COVID Cases Among Children Are Declining. Has the Back-to-School Surge Peaked?

The latest coronavirus wave may be subsiding for school-age children, but the worry is that the good news may harden resistance to vaccination and other mitigation practices schools are using to keep outbreaks in check.

“The number of new child COVID cases remains exceptionally high,” the American Academy of Pediatrics reported as of Sept. 30, with more than 173,000 cases added from state data in the past week. Yet the overall infection rates among both young and older children appear to have peaked, according to data from the Centers for Disease Control and Prevention.

As of Oct. 2, the CDC projected infection rates of nearly 145 per 100,000 children ages 5-11, 144 for ages 12-15, and 148 for those ages 16-17. A month ago, infection rates for adolescents were more than double that, and nearly double for elementary-age children.

It’s not entirely clear why pediatric infections have dropped so precipitously, though experts have cited rising vaccination rates and community saturation from Delta among possible reasons. Dr. Tina Tan, a pediatric infectious disease doctor at Lurie Children’s Hospital in Chicago and a coronavirus expert with the Infectious Disease Society of America, said the decline represents “a normal ebb in the circulation of the Delta variant in the community.”

In fact, U.S. school openings may have extended the Delta wave longer in the United States than in other countries such as India and the United Kingdom, according to Dr. David Kimberlin, a professor and co-director of pediatric infectious diseases at the University of Alabama at Birmingham and Children’s of Alabama Hospital.

“This [pandemic surge] did stay with us longer than some of the prior ones did,” Kimberlin said. “I think that may have been related to children going back to school at the same time that we were being hit so hard with Delta.”

But Tan and Kimberlin said it may be too early to consider the latest wave fully passed, as some expect a resurgence this winter as more people stay indoors, in closer contact.

“You know, if you had asked me in June, if I anticipated such a horrific, truly terrible, horrifying experience in August and September that we’ve had, I would’ve said, no, I don’t,” Kimberlin said. “I think that we need to maintain our diligence and we need to be ready for a next wave, because each time we’ve had a very bad wave, we thought it’s been the last—and every single time so far we’ve been wrong.”

Vaccinations are rising

The CDC has found more than half of 16- to 17-year-olds have been fully vaccinated, but less than 45 percent of 12- to 15-year-olds have had a full course of coronavirus vaccine. About 55 percent of those younger teens and more than 62 percent of older adolescents have had at least one dose, but the burst of outbreaks among children that came with the start of school has helped spur vaccination.

This week, Pfizer-BioNTech, the developer of the coronavirus vaccine approved for adolescents ages 12 and up, formally asked the Food and Drug Administration for emergency approval to provide vaccine for 5- to 11-year-olds as well. The FDA’s review committee was set to analyze the evidence on the vaccine’s safety and effectiveness on Oct. 26, but some preliminary research has already found children can have a strong immune response even with a dose one-third as large as that given to older adolescents and adults.

If child case rates continue to decline, school leaders may face more inertia from families on immunizing their children, said Nat Malkus, an education policy researcher with the American Enterprise Institute who has been studying public opinion on pandemic mitigation efforts. “Especially for those folks who are nervous about whether vaccines are safe or have some reason to avoid them, they will be past the pressure point when they might crack on that,” he said.

Malkus and his AEI colleagues found, in a nationally representative survey, that parents have on average been more reluctant to approve of child vaccination than the public as a whole. While Republican parents were three times less likely than Democrat parents to say they would get their 5- to 11-year-old children immunized as soon as a coronavirus vaccine is approved—20 percent versus 63 percent—parents across the political aisle were more hesitant than other adults.

“It’s one thing for someone to say, I’m willing to take the risk [in choosing whether or not to be vaccinated],” Malkus said. “It’s very different to say, I’m willing to take the risk with my 11-year-old.”

In most states, children under 18 still make up less than 10 percent of new COVID-19 infections, but that proportion has climbed in recent weeks in the West and Northeast.

Consistency will be key to keeping the momentum in schools that hope to have all students vaccinated, Malkus said.

“Pretty eminently we’re looking at the likelihood of [vaccine] authorization for 5- to 11-year-olds, and it’s going to be even more critical that schools double and triple and quadruple down on that,” Kimberlin said. “I do know that things have gotten really very contentious between school leaders, school boards, and some very loud, angry components of their districts. I really, really think they are the minority, and school district superintendents and boards of education need to be leaders. They need to step forward and say: The science is clear: these vaccines are remarkably effective and remarkably safe. And we want everyone to be vaccinated.”