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Pediatrician experts at an AAP town hall discussed risks to children who return to school with varying levels of protection against COVID-19 and shared tips to mitigate community spread of the delta variant.
The COVID-19 Hot Topics town hall included Sara M. Bode, M.D., FAAP, chair-elect of the AAP Council on School Health Executive Committee; David W. Kimberlin, M.D., FAAP, AAP Red Book editor; Yvonne A. Maldonado, M.D., FAAP, chair of the AAP Committee on Infectious Diseases; and Anne R. Edwards, M.D., FAAP, AAP chief population health officer, who moderated the video conference.
The experts said data continue to demonstrate the benefits of masking, distancing and hygiene to keep children in school.
Despite what’s known about preventing the spread of the virus, they said pediatricians across the U.S. are facing opposition to mitigation measures and vaccination lags.
Surge in the South
In Alabama, the rise of the delta variant and resistance to masking and vaccinations have spelled trouble, Dr. Kimberlin said.
“I’m more bleak now than I've ever been throughout this pandemic. I wish I could say different, but that's the reality of it,” he said.
School is in session in many parts of his state, but Dr. Kimberlin said he is taking a “try anyway” approach as he presses on at school meetings to address points raised by those who oppose masks and other mitigation measures. Fortunately, he said, school boards’ leaders and superintendents have been receptive to hearing his recommendations.
“It's not just a coincidence, as Dr Kimberlin can tell you, that the highest rates right now are happening in places where masks and vaccines are not being encouraged or recommended,” Dr. Maldonado added.
Dr. Bode said parents of younger children also continue to be apprehensive about masking in child care. But the good news is that wearing a mask is not reported to be difficult for younger children, who adapt to naps on cots and other routines at child care and school.
“Once kids get into a setting where there's this expectation … they put on the mask because everyone else has,” she said.
Pediatricians can be a resource to schools on the use of tests and contact tracing, the experts said. Antigen tests can detect the delta variant, which has a viral load that is 1,000-fold higher than other strains.
For areas not already hit hard by the delta variant, Dr. Kimberlin said antigen tests can help the community stay ahead of the virus, which also will avoid overwhelming the health care system. He said the delta variant is “a different animal” and urged pediatricians to “be very, very cognizant of what it can do and how fast it can move to a community.”
When families have questions about the risk of in-person learning because their child is immunocompromised or too young for the vaccine, Dr. Bode said she uses a risk checklist to help them come to an individual decision about sending their child to school. This includes talking about:
- who in the home is vaccinated and who isn't;
- the health status of everyone in the home;
- whether the child masks consistently; and
- what activities the child participates in outside of school hours and whether risk is limited when not in school.
“I’ve had these difficult conversations with many of my patients over these last few weeks about back to school,” she said. “But I think if you're working on the system level to help and then help on the individual level advocating, you can at least feel like you have a process and can move the needle a little bit.”
Pediatric vaccine status
Dr. Maldonado said trials for children ages 5 to 11 years old are nearly complete, and it is possible that Pfizer data will be submitted to the Food and Drug Administration in October. Pfizer has enrolled children in phase two trials in two age groups (2 to 4 years old; 6 months to under 2 years old), and the vaccine for children under five may become available in the beginning of 2022, she said.
She also noted that the pediatric doses are not the same as the adult dose. “I know everybody's desperate, truly, to get the vaccines (for younger children),” she said.
“It's our time for us to really stand up for our children and our families … you are all still our trusted emissaries to our families and our school districts,” she said. “We will get our families through … let's just stand strong together.”
Connecting with the Experts: A COVID-19 Town Hall Series, http://bit.ly/covid19townhallseries