New weekly COVID-19 cases in children hit record levels the week of Aug. 26 in the United States, representing 22% of the total cases that week, according to the American Academy of Pediatrics. Hospitalizations of children from the virus have been rising as well, and now comprise between 2% and 4% of the total.
The U.S. will not be able to fully reopen the economy or capitalize on the recovery boom until children and young adults are able to return to their schools.
A combination of factors is behind this increase, including the spread of the more contagious delta variant, resistance to receiving vaccines among some people, and logistical challenges on a global scale. All of these factors have pushed much of the world into a fourth wave of the coronavirus just as the school year kicks off, and have brought closer the day when COVID-19 becomes endemic—or when people learn to live with the disease.
While the highly transmissible delta variant has resulted in breakthrough cases, that does not diminish the major health and economic benefits of widely adopted vaccination. Unvaccinated people are five times as likely to be infected, and 29 times more likely to be hospitalized, according to a new study from the Centers for Disease Control and Prevention.
High transmissibility and case severity of new variants add urgency to protecting those who cannot be vaccinated, increasing overall vaccination rates, and ensuring a safe and productive environment for a full reopening of the economy.
A focus on children
As cases have risen this summer, mask mandates and safety protocols are being reimposed in schools. It all gives parents painful reminders of the challenges they faced last year.
But the one major difference from last year is that three COVID-19 vaccines have been approved in the United States—Moderna and Johnson & Johnson with emergency use authorization, and Pfizer-BioNTech, which received full FDA approval. Now, half of the total U.S. population has been fully vaccinated, and 62% has received at least one shot, according to the CDC’s vaccination tracker.
These are important metrics because there is an inverse correlation between vaccination rates and new cases. This is encouraging for heavily vaccinated adult populations, but of little comfort to the 22% of U.S. residents (approximately 75 million) who are 17 or younger and have limited or no access to vaccines, and who have no personal control to make health care decisions.
The three vaccines are also being studied for use in children, and are in various states of submission and review.
In terms of clinical trials in children, Pfizer and BioNTech are the furthest along from a submission perspective for their Phase 1/2/3 study in children between 6 months and 11 years old. The study is being conducted among 4,500 children in the U.S. and in European countries, and is broken into three age groups (5 to 11 years, 2 to 5 years, and 6 months to 2 years).
The study is following the same two-dose schedule (approximately three weeks apart) as adults and adolescents receive. Moderna also launched a clinical trial in children under 12 in March, and the results are expected this fall.
Parents to lead by example
For schools to return to any kind of normal activity, children will not only need to be vaccinated, but they will also need to catch up with the rest of the population.
The following chart represents the velocity of vaccination among different age groups in the U.S., as measured by the percentage of the population having received at least one dose.
Older adults who had earlier access to vaccines and a higher risk of severe infection were quick to be vaccinated and have reached high vaccination levels. But that rate declines as age groups decline from 65 to 18, according to the CDC’s COVID-19 data tracker.
The most encouraging data suggests that children under 18 have fast initial adoption rates, even considering that there is only one vaccine available. This behavior is likely attributable to vaccinated parents who used themselves as a safety barometer for the family, and had an increased comfort level to have their children vaccinated.
Data from the National Vital Statistics System indicates that the average age of mothers is 26, and using 25 to 49 as proxies for parent-aged populations, we see that between 52% and 61% of those adults have been vaccinated.
The underlying concern with these numbers is that as child vaccinations approach the rates of parents, there may be a lower likelihood of achieving highly protective levels within child-aged communities.
Based upon the distribution of adult vaccination rates at the state level, one can reasonably conclude that low adult vaccination states will also be low child vaccination states.
If this is the case, these states will continue to face the short-term burden of uncertain schooling and child care, and the long-term economic impact of employment instability, pressure for parents to leave the workforce and the potential for a generational gap in childhood education.
When it comes to protecting children from COVID-19, there are the first-order concerns of their health and safety, as well as allowing them to return to school and extracurricular activities.
The second-order effects are known all too well by parents and caretakers who have come under intense economic and social strain as they rebalance their lives, schedules and careers.
From an economic perspective, the U.S. will not be able to fully reopen the economy or capitalize on the recovery boom until children and young adults are able to return to their schools.
Ethan Schmidt, an economics intern at RSM US, contributed research.
For more information on how the coronavirus pandemic is affecting midsize businesses, please visit the RSM Coronavirus Resource Center.