Virginia Vaccine Coordinator Dr. Danny Avula explains the data when it comes to COVID and kids

Posted at 12:48 PM, Sep 29, 2021
and last updated 2021-09-29 18:37:16-04

RICHMOND, Va - Hospitalization rates for children 11 years old or younger are at the highest rate since the pandemic began, according to the CDC. In Virginia, the numbers of young kids experiencing the most severe symptoms of COVID-19 have also been on the rise in September, data show.

It must be noted that the level of infection and severe cases among young children remains very low compared to adult populations.

Since the pandemic began, 1,058 patients under the age of 19 have been hospitalized in Virginia, with the number of young children and teens about even, according to data from the Virginia Department of Health. That compares to 10,140 Virginians ages 40-59 years old, basically, their parent’s age, have been hospitalized.

The numbers are even higher for Virginians over 60 years of age.

Still, the highly contagious delta variant and return to more group settings are contributing to the jump in cases among the youngest Virginians, experts said. Wednesday, a 10-year-old student in Suffolk died from complications related to COVID, according to reports.

Since cases and hospitalizations have been increasing of late, CBS 6 asked a trusted expert to weigh in on what’s happening, why, and what families should consider.

Dr. Danny Avula is not only Virginia’s Vaccine Coordinator but also a practicing pediatrician at a Richmond children’s hospital. In an interview with CBS 6, Dr. Avula spoke about potential causes for the spike among children, how school environments might not be the main driver, and how vaccines for young children will play a role in the months to come.

The following is a transcript of the interview lightly edited for clarity:

Jake Burns
Walk me through what you think about this moment when it comes to this severe illness we're seeing among children, albeit at a lower level than adults.

Dr. Danny Avula
So the trend in pediatric hospitalization in Virginia has certainly mirrored what we're seeing nationally, when that means we're seeing the highest rates of pediatric hospitalization that we have, at any point during the pandemic.

We're also seeing the highest rates of pediatric disease that we've seen at any point during this pandemic.

I think there's a lot of reasons for that.

This time last year, pretty much everything was on lockdown. Most schools were not in session, kids were staying home, there wasn't a lot of opportunity for intersection and ultimately infection. And so we just didn't see that much pediatric disease.

As we progress through the pandemic, things have gotten better with the introduction of vaccines for adults.

We have also seen a lot more congregate activity and the emergence of a very contagious delta variant. And so that combination has led to the highest rates of pediatric disease and subsequently the highest rates of pediatric hospitalization.

Now, compared to adults, we're still seeing very, very low rates of hospitalization.

I'm a pediatrician, I still work in one of our local hospitals. And so I've gotten to kind of have a finger on the pulse of this over the course of the last year and a half.

In the last year, we would have kids in the hospital who are COVID positive, but they weren't there for COVID. They would be there to have their appendix removed and they happen to screen positive for COVID.

But this year, every time I go in, we do see one or two patients who actually do have lung disease. They're there because of the symptoms of COVID. And so that does feel different.

And I think, as we've looked both at the state data and the national data, it's hard to come to the conclusion right now that this variant is causing more severe disease, I think we're just seeing so much more infection, that that is leading to increased hospitalization. And that's what a lot of our colleagues around the country are saying as well.

Jake Burns
What are some of the things that parents, in particular, need to be thinking about with the delta variant and the fact that we are seeing pretty much life close to normal than last year?

Dr. Danny Avula
Yeah. Well, first, I would reassure parents and say that the incidence of severe disease in children is extremely, extremely low.

So while kids are seeing higher rates of COVID infection, it is very rare that they develop severe disease.

Second, as it relates to school re-entry, I think our schools have done a fantastic job of the mitigation efforts of really trying to enforce masking and distancing, increasing and improving ventilation. And so while we are seeing a lot of cases in schools, we are not at this point, seeing a lot of transmission in schools. And so that's really reassuring.

What we are seeing is that a lot of kids in their home environments or other activities, youth sports, things like that, we are seeing transmission in those settings. And right now, when we're seeing some of the highest rates of COVID, we've seen at any point during the pandemic, we need to remember that when there's a high rate of disease in the community, the risk is higher to our children.

And so there's a couple of things I think we can do.

As parents and family members make sure that we're vaccinated because if our kids are too young to be vaccinated, then we can at least protect them by protecting ourselves and limiting their exposure by surrounding them with a cocoon of protected people.

If your child's older than 12, then they are eligible to be vaccinated. And if there are five to 11, that's around the corner, I expect that we'll have an approved vaccine sometime in early November. And so I would absolutely encourage parents to have their children vaccinated at that point if they aren't eligible already.

And then I think reminding our kids that COVID is still out there and that while most kids will do fine, there are a small percentage of kids who will develop more severe disease and so continuing to encourage mask wearing certainly in schools where it's required but even when you go to a restaurant or the grocery store or some public setting, having our younger kids wear masks is a really important part of protecting them.

Jake Burns
You mentioned severe disease in children is rare. Is there anything you have read or seen or noticed about the kids that do get the severe disease? Is there a common thread?

Dr. Danny Avula
So nationally, we're still looking at that. We're still trying to figure out, are there underlying conditions that put you at higher risk?

I do think that kids who have had asthma and are more susceptible to viral infections that cause an asthma exacerbation, we've certainly seen that. And so I do think underlying conditions like asthma, like obesity, do put children at higher risk for hospitalization.

And usually, that doesn't occur, obesity in particular, until kids are slightly older in age. And so again, really would encourage those parents to get their children vaccinated, especially if they have an underlying condition.

Jake Burns
You said November seems like the time frame when the vaccine will be available for children ages five - 11. What do you think it will mean, though, that by November, we will have had so many million adults vaccinated? Do you feel encouraged that maybe the progress of the vaccine will convince parents that it might be safe for their kid or especially the younger kids? Because that's a whole different ballgame than a 12 year old?

Dr. Danny Avula
Yeah, it is. And I think a lot of parents ask the very reasonable question, you know, my kid is not going to get the severe disease, then why should I get them vaccinated? And I think that's the analysis we're really looking for from the FDA and the CDC, because every decision about vaccination is a decision of risk versus benefit. And so we really want to be sure that the benefit to children five to 11 outweighs the risk of them contracting COVID.

That's what we're waiting on. Pfizer is going to submit their data and then what we'll see as they finalize that data submission over the next few weeks, the FDA will review that data and determine whether or not the benefit outweighs the risk.

If our national experts look at the science, and they say the benefit does outweigh the risk, then I do think we should all feel confident that we should get our kids vaccinated and feel confident that the vaccine is going to protect them, it's gonna protect them from any severe disease, it's also going to protect the people that they come into contact with.

There's one other element of this that I think, as a parent of five children, we've already started to experience. Kids are back in school and some of their friends or classmates have been exposed. This has been a challenging few weeks already in terms of exposure and quarantining and figuring out how to do school in this context.

If you're fully vaccinated, you don't need to quarantine once you've been exposed. And so on a very practical level, one of the ways that we can keep kids in school is to make sure they're vaccinated.

Jake Burns
I know five to 11 is the next kind of chunk of children who may be eligible to be vaccinated. How about even younger kids? Tell me a bit about the vaccine process when it comes to clinical trials and why it probably will be even longer for very young children.

Dr. Danny Avula
So the five to 11 year olds have been in clinical trials for the last few months. Pfizer did release some very encouraging data showing that their dosing for five to 11 year olds, which is about a third of the dose of the full strength adult dose, is producing about the same level of antibody responses as their adult trials. That's what they're looking for. They're looking for, does [the vaccine] produce an antibody response? And is it safe? Are they seeing side effects?

Initially, things are looking really good, which is why they've moved forward and started to submit that data to the FDA.

Now, younger age groups, they really have to work at different dose strengths to see what's the right balance of safety and efficacy.

And so that's why it's taking longer for kids down to six months for them to collect data on that group.

So they are conducting those trials, they don't think they will have data until either the very end of 2021 or the early part of 2022. So at some point in the near future, we should see the results of those trials.

And then again, the FDA and CDC will review the data and determine does the benefit outweigh the risk? And if so that'll become a part of our recommendation as well.

Jake Burns
I just want to clarify that while the number of cases and severe cases among children have been going up, it is still much lower than adults and where we currently sit with that, right?

Dr. Danny Avula
Yeah. It's actually on the CDC website. When you see the arc by itself, you see, wow, we really have had a spike of pediatric hospitalization. But when you see it relative to adult hospitalization, it pales in comparison to the rate that adults have been hospitalized.

So yes, it's definitely a different trend that we've seen at any point, but still very, very low risk for children.