The COVID-19 pandemic is now defined by its impact on two groups of people: the vaccinated and the unvaccinated. Lest we forget, all children under 12 years of age fall into the latter category. As pediatric pulmonologists, we care for children with chronic respiratory conditions whose lives are threatened by COVID-19, as well as previously healthy children who have suffered from COVID-19 infections.
As of the most recent data, some 4.3 million children have tested positive for COVID-19. This number is likely an underestimate, as some children can become infected but show no or only milder symptoms and may not get tested. But, despite some claims to the contrary, not all children cope so well with infection. In the U.S., well over 17,000 children have been hospitalized with COVID-19, thousands have developed a severe, life-threatening post-COVID-19 illness that impacts the heart, and hundreds have died from this now vaccine-preventable disease. As the highly transmissible SARS-CoV-2 Delta variant triggers a steep incline in COVID-19 infections across the U.S., pediatric cases, too, are rising dramatically. We must protect our children.
Vaccinations save lives, but our children cannot get them
The COVID-19 vaccines have dramatically changed the course of disease for people who are fully vaccinated. All of the authorized vaccines were, indeed, designed to prevent severe COVID-19 disease—and thus reduce hospitalizations. At this point in the pandemic, those who require intensive care from COVID-19 complications are the unvaccinated.
However, not all Americans have access to these life-saving vaccines. In particular, access for children under the age of 12 has been delayed for several reasons. First, as is typical for new drug and vaccine development, children were not enrolled in early vaccine trials. Second, ongoing vaccine trials for children were not as widely available for potential volunteers compared to adult studies, and some sites have reported slow enrollment. Finally, COVID-19 vaccines have faced extensive scrutiny for rare or delayed side effects—and one of these rare effects is vaccine myocarditis, or inflammation in the heart tissue, which has been reported in adolescents and young adults.
Along with all pediatricians, we eagerly await clinical trial results showing that COVID-19 vaccines can be given to our younger patients safely and with efficacy. But time is short. With the rising wave of COVID-19 driven by the Delta variant, widespread relaxing of safety precautions, and the start of a new school year, unvaccinated children are not only increasingly at risk of infection and its complications but they are also more likely to spread the virus unknowingly, putting others at risk who might have a higher likelihood of developing severe disease.—While safety data are essential, especially for interventions involving children, the U.S. Centers for Disease Control and Prevention emphasizes that the risk of adolescents developing severe COVID-19 illness outweighs the risk of developing vaccine-related myocarditis, which is rare and usually resolves without the need for treatment. Because of the sharp increase in COVID-19 cases as children return to schools and after-school activities, the risks of COVID-19 infections for children, especially those living with chronic lung diseases, likely exceed the potential risks of the vaccine. We urge the FDA to act immediately to protect children from the looming threat of COVID-19.
In the meanwhile, there are other actions we can take to protect our kids. Children under 12 are not yet eligible for vaccines—but their parents, grandparents, aunts, uncles, older siblings, teachers, and coaches are. The risk of severe COVID-19 for these older groups is higher, and if they become infected, they can transmit the virus to children under 12. There is no reason for those eligible to delay vaccination, particularly with rising numbers of positive COVID-19 tests throughout the country. Vaccines save lives. We implore parents and caretakers to get vaccinated themselves to protect vulnerable children from infection.
Masks are a must
As summer ends and schools reopen, many children will be restarting in-class learning—at facilities where mask usage is limited. In fact, several states have enacted laws that block mask requirements for schools, despite most parents preferring a mask requirement. Mask use is a simple and effective safety measure for preventing the spread this airborne illness. In schools that required masks during the previous academic year, viral transmission was minimal. The American Academy of Pediatrics, the most highly respected organization of pediatricians world-wide, recommends universal masking in schools to protect our children. States that enact policies that effectively decrease mask usage will put their children at higher risk of contracting COVID-19.
Reports suggesting that masks are harmful or result in toxic levels of inhaled carbon dioxide are false—in fact, a recent publication claiming harm from masks has been retracted. On the contrary, extensive research has shown that face masks are safe and do not affect carbon dioxide levels at rest or with exercise—not just for SARS-CoV-2 but for the flu and other respiratory viruses.
New SARS-CoV-2 variants will keep the COVID-19 pandemic unpredictable
As the COVID-19 virus replicates, its genetic makeup changes and mutates; this is a common trick of infectious pathogens. Mutations that are more contagious have a selective advantage that allows some strains of the virus to dominate. This is what we’ve seen with the Delta variant, now the predominant SARS-CoV-2 strain in the U.S., and in many other parts of the world. It is more contagious, and more people—including children—are now getting sick as this virus spreads more quickly than prior variants. We are in a sharp uptick of the Delta surge. New variants have the potential to challenge vaccine, monoclonal antibody, or anti-viral efficacy. The best way to prevent new, potentially more contagious or lethal variants is to contain the current virus; this can be done with higher rates of vaccination and wide-spread efforts to reduce transmission, including among children.
Safety measures for children are needed now more than ever
Now is the time to take safety measures, vaccinate yourself if you are eligible, vaccinate your children as soon as allowed, wear your mask, and help your children wear their masks when you are in public. We’ve seen children who’ve lost parents to COVID-19; we’ve seen children who require ventilators and other advanced life support due to COVID infections; we’ve all seen the schools shut down, the mental health crisis, and how our children struggle when COVID-19 cases soar. Too many children have been harmed by COVID-19, a disease that is now nearly preventable. We all must take precautions, vaccinate, and encourage others to take these same measures by “normalizing” them. We must protect our children.
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Contributor: Lael M. Yonker and Anthony J. Fischer