospital has seen myocarditis, heart inflammation, as a result of COVID-19, not vaccination. (It also has been, in rare cases, linked to the mRNA vaccines, especially in adolescents and young males.)

Case rate trends are increasing across all age groups, but the highest case counts are among those 20 to 29, Bagdasarian said.

Those in this age group are least likely of all adult age groups to be vaccinated. Slightly more than half have received at least one dose.

Younger people usually experience mild illness. The state reports there have been 29 deaths in children 19 or younger and 160 deaths among people 20 to 29. In total, about 28,000 people have died from COVID-19 in Michigan.

Thinking that children are immune to or unaffected by the disease is showing to be “pretty dangerous thinking,” Dr. Dan Zoller, pediatric hospitalist with Beaumont Health in Royal Oak, said last week.

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