MarkAlain Déry, DO, MPH, FACOI

A Public Health Perspective

COVID-19 in Children; Updates on Vaccination for Pregnant Women

by MarkAlain Déry, DO, MPH, FACOI
Infectious Disease Specialist

August 17, 2021

We’re getting back to COVID-19 news this week because it is simply too big of a story to skip over. So what’s going on?

  • Kids are going back to school and school districts are pitted against some governors on mask mandates.
  • We have a large population of unvaccinated pregnant women and the danger of the Delta variant
  • Some hotspots that are putting hospitals over capacity creating a strain on all of us in healthcare

Hot Spots and Vaccines for Pregnant Women


First, the hot spots. This week I saw a video from Dr. Catherine O’Neal, chief medical officer at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, just up the road from New Orleans where I am, and she articulated some sobering realities that I too have been seeing here in Louisiana as well as in other places in the country. Her hospital and many others have few if any beds left, and even worse, staff shortages that have reached critical levels. Dr. O’Neal gives some pretty frightening facts: a little more than two weeks ago her hospital had 36 COVID-19 patients in the hospital. As of the day of her press briefing, they had 155 – reflecting their max from April 2020. She represents the largest hospital in the state with nearly 800 beds. She reported that they had 713 people admitted that day.  She is concerned that the people who come in with traumatic injuries from everyday mishaps like four-wheeler accidents or motorcycle accidents or farming accidents won’t be able to get the care they need because of staff and bed shortages.

 

To illustrate with a specific example, Joe Kanter, Louisiana’s chief public health officer, reported that one person who suffered a heart attack was bounced from six hospitals before finding an emergency room in New Orleans that could take him in. As of now, Florida, Arkansas, Louisiana, and Oregon all have more people hospitalized with COVID-19 than at any other point in the pandemic, and nursing staffs are badly strained.

It’s hurting all of us. It’s hurting those of us caring for patients as we see our teams or ourselves hit a wall. It is hurting people who are having medical emergencies and cannot get care. Now there’s a group of people who are in extreme danger because of two things that are coming together like a perfect storm – this group’s low vaccination rates and the how prolific the Delta variant is. Who is that group you ask? Pregnant women.

The CDC is urgently calling for pregnant women to get vaccinated. Why now? Because new data has surfaced about the safety and efficacy of the vaccines for pregnant women – whether taking them early, mid-term, or late in pregnancy. And that recommendation also extends to breastfeeding moms. The low vaccination rate in this group is a huge concern. According to the CDC, as of July 31, only 23% of those who are pregnant had received at least one dose of vaccine. Pregnant moms are going to the hospital very sick and needing oxygen. Some who survive are facing a lifetime of disabilities as a result. Two organizations, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine have sent out formal statements urging the vaccine for all pregnant women.

A Texas physician who has seen a dramatic increase in pregnant women being hospitalized with COVID commented that the danger of COVID-19 isn’t just for the moms, but the fetuses too, with complications that include preterm birth and prematurity. Because of increased risk of preeclampsia for these moms there is a high chance for a preterm delivery.

We have a public health emergency that could be controlled if everyone got vaccinated. It’s very taxing for us in healthcare to see this unfolding needlessly. I have stories of plenty of individuals who are on their deathbeds and begging for the vaccine. It is too late for them and a grueling heartbreak for those of us caring for them. Tell your patients to get vaccinated.

COVID: Schools and Children
 

I am hoping that for some who remain unvaccinated the weight of the responsibility of how they are contributing to the pandemic by infecting our kids will help them change their ways. I am talking about the plethora of cases now in children.

Dr. Mark Kline, physician and chief of Children's Hospital here in New Orleans reported a few days ago that the positivity rate for children in our outpatient settings increased from 1% a month ago, to 7% two weeks ago, to 20% now. According to our governor, more than 6,000 Louisiana children now have COVID-19. Governor Edwards said this is the most positive cases in children since the pandemic began.

We’ve had an RSV epidemic here in the South and now on top of that the Delta variant is creating additional illness with kids getting pneumonia-like symptoms such as respiratory distress, low blood oxygen concentration and requiring supplemental oxygen needs. At last count 18 children are hospitalized now – the youngest being 7 weeks old. One of the patients on a ventilator is 3 months old. 

It’s easy for some to say kids can recover just fine and very few will have serious issues, but what is not known are the long-term effects. Governor Edwards stressed that this is why children should be wearing masks when they return to school in the coming days. This week in the US roughly a quarter of American kids are headed back to school. Unfortunately, we are seeing measures by some states discouraging school districts from requiring masks and  even punishments for doing so! 

School districts are fighting back: Dallas Independent School District and Austin Independent School District, two of the largest districts in Texas, announced Monday that all students and staff would be required to wear masks beginning this week, even though Texas Gov. Greg Abbott had banned schools from requiring masks. Other school districts in other states, including Florida and Arizona are similarly facing the same bans that their governors are pushing. This is putting school superintendents in tenuous positions. They are publicly stating that they are responsible for the health and wellbeing of their students and their staffs and so they are openly defying these anti-mask mandates.

Look at the numbers, just 29% of 12- to 15-year-olds in the U.S. as of August 4 were fully vaccinated against COVID-19 according to data from the American Academy of Pediatrics. Children under 12 are not yet eligible for COVID-19 vaccines so none of them are vaccinated. Schools are hoping that other precautions—including masks, physical distancing, and ventilation—can be adhered to in order to keep children safe from the virus.

Families are being put in a tough spot too – with some schools having no mask mandates and the inability to go virtual, some are masking their kids hoping for the best. That isn’t how the first days of school should be – with parents crossing their fingers that their kids don’t get sick. Even in counties where the public health director is advising to follow CDC recommendations that everybody in K through 12 needs to wear their masks, some school districts like Cobb County Schools in Georgia are refusing to require masks.

From a public health perspective this should be non-negotiable and in fact, most Americans seem to agree. A Kaiser Family Foundation survey released this week shows that 62% of parents of children aged 5 to 17 think their child's school should require unvaccinated students and staff to wear masks.

We’re already seeing the flood of cases due to the school year starting. A school in Clayton County, just south of Atlanta, already shuttered an elementary school and returned to virtual learning for a week as a precaution, citing COVID-19 transmission rates. Across Mississippi, nearly 5,000 children, educators and school staff were quarantined after 69 outbreaks were reported between Aug. 2-6 – the second week of school for some districts – nearly 1,000 children and 300 teachers and staff tested positive for COVID-19, according to a weekly report from Mississippi's Department of Health.

The idea that we are somehow politicizing the wearing of masks, citing zero science, is something we need to fight back against. Stay on the lookout for these updates and check the sources below to read more.

Sources:

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