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Q&A With UK Pediatricians on the Rise of COVID-19 Infections in Children

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LEXINGTON, Ky. (Aug. 13, 2021) ­— As the delta variant continues to drive COVID-19 infections to increase all over the world, taking measures to protect yourself, your loved ones and your community is more important than ever.

A panel of experts from Kentucky Children’s Hospital (KCH) convened to address some of the questions about the latest surge in infections and how it’s impacting children. Dr. Scottie B. Day, KCH physician-in-chief, Dr. Sean McTigue, medical director for pediatric infection prevention and control, Dr. George Fuchs, principal investigator for the KIDCOVE Moderna trial at UK HealthCare, and Dr. Matthew Bacon, interim chief of pediatric critical care medicine at KCH, addressed how the current public health crisis is impacting children.

Since the pandemic began, KCH has seen 10 children admitted for severe COVID-19, eight of whom were old enough to be vaccinated. Twenty-six children were admitted with multisystem inflammatory syndrome in children (MIS-C), a serious complication associated with COVID-19.

MIS-C is a rare but serious condition associated with COVID-19 in which different body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs.

“Four hundred children have died (in the U.S.),” said Fuchs. “It might not seem like that many. But even if it was one in a thousand, that’s still your child.”

Early in the pandemic, children were not considered to have a high risk of contracting COVID-19. What changed?

McTigue: In the interest of complete honesty, there is some truth in that the vast majority of children who do become infected with COVID will either be asymptomatic or mildly symptomatic. However, there is no way to assure that your child is going to be the one who is asymptomatic or mildly symptomatic, as opposed to one who winds up with severe COVID.

During this past month, we've been seeing a rise in the delta variant, which is a much more contagious stream of COVID-19 than earlier strains. We're starting to see more and more children becoming infected. This is a pandemic of the unimmunized. Older people are more likely to be immunized than younger people, and children under 12 aren’t immunized at all.

What sort of increases are we seeing?

Day: As we look across the country, the number of children who are testing positive make up as much as 70% of total cases, but we know that many children are not being tested across the country making it kind of difficult for us to understand what's happening. We do know that hotspot areas with high rates of infections in adults also have high rates of infections in kids.

McTigue: Since the beginning of the pandemic, we've treated 10 kids for severe COVID, which doesn't sound like a lot. However, four of those have been within the past two weeks, and two of those were within the past two days. Eight of those ten have been in children who are over the age of 12 and therefore eligible for COVID-19 vaccine.

What are the potential complications children experience?

Bacon: It’s important for everyone to know that children can get quite ill, both with severe COVID-19 that requires oxygen support and with MIS-C, which we’ve seen quite a lot of. And it’s not just a one- or two-day hospital stay. Most of them stay in the hospital for quite a long time, and require essentially life support, the most extreme therapy to keep them alive.

What are some of the risk factors? Are some children more susceptible than others?

McTigue: It's older children, particularly teenagers — also known as those who are eligible for immunization — who are overwhelmingly the ones who are more likely to get severe COVID. Children with things like immune-suppressing conditions and cancer. Obesity is a huge driver of the increased risk for severe COVID. That's important because obesity is incredibly common, not just nationwide, but also in our state. So for these kids who may be overweight or obese, it’s even more important for them to get protected. Also, there are some racial disparities. African Americans in particular are at higher risk of severe COVID and MIS-C. So there are definitely pockets of children who are at higher risk than average, but for any child, the risk is certainly not zero.

Can hospitals handle a surge of pediatric COVID-19 patients?

Bacon: Right now we have capacity. But we’re seeing a spike in other respiratory diseases that we don’t normally see this time of year. With the influx of MIS-C patients, we may not have the capacity. KCH and Norton Children’s Hospital in Louisville are equipped with pediatric specialists that regional hospitals don’t have.

McTigue: You can have capacity in the hospital where you have open beds, but you might not necessarily have the right type of beds. The ICU has very different type of capacity than just having a bed available on the general children's floor. Patients that are admitted with COVID-19 infection require airborne isolation, so they need a separate type of room that has negative pressure — meaning when the door is open, air is flowing into the room as opposed to flowing outside the room. So you may potentially have beds available, not necessarily have the right type of beds.

What would you say to parents who are on the fence about having their children vaccinated?

McTigue: The data is very robust showing that this is a very effective vaccine. Regarding efficacy, the vaccines are almost 100% effective at preventing death and severe illness with hospitalizationin the ICU with life support. I would say absolutely you should go and get your children vaccinated.

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