Kids with COVID: A ‘crisis’ among us: Doctors report increase in cases, severity

NORTHAMPTON — The sharp upward trend in COVID-19 cases statewide continued this week with more sky-high, single-day case counts as hospitals approach their breaking points and area pediatricians keep working to persuade parents to vaccinate themselves and their children.

On Thursday, the Massachusetts Department of Elementary and Secondary Education (DESE) reported 38,887 cases among public school students and 12,213 cases among staff members in the two-week period from Dec. 23 to Jan. 5.

As Gov. Charlie Baker insists on full in-person learning for students statewide, DESE plans to announce next week whether it will extend the state’s mask mandate in schools.

The Massachusetts Department of Public Health reported 26,187 new cases in people of all ages on Friday alone, the latest single-day total that eclipses the peak of last winter’s COVID surge. The seven-day test positivity rate keeps rising steadily, as well, now sitting at 23.02%, compared to 1.67% at the end of October. Case counts do not include the results of at-home antigen tests.

Dr. David Gottsegen, a pediatrician at Holyoke Pediatric Associates in Holyoke and South Hadley, said the practice’s “volume is through the roof. We’re having, I’d say in our whole practice, 10, 12, 15 (cases) a day.” Two of those cases, he said, were identified on Monday and “one was pretty sick. Typically, in the past, kids would not be ill, or certainly not as ill as their parents.”

COVID hospitalization rates for children are at an all-time high, according to the American Academy of Pediatrics.

“This is really a crisis, and I think a lot of people don’t realize it,” Gottsegen said.

In October, Giada Rodriguez, a 13-year-old student at Holyoke Community Charter School, died about two weeks after testing positive for COVID-19.  Gottsegen said his practice has treated a child who had fevers for a month, one who suffered damage to his heart and another who suffered brain fog from long-haul COVID.

At the Community Health Center of Franklin County in Greenfield, CEO Dr. Allison van der Velden said although she doesn’t have data on how many of the practice’s pediatric patients have tested positive for COVID (as most are tested off-site), there does seem to be an uptick in families reaching out with questions.

“There’s definitely been an increase in phone calls,” van der Velden said. “Part of the problem is there are still a lot of unvaccinated kids … The phones are ringing off the hook with people looking for guidance; either they tested positive at home, or the kid had contact with a friend and they don’t know what to do.”

To her knowledge, there haven’t been any cases of pediatric patients at Community Health Center who have been hospitalized for COVID.

The surge in pediatric cases can be tied to holiday gatherings and, Gottsegen said, a lack of mask mandates at popular shopping spots like the Holyoke Mall. The Holyoke Board of Health reimposed its indoor public mask mandate this week for everyone 2 and older. South Hadley reinstated its mask mandate on Dec. 23.

According to data from the U.S. Centers for Disease Control and Prevention, the current vaccination rate for people 5 and older in Hampden County is 65.4%, while the rate in Hampshire County is 66.3% and Franklin County’s rate is 68.1%.

Dr. Kate Atkinson of Atkinson Family Practice in Amherst said “we are also being flooded” with “probably 25 to 30” cases per day in patients of all ages. Among vaccinated patients who have received booster shots, she said, “almost everyone has had a mild case,” but among the unvaccinated and those who have not yet received boosters, “We’re seeing some pretty sick people.”

Citing severe strain on staff and resources, Baystate Health has asked local doctors not to send patients with mild COVID symptoms to its emergency departments for testing. Several days this week, Baystate reported record-breaking numbers of COVID patients across its hospital system, hitting a new high of 275 on Thursday.

Atkinson’s colleague Dr. Michele Spirko said “it’s absolutely vital that everyone in the community do their part to prevent unnecessary trips to the local hospitals. This is not the time to be skating on thin ice. You don’t want to get injured right now.”

Testing sites don’t require a doctor’s order. Unobserved testing, like the programs offered at UMass Amherst and Jones Library, allows a person pick up a test and hang onto it until it’s needed. Anyone who is concerned about COVID symptoms or exposure should consult with their primary care physician, Spirko said.

Atkinson and Spirko also recommend that every household get a pulse oximeter, saying that the tool, which measures heart rate and blood oxygen levels, should be seen as critical to a home health kit, like a thermometer. They’re available in pharmacies and online for $40 or less.

“Usually, you don’t have symptoms early, but your oxygen drops early,” Atkinson said.

Spirko said older patients and those with multiple chronic health conditions fare worse than young people and those with fewer health problems, but some children under 5 who cannot be vaccinated due to their age are experiencing “more significant respiratory illness, at times requiring hospitalization” when infected with the omicron variant than with previous variants like delta.

Children 5 and older in their practice who are vaccinated, Spirko said, are generally experiencing little to no symptoms at all.

A Dec. 30 report from the American Academy of Pediatrics and the Children’s Hospital Association found that over 10% of U.S. children, about 7.9 million, have been infected with COVID-19 since the pandemic began. About 2.8 million of those cases were identified since September.

The pediatrics association describes severe illness, hospitalization and death as “uncommon” in children with COVID-19, but warns that the data is not complete and there could be long-term physical and mental health effects.

“Current evidence suggests that children with special health care needs, including genetic, neurologic, metabolic conditions, or with congenital heart disease, can be at increased risk for severe illness from COVID-19,” the CDC reports on its COVID Data Tracker website. “Similar to adults, children with obesity, diabetes, asthma or chronic lung disease, sickle cell disease, or immunosuppression can also be at increased risk for severe illness from COVID-19.”

Some children can develop a potentially fatal condition called MIS-C, or Multisystem Inflammatory Syndrome in Children, after exposure to the coronavirus, according to the CDC.

The best protection for children under 5, who cannot receive the COVID vaccine, is for their parents to get vaccinated, said Gottsegen, the Holyoke pediatrician. Children should wear masks in public starting at age 2 and families should continue to avoid large gatherings, he added.

“Parents are giving children more autonomy than ever before about whether to have shots,” Gottsegen said. “Tell your child or your teenager that it’s very important to get them, and if your child is afraid of shots, we can help them.”

As the crisis deepens, Gottsegen and his colleagues continue to face vaccine hesitancy in parents, even when their children become infected. Asked if some parents are misinformed or repeating conspiracy theories about the vaccine’s supposed side effects, he said, “All the time. At least down here in Holyoke, I’m hearing it all the time.”

Gottsegen said some parents claim they and their children can’t receive the vaccine because of a chronic health condition or compromised immune system, but those are among the patients who need vaccines the most, and even people with “healthy lifestyles” — good diet, exercise, sleep and stress management habits — can become extremely ill from COVID-19. Vaccination, he said, provides more protection than post-infection natural immunity.

At the Community Health Center of Franklin County, van der Velden said she continues to encourage people to schedule an appointment for a vaccine if they haven’t done so already.

“Even though it can be frustrating to find the vaccine or schedule them, make it happen so everyone is getting vaccinated,” she said. “Even though people are getting breakthrough cases, it’s still the number one thing we can do to prevent this pandemic from killing even more people.”

Patients sometimes share stories about a distant friend or relative who died after receiving the shot, which Gottsegen chalks up to misunderstanding and coincidence.

“Eight-thousand Americans die every day from illness or accidents, so just by chance, they may die the day they get the vaccine or the day after,” he said.

In Amherst, Dr. Atkinson said her practice ran a vaccine clinic for children 5-11 in November, and so did the local schools. Parents, she said, were eager to take advantage of the opportunity.

“There are some holdouts, but we’re pretty fortunate that … people have been celebrating their ability to access the vaccine,” Atkinson said. “A lot of parents were actually clamoring for the vaccine and very eager to book those appointments.”

Local schools, Atkinson said, have done an excellent job preventing spread and students should return to in-person classes with precautions in place.

“We have not witnessed infections from the classroom,” Atkinson said. When students learned remotely last year, she said, there were significant upswings in “the suicidality, the obesity, the eating disorders. It was really bad and we’re still dealing with the consequences of those.”