Virus is ‘super-scary’ in kids
Just assessing their risk is complicated because of the unknowns
SAN ANTONIO — When her daughter’s toes and fingers started turning blue, San Juana Rios knew it was time for drastic action. The 9-year-old had been having fevers on and off since late July. Twice, Rios had taken daughter Makayla Rodriguez to an emergency room in Laredo, where the family lives. Could the cause be the coronavirus?
The blue color alarmed Rios. She called an ambulance. The paramedic told her if he was Makayla’s parent, he would take her to a hospital in San Antonio.
“The trip normally takes 2 1⁄2 hours,” Rios said. “I got there in a little over an hour.”
On Aug. 6, Makayla was admitted to Methodist Children’s Hospital at the Medical Center. She tested positive for the virus and would undergo treatment for 11 days.
Her experience was unusual in that most children with COVID-19 don’t wind up in a hospital with such severe symptoms and for that long. Still, Makayla had joined the growing ranks of children infected by the virus, sometimes unknowingly.
The proportion of children in Bexar County infected by the virus has doubled over the past two months, officials reported this week. Youths 17 and under now account for 12.6 percent of all coronavirus cases, up from 6.4 percent in mid-June.
Similarly, pediatric hospitalizations related to COVID-19 have increased from 1.8 percent to 3.7 percent of all hospitalizations.
The Centers for Disease Control and Prevention reports the same trend nationally, with the number and rate of coronavirus cases in people ages 17 and under rising steadily from March to July.
A joint report by the American Academy of Pediatrics and the Children’s Hospital Foundation found more than 380,000 children were infected in the nation by the end of July — 8.8 percent of all COVID-19 cases.
Now, health officials and others are bracing as schools and colleges reopen here and across the country, worried the spread of viral cases among younger people only will get worse. It took just days for a number of schools elsewhere in the U.S. to open for in-person instruction then shut due to a rash of positive cases.
In San Antonio, some impor
“It was so hard, because even though I was sick, I still had to take care of them.”
Zenaida Jeana Tijerina
tant indicators of the virus’ presence are moving in a hopeful direction of late, but not far enough to allow students, teachers and staff to return fully to schools and campuses yet.
Assessing the risks is complicated by the many unknowns when it comes to kids and COVID-19, medical experts say.
They are confident that children, as a rule, don’t contract the virus as readily as adults. When they do, they don’t get as sick. Many don’t show symptoms at all.
What we don’t know
But how adept are children and teens at spreading the disease?
Dr. Dina Tom, associate professor of inpatient pediatrics at UT Health San Antonio, said the general assumption is “that children don’t give or get the virus as easily as adults.”
But more definitive studies are works in progress. Tom said there hasn’t been widespread, universal testing of children. When adults and teens get tested, it’s because they have symptoms.
When younger children are tested, it’s often because they have something unrelated, such as a skin infection or trauma. When they’re screened for the virus, it comes back positive. So far, many of these children are asymptomatic, Tom said.
So it’s difficult to know really how prevalent COVID-19 is among children and adolescents.
“The other thing is, we don’t have a good sense of how long kids are carriers,” she said. “They may carry the virus around in their nasal cavity longer than teens or adults, but we don’t know if that’s significant or not.”
When asymptomatic kids under age 10 go back to school, she said, they may have a lower risk of spreading the virus, but the concern is that a child might spread it to one staff member or teacher, and then that person develops symptoms and spreads it among the adults.
Tom said there are theories why children don’t catch and spread the virus as easily.
They may have a partial immunity from all the vaccines they receive for other illnesses. They may not cough as forcefully as adults, and so spread fewer aerosol droplets, the main way of transmission.
Children tend to have fewer underlying conditions — diabetes, hypertension, chronic obstructive pulmonary disease and so on — than adults do.
They are far less likely to die from the virus, she said. Of local COVID-19-related deaths, 0.6 percent were people under age 19 — three out of more than 700.
The increase in more children testing positive in Bexar County may stem from hospitals and other places doing more widespread testing — including testing kids if their adult family members test positive — as well as testing requirements connected to summer activities, such as camps.
When schools fully reopen with in-person instruction, the number of children being exposed to the virus will go up simply because of more social interactions, Tom said.
Children age 4 to 7 or 8 might not be as susceptible to infection, she said, because they’re more likely to wear masks, wash their hands and not be constantly in close proximity to adult caregivers.
“Children younger than that are much more likely to be in their caregivers’ faces, with their diapers being changed and such, and are much more likely to come into contact with secretions,” Tom said.
But as children reach age 10 or older, transmission begins to look more like how adults spread the virus, she said.
Learning to live with virus
Dr. Alvaro Moreira, a neonatal intensive care pediatrician at University Hospital and faculty member at UT Health San Antonio, said some studies suggest children 10 and older may have more receptors in their noses for the virus to bind to. This may explain why older children may not only have more symptoms, but are more likely to be hospitalized.
“We know that a lot of children who are getting the disease have co-morbidities, such as being overweight or obese,” he said. “Potential reasons why this subset of children are at higher risk is that fat cells have more receptors to the novel coronavirus. This may also explain why obese adults are at increased risk for death.”
Moreira said that currently, the most common way a child catches the virus is through an infected family member. Studies from the CDC also show that Black and Hispanic children are much more likely to be hospitalized, and develop a severe inflammatory form of the disease, than Anglo or Asian children.
Moreira said a number of things could account for that — genetic factors, socioeconomic factors and an increased risk of underlying conditions in Black or Hispanic kids. Some theorize that the cultural tradition in communities of color to have multiple generations living in the same household could account for more — and more intensive — exposure to the virus.
Moreira said he hates to sound like a “broken record,” but when it comes to protecting children from the virus, everyone should know the drill by now: Masks. Social distancing, be it at home or school. Hand washing. If a child has a fever or symptom like a cough, they should stay home.
“And children should get a flu shot this year,” he said. Dr. Robert Sanders is a pediatrician with PediExpress, an urgent care clinic with the University Health System at the downtown Robert B. Green Campus.
He said his clinic has been all coronavirus, all the time since March.
“Ever since the beginning of the pandemic, we’ve been seeing children with COVID in the clinic on a daily basis pretty much,” he said.
He said patients range in age from one month to 18 years. In mid-May, the pediatric patients had a viral positivity test rate of almost 30 percent, at a time when adults visiting the urgent care clinic were testing positive about 50 percent of the time.
“That has tapered off quite a bit,” Sanders said. “We’re now seeing 1 to 2 percent positivity rate among kids in the clinic, where we only test patients if they’re having symptoms.”
Those symptoms range from the mild sniffles up to what you’d expect with the flu — fever, body aches. Teens especially struggle with headaches and a flu-like malaise, he said.
Sanders has his own theories as to why kids might not be as affected as adults.
“Children are exposed to viruses, including coronaviruses (such as the common cold) more frequently, and may have some potential innate immunity to the virus,” he said.
At the height of the pandemic, his clinic was seeing 30 or 40 pediatric patients a day. Now it’s down to five to 10, he said.
“The goal is to learn to live with this thing, because we’re not going to be able to eradicate it for a while,” Sanders said.
Entire family attacked
The virus tore through Zenaida Jeana Tijerina’s family, infecting her and all four of her children, three of whom would go on to develop symptoms.
One child, Gabriel, 12, ended up at Methodist Hospital South in Jourdanton, where he received IV treatment for four hours when his fever refused to break.
He had an almost constant fever for 10 days, said Tijerina, who works in the health care field and lives in Poteet.
“Nah, I didn’t really feel it,” Gabriel said, grinning as he hung out with his siblings at home on a recent afternoon. “I just kept playing video games.”
Tijerina said she worried that her son’s high fevers were going to trigger seizures in him. Her other children had less severe symptoms, she said — headaches, body aches.
Tijerina lost her sense of taste, which, weeks after everyone recovered, only now is returning. Her son Derrin, 11, has recurrent headaches.
Tijerina herself ended up in the hospital after recovering, with complications from a pre-existing kidney ailment, dehydration and mental fogginess, which doctors told her could be a case of “postCOVID.”
Tijerina said she kept her kids home ever since the pandemic broke, and she only left their home to go to H-E-B. She thinks she picked up the virus while waiting for one of her kids’ prescription medications.
She brought the disease home in mid-July.
“It was so hard, because even though I was sick, I still had to take care of them,” she said. “I’m all they have and they really depend on me.”
She has been able to work only part-time since the illnesses and is behind on her car payment and other bills. Her children receive health care under Medicaid. During the worst of their illness, family and friends brought casseroles and other food and left it on the front porch of Tijerina’s modest home.
Tijerina is studying to become a paramedic. She says she was so traumatized by the virus that she checked her kids’ temperature and oxygen level every four hours when they were ill. But she does plan to send them back to in-person school, when that becomes an option, so she can get back to work.
“Plus, I figure that they’re immune, at least for the next three months,” she said.
A mother’s fury
Once in San Antonio, Makayla, Rios’ daughter, would end up receiving a number of medications through an IV, including a blood thinner to prevent blood clots, one possible complication of COVID-19.
Rios thinks Makayla contracted the virus from her grandmother, with whom Rios and her four children live, and who had tested positive during weekly checks for her home health job, although she had no symptoms.
When Makayla’s fevers started, Rios took her to a hospital emergency room, where doctors didn’t test her for the virus. They sent her home with Tylenol.
The fevers continued, so Rios got tested, along with all of her kids. Only Makayla’s 14-year-old sister tested positive. She had mild symptoms — a headache and occasional chills.
Makayla continued to spike fevers, some dangerously high. A doctor prescribed antibiotics over the phone.
More fevers. A second trip to the emergency room showed the girl had mild pneumonia. She was tested again for the virus and sent home, to await the results. The next morning, her toes and fingernails were blue, a sign she wasn’t getting enough oxygen.
Then came the frantic drive to San Antonio.
Dr. Kelly Spence, a hospitalist with Pediatrix Medical Group of Texas, affiliated with Methodist Children's Hospital, was Makayla’s physician.
She said she first started seeing COVID-19 pediatric patients in May, and that their numbers increased over the summer but have since “plateaued.”
Methodist Children’s has treated 52 patients ages 17 and under during the last four months — two in May, 16 in June, 24 in July and 10 in August, said a hospital spokeswoman.
The average length of stay for pediatric COVID-19 patients is four days, she said. So far, none has required the use of a ventilator or other extreme measures.
Most of the hospital’s COVID-19 pediatric patients are older teens — 15 to 17 — and many have underlying health problems, such as diabetes and obesity, Spence said. Most of the pediatric patients in the hospital are asymptomatic — they were admitted for unrelated issues or illnesses and then tested positive, she said.
Makayla was in the hospital for an uncommonly long period, Spence said. But it speaks to the unpredictable nature of the disease and how the symptoms progress in each person.
Rios still can’t believe her daughter caught the virus and became so seriously ill. From the start of the pandemic, like Tijerina, she made sure to keep the whole family home, except for trips to the grocery store or Walmart.
The whole time Makayla was being treated in San Antonio, Rios stayed quarantined with her in her hospital room. She looked on as the nurses took care of her daughter, praying over her when her fever triggered hallucinations.
“It was so superscary,” said Rios, an optometrist’s assistant who hasn’t been able to work.
Rios said she plans on homeschooling her kids this fall. She’s not about to send them out into the world. Not yet.
Makayla now is on a steroid and long-term inhaler to help mitigate any lung damage the virus caused and will continue to see a lung specialist.
Her prognosis is unknown at this time.
“I don’t think any of us know long-term what is going to happen with these children, who present with significant respiratory symptoms,” Spence said.
Rios becomes infuriated when she sees clips on the news of people gathering in large crowds for parties and cookouts.
“They’re not going to get it until their own kid is in a hospital bed, having hallucinations,” she said. “Then maybe they’ll understand.”