Kristina Bowman thought she and her family were doing all the right things to avoid COVID-19. She and her husband got vaccinated as soon as they were eligible. They only invited other vaccinated people to their home. They always wore masks in public.
So when her two young kids came down with fevers in mid-July, she was shocked.
Bowman’s parents, both vaccinated, were visiting from Montana at the time. A few days after her dad arrived, he started coughing.
“My mom told him he needed to go to the doctor … because he was coughing so much,” Bowman said.
She later added, “My first thought was for my kids.”
Her parents both tested positive for the coronavirus. So did she and her husband, as well as their 6-year-old son, Brayden, and 9-year-old daughter, Mikayla — neither old enough for a COVID-19 vaccine.
At the time, pediatric cases still weren’t very common, with not much data on how the virus affects children. But as the delta variant surged throughout the country in the most recent wave of the pandemic, the number of infections among younger kids had jumped at least tenfold.
At the end of July, Washington state was reporting a seven-day rate of 25 to 30 new infections per 100,000 children, according to the state Department of Health (DOH). In early September, the rate had skyrocketed past 300 new infections per 100,000 children.
Now that schools have reopened, health officials are warning students, parents, teachers and staff to “do their part” in preventing another shutdown.
“We know mitigation efforts within school settings do work to prevent transmission,” said Dr. Danielle Zerr, chief of infectious disease and virology at Seattle Children’s. “Mask-wearing, frequent hand hygiene, physical distancing — we really want everybody to be practicing all these measures to support kids returning to and remaining in in-person education.”
In recent weeks, pediatric cases have been flattening out, said Lacy Fehrenbach, a DOH deputy secretary for the COVID-19 response, citing the state’s most recent complete data.
“We hope they’ll turn downward in the future,” Fehrenbach said. “They’re not quite there yet.”
Brayden and Mikayla are two of tens of thousands of Washington children who have tested positive since the pandemic began. As of last week, DOH had counted about 57,800 cases among kids 11 and younger, and about 68,300 cases among those 12 to 19. Of those, about 870 have been hospitalized. Thirteen have died.
Most COVID-19 infections among younger, unvaccinated children throughout the country are mild, and serious cases and deaths among kids are rare. Still, Bowman and health experts encourage all eligible parents and children to get vaccinated and to get tested if they suspect a viral infection to contain the spread.
Unvaccinated parents are one of Dr. Janet Englund’s biggest concerns when thinking about keeping children safe.
“When parents are vaccinated, they have less virus that’s less transmissible and it’s less likely their kids will get more sick,” said Englund, an infectious disease specialist from Seattle Children’s. “I’m very strongly of the opinion that parents should be thinking about their children when they decide to get a vaccine.”
‘Two steps forward, one step back’
For the Bowmans, Mikayla, the older sibling, got the worst of the symptoms. She had a high fever, though never quite high enough for a trip to the hospital, and later developed an itchy rash all over her legs.
Bowman said her daughter also started feeling a sensation of “walking on pins and needles” on her hands and feet.
Her son, meanwhile, was congested and had postnasal drip. Both kids had a cough. The entire family was exhausted.
“I’ve tried to explain it to people — from day to day, you’re not really sure what to expect,” Bowman said. “It can feel like you go two steps forward, one step back.”
All in all, however, Bowman said it could have been much worse. For 10 days, the four of them stayed in, played virtual trivia, watched movies and spent time in the backyard when the weather was good. A friend went shopping and brought meals over.
“We got through it,” Bowman said. “And at the same time, none of us were hospitalized. The vaccine did what it was supposed to do” for her and her husband.
Severe cases at Seattle Children’s
At the beginning of July, Seattle Children’s had hardly any COVID-19 patients, but that changed quickly, said Dr. John McGuire, chief of Seattle Children’s division of pediatric critical care medicine.
“We became more concerned in mid-July when we started seeing an uptick in kids coming in, a lot sicker than we had seen before,” McGuire said.
While there’s not much data yet on whether the delta variant definitively causes more severe disease, McGuire said the hospital has been seeing more severe cases and a higher percentage of kids needing treatment in the intensive-care unit.
Fortunately, McGuire said, children appear to show “higher resilience and recovery.”
“But even though there’s a small population of kids who get infected and then end up in the hospital, if there’s more total cases, it increases the likelihood of seeing more severe cases in the ICU,” McGuire said. “And that’s worrisome.”
Hospital leaders are still unsure how the winter months will play out. Seattle Children’s saw its highest COVID-19 inpatient numbers to date in August and early September, with fluctuating numbers since then, the hospital said last week.
Now, more than half of Seattle Children’s patients admitted to the intensive-care unit are older than 12, hospital spokesperson Casey Egan said. Many are unvaccinated with no underlying health conditions, Zerr said, the infectious disease chief at Children’s.
Statewide, hospitalizations among children and teens remain uncommon with between 1 and 3 per 100,000 people over a seven-day average, DOH data show. For most of the pandemic, however, hospitalization rates among kids were often lower than 1 per 100,000.
It’s unclear how the majority of children had been getting sick during July and August peaks, but anecdotally, Zerr said she saw many patients get sick after their parents or siblings became infected.
Unique challenges
While pediatricians are used to treating respiratory problems in children, one of the trickier parts about COVID-19 is the isolation required, McGuire said.
“In an adult situation, they typically have no visitors,” he said. “That’s not suitable for a young child.”
A parent or caregiver is allowed to stay with their child, but McGuire said that can be “tough.”
“If a child has COVID, their parent is exposed. We don’t want exposed people walking around the hospital,” he said. “We bring food in and have guidelines where we can trade out family members … but it’s really hard on families.”
A lack of data on different kids’ age groups has also proved challenging, given that a 2-year-old’s body and a 16-year-old’s body might respond very differently, McGuire said.
Treatment options for kids are also more limited than those for adults, though many are extrapolated from adult therapies or care. But monoclonal antibodies, plasma therapy or other antibody-based therapies haven’t yet been authorized for those under 12, he said.
“There just really isn’t enough information on safety in kids,” McGuire said. “And the effectiveness data isn’t there as well.”
The U.S. Food and Drug Administration has shared little information on a detailed timeline for vaccine approval for children ages 5 through 11, though it said last month it’s attempting to “complete its review as quickly as possible, likely in a matter of weeks rather than months.”
Last month, Pfizer reported that clinical trial data showed its vaccine was safe and effective in younger kids, though it hasn’t yet been peer-reviewed or published. The data was submitted to the FDA last week — meaning, pending regulatory approval, the vaccine could be available for 5- to 11-year-olds by Halloween.
‘Then it got scary’
Pediatricians say getting a child tested for the virus early is still one of the best things parents can do if their child starts showing symptoms. Early identification can help schools, day care centers or other facilities squash or get ahead of any potential outbreaks.
State Rep. Noel Frame, who represents Seattle, has also urged families to get their children tested earlier after sharing that her 1-year-old son, Holden, tested positive for the virus this summer.
“We thought it was a cold,” she said in an interview. “Then it got scary. I’m just glad I took the step to test him so I knew what I was looking at.”
Frame said she started noticing symptoms two days after Holden’s 1st birthday, though she didn’t immediately recognize it as COVID-19. He likely contracted it from his day care center, she said.
Holden started vomiting and coughing. He was very congested. “We were super freaked out,” Frame said.
She and her husband eventually took Holden to Seattle Children’s, where a medical team suctioned mucus from his throat and gave him intravenous fluids. After more than six hours at the hospital, the couple took their baby home and watched as he made steady improvements.
“In two days, he was eating and drinking fine,” Frame said. A week later, his symptoms had more or less cleared up, she said.
Frame said she hopes other parents and caretakers will be more alert to potential virus symptoms, adding that identification can go a long way in slowing the spread of the virus.
“Don’t dismiss a runny nose, a cough, a fever as normal infant or toddler activity,” she said. “Not with COVID, not with delta.”
