Despite high hopes for a so-called vaxx summer, the Delta variant of the novel coronavirus is driving a wild new spike in infections across the United States, especially in areas where a large number of residents have rejected the COVID-19 vaccines.
But it’s not just stubborn, unvaccinated adults who are catching Delta and getting really, really sick. The variant—“lineage” is the scientific term—also may be sending children to the hospital at a higher rate than previous variants. And Florida, where the number of children hospitalized with COVID-19 appears to be higher than ever, could reach a new frontier of pandemic chaos in the coming weeks thanks to the flourishing variant, middling vaccination rates, and a risky school reopening scheme.
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The vaccines are safe and effective, including against the Delta variant. But across the United States, kids under 12 can’t get the vaccine until the U.S. Food and Drug Administration expands its eligibility rules, a move that’s widely expected to come this winter.
Meanwhile, a surge in serious pediatric infections is already here, and it worries many doctors and scientists. It could point to a dangerous new dynamic as the pandemic enters its 18th month and a new school year begins. This is especially true in states where right-wing politicians have worked hard to discourage, or even ban, mask mandates at schools.
Florida, as usual, stands out from the pack.
“I am genuinely afraid of what the next few weeks will bring,” Elias Sayour, a University of Florida professor of neurosurgery and pediatrics and director of the school’s Pediatric Cancer Immunotherapy Initiative, told The Daily Beast.
Up until now, even as it has killed hundreds of thousands of people across the U.S., SARS-CoV-2 has not come with equal lethality for the youngest Americans. No one would argue children haven’t suffered from more than a year of disruptions to their schooling and friendships, and many have become seriously ill and died, not to mention losing loved ones. But early on, at least, they weren’t getting sick in large numbers.
That might be changing as the pathogen evolves.
Delta, which features changes to its spike protein—the part of the virus that allows it to grab onto and infect our cells—could be the lineage that extends the coronavirus’ deadly reach even more to, well, everyone. Regardless of age.
Jason Salemi, a University of South Florida epidemiologist, was one of the first to sound the alarm about pediatric hospitalizations there in recent days. Salemi closely tracks state and national COVID-19 data in order to detect trends, and shares his results with other experts and the media.
On Saturday, Salemi noticed something disturbing in the latest figures from the U.S. Department of Health and Human Services. In Florida, Salemi wrote, “There seem to currently be 114 pediatric patients currently hospitalized with confirmed COVID-19.” In other words, 114 COVID patients under the age of 18.
That’s a new record for Florida. The previous high before the current surge for pediatric hospitalizations in the state was on Jan. 25, when there were just 65 kids in the hospital with serious COVID, according to data Salemi analyzed.
The chilling new statistic emerged as Florida counted a near-record number of hospitalizations across all age groups. On Monday, the Sunshine State had 10,389 people in the hospital for COVID-19, and as a local NBC affiliate in Miami reported, some 90 percent of cases at local hospital systems had been attributed to the Delta variant.
The previous record before the current surge—10,170 COVID hospitalizations—was 53 weeks ago, before vaccines were widely available, and before Delta was so dominant.
The spike in hospitalizations follows a huge increase in cases across all age groups. Florida has reported an average of 16,000 new cases a day in recent days, just shy of the record 17,000 new cases it was counting back in early January. In fact, Florida had its highest one-day case surge ever, with over 21,000 new cases, this past Friday.
Sayour has witnessed Florida’s wave of sick kids first-hand.
“Over the last week, on inpatient pediatric services, my experiences managing COVID-19 infection in children is starkly different from a year ago,” he said. “Our hospital system is already overwhelmed.”
He was not alone.
Marcos Mestre, chief medical officer at Nicklaus Children’s Hospital in Miami, said he wasn’t surprised that the number of children hospitalized with COVID-19 had spiked from the previous high from six months ago. “Over the weekend, we had 18 to 19 patients,” Mestre told The Daily Beast on Monday. “Today, we had 17 patients. Time will tell if we will continue to see a higher amount than last summer. We are just getting to the upside of this [surge]. That is my concern.”
In the last two weeks, there have been more kids who required oxygen support than earlier in the year, Mestre said, adding, “It’s too early to tell at this point how much worse it could get.”
Mestre went on to argue that what’s helped hospitals in Miami-Dade from being even more overwhelmed is that the county’s vaccination rate is higher than any of the other 67 counties in Florida. “It correlates with us not having as many hospitalizations as Orland and Jacksonville,” he said. “We are lucky in that sense.”
It’s possible the surge in child infections is, in part, a statistical mirage reflecting the demographic shift in COVID-19 cases. Because the FDA hasn’t authorized the vaccines for children under 12, that population—around 15 percent of the country, or 50 million people—naturally accounts for a greater share of infections as the virus seeks out unvaccinated hosts.
“I am not aware of any studies indicating that children are at higher risk from the Delta per se,” Mary Jo Trepka, a Florida International University epidemiologist, told The Daily Beast. “However, I think there is a lot that is still unknown about Delta.”
“What we do know is that all children under 12 are not vaccinated because the vaccine has not yet been approved for that age group,” Trepka added. “Further, we know that most children between 12 and 18 are not fully vaccinated, so they are highly susceptible.”
In Florida, just 38 percent of 12- to-19-year-olds have gotten at least one dose of vaccine. Overall in the state, 59 percent of the population—that’s 12.7 million out of 21.5 million Floridians—has gotten their first jab. That’s significantly below the national average of 68 percent.
As far as we know, kids are still less vulnerable to COVID-19 than adults are. In fact, the older you are, the higher your risk of serious infection, hospitalization, and death. Assuming you’re not vaccinated, of course.
“Children have a lower risk from COVID than the elderly, but there has always been a risk for children and thus it is not surprising that, given the large number of observed cases… we would also see a large number of hospitalizations, even for kids,” Trepka said.
But Sayour, for one, said he suspected something else was going on. “This new Delta variant is distinct based on infectivity,” he argued. That is to say, compared to older lineages, Delta might be more likely to cause infection after a given level of exposure.
The new lineage could also spread in the air more easily than previous lineages, Sayour suggested, though this remains far from clear. Finally, in addition to spreading faster, Delta might also be more dangerous to individual patients, he added, echoing preliminary findings in some early studies.
In sum, it’s possible the new lineage is more infective, more transmissible, and more pathogenic. The apex predator of lineages.
As cases pile up and scientists continue to scrutinize Delta, we’ll learn more. Maybe we’ll discover that Florida’s surge in pediatric infections was an outlier.
If it’s not, we could be in for a rough fall. School starts up again in August in many communities. Some school districts are mandating masks or taking other steps to limit viral transmission.
But it’s not so simple in Florida.
On Friday, the day before the state announced its record number of COVID-19 cases, DeSantis signed an executive order banning school districts from requiring masks. When, on Tuesday, a reporter asked DeSantis about the increase in pediatric hospitalizations, DeSantis rejected the question, calling it “deplorable.”
“Governor DeSantis is not going to enact any lockdowns, mask mandates, vaccine mandates, school closures or business restrictions. These policies are off the table,” the governor’s press secretary, Christina Pushaw, said in a statement to The Daily Beast.
Neither the Florida Department of Health, nor the Florida Department of Education responded to emails requesting comment for this story.
Statewide bans on mask mandates are popular among right-wing governors who are eager to prove their bona fides to an anti-vax, science-denying political base. Tragically, the states where school districts legally can’t require masks are the same states where vaccination rates are lowest and where everyone—not just kids—is more vulnerable to COVID. Florida. Arkansas. South Carolina.
“Given where we are now, we will in all likelihood still have a lot of SARS CoV-2 transmission once schools reopen,” Trepka said.
That’s not just her gut feeling. Edwin Michael, an epidemiologist at the Center for Global Health Infectious Disease Research at the University of South Florida, has created sophisticated computer models for projecting COVID-19 trends. Right now, his models—which take into account the coming school year—are a red flag for all Floridians, including kids.
“For Florida as a whole, we are forecasting that hospitalizations across all age groups will peak around 65,000 around Sept. 8 or thereabouts if current vaccination and levels of social protective measures continue across the state,” Michael told The Daily Beast.
“Children make up to some 3 percent of all reported COVID hospitalizations recently in the U.S,” he added. “If this applies going forward—and it could increase—then we could expect 1,950 pediatric cases at the peak of hospitalizations arising from the coming wave. But this could be a larger number if the rate of infection in this group increases going forward.”
It’s hard to say where this ends. But it’s a safe bet kids are going to die.
“One implication of more pediatric hospitalizations is that we have to unfortunately expect more pediatric deaths than we saw before, as a proportion of all those hospitalized,” Cindy Prins, a University of Florida epidemiologist, told The Daily Beast.
Even children who recover from serious COVID-19 aren’t out of the woods. “There’s also a concern for multisystem inflammatory syndrome in children, and the possibility of long COVID after recovery from the acute infection,” Prins added.
A hundred-plus young Floridians in the hospital with COVID-19 is bad. Two thousand in the same dire situation—Michael’s projection for a month from now—would obviously be much worse. But even that startling figure belies the true danger Delta poses to tens of millions of unvaccinated children, not just in Florida but nationwide.
If 2,000 Floridians under the age of 18 land in the hospital with COVID-19, it probably means thousands more in the Sunshine State—and tens of thousands in other states—got pretty bad cases of the disease but stayed home.
To give kids the best chance of escaping Delta while going to school in a state that is hostile to even the most basic public-health measures, experts advised parents to understand they’re not totally powerless. “Regardless of ultimate policies, every family has the right to make decisions to protect their children and everyone in schools working hard to give their children an enjoyable, enriching, and safe learning environment,” Salemi told The Daily Beast.
“Parents should not delay” getting eligible kids vaccinated, Trepka added.
“All parents should also make sure that they have bought good, well-fitting masks for their kids that don’t slide off their nose,” she continued.
Still, experts couldn’t help but fear the worst in a state that has long set records for pandemic disaster. Many of these pediatric cases could drag on for months or even years with serious implications for heart and lung function, cognition, and taste and smell.
Prins put it bluntly: “I worry about the long-term effects of COVID-19 infection on these kids.”
—with additional reporting by Francisco Alvarado
