Diseases, Conditions, Syndromes

Hospitalisation of children with SARS-CoV-2 on the general paediatric ward: coping with a persistent pandemic

Introduction

The Centers for Disease Control and Prevention (CDC) recommends considering admitting patients with SARS-CoV-2 virus to a dedicated ward.1 These guidelines are problematic for children as the number of children admitted with COVID-19 during the pandemic is small compared with adults, and in clinical practice, many children who test positive for the virus are hospitalised for non-COVID-19-related reasons. Admission to the general paediatric ward may be the better option.

We examined the number of infections among staff and patients during and after hospitalisation to a general paediatric ward admitting patients with SARS-CoV-2.

Methods

Ours is the largest tertiary paediatric hospital in Israel. The hospital policy is to screen all patients and most caregivers of admitted children with SARS-CoV-2. During May to August 2020 (123 days), patients positive for SARS-CoV-2 were placed in isolation rooms in the paediatric ward (figure 1), each with a dedicated bathroom and an antechamber for removing personal protective equipment (PPE). Every staff member entering the isolation room was required to wear full PPE according to CDC guidelines.

Figure 1

Floor plan of a general paediatric ward, including rooms for isolated SARS-CoV-2-positive patients.

We used audio and visual measurements to examine patients in the isolation rooms, as well as staff who entered these rooms as medically necessary. Data on staff infection were retrieved from the infection control unit. We examined the national computerised medical records for the post-hospitalisation 14-day period of all negative patients, in order to identify cases of infection after hospitalisation.

Results

A SARS-CoV-2-positive patient was present on the ward for 56/123 (45.5%) days of the study period. Of 39 confirmed patients with SARS-CoV-2 hospitalised in isolation rooms, 19 were family members (adults) and 20 children; 10 children were admitted due to signs/symptoms of COVID-19 and 10 due to other medical conditions alongside SARS-CoV-2 infection. Disease severity was mild in 17 children, moderate in 2 and severe in 1.

Only one staff member tested positive for SARS-CoV-2 during the study period, infected via a positive family member, not in hospital. No other patients from the ward tested positive. Among the 566 negative patients, 7 tested positive after hospitalisation, all of them more than 14 days after discharge. There were two cases of non-compliance with isolation rules involving patients with psychiatric symptoms.

Discussion

We found that admitting children or parents who are SARS-CoV-2 positive in a general paediatric ward has a very low risk of infection to other patients or staff. In adults, there were reports of a nosocomial SARS-CoV-2 infection rate of 7.1%–20%.2 3 The low infection rate in our study may be attributed to the measures taken and to the less contagious nature of children.4

SARS-CoV-2-positive children are often hospitalised for reasons related to other general paediatric diseases, and in our opinion, they deserve multidisciplinary treatment managed by experienced staff from the regular paediatric ward.

Towards the upcoming winter months, we suggest to admit SARS-CoV-2-positive children in a standard paediatric ward, while taking protective measures for staff and patients.

Ethics statements

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