"Unprecedented" ... "historic volumes" ... "crisis mode." These terms have been used repeatedly over the past 2 months as pediatric hospitals, emergency departments, and pediatricians' offices have been strained with the recent surge in Delta variant COVID-19 cases. Unusually high rates of seasonal respiratory viruses such as respiratory syncytial (RSV), rhinovirus, and parainfluenza have compounded the problem -- viruses that largely spared kids last year, even while attending school. As COVID-19 cases declined during late spring, people stopped wearing masks, and resumed social engagements and large group gatherings. This made sense at the time and all of us welcomed the opportunity to try and return to some sense of normalcy.
But the first clues indicating bad news for kids began in early summer, and since then, several issues have trickled down to create a deeply concerning situation for the youngest members of our country.
It began with another respiratory virus. In June, pediatric hospitals started seeing cases of RSV, which is almost unheard of in the summer months in the U.S. Typically, RSV circulates widely every autumn and winter and can cause severe illness among infants as it fills their tiny lower airways with mucous and inflammation. But this year, cases of RSV through July and August, joined by other viruses typically seen in the winter. Soon thereafter, the Delta variant ripped through the unvaccinated population, causing surges in hospitalizations and demand for ICU beds. Children are now being affected with dramatic rises in COVID-19 cases, reaching numbers higher than at any point in the pandemic to date.
Infections are spreading rapidly. Pandemics are about math. Although children, in general, are at lower risk for severe illness from COVID-19 compared with adults, as more children have become infected, the absolute numbers of children requiring hospitalization has increased. And as children return to school, with variable masking policies throughout the country, rates of COVID-19 transmission within schools as well. This not only leads to increased infections, but increased need for testing and quarantines for close contacts. Widespread transmission among children interferes with their ability to attend school and clogs pediatric offices and emergency departments as families seek testing options.
The healthcare system is severely strained. The rise in COVID-19 cases and other viral infections among children have strained staffing and availability of inpatient hospital beds, and has resulted in exceptionally long wait times at emergency departments. Pediatricians and all pediatric healthcare professionals are exhausted as they treat volumes of patients typically only seen in January or February. Parents are stressed and exhausted as they navigate all of the external factors that impact their child's health. Children will still suffer from broken bones, appendicitis, cancer, and all of the other normal pediatric concerns that require treatment. But now, they either have to potentially expose themselves to COVID-19 in crowded waiting rooms or wait prolonged times to be seen. Many pediatric conditions require prompt diagnosis and treatment in order to prevent avoidable complications. Appendices that rupture require surgery. Delayed treatment of asthma exacerbations may require hospitalization instead of a few hours of breathing treatments in the emergency department. This is problematic and strains the entire system with children left to suffer. The CEOs of four large hospitals in central Ohio penned an in late August explaining this exact trickle-down effect and how pediatric hospitals may be forced to adopt extreme measures similar to adult hospitals last year with cancellation of elective surgeries or procedures.
The pandemic just won't end. Suboptimal vaccination rates among adults and eligible children and adolescents, anti-mask sentiments, conspiracy theorists, and many elected officials are all actively prolonging the COVID-19 pandemic. We have a safe and highly effective path toward ending the pandemic while reducing the toll that comes from infection and death. COVID-19 denialists like to point to "only" 500 deaths among children or the generally milder infections they experience. This is not just disrespectful to those who have suffered from COVID-19, but this neglects to consider the massive collateral effect on children. It's not just about missed school due to infection or quarantine; it's now impacting the entire healthcare system.
So, what can we do? There are some simple steps we can all take to help curb the rise in COVID-19 cases and ultimately lessen the downstream effect on children. All eligible individuals 12 years of age and older who have not been vaccinated should receive the very safe and highly effective COVID-19 vaccine. We can all wear masks when indoors and avoid large group gatherings, particularly among people who are not vaccinated. Healthcare professionals can take every opportunity to discuss COVID-19 prevention strategies with their patients, the general public, friends, family, and neighbors. As Surgeon General Vivek Murthy, MD, discussed in . "Limiting the spread of health misinformation is a moral and civic imperative that will require a whole-of-society effort."
I hope we'll see a decline in COVID-19 and other infections among children soon. I hope we have another mild influenza season. I hope we all get a break from this pandemic as soon as possible. Unfortunately, hope is not a strategy nor a solution. Conveniently enough, we actually have both a strategy and solution available, should enough people decide to contribute.
, is professor of clinical pediatrics in the Division of Allergy/Immunology at Nationwide Children's Hospital.