Like many regions, Greater Cincinnati has had an increase in COVID-19 cases over the summer — but it's not just affecting adults anymore.
During a Hamilton County Commissioners briefing Wednesday with reporters, officials were demonstrably frustrated with the latest COVID-19 surge.
“All of the metrics continue to head upward, so there is no end in sight,” Greg Kesterman, health commissioner for Hamilton County, said. “All of the metrics are going in the wrong direction.”
Unlike early in the coronavirus pandemic, COVID-19 cases in children are rising.
“The dynamics of COVID have changed. As you may know, many of our elderly neighbors are vaccinated, so many of the new cases are among young people and those who are not vaccinated,” said Denise Driehaus, Hamilton County Commissioner. “Those age 0-19 now have highest incidence in the region of COVID-19.”
Dr. Patricia Manning-Courtney, chief of staff at Cincinnati Children's Hospital Medical Center, agreed with Driehaus, saying, “We have seen a very dramatic increase in the number of children testing positive for COVID — both children who require hospitalization (meaning they get sick enough to be hospitalized with COVID or with COVID and other things), as well as children who are not being hospitalized.”
Manning-Courtney said that Cincinnati Children’s tracks the number of children who have COVID but are ineligible for a hospital stay.
“That number was over 500 this past week. The previous week, it was 300. The week before that, it was 150. I’m not sure how else to better illustrate a dramatic rise,” she said.
Manning-Courtney added that Children’s also has seen a steady increase in the number of children who are hospitalized, but the facility does not share those figures in order to protect patients’ privacy. “I can promise you that those numbers have gone up steadily since early- to mid-June and are now approaching the levels that we had back in the wintertime,” she said.
In early June, Ohio’s and Kentucky’s governors ended the majority of COVID-19 emergency protocols such as mandatory masking and venue capacity limits. Kesterman noted that safety orders likely are not coming back due to political football.
“Here in Ohio, our state legislature passed a bill that essentially provided a check and balance on the governor and the Ohio Department of Health, and so mandates are not anticipated at any level,” Kesterman said. “Here locally, we really have not had the power to create our own county-wide mandates. It’s always really been enforcement and action upon statewide mandates.”
In Kentucky, Gov. Andy Beshear rescinded masking and other COVID-19 health orders at the beginning of summer. In August, he reinstated a mandate for masking within schools, but that was recently shot down by the Kentucky Supreme Court.
The abundance of COVID-19 within the region also is exacerbating other health problems in children, Manning-Courtney said. Medical staff are seeing more children with respiratory issues such as RSV (respiratory syncytial virus) and parainfluenza that normally wouldn’t arise until fall or winter. Like COVID-19, RSV and parainfluenza are transmitted through the air, Manning-Courtney said, adding that masking helps keep all of these at bay.
In 2020, many health experts had initially believed that children naturally were more immune to the coronavirus than adults were, but with continued research, scientists have since found that masking and social distancing had largely kept kids from encountering or spreading the virus during those first infection waves. In addition, the Delta variant of the coronavirus is much more transmissible and has a higher viral load than the original strain had.
Manning-Courtney noted that masking earlier in the pandemic meant very low rates of COVID-19 and respiratory illnesses in kids. But things are different now.
“Now that we have loosened up on our masking practices and kids are getting back together, whether it’s in school or other settings, we’re seeing explosions of these other respiratory viruses at a time when we never see them,” she said.
“As a developmental pediatrician, the one thing I can say with confidence that many of us agree on is that we want kids to be back in school. Unfortunately, the tools that we can use to do that safely are being variably employed, and I think that does place students and teachers at risk,” she added.
Manning-Courtney also said that kids frequently mimic the actions they see adults in their lives taking.
“It’s pretty clear to us as pediatricians that when you make masks recommended or optional that the peer pressure to not wear a mask is really high, and kids will err on the side of not wearing masks if the adults in their lives are not wearing masks,” Manning-Courtney said.
All of this is adding up to surging numbers in pediatric care facilities.
“I really want to stress that our entire pediatric healthcare system is under stress and strain right now. By that, I mean our emergency rooms, our urgent cares, our primary care practices, our community physicians are seeing some of the highest volumes that they ever see,” Manning-Courtney said.
Manning-Courtney said that the ever-increasing number of patients means that hospital officials have to make difficult decisions about deferring surgeries, turning away transfer patients and postponing outpatient visits. “That will mean affecting care for everyone — even those who don’t believe that COVID-19 is real."
“If you’re a human being and you might have a healthcare issue, this affects you. Because if you need a healthcare system to meet your need… and particularly if you’re a child, you might need a healthcare system. If those healthcare systems are under so much stress and strain and we have limited beds, your ability to get any kind of care will be impacted because we will have to make decisions around where our resources go,” Manning-Courtney said. “We don’t want to have to do that, so we’re begging you to help us.”
Manning-Courtney noted that Cincinnati Children’s and other pediatric hospitals frequently made decisions to defer certain types of care at the beginning of the pandemic. But she frequently thinks about the impact that has had on those kids since.
“I believe we’re still paying the price for that delay in care for those children,” she said.
Manning-Courtney stressed that getting vaccinated from COVID-19 is the best way to protect loved ones.
“When you think about what you can do to protect the kids in your life, you can get vaccinated,” Manning-Courtney insisted. “You can wear a mask when you’re indoors, including at school. You can really be careful about large events and whether or not those need to be attended. All of those things will help us manage those volumes that we’re dealing with.”
Cincinnati Children's has been vocal about protecting kids during the pandemic. Michael Fisher, CEO of Cincinnati Children's, signed an open letter that was published as a full-page advertisement in the Aug. 29 edition of the New York Times and the Los Angeles Times. In it, Fisher and nearly 70 other children's hospital leaders urged robust COVID-19 precautions as infections from the virus rise among younger people, particularly due to the highly transmissible Delta variant.
"Tragically, rising numbers of COVID-19 infections among children, surging cases of respiratory illnesses such as RSV [respiratory syncytial virus] and the pandemic's ongoing impact on mental health are pushing our children's hospitals to capacity," Fisher and the others wrote. "Combined with significant hospital workforce shortages, the pediatric safety net for all children is being threatened in unprecedented ways."
"Requiring the COVID-19 vaccination for all of our healthcare providers and staff is the responsible thing to do, not only to protect our patients, their families and our workforce but also our community as a whole and especially, certainly from my perspective, kids who aren't yet eligible for vaccinations," Fisher said at the time.
Overall, Commissioner Driehaus said that the Greater Cincinnati region’s positivity rate (the rate of people who take a COVID test who test positive for the virus) of 9.5% is considered “substantial,” and the number of patients in hospital and intensive care unit beds is the highest since February and continues to rise.
Kesterman noted that there are currently more than 5,700 active cases of COVID-19 within the region. “There remains a lot of opportunity to get sick out there, and so there still is a need to be as cautious as possible when moving about.”
Since the beginning of June, Greater Cincinnati has added more than 8,000 positive COVID-19 cases, more than 3,500 hospitalizations and more than 61 deaths, Driehaus said.
“We continue to see the rate of those ending up within the hospital climb at, really, an unprecedented rate,” Kesterman said, adding that people ages 50-70 are increasingly being hospitalized. “It’s concerning because over the last 48 hours, we had 35 more people admitted into our region’s hospital systems. And of those, we have 110 folks within the intensive care unit. When you see this kind of increase, it puts significant stress on our hospitals.”
Ohio and Kentucky both are seeing sustained spikes in COVID-19 cases — spikes that the states hadn't seen in many months or even since last year. Last week, Ohio reported a 900% increase in COVID-19 infections over the last month, with the southern border of the state considered a hot spot. Meanwhile, Kentucky had a 26% increase in COVID-19 hospitalizations over a one-week period, with more than 20% of the Commonwealth's hospitals experiencing staff shortages.
The CDC continues to label all counties in the Cincinnati area as "high" risk.
"I remember thinking back in May at the last briefing we'd held regarding COVID-19 that it was such a relief to finally have all indicators — those being positive cases, hospitalizations, death counts — heading in the downward direction,” Driehaus said. “I think we all had optimism that the worst was behind us at that time and that we would no longer need to do these briefings. But here we are. Trends are heading in the wrong direction.”
For COVID-19 vaccine locations and information, visit coronavirus.ohio.gov in Ohio and kycovid19.ky.gov in Kentucky.
Watch the entire briefing below:
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