“From a public health standpoint, I think we have an evolving situation,” said Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, in a moderated session with Lee Beers, MD, president of the American Academy of Pediatrics, at the virtual Pediatric Hospital Medicine annual conference.
Early in the COVID-19 pandemic, the data suggested that children could become infected, but that serious outcomes were unlikely, said Dr. Fauci. Now, with the delta variant surging in the United States and globally, “what we are seeing is really quite disturbing,” as more children are impacted and hospitalized with serious illness, he noted.
The reasons for this shift remain unclear, he said.
Dr. Beers emphasized the ability of pediatric hospitalists to be flexible in the face of uncertainty and the evolving virus, and asked Dr. Fauci to elaborate on the unique traits of the delta variant that make it especially challenging.
“There is no doubt that delta transmits much more efficiently than the alpha variant or any other variant,” Dr. Fauci said. The transmissibility is evident in comparisons of the level of virus in the nasopharynx of the delta variant, compared with the original alpha COVID-19 virus – delta is as much as 1,000 times higher, he explained.
In addition, the level of virus in the nasopharynx of vaccinated individuals who develop breakthrough infections with the delta variant is similar to the levels in unvaccinated individuals who are infected with the delta variant.
The delta variant is “the tough guy on the block” at the moment, Dr. Fauci said.
Dr. Fauci also responded to a question on the lack of winter viruses, such as RSV and the flu, last winter, but the surge in these viruses over the summer.
This winter’s activity remains uncertain, Dr. Fauci said. However, he speculated “with a strong dose of humility and modesty” that viruses tend to have niches, some are seasonal, and the winter viruses that were displaced by COVID-19 hit harder in the summer instead. “If I were a [non-COVID] virus looking for a niche, I would be really confused,” he said. “I don’t know what will happen this winter, but if we get good control over COVID-19 by winter, we could have a very vengeful influenza season,” he said. “This is speculation, I don’t have any data for this,” he cautioned.
Dr. Beers raised the issue of back-to-school safety, and the updated AAP guidance for universal masking for K-12 students. “Our guidance about return to school gets updated as the situation changes and we gain a better understanding of how kids can get to school safely,” she said. A combination of factors affect back-to-school guidance, including the ineligibility of children younger than 12 years to be vaccinated, the number of adolescents who are eligible but have not been vaccinated, and the challenge for educators to navigate which children should wear masks, Dr. Beers said.
“We want to get vaccines for our youngest kids as soon as safely possible,” Dr. Beers emphasized. She noted that the same urgency is needed to provide vaccines for children as for adults, although “we have to do it safely, and be sure and feel confident in the data.”
When asked to comment about the status of FDA authorization of COVID-19 vaccines for younger children, Dr. Fauci described the current situation as one that “might require some unprecedented and unique action” on the part of the FDA, which tends to move cautiously because of safety considerations. However, concerns about adverse events might get in the way of protecting children against what “you are really worried about,” in this case COVID-19 and its variants, he said. Despite the breakthrough infections, “vaccination continues to very adequately protect people from getting severe disease,” he emphasized.
Dr. Fauci also said that he believes the current data support boosters for the immune compromised; however “it is a different story about the general vaccinated population and the vaccinated elderly,” he said. Sooner or later most people will likely need boosters; “the question is who, when, and how soon,” he noted.
Dr. Fauci wrapped up the session with kudos and support for the pediatric health care community. “As a nonpediatrician, I have a great deal of respect for the job you are doing,” he said. “Keep up the great work.”
Dr. Beers echoed this sentiment, saying that she was “continually awed, impressed, and inspired” by how the pediatric hospitalists are navigating the ever-changing pandemic environment.