By Karen Kier
Pharmacist on behalf of the ONU HealthWise team

The idiom that big things can come in small packages refers to small things have a high quality and value and that bigger is not always better. Unfortunately, when dealing with COVID-19 in the last month, our small packages are getting bigger numbers. Our children under the age of 18 are getting COVID-19 in steadily larger numbers and some pediatric hospitals are becoming overwhelmed. As of August 5, 2021, 4.3 million children have tested positive for COVID-19 since the pandemic started in 2020. In the past week, over 94,000 children have been diagnosed with the number steadily rising since July 1. This increase is hitting as our schools are about to open for fall classes. Children make up 15% of all cases in the United States, which is the highest percentage since 2020. 

The American Academy of Pediatrics is a consortium of 67,000 physicians and pediatric subspecialists predominately from the United States, Canada, and Mexico. The Academy has urged the Food and Drug Administration to give emergency use authorization (EUA) for children 2 years and up to add to the current EUA of 12 years and older. Studies with the mRNA vaccine have been ongoing in children as young as six months. The Academy is asking the FDA to give a priority ruling on these studies due to the current case volume in the United States. 

Children have similar symptoms with COVID-19 that are seen in adults including the delta variant. The delta variant is responsible for 80% of the cases in the United States and has symptoms that mimic the common cold. Children can have fever, shortness of breath, cough, runny nose, tiredness, body aches, and lost of taste and smell. Interestingly, children are less likely to have shortness of breath, body aches, and loss of smell or taste compared to adults.  The recommendations for testing in children are the same as adults. If the child has symptoms, then immediate testing is warranted for COVID-19. A child that has been exposed with a close contact who has been given a positive COVID-19 diagnosis is to wait at least four days before testing. It is important to quarantine until the testing time. Health officials warn to resist the urge to test immediately upon exposure because it will not be accurate. The only exception to testing earlier than four days postexposure is if the child has symptoms. 

The FDA has granted EUA to home antigen tests that can be used in children 2 years and older and purchased without a prescription. These tests include CareStart COVID-19, InteliSwab COVID-10 Rapid Test, QuickVue At Home, BinaxNow COVID-19 Ag Card and Ellume COVID-10.  The ONU HealthWise team has used the BinaxNow for testing at our pharmacy. The nasal swab test is easy to administer and read with counseling from your healthcare professional. 

The uptake in giving COVID-19 mRNA vaccines in children has been much slower than the adult population. The vaccination rate in the 12-15 age range is 25% with the 16-17 age group at 37%. The 18-24 age group is only slightly better at 41%. Some parents were willing to risk their child getting COVID-19 since the younger age groups typically had lower rates of death and hospitalization. The delta variant has turned the tables on the young as documented with the increasing numbers of severely ill children in certain parts of the country.  One pediatric hospital in Texas announced they had no more beds available for ICU treatment and children would need to be airlifted to other areas. As with adults who have had COVID-19, we are only beginning to understand the long-term complications of the disease in children.

Children seem to be susceptible to a rare condition that shows up about four weeks after a COVID-19 infection resolves that is referred to as Multisystem Inflammatory Syndrome (MIS-C).  This severe complication includes symptoms of a rash of red spots or bumps, red eyes, confusion, fever, diarrhea and vomiting. The heart and blood vessels become inflamed as part of the condition. Children displaying these symptoms should receive immediate medical attention.

The mRNA vaccine studies in children 12 years and up show an effectiveness rate of 100% with a very good safety profile. Children have similar side effects from the vaccine as adults including a sore arm, tiredness, fever, and headache. A rare side effect has been documented with the mRNA vaccine called myocarditis or pericarditis, which are an inflammation of the heart muscle or an inflammation of the pericardial sac around the heart. This rare reaction is usually seen after the second vaccine dose in young males less than 30 years of age. The CDC Vaccine Adverse Effects Reporting System (VAERS) is following up with reported cases. The symptoms include chest pain, shortness of breath, and a fast heart beat that normally resolves within a few days but should be evaluated by a healthcare professional. It is important to note that COVID-19 infections can cause a similar reaction and that is why many sporting organizations require a heart health check prior to returning to practice and games. 

Feel free to call the ONU HealthWise Pharmacy or talk to your health care professional. ONU HealthWise is offering walk-ins for COVID-19 vaccines. Call the pharmacy to get more information on getting vaccinated.