As the number of COVID-19 cases in Alberta soars, the number of children and teens being hospitalized has nearly tripled and fuelled fears that the province will see more cases of a serious inflammatory condition triggered by the coronavirus.
The total number of Albertans aged 19 and under who have been hospitalized with COVID-19 has nearly tripled since early August — from 13 to 37, according to statistics collected by Alberta Health.
Six Alberta children and teens have ended up needing treatment in the intensive care: one between the ages of one and four, and five between 10 and 19. No one under age 19 has died as a result of the virus.
"Clearly, there is more COVID-19 in the community and therefore the risk is higher for every age group, including children," said Dr. Susa Benseler, pediatric rheumatologist at Alberta Children's Hospital in Calgary.
On Friday, Alberta set another new record for daily new cases of COVID-19, 1,155, with 10,655 active cases, 11 new deaths and a total of 310 people in hospital with 58 in ICU.
By the start of August, 13 Albertans ages 19 and under had been hospitalized, including two in ICU:
10 in the 10-19 age range.
3 in the 1-4 age range.
By Thursday, that number had grown to 37 Albertans ages 19 and under that had been hospitalized, including six in ICU:
24 in the 10-19 age range (5 in ICU).
1 in the 5-9 age range.
5 in the 1-4 age range (1 in ICU).
7 under 1 year.
Rare condition can pop up weeks after mild cases
While the number is still small, the province is seeing more cases of a rare condition that can be associated with COVID-19 in children.
Seven cases of multisystem inflammatory syndrome in children (MIS-C) have been reported in Alberta, up from three probable cases in June. MIS-C is a rare condition that can be triggered by COVID-19, causing severe inflammation in organs such as the heart weeks after an infection.
"What is scary for families is that their children are generally healthy and have had a very mild case of COVID and a few weeks later suddenly have systemic hyper inflammation or MIS-C," said Benseler, who treats children with the condition.
"That is something that's obviously a worry for every family across the province."
She's concerned cases will continue to rise as the virus surges through Alberta.
"If you have a high rate of COVID in your community, just a few weeks later … you have a peak of hyper-inflammation in the hospital," she said.
"So we are all holding our breath right now because we are just in the midst of it. That means we are really looking carefully out for children that may develop hyper inflammation — making sure they get recognized early, making sure they get treated early."
Otherwise healthy kids can get very sick
At the children's hospital, Benseler sees a spectrum of this type of immune response in kids ranging from a milder reaction (which can include high fever, rashes, red eyes and cracked lips) to full-blown MIS-C (where inflammation attacks the heart muscle and coronary arteries).
When milder reactions are factored in, she says, the number of children impacted is likely more than three times higher than the seven cases officially reported by the province.
Benseler says not every reaction on that spectrum would be considered life-threatening and reach the threshold for a MIS-C diagnosis.
"But we do see a cluster of children being previously super healthy developing a hyper inflammatory syndrome," she said.
What is reassuring, according to Benseler, is that doctors know a lot more about MIS-C than they did just a few months ago and as a result they're well trained to identify and treat it.
According to Alberta Health, the Alberta MIS-C cases were found in children between the ages of one and 16. While three cases have totally recovered, four of them are being monitored at home for potential health problems often seen with the syndrome such as fever, rash, vomiting, diarrhea and abdominal pain
Hospitalization still rare
Doctors caution that hospitalizations among children remain very rare. Some cases, they say, are found in kids who are taken to hospital for treatment of other conditions or injuries.
"We still continue to see very, very few children who are acutely unwell from COVID infection," said Dr. Stephen Freedman, professor of pediatrics and emergency medicine at the University of Calgary's Cumming School of Medicine.
The emergency room at Alberta Children's Hospital hasn't found a single positive COVID-19 case in the last two weeks, despite testing 10 to 15 children per day who present with potential COVID symptoms, according to Freedman.
"Less than one in a thousand children who've been documented infected have been critically unwell. So while concerning, the biggest focus is we need to get the numbers down at a provincial level and if we do that, there will be fewer children infected, fewer adults infected [and] fewer adults in the intensive care units," he said.
Infection rates are steadily rising among children and, according to Freedman, reflect the spiking community transmission rates in Alberta.
Children now make up about 20% of cases
Early in the pandemic, kids represented seven to 10 per cent of cases both in Alberta and across the country, said Freedman.
With more than 8,400 children who have tested positive to date, they now represent about 20 per cent of the province's total infections.
"It's hard to say exactly where they are getting it and I think one of the challenges currently in our province is the contact tracing is unable to keep up with the demand and the need, and it is vitally important," he said.
When the source of the virus can be tracked, Freedman says it appears the vast majority of children are acquiring it in the community through social or family gatherings. Some are also catching it at schools.
"Definitely targeting community transmission is vitally important right now," said Freedman, who worries about the growing number of deaths — particularly among the elderly — and continued pressure on Alberta's intensive care units, which are struggling under the weight of the ballooning number of critically ill patients.
"We continue to head in the wrong direction and [yesterday's case numbers] highlight the urgent need for the government to act — to close malls, restaurants, and non-essential stores — unfortunately," he said.
While Freedman wants the province to bring in restrictions, he believes schools should remain open.
"Schools appear to be a small player in COVID-19 transmission and if we lower spread everywhere else, the numbers among our youth will drop as well."