COVID outbreak for children renews fears for medically fragile children


Whenever someone tells Jamie Chong that COVID-19 is not a serious threat to children, she reminds them that the common cold can send her child to the hospital.

Her son, Asher, who is approaching his third birthday, suffers from cerebral palsy and respiratory and gastrointestinal problems, making him more vulnerable to coronavirus.

Chong has taken care of him at their Simi Valley home during the pandemic and has strictly limited who can enter. Sometimes, when cases exploded, she even decided to turn down her home nurses.

“It’s scarier than it was even at the start,” Chong said. “When things were really bad before, children didn’t go to school. People were working from home. Now they say it’s much more contagious – and it’s all open.

There’s the notion that “’If you’re vulnerable, then you should stay home.’ Well, we do. But how much longer can we? Chong asked. “My son deserves to live a life outside his home.”

Young children – those under the age of 5 – are newly hospitalized with COVID-19 at higher rates than at any other time during the pandemic, according to federal data. Health officials say the increase in the number of children is the result of the rapid spread of the Omicron variant, which is transmitted much more easily than earlier variants of the coronavirus.

The latest surge has been particularly alarming for many families with medically fragile and under-5 children – the age group still not eligible for COVID vaccines. Federal authorization of a vaccine for younger children is still expected to take months.

“We don’t have a vaccine. We have very few treatments available for this age group. And we’re not telling people to be judicious and careful with young children,” said Dr. Jorge A. Caballero, anesthesiologist and co-founder of the voluntary organization Coders Against COVID.

“We can’t just ignore the needs of an entire group,” Caballero said, but “we do much the same with people with disabilities of all ages.” Disability groups recently denounced the remarks by the director of the Centers for Disease Control and Prevention as “encouraging” that disproportionate deaths have occurred among people with comorbidities.

“The public health response to COVID-19 has treated people with disabilities as disposable,” said the American Assn. people with disabilities and dozens of other groups wrote in their letter.

Young children and adolescents do not usually end up in hospital because of the coronavirus: less than 1% of children and adolescents who have been infected have been hospitalized and 0.01% have died, according to cumulative data collected from States by the American Academy of Pediatrics and the Association of Children’s Hospitals.

But with massive increases in infections, even a small percentage of hospitalized children has resulted in many more children in hospital beds than before. For the seven-day period ending Jan. 12, the United States averaged 881 newly admitted children and adolescents with COVID-19 per day; the rate of new hospitalizations in this group is six times higher than two months ago.

Recent federal data shows that children too young to be vaccinated were hospitalized with COVID-19 at rates close to those of young adults, although still much lower than the rates of middle-aged and elderly people. .

At Children’s Hospital Los Angeles, there were more than 40 pediatric patients who tested positive for the coronavirus as of early last week – nearly six times more than in November, a hospital official says. . About a quarter of children admitted with COVID-19 are heading to intensive care, and some have required intubation, said Dr. Michael Smit, its medical director for infection prevention and control.

“We used to have the luxury of saying, ‘This is bad, but it’s really not that bad for most kids,'” said Dr Garey Noritz, professor of pediatrics at the Ohio State University and president of the Council on Children with Disabilities for the American Academy of Pediatrics. While the numbers have increased, “it’s not like that anymore”.

The risks of COVID-19 are much more pronounced for immunocompromised or medically fragile children, including children with cancer, lupus and other conditions.

As older children and adults were able to get vaccinated, “it feels like we’ve been left behind,” said Fresno resident Matt Heidrick. “My son is still not vaccinated – and we have to be careful around him.”

Betsey and Matt Heidrick have been keeping 3-year-old Arthur in virtual preschool throughout the pandemic. Their son has spinal muscular atrophy type 1 and uses a BiPAP machine to help him breathe at night.

He landed in intensive care for a respiratory virus in the past. Even before COVID-19, the couple had to be careful during flu season to protect him. Whenever one of them felt sick, they would hide and isolate themselves from the others.

When the pandemic started, it was like, “Oh, the rest of the world is in our boat now,” Betsey Heidrick recalls. But as a third year of COVID-19 approaches, she feels invisible when people suggest the virus is no longer a threat.

Prior to Omicron’s surge, the Heidricks would occasionally venture out with Arthur for short trips to Target when the store was not busy. A few times he visited the zoo for quiet hours, staying outside and wearing a mask.

Now, as cases have increased, her main trips outside the home are for medical appointments. He occasionally sees other children in the neighborhood, but he limits himself to waving at them from a distance, instead of joining in the game.

When he can finally get a shot, “at least we would have some assurance that he has all the protection we can give him,” Betsey Heidrick said. “Maybe he can play with one of the little kids. Or he can go to school. Or he can go to the zoo – and we can feel less terrified.

Many doctors have said it’s still unclear whether Omicron, which increases the number of cases in children, causes more or less severe disease in children than previous variants. The new variant appears to settle higher in the airways, which can make children vulnerable to a barking cough called croup.

Because small children have small airways, “all it takes is a little swelling in those airways to cause croup,” said Dr. Graham Tse, chief medical officer at MemorialCare Miller Children’s & Women’s Hospital in Long Beach. . “We certainly saw an increased number of children admitted with clinical croup” who turned out to have COVID-19.

Public health officials have also warned that children may experience lingering effects from long COVID, which can include fatigue and breathing problems, although researchers are still assessing how often this occurs. Children infected with the coronavirus can also contract multisystem inflammatory syndrome, a rare but potentially fatal disease.

While Omicron has taken hold, “we cannot consider it to be a more benign virus,” said Dr. Colleen Kraft, a general pediatrician at Children’s Hospital Los Angeles. Its sheer contagiousness means ‘so many more children are getting this and so many more children have to go to hospital for it’.

Across LA County, 58 children under the age of 5 had tested positive for the coronavirus and were hospitalized as of January 1. Less than a month earlier, that number was just four.

Pediatricians say many of the same steps recommended for suppressing COVID-19 in general — including vaccinating everyone who is eligible, masking and avoiding crowds — will help protect very young children who are medically fragile.

“It’s definitely helpful to get vaccinated, in terms of protecting your own health,” said Dr. Steven Barkley, chief pediatrician at Cottage Children’s Medical Center in Santa Barbara.

“But the greater good is trying to keep our environment sanitary for children – and for children who are in a position where they cannot be vaccinated and who really rely on us – adults, parents, older children – to do what we can to limit the spread of this virus,” he said.

Families are doing what they can to manage the ongoing risks, but many policymakers across the country are not doing enough to protect young children who are medically vulnerable, including ensuring ventilation in public spaces, requiring the mask-wearing and making sure people can get tested, Caballero said. .

“It’s very frustrating as a parent. It’s very frustrating as a defender,” Caballero said. “We know exactly what needs to happen…but too many policy makers and stakeholders are stuck in a mentality that kids can’t get sick.”

Noritz, who practices in Ohio, argued that “if it made sense, we would be stuck now” as cases have increased. But Dr. Alice Kuo, director of UCLA’s Maternal and Child Health Center of Excellence, countered that the lockdowns have exacerbated other problems, including child abuse and mental illness in young people.

“If all that mattered was COVID,” said Kuo, a professor of pediatrics at UCLA, “then everything would be shut down again. But lockdowns aren’t sustainable, and other health issues matter too. »

In Manhattan Beach, Devon Cordova finds herself weighing whether everyone who might be around her daughter Rafaella is likely to be paying enough attention to COVID-19. She was reassured by the thought, before sending her daughter to see a private teacher, that the educator had an immunocompromised parent at home.

“We can’t just say, ‘Send the kids to school, they’ll be safe.’ We have to rely on so many other people to make the right choices,” Cordova said.

Rafaella suffers from a rare disease that affects the brain, spinal cord and immune system. She’s 6 – old enough to get the COVID shot – but Cordova said her daughter didn’t get the shots due to a past reaction and medical issues related to her condition. The rest of the family are vaccinated, said Cordova, who is vice president of a national organization focused on the disease.

The pandemic pushed much of Rafaella’s therapy online, although when cases were down she began working with her therapists outside. Before Omicron’s push, the family was tiptoeing back to normal life. Rafaella had play dates in the park and started in-person school in the fall.

“And then the rug was pulled out from under us with that last push,” Cordova said. “I don’t really know what to do at this point. Are we going back to school?

Noritz said of some people who have bristled at protective measures such as vaccinations and masks, “there’s a kind of very individualistic mentality around that, ‘Well, you’ll be fine’.”

“It doesn’t protect the most vulnerable people,” he said.

Times writer Rong-Gong Lin II contributed to this report.


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