Katelyn Jetelina, PhD, MPH, flew out to California from Texas to be with family for the holidays. She and her family played it as safe as possible, since her two girls -- ages 14 months and 2.5 years -- can't be vaccinated against COVID-19 yet.
Everyone got a PCR test before they flew. They did rapid antigen tests daily while quarantining in California ahead of gathering with family for Christmas.
On the morning of Christmas Eve, her 14-month-old tested positive.
"We were all very shocked," Jetelina told MedPage Today. "There was too much time between the flight and the positive test, so she didn't get it there. We have no idea where she got it. We haven't been doing much besides going to the beach."
Jetelina, an epidemiologist at UT Health Science Center at Houston, is among the many parents with children too young to be vaccinated.
It's a challenging time for these parents. The data show that most children fight off a COVID-19 infection without any problem -- but many parents are risk-averse, as small as that risk may be.
"It's a really tough balance for parents right now," Jetelina said. "You don't want to take this lightly, but don't want to paralyze your life, either."
A Difficult Line to Walk
Nicole Baldwin, MD, a pediatrician in private practice in Cincinnati, emphasized that kids without underlying risk factors fare very well with COVID.
"The hospitalization rate is still low in kids, and the death rate is very, very low," she said. "While it's important that parents stay vigilant, it's a fine line to walk figuring out, 'What do I still need to be afraid of, and where can I let my guard down and allow more normalcy back into my life?'"
Like Jetelina, Leana Wen, MD, of George Washington University in Washington, D.C., also has two children under 5 who can't be vaccinated.
"It's a difficult time for us," she said. "There's just so much virus around. It's an extremely challenging time to try to protect our children."
One of the hardest parts is that there are so many different interpretations as to how to move forward, and they're all very reasonable, Wen noted.
"We're at a point in the pandemic where people have different realities based on individual circumstances. A family that's healthy, vaccinated, and boosted could very reasonably decide they're going to be exposed if they haven't already, and the risk to their unvaccinated young child is low," she said.
"At the same time, a family with a child who has an underlying medical condition or is immunocompromised wants to take many additional precautions," she added. "That's a reasonable decision based on those circumstances."
By the Numbers
Pediatric COVID-19 cases in the U.S. are at an all-time high. According to the latest report from the American Academy of Pediatrics (AAP), there were 325,340 pediatric cases in the week ending Dec. 30, 2021 -- topping the fall Delta surge peak of 251,781 cases for the week ending September 2.
Pediatric hospitalizations are also the highest they've ever been, with a current 7-day average of 574 daily admissions in kids under 18 -- up from the previous week's 7-day average of 294, according to the latest CDC data.
That translates to about 0.8 new admissions per 100,000 population ages 0 to 17.
Pediatric mortality from COVID-19 also remains very low, with 735 deaths since May 2020, according to the AAP data. Pediatric deaths make up just 0.1% of total COVID-19 deaths, and only 0.01% of pediatric cases have resulted in death, according to the AAP.
Still, Wen noted that COVID in kids is not something to take lightly: "It's so disturbing that COVID came out of nowhere to become one of the leading causes of death among children," she said. "The risk to an individual child of severe illness is thankfully very low. However, children do become ill, and some become severely ill. This is not a trivial illness."
Baldwin pointed out that "with so many more cases, we're definitely going to have more children hospitalized." While the Omicron variant is likely leading to less severe illness for both adults and children, the sheer number of children infected is leading to an expected uptick in hospitalizations.
Indeed, some children's hospitals are busier than they've ever been. CNN reported that Texas Children's Hospital is currently treating 70 patients, a more than four-fold rise in the last 2 weeks alone.
Baldwin said that with other respiratory illnesses going around among kids, in addition to illness among hospital staff, "there's huge stress on children's hospitals right now, and whatever we can do to keep the family healthy and out of the hospital is a good idea."
Other worries for parents of kids under 5 include long COVID and the inflammatory condition MIS-C.
When it comes to long COVID in kids, the picture in the U.S. isn't clear, Jetelina said. She noted that the U.K. has estimated around 7% of kids with COVID will develop long COVID, and the Swiss estimate puts that figure at just 3%.
Either way, the estimates are "much lower than the 10% to 30% we're seeing in adults, which is very reassuring," she noted.
Finally, when it comes to MIS-C, the CDC reports that there have been about 6,000 cases in the U.S., and most children have recovered, though there have been 52 deaths.
In the Meantime
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, has previously said that data on a three-dose vaccine series from Pfizer for kids under 5 aren't expected until the end of the first quarter of 2022, meaning vaccines for this population won't be available until "a few months into 2022."
In the meantime, Baldwin said parents of kids under 5 who can't be vaccinated "have to control what we can control. ... We can't forget about masking, ventilation, and testing. We have to do what we can with what's available."
She also said that everyone around those children should be vaccinated and boosted, including teachers and daycare professionals, who should also be wearing masks.
Wen added that all siblings ages 5 and up should be vaccinated as well. But vaccination rates remain abysmally low among eligible kids. According to CNN, only 9% of kids ages 5 to 12 are fully vaccinated, and among those ages 12 to 15, only 51% are fully vaccinated.
Baldwin was just getting over COVID-19 when she spoke with MedPage Today on Monday. She had only mild symptoms -- a sore throat and a runny nose for a few days -- which she attributes to being boosted.
She was feeling back to normal 5 days after her symptoms started and was eager to get back to her pediatric practice to help out other staffers, many of whom "have kids home with COVID right now."
"What's so hard about this now is that it's happening to everybody," she said. "But we'll get through it."
Jetelina's youngest daughter developed symptoms after her positive rapid test -- a low-grade fever, "a lot of snot," and a lot of crankiness. It all lasted about 7 days, Jetelina said.
Jetelina and her 2.5-year-old both developed very mild symptoms, and Jetelina's husband remained symptom-free, which she attributes to both of them being boosted: "We may be proof that boosters are working," she said.
One of the most important things to remember during this Omicron surge, she noted, is that "even if your family gets infected, it doesn't mean you failed as a parent. It's more an indication of how transmissible Omicron is, and how much community transmission we have now."
https://www.medpagetoday.com/special-reports/exclusives/96510
