It all could have been prevented. That’s what sticks with Dr. Jeffrey Kahn, the director of pediatric infectious diseases at Children’s Health. His patient, who was old enough to receive a vaccine, had been in the intensive care unit for three weeks with COVID-19.
Kahn spoke with the mother to understand why the child had not been vaccinated. The mother said she had heard some of her friends say something negative about the vaccine, so they opted out. “This mother’s going to have to live with that decision,” he says. “It’s a shame.”
COVID-19 hospitalizations are as high as they have ever been during the pandemic. But there have never been this many kids hospitalized for the virus across North Texas. The patient census at Children’s Medical Center has increased 600 percent since June 20, when just six children were in the hospital battling a coronavirus infection. Now there are 40 children hospitalized with COVID-19 at that system alone. These extreme cases represent more than a fifth of all positive cases the system has identified across its sites of care since August 1. The vast majority of the hospitalized children are unvaccinated, Kahn says. “That’s an ominous sign.”
According to the Dallas Fort Worth Hospital Council, there are 73 pediatric patients being treated in North Texas, more than any time in the pandemic. There are currently zero staffed pediatric ICU beds in Trauma Service Area E as of Thursday afternoon.
Cook Children’s in Fort Worth is experiencing a similar trend of rising hospitalizations. In June, the hospital had so few patients that it stopped updating staff on the numbers. By early August, there were 23 kids admitted to the hospital with COVID-19; eight were in the intensive care unit. The pattern is the same nationwide. The American Academy of Pediatrics says that 90,000 children were diagnosed with COVID-19 last week. Earlier in August, the U.S. experienced the largest week-over-week increase in pediatric COVID-19 cases since the beginning of the pandemic, when the number nearly doubled in a week. Across the 19-county segment that makes up Trauma Service Area E, there are 150 pediatric patients on ventilators. (Those include both COVID and non-COVID patients.)
Teens who are eligible to be vaccinated are also the ones who are most likely to have an intense infection, says Dr. Nicholas Rister, an infectious disease expert at Cook Children’s. “Teenagers behave more like adults regarding COVID, and the younger kids are going to do exceptionally well,” he says. “Older teenagers especially have the same risk factors as adults.”
Hospitals are looking at converting space to add more ICU or hospital beds, but options are limited. Handling the COVID-19 cases would not be as much of a stressor on the hospital’s emergency department and intensive care units if they weren’t also experiencing an unprecedented surge of other severe respiratory viruses, which is spiking in the summer after almost no cases during the fall and winter.
The pediatric hospitals aren’t sequencing patient genes to see how much of the rise in infections is due to the more contagious delta variant, but they are assuming that the sequencing done by UTSW is reflected in their patient population as well. D Magazine’s Matt Goodman spoke with Dr. Joseph Chang, Parkland’s chief medical officer, who said that 90 percent of its patients are sick with the highly contagious delta variant. “We assume all (patients) are delta at this point,” Chang wrote. UT Southwestern said that percentage held true for their patients as well. The good news is that the delta variant doesn’t seem to be any more deadly than the ancestral variant, but its higher viral load means more people are at greater risk of infection.
Our Two Foes
With schools opening, healthcare workers are anxious about how the more contagious variant will impact students, especially given Gov. Greg Abbott’s ban on mask mandates (which has now been challenged by several large school districts and County Judge Clay Jenkins, whose countywide mask mandate went into effect Thursday morning). Adding to the heartbreak of seeing the hospitals fill up with sick children is the knowledge that so much of the carnage could have been prevented with higher vaccination rates. Many of these hospitalized children have been suffering when the answer was just a shot or two away. Kahn blames misinformation about the vaccine.
“Right now, we have two foes: the virus and misinformation. The tools we have against the virus are much better than we are against the misinformation,” Kahn says. “It is a real blessing to be in this country because we have highly effective vaccines that are readily available, and a year ago, we were yearning for that. Now we have it, and we should be using it as much as we possibly can.”
For many children, vaccines aren’t yet an option, but help is on the way. Pfizer will submit safety data to the FDA about use by 5 to 11-year-olds by the end of September, and Moderna will follow in the fall, ABC reports. At that point, it will be up to the FDA to decide when it is made available to the public, but most put estimates at the end of the year or early 2022. For those under five, experts hope a vaccine will be approved soon after.
Dr. Lee Savio Beers, the president of the American Academy of Pediatrics, wrote a letter to the FDA’s acting commissioner, Dr. Janet Woodcock, urging the approval of a vaccine for children. “The delta variant changes the risk-benefit analysis for authorizing vaccines in children,” the letter reads. “The FDA should strongly consider authorizing these vaccines for children ages 5-11 years based on data from the initial enrolled cohort, which are already available.”
But until the vaccines are available for children under 12, experts hope that vaccination rates continue to increase among the eligible and other precautions continue. “We know the mitigation strategies like masking and social distancing works,” Kahn says. “They are not perfect, but low-tech measures worked quite well. My hope is that we will keep up these measures to try to get this under control.”