Jan. 21—PLATTSBURGH — While the United States is seeing more COVID hospitalizations among children, the risk to kids in general remains very small, Dr. Wouter Rietsema says.
The infectious disease physician pointed to how the numbers have been reported as "skyrocketing," as well as associated fear mongering in the media.
"That small risk has increased, maybe doubled, maybe tripled, of hospitalization and death," he said. "But when you start with a very small number, you can double it and triple it and still have a very small number. So we need to put it into context."
VAST MAJORITY FINE
COVID in children was among the topics Rietsema discussed during the Plattsburgh Rotary Club's virtual luncheon Wednesday.
The infectious disease physician is vice president for population health and information services at University of Vermont Health Network, Champlain Valley Physicians Hospital.
According to state-level data compiled by the American Academy of Pediatrics, in 24 states and New York City, children have made up 1.7% to 4.4% of cumulated hospitalizations, and 0.1% to 1.5% of all their child COVID-19 cases resulted in hospitalization.
Across 46 states, New York City, Puerto and Guam, children represented 0% to .26% of all COVID deaths.
Children with preexisting conditions tend to be the ones that end up in the hospital, Rietsema said. For kids with normal immune systems, the risk remains very low.
"Children can go out of the house and, if they get COVID, the vast majority of them, even without vaccination, will do just fine," Rietsema said.
Regarding at-home COVID tests, Rietsema said their reliability is complicated to explain.
"If you're sick with COVID symptoms and you do a home test and it's positive, you can take that to the bank. That is almost 100% sure that it is what we call a 'true positive.'"
But if you're sick and the test comes back negative, the result is only about 70% reliable, meaning about 30% of cases are missed, he continued.
Whether or not individuals should then seek out a PCR (polymerase chain reaction) test — which Rietsema has described as the "gold standard" — depends on their situation, such as if they have at-risk individuals in their lives.
That guidance pretty much holds true if you have been exposed, but are not sick, the doctor said, noting the accuracy numbers are roughly similar.
Those who are sick should not go back to work until they are better anyway, he added.
Answering a question on whether home tests are useful for determining whether a child should return to daycare, Rietsema stressed the need to understand the limitations of such tests.
He said there's some thinking that testing every day until you get a negative result is the way to go and might correlate with infectiousness.
"We think that's probably the case, but I can't tell you that we have really good data to support that notion," Rietsema said.
"It's not a great answer, but I don't think we have a great answer."
Rietsema said he hopes we're seeing the light at the end of the pandemic tunnel.
"But we don't know. I thought last summer we were heading out, and then along came omicron."
He said it's possible to get another variant, though it would be hard to imagine something more infectious than omicron taking over.
"The nature of pandemics over time is to get variants that are less severe and omicron is an example, we think, of that, " Rietsema said.
It may take years to get a very benign variant, and rather than occurring in a linear process, we may see fits and starts, he added.
"So that being said, between vaccine and natural immunity, we're building up a bit of a population immunity which will serve us well going forward and I do hope that this bodes well for the future, at least for severe disease and death."
MOVING TOWARD ENDEMIC
Rietsema said he did not know the answer to the question of whether the pandemic is shifting into an endemic situation.
According to the U.S. Centers for Disease Control and Prevention website, the term endemic "refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area." For example, influenza, or the flu, is endemic.
"We're moving in that direction" with COVID, Rietsema said. "At the end of the day, the World Health Organization is usually the organization that says it's no longer a pandemic, it's endemic. I don't think we're there yet.
"When you still see surges like we've experienced happening across the country and across the world, I don't think you can say we're out of this pandemic situation."
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