Doctors at CHOP say kids probably missed out on building immunity due to the pandemic

Michael DePeau-Wilson,:

Children have been presenting in large numbers and with more severe viral illnesses than typically seen, physicians at Children’s Hospital of Philadelphia (CHOP) said.

The CHOP healthcare system, which includes two hospitals and more than 600 beds, is still grappling with a high volume of pediatric patients with viral infections, including respiratory syncytial virus (RSV), even after this year’s “sick season” began months earlier than expected, said chief medical officer Ron Keren, MD, MPH.

“It’s really important for everyone to know that volumes are extremely high right now in primary care pediatricians’ offices, in urgent care centers, in our emergency departments, as well as in our inpatient units,” Keren said during a press briefing on Wednesday. “It’s causing a lot of strain on the system, and it’s a phenomenon that’s happening across the country.”

Keren said that CHOP has been operating at near-full capacity every day for the last several weeks, and the demand for care is primarily coming from children, especially infants who have developed bronchiolitis caused by RSV. He attributed the surge in respiratory viruses over the past 2 months to a lack of immunity in this patient population.

“I think it gets to this idea that some folks are calling ‘an immunity debt,'” Keren said. “We think that that may be because during the pandemic, there were a few cohorts of infants born who, due to social distancing and masking, probably didn’t get exposed to these respiratory viruses, including RSV, and so they were not able to build up an immune defense to RSV and other respiratory viruses, leaving them vulnerable now.”

Although some of the cases at CHOP have been severe, with some infants being admitted to the ICU to receive a higher level of respiratory support for breathing difficulties, Keren noted that most of these illnesses have been short-lived and that typically kids are getting better within a day or two of receiving respiratory support.

Katie Lockwood, MD, MEd, an attending physician at CHOP, said that the key to addressing this surge and the immunity debt is to get children back on track with vaccinations and to teach them healthy habits, like hand washing and masking.

“During the pandemic, there were many children who did not seek routine preventative care, especially early in 2020,” Lockwood said. “So some families missed those appointments and have been slower to catch back up on those, [and] children have missed some of their routine childhood immunizations.”

She noted that when a large population falls behind on the standard vaccination schedule, community vaccination rates can decline, causing a loss of herd immunity that keeps communities safe from some of these vaccine-preventable diseases.

This concern was exacerbated, Keren noted, by several years of uncertainty caused by the pandemic.