As students head back to in-person school, many parents and guardians across South Florida are nervously awaiting the potential for outbreaks of COVID-19 cases that could arise once millions of children come together again.
Their fears are not unwarranted, University of Miami pediatricians say. In July, as the highly contagious Delta variant drove up the number of cases of COVID-19, children—previously seen as a tiny subset of patients with this evolving disease—started being afflicted by the illness more often. Local children’s hospitals are now reporting more cases and according to the American Academy of Pediatrics, last week 18 percent of the nation’s COVID-19 cases were children. University of Miami pediatricians say that number may rise as children head back to school. However, they added that there are ways that parents, guardians, and school personnel can help safeguard students from being infected. And these pediatricians all remain hopeful that COVID-19 vaccines will be approved for children younger than 12 years old this winter.
The following pediatricians answered some questions about how the Delta variant is impacting children and about how adults can help curb the spread.
- Charles Mitchell is an infectious disease specialist and professor in the Department of Pediatrics at the Miller School of Medicine, where he has been teaching and treating patients at Holtz Children’s Hospital for three decades.
- Lisa Gwynn is an associate professor of pediatrics and public health and serves as interim division chief of child and adolescent health in the Department of Pediatrics. She is also director of the Pediatric Mobile Clinic, which offers free COVID-19 tests and vaccinations, along with all routine school vaccinations, to children across Miami-Dade County. Gwynn also serves on the superintendent’s school health task force for Miami-Dade County Public Schools and is president of the Florida chapter of the American Academy of Pediatrics.
- Michael Nares is an intensive care specialist and associate professor of clinical pediatrics in the Department of Pediatrics at the Miller School.
- Melvin Almodovar is chief of pediatric cardiology and director of the Children’s Heart Center in the Department of Pediatrics at the Miller School.
As a result of the Delta surge, are you seeing more children with COVID-19 in the hospitals and at the clinics?
Mitchell: We are definitely seeing an upswing in the number of hospitalized children now. During the early stages of the pandemic, we were treating mostly adults in higher risk groups, and we were seeing some multisystem inflammatory syndrome (MIS-C) in children (which typically occurs after an asymptomatic COVID-19 infection), but we aren’t seeing that as much now. Most kids admitted to the hospital at this point have more symptomatic, acute COVID-19, meaning pneumonia symptoms. That’s different from last year. Also, lots of these patients do have risk factors like obesity, cystic fibrosis, and pulmonary disorders, which are all conditions that have been recognized among adults as factors that increase the chance of hospitalization for COVID-19.
Nares: Yes, we are seeing more COVID-19 pneumonia in patients at Holtz Children’s Hospital. And yes, they are still a small percentage of the total amount of COVID-19 hospitalized patients. About 2 percent of the hospitalized patients in the Jackson Memorial System are pediatric, but only 0.5-1 percent of all the COVID-19 positive patients are in our Intensive Care Unit.
What sort of symptoms should parents and guardians look for if they suspect their child may have COVID-19?
Mitchell: There are the usual symptoms we learned of earlier in the pandemic in adults—like shortness of breath, fever, and loss of taste or smell for a short time. But now we are also seeing more runny noses, coughing, and sneezing, too. If the coughing gets worse as the virus progresses, if a child is struggling to breathe or can’t sleep or lay down, and if they are excessively tired during the day, or if they have a persistent fever, these are all things to look for and may indicate they need to get checked at a hospital.
Gwynn: If kids get a cold, they need to get checked for COVID-19.
Almodovar: As we are learning more about the Delta variant, we are noticing that the illness can evolve very rapidly. A child can start out with symptoms that seem like a cold, but it can quickly involve the lungs, heart, and other systems in the body and the transition can be very rapid.
Symptoms like a runny nose, cough, low-grade fever, or muscle aches should prompt a parent to reach out to their pediatrician to make sure it’s not COVID-19. But if they are mentioning a fluttering in the chest or their heart racing, any difficulty breathing or an inability to lie flat, those demand a prompt response from the parent and evaluation by a pediatrician or hospital.
How can children be protected from catching COVID-19 at school and elsewhere during the current surge?
Gwynn: Unfortunately, we are in the same position we were a year ago, and nothing has changed for those who aren’t vaccinated. Therefore, wearing a mask is the only way to protect kids younger than 12 years old. And now that we’ve learned that even vaccinated children and adults can still transmit the virus with the Delta variant, they need to wear a mask, too. If everyone wears a mask, hopefully, that should minimize the spread of the virus.
Children should also sanitize their hands as often as possible and keep their distance from other kids at school as much as possible.
In addition, the adults who are around children need to get vaccinated, too. Because the more this virus lives in humans, the more virulent it can become. That means the more humans who harbor COVID-19, the more the virus can mutate, and the stronger and more deadly it can get. We know how to get out of this pandemic—with masks, vaccines, and distancing and that’s all we can do.
Mitchell: The CDC has encouraged the use of masks in schools among children and staff. I think this will be critically important, but even more important is ensuring that all the teachers, the school staff, and the families of students are all vaccinated—to establish a ring of protection around the children.
Nares: Another good public health measure is that children should not be sent to school if they have a fever or symptoms of a cold.
Almodovar: One of the things we can do to help protect our kids is to get vaccinated, because that will reduce their exposure to COVID-19. And when the FDA approves emergency use of COVID-19 vaccines for kids under 12, parents should seriously consider it.
Many parents with children older than the age of 12 are fearful about vaccinating them because of the possible side effects—such as myocarditis among teenage boys—so they choose not to. What do you think about this decision?
Almodovar: Myocarditis is an inflammatory condition of the heart muscle where the heart’s pumping ability can weaken, possibly with the development of extra heartbeats or arrhythmias. If the heart muscle is significantly weakened, heart failure symptoms can develop. These include excessive tiredness, chest pain, difficulty breathing, abdominal pain, and even anxiety. In addition, extra heart beats (or arrhythmias) can lead to a feeling that the heart is racing or fluttering. Myocarditis is readily diagnosed by a cardiologist and, fortunately, myocarditis in children—that results in hospitalization or the need for intensive care—is extremely rare, even in the era of COVID-19. At Holtz Children’s Hospital, we have not seen an increased rate of myocarditis that we attribute to active COVID-19 infection or COVID-19 vaccinations.
We had two teenage patients this spring and early summer who presented with myocarditis a few days after being vaccinated, and—like many of the small number of patients reported to the CDC’s vaccine reporting registry—both were treated and recovered with a short hospital stay. We have also seen kids with myocarditis who were not vaccinated, but coincidentally had evidence of a previous asymptomatic COVID-19 infection based on antibody testing. This raises the question of whether there are any delayed effects of a primary COVID-19 infection.
Still, in my view, the risk of significant illness, including myocarditis, from COVID-19 vaccines appears to be low. I have 12- and 14-year-old children who are vaccinated because the risk of any significant vaccine-related side effects is very low, and it is lower than the risks of becoming sick and possibly dying from a COVID-19 infection, or its related condition, MIS-C.
Gwynn: We look at the risks and benefits with every single vaccine that comes out; and without a vaccine, your child is more likely to get COVID-19 and can get very sick with complications—including myocarditis—as opposed to the very small chance of having side effects from the vaccine. Those teens and young adults who got myocarditis following the vaccine had very mild cases and all had a complete recovery. We don’t know how COVID-19 affects everyone and your child may be the one who has severe complications from it, such as long haul COVID-19 syndrome, or others.
Nares: The risks of side effects or complications from the vaccine are much, much, much less than the possible consequences of an infection with COVID-19. For the record, I have 15-year-old twins, and both were vaccinated as soon as the vaccine was available for their age group.
If you would like to get your child tested or vaccinated for COVID-19 free of charge, the Pediatric Mobile Clinic and its Shotz-2-Go van is visiting schools and other locations in Miami-Dade County each week. Check their schedule; or call 305-243-6407 to get more information.
