What an Oregon pediatric doctor wants parents to know about COVID-19 as schools reopen

Clear Lake Elementary students arrive for their first day of in-person school last March (File).

There’s still much pediatricians and infectious disease experts don’t know about how the more contagious Delta variant of COVID spreads among children, Dr. Dawn Nolt said.

Dr. Dawn Nolt, a professor of pediatrics and infectious diseases at Oregon Health and Science University’s Doernbecher Children’s Hospital, said pediatricians remain in agreement that in-person school can operate safely this fall, provided mitigation measures are in place.

“Overall, we feel that the priority should be in-person education,” Nolt said. “Once you have that, then the next priority is how to keep them safe.”

The issue has renewed significance as school is less than a week away from starting in Salem-Keizer, and in many of Oregon’s largest districts. While kids 12 and older have the option to be vaccinated against COVID, their younger classmates don’t.

Nolt said that means it’s up to the adults around young children to ensure they’re protected and avoid outbreaks that can lead to quarantines, school closures and sick kids — problems that have plagued some districts in other parts of the country that opened schools earlier.

Nolt said she understands why parents are worried when they see headlines about young children with serious cases of COVID or pediatric hospital beds filling up in other parts of the country. But she said it’s also important to remember young children remain very unlikely to develop serious illness from COVID that requires hospitalization.

“The studies early in the pandemic showed that they’re less likely to be infected, they’re less likely to have severe disease” compared to adolescents and adults, Nolt said. That’s held true for the Delta variant as well, she said.

She said reports from southeastern states where kids with COVID are filling up pediatric hospitals reflect surging COVID infections across all age groups, not just kids.

“It’s not that the Delta variant is making those kids more sick. It’s just we’re seeing such large numbers of kids be infected, that even a small percentage that end up needing ICU care, hospital care is a large number. Here in Oregon, we’re not seeing that level of numbers of kids being infected,” she said.

Since the pandemic began, 15,099 Oregonians age nine and younger have been diagnosed with COVID. Of those, 164 have been hospitalized, about 1%, and one has died.

The number of Oregon kids testing positive for COVID has climbed significantly over the past month as the number of cases across all age groups has risen, according to Oregon Health Authority data.

The rate of new infections is highest among 12 to 17-year-olds, who are eligible to be vaccinated. Household transmission is the most common infection source for kids who do get sick, rather than an outbreak outside the home or an unknown source.

About three in five kids who test positive for COVID report any symptoms of illness, the most common being a cough.

Pacific Islander, Latino, Native American and Black children are also contracting COVID at higher rates than white, Asian and multiracial children, state data shows.

State data also shows hospitalization rates for children remain low, and pediatric hospital beds are in much better supply than beds for adults. The week of Aug. 8, OHA reported five kids age five and under hospitalized with COVID statewide, as well as one kid between the ages of six and 11, and one between the ages of 12 and 17.

As of Aug. 25, about one in five intensive care unit beds for babies and children in Oregon was empty — a far higher share than for adults, where fewer than 8% of beds were vacant.

Nolt said masking and vaccinating adults who will be around unvaccinated children remain key strategies for preventing the spread of COVID in schools.

Oregon Gov. Kate Brown is requiring students, employees and visitors in all Oregon schools to wear masks indoors, and mandating K-12 teachers and school employees get vaccinated against COVID.

Well-fitted, double-layered masks remain important, Nolt said, despite the pushback from some parents and educators who are opposed. A common refrain from people opposed to masks is that the virus is too small to be trapped by a cloth mask, but Nolt said the mask is intended to capture droplets, and can do so effectively.

“The virus particle itself is super small, but it’s carried by this lovely, juicy liquid. And that is bigger than the mask openings. That’s what we’re trying to capture, not the virus,” she said.

Chunhuei Chi, director of the Center for Global Health at Oregon State University, agreed examples from other countries show schools can reopen safely, but he said the increased transmissibility of the Delta variant means precautions become more important.

While kids are unlikely to become seriously ill, preventing them from getting infected at all still matters, because they can carry the virus home and may infect vulnerable relatives.

“We have to be extra careful,” he said. Like Nolt, he said masking and vaccination for adults interacting with students are important, as well as good ventilation inside buildings.

He said schools should keep windows open whenever possible, use HEPA air filters and hold lunch outside if they’re able so students unmasking to eat are less likely to breathe in any virus.