A closer look at the pandemic's toll on Arkansas' children

As COVID-19 takes its toll on Arkansans, the state's youngest residents are among the latest victims of the pandemic's newest variant. Arkansas Children's, the only health system in the state focused solely on children, experienced a record number of COVID-19 hospitalizations in August with 31 patients positive on a single day. Throughout the rest of August and early September, Arkansas Children's Hospital in Little Rock, the system's facility with intensive care capabilities, often saw as many as 10 to 11 children in the Pediatric Intensive Care Unit - many reliant on ventilators. By late September the spike was settling, but providers caution that numbers could rise again if masking compliance and vaccination rates fall. Statewide, Arkansas' 10-and-under age group saw 3,208 additional cases between June 30 and July 30, a 15 percent increase in the total number of cases, according to an arkansascovid.com analysis of Arkansas Department of Health data. According to a release, "the 25-34 age group suffered a significant outbreak as well, experiencing a 12 percent increase with 6,780 additional cases."

A growing problem

"Earlier in the pandemic a busy day was five kids with COVID-19, and now we're seeing around 20 to 40," said Jessica Snowden, MD, division chief of Pediatric Infectious Disease at UAMS Pediatrics and associate director for Clinical and Translational Research at Arkansas Children's Research Institute. Unlike the first variant, which seemed to hospitalize only the high-risk, Snowden said the Delta variant is hitting kids with no pre-existing conditions, while those with obesity, diabetes and other risk factors face an even greater threat. "It seems like they're getting sicker faster," Snowden said of the hospital's most recent COVID-19 patients. "Delta appears to be able to infect kids more readily than earlier and we don't quite understand the physiology behind that." Exasperating the Delta strain is the fact that countless kids aren't old enough to vaccinate. The result, Snowden said, is longer hospital stays and more kids on ventilators. "We're looking at whether it's just because more kids are getting sick or because the Delta variant is more aggressive," she said.

Finding answers

In July 2020, ACRI researchers were part of a statewide team that received a $770,000 National Institutes of Health grant to understand more about variants of COVID-19 circulating in the state by increasing capacity for genomic sequencing, tracking and analyses of virus samples. The collaboration is among scientists at Arkansas Children's Research Institute, the University of Arkansas for Medical Sciences, the Centers for Disease Control and Prevention and the Arkansas Department of Health. The Arkansas Sequencing (ArkSeq) Consortium will be a source for samples from across the state to be used for sequencing COVID-19 variants. ACRI committed to providing an additional $200,000, in part from Arkansas Biosciences Institute funds, to expand sequencing capacity. "As a provider on the ground this is valuable work, because we've shifted from earlier variants which affects how we manage patients," Snowden said. "Their works is allowing us to adapt quickly and provide the best care for kids, as some monoclonal antibodies and meds are no longer effective with Delta, and we don't yet know what future variants will look like."

Erring toward caution

With school in full swing and cold and flu season approaching, expected seasonal health threats also are magnified. "COVID is now so incredibly contagious that we need to assume any cold symptoms are COVID, so isolation will be very important," Snowden said, pointing to a recent uptick in cases of RSV, rhinovirus and parainfluenza. Unlike fall of 2020, providers can no longer assume children are relatively safe from the virus, and stress the need to take symptoms seriously. "We're all tired and ready for it to be over," Snowden said. "It's important for all of us as providers to keep reinforcing the importance of testing and isolation, because the only way it's going to end is if we follow guidelines and stay home when sick."

Challenges to providers

While the pressure of caring for young patients can take its toll, Snowden said it's essential to assume positive intent toward each family. "As providers we have to keep in mind that children are very rarely the ones making decisions about how the deal with the virus," she said. "It's never a child's fault that he's sick, and it's up to all of us to care for them -- even those families who may not have made the same decisions I made for my family. No one chooses to put their child in harm's way. Many adults are victims of misinformation, and it's really important for us as physicians to remember that." Snowden also stressed the importance of self-care for physicians, especially those on the front line. "It's a really a challenging time for all of us, and one of most important things we can do is figure out what it is that works for us to maintain our equilibrium," she said. "We're being challenged more than ever, but we have to take care of ourselves so we don't burn out. What is it that helps us individually recharge?"

Learning from the past

Going forward, she encourages physicians to reconsider their approach to health literacy and communication post-pandemic. "How did we get in a position where so much misinformation can take hold, and how can we avoid getting in this situation again as a community?" she asked, pointing to barriers such as medical access and telehealth. "This brought about core gaps in infrastructure, especially in rural settings where there are healthcare deserts exasperating disparities we know exist. We need to look at equity and infrastructure and how we communicate as we recover to make sure this doesn't happen again." Growing health disparities were highlighted in September, with the release of a study from the Centers of Disease Control and Prevention that found American children and teenagers have seen a significant increase in weight gain since the pandemic began. According to the report, the biggest jumps occurred in younger school-aged children and those who were already prone to obesity. The study looked at 432,302 people between the ages of two and 19 years old and found, among other things, that the percentage of obese children and teens increased to 22 percent, compared with 19 percent before the pandemic. It's one more challenge today's pediatricians will face going forward, but Snowden remains optimistic about the future - thanks in part to an uptick in vaccination rates statewide. "Another interesting thing is this whole generation of kids will grow up with a different understanding of science, and what it means to care for your community," she said. "It makes me hopeful that they'll grow up with a worldview that sees public health through a different lens than any of us ever did."