As summer break began, it seemed like the worst of the pandemic was behind us. After a year of virtual learning, parents, teachers and students were all looking forward to returning to the classroom. Unfortunately, the Delta variant has allowed COVID-19 to take root again just as school starts.
Amid tussles over mask mandates and vaccine hesitancy, COVID-19 has begun to quickly spread in unvaccinated populations, which includes all children under the age of 12 and many teens who are eligible but remain unvaccinated. In a two-week period at the beginning of last month, Alabama saw more than 6,000 new pediatric COVID cases in children ages five to 17, nearly five times as many as the same time period last year.
Forbes reported that Alabama has set a new state record for children hospitalized with COVID with 50 children hospitalized across the state. At least nine were on ventilators. In addition, information from the Alabama Department of Public Health showed at least 113 children had been seen with multisystem inflammatory syndrome in children (MIS-C).
As parents seek answers, pediatricians are stepping up to dispel myths and share the facts on vaccination efforts and mitigation measures.
Vaccines & Cardiac Concerns
Stuart Berger, MD, FAAP, chair of the Section of Cardiology and Cardiac Surgery for the American Academy of Pediatrics (AAP), spoke with the Birmingham Medical News to address MIS-C and parent concerns over reports of myocarditis or pericarditis linked to vaccination in children 12 and up.
"There seems to be an association with the MRNA vaccination and myocarditis," he said. "It's been seen typically in the 16 to 24 age range and in boys more than girls. However, it's relatively uncommon to see it, and when it is presented, it's very, very mild. The children who have been diagnosed haven't been very sick, and the inflammation has gone away fairly quickly. Thus far, it has not required any treatment other than one to two days of pain management such as non-steroidal anti-inflammatory drugs." Typically, the self-limiting condition requires no intervention at all outside of rest and OTC pain relievers as needed.
"This is in stark contrast with myocarditis that can be seen from an acute COVID infection or in association with MIS-C," said Berger, who is the division head of Cardiology at the Ann & Robert H. Lurie Children's Hospital of Chicago. "Those patients can be very sick and often end up in the hospital and can get a very severe form of myocarditis requiring treatment and a fairly intense therapy for a period of time.
"Many of those patients can require therapy in the Intensive Care Unit and can have morbidity and mortality if they get this. Data is also being gathered on possible residual issues these children could face over the long term.
"In my experience with seeing COVID and MIS-C in young patients and my experience in seeing patients post-vaccine, it is a no-brainer to me that getting the vaccine is critical and what is best for every individual and for society in general."
Mitigating Risks
Anna Morad, MD, FAAP, president of the Tennessee Chapter of the American Academy of Pediatrics (TNAAP), said AAP guidelines call for masking children in the school setting. With low vaccination rates throughout the south, the bulk of people entering these schools will be unvaccinated.
Even if more were vaccinated, Morad said most schools don't have a robust system in place to determine vaccination status. And evidence continues to mount that vaccinated individuals with breakthrough infections can spread the Delta variant more easily than initially thought.
As important as it is to keep kids and teachers well, it's equally important to keep them in class. Many students had a tough time last year emotionally, socially and academically. "Kids do well with routine, and with having their peers around them," Morad said. "Virtual learning has a disproportionate impact on kids who don't have reliable internet access or a parent who can't be home during the day to help."
Without masks and other mitigation measures, in-person learning could quickly become another victim of the Delta surge. Within two weeks of returning to class, several districts in Georgia and Mississippi have already returned to remote learning. Florida's Hillsborough County, which includes Tampa, has already seen more than 10,000 students be isolated or sent home to quarantine.
"Masks have become politicized, but they should simply be viewed as an effective strategy to prevent the spread of COVID-19," Morad said. "While parents have become passionate about their children's 'right' to be mask-free, most kids aren't terribly bothered by wearing them."
While most children do recover, hospitalizations and deaths do occur. "The mortality rate for children is not as high as for adults," Morad said. "But these are children. We should not be talking about mortality among children. No child deserves to have a vaccine-preventable disease because people around them refused to wear masks or get vaccinated."
