The Delta variant is proving just as infectious for children as for everyone else, with pediatric cases surging in some parts of the United States, pediatricians and children's hospitals say.
However, it's not clear yet whether the variant is any harsher on kids compared to earlier COVID-19 strains, leading to more hospitalizations and brushes with death rather than just the sniffles.
Child cases of COVID-19 steadily increased throughout July, as Delta became the dominant strain in the United States, according to tracking data kept by the Children's Hospital Association and the American Academy of Pediatrics (AAP).
More than 71,700 COVID-19 cases in people under the age of 18 were reported between July 22 and July 29, with kids and teens representing about one in five new cases that week, the data shows.
Doctors and nurses at Johns Hopkins All Children's Hospital in St. Petersburg, Fla.— a state hammered by the Delta surge — "have been extremely busy caring for pediatric patients diagnosed with COVID-19 in the past few weeks as we've seen one of the highest increases in COVID-19 cases at our hospital since the beginning of the pandemic," said Angela Green, the hospital's vice president and chief patient safety and quality officer.
But there are mixed reports regarding the severity of illness linked to the Delta variant in kids.
The tracking numbers show that the rate of pediatric COVID-19 hospitalizations is about the same as it has been for earlier variants, varying between 0.1% and 1.9% depending on the state.
"While we are seeing an increase in overall cases, our hospitalization rate for COVID has remained the same," Green said.
The AAP agrees, saying that "at this time, it appears that severe illness due to COVID-19 is uncommon among children."
Some doctors seeing more severe COVID in children as cases rise
But one front-line doctor disagrees, suspecting that Delta is indeed harder on kids although there's currently no hard numbers to prove it.
In the past, doctors in the emergency room at Le Bonheur Children's Hospital in Memphis, Tenn., usually learned that a kid had COVID while treating some other problem, like a broken leg or arm, said Dr. Nick Hysmith, the hospital's medical director of infection prevention. Routine testing would reveal an asymptomatic infection while doctors treated the immediate medical issue.
The Delta surge has changed that equation for Le Bonheur, which receives patients from Arkansas, Mississippi and west Tennessee, Hysmith said.
"In the past week and a half to two weeks, we've seen kids presenting and being admitted for COVID. They're having respiratory symptoms, shortness of breath that has required hospital admission," Hysmith said, noting that these patients are mainly between the ages of 10 and 13.
"We've had kids intubated over the past week with COVID pneumonia. We've had kids that have required very aggressive pulmonary interventions just shy of being intubated in our critical care area," he continued.
Hysmith thinks "there's something about Delta that's a little different, in that we are seeing more severe disease."
Other experts aren't so sure, instead wondering if the sheer number of new cases caused by the Delta variant has simply led to a misperception of that strain's severity.
"I think the jury's still out. There's not enough data at this point to say for sure if it's going to be more severe," said Dr. Kristin Oliver, an assistant professor of pediatrics with the Icahn School of Medicine at Mount Sinai, in New York City.
Rise in infections could trigger more cases of inflammatory condition in coming weeks
The infectiousness of the Delta variant has meant that more kids are catching the virus, said Dr. Ezekiel Emanuel, co-director of the Healthcare Transformation Institute at the University of Pennsylvania, in Philadelphia.
That's compounded by the fact that kids younger than 12 still don't have a vaccine approved for them, while a majority of older folks now are vaccine-protected against severe COVID, Emanuel and Oliver said.
"If you're looking just at the straight numbers, even if it's not more severe, as you get more infections you're going to get more kids hospitalized and unfortunately more kids die," Oliver said. "We'll be seeing that increase whether or not it's more severe."
There is one concern for current child COVID-19 patients that should be kept in mind, even if their Delta infections are no worse than with previous strains, said Dr. Alice Sato, hospital epidemiologist at Children's Hospital & Medical Center in Omaha, Neb.
A small number of kids with an initially mild COVID-19 infection can later develop MIS-C (multisystem inflammatory syndrome-children), a syndrome in which hyperactive inflammation damages the heart, lungs, kidneys, brain and other organs.
"We expect to start seeing more of those cases as well, and a third to a half of those children require ICU care," Sato said. "It very heavily impacts their heart in most of those children. Those are the ones who need ICU care, when we really need to support their heart function."
Because of the delayed onset of MIS-C, we'll start seeing those cases in one or two months, Sato and Hysmith predicted.
"If we're seeing this surge in our pediatric population, I'm very concerned that we're going to see a surge in MIS-C as well, four to six weeks from now," Hysmith said.