Influx of COVID-19 paediatric cases in early Omicron stages put pressure on Tshwane hospitals – UP study finds

A multidisciplinary study led by two University of Pretoria (UP) researchers has found that Tshwane District hospitals were under immense pressure to provide clinical services in the face of an influx of paediatric patients (under 19 years old) during the early stages of the COVID-19 Omicron wave in November and December 2021. 

The study provides data to assist with the worldwide preparation for the impact of the Omicron variant among children.

It describes the rapid rise in paediatric COVID-19-associated hospitalisations in the Tshwane District (which has a population of 3 552 452 and a population density of 527 people/km2), one of the first known epicentres of the Omicron variant. The study showed that there had been an increase in infections among paediatric patients, starting from mid-November 2021 onwards.  

Professor Ute Feucht – Director of the Centre for Maternal, Fetal, Newborn and Child Health Care Strategies in UP’s Faculty of Health Sciences – and Adjunct Professor and paediatrician Jeané Cloete of Steve Biko Academic Hospital (UP’s main teaching hospital) headed up the study. They collaborated with Dr George Mukhari Academic Hospital, Tshwane District Health Services, the Gauteng Department of Health, the National Institute for Communicable Diseases, district officials and other scientists.

The study – titled ‘Paediatric hospitalisations due to COVID-19 during the first SARS-CoV-2 Omicron (B.1.1.529) variant wave in South Africa: a multicentre observational study’ – was published in The Lancet Child & Adolescent Health, and was conducted over a six-week period in which 6 287 paediatric COVID-19 cases were recorded in Tshwane. 

According to the scientists, 462 (7.3%) paediatric patients were admitted to 38 hospitals, making up 18% of overall admissions. “This was in stark contrast to the number of paediatric cases in the previous three waves, uncharacteristically preceding adult hospitalisations, thus raising the alarm about the readiness of hospitals, which have generally focused on adult patients,” they said. 

The relevant data was extracted from various sources, including COVID-19 line lists for contact tracing activities; SARS-CoV-2 testing data collated by the National Institute for Communicable Diseases; and SARS-CoV-2 genomic sequencing data from specimens obtained within the district through UP’s Zoonotic Arbo- and Respiratory Virus research group. 

“Information obtained during the study revealed that young children (0–4 years) were most affected,” the researchers explained. “Symptoms included fever (61%), coughing (57%), shortness of breath (31%), seizures (31%), vomiting (26%) and diarrhoea (25%). The length of hospital stay was short, averaging 3.2 days, and in 45% of cases, COVID-19 was the primary diagnosis.” 

Most children received standard ward care (92%), with 27 (23%) receiving oxygen therapy. Seven children (6%) were ventilated; four died as a result of additional illnesses that were the main cause of death. However, no child died primarily due to the COVID-19 virus.

Prof Cloete said the fourth COVID-19 wave started from a low base, with evidence in Tshwane District communities of low transmission levels; there were very low numbers of COVID-19 infections documented in Tshwane despite continued testing. 

She added that the wave started earlier than expected, with paediatric hospital wards noticing marked increases in admissions of COVID-19-infected children from mid-November 2021, at much higher levels than during the previous three COVID-19 waves and uncharacteristically ahead of adult COVID-19-related admissions. 

“The increased numbers of paediatric admissions, and rapid upward trajectory thereof, created logistical issues locally, as few paediatric COVID-19 hospital beds were available,” Prof Cloete said. “Coupled with acute staff shortages due to COVID-19-related isolation and quarantine, this created a challenging environment in which to admit the unexpectedly large number of COVID-19 paediatric patients.”

“Most of the admitted COVID-19 paediatric patients had mild-to-moderate symptoms and had been discharged after only a few days in hospital,” Prof Feucht said. “The clinical picture is mixed with other childhood illnesses – children were presenting with childhood diseases at different times of the year compared to the pre-COVID 19 waves.” She added that many COVID-19 diagnoses were incidental in that children presented with trauma or injury before being diagnosed with COVID-19. 

“What happened in Tshwane was unexpected – it seemed to have come out of nowhere. For genomic sequencing, the clinical specimens were used from public sector health facilities, showing that the Omicron variant was causing this fourth COVID-19 wave. The lessons would provide insight into other parts of South Africa that experienced a surge, and Europe and the US, which are contending with escalating numbers.” 
The scientists said that district-based research must continue to include research around the impact of COVID-19 on children and how this affects the healthcare system. This is critical in the long term in order to save the lives of children by ensuring that they get the same treatment as adults.  

Prof Ute Feucht and Dr Jeane Cloete

March 3, 2022

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  • Professor Ute Feucht
    Professor Ute Feucht is the Director of the University of Pretoria’s (UP) Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies and of the South African Medical Research Council’s Maternal and Infant Health Care Strategies Unit, which is based at UP.

    Prof Feucht has a joint appointment in Gauteng, where she works as a paediatrician as part of the Tshwane District Clinical Specialist Team, a multi-disciplinary unit of specialists tasked with improving maternal and child health services, and outcomes at district level.

    She graduated in 1995 with a degree in Medicine (cum laude) from Stellenbosch University and specialised in Paediatrics at UP, before obtaining her PhD in Paediatrics at Stellenbosch University.

    Prof Feucht’s research addresses broad questions of child health, with a focus on the prevention of mother-to-child transmission, paediatric HIV treatment and care, childhood nutrition and growth, and improving childhood morbidity and mortality. She also works on the development of data systems to improve clinical care and monitor health outcomes. Much of her work is informed by the “survive, thrive, transform” principle, with the ultimate goal of improving the outcomes of children and their families within the communities she works in, in South Africa and beyond.

    The work of UP’s Research Centre for Maternal, Infant and Child Health Care Strategies is a collaboration between Obstetrics, Paediatrics, Nutrition, Immunology and Health Care Provision, with a strong nation-wide implementation and research footprint. The centre also works very closely with national and provincial departments of health.
    The centre aims to be a leader in the field of perinatal healthcare by improving the neurodevelopment of children and seeking saleable, sustainable solutions to prevent maternal, foetal, newborn and child morbidity and mortality in the primary and secondary levels of care.

    Being part of the Umbiflow research team has been a recent research highlight for Prof Feucht. The obstetric section of this work has shown the UmbiflowTM device – a continuous-wave Doppler ultrasound – to be a groundbreaking innovation in the detection and prevention of foetuses that are at risk of stillbirth. A pilot study has been established in nine sites in South Africa. The extension of this work into the paediatric and nutrition fields has highlighted the ability of this device to detect previously undetected in utero growth restriction and has introduced a new, exciting field of research.

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  • Professor Jeané Cloete
    Professor Jeané Cloete completed her undergraduate studies at Stellenbosch University and has been involved in research at the University of Pretoria (UP) for the past eight years. Her work with the Gauteng Department of Health and her role as a lecturer at UP place her in a unique position to do research across many departments and in the clinical public healthcare setting.

    She is currently working on COVID-19 research in the Tshwane District, collaborating with other Tshwane District personnel in family medicine. Her field of research highlights child medical care in the public health sector and helps to improve the care provided to children in South Africa, particularly in Gauteng.

    Prof Cloete also works at UP’s Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, and is collaborating with the University’s Department of Immunology on COVID-19 research projects and with the Department of Obstetrics and Gynaecology and Family Medicine on various projects pertaining to the virus.

    She regards her current research on COVID-19 among children as a highlight, adding that a recent milestone was the publication of a collaborative article on Omicron in the Tshwane District.

    For Prof Cloete, research plays an integral role in advancing current knowledge in any field. In her particular field, she says it also assists with stakeholder decision-making to improve care for children.

    Her academic role model is Prof Dankwart Wittenberg. She regards him as a fantastic clinician and teacher who understood the value of research in assisting with management, patient care and decision-making on a personal as well as public health level.
    Prof Cloete hopes to contribute to evidence-based research that will improve the care provided to children in South Africa and improve their outcomes.

    She assures school learners or undergraduates who are interested in her field that while it may seem intimidating to study and work in the medical field, and that succeeding requires hard work, it is extremely rewarding.

    In her spare time, Prof Cloete enjoys cooking, building wooden models, reading and gardening.
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