Children are being hospitalized with COVID-19 in record numbers across the United States. As most children are not old enough to get vaccinated, hospitalizations could further increase as schools reopen. Doctors and epidemiologists are thus calling for the use of safety precautions, such as masks and ventilation, during class.
In a new feature, MNT explores the risks of SARS-CoV-2 spreading among children and looks at what strategies might prevent it. Image credit: FluxFactory/Getty Images
The rise in cases of COVID-19 among children in the U.S. is primarily linked to the Delta variant. Cases are rising especially quickly in communities with low rates of COVID-19 vaccinations.
Although the Centers for Disease Control and Prevention (CDC)Trusted Source recommend universal indoor masking and physical distancing in schools, mask-wearing is optional in North Dakota and Ohio.
Rapidly increasing infection rates among children and teachers have forced many schools in the U.S. to halt in-person learning and turn to hybrid models of education. This comes despite 175 pediatric disease experts agreeing earlier this year that elementary schools could open full-time for in-person instruction.
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Although children generally have milder COVID-19 symptomsTrusted Source than adults, the fact that few studies have investigated how the disease affects children means that many questions remain unanswered. For example, why are so many children being hospitalized with COVID-19? Which children are most at risk? And what can parents and authorities do so that children can return to school safely?
To answer these questions and more, Medical News Today spoke with seven doctors and researchers who specialize in pediatrics and infectious diseases and have worked directly with children with COVID-19.
Why are COVID-19 hospitalizations among children increasing?
The Delta variant of COVID-19 is more than two timesTrusted Source as contagious as previous variants. Alongside school reopenings, this may partially explain the increase in pediatric hospitalizations due to COVID-19.
“The Delta variant that is circulating widely is more contagious, and children are getting infected more often than previously during the pandemic,” Michael L. Chang, M.D., director of pediatric antimicrobial stewardship for McGovern Medical School and Children’s Memorial Hermann Hospital in Texas, told MNT. “Also, across the country, mitigation measures such as masks, reduced occupancy indoors, physical distancing, etc., all ended around the same time.”
“Now, you have a more contagious variant with fewer mitigation measures in place. With the rising number of cases, unfortunately, you will see more hospitalizations. As an example, if 2% of children need hospitalization, then it’s a big difference between 2% of 10,000 cases vs. 2% of 100,000 cases,” he added.
Another reason for rising COVID-19 hospitalizations among children may be that those under the age of 12 years cannot get the vaccination yet.
“Vaccines remain effective at preventing severe illness, hospitalization, and death from [SARS-CoV-2] infection, even Delta strain infection,” Kristin Moffitt, M.D., an infectious disease expert at Boston Children’s Hospital, MA, told MNT. “This is consistent with reports that the overwhelming majority of hospitalizations and deaths during the recent surge are occurring in unvaccinated individuals.”
“Since children under 12 aren’t yet able to be vaccinated, and many adolescents and young adults remain unvaccinated relative to older individuals, this age group is making up a bigger proportion of those at risk for severe illness based on their unvaccinated status,” she added.
“Early in the pandemic, those over 65 accounted for more severe disease and hospitalization. Now that this age group has a higher percentage of vaccinated persons, the disease burden will be seen in the younger, unvaccinated population,” said Dr. Adriana Cadilla, an infectious diseases pediatric specialist at Nemours Children’s Hospital in Orlando, FL. “[In Florida,] there has been over a four-fold increase in child [SARS-CoV-2] infections in the past month,” Dr. Cadilla added.
Is the Delta variant more severe than earlier strains?
Although the number of COVID-19 cases among children is increasing more quickly now than at any other time in the pandemic, it is unclear whether the Delta variant of SARS-CoV-2 is more severe for children than previous variants.
“We don’t know if the Delta variant causes more severe disease for kids than previous variants, but it’s definitely more contagious,” said Dr. Chang.
Due to low testing and hospital admissions among children from previous variants, the data to compare the outcome of COVID-19 strains are sparse. As schools reopen, however, and safety precautions such as mask-wearing wane, more children are becoming infected with SARS-CoV-2 at the same time, leading to higher numbers of children developing severe COVID-19.
“There are some indications to suggest that COVID-19 from the Delta variant is more severe in children than with earlier strains,” Dr. Allison Ross Eckard, M.D., professor of pediatrics and medicine at the Medical University of South Carolina, told MNT.
“We are seeing a greater number of children, particularly unvaccinated adolescents, with more severe COVID-19 resulting in respiratory failure that is requiring intubation and sometimes ECMO (heart-lung bypass machine), ARDS (a very serious lung condition that develops as a result of the inflammation associated with COVID-19), and other COVID-related problems — all complications we more commonly see in adults,” she continued.
“It may be that the increased number of hospitalizations among children is a result of both of these factors — more cases combined with a higher chance of severe disease. More data is needed to determine the exact reason(s) behind what we are seeing,” she added.