What if we closed schools in the wrong year?
As kids don face masks and converge in classrooms — some for the first time since COVID-19 upended life as we know it — many jittery parents and teachers are nagged by that very question.
In the noble pursuit of reading, writing and arithmetic, it’s the numbers that make them nervous. Infections in children plunged to near-historic lows as summer began, a Southern California News Group analysis of state data show, but they’ve skyrocketed in recent weeks as the delta variant surges:
• In June, there were 4,704 confirmed COVID cases reported in California in kids aged 0-17.
• In August, 65,601 cases have been confirmed in this age group — and that’s only through Aug. 21. With another 10 days left to be tallied, August’s total could hit 100,000 — the greatest surge since the dark days of winter.
While hospitalizations among kids remain infrequent, those are climbing as well. Data from the U.S. Centers for Disease Control show that hospitalizations nationwide were at a low of 20 in mid-June, but climbed to 96 in mid-August.
Deaths of children remain rarer still. Since the pandemic began, 32 children in California have died from COVID-19 — out of some 65,000 deaths. That’s just 0.05% of all COVID deaths in the state, while kids make up 22.5% of the population. Nationwide, experts say there have been 300 to 600 child deaths since the pandemic began — a fraction of 1% of the total, even at the highest estimate.
In California, the first child death was not logged until August 2020. Nine children have died in the seven weeks from July 1 to Aug. 21 — nearly one-third of the total.
It’s easy to worry when hundreds of students in Santa Ana are already in quarantine because of campus exposures, and an outbreak closed an entire school in East Hollywood just a week-and-a-half into the new school year.
But, as the high school crowd says, folks should just “chillax.”
Keep calm, study on
Andrew Noymer, an epidemiologist and demographer at UC Irvine, cautions strongly against drawing any conclusions from a tiny number of deaths in an extraordinarily large state over an extended period of time.
Seeing totals rise from zero to five on a chart might seem like it means something, but, statistically speaking, it doesn’t, he said.
“It’s just the nature of small numbers. They bounce around. In weird ways,” he said. “These numbers don’t concern me tons. There is plenty of scope to be worried, but I’m not worried yet.”
Noymer has yet to see population studies showing that delta affects kids more than earlier versions of the virus. “I’m open to it. I just haven’t seen the numbers. I have seen pediatricians with Twitter accounts saying ‘our ward is full of sick kids,’ but that’s not a study.”
Dr. Brigham C. Willis, senior associate dean for medical education and pediatrics professor at UC Riverside School of Medicine, agrees. Yes, delta is more infectious than previous variants, but that hasn’t translated into spikes of severe illness or death for children just yet, he said.
“Not completely clear yet, but the number of deaths/severe morbidity remains incredibly low for kids,” Willis said by email.
Data show the peak of child cases and mortality in December and January, when 10 children died. While tragic, “I can almost guarantee those were all in kids with other chronic conditions,” he said. “I work in the ICU every few weeks, and yes, we have a kid or two who get the MIS-C (severe inflammation) syndrome, and sometimes some cardiac stuff. They all, almost to a person, get completely better relatively quickly. Unlike a lot of other viruses I have seen.”
Richard Carpiano, a professor of public policy at UC Riverside, takes heart that, as COVID cases and hospitalizations rise in children, there appears to be no corresponding leap in child deaths. But he still has concerns.
“One thing to consider is that, though a lot of kids who get COVID-19 are asymptomatic or have mild cases, we still are figuring out the long-term effects of long COVID,” he said.
It’s unclear what those are for the delta variant — and for the other variants as well. Time will tell.
Vaccines to the rescue?
Dr. Moshe Arditi, director of the Pediatric Infectious Diseases Division at Cedars-Sinai, and his colleagues have finished a study of children who develop Multisystem Inflammatory Syndrome — a serious complication many parents fear — some four to six weeks after otherwise unremarkable COVID infections.
“Thank God this is a very rare childhood inflammatory disease, a very rare complication that occurs only in certain children most likely genetically predisposed,” Arditi said. “If you have 4,000 infected children, one of them will develop MIS-C.”
Their research, published in the Journal of Clinical Investigation, found that MIS-C appears to be as an autoimmune disease where the immune system becomes overactive and mistakenly attacks the body’s own organs. It might be triggered by widespread tissue damage caused by the COVID-19 infection.
As cases rise, the big concern is not so much MIS-C, but more acute pneumonia that may be tied to the delta variant, Arditi said.
“The most important thing is that the adults are completely vaccinated, and all students 12 or older are completely vaccinated. Studies have shown that if the adults are vaccinated, that really protects the kids as well. “
Elementary schoolers are not yet eligible for COVID vaccines. Pfizer originally was expected to submit data and request emergency use authorization for this age group in September, but the timeline has stretched a bit.
Federal regulators asked both Pfizer and Moderna to expand the number of kids in their clinical trials to help detect rare side effects such as heart inflammation. Pfizer is now expected to submit its data later in the fall. Moderna is not far behind.
In the meantime, pediatric cases are likely to keep rising as fall comes and some are less vigilant about distancing and masking, said Dr. Coleen K. Cunningham, a board-certified pediatric infectious diseases physician, professor and chair of pediatrics at UC Irvine and pediatrician-in-chief at Children’s Hospital of Orange County.
“If children don’t mask in schools, it will rise even more,” she said. Parents can help by supporting masks in schools and other indoor facilities, encouraging their children to wear masks correctly at all times, and seeking medical care and testing if the child does develop symptoms, she said. Encouraging friends and family to be immunized can help the whole community as well.
To counter cresting waves of misinformation as that date for younger-child vaccination draws nearer, the Kaiser Family Foundation and American Academy of Pediatrics have developed an informational video series about kids, COVID and vaccines featuring experts explaining the facts in user-friendly language.
Some impatient parents are seeking vaccinations for their not-yet-eligible children anyway — via medical providers who’ll prescribe “off-label use” of the now-fully-approved Pfizer vaccine — but pediatricians recommend against it. Children need different doses than adults, and eager parents should just sit tight for a little while longer and wait for the data to come in, the American Academy of Pediatrics says.
Willis, of UC Riverside, said kids in Arizona have been back in school for months and there has been no rush on pediatric units or ICUs.
“I still think we are lucky with this one. Kids are relatively spared,” Willis said. “My kids are all in person, in school, and I don’t worry. My teens are vaxxed, but my 8-year-old is not, and I don’t worry more about COVID than any other disease they could contract in school.”
Source: Orange County Register