As child hospitalizations rise, leaders must act now

With schools opening as the Delta variant of COVID-19 surges, children under 12 face rising infection risks with no protection from vaccines. There are thousands of preventable child hospital admissions from COVID-19 in the U.S. each week, and their numbers increase every day. Hospitals across the country, especially in areas experiencing significant COVID-19 outbreaks, have reported shortages in beds for pediatric patients. Assuming that “everyone will get the virus” while hoping that vaccines reduce severe outcomes is untenable for children, who remain ineligible for vaccines. With Delta spreading rapidly and child vaccines just around the corner, we need effective prevention policies to prevent any more child illnesses, hospitalizations and possible child deaths.

As parents to young children, we share the parental anxiety that arises from having to choose between sending our kids to school or child care and protecting them from illness. Some schools have closed in the past week because of rising infections, leaving parents few options, just as federal unemployment insurance benefits are about to end. 

As policy researchers, we know that there is clear evidence that universal mask policies and other mitigation strategies can reduce child risks. The greatest challenge we face is a lack of federal leadership and political will to act.

Record high child hospitalizations constitute a national emergency. We need President Biden’s leadership. There are several steps the administration can take to protect our kids. 

• Call for statewide indoor mask policies. “Universal masking is essential” is the unambiguous recommendation of Centers for Disease Control and Prevention (CDC) scientists. Mask policies are an easy, cost-effective strategy for reducing risks. A few states and the District of Columbia now have indoor mask policies, but 43 states and D.C. had statewide mask policies in 2020. Statewide mask policies don’t need to mean masking forever. Nevada has a smart, data-driven policy that calls for masking indoors when cases increase and removing masks when cases decrease. A team of modelers has developed a similar strategy for schools, best implemented when transmission meets the CDC standard for “low.” The CDC and the American Academy of Pediatrics recommend universal masking in schools, and a majority of parents support school mask requirements.  

• Issue emergency use authorization for vaccines for kids under 12. With the Delta variant surging, kids need to be vaccinated. Data from child vaccine clinical trials will be available as early as September. While the Food and Drug Administration (FDA) required two months of follow-up data from the adult trials to issue emergency use authorization, the agency asked for four to six months of data from the child trials. This is longer than our kids can wait, with estimates indicating that upwards of 80 percent could be infected this fall. Tens of millions of people have safely received the vaccines. Rare reactions that occur are generally mild, especially when compared to the risks of COVID. A vaccine distribution plan that delivers child vaccines rapidly and equitably can ensure that the children who need vaccine protection most will get it quickly and easily.

• Require vaccinations for school staff, including teachers. Vaccines work remarkably well to prevent infections and hospitalization, and they are an important strategy for reducing transmission. California recently became the first state to mandate teachers and school staff be vaccinated or submit to weekly testing. Several other states have mandated vaccination for other sectors, such as health care workers, correctional staff, and other state employees. When paired with universal masking policies, vaccination requirements for teachers and other employees will reduce child risks.

• Support other in-school mitigation strategies. Mitigation strategies are most effective when layered. Together with universal indoor masking and vaccines, the Biden administration should support school districts in improving ventilation in schools, eliminating risky indoor activities such as crowded cafeteria dining, and regularly testing students and staff.

Instead of asking American families to make the difficult decision of choosing between keeping their kids isolated or sending them to potentially risky schools, our leaders have an easy choice: act now to reduce risks for children, or allow uncontrolled transmission to continue in communities and schools, possibly resulting in severe sickness or death among America’s children. The moral and ethical choice is clear. We must protect our kids.

Courtney E. Boen, Ph.D., MPH, is assistant professor and the Axilrod Faculty Fellow in the Department of Sociology, research associate in the Population Studies Center & Population Aging Research Center, and senior fellow in the Leonard Davis Institute for Health Economics at the University of Pennsylvania. Her research focuses on drivers of population health disparities. Follow her on Twitter @CourtneyBoen.

Julia Raifman, ScD, is an assistant professor at the Boston University School of Public Health, where she conducts research on how social policies affect population health. She developed the COVID-19 U.S. State Policy Database to track changes in state health and social policies with a focus on those most vulnerable to COVID-19 and its consequences. Follow her on Twitter @JuliaRaifman.