As COVID-19 cases rise, doctors fight ‘myth that kids were spared’

With schools about to open, doctors urge vaccinations as they treat more children than usual
Credit: (AP Photo/Rick Bowmer)
Shortly after Thanksgiving 2020, Cooper Wuthrich of Montpelier, Idaho was diagnosed with a rare COVID-19 complication that landed him in an emergency room three hours away from his tiny hometown in a secluded Idaho valley.

COVID-19 cases and hospitalizations continue to rise among young New Jerseyans — with pediatric admissions up almost one-third over last week in this state — and clinicians find themselves busier than usual treating children with COVID-19 and other respiratory diseases just weeks before school is to start.

While state health facilities are prepared to handle the rising cases, treating children presents unique challenges and can require special equipment and expertise, according to Dr. Katherine Clouser, a hospitalist and vice president-elect of the NJ Chapter of the American Academy of Pediatrics. She urges parents of children ages 12 and older to get them vaccinated and reminds New Jerseyans of all ages to take other infection-control precautions, like wearing masks indoors, washing hands and staying home when sick.

“Vaccinating all those who are eligible is really going to help with all this,” Clouser said. “Masks are also a great way to prevent infection,” she added, and wearing them in school settings will guard against COVID-19 spread and also “protect kids from other viruses. The last thing someone wants is for their kid to have more than one virus.”

Clouser said 52% of New Jersey children ages 12 and older  — the group currently approved for coronavirus immunization — have had at least one shot. While this may surpass the national average, estimated to be no more than 48% as of late July by the nonprofit Kaiser Health Foundation, it is not good enough, she said. Kaiser also found half of the parents it surveyed said their children have been or will be vaccinated by the time school starts, but public health officials would like to see at least 70% of all age groups immunized against the virus.

Rising case numbers among the young

Since the pandemic began in March 2020, children have been a small fraction of the cases and hospitalizations overall and at the start clinicians struggled to overcome common misassumptions that coronavirus posed little risk to kids.

Today minors make up less than 13% of all COVID-19 diagnoses in New Jersey, according to the state Department of Health, but that still accounts for more than 116,000 infections. Nearly 1,500 of these youngsters have been hospitalized, accounting for just 1.6% of the state’s admissions to date.

Seven children have died of the virus — a negligible percentage statistically, but each one tragic.

The pandemic’s impact on young people is clearly growing nationwide, according to data that shows children’s hospitalizations spiked rapidly in July. In New Jersey, there are now 17 patients under age 18 in hospitals here, according to state health officials, up from the 13 under acute care early last week, including two youngsters in intensive care.  The percentage of children that make up all hospital admissions increased more than threefold between January and August, health officials said last week.

“We started with this myth that kids were spared” the worst impacts of the coronavirus, said Dr. Lawrence Kleinman, a professor and population health expert in the pediatric department of Rutgers University’s Robert Wood Johnson Medical School in New Brunswick. “Kids weren’t spared and the delta variant is showing us what a myth it was that kids couldn’t get very sick.”

Other illnesses also a factor

Pediatricians are treating a greater number of sick children this year than in previous late summers, Clouser and others said, in part because of a growing circulation of flu and other viral infections that are not part of the coronavirus family. But COVID-19 cases are also on the increase among kids. Nationwide, nearly 74,000 children tested positive for COVID-19 during the last week of July, New Jersey officials said last week, up 84% over the prior week.

“All these developments point to an urgent need for everyone to get vaccinated, especially for parents to take their 12- to 17-year-olds to be vaccinated as soon as possible,” state Health Commissioner Judy Persichilli said last week, urging families to get their shots — or a COVID-19 test — before schools reopen in the weeks to come. State, county and local officials are working together to host back-to-school vaccination events, she said, and the state has mandated everyone wear masks when classes begin in person.

“Vaccination is the best weapon that we have against this unrelenting virus,” Persichilli said, noting that hand washing, distancing and staying home when sick are also important safety measures.

Rutgers’ Kleinman urged families to be cautious about large group activities and always wear a mask, both adults and children.

“Think twice when you are going to public places,” he said, suggesting also that parents choose schools and programs that require face coverings when possible. “These are things parents can do, when they have these options.”

Care often highly specialized

When children do require hospitalization, the demands of their care can be highly specialized — especially for younger patients, clinicians said. Not all community hospitals have the capacity or proper equipment to handle serious pediatric cases and some closed children’s wards last year to accommodate more adults with COVID-19. Clouser said this situation has led to a rising number of pediatric transfers from smaller local hospitals to specialized children’s facilities, which exist throughout the state.

“When the child is sicker, that’s really what you want,” she added.

While doctors have learned quickly how best to treat these young COVID-19 patients, there is less data and clinical trial results for pediatric cases than for adults, experts note.

Generally, treatments that work well in adults can be adjusted to suit children, Clouser said, but it is not always known that kids will respond the same way as older patients. Kleinman also urges federal regulators to better prioritize and invest in coronavirus research involving children, who he feels have been largely overlooked in the public health response.

When it comes to treating children with COVID-19, “the data is positive, the data is reassuring, but the numbers are small,” Clouser said.

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