As vaccines roll out, what are risks for kids?
As adults across the U.S. are vaccinated against COVID-19, many parents have vaccine questions related to children. To answer them, we turned to Jim Versalovic, the interim pediatrician-in-chief of Texas Children’s Hospital in Houston.
Could you start with the big picture? What’s the most important things to know about kids and the COVID vaccines?
First of all, you should know that children certainly can be infected with COVID-19. They definitely are vulnerable. We need to be safe with our children — in our households, in schools and throughout our communities. We need to be vigilant and continue to promote safe behavior with our children.
Yes, it’s true that COVID-19 has a much greater impact on older adults. There’s no question about that in terms of hospitalization and mortality. But children can be infected. They can get sick with COVID. And yes, there are children that have to be hospitalized. We’re taking care of many of these children at Texas Children’s.
So just because it’s legal now to go into Mcdonald’s and eat a Happy Meal indoors doesn’t mean it’s a great idea?
Yes. We need to be really careful now (that the statewide masking mandate has ended). Children, adolescents and particularly young adults may be ready to take liberties with masking and distancing — like going into a fast-food restaurant and eating, which requires taking masks off.
It will be very important for everyone to continue to think about risks and how to reduce them. Ask yourself: Is this eating establishment too crowded? Can I be in a less crowded environment? Can I eat outdoors versus indoors? Can I sit at a table that’s at a distance from the next one?
What do we know so far about how COVID-19 affects kids of different ages — babies, toddlers, and so on up the line?
Over the past year, we’ve taken care of many children. We’ve tested and diagnosed more than 10,000 cases of COVID-19 in children at Texas Children’s, then following thousands of children who had been infected with COVID-19.
Adolescents are at greater risk of disease from COVID than younger children.
Elementary-school-age children and younger are at lower risk of severe disease. But we do have to keep an eye on children with chronic underlying medical conditions.
Fortunately, very few children are at risk of succumbing or dying of COVID. Children and adolescents who have underlying medical conditions — chronic heart conditions, kidney disease, cancer, obesity, Type 2 diabetes — are at greater risk of moderate to severe COVID and hospitalization. And we know that children can get pneumonia and respiratory distress.
Children who had a very mild infections may, several weeks after other symptoms clear, develop other symptoms that require hospitalization. That is the Multisystem Inflammatory Syndrome in Children, MIS-C. Due to this disease, children may need to be hospitalized weeks after a mild infection. So there are possible complications of COVID affecting the heart and lungs.
There’s also another aspect of COVID: “long-haul COVID” or “long COVID.” We’re learning more about this in children. Generally speaking, adolescents are at greater risk than younger children, and children who are otherwise healthy are at much lower risk than adults.
Early on, there were concerns that long-haul COVID was affecting the hearts of some college athletes, and maybe younger ones as well. Are researchers and doctors still worried about that?
Yes. Young athletes of middle-school and highschool age may have a cardiac complications due to COVID. Again, this may follow weeks after the first phase of the infection. It may be part of MIS-C, or it may be separate from that.
They may have heart palpitations; they may have other cardiac findings. In our heart center, our cardiologists see these young athletes who were previously very healthy but have ongoing symptoms — for instance, weeks after having a mild COVID infection, they may get tired from physical activity.
It’s a real problem — one that parents need to follow closely with their young athletes at home, and if necessary, bring them to a pediatrician or a pediatric cardiologist.
Tons of parents want to know what’s going on with vaccines for children. When can we expect them?
The vaccine safety trials are occurring in a stepwise fashion, working backward in age from older adolescents to the younger adolescents to school-aged children and then to preschool children. We are now keeping a close eye on adolescent trials with both the Pfizer and Moderna vaccines, and more to follow with J&J and others.
For the younger adolescents, those ages 12 and above, we expect the trials to be completed by summertime, then go to the FDA for authorization hopefully by early-to-mid summer. That will be important: Once vaccines are authorized, that means that children ages 12 and above could get vaccines just prior to the beginning of the next school year. And that would include students going off to college.
For younger children, Texas Children’s and other hospitals are planning trials with Pfizer, Moderna and J&J. We expect to begin trials by early summer for children 5 and above, so we will hope to have vaccines available for children 5 and above before the end of the calendar year 2021.
Beyond that will be the children younger than 5. And so the the tough part is that parents will need to wait several months for these vaccines to become available for children.
The CDC recently released guidelines saying that people who’ve been vaccinated can begin feeling a little freer — that they can gather in small numbers with other people who’ve been vaccinated, and that they’re safe to visit family members who haven’t been vaccinated. Are there any health concerns for children being visited by a vaccinated person?
A vaccinated person still needs to be cautious with the children in their home and with unvaccinated children. The vaccinated person could still possibly pass that virus along to children. One needs to be vigilant about whether that child develops symptoms.
We can treat most children as outpatients. They do not need to be hospitalized; parents just need to keep a watchful eye. We understand that families are congregating and are gathering in small groups, and we understand the importance of that to the family unit. But we have to continue to be careful about mixing vaccinated with unvaccinated individuals, including inside the household.