If there was one saving grace during the early days of the COVID-19 pandemic it was that children rarely contracted the virus. That changed with the rise of the much more contagious delta variant.
“It definitely is different,” said Dr. Rick Barr, executive vice president and chief clinical and academic officer of Arkansas Children’s, the state’s only pediatric health system. “I counsel people to think of it as a completely different virus.”
“The original strain really didn’t cause much disease in children,” he said. “In fact, we would see kids that would just test positive when they were in the hospital for some other reason.
“That changed with the delta strain, and the kids were coming in with COVID pneumonia and respiratory infections, where that was their primary reason to be in the hospital, so it definitely has affected kids very differently and really ramped up the numbers we saw in the intensive care unit, as well.
“It particularly seems to be affecting adolescents, who are eligible for the vaccine,” Barr said. “And almost all the kids we’ve seen in intensive care and a large number in the hospital are adolescents who are unvaccinated.”
In Arkansas, 93,565 children ages infant to 18 have been infected with COVID as of Thursday, according to the state Department of Health’s COVID-19 Dashboard. Of those, 860 were hospitalized and 110 were admitted to the intensive care unit.
The department said that 96.9% of the total cases were unvaccinated. Vaccinations are currently available only for children 12 and older. Pfizer-BioNTech has said it soon will seek emergency authorization for its vaccine for children 5 to 11.
COVID-19 has killed three children 17 or younger in Arkansas.
Last Monday, when Arkansas Business interviewed Barr, 11 children or adolescents were hospitalized with COVID at Arkansas Children’s in Little Rock, two were hospitalized at Arkansas Children’s Northwest in Springdale. Five of those hospitalized at Arkansas Children’s were in intensive care, with three requiring a ventilator.
Between March 2020, the start of the pandemic, and Sept. 27, 2021, Arkansas Children’s and Arkansas Children’s Northwest together had admitted 746 children with COVID. Only seven of those were fully vaccinated and six were partially vaccinated, according to Hilary DeMillo, media relations manager for Arkansas Children’s.
From late June to mid-August of this year, weekly COVID hospitalization rates for children and adolescents rose nearly five-fold, “coinciding with increased circulation of the highly transmissible SARS-CoV-2 Delta variant,” the Centers for Disease Control & Prevention reported Sept. 10. “Hospitalization rates were 10 times higher among unvaccinated than among fully vaccinated adolescents,” the CDC said.
The number of children with COVID hospitalized at Arkansas Children’s hit its peak on Aug. 13 at 31, said Marcy Doderer, president and CEO. “Those mid-August days we were often well above 20.”
The numbers have declined, Barr said, “but they’ve kind of plateaued. We’re presently in between 10 and 15 patients hospitalized here in Little Rock on any given day. And about a third of those are requiring intensive care, and we’ve been there about a month, at those numbers.”
With the original coronavirus variants, “kids didn’t really get that sick with respiratory infections,” Barr said. “But with the delta variant, we’re seeing kids with pneumonia, respiratory failure requiring ventilators, even requiring heart-lung bypass on ECMO [extracorporeal membrane oxygenation machine] for COVID pneumonia.”
Arkansas Children’s Northwest saw its peak of child COVID admissions in late June or early July, said Shannon Hendrix, senior vice president and administrator of Children’s Northwest. Children and adolescent COVID patients now number five or fewer on a daily basis, she said, with some of the sicker patients sent to Children’s in Little Rock.
The delta variant sent more kids to the hospital than did the earlier strains, Hendrix said, and “with increased complications.”
‘Kids Have Suffered’
The delta variant has minimized the differences in how COVID affects children and adults, Barr said.
The therapies used to treat the disease in children are essentially the same as those used to treat adults: monoclonal antibody therapy and retrovirals, as well as steroids and anticoagulants “to treat all the complications of COVID,” he said.
But the survival rates for children and adolescents are much better than those for adults because they’re more resilient and have fewer medical complications. “The outcomes are definitely much better,” he said. “But I have to emphasize, kids get really sick. We’ve had some in the hospital for a month or two, related to COVID pneumonia, and have been very, very sick.
“Even though the outcomes are good, kids have suffered because of the delta variant,” Barr said.
As for long-term effects of the delta variant on children and adolescents, “it’s really hard to tell at this point. It’s something we’re definitely monitoring for,” he said.
“Early on, with the original variants, we saw a number of cases of what’s called COVID-related systemic inflammatory response. We’ve seen 20 or 30 kids throughout the pandemic who’ve developed that and they’ve developed heart problems and kidney failure. And that was usually weeks to even a month after the original COVID infection,” Barr said.
Because it takes patients up to 21 years old, Arkansas Children’s also routinely treats young adult COVID patients. In addition, during the pandemic’s winter surge, when other hospitals were overwhelmed, Children’s also treated adults in their 40s and 50s, including one patient who was hospitalized for seven months.
Staff fatigue is a factor in treating patients during a pandemic that has been lengthened by some Americans’ resistance to being vaccinated against the virus, Doderer said.
“It’s physically harder to take care of a person who has active COVID-19 symptoms because of the level of infection prevention you must take with PPE and all of the things that go into that,” she said. “That becomes a physical burden to the team. And then it’s very stressful because the children are so very sick.”
She also cited the shortage of nurses and respiratory therapists as a factor contributing to emotional challenges for the staff, who find it difficult to take days off.
Vaccinations Stressed
Everyone interviewed for this article stressed the importance of vaccinations of adults and eligible children and adolescents to protect Arkansas’ children from COVID. “We tell parents the best way to protect your school-age child is for you to get vaccinated,” Barr said.
He also recommends wearing masks in public and “definitely in school,” as well as “social distancing where appropriate.”
Dr. Jennifer Dillaha, chief medical officer and medical director for immunizations and outbreak response at the state Health Department, said, “I think it’s important for parents to know about the complications that can result to children from COVID that will enable them to make a balanced comparison between the high risk of COVID and the low risk for vaccination.”
One good source of information about pediatric COVID, Dillaha said, is the website healthychildren.org, the American Academy of Pediatrics’ website for parents.
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