San Diego Union-Tribune (Sunday)
DELTA VARIANT LOOMS OVER SCHOOLS REOPENING
S.D. County has not yet seen a surge in pediatric virus cases
It wasn’t supposed to be this way.
August 2021 was to be the start of the first post-pandemic school year, one in which masks, tests and symptom checks would be memories, not realities.
But the Delta variant has turned those dreams inside out. As daily new-case totals have remained stubbornly over the 1,000 mark, hospitals have begun reporting workforce shortages, the result of running too long on adrenaline serving some who say that their work was an unnecessary response to an elaborate hoax.
It is not the situation many envisioned in the spring when newly available vaccines caused case rates to plummet and the world to reopen, but here we are. Today, 35 of the region’s 42 public school districts are back in session, and the remaining seven are scheduled to be at their desks by Aug. 30.
For most of those who
spoke at Tuesday’s raucous county Board of Supervisors meeting, there is no contagion fear. Anyone could see it right there on the T-shirt worn by an 11-year-old girl that said “your mask won’t save you.”
But for others the decision to return to school is much more fraught.
Having to make the decision put Ian Ricksecker of University City at an impossible crossroads where he and his ex-wife had to balance their 9-year-old daughter’s need for an in-person education against risk to other vulnerable members of the family. His mother, he said, lives in his home and takes immune suppressing medications that put her at significantly greater risk than the average person her age.
While experts continue to say that kids, especially relatively young kids, fare better than adults when they become infected, one must consider the potential psychological scars of bringing the virus home at the end of the school day.
“What if the worst happens? If my mom dies, will my daughter blame herself for killing her baba?” he said.
On the other hand, there is plenty of harm in keeping kids home. Grades already suffered during distance learning last year. In the end, the decision was made to enroll at Spreckles Elementary after the school’s principal detailed the types of air filters that will be present in each room. But Delta, Ricksecker said, made the decision so much more agonizing by far.
“Delta is so much more transmissible and so much more prevalent in the community that I think the risks are vastly different than they were,” he said. “The risk lens is completely changed, and I don’t think that our public health thinking has caught up to that.”
And that seems to be the growing opinion of those who study the patterns of infectious disease professionally.
Gretchen Bandoli, a mother of two school-aged kids and an epidemiologist in the Department of Pediatrics at UC San Diego School of Medicine, said Friday afternoon that it’s hard not to feel torn. It’s clear, she said, that kids suffer in myriad ways when they’re kept home from school. Some will adapt to online learning — many won’t. But at the same time, her training, which includes a doctorate in epidemiology, can’t help but draw her to the trends. Daily new cases were in the hundreds last August, and now they’re in the thousands.
“With schools opening, it’s hard to believe, looking at the numbers that we’re seeing every day right now, that this is not going to get worse before it gets better,” Bandoli said.
It is easy to see what worse looks like.
In recent weeks, reports have continued to surface indicating that some children’s hospitals — many of them in southern states with low vaccination rates — have begun to run out of beds as some cases inevitably turn serious.
But that has not happened here, at least not yet.
Dr. John Bradley, medical director of the Division of Infectious Diseases at Rady Children’s Hospital in San Diego with extensive experience in national health policy, said there were nine kids in the hospital Friday who tested positive for coronavirus, with one adolescent in the intensive care unit.
Rady, he said, has seen about 30 or 40 corona-positive patients per month recently, and about half of them have come in for other reasons, then tested positive after being admitted. So far, he said, Delta has not produced the kind of patient volume responsible for swamping other children’s hospitals in other places.
“The trend for COVID cases is going up, but the level of illness isn’t as high as what we saw last winter and fall,” he said, adding that adolescents, rather than children, tend to be the ones who end up in intensive care units.
Intensive care cases, he added, tend to be among kids with a complicating medical factor, usually obesity.
Though the Delta variant is significantly more contagious than other variants that have circulated this year, it so far has not managed to significantly change the long-standing truth that kids get severely ill far less often than adults.
According to the U.S. Centers for Disease Control and Prevention’s COVID Data Tracker, there were 0.42 admissions per 100,000 kids age zero through 19 nationwide from Aug. 1 through Aug. 17. The rate for all ages was 3.47 per 100,000.
California has been doing significantly better than the national trend at 0.24 hospital admissions per 100,000 compared to 2.35 for all ages. Region 4 of the federal health care statistical surveillance system, a multistate area that takes in a large swath of the south, was at 1.03 per 100,000 in kids and 6.99 in adults.
Bradley said he knows that those who have opposed masking and vaccination mandates are likely to latch onto the basic truth that COVID-19 is significantly less severe in children and adolescents than it is in adults as proof that current school precautions are overblown.
Though COVID-19 has not killed a child at Rady yet, the AAP report does state that there have been 378 pediatric deaths among the 43 states that regularly report such information.
Should the return to school result in a massive increase in local cases, Bradley said, it’s important to remember that even the very, very rare becomes more probable.
“You’re gambling with the odds, especially if you don’t get your adolescent child immunized,” Bradley said. “It’s an unnecessary risk to take.”
The real kid-related coronavirus surge of the moment, said Dr. Rita Feghali, chief of service at Kaiser Permanente San Diego Pediatrics, is around testing. That’s because local school districts are requiring regular testing of any student who was in close contact of another student who tested positive.
“Some school districts are saying no to them being in school, some are saying ‘test them twice a week,’” Feghali said. “It’s a little bit confusing, because there isn’t just one universal approach.”
The pediatrician said she has been impressed with the overall dedication to getting schools up and running, though everyone, she said, should realize that young immune systems, which were less challenged by infectious diseases than usual last year, are already showing increases in infections causing the common cold, an inflammatory lung infection in young kids called bronchiolitis, and respiratory syncytial virus.
“They weren’t really catching much last winter, but they’re going to catch up this winter,” Feghali said.