We have all been there. We have watched our favorite team score enough to have a comfortable lead going into the final minutes of play. We may have even contemplated leaving early to avoid a congested parking lot or highway home. 

Then, before you realize it, key members of your team make bonehead errors or underestimate their opponents. Now, with the outcome not as straightforward as it once was, we resort to biting our nails, covering our eyes, or rubbing our superstitious lucky charm a time or two.

Such is the case with this current stage of the coronavirus pandemic.

In the late Spring and early Summer, cases were low compared to the prior six months. Vaccines from multiple manufacturers were readily available. Federal and state vaccine mega-sites gave way to community physician offices along with franchise and so-called mom-and-pop pharmacies as outlets for immunizations.

Hospitalizations, emergency room and urgent care visits, and even death rates due to COVID were trending down. Restaurants, hotels, and airlines took advantage of the new demand for travel and leisure activity. Life appeared to look normal again, and unfortunately, the public interest in COVID-19 vaccinations — the primary tool in our arsenal against this awful illness — waned.

Unfortunately, the result is that the landscape we face with COVID-19 in the late Summer and Fall is entirely different from the Spring, thanks to the Delta variant.

According to the CDC, the current average number of new coronavirus cases during the last seven days is just above 140,000. Contrast this with an average of less than 9,000 new cases during the fourth week of June.

The total number of individuals hospitalized due to COVID-19 has also spiked to about 90,000 as of the writing of this article.

It was once viewed as a silver lining that children generally speaking experienced less severe disease than adults. Generally, this holds true as the American Academy of Pediatrics reports that of all the children who are infected with COVID-19, less than 2% become sick enough to need hospitalization. Still, 1,900 children were hospitalized due to COVID-19 in mid-August.

At the end of June, that figure was just over 400. The availability of pediatric ICU beds, particularly in the southern states, has become severely limited. We are running out of beds.

High census rates in pediatric wards have challenged hospital systems making finding available beds for even non-COVID pediatric patients difficult. This negatively affects the quality of care for children seeking treatment for asthma, pneumonia, and even severe ailments like seizures. Even more tragically, 400 children have died directly due to COVID-19 since the pandemic began.

No matter what part of the country or even the world you are in, the thought of severely sick children can cause nail-biting and overall queasiness in even the most stalwart individuals. The following offers up some answers to some frequently asked questions that parents, school officials, and coaches will wrestle with during the back-to-school season.

What is the best way to prevent my child from getting infected with COVID-19?

If your child is 12 years of age or older, the single best prevention mechanism is the Pfizer COVID-19 vaccination. Just as it has in the adult population, the Pfizer vaccine has achieved remarkable efficacy against infection.

In children aged 12–15, the vaccine has been shown to prevent infection 100% of the time compared to controlled groups of the same age bracket.

No vaccine is perfect, but vaccination can prevent severe illness requiring hospitalization, ventilator support, and emergency room visits. That can potentially lead to death can be averted even with a breakthrough infection. The mRNA vaccines (Pfizer and Moderna) also perform excellently against the Delta variant, though the Moderna vaccine is currently approved only for those 18 years of age and older.

The other critical motivating factor for vaccinating this population is that while the jury is still out on the ability of young children under age 10 to transmit the disease to others, adolescents seem to be able to transmit the disease nearly as effectively as adults.

The bottom line is that the more people vaccinated — parents, teachers, students, school officials, etc. — the more likely we can reduce community spread and eliminate further variants.

What are the side effects of the COVID-19 vaccines?

The side effects are similar to those in the adult population. They include pain at the injection site, fever, fatigue, chills, headache, and muscle aches. These side effects usually resolve within 48 hours.

On a much rarer note, there have been some cases of inflammatory conditions affecting the heart. Myocarditis is inflammation of the heart muscle, while pericarditis is defined as inflammation of the lining around the heart.

There have been over 2 million COVID-19 vaccines administered to children aged 12–17. There have been 19 cases of heart inflammation. This amounts to nearly 9 cases per million COVID-19 doses.

Boys have been affected more than girls, and the symptoms usually occur within a week after the second dose. Myocarditis at much higher rates than this occurs in people who have been infected with COVID-19 in both pediatric and adult populations.

The Pfizer vaccine has undergone rigorous safety protocols and has been granted Emergency Use Authorization by the FDA. The New England Journal of Medicine describes a vaccine trial involving nearly 40,000 people.

The vaccines are generally safe, but like most medications and immunizations, a small percentage of the population may be allergic to one or more vaccine components. If an individual develops an allergic reaction to the first dose of the Pfizer vaccine, he/she should avoid a second dose.

Can the COVID-19 vaccine give my child COVID-19 disease? 

The COVID-19 vaccine is not a live vaccine. While it may give you some temporary body aches and fever, as described above, active coronavirus disease is not one of its side effects.

Will the COVID-19 vaccine interfere with other vaccines that my child may be due to receive like the flu shot? Should I stagger the other adolescent vaccines my child should be due for? Which is more important?

All vaccines are important. When the COVID-19 vaccine first became available it was recommended to have an interval of time between it and other common vaccines like the influenza vaccine. As we have had more time to study the vaccine and how it interacts with patients and impacts their health, that recommendation has been lifted.

There is no longer a waiting period between COVID-19 vaccines and other vaccines.

You or your child can be immunized against COVID-19 and other diseases even on the same day. This is consistent with other traditional vaccines that your child receives. At 2, 4, and 6 months as many as six vaccines are given simultaneously.

Can the COVID-19 vaccine cause infertility either now or in the future? According to the CDC, there is no evidencethat the COVID-19 vaccine causes reproductive problems in either males or females.

Can pregnant women or breastfeeding women receive COVID-19 vaccines?

As more and more data has emerged, the safety and efficacy of the COVID-19 vaccines in pregnant and breastfeeding women have become more apparent.

Research data has shown no increased risk of miscarriages in pregnant women. By contrast, pregnant women, especially those early in their first trimester, are at increased risk for severe illness if they get infected with COVID-19. Getting vaccinated can help reduce the risk of severe infection in this population.

Also, antibodies to the disease have been noted in the blood of infants born to mothers who have received the COVID-19 vaccine. These antibodies, which can also be passed on to infants through breastmilk may afford some protection to these young, vulnerable babies.

Can patients under 12 receive the vaccine if my healthcare provider orders it?

This would be considered an ‘off-label’ use of the vaccine at this point in time. Children younger than 12 may need a smaller dose than that currently given to adolescents and adults. 

For this reason, the FDA and American Academy of Pediatrics discourage giving the vaccine to children younger than age 12. The situation is fluid, though, and more data is emerging every day. There could be announcements concerning the COVID-19 vaccine for younger children emerging as we venture into the Fall.

Will my child need a third dose of COVID-19 vaccine like the adults get 8 months after the second dose?

As of now, no booster dosages of COVID-19 vaccines are required after the second shot in adolescents younger than 18 years of age.

What can I do for my child less than 12 years of age?

The next best way to prevent COVID-19 infection in children is to employ the uses of masks or facial coverings in children two years of age or older.

Teachers, staff, coaches, and visitors should also wear masks while indoors. Until we have better control of the infection rate, both vaccinated and unvaccinated individuals should wear face masks while indoors. The vaccines are remarkable in preventing severe illness and hospitalizations, but breakthrough infections can occur.

More importantly, data appears to show that while vaccinated individuals are largely free from high morbidity, they can, in fact, spread the virus to those around them. Encouraging children to wear masks while indoors would go a long way toward preventing infection.

Remember that transportation mechanisms like school buses, public transit, and even carpool vehicles also count as indoor venues. Masks should be worn in any vehicle that carries people from multiple households.

Wearing masks outdoors is much less crucial. The risk of transmitting the virus is greatly decreased in outdoor settings. Participants at outdoor events with large crowds may need to use masks if they are particularly congested.

Can my child participate in sports during the pandemic?

Physical education and scholastic sports are important to the overall health of children. They contribute to their overall physical fitness. They also provide social interaction, which contributes positively to their emotional well-being.

However, like in other scenarios, children who play indoor sports in closer contact with each other for a longer period of time are at increased risk of contracting COVID-19.

Hence, those who play basketball, wrestling, and hockey have been shown to have higher transmission rates than children who play soccer, football, and rugby outdoors.

Mask wearing can help in reducing the transmission of the virus while playing sports. Studies have shown that mask-wearing in general during physical activity is well tolerated.

There are sports, however, where mask-wearing is contraindicated. These include gymnastics, cheerleading that involves tumbling, and wrestling. It may be difficult to employ the use of masks in sports in which the athlete sweats fairly profusely. Also, masks would not be useable while swimming or doing water sports. Spectators, coaches, trainers, and staff should also wear masks and participants on the sidelines.

Masks should also be worn in locker rooms and other areas, including travel buses where athletes gather in groups. It is also important for children not to share water bottles.

What should I do if my child tests positive for COVID-19?

Parents of children who test positive for COVID-19 should notify their pediatric primary care provider fairly urgently. Children without any symptoms or with mild symptoms warrant a phone call to their medical home or a telemedicine visit. This helps to document the history of COVID-19 infection in the child’s medical record and assists in educating parents about the quarantine period and the reasons to notify the office should symptoms worsen.

Children with moderate symptoms with persisting fevers should be examined in the office by their pediatric provider. The quarantine period varies as children will manifest COVID signs differently.

Generally, though it may be challenging to ascertain the exact day of origin of infection, 14 days is considered the acceptable quarantine time for most.

If a child has no symptoms at all, they may be able to return to school ten days after the first positive test. Those children with more symptoms, especially with syncope, chest pain, and shortness of breath, may not only need to quarantine longer but also cardiology evaluation or at the very least an electrocardiogram (ECG).

What else can be done to prevent the spread of this disease?

The infection control principles that have been widely employed before the pandemic still hold true today. Frequent handwashing with soap and water or hand sanitizers containing at least 60% ethyl alcohol is still vital in reducing transmission.

We have learned after a year and a half of experience with COVID-19 that respiratory droplets contribute to spread of the disease much more than the virus on hard surfaces. Still, it is prudent to wipe down hard surfaces, especially where you work once daily.

Also, if you or your child feel sick or exhibit symptoms, there is no need to play the role of an all-star. Children who are sick should not attend school without first being tested. While the CDC does not place a preference on whether to use the rapid antigen test or the PCR, your child’s school district may.

It is important to find out which test they will accept from your school officials to avoid wasted time and misunderstandings.

Finally, as parents, you are your children’s greatest advocate. Lobbying your school officials to ensure that proper attention has been paid to employing at least 3 feet of social distancing in the classroom and investing in modern HVAC units that can promote adequate ventilation is vital.

As a nation, we have come a long way. A year ago, we all were stuck indoors with our kids trying to teach the new math using Zoom or Google. Gone are the days of strategically planning how we could score toilet paper from our local brick and mortar stores. We are definitely in the second half of this battle against COVID-19. Now more than ever, though, we must refocus our efforts to secure the win.

It is critical to understand that decisions made by segments of one population can negatively or positively affect another. It is also important to note that the virus does not respect state lines. Instead, it will continue to replicate itself — and potentially bring new variants — along the path of the least resistance i.e., the unvaccinated.

In states where COVID-19 rates are higher, like New York, Pennsylvania, and Massachusetts, pediatric hospitalizations are low (less than five pediatric admissions per 100,000). However, states like Texas, Alabama, and Georgia, where the adult vaccine rates are significantly below the national average, have pediatric admission rates that are staggering by comparison (15–30 pediatric admissions per 100,000).

We must make intelligent decisions down the stretch in the same vein as a quarterback engineering a team’s final drive. For us, that means getting a COVID-19 vaccine if you have not already.

Vaccines will go a long way toward protecting those who are unable to get vaccinated; namely our younger children. Also, wear a mask indoors whenever possible. By implementing these steps, we can leave COVID-19 behind us once and for all and feel empowered enough to stop biting our nails and raise our hands in victory. We might even be able to share a congratulatory high five.

Agboola O. Fatiregun, MD, FAAP