COVID-19 Corner:August 2021 Updates

August 2, 2021 by

Brief updates on epidemiology, variants, vaccines and more…

by Dr. Debbie-Ann Shirley, Division Head of Pediatric Infectious Disease

The pandemic and children. Over 4.13 million children have tested positive for COVID-19 in the United States with at least 349 deaths, while 4,196 patients have been diagnosed with the severe multisystem inflammatory syndrome in children following COVID-19 infection (MIS-C), including 78 children from Virginia. The relative lull is over and we are witnessing a rapid rise in new cases including in children, with an estimated 400% increase in cases seen since early July 2021.  Most cases of COVID-19 and hospitalizations are in the unvaccinated. Only about 7.1 million children are fully vaccinated, representing 40% of 16-17 year-olds and 28% of 12-15 year-olds. As children begin to prepare to start in person school, the CDC now joins the AAP in recommending indoor masking for all teachers, staff and students in K-12 schools, regardless of vaccination status.

Variants of concern. The delta (B.1.617) variant, which has quickly emerged to become the predominant variant in the US, currently accounts for at least 80% of viral lineages. We have quickly learned some ways that delta differs from other strains. Higher amounts of virus have been detected from respiratory samples in those infected with delta variant compared to other variants, for example, adding to other reports that the variant may be about twice as infectious. While breakthrough infections in vaccinated people are rare, a recent outbreak investigation showed the amount of virus detected in both infected vaccinated and unvaccinated people is similar, hence suggesting that fully vaccinated people who do become infected with the delta variant can spread the virus to others. The CDC has since updated their masking guidance for vaccinated people to also wear a mask in public indoor settings if they are in an area of substantial or high transmission to help prevent the spread of delta variant and protect others.

Despite these concerning developments with the delta variant, vaccines remain highly effective at preventing symptomatic and severe disease, saving lives. Urgently working to increase vaccination coverage should remain a high priority for us all to reduce transmission as well as reduce the risk of more emerging variants. Appointments for team members to get a COVID-19 vaccine can be made in VaxTrax or by calling 434.297.4829. If you are hesitant about vaccination because of allergies, Allergists are on hand in the COVID Clinic on Fridays, 1-3 p.m to help.

COVID-19 vaccines and children. There has been much ongoing discussion about how best to help protect immunocompromised patients against COVID-19 and was highlighted at last month’s CDC advisory group meeting. Immunocompromised people may be more likely to get severely ill from COVID-19. By one report, 44% of hospitalized breakthrough infections occur in immunocompromised patients. While immunocompromised patients may show lower antibody responses to vaccines, without a yet established correlate of protection, the FDA and CDC advises against routine post-vaccination titers. The practice of giving a third dose of COVID-19 vaccine remains outside of the current emergency use authorization. Studies on how best to address low antibody responses in immunosuppressed patients are ongoing, so additional guidance is anticipated soon. In the meantime, masking, social distancing, avoiding crowded or poorly ventilated spaces and hand hygiene can help to provide additional layers of protection to vaccinated immunosuppressed patients and we should encourage vaccination among all those around immunocompromised patients to protect them.

Filed Under: Features