More Children Are Being Hospitalized for COVID-19

The Centers for Disease Control and Prevention (CDC) reports a recent spike in COVID-19 hospitalizations for children 17 and younger. The number of new admissions started to climb in early July, similar to other age groups.

Compared to adults, children are less likely to develop a severe illness or be admitted to the hospital due to COVID-19. A recent study also found that long COVID is less common in children. So what's driving these soaring hospitalization numbers?

Factors Contributing to Increase in Hospitalizations

Experts say the sharp increase in COVID-19 hospitalizations among children is likely caused by a variety of factors.

Delta Variant

The continued spread of the Delta variant, the dominant strain in the U.S., may be driving pediatric COVID-19 hospitalizations. According to the CDC, the Delta variant is more than twice as contagious as other variants.

“This SARS-CoV-2 strain replicates at a far more rapid pace than the original strains, which makes it more contagious because infected individuals carry a higher viral load at any given time,” Carlos Oliveira, MD, PhD, Yale Medicine pediatric infectious diseases specialist and assistant professor of pediatrics at the Yale School of Medicine, tells Verywell.

Although there's no conclusive data yet, it's possible that the Delta variant is causing a more severe course of illness, especially for unvaccinated individuals.

Relaxation of Safety Measures

Back in May, the CDC announced that fully vaccinated individuals were allowed to forego masking and social distancing for most indoor and outdoor settings, except for specific situations. As a result, many states eased or eliminated their mask requirements.

“Another reason for the increased rates is that social distancing and mask-wearing requirements have been relaxed throughout the country,” Oliveira says. “This means that when any given person is exposed to the virus, they are more likely to receive a higher ‘viral dose.’ This will naturally lead to higher rates of infection, but may also lead to a more severe disease course.”

“There is also the issue of coinfections,” Oliveira says. “Since we removed the mask mandates, other respiratory viruses that haven’t been around all year have returned all at once. Viruses like respiratory syncytial virus (RSV), rhinovirus, and enterovirus have been rapidly increasing in prevalence in the last few months."

"Coinfections—such as COVID-19 plus RSV—are likely to be causing more severe clinical courses and subsequently higher rates of hospitalization," Oliveira adds.

A recent study found a significant reduction of many seasonal respiratory illnesses in 2020, possibly due to the safety measures established to reduce the spread of COVID-19.

However, the recent relaxation of COVID-19 interventions may have reversed this trend. In June, the CDC issued a health advisory that there is an increased activity of RSV detected in Southern states.

Ineligibility for Vaccination

Getting vaccinated is the best course of action to protect against severe COVID-19 disease. Unvaccinated children, especially those who are not yet eligible to take the vaccine, remain more vulnerable to infection. 

“This spike in pediatric hospitalizations is due to the widespread transmission of the Delta variant and surging case numbers, particularly in some hotspots in the southern United States where vaccination coverage is low,” William Moss, MD, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, tells Verywell. “Children younger than 12 years of age are not eligible for vaccination, placing them at risk.”

Both Pfizer-BioNTech and Moderna are conducting their clinical trials on children ages 5 to 11 to observe their vaccines’ safety and effectiveness in this age group. They are required to provide months' worth of follow-up data to request vaccine authorization, which they're expected to receive in the coming months.

Why Children Are Less Likely to Develop Severe COVID-19

A recent study published in The Journal of Pediatrics found that many parents are hesitant about vaccinating their children aged 12 years old and below. Some were concerned about its safety and efficacy, while others believed that children don’t need to get vaccinated.

“Children are certainly susceptible to the virus,” Oliveira says. “In context, COVID-19 killed more children in the last year alone—pre-Delta—than the influenza virus did in the last three years combined. So, COVID-19 is definitely bad for kids.”

While it’s true that children are less likely to develop severe disease from COVID-19, mild or asymptomatic cases still put them at risk for long COVID or a rare but dangerous disease called multisystem inflammatory syndrome in children (MIS-C).

“Children are not immune to COVID-19, and some children do experience more severe symptoms,” Dane Snyder, MD, section chief of primary care pediatrics at Nationwide Children’s Hospital, tells Verywell. “However, most children who become infected with COVID-19 seem to have milder symptoms, and it’s not entirely clear if the Delta variant causes more severe illness in kids than other strains.”

Why COVID-19 presents differently among children and adults is still unclear. However, there are several theories why this is the case.

“It is possible that because children frequently experience other coronaviruses throughout the year—like the common cold—children may have some level of protection against COVID-19,” Snyder says. “Children’s immune systems are also different from adults’, so it’s possible that a child’s immune system interacts with the COVID-19 virus differently than an adult’s immune system does.”

According to a study, infection from commonly circulating coronaviruses causes long-lasting T-cell immunity to an extent, but its relation to SARS-CoV-2, in particular, remains unknown.

“Pre-existing immunity is also a likely contributor,” Oliveira says. “Adults normally have some pre-existing immunity to circulating viruses, so respiratory infections often do not cause them to have as severe disease as children who are more likely to be immunologically naïve to any given respiratory virus. However, since COVID-19 is a novel virus, no one has pre-existing immunity.”

How to Prevent Hospitalizations in Children

According to Moss, there are three basic ways to prevent further COVID-19 hospitalizations in children, which are particularly important as children return to school:

• Vaccinating eligible children
• Vaccinating adults with whom children come in contact with, such as parents and teachers, to reduce the risk of exposure to the virus
• Continuing to practice basic public health measures like masking, social distancing, and handwashing to increase protection especially in high-risk settings

As children start going back to school, it’s important for parents to keep their children at home if they start showing any signs of sickness.

“Household infections are still a reality, as well—parents and other family members who may be unvaccinated or are otherwise carriers of the virus are bringing COVID-19 home without knowing it, which is leading to more children becoming infected,” Snyder says. “The key message is that if you are eligible to be vaccinated, get that vaccine today.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.