Justice Sotomayor is likely right in what she said at oral argument last week: 100,000 children in “serious condition and many on ventilators.”
Those claiming otherwise equate her use of the term “serious” with “hospitalized” or “severe.” Indeed, many outright misrepresent what she said by claiming she said 100,000 children are “hospitalized” or are “in critical care.”
But those equating serious with hospitalized or the like are blatantly incorrect, as the medical and legal definitions of a “serious” condition are much broader, indicating Justice Sotomayor is likely right.
Using Medical and Legal Definitions, She’s Probably Right
“Serious,” in medical terms, is not the same as hospitalized or severe (severe, per the CDC, in this context includes hospitalized, intubated, vented, or dead).
“Serious,” per the Merriam-Webster Medical Dictionary, is “having important or dangerous possible consequences.” Not hospitalization. Important. Possible consequences.
Per the Oxford English Dictionary: Entry for “serious” relating to “Of an injury, condition, etc.,” includes injuries or conditions that are “significant or worrying” or “giving cause for anxiety or concern” or “grave, threatening, or dangerous.” Not hospitalization. Instead, significant. Or Worrying. Or a condition that gives cause for concern or is threatening (again, potential).
Beyond physical condition, it seems a child’s inability to attend school or function normally would be considered a “serious condition” relative to their health, including the child’s mental health.
“Serious” is Much Broader Than Hospitalized or Severe
“Serious,” in medical context, per Johns Hopkins, is the term for the very first category of condition in which a) a patient’s vital signs are outside the norm (e.g., fever) or are unstable, b) their condition is questionable (e.g., potentially negative), or c) their condition is acute (e.g., recent and sudden onset of illness). It’s based on such factors.
One can be in “serious” in the ER. At home. At the doctor’s office. Anywhere. For a short time. Or for a long time. After being released from a hospital. Before going to a hospital or a doctor’s office. Anywhere, anytime.
The very name for COVID-19 contains “acute”: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute refers to recent onset, not to severity, and differentiates from chronic or long-time. The concept of acuteness is built in. Of course, a very large percentage of children who have COVID-19 are properly under close watch for a potentially negative turn, as their condition is unknown and questionable. In studies, 35% – 61% of children with COVID-19 had a fever (a temperature outside the normal range for children).
Places like the Mayo Clinic and Johns Hopkins use the term for conditions that usually don’t require hospitalization, including diabetes and cancer. In other words, they don’t use the term “serious” to mean what so many have assumed it means, hospitalization or severe.
The Family Medical Leave Act includes in its definition of “serious” condition one who is under continuing treatment by a healthcare provider for the illness. Not just “hospitalized” or “severe.”
Here, There, Anywhere
A person can be in “serious” condition at home, in the hospital, anywhere. Seems obvious.
Also seems obvious that a Supreme Court justice considering a medical-related case would use words in the sense of their legal and medical definitions. But critics, fact checkers, and others seem to ignore this.
During the oral argument, just two sentences before she referred to “serious condition,” Justice Sotomayor referred to “hospitalization.” Two sentence before, she referred to “severely ill.” If she had meant 100,000 hospitalized or severely ill, she knew how to say so. But she didn’t. She used a different term, “serious,” suggesting that by serious she meant something different than hospitalized or severe. It seems straightforward enough that the most likely meaning she ascribed to “serious” are the known medical and legal meanings of “serious.”
The definition of “serious” for the condition of a person is not defined with great precision, as far as I can tell, as it is broad and is much broader than hospitalized or severe. The medical dictionary and standard usage of the term includes at least a child with COVID having sudden onset (i.e., acute) of a fever and a negative or unknown direction relative to their health or a child being under a doctor’s continuing care for the illness in this context, along with similar happenings.
Indeed, I could find no support at all for defining “serious condition” of a person as hospitalization or severe, as several fact checkers did.
Instead, under these known legal and medical meanings of “serious condition,” Justice Sotomayor’s statement appears likely or at least plausibly true.
Child COVID Skyrocketing
Over 1 million child COVID cases were detected in just the last 5-6 weeks. The rate has doubled week to week a few times recently.
Around 15,000-25,000 or more children have been *admitted* to the hospital with COVID in the past 6 weeks or so. This is a substantial percentage of those admitted with it since the beginning. (Detailed study published last week by CDC showed in pediatric cases only 19.3% of those admitted had incidental positive test results in admission for unrelated reason. Of course, some of the 19.3% likely developed COVID problems afterward.)
Short Hospitalizations, ER Visits Aren’t Admissions
Although many emphasize that around 3500-5000 admitted children were in the hospital with COVID on the day Justice Sotomayor made her statement, it is important to note that a published study by the CDC COVID-19 Response Team found the median length of stay for a child admitted with COVID is 2 to 3 days.
This suggests then that it is likely 8,000 – 15,000 or more different children were admitted to the hospital just during that week with COVID or suspected COVID (treated in the ER, even overnight, is not an admission to the hospital, by the way).
Daily rate recently doubled and doubled again. Remember, this is *admissions.* The vast majority of people treated in the ER, for example, are treated and released to other doctors’ care, not admitted, with the most recent CDC data showing, overall, only 12.4% of ER visits results in admission to the hospital, for all causes.
That is, generally, for all types of illnesses and injuries, for every 1 person who is treated at the ER and is admitted to the hospital, there are 8 who are treated and released without being admitted. If that ratio holds for those with COVID, that means for the 15,000 – 25,000 or more kids admitted in the last 5-6 weeks or so, there were likely another 120,000 – 200,000 whose condition was concerning enough that they were taken to the ER. Even at a lower ratio, the numbers are significant. It seems probable that the condition of the vast majority of those would likely qualify as “serious” under the legal or medical definitions mentioned. And this does not even include those treated at Urgent Care, by a pediatrician, or another doctor.
That’s well over 100,000 in serious condition.
How Many in “Serious” Condition?
How many of those 1 million or so children with COVID in last 5-6 weeks are in “serious” condition?
One can easily infer that 4-8 times or more the number of children actually *admitted* to the hospital with COVID over past several weeks fit the medical or legal definition of “serious”: have acute (sudden onset of) illness, symptoms, but haven’t gone to the doctor or hospital; or have high temperature and under care of a parent, watching; under care of a pediatrician; treated at ER, not admitted, and released to go home under care of parents, doctor; admitted to hospital; recently released and at home, weak but recovering; have long covid; etc.
The same is true for 10% or more of the total recently diagnosed with COVID (i.e., 10%+ of the 1 million or more, more than 100,000) — sudden onset (so acute), under doctor care, having a fever, uncertain or questionable status, or …. More than 35% – 61% of children with COVID-19 had a fever in studies.
Add to that number those children dealing with long COVID and other challenges, then it seems rather likely that more than 100,000 fit the legal or medical “serious” definition.
Again, well over 100,000 in serious condition.
Sotomayor referring to ventilators, saying over 100,000 children “in serious condition and many on ventilators,” doesn’t indicate “serious” means hospitalized or requires hospitalization.
It’s unclear whether Sotomayor, by saying over 100,000 children “in serious condition and many on ventilators,” was referring to children on ventilators as (a) an example of a particularly intense sub-set of those 100,000 in “serious condition” or (b) a second category separate from the 100,000, i.e., X number (“over 100,000”) in serious condition and Y number (“many”) in a different condition, “on ventilators.” That is, it is ambiguous whether “many” means many of the 100,000 or a different group.
Assuming her reference to ventilators defines “serious” as hospitalized is like assuming a newspaper editor, by saying “Our newspaper has over 1000 journalists in work mode, and many on InFlight WiFi,” means the editor’s newspaper has over 1000 journalists on airplanes right now when such an assumption would make what the editor said obviously absurd or false.
Regardless, the CDC published a study last week that indicated around 7% of pediatric COVID admits were invasively intubated. That would qualify as “many” to me. Too many.
She’s Probably Right
So, sure, if you assume that “serious” means something narrow, like admitted to the hospital, then Sotomayor got it wrong.
But there’s no basis I can see to make such an assumption. It isn’t the medical definition of “serious.” Or the legal definition. She was likely using one or both, as she’s a judge considering a medical-related case.
And if you realize what “serious” likely indicates in medical or legal terms, then she’s likely right.
I don’t know how many are in serious condition. I could be wrong. Justice Sotomayor could be wrong. But it looks like those criticizing her are blowing past the medical and legal definitions of “serious.” And it looks likely she’s right.
Mercy, justice, and peace to you.
Updated: Jan 9:-20 Mayo Clinic and second Johns Hopkins added, “plausibly” sentence, detailed study cite and sentence, added CDC hospital admissions tracker and changed upper bound for estimated to 25,000 (see below), basic clarifying edits (10:37 am – 11:58 am eastern). Added the ” Although many emphasize …” and “This suggests then …” paragraphs and the 12.4% ER visit data Jan. 11 at 2:02 pm. Made the third paragraph clearer relative to antecedent, as referring there not just to those outright misrepresenting, but those equating. Jan. 11 2:45 pm. Added the “That is, generally …” paragraph Jan. 11 4:42 pm. Added additional headers for readability, corrected one “for” that should be “with” relative to admission numbers, added dictionaries and school inability and no support material and “That’s well over …”. Jan. 11 10:21 pm, 10:41 pm. Paragraph regarding temperature, acute, etc., and sentence re temperature Jan 15 5:43 pm. Added still more header. Jan 15 8:43 pm. Made CDC severe definition clearer. 11:20 am Jan 16. Added ventilator header and provided additional commentary there. Jan 17 11:55 am. Added paragraph regarding using the term hospitalized and severely. 1/20 at 12:34 pm.
Notes / Sources
See links in text.
With 100 – 850+ new pediatric admissions per day over last 6 weeks, with significant increase over last 3 weeks, plus ** delays in reporting *** is likely (e.g., 6 weeks x 7 days per week x around 400-600 per day = around 17000 – 25000 or more children in 6 weeks). With the delays in reporting, the major ramp up in last 3-4 weeks, the unknown number who are admitted for something else and then test positive (CDC study from late summer showed its about 20% who are that), etc., there is a wide range of possibilities here. With 1 million COVID-positive children in last 5-6 weeks or so, and even 14000 – 20000 hospitalized in that time, and with hospitalizations ramping up in significant way, seems straightforward to see it as likely that 100,000 are in serious condition under the legal / med definitions mentioned above.
With ~25k+ kids who, today, are either (a) admitted to hospital, (b) were admitted in past 4-5 wks & released remaining under doc care, or (c) about to enter hospital this week, the idea that for every 1 of them, there aren’t 3+ others who aren’t admitted-level but who are at a “serious” level is impossible. That means there were 100,000 or more kids in serious condition when Justice Sotomayor made here statement. “Admitted” doesn’t include treated at the ER, by the way. I wonder how many kids who have COVID are in “serious” condition — sudden onset of fever, are being seen and cared for by a doctor, etc. — sufficiently serious to be taken to the ER, are treated at the ER, but not admitted to the hospital. The vast majority of people who go to the ER are not admitted; only around 12% of people treated at the ER in general are admitted (not just for COVID, for all matters).
https://cdc.gov/nchs/fastats/emergency-department.htm… (ER 12.4%)
https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions… (0-17 year old admits, click Pediatric Data, then click New Hospital Admissions, click Select Age Group, click 0-17; week ending 1/13, 893 0=17 yr olds with COVID admitted per day)