Delta — the variant of COVID-19 as contagious as chicken pox — is scary. It’s even scarier for parents of children under 12, who are not eligible to be vaccinated against COVID-19.
We asked doctors to address a few parental concerns about Delta, back-to-school, and vaccines.
Is the variant more severe in children?
“I have not seen any peer-reviewed data, or data from a reliable source, to suggest that,” said Dr. Shira Doron, an epidemiologist at Tufts Medical Center.
Dr. Vandana Madhavan, a pediatric infectious disease specialist at Massachusetts General Hospital, also said the variant has not caused worse infections in children than previous variants.
The majority of pediatric infections are still mild, said Dr. Philip Landrigan, a pediatrician and epidemiologist who directs the Global Public Health Program at Boston College.
“They may have the same symptoms as the adults — cough, cold, fever, muscle aches, runny nose — but the whole thing is generally milder than it’s been in adults,” he said.
Regardless of variant, only about 0.3 to 1 percent of children who are infected with COVID-19 have to be hospitalized, according to Doron.
Have pediatric hospitalizations been on the rise?
In recent weeks, pediatric intensive care units have started to fill up around the United States. Children now make up 2.3 percent of patients hospitalized with COVID-19, a high point since the beginning of the pandemic, according to data compiled by the American Academy of Pediatrics and the Children’s Hospital Association.
First, they’re not vaccinated.
“Since children under 12 are all unvaccinated, they now form a larger percentage of the population who can be infected,” Madhavan said. Accordingly, they make up a greater proportion of hospitalized patients.
Second, there’s Delta.
Delta has a higher viral load and replicates faster than previous lineages of the virus, which makes it about twice as transmissible, said Doron. That’s the case across all ages, including children. As a result, cases of COVID-19 have risen in adults and children alike. That rise in total cases has resulted in a corresponding rise in total hospitalizations.
But the number of hospitalizations per case hasn’t risen, again suggesting that the infection that results from Delta is not worse, said Doron.
“[Delta] is still causing way more hospitalizations because there’s so much of it,” she said. “That in and of itself is a tragedy, but we don’t need to attribute it to [the virus] having changed its lack of predilection for children.”
“With more children infected, we will obviously see more children overall requiring hospitalization and ICU admission,” Madhavan agreed.
What’s the story in Massachusetts?
The rise in pediatric hospitalizations is a much more significant concern in states outside of New England with far lower vaccination rates, said Doron.
Massachusetts stopped recording how many of its children were hospitalized with COVID-19 on June 30 because there were so few cases, though Governor Charlie Baker said the state plans to resume counting soon. The Massachusetts Department of Public Health hopes to make pediatric hospitalization data available by the end of the week, a spokeswoman told the Globe in an e-mail.
A spokeswoman for Boston Children’s Hospital told the Globe that it has not seen an increase in hospitalizations for COVID-19, which is “very encouraging.”
“It’s a nice opportunity to report how highly vaccinated states are protecting children from this pandemic,” she said.
How should I protect my child at school or day care?
Masks, masks, masks.
“It makes sense right now in Massachusetts for parents to send their unvaccinated children to school in a good quality, well-fitting mask,” Doron said.
She prefers child-sized hospital masks, because they offer a “combination of quality fit and filtration, but also tolerability.” Masks like K-N95s have the filtration capabilities, but are often too uncomfortable for children to wear for hours on end at school, she said.
Parents who can’t find a child-sized hospital mask should practice the knot-and-tuck method, she said. It’s been demonstrated in videos online by the CDC.
“The important thing is to keep is to keep the virus from getting airborne and spreading in the classroom,” Landrigan said.
Parents should also read and follow recommendations from the American Academy of Pediatrics, he said — including the recommendation that all individuals over 2 years old wear masks at school, regardless of vaccination status.
There’s no need for children to wear masks outdoors, said Doron — a fact that hasn’t changed with the rapid rise of Delta. “The mode of transmission has not changed,” she explained. “Outdoors is the best possible ventilation, and it really dissipates the viral particles quickly.”
“Outdoors, I think you can relax,” Landrigan agreed, “Indoors, I think the masks are essential.”
When it comes to playdates or hangouts, “outdoors is better than indoors, [and] an indoor activity at home with one other family is better than a larger group,” said Madhavan.
What should I do if my child has symptoms?
Symptoms of COVID-19 include fever or chills, cough, shortness of breath, fatigue, muscle aches, headaches, loss of taste or smell, sore throat, congestion, nausea, and diarrhea.
“If all they’re showing is a sniffle, congestion, a little sore throat, or a cough, it could absolutely be a manifestation of COVID-19,” Doron said.
She recommends that parents take their children to be tested for the virus “every single time” they show a new symptom — even if it seems like just a cold.
Parents should also keep their kids at home until they have the results.
“If it turns out the child’s sniffle is due to COVID and that child goes to school, the risk is high that that child is going to spread it,” Landrigan said.
Parents should also be aware of the possibility of intra-household transmission to themselves or their other children. A study published in JAMA Pediatrics on Monday found that 27.3 percent of children who contracted COVID-19 passed the virus along to at least one other member of their household. Notably, children under 3 most often passed the virus within the home.
When will children under 12 become eligible for the vaccine?
It’s hard to say.
Both Pfizer and Moderna launched studies of their vaccines in children under 12 earlier this year. Last month, the Food and Drug Administration requested that they expand the size of those clinical trials in order to detect rare side effects.
Pfizer — the only vaccine manufacturer with a shot currently approved for children between 12 and 18 — will likely still be the first to submit vaccine safety data in children under 12 to the FDA. In July, Pfizer told NBC News that it expects clinical trial results for 5- to 11-year-olds in September, and results for 2- to 5-year-olds “soon after.”
Then, it will be up to the FDA to grant an Emergency Use Authorization for the shot.
Last week, US Surgeon General Dr. Vivek Murthy told CNN that the FDA will “move fast” to evaluate the data once it is submitted, and predicted that children under 12 might become eligible for the shot in late 2021.
“If everything were to go well, and everything were to fall into place, I think it’s possible that we could see a vaccine before the end of the calendar year for kids under 12,” Murthy said. “Make no mistake, the FDA will move quickly on this because they recognize what’s at stake. It’s the health of our children, and there’s really nothing more important than that.”
Doron said her latest estimate for approval is January. After approval, “there will be a rollout and then time to get to that fully vaccinated status,” she said. “Really, this school year is not when we think those kids are going to be vaccinated.”
Landrigan said he has heard estimates of authorization in November or December, but it’s impossible to predict.
“Whenever the vaccine is approved for children, I urgently encourage parents to get their kids vaccinated as quickly as they can,” Landrigan said. “The vaccine protects against hospitalization and it protects against death, and if kids get vaccinated, we’re going to save lives.”
Until then, parents who want to protect their children should still procure a vaccine — for themselves, and any of their older children who are eligible.
Correspondent Jack Lyons contributed to this report.
Camille Caldera was a Globe intern in 2022.Follow her on Twitter @camille_caldera.