058 - Riding the Waves of COVID-19 in a Children’s Hospital

Publication Number: 58.6175

Clare R. Bozso, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Astoria, NY, United States; Anvin D. Thomas, Cohen Children's Medical Center, Queens, NY, United States; Calvin Huang, Cohen Children's Medical Center, New Hyde Park, NY, United States; Joanna Fishbein, Northwell Health, Plainview, NY, United States; Christine A.. Capone, Cohen Children's Medical Center, queens, NY, United States; Katherine Carroll, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, BETHESDA, MD, United States; Dalia Eid, Stony Brook Children's Hospital, Hauppauge, NY, United States; William Krief, Cohen Children's Medical Center, Centerport, NY, United States; Elizabeth Mitchell, Cohen Children's Medical Center, New Hyde Park, NY, United States; Annabelle Quizon, Cohen Children's Medical Center, New Hyde Park, NY, United States; Sujatha Rajan, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States; Lorry G. Rubin, Cohen Children's Medical Center of Northwell Health, New Hyde Park, NY, United States; Ashley Sands, Sanford Children's Hospital, Sioux Falls, SD, United States; Maria T. Santiago, CCMC, New Hyde Park, NY, United States; Nehal J.. Shah, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Anupama Subramony, Cohen Children's Medical Center, New Hyde Park, NY, United States; Kristy Williamson, Cohen Children's Medical Center, New Hyde Park, NY, United States; Hanwen Yang, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Woodside, NY, United States; Mundeep Kainth, Northwell Health, New Hyde Park, NY, United States

Background: COVID-19 and multisystem inflammatory syndrome (MIS-C) have had a significant impact on children. The comparative severity of pediatric COVID-19 and MIS-C through the variant waves has not been thoroughly described.

Objective: To compare patient characteristics and clinical severity of COVID-19 and frequency of MIS-C in hospitalized pediatric patients over sequential variant waves.

Design/Methods: This single-center retrospective cohort study included hospitalized children aged < 22 years with COVID-19 or MIS-C at a tertiary care children's hospital from 1/23/2020-1/31/2022 using the database from the Repository for Aggregated International Pediatric Data on COVID-19. Patients were categorized based on comorbidity and age (healthy infants ≤60 days old, healthy children >60 days old, immunocompromised, or chronically ill), COVID-19 severity (asymptomatic, mild/moderate, severe, and MIS-C), and variant wave (original, Alpha, Delta, and Omicron). Inferential analysis was performed with Chi-square or Fisher’s exact tests; multinomial logistic regression was used to model disease severity as a function of patient cohort and variant.

Results: COVID-19 severity was associated with variant (p < 0.0001). Out of 610 hospitalized children, mild/moderate illness was observed in 40.6% in the original wave, 48.6% in Delta, and 47.1% in Omicron compared to 28.9% in Alpha (Table 1). Severe disease was observed in 15.4% in the original wave, 13.5% in Alpha, 22.4% in Delta, and 22.9% in Omicron (Table 1). MIS-C was diagnosed in 26.5% with the original variant, declining to 13.5%, 18.7% and 11.8% with Alpha, Delta, and Omicron, respectively (Table 1). When excluding MIS-C cases, variant continued to be significantly associated with severity, after adjusting for patient comorbidity (p=0.0012). However, patient comorbidity was not significantly associated with severity after adjusting for variant (p=0.07). There was a significant age difference among variant waves (p=0.0005), with children hospitalized during the Alpha wave being significantly older than those during Omicron (mean age difference 3.2 years [95% CI: 0.6 to 5.7 years]) (Fig 2).

Conclusion(s): As variants emerged, there was a trend toward an increase in COVID-19 severity, decrease in MIS-C cases, and younger patients. Patients admitted during the Alpha wave were more likely to be asymptomatic and Delta variant was more likely to have mild/moderate disease. Though comorbidity was not significantly associated with disease severity after considering variants, co-infections may play a role.

Figure 1. Riding the Waves - Number of COVID-19 cases by severity and variant
From the CDC (Morbidity and Mortality Weekly Report, Feb. 11, 2022), dates were calculated when variants first reached 50% of isolates to estimate the start points of each variant wave.

Table 1. Disease severity stratified by variant and comorbidity
1. p<0.0001.
2. n represents the frequency of patients within each variant wave or comorbidity cohort, followed by the percentage of patients within each group.
3. MIS-C = Multisystem Inflammatory Syndrome in Children.
4. d = days.

Figure 2. Riding the Waves - Age Distribution by Variant


Figure 1. Riding the Waves - Number of COVID-19 cases by severity and variant
From the CDC (Morbidity and Mortality Weekly Report, Feb. 11, 2022), dates were calculated when variants first reached 50% of isolates to estimate the start points of each variant wave.

Table 1. Disease severity stratified by variant and comorbidity
1. p<0.0001.
2. n represents the frequency of patients within each variant wave or comorbidity cohort, followed by the percentage of patients within each group.
3. MIS-C = Multisystem Inflammatory Syndrome in Children.
4. d = days.

Figure 2. Riding the Waves - Age Distribution by Variant