Children usually don’t get as sick as adults from COVID-19 and, while the number of new diagnoses has been rising for youngsters in New Jersey and nationwide, their cases remain a small slice of the overall pandemic pie.

But kids remain critical vectors for pathogens like the coronavirus, experts note, an issue that becomes more urgent as they return to school in the coming weeks. Young children and tweens aren’t yet eligible for COVID-19 vaccinations and the older ones who are eligible for the shot are being immunized at lower rates than adults, state and national data show.

Young people have also suffered in other ways under the pandemic, from the isolation and learning loss to disruptions in regular preventive medical care, studies show. Others are enduring mental health challenges, food and housing insecurity, or violence at home.

Some child experts suggest policymakers should have done more to prioritize children in the pandemic, in everything from developing the COVID-19 vaccines to determining school closures. They want to see kids, especially young kids, get more attention from here on.

‘They are suffering in many ways’

“This has been my bone of contention. When are we going to start thinking about the younger kids,” said Cecilia Zalkind, president & CEO of Advocates for Children of New Jersey, which works on a range of child health and welfare issues. “We assumed they weren’t impacted, but actually they are suffering in many ways,” she said. “And they can spread” the virus.

Other experts say the decision to focus first on adults and the elderly, especially in crafting the vaccines, makes sense from a public health point of view. The goal, after all, is to save as many lives as possible and nearly half the 26,800 deaths recorded in New Jersey have been among residents over age 65.

“In a pandemic, the first target” for intervention is “those who are getting sickest the fastest,” said Dr. Jeanne Craft, a pediatric critical care specialist and president of the New Jersey chapter of the American Academy of Pediatrics. “And that makes sense.”

When it comes to developing the vaccines, Craft said, “It’s not that children are an afterthought. It’s just that children weren’t in that first targeted group. They weren’t the ones getting sickest the fastest.”

Minors make up 13% of diagnoses in NJ

The number of children hospitalized with COVID-19 has been on the rise in recent weeks, both in New Jersey and nationwide, and seven young people have died of the disease in this state. But overall, the coronavirus’s impact on kids remains relatively light. Minors make up around 13% of the total diagnoses in New Jersey, according to state data, and less than 2% of all hospitalizations. The bulk of these cases involve youngsters in the  5-17 age range.

The rise of the delta variant of the virus, which is far more infectious than the original strain, combined with the pending return to the classroom has some concerned. Gov. Phil Murphy has ordered that students, teachers and other school personnel wear masks and is requiring all staff to get vaccinated or tested regularly, but he has also mandated that schools teach classes in person.

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, said he would like to see greater federal investment in research on COVID-19 in kids. Kleinman — who acknowledges he has applied for this type of funding — said the principal focus on adults in the nation’s pandemic response results in policy decisions that have unintended negative consequences for kids; closing schools may have helped control the spread of the virus, he said by way of example, but isolation, learning loss and other impacts have also proven harmful to young students.

“There’s a disproportionate amount of money focused on adults” when it comes to research and developing treatments and vaccines in general, Kleinman said. He said the Food and Drug Administration should have done more to accelerate the coronavirus vaccine trials in children, which are ongoing.

Vaccine trials

Officials with the FDA said the agency does not comment on its timeline for pending product approvals. The federal government granted emergency use authorization in May for the Pfizer vaccine, one of three forms now available in the U.S., to be administered to children ages 12 to 15, nearly five months after it OK’d the shot for those 16 years and older. While public health officials had hoped the FDA would also permit vaccines to be used in children under age 12 before the start of the school year, in July it asked drugmakers to expand the clinical trials and the review process is ongoing.

Nearly four months after immunizations began in the 12- to 15-year-old age group, coverage for children continues to lag behind adults. While 72% of New Jerseyans over age 18 have been fully vaccinated, just 47% of those ages 12 to 17 have had all the necessary shots, according to data from the Centers for Disease Control and Prevention. In addition, the number of young people beginning the immunization process declined over the previous week, numbers from the week ending Aug. 20 show.

Craft said she hopes the FDA will authorize emergency use for younger kids before the end of the year. “On the one hand, it’s great that we’re paying attention to the safety for children,” she said. “And if it’s safe, we want to know it as soon as possible so we can start the rollout.”

While drug and vaccine trials once focused largely on adults, Craft said federal regulators have done a better job in recent years including children earlier in the process. In addition, releasing a vaccine to adults first provides additional opportunity to identify side effects and study dosing, she said. “The fact that it’s already been fine tuning helps protect children,” she added.

Children may be less likely to show symptoms, but they remain vulnerable to infection from the coronavirus  and Craft said parents should vaccinate all those who are eligible. She also encouraged families to wear masks  at all indoor events, maintain physical distancing, wash their hands and use other protections. “Anytime there is a weak spot in one of (these methods) we need to double down on the others,” she added.

Zalkind worries about the nonclinical impacts of the coronavirus on children, particularly those under age 5 who are less able to express themselves through words. For many, a critical time in their development has been heavily shaped by the pandemic, with isolation, learning loss and stress caused by the lockdown itself.

‘Virtual learning is not the way young kids learn’

“We already have a mental health system that does not adequately care for kids under five,” Zalkind said. “New Jersey has made progress, but there’s just not enough mental health services here for infants and toddlers.”

Zalkind pointed to a report released this summer by the National Association of Medicaid Directors which found that, nationwide, 77 million students endured school closures since the start of the pandemic and 40% still haven’t returned to a classroom full-time. Nearly 30% of families with children faced hunger, making it harder for young children to develop and grow.

“Virtual learning is not the way young kids learn,” Zalkind said. “They learn through play and interaction. And the impact of that isolation has to me gotten very little attention,” she added, noting, “what happens in those early years impacts their entire lives.”

There’s also the learning loss among children of all ages, including those who were slated to start preschool but were held back during the pandemic. “Kids who do not have that positive early childhood learning experience start school behind,” Zalkind said. “And they never really catch up.”

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