#childsafety | Texas Children’s has diagnosed more than 10K cases of COVID in kids. Here’s what you need to know.

As adults across the U.S. are vaccinated against COVID-19, many parents have vaccine questions related to kids. To answer them, we turned to Jim Versalovic, the interim pediatrician-in-chief of Texas Children’s Hospital.

Could you start with the big picture? What’s the most important things to know about kids and the COVID vaccines?

First of all, you should know that children certainly can be infected with COVID-19. They definitely are vulnerable. We need to be safe with our children — in our households, in schools and throughout our communities. We need to be vigilant and continue to promote safe behavior with our children.

Yes, it’s true that COVID-19 has a much greater impact on older adults. There’s no question about that in terms of hospitalization and mortality. But children can be infected. They can get sick with COVID. And yes, there are children that have to be hospitalized. We’re taking care of many of these children at Texas Children’s.

Spring break is coming. What recommendations do you have for parents and students?

Let’s start first with college students. We certainly know that older adolescents and young adults can have severe COVID infections. Any young adult who has a chronic underlying medical condition that would put them at greater risk for severe COVID needs to be especially careful in any large gathering. Even if they’re vaccinated, they need to be masking and distancing and doing appropriate hand hygiene. Those who are healthy need to continue to be very careful in large gatherings. It would be wise to continue to mask and distance and use proper hand hygiene.

We don’t know who can have severe COVID. We know that previously healthy adolescents and young adults may require hospitalization due to COVID. It is hard to predict.

With children and older adolescents, parents are going to have to be very emphatic. Older adolescents and young adults are prone to taking risks, and getting out. They want to socialize — it’s been a year now in this pandemic. But the advice for high school and below is the same as for college students: We have to continue safe behavior.

The reality is that there is plenty of COVID still in the community, we still have a hard time predicting which healthy people may get severe COVID, and it’s better to be safe than sorry.

So just because it’s legal now to go into McDonald’s and eat a Happy Meal indoors doesn’t mean it’s a great idea?

Yes. We need to be really careful now. The statewide masking mandate is ending, and children, adolescents and particularly young adults may be ready to take liberties with masking and distancing — like going into a fast food restaurant and eating, which requires taking masks off.

It will be very important for everyone to continue to think about risks and how to reduce them. Ask yourself: Is this eating establishment too crowded? Can I be in a less crowded environment? Can I eat outdoors versus indoors? Can I sit at a table that’s at a distance from the next one?

What do we know so far about how COVID-19 affects kids of different ages — babies, toddlers, and so on up the line?

It’s been more than a year since COVID-19 arrived in the Greater Houston area. So over the past year, we’ve taken care of many children. We’ve tested and diagnosed more than 10,000 cases of COVID-19 in children at Texas Children’s, then following thousands of children who had been infected with COVID-19.

Adolescents are at greater risk of disease from COVID than younger children.

Elementary-school-age children and younger are at lower risk of severe disease. But we do have to keep an eye on again those children with chronic underlying medical conditions.

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James Versalovic, M.D., Ph.D., the interim pediatrician-in-chief and the pathologist-in-chief at Texas Children’s Hospital, poses for a portrait Friday, Feb. 5, 2021, at the hospital in Houston.Jon Shapley/Staff photographer

Fortunately, very few children are at risk of succumbing or dying of COVID. Children and adolescents who have underlying medical conditions — chronic heart conditions, kidney disease, cancer, obesity, Type 2 diabetes — are at greater risk of moderate to severe COVID and hospitalization. And we know that children can get pneumonia and respiratory distress.

Children who had a very mild infections may, several weeks after other symptoms clear, develop other symptoms that require hospitalization. That is the Multisystem Inflammatory Syndrome in Children, MIS-C. Due to this disease, children may need to be hospitalized weeks after a mild infection. So there are possible complications of COVID affecting the heart and lungs.

There’s also another aspect of COVID: “long-haul COVID” or “long COVID.” We’re learning more about this in children. Generally speaking, adolescents are at greater risk than younger children, and children who are otherwise healthy rate at much lower risk than adults.

But we do have to keep an eye on their symptoms and keep an eye on underlying medical conditions.

Early on, there were concerns that long-haul COVID was affecting the hearts of some college athletes, and maybe younger ones as well. Are researchers and doctors still worried about that?

Yes. Young athletes of middle-school and high-school age may have a cardiac complications due to COVID. Again, this may follow weeks after the first phase of the infection. It may be part of MIS-C, or it may be separate from that.

They may have heart palpitations; they may have other cardiac findings. In our heart center, our cardiologists see these young athletes who were previously very healthy, but have ongoing symptoms — for instance, weeks after having a mild COVID infection, they may get tired from physical activity.

It’s a real problem — one that parents need to follow closely with their young athletes at home, and if necessary, bring them to a pediatrician or a pediatric cardiologist.

Adults are advised to wear double masks now. Should children wear double masks?

Generally, I would say it’s not necessary for healthy young children to have double masking. It’s very difficult for most children to keep a single mask on, let alone worrying about double masking. So I worry that double-masking would be so difficult and cumbersome that children will just not mask, or the second they’re away from parents, they’ll take it off.

There’s good reason for adults or children with underlying medical conditions to consider double masking — particularly now with variants such as the UK variant spreading in Texas. These new variants of COVID may be very highly contagious.

But generally, for children, we would recommend that single masks are sufficient.

Tons of parents want to know what’s going on with vaccines for children. When can we expect them?

We’re trying to keep this vaccine train moving rapidly. As you know, we started vaccinating in December with health care workers in Category 1a at Texas Children’s and other children’s hospitals across the country. In January we began vaccinating older adolescents and younger adults, ages 16 and above, in Category 1b — people with chronic underlying medical medical conditions that put them at high risk for severe COVID and possible hospitalization.

The vaccine safety trials are occurring in a stepwise fashion, working backward in age from older adolescents to the younger adolescents to school-aged children and then to preschool children. We are now keeping a close eye on adolescent trials with both the Pfizer and Moderna vaccines, and more to follow with J&J and others.

For the younger adolescents, those ages 12 and above, we expect the trials to be completed by summertime, then go to the FDA for authorization hopefully by early to mid-summer. That will be very important: Once vaccines are authorized, that means that children ages 12 and above could get vaccines just prior to the beginning of the next school year. And that would include students going off to college.

For younger children, Texas Children’s and other hospitals are planning trials with Pfizer, Moderna and J&J. We expect to begin trials by early summer for children 5 and above, so we will hope to have vaccines available for children 5 and above before the end of the calendar year 2021.

Beyond that will be the children younger than 5. And so the the tough part is that parents will need to wait several months for these vaccines to become available for children. But we are working very actively now with vaccine manufacturers and with the governments to make sure these vaccines are available later this year.

The CDC recently released guidelines saying that people who’ve been vaccinated can begin feeling a little freer — that they can gather in small numbers with other people who’ve been vaccinated, and that they’re safe to visit family members who haven’t been vaccinated. Are there any health concerns for children being visited by a vaccinated person?

This is going to be a tender topic in the weeks and months ahead. We certainly understand the rationale behind the CDC’s latest guidance that vaccinated adults may gather in small numbers with other vaccinated adults. That’s certainly fine. We believe in these vaccines. They are highly safe, highly effective, particularly at preventing a severe disease and a hospitalization.

But people under 16, unless they’re participating in a trial, are not vaccinated. And we know that vaccinated individuals may pass the virus to an unvaccinated individual. It’s safe to say that the risk of transmission from a vaccinated individual to an unvaccinated person is substantially less than from a non-vaccinated person to another unvaccinated person. That said, it’s difficult now to quantify how much the transmission risk is lower.

A vaccinated person still needs to be cautious with the children in their home, and with unvaccinated children. The vaccinated person could still possibly pass that virus along to children. One needs to be vigilant about whether that child develops symptoms.

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