American Family Children's Hospital in Madison. (Wisconsin Examiner photo)
The spread of COVID-19 has slowly diminished in Wisconsin since Memorial Day, but public health specialists and health care providers are watching for the likelihood of a new increase in the coming weeks.
There are already signs that a rise in cases might have begun, although doctors caution that the novel coronavirus’s evolution has been unpredictable since it emerged nearly three years ago.
At the same time, though, some providers say they’re facing an unexpected increase in other upper respiratory illnesses, especially in children.
On Thursday, Oct. 13, the Centers for Disease Control and Prevention (CDC) reported that what the agency calls community levels of COVID-19 had risen to medium in 24 counties — five more counties than the previous week. Community levels were listed as high in two: Rusk and Barron counties.
The community levels reflect the rate that the virus is spreading in a county combined with the number of hospitalizations, reflecting the burden that the pandemic is placing on the community’s health systems.
Counties where the level had risen to medium from low in the new weekly update include Milwaukee, Ozaukee, Waukesha and Washington counties in the Southeast, Door, Kewaunee and Brown counties in the Northeast, and Crawford, Lafayette, Green and Rock counties in the South and Southwest.
CDC guidelines recommend that people at high risk for getting severe illness from COVID-19 wear masks when the level is medium, and that everyone wear masks indoors away from home where the community level is high.
Since May 12, when, on average, more than 2,000 people per day were diagnosed with the virus, the infection rate has mostly trended downward. As of Thursday, an average of 839 new cases per day were being identified, according to the Wisconsin Department of Health Services (DHS).
DHS has counted nearly 1.66 million cases of COVID-19 in the state since the pandemic first surfaced in Wisconsin in early 2020. At least 13,500 deaths have been attributed to COVID-19. Public health providers generally agree that the actual number of cases and deaths from the virus is almost certainly higher.
The CDC also tracks community spread for COVID-19, based on the rate of new infections and the rate of positive tests for the illness. Community spread remains substantial or high in all but two Wisconsin counties.
With school resuming in Wisconsin at the beginning of September, putting more children in close contact with each other, health providers who treat children have been on the lookout for a possible new surge in cases among younger age groups.
So far, that hasn’t happened to a significant degree, says Dr. Frank Zhu, medical director for infection control and prevention at Children’s Wisconsin, a system of hospitals and primary care clinics in Southeast Wisconsin and the Fox Valley.
“With respect to COVID-19 in children, the overall infection rates are slowly trending down since the middle of July or so,” Zhu said in an interview.
At the beginning of 2022, as the COVID-19 variant known as omicron was racing through Wisconsin communities, Children’s Wisconsin and other health providers saw a surge in infections of kids. The most recent data from Children’s Wisconsin show a slight increase in kids hospitalized for the illness, but nothing like that omicron spike.
At American Family Children’s Hospital in Madison, part of the UW Health system, on any given day there may be one to five children in the hospital who have tested positive for COVID-19, said the hospital’s chief medical officer, Dr. Joshua Ross.
But two out of three of those children, or even more, are “incidental COVID” patients, Ross said — admitted for treatment of some other problem, then found to be positive for COVID-19 in a routine test that is part of the hospital’s admission process.
Zhu said Children’s Wisconsin has had a similar experience. “We do see a number of asymptomatic cases in children,” he said. “I think the prevalence of COVID-19 in children is higher than our tests indicate.”
While COVID cases in children aren’t exploding, Ross says American Family Children’s Hospital has seen a dramatic increase in young patients with other upper respiratory illnesses.
“We’re busier than we’ve ever been,” Ross said, with upticks in influenza, other cold-like viruses, respiratory syncytial virus (RSV) and enterovirus D-68 spreading among children.
“Kids are back in school, they’re not wearing masks, and people are sharing these respiratory viruses,” Ross said. Children are especially vulnerable because youngsters are still building their immune systems, he explained.
Smaller, outlying hospitals are also seeing their resources strained by some of these other illness outbreaks, he added. “It’s been quite a challenge for our region and I do worry about what’s to come.”
As colder weather sends more people indoors and in closer quarters, a new round of COVID-19 infections could be coming. But what that looks like isn’t predictable. “It is difficult to know for sure what the direction of it this winter could be,” said Zhu.
While fewer people are masking, and many who have been vaccinated and even boosted may feel freer to mingle without covering their faces, “it’s reasonable to follow CDC guidance,” said Zhu.
That includes continuing with diligent handwashing and prudent social distancing, both doctors said.
“If you’ve got a cold or you’ve got a fever, you shouldn’t be exposing others,” said Ross.
And both emphasize the value of getting the newest booster, which has been tweaked to more effectively combat the omicron virus, according to the CDC and other health agencies. Last week, the federal government cleared the way for the new bivalent booster to be administered to children age 5 or older.
With COVID-19 still widespread, Ross said he’s concerned about less vulnerable children spreading it to others, adults or children, who are more vulnerable. He’s also concerned about longer effects from the illness, including the rare but serious complication called multisystem inflammatory syndrome in children (MIS-C).
He also worries that if fewer people get influenza vaccines, hospitals and clinics could see outbreaks of flu colliding with a COVID-19 resurgence.,
“I would encourage children and families making decisions for children to get immunized,” Ross said. “My hope is that people do that so we might not get the big respiratory surge that we could get otherwise.”
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