Ahh, the summer – BBQs, the beach, and the lull before respiratory season. Wait, what? My patient in room 3 has COVID? And the parents of the kid in room 8? Oh no, oh no! It can’t be! This isn’t supposed to happen.
What is going on with the recent bump in COVID? Is it just a Philadelphia thing? A Northeast thing?
Let’s take a look at some of the early data and explore what’s going on with this recent increase in COVID in the Pediatric ER.
What do the numbers say?
You can see in the chart below (courtesy of the CDC Tracker) that from the start of 2025 we’ve had a steady downtrend of ED visits with diagnosed COVID, for all ages. That is, until about the end of May, when we started again seeing an uptick.
When separated by age group (below), we see that the greatest slope of increase occurred in the 0-11 year old age group (yellow solid line).
But we all know that the trend in COVID positivity doesn’t tell the whole (or even the important) story – kids are going to get sick, it’s more a matter of how sick the virus is making them.
How sick are children getting from COVID?
In comes the data from the CDC’s COVID-NET surveillance network, which tracks the rates of COVID-associated hospitalizations across 185 counties in 13 states. Let’s compare a few of the charts for different age groups (Panel A-D below).
What I take from this?
- Pay attention to the Y-axis: In each of the charts below, the scale of the Y-axis (hospitalization rate) changes. Perhaps not surprisingly, the highest overall rates of hospitalization are seen in the 0-1 year old and 1-4 year old age groups.
- For most of the age groups, the trend remains about steady
- For the 0-1 year old age group, while rates have certainly dropped since January/February 2025, it appears we have a slight upswing from mid-June to mid-July. We will have to see if this trend continues into August.
Panel A: 0-17 years old
Panel B: 0-<1 year old
Panel C: 1-4 years old
Panel D: 5-17 years old
What states have it worst?
The CDC provides two interesting ways to trend viruses:
- Wastewater map – Per the CDC, “wastewater (sewage) can be tested to detect traces of infectious diseases circulating in a community, even if people don’t have symptoms. You can use these data as an early warning that levels of infections may be increasing or decreasing in your community.”
- Epidemic trend – “CDC uses data from emergency department visits to model epidemic trends. This model helps tell whether the number of new respiratory infections is growing or declining in your state. While this model tells us the trend, it does not tell us the actual number of current infections of SARS-CoV-2…or influenza virus.”
Are other viruses spiking too?
With COVID clearly increasing, does it mirror a trend in other viruses, namely flu and RSV? Maybe there’s just a bump in all viruses?
Let’s look at ED visits for different viruses (for all ages):
As the CDC summarizes it, “COVID-19 activity is increasing in many areas of the country. Seasonal influenza activity is low, and RSV activity is very low.”
So, what does it all mean?
- COVID-19 is spiking, a trend seen in much of the country
- This increase in COVID seems to be isolated, without a similar increase in flu or RSV being observed
- While the rate of COVID hospitalizations across all pediatric age groups remains steady, the youngest children (0-1 years old) have had an increase in hospitalizations since mid-June
With children getting ready to return back to school, you can’t imagine these numbers will look much better come September. But for the sake of all of us, let’s hope that we get some reprieve prior to our favorite time of the year: WINTER RESPIRATORY SEASON!
Want more studies?
- In this study analyzing data from 2022-2024, patients with RSV – compared to COVID and influenza – had significantly higher risk for ICU admission, supplemental O2 requirement, and need for mechanical ventilation. However, in-hospital mortality for COVID-19 and influenza was higher than RSV. Check out the JournalFeed summary here.
- Data from the same time period showed that for children hospitalized with COVID, most had at least one underlying condition (i.e. chronic lung disease, cardiovascular disease, diabetes) and very few (<5%) were up to date on COVID vaccines. Check out the JournalFeed summary here.
Dr. Joshua Belfer, MD, is a Pediatric Emergency Medicine physician at the Children’s Hospital of Philadelphia, and is the Founder and Editor-in-Chief of HipPEMcrates. He can be reached at HipPEMcrates@gmail.com.
