'As Contagious As Chickenpox': What To Know About Children And COVID-19
Dr. Juan Dumois, a pediatric infectious disease specialist at Johns Hopkins All Children's Hospital, cites the importance of masks and unpredictability of complications like MIS-C.
Children are increasingly becoming infected by coronavirus, as cases and hospitalizations surge in Florida. Data from the Centers for Disease Control and Prevention show Florida leads the nation in the rate of children hospitalized.
In the last week of July, there were 32 pediatric COVID-19 hospitalizations per day, which when adjusted for population equals 0.76 kids hospitalized per 100,000 residents.
Staff at Johns Hopkins All Children's Hospital in St. Petersburg "have been extremely busy caring for pediatric patients diagnosed with COVID-19 in the past few weeks as we've seen one of the highest increases in COVID-19 cases at our hospital since the beginning of the pandemic," said Vice President and Chief Patient Safety and Quality Officer Angela Green.
Fifteen children with COVID-19 were admitted to the hospital as of Tuesday, with four in the ICU, Green said. Hospitalization rates at All Children's have stayed steady, but positive diagnoses have skyrocketed — from 12 positive tests among children in June to 181 in July. Last week alone, 74 children tested positive.
With Florida schools on the verge of reopening for fall, and masks widely optional due to an executive order by Gov. Ron DeSantis, many parents are concerned about the risks to children, especially those who are too young to get vaccinated.
WUSF's Kerry Sheridan spoke with Dr. Juan Dumois, a pediatric infectious disease specialist at All Children's about the risks and what's driving the surge.
What should people understand about the delta variant?
DUMOIS: This delta variant is so much more contagious than the COVID we were seeing a year ago that it is becoming one of the most contagious viruses we have ever seen. It is almost as contagious as chickenpox. Chickenpox is so contagious, that if you had a patient sitting in a room with chickenpox, someone walking by in the hallway outside the room with that door open could catch it. That's how contagious it was -- just breathing the same air from an adjacent room.
And that's what we're starting to see with the delta variant. And we think that the most common reason that the delta variant is more contagious is that there's more virus in your mucus and in your saliva when you're sick. So, in one estimate, the amount of virus in your mucus with the delta variant is 1,000 times more virus than if you had COVID-19 last year. That's why it's more contagious. That's why you're going to get it if you're not vaccinated.
And if you're vaccinated, you might get infected, but you're not likely to end up in the hospital or die from it. That's how protective the vaccines are.
So with school starting and masks optional across most of the state, how effective are masks going to be if only some of the children are wearing them?
The fewer people that are wearing masks, the less likely you can mitigate the spread. So, for example, let's say half of kids are wearing masks in the classroom. If an unmasked child comes to school, and they are infected with the coronavirus, they can start spreading it. It'll just be in their environment, it will be in the air of their classroom.
The children who are wearing a mask in that classroom, the 50%, who are wearing a mask, they're not as likely to get it, but that one sick child will infect some of the other unmasked children. And once you have a couple of kids in a classroom, they'll have to shut down that classroom for 14 days. Even the masked kids in that classroom will have to be sent home and quarantined for 14 days. And so, practically speaking, if most of the kids aren't wearing the masks in class, then the chance of spread to any other child can shut down a classroom or the entire school.
So what do you think we’ll see when schools open?
I think we're gonna see a lot more schools shutting down more quickly this year than when school started last year because of the delta variant. It is that much more contagious.
What are you seeing in your hospital right now in terms of kids being diagnosed with coronavirus?
We are seeing more kids being diagnosed with coronavirus. Most of them are diagnosed in the emergency center because we have a rapid diagnostic test and they are sent home. They're not sick enough to be hospitalized. We do have some children who are being hospitalized, they need oxygen for a few days, or in some cases, they're much sicker.
Some need to be in the intensive care unit, to either be on a ventilator or sometimes they present with a form of COVID-19 disease that affects children primarily called multisystem inflammatory syndrome or MIS-C (the "C" is for children). That is a condition where the SARS coronavirus-2 tends to stimulate the immune system to just attack the whole body. And very often these children have inflammation in the heart. So we have to monitor their heart function very closely over several days and,and treat them aggressively. Most of them do well, but it's a serious illness.
What are some of the top myths or misunderstandings that people have about COVID and children?
The No. is that kids don't get COVID, or they don't get it bad. It is correct to say that for most kids, if they get COVID-19, they will recover and be fine. But even though the chance of your child getting hospitalized for COVID or dying of COVID is low, if it happens to your child, it doesn't matter how rare it is. It's 100% if it happened to your child.
And children have died of COVID. And unfortunately, we've even seen that happen at our hospital, some children have died of COVID. And sometimes it's a totally healthy child, it is not just children with underlying medical conditions who have been hospitalized or died of COVID.
So it’s unpredictable. What about the vaccines available for kids 12 and up? What do we know about how safe they are?
We've got really good information from over 150 million people getting these mRNA vaccines and hundreds of thousands getting some of the other vaccines showing that the safety is far safer than getting COVID. You're far more likely to suffer severe effects and many times long term effects like long COVID if you get COVID-19, than anything like that after the vaccine.
Most schools in Florida are not challenging the governor's order, which makes masks optional. What should schools do in the absence of mask mandates?
Without any mask mandate in school, what I think schools should endeavor to do is to communicate as effectively as possible to the parents the importance of masking to prevent closing down the school. Because in the studies of how schools functioned last year, the schools that did the best at not having to shut down and mitigating the spread of COVID-19 within those schools, they had the kids wear masks.
Mask-wearing seemed to be more important than social distancing. The science has shown that the school is far less likely to have to shut down either a classroom or the entire school if they had consistent mask-wearing by the staff and the students all year long.
So if schools can, focus on talking to parents, (saying) if you allow your child to wear a mask all day at school, we're less likely to have to send them home for 14 days of quarantine, and you having to figure out what you're going to do with them for two weeks.
What do you think of the emphasis on parental choice in these matters?
I think that it puts too much on the parents. Parents have enough to worry about just getting their kids ready to school while also dealing with their own work responsibilities and other personal issues that are going on. And then to have to make a conscious decision of the importance of wearing a mask and the effects on their own family and that of all the other children in the school. I think that's too much on parents.
It's hard enough for me, as an infectious disease specialist. And it's my job to keep up to date on what's going on with COVID-19. To expect people who don't have the medical background that I have, and do that efficiently? It's not practical. So I think that parents not only look for guidance from their doctors, they look for guidance from the schools and their trusted people in their schools like the teachers and the principals. They will listen to those people, if the message is communicated properly.
So that's why I think right now with the way mask mandates are forbidden in the schools, it's now falling upon each school principal to communicate the importance of mask-wearing to the parents.
How has this pandemic changed over time, in terms of the age and overall health of the people infected?
Now what we're seeing is that the majority of people who are being hospitalized with bad COVID-19 are younger, and many of them were previously healthy. They are not younger people who had a lot of medical conditions to start with. And they're sick enough to not only feel terrible, but they need oxygen. They can't survive outside the hospital. So that's been one big change.
Another very interesting phenomenon that's occurred, especially in children, has been that the effects of trying to mitigate the spread of COVID-19 with social distancing, not going out, wearing of masks outdoors, has completely altered what we normally see with winter virus season.
Normally every winter, we see spread of several contagious viruses and children. They're called influenza, parainfluenza, RSV, adenovirus. And it almost did not happen at all. We saw just a few cases all winter long. And it was because those viruses are spread very similar to how COVID-19 is spread. And by limiting the spread of COVID-19, we had an even stronger effect in limiting the spread of these other viruses, which are less contagious than COVID-19.
And with the release of certain restrictions, masking guidelines, opening up of restaurants and people not wearing masks out in public, we have now seen that these common winter viruses are now peaking in the middle of the summer. And I've never seen that. And I've been doing this for over 30 years. So it's a very interesting phenomenon, where our human behavior has totally changed the epidemiology of these viruses.
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