As the Delta variant pummels its way through communities and sparks a fourth COVID-19 wave, vaccines are buttressing many from the worst outcomes of the virus. But for the unvaccinated — including kids — the threat of COVID-19 remains very real.
The consequences are already playing out in Texas, Louisiana, Georgia, Florida and Arkansas, where an increasing number of children are testing positive for COVID-19. While children are generally more resilient against the virus than older populations, some are still ending up in the hospital and, in some cases, on ventilators.
But the kids who catch COVID-19 are “not little adults,” as pediatric infectious disease specialist Dr. Nisha Thampi put it in an interview with Global News. Because of key differences in both their bodies and their lifestyles, COVID-19 can be a different beast for children.
COVID-19 in kids
When children walk into a hospital with COVID-19 concerns, they often have few — if any — symptoms. Even as the more transmissible Delta variant spreads, doctors sometimes only discover a child has COVID-19 after they’ve already been admitted to the hospital for a totally unrelated reason.
“Not every kid who’s admitted to hospital with a positive COVID swab is admitted because of COVID,” Thampi said.
“They could be admitted because they were in a motor vehicle collision, and then they happened to test positive for COVID.”
Experts aren’t sure why kids are better at fighting off COVID-19, but an early study published in the Journal of Clinical Investigation hints at possible reasons. It suggests their bodies might be better at sending the signal needed to trigger an immune response.
It might also be harder for the coronavirus to break into kids’ airway cells, one immunologist from Duke University told The Atlantic in a recent interview.
Still, despite the trend of milder COVID-19 symptoms among children, with increased spread also comes increased instances of rare severe outcomes, according to the doctors.
The United States is already facing this reality. As COVID-19 spreads through states with lower vaccination rates and lax masking and distancing policies, the cases among children are spiking, according to a joint report from the American Academy of Pediatrics and the Children’s Hospital Association.
As of Aug. 5, over 14 per cent of the total COVID-19 cases in the United States were in kids. Still, children made up just 1.5 per cent to 3.5 per cent of hospitalizations in the 23 states that record those figures.
On top of that, seven states reported no child deaths from COVID-19 — and in the states where child COVID-19 deaths were reported, this worst-case scenario happened in just 0.03 per cent of cases.
In Canada, the under-19 population has experienced the most COVID-19 infections to date. Over 19 per cent of the total cases in Canada have occurred in those under 19 years old, according to Health Canada.
Experts worry this figure is going to keep climbing.
“I can’t say that the Delta variant will cause more severe disease than other COVID infections in kids,” said Dr. Jesse Papenburg, a pediatric infectious disease specialist with McGill University.
“But the concern here is that because you’re going to have more cases, because it is a more transmissible virus, you’re going to wind up seeing the tip of the iceberg — the most severe cases — occurring more frequently.”
How is COVID-19 treated in kids?
Typically, the same methods used to fight COVID-19 in adults also work for children, according to Thampi. But treating kids requires specific knowledge, skills and, sometimes, smaller tools.
If Delta causes an onslaught of COVID-19 cases, the capacity of the health-care system to provide kids with the best possible care could become a problem.
“It’s a highly skilled set of nurses who are in the neonatal intensive care unit, in the pediatric ICU setting, in oncology, and in the general inpatient unit,” Thampi said.
Children also don’t make their own decisions and need a parent or guardian around — which can present its own problems.
Parents and guardians make health-care decisions, like whether a teen can get a vaccine or how closely a child has to follow restrictions, on behalf of their kids, Thampi said.
On top of that, kids need a caregiver alongside them at the hospital. That means hospitals don’t only consider the risk of a child being admitted to the hospital carrying COVID. They have to think about the parents, too, Thampi said.
“We have parents in the hospital, (and) they’re not visitors. They’re essential care providers for their kids in hospitals, so when we have an admission for a child, even if it’s not for COVID, we still think about COVID,” Thampi said.
“There are other children who are in the hospital with them, and who are sharing their room or who are in other public spaces in the hospital.”
Hospitals are extra concerned about the potential surge in other respiratory illnesses as society starts to open up. In the U.K., hospitals saw an uptick in cases of respiratory syncytial virus (RSV) — a common virus that affects the lungs and breathing tubes, and that is often most severe in babies. States like Texas are facing a similar surge of RSV.
Now, Canada is bracing for its own wave of the respiratory illness.
“I think the one thing we’ve learned from COVID-19, if nothing else … there is no exceptionalism,” Thampi said.
“If we’re seeing things happen in other settings. We’d do well to learn from them and try to get ahead of those situations.”
Doctors are worried about the effect these common, seasonal viruses could have as more and more kids contract COVID-19 — a disease that also pummels the respiratory system.
“What we are still learning about is the impact of co-circulating viruses: whether they have an impact on kids’ ability to manage their COVID-19 infection, or on their susceptibility to COVID-19 infections,” Thampi said.
Keeping kids safe
Luckily, parents and society alike have a number of tools at their disposal that they can deploy to keep their kids safe, even in light of the Delta variants.
The same public health measures that help to keep adults safe from the virus can boost kids’ safety, too, including at schools.
“It’s the combination of different interventions that can actually reduce transmission in schools to basically the same level of risk as anybody else in the community,” said Papenburg.
“So whether that be wearing masks, cohorting, improv(ing) ventilation, social distancing — especially when it comes to mealtime — all these things together help make schools a safe place, even for children who are too young to get vaccinated.”
Parents can also choose to continue meeting friends outside, distancing and masking — even as restrictions lift and they get fully vaccinated, Thampi said.
That’s because, as the CDC has warned, fully vaccinated people infected with Delta carry a similarly high viral load to unvaccinated people.
“High viral loads suggest an increased risk of transmission and raised concern that, unlike with other variants, vaccinated people infected with Delta can transmit the virus,” the CDC wrote in a statement in late July.
That means, for Thampi, protecting kids means holding on a bit longer.
“Until we have a better understanding of what the Delta variant means in kids, I am more cautious and I would like to see a more cautious approach to August at a societal level,” she said.