Georgia Today: Largely Unvaccinated, Georgia Children Face Brunt Of The Raging Delta Variant
Georgia faces its worst crisis of the pandemic, with more patients than ever before hospitalized for COVID-19. The state's also breaking records for the number of children in the hospital with the virus. As the delta variant tightens its grip on the state, the Georgia Today podcast gets a firsthand account of the situation inside Georgia's pediatric hospitals from Dr. Matthew Linam, an infectious disease specialist at Children’s Healthcare of Atlanta and Emory University.
Steve Fennessy: This is Georgia Today; I'm Steve Fennessy. Since the pandemic began, there hasn't been a worse week in Georgia, at least in terms of patients hospitalized with COVID-19. Emergency rooms are inundated. Some hospitals are turning patients away for lack of ICU space. At least one out of every three patients hospitalized right now in Georgia is there for COVID-19. To help beleaguered front-line workers, Gov. Brian Kemp this week says he's deploying hundreds of troops to hospitals across the state to help with everything from directing crowds to disinfecting facilities. And the governor is speaking more bluntly than ever before about the potential consequences of going unvaccinated.
Brian Kemp: You're going to remain at risk of being in the hospital with COVID-19 and you run the risk of being on a ventilator for two or three weeks and then dying.
Steve Fennessy: And yet Georgia's vaccination rate remains dismal. Just 42% of Georgians are fully vaccinated compared to a nationwide average of 53%. Health officials say vaccination is critical in the fight against the delta variant and perhaps the most vulnerable population are children under 12, who still are not eligible for a shot. CDC data show Georgia is among the states breaking records for the number of children hospitalized for COVID-19. For a firsthand look at the situation in Georgia's pediatric hospitals with COVID-19 and with rising rates of other respiratory infections, I'm joined by Dr. Matthew Linam. He's an infectious disease specialist at Children's Healthcare of Atlanta and Emory University. The narrative of this pandemic for the first year or so was that kids are largely going to be spared the worst outcomes of COVID-19. To what degree has the emergence of the delta variant upended that narrative, in your view?
Dr. Matthew Linam: In going back and looking at some of the original studies that came out that suggested that children were largely spared from the pandemic, a lot of those those studies came out when children were being sequestered at home. Schools were doing virtual learning. In some ways, they were largely spared because of their limited interactions and we're actually seeing that children and adolescents have rates of infection that are as high as adults and in some cases even even a little higher. What we're seeing now is a combination of a variant of the virus that is way more contagious than the earlier variants and a population of children who, for the most part, are not eligible for being vaccinated, but are also now back in school. They're also more involved in their extracurricular activities, like sports and spending time with their friends. So what I think we're seeing right now is this combination of the more contagious variant children who are much more active and significantly at this point. There's very low percentage of vaccination at this time. If you're under the age of 12, you're not eligible to be vaccinated. So that's a that's a large chunk of the pediatric population. But even when you look at children who are eligible, only about 33% of children between the ages of 12 and 15 are fully vaccinated. And only 43% of children 16 to 18 years of age are fully vaccinated. Even in the population of children that are eligible for vaccination, our numbers are very low.
Steve Fennessy: How are you and your colleagues holding up in the middle of this surge?
Dr. Matthew Linam: You know, we're definitely seeing a lot of sick kids in the hospital right now with COVID-19. And a lot of ways I think they seem a little bit sicker than I remember them earlier in the pandemic as we moved into the beginning of the summer, vaccinations were going up, cases were going down. We actually at one point reached our lowest number of cases of children that were hospitalized where we actually had some periods of time, where we had no children in the hospital with COVID-19. But then as we begin to see more circulation of the delta variant, in more cases, we begin to start seeing more and more children in the hospital. I think our peak in July of this year was 17 patients at one time in the hospital. But that's since climbed to our current peak, which is we have 38 patients in our system. That is our highest number of children in the hospital at any one time.
Steve Fennessy: How is treating kids with COVID-19 different than treating adults with COVID? Is there any substantive difference?
Dr. Matthew Linam: A lot of what we're doing is following sort of the adult treatment guidelines for using steroids like dexamethasone, in some cases treating children with the antiviral remdesivir, monoclonal antibody therapies and things like that. But for most treatments, we have less data for their use in children and have to go based on what we know from adult studies.
Steve Fennessy: When you're treating a patient, what are you what are you looking for before you even sort of prescribe a course of of of therapy for
Dr. Matthew Linam: How sick they are, their level of risk. Most of the children that we are seeing in the hospital right now have some preexisting condition. I think a lot of people think of things like cancer or autoimmune disease or things like that. But I think it's important to remember that there are other preexisting conditions that can make children very sick with COVID-19 like asthma or being significantly overweight. But I think it's also important to keep in mind we still have children that are hospitalized with many other things, including a number of different other respiratory viruses that are also circulating right now.
[News tape] ABC11: Emergency room doctors are seeing an increase in COVID-19 infections among the unvaccinated and the respiratory virus called RSV among children. RSV has similar symptoms to COVID, like cough, congestion and breathing issues. It's more common in the fall and winter. UNC’s chief of pediatricemergency medicine says she's seeing a 30% increase in RSV cases right now compared to summer 2019.
Dr. Matthew Linam: And we're actually seeing surges in those other respiratory viruses that we typically don't see in the summer — We typically see in the winter. RSV is one that can cause significant Illness in small children. It's also one that I think we track a little bit more and I think we use it as a marker for some of the other respiratory viruses that are circulating.
Steve Fennessy: Is it worth discussing how you distinguish RSV from COVID-19? Because they're both respiratory diseases and they're both spreading among children, right?
Dr. Matthew Linam: Most of these respiratory viruses are often pretty indistinguishable from each other, clinically.
[News tape] WKOW: So how can you tell if it's something mild or COVID-19? SSM Health says they see cases of RSV every year, but its symptoms are pretty similar to coronavirus: fevers, coughing and wheezing are all common. SSM Health says it's important people pay close attention to their symptoms and how their illness is progressing in order to decide the best course of action.
Dr. Matthew Linam: That's also makes it challenging as we move into the school year. And the implications, certainly from a public health standpoint, are very different.
Steve Fennessy: You mentioned that you have 38 pediatric patients who are battling COVID-19 at the moment. Are any of them vaccinated? Because we've heard about some breakthrough infections — if you talk about pediatric patients who are over 12.
Dr. Matthew Linam: We have seen a few children that have had breakthrough infections, but I don't think we've had a single child that was fully vaccinated that required hospitalization. The vaccines were designed to prevent severe illness, hospitalization and death. And they remain, even with the delta variant, highly effective at doing that job. The vaccines were also early on showed that they were very effective at preventing symptomatic and asymptomatic infections as well. And that helped cut down on the transmission of the virus and I think played a large role in this, the drop of cases that we saw across the country. But unfortunately, when those people have breakthrough infections, they can potentially transmit the virus to other people.
Steve Fennessy: In early August, I know that the American Academy of Pediatrics sent a letter to the FDA urging it to work aggressively to approve a vaccine for kids under 12. And then now we have Francis Collins at the NIH saying, well, it's likely going to be later this year at the soonest.
[Tape] Dr. Francis S. Collins: The companies, Pfizer, Moderna, are working hard on collecting data from rigorous trials to be sure they've got that part right. But actually, the data hasn't been submitted to FDA yet. Pfizer thinks maybe by the end of September they'll be ready to send in their trial data and then FDA will have to review it. I've got to be honest, I don't see the approval for kids 5 to 11 coming months before the end of 2021.
[News tape] NPR News: That means that millions of parents are going to be sending their kids under 12 to school, in-person school. There might be masks, there might not be masks, but there are not going to be vaccines.
Steve Fennessy: Are regulators moving fast enough to approve a vaccine for kids under 12?
Dr. Matthew Linam: The FDA, the CDC continue to move through the process to make sure that the vaccines are appropriately studied and that they are appropriately effective and most importantly, equally safe in younger children as they have been in older populations.
Steve Fennessy: Next, more of my conversation with Dr. Matthew Linam and what it's like to treat a child who's fighting COVID-19.
Dr. Matthew Linam: I don't think that there's anything quite as terrifying to a parent than looking at their child and seeing their child struggle to breathe. And that's what these parents are going through.
Steve Fennessy: That's ahead. This is Georgia Today.
You're listening to Georgia Today. I'm Steve Fennessy. Joining me is Children's Healthcare of Atlanta infectious disease specialist Dr. Matthew Linam.
I happen to live in a district where there — there is a masking mandate, so, you know, that's that's certainly a relief to to a large degree for a parent like me and other parents. But so many districts don't have those mandates. And I mean, what's going to happen?
Dr. Matthew Linam: The thing that probably worries me the most is for the schools that are out there, the following guidance from the American Academy of Pediatrics and the CDC, they'll be able to keep kids safely in the classroom where they're going to learn the best. I worry about these schools that have chosen to do things differently. And I think they're going to have students and teachers who are going to get sick and in the end may jeopardize their ability to have in-person learning as long as they continue down this path.
[News tape] 11Alive: Gov. Kemp says his number one priority is to convince people to get vaccinated and wear masks. No state mandates, do it voluntarily, he says, or accept the potential consequences.
Steve Fennessy: In the meantime, until they're vaccinated, what advice do you have for parents in that situation who are like, “My kid needs to be back in school; they can't get vaccinated?” What's the best sort of mitigation measures to be taking at this point?
Dr. Matthew Linam: I think a lot of it goes back to the three W's.
[News tape] ABC11: Practice the three W's with your child: Wear a mask, wash your hands and social distance to reduce spreading germs.
Dr. Matthew Linam: Even before vaccines, we were able — a number of, many schools were able to keep their students in the classroom, sometimes for the entire year with these sort of measures in place. You know, now we have, on top of that, many older students and many, many teachers and school staff are vaccinated. So we have this added layer of protection in place. And one of the best things that a family can do to protect their children who are too young to be vaccinated is to provide a safe cocoon around them to help keep those younger children protected until they're eligible for vaccination.
Steve Fennessy: It's scary for anybody to be admitted to the hospital, but for a child to be admitted to the hospital who's suffering from a disease for which there is no cure at this point, there's just some treatments. And what are you seeing? And what do you what do you tell kids? What do you tell their parents?
Dr. Matthew Linam: It is scary. It's scary for parents when their kid’s sick. You know, I think sometimes it's also, you know, there can be a level of of guilt that families that parents feel they end up with a child that's in the hospital and sometimes they worry, “Could we have done more?” I think the good news is that in the vast majority of cases, we are able to, you know, through giving them oxygen and support to help them breathe more comfortably in some of the medicines that we have, like dexamethasone and Vestavia severe, that we probably most of the treatments out there use the most frequently we're able to get children better and get them home. Most of the time I'm able to provide some reassurance, like, you know, “You're sick right now and I know you're scared. But, you know, we have we have some things to do that we can help you get through it. It may take it may take us a little while, but we'll get you there.”
Steve Fennessy: Are the parents allowed to stay with their kids?
Dr. Matthew Linam: Absolutely. You know, that's one of the the differences in children's hospitals compared to adult hospitals. You know, we we recognize that parents and caregivers play a vital role in their child's care as parents. They know they understand their children better than anyone. They are able to communicate, you know, their child's symptoms and their concerns, you know better than anybody can. They're a vital part of the care of children, of all children that are in the hospital. So they are allowed at the bedside 24/7.
Steve Fennessy: Dr. Linam, the latest data is showing that 2,000 children a day are being diagnosed in Georgia with COVID-19. What is all this going?
Dr. Matthew Linam: The thing that sort of just continues to sort of eat at me is just the fact that a lot of times we know the things that it takes to sort of control the spread of this virus. So in some ways, it's a little disheartening, a little frustrating when I hear about, you know, school systems that are choosing strategies for their schools that are very different from what's recommended by the CDC and the American Academy of Pediatrics, you know, knowing that they're going to have kids that get sick, possibly teachers that get sick from the virus. You know, it is frustrating to see this surge that we're currently going through across the country, in Georgia, in children, knowing that it largely could have been prevented if there was more universal adoption of tried-and-true prevention measures.
Steve Fennessy: Is there an interaction you've had with a child, with a patient or with their family, that kind of sticks out that you feel is representative or emblematic in some way of this whole pandemic?
Dr. Matthew Linam: You know, there actually is, actually. A patient that's been on my mind recently, is a teenage young lady that was admitted to the hospital. And, you know, she actually ended up being decently sick. And, you know, in talking with the family, the mother was telling us that everybody else in their family was — was vaccinated and their daughter was not yet vaccinated. I didn't press because, you know, the mother was very upset and scared for her daughter. And I felt pretty confident that they had probably gotten tangled up in some of the misinformation that's out there about vaccines and, you know, false statements about their impact on young women. And it may have confused them just enough that they were holding off and hadn't gotten her vaccinated yet. And then, unfortunately, she became sick. And to me, it brought it into very clear focus the true harm that can happen with misinformation about COVID-19 in general, but COVID-19 vaccines specifically. And if all of this misinformation wasn't going around, she probably would have been vaccinated and most definitely wouldn't have been in the hospital.
[News tape] 11Alive: Masks and vaccinations continue to be so divisive across this state. Georgia's commissioner of public health says nurses and other medical workers at vaccination sites are receiving threats in person in emails on social media. In fact, she says, one mobile vaccination site had to shut down because of all the threats.
Steve Fennessy: How have these last 18 months impacted you emotionally, psychologically, and is it — has it changed your perspective at all?
Dr. Matthew Linam: In some ways, being able to have a skillset that I can sort of, you know, dive in and help, it's been rewarding to be able to play a role and help, exhausting for just how long it's been. And just to see how many people that have gotten sick and died from all of this.
Steve Fennessy: Do you see the toll in your colleagues?
Dr. Matthew Linam: You catch people on different days. You go through a period of time where there's a lot of children in the hospital, you know, a lot of kids in the ICU. And those are those are tough days. I'll see a lot of my colleagues feeling the brunt of that. I work with a bunch of amazing doctors and nurses that are passionate about what they do. They love taking care of kids and will be here every day that we need to taking care of kids. I wish I could give people sort of a sense of how real this is and how sick it can make people of all ages, including really young children. I don't think that there's anything quite as terrifying to a parent than looking at their child and seeing their child struggle to breathe. And that's what these parents are going through, just about every parent out there would do just about anything they could to protect their child from that. That's what I would impress upon parents, is we should be doing everything we can as parents to protect our kids and make sure that they never have to go through that and we never have to watch it.
Steve Fennessy: My thanks to Dr. Mathew Linam. As the delta variant continues to take hold in Georgia, the state last week ranked behind only Texas and Florida in pediatric COVID hospital admissions. So far, of Georgia's 19,000 confirmed COVID deaths, at least 17 have been in children.
For more Georgia Today, go to GPB.org. I'm Steve Fennessy. Georgia Today is a production of Georgia Public Broadcasting. Subscribe to our show anywhere you get podcasts. And don't forget to leave us a review on Apple. Jess Mador produced this episode. Our engineers are Jesse Nighswonger and Jahi Whitehead. Thanks for listening. See you next week.