Kootenai Health responds to Press error on pediatric COVID concerns

On Sept. 10, medical director of pediatrics at Kootenai Health, Vanessa Carroll, M.D., was invited to give a presentation to the Coeur d’Alene Rotary outlining the projected impact of COVID-19 on children in our region. The presentation contained content that was prepared by a team of specialists within Kootenai Health, including Dr. Carroll, and has been shared in several venues, including via YouTube.

This presentation was attended and reported on by the Coeur d’Alene Press with an article published on Sept. 15. Unfortunately, the reporter made an error. The number of children Dr. Carroll noted as the number that could require hospitalization in a “worst-case scenario” was reported at the number of children who would require pediatric intensive care in a worst-case scenario.

The error was recognized by Dr. Carroll and other staff members at Kootenai Health who contacted The Press. The online version of the article was corrected. It was an honest mistake made by an honest reporter covering a complex topic in an effort to provide the community accurate information.

However, this error became fuel for a subsequent opinion piece by Scott MacPhee, a member of the Coeur d’Alene Charter Academy school board, that called into question not only the data but also the ethics and integrity of Dr. Carroll and the professionalism of the Coeur d’Alene Press.

For those who wish to know, the data is below. But before reviewing it, it is important to understand what it is and how it was developed.

This data is what is known as a “predictive model.” Every prediction, whether it is what the weather will be tomorrow, how much you need to save for retirement, or how much spaghetti you need to prepare for dinner, is based on assumptions — barometric pressure, cost of living increases, or the number of people coming for dinner. They allow us to consider likely outcomes and plan accordingly.

The predictive model Dr. Carroll referenced includes two important assumptions. The first assumption is that of those children who contract COVID-19, a certain percent will require hospitalization. This assumption is based on data provided by the American Academy of Pediatrics (AAP). (https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/)

Although this varies between 0.1% and 2.0%, for the purpose of Dr. Carroll’s presentation, which, as stated, offered a “worst-case scenario,” the 2% was used given no universal masking, no consistent social distancing, no community surveillance testing, vaccination rate of 12 – 17 years of age of approximately 15%, no consistent adjustments to school ventilation, no contact tracing, and a low community vaccination rate.

The next assumption is that of those pediatric patients hospitalized, 33% will require intensive care services such as high flow nasal cannula and mechanical ventilation, which have limited availability. https://www.aappublications.org/news/2020/08/07/covid19hospitalization080720.

If one is to consider the population of the Coeur d’Alene School District alone while rounding for simplicity’s sake — 11,000 students, with 5,000 in elementary school (vaccine ineligible) and 6,000 in middle/high school (vaccine eligible). If 85% of the middle/high school students are unvaccinated, then there are approximately 10,000 students (5,000 elementary + 5,000 middle/high school) at risk for getting COVID-19.

Assuming no changes occur in immunity to delta for those 10,000 students, then 2%, or 200 students, could require hospitalization for COVID-19 infections/complications. If we consider the worst-case scenario of 33% of those hospitalized requiring intensive care services, that is 60 pediatric patients.

While these may seem like large numbers, the point of Dr. Carroll’s presentation was, and is, that our region does not have enough pediatric resources to care for that many critically ill children in addition to the other common causes of hospitalization. The concern multiplies when you consider the predictive model offered does not include the other thousands of children in our region beyond the Coeur d’Alene School District.

The intent of the original presentation was not to cause fear or panic, but to provide everyone with as clear and up-to-date information as possible to help them make decisions about mitigations, such as vaccinations, masks, and updated social distancing.

We at Kootenai Health are doing everything we can to prepare and provide the best care we can to the community, especially the pediatric population, but we can’t do it alone. Once again, we are imploring our community to help by getting vaccinated, wearing masks in schools, maintaining hygiene, and social distancing. These recommendations are consistent with CDC, AAP, and other medical associations and health organizations.

In the opinion letter referenced above, Mr. MacPhee accused Dr. Carroll and, by association, the other health professionals at Kootenai Health, of an ethics violation — a strong accusation indeed. It is ironic that he raises this point, as this is the exact reason that we requested The Press to correct this reporting error.

We take our professional integrity, Hippocratic Oath, and duty to the community seriously and would not want to share incorrect information within the community, especially during these times where misinformation is so pervasive in our society.

Ultimately, data is only as good as the way in which you use it. You can use it to inform decision-making, or you can use it to support your already closely-held beliefs. We deeply hope that the projections of COVID positivity, hospitalization, and advanced care requirements are lower for our region, but we must prepare for this real possibility.

With emotions high and the health of our community’s children at stake, let’s work together for the betterment of our most valuable, yet vulnerable, members of our society — our children. Together, we can calmly and transparently make it through the current COVID crisis.