School outbreaks and what it means for hospital capacity

Well, to no one’s surprise, we’re setting records for kids across the nation as schools re-open. We have no national COVID19 school surveillance program in place, so we’re relying on anecdotal evidence, state-level data, and data gurus in the private sector to piece together an epidemiological picture. As of today, this is what it looks like…

School Situation

For some states in the South whose schools have been opened for a few weeks, we can get a fairly comprehensive picture. For example, Texas has a dashboard for school reported COVID-19 cases in public schools. Since August 8 (when schools started to open), 51,904 student cases and 13,026 teacher/staff cases have been reported. This equates to ~7 cases per 1000 students and ~16 cases per 1000 teacher/staff. Last school year, at this time, there were 1,742 cumulative cases of COVID19 among students. A lot has changed in one year.

Mississippi also has a pretty great school case tracker. Schools reported 1,118 COVID-19 outbreaks infecting 18,825 students and 3,600 teachers/staff in the month of August. In the past week, they reported 123 school-related outbreaks infecting 2,869 students and quarantining more than 15,000 students.

Thanks to Burbio's K-12 School Opening Tracker — which actively monitors 1,200 districts, including the 200 largest school districts in the U.S.— we have a national picture of school closures. More than 1,400 schools across 278 districts have closed in 35 states. Unfortunately, this is just the beginning as many schools in the West and Northeast have yet to start.

National Pediatric Numbers

Last week there were 251,781 new pediatric cases in the United States. This is an all time record for the pandemic. According to the American Academy of Pediatrics, kids represented 1 in 4 Americans testing positive for COVID-19 last week. Unfortunately, this isn’t a complete picture; it’s likely an underestimate because Texas only reports 3% of pediatric cases and Nebraska isn’t reporting COVID-19 data since June.

What about hospitalizations?

As COVID19 is introduced into pediatric populations, we should closely follow the capacity of pediatric ICUs’ (PICU). While the pediatric hospitalization rate is holding steady at 0.8% (1 of ~125 pediatric cases are hospitalized), this could really start adding up. If an estimated 34 million kids are susceptible to COVID19 and 33% of the hospitalized kids go to the PICU, that means we will need 6,800 PICU beds. The U.S. only has 4,500.

I tried to get an understanding of where we are at with PICU capacity. Unfortunately, the CDC and/or AAP and/or anyone else isn’t publicly reporting this data. The NYT ICU bed map is fantastic, but doesn’t allow the reader to display just pediatric ICU’s.

If we zoom on specific hospitals, we can start seeing the problem emerge. For example, Texas Children’s Hospital — a Houston hospital system that has more than 4.3 million annual patient encounters — currently has 150 COVID19 patients and reporting zero available PICU beds. Their PICU is at 100% capacity.

In normal times, pediatric hospitals operate at ~80% capacity, but this can vary significantly by region and time of year. Pediatric hospitals are accustomed to seasonal surges, like RSV. One study that evaluated occupancy levels across 39 children's hospitals found 42% of nights in pediatric hospitals reached above 95% occupancy. As the authors pointed out, though, this comes with a price. There are major consequences with a pediatric hospital capacity >90%: patient safety, quality of care, patient/family experience, rejected transports and referrals, ED crowding, and staff stress. Yes we can create surge units, but then we need the staff to man those beds. And we can’t find enough healthcare workers right now.

This Fall may get messy, if it isn’t already.

Love, YLE


And just because I know I will get asked a thousand times…

  1. I do not have an updated timeline on pediatric vaccines. I’m still hoping for late Fall for 5-11 year olds;

  2. Vaccines continue to be safe for adolescents. For the latest data update, go here.

  3. For school board talking points, go here. If you’re a paid subscriber, reply to this email and I can send you a PDF of the one-pager; and,

  4. For evidence-based ways to make schools safer in the wake of Delta, go here.