As the COVID-19 Delta variant rages through our country, it appears to have found a new victim: children. Because of its propensity to spread more easily than previous COVID-19 strains, hospitals across the United States are reporting an uptick in the number of children presenting with respiratory issues associated with the variant. Driving this hospitalization spike is the spread of infections in households.
Dr. Jim Versalovic, the chief pathologist and interim chief pediatrician at Texas Children’s Hospital in Houston said, “Absolutely, household infections are the beginning of this pandemic, that is a major driving force in the spread of infections. We see it often within households, parents to children. We have certainly seen siblings — more than two at times — with an infection at the same time, so spread within households is certainly a very real phenomenon.”
Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security, agrees with this perspective, stating, “This new variant is a major contributor, but a major issue is that people’s behavior has changed. I don’t think we can absolve people and leaders of responsibility for this because it gives them a pass. The reason kids are getting infected is because we don’t have those precautions and parents and households are getting infected.”
The Delta Variant is not, however, specifically targeting children, as was initially thought. “There was some suggestion that the variants were specifically targeting children, but that actually is not the case. What we are seeing is that the variants will target those who are socially mixing,” stated Maira Van Kerkhove, The WHO’s Covid-19 technical lead.
However, once kids do get the virus, there are often complications. Some of the complications are serious in nature, and require aggressive treatment with extended hospital stays.
Dr. Mark Kline, physician-in-chief for Children’s Hospital New Orleans remarked, “I’ve never seen anything like it. We are seeing children fall ill that we just simply didn’t see in the first year of the pandemic, before the delta variant came along.” In fact, the state of Louisiana as a whole is reaching a crisis level with regard to children become sickened by the Delta variant. At a recent press conference, Dr. Joseph Kanter, the state’s health officer, warned, “We’re seeing more children sick with COVID now with delta than we have at any other point in this pandemic.”
And for the short future, things are looking a little grim for the Pelican state. “Children in Louisiana have died of COVID and more unfortunately will die,” said Dr. John Vanchiere, a pediatric infectious disease specialist. This is not a time for politics, for fighting or threatening lawsuits about masks. Masks save lives. And if you’re a pro-life Louisiana resident like I am, wear your mask.”
Although it is too early to understand the connection, some doctors fear they may be a link between COVID-19 and multisystem inflammatory syndrome (MIS-C). MIS-C is a “ rare but serious condition associated with COVID-19 in which different body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.”
A recent article from the National Library of Medicine describes issues related to 27 patients who “had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness and concurrently received positive test results for SARS-CoV-2, the virus that causes COVID-19.”
The connection between COVID-19 and MIS-C appears to be differentiated along racial and age boundaries, with certain demographics more at risk than others. A study from the Journal of the American Medical Association (JAMA) of 248 persons with MIS-C found that “MIS-C incidence was 5.1 persons per 1 000 000 person-months and 316 persons per 1 000 000 SARS-CoV-2 infections in persons younger than 21 years. Incidence was higher among Black, Hispanic or Latino, and Asian or Pacific Islander persons compared with White persons and in younger persons compared with older persons.”
Other research points to the inflammatory nature of COVID-19 as a connection to MIS-C. Researchers in a meta-analysis hypothesize “a potentially life-threatening cytokine storm” triggers an overactive immune response in children with COVID-19 infections, thus leading to the symptomology associated with MIS-C.
On a positive note, the same researchers found that “Early management with intravenous immunoglobulins and aspirin has been found to have a favorable outcome.” The bottom line, then, is early detection and intervention to lessen the chances of severity and increase the possibility of a robust recovery.
Of course, the fact that the vaccine is not available to children under the age of 12 is a large driver of the recent spike and resulting hospitalizations. The Food and Drug Administration has not released emergency authorization for them to get the shot, which is fueling worries as many kids are scheduled to begin school in the coming weeks.
Versalovic remains optimistic, saying, “Hopefully, there will be emergency authorization soon after we release the data, but we have to face the reality of beginning the school year without it. We do anticipate having vaccines available for kids during the first half of the school year, but for children under 5 that’s likely to occur later in the year, possibly early 2022. It’s going to be an ongoing effort.”
Compounding all of these treatment challenges is the fact that non-Covid-19 respiratory diseases, in general, are spiking as well, stressing hospital capacities, including the number of beds available for patients. During the early part of the pandemic, respiratory viral infections, especially those associated with the flu, were uncommon, meaning hospitals could focus their energies and resources on combating COVID-19. As a Scientific American article noted, “Since the novel coronavirus began its global spread, influenza cases reported to the World Health Organization from the Northern and Southern Hemispheres have dropped to minute levels.”
However, with the advent of the delta variant, it appears respiratory illnesses are also on the rise. Dr. Gregory Poland, an infectious diseases physician and researcher at Mayo Clinic, explains, “Particularly in the South part of the U.S., we have seen an increase in what’s called RSV, or respiratory syncytial virus. It’s a virus that causes a cold much like influenza causes a cold, though it can be severe in very young children and elderly adults.”
There is a direct connection between these infections and vaccinations, or the lack thereof. As Poland put it, “The very areas where we are seeing an increase in RSV cases are the areas that have the lowest uptake of the COVID vaccine and the highest case rates of infection.”
And beyond all of the struggles that adults typically have with COVID-19, children, especially young children, have psychological stressors that compound their treatments. This is because children don’t have the same depth of coping mechanisms as adults. Dr. Kelechi Iheagwara, medical director of the pediatric intensive care unit at the Our Lady of the Lake Children’s Hospital in Baton Rouge, Louisiana states, “It is scary, especially for kids who don’t fully understand what’s going on. They’re air hungry, struggling for breath, and it’s just scary. You have the illness, the fear, they can’t breathe, they’re isolated — that’s hard for anyone to understand, but can you imagine what it’s like for a kid?”
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