Cianan Brennan: Parents are entitled to worry about Covid impact on kids as schools return

Just two paediatric intensive care beds, out of a total of 30, were available last week for sick children for the whole of Ireland

The last time schools were open, the highly infectious Delta variant was in its infancy in Irish terms and our society was only beginning to emerge from a six-month lockdown. 

The man in charge of Covid-19 modelling in Ireland has dismissed concerns about available emergency care for children.

As of Thursday evening, just two paediatric intensive care beds, out of a total of 30, were available for sick children for the whole of Ireland.

As schools were due to return for the new academic year, Philip Nolan, chair of the National Public Health Emergency Team’s (NPHET) epidemiological modelling advisory group, was queried as to whether or not having one or two beds free for sick children is really sufficient capacity as things stand.

“There’s a big leap from opening schools to the need for paediatric ICU,” he said. 

“Even at a very high incidence of this disease, as we might have had in January, the numbers of admissions to hospital and then beyond that are very low indeed. I wouldn’t frame the question that way.

"The bigger challenge is looking after the adults.” 

Children with Covid

There are a few issues with that statement. It is true that there have been very few children admitted to intensive care with Covid since the beginning of the pandemic.

Nevertheless, some children have been admitted. 

In fact, we know that of the 24 children in a paediatric ICU bed last Monday, two of them were Covid-19 patients. 

It does happen. 

And, as previously mentioned, the total number of staffed and open paediatric intensive care beds in the country is just 30.

At the same NPHET conference, the HSE’s clinical lead for critical care Michael Power was asked what sort of symptoms or underlying conditions the children who had been admitted to ICU to date had displayed.

“These children have had underlying conditions and high-grade immunosuppression," he said. "The figures have been much less than in the adult population, it’s very small figures, thankfully.” 

That’s a reassuring statement. 

However, in July, the Health Protection Surveillance Centre’s monthly report on infectious disease in Ireland included an information summary of ICU admissions among children as of the end of April.

That report found some 13 of the 18 children who at that point had required ICU care had no underlying conditions. That’s 72%, and it is coming from the HSE’s own statistics.

When asked to clarify Dr Power's statement, the Department of Health had yet to issue a reply.

Coming back to Professor Nolan’s dismissal of the significance of paediatric care though, it is true that Covid-19 in adults may represent the ‘bigger challenge’, but you can be sure the issue of Covid care for children as schools return is of heightened importance to one cohort — the parents. 

Further, the last time schools were open, the highly infectious Delta variant — which is twice as likely as the previously dominant alpha variant to cause hospitalisation, according to a study published recently in The Lancet — was in its infancy in Irish terms and our society was only beginning to emerge from a six-month lockdown. 

No restrictions this time out

There are no such restrictions this time out, while the suppression of Delta is in the hands of the (admittedly fantastic) vaccination programme and people’s own sense of self-responsibility alone.

I’ll lay my cards on the table here and say that, as a parent, I’ve had a couple of not-enjoyable brushes with Covid in the recent past.

In June, the creche of my two-year-old son was shut for just under a month due to the virus. At least three children caught it, and nearly all the staff. Most of the workers were left horribly sick. Three of them were hospitalised, one for a significant period. And the HSE’s contact management programme took six days to even make contact with the creche to manage the situation.

Immediately after that, our daughter’s summer camp was shut from its first day for two weeks because of a case of Covid in her pod.

Now, granted, these were childcare not schooling issues, but it brought home a few things that I know many parents sending their children back to school are probably feeling right now.

Firstly, the Delta variant of Covid is everywhere, and can and will affect settings where children are present, no matter how much Education Minister Norma Foley insists that schools are “safe settings”.

Second, when an outbreak happens, it’s one thing the HSE’s often admirable virus response is less than stellar at dealing with.

Finally, more than anything, it brought home to me how vulnerable our children are. Most of them are unvaccinated. 

For under-12s, there isn’t even the option of vaccine protection, and likely there won’t be until next year at the earliest. And, right or wrong, there is no mask mandate for primary school children.

Meanwhile, the evidence is mounting that Covid is more of an issue for children than the conventional wisdom might suggest — mostly in America, where there were 1,900 children hospitalised with Covid a week ago, and where admittedly the levels of vaccination penetration among adults are vastly inferior to our own. 

Nevertheless, with just two children’s ICU berths available in Ireland, a situation where suddenly no spaces are available is hardly unimaginable.

Full capacity

That is even more the case when you remember that our health service is currently running at full capacity for the first time since the pandemic began, which means that other essential services such as cancer treatments have to be catered for. 

And we are heading into a winter where the flu and RSV (respiratory syncytial virus) are likely to cause major problems after being largely eradicated last year due to a combination of lockdown, social distancing, and increased hand hygiene.

So yes, parents are perfectly entitled to be concerned about what Covid may mean for their children in the coming months.

“There is no evidence to suggest a correlation between children attending school and an increased number of paediatric ICU beds needed for Covid-19 admissions,” said a HSE spokesperson when queried regarding the low level of ICU berths available.

“Intensive care for children is always busy in winter even without the flu,” said Niamh Lynch, consultant paediatrician at the Bon Secours Hospital in Cork.

“This winter, we would expect to be even busier than last year. As regards what effect Covid will have on things, we simply don’t know yet. It’s a case of wait and see.” 

We can only hope a surge of infection among children doesn’t happen in the coming months, but if it does, we won’t be able to say we weren’t given fair warning.

The very least the health authorities can do in the current situation, though, is not treat parents like idiots for asking questions that it’s only logical for them to ask.