At a special briefing, Mar. 16, co-hosted by Ethnic Media Services and the Vaccinate for All 58 initiative, panelists – Sohil R. Sud, MD MA is Associate Clinical Professor of Pediatrics in the Division of Pediatric Hospital Medicine at the University of California, San Francisco. He cares for newborns and hospitalized children at Zuckerberg San Francisco General Hospital and Washington Hospital in Fremont, Calif.; Dr. Veronica A. Kelley, DSW, LCSW is the Chief of Mental Health & Recovery Services of the Orange County Health Care Agency; Beth Jarosz is the U.S. Programs and Deputy Director for KidsData. Her focus is on subnational demographic and socio-economic trends, estimation and forecasting, and trends in child well-being; and Jennifer Miller, MD, practicing at East Bay Pediatrics since 2006, but has been taking care of children and adolescents in the East Bay for the last 8 years – focused on five to 11-year-olds, one of the most vulnerable groups amid the COVID 19 pandemic. Statewide, fewer than 25 percent of children in this age group have been fully vaccinated.

The speakers discussed parental hesitation, the safety of vaccines for children, recommendations for safe in person learning as mandates end, and the mental health toll on young children.

Sohil R. Sud, MD MA is Associate Clinical Professor of Pediatrics in the Division of Pediatric Hospital Medicine at the University of California, San Francisco. He cares for newborns and hospitalized children at Zuckerberg San Francisco General Hospital and Washington Hospital in Fremont, Calif.; Dr. Veronica A. Kelley, DSW, LCSW is the Chief of Mental Health & Recovery Services of the Orange County Health Care Agency. Dr. Kelley previously served as Director for the San Bernardino County Department of Behavioral Health and oversaw the daily operations for both Mental Health and Substance Use Disorder Services; Beth Jarosz is the U.S. Programs and Deputy Director for KidsData. She joined PRB in 2013. Her focus is on subnational demographic and socio-economic trends, estimation and forecasting, and trends in child well-being; and Jennifer Miller, MD, has been practicing at East Bay Pediatrics since 2006, but has been taking care of children and adolescents in the East Bay for the last 8 years. (EMS/Siliconeer)

As per Dr Jennifer Miller, “Only 26 percent of the eligible children have received two doses of vaccine and 33 percent have received one dose, and we’re seeing sick kids. A lot of people believe that the kids don’t get COVID. Based on what we are seeing, the kids are getting it. Not as severe of a disease in large part as adults, but they’re getting it and they are getting sick. Thousands of children have been hospitalized with COVID we know that hundreds of children have died from COVID.

“We’re also seeing that kids have complications from coping, so kids are suffering from something called multi-system inflammatory syndrome and this causes inflammation in many body systems – the heart, the lungs, the kidneys, the brain, the eyes, and these cases, while rare, are really impacting communities, largely the black and brown communities. They’re affecting children.

“Often these children are in communities where there’s high incidence of obesity and chronic illness and as of now there’s not a cure for this syndrome. Kids are missing school, sports activities, and they’re not being able to participate in all the things that they like to participate.

“In communities of color where often families live paycheck to paycheck, these caregivers have to be out of work to stay home and take care of their kids, sometimes for five to ten days and many of these families are not equipped to deal with this.

“These families also live in larger groups and larger extended families which causes increased spread of the disease. We’re seeing that the kids are getting it they’re spreading it to their caregivers. In vulnerable communities that are often high risk and suffer from chronic disease we also see that kids do get long COVID. We don’t fully know the extent of that disease, but we know that kids suffer from confusion, prolonged shortness of breath, just not feeling back to themselves, much more fatigue and malaise. We are seeing that in the older adolescents and teenagers.

“Additionally, we’ve talked a lot about the mental health crisis and adolescents and older teens but I see that in kids 5-to-11. We also see lots of incidents of anxiety and depression. Kids are worried about if they’re going to get sick, they’re worried about if their parents are sick, and now we’re telling them they don’t have to wear masks as often in school. They’re afraid that if they take their masks off they’re going to get sick so there’s a lot more anxiety in the communities, even in elementary school.

“In the smaller ones, anecdotally, with the toddlers that I see, many of them were kept out of daycare and they’re afraid to be in a room with me because they’re so used to being with their parents all the time and not being with other people.

“We’re seeing lots of anxiety and depression as well. Knowing these things, knowing these kids are getting sick, knowing these kids are missing out on their normal activities, you know why parents are hesitating to get vaccines.

“I find the biggest reason is because they’re afraid of the consequences; they’re afraid of what might happen to their children. I find that parents are more willing to get the vaccine for themselves. Sometimes they need to do it for their work, or sometimes they need to do it because they’ve seen other people get sick and have complications and so more adults are willing to get it for themselves but when it comes to doing it for their children, they find that they’re just unable.

“Some families worry that the vaccine can affect the fertility or their reproductive years and there’s no data that shows this at all, in fact, all the data suggest the opposite.

“Families, especially in our black and brown communities, are not totally trustful. They’re not totally trusting of the medical community and our recommendations on vaccines, and they come with a skeptical brain, questioning what we’re doing and what we’re saying.

“My advice to these families is the vaccine is safe, it’s been rigorously tested, by the time this pandemic is over we’re going to see that this is going to be the most studied vaccine in history. The side effect profile is just like any of the routine vaccines that we give. They often will have fever. They often will have soreness at the vaccine site, sometimes they can have some redness at the vaccine site, sometimes they’ll have malaise or headache, not feeling so well.

“These are normal signs that show that the body is building protection against COVID so it’s good to have some of these mild side effects.

“Finally, vaccines are free. You don’t need insurance, you don’t need citizenship, you can get it from your pharmacy, you can get it from your doctor’s office, your internist, or your pediatrician. It’s widely available, please get vaccinated, please get your 5 to 11-year-olds vaccinated because we want to be able to protect them and keep them safe,” concluded Dr Miller.

Dr Sohil Sud, next talked about how to return to school safely even as mass mandates come off.

“As the lead for school teams at the California Department of Public Health, I spend a good portion of my days thinking about how to keep our kids in school and out of hospitals, and how to ensure that we’re effectively mitigating transmission and protecting school staff, parents, families, and California communities,” said Dr Sud.

“The trends in recent times are quite favorable. Test positivity is down to 1.5 percent, down from a peak of close to 25 percent. In a matter of months, we’ve gone from one out of every four tests done in the state of California being positive for COVID 19, to close to one in a hundred.

“Starting mid-March, California transitioned from a masking requirement in indoor K to 12 school settings to a strong recommendation. This means we are still asking students and staff to continue wearing masks just as we stated for the general public a few weeks ago but the state no longer requires that schools track and enforce this.

“We are also now strongly recommending that schools use or transition to using a notification-based model for managing students exposed to COVID 19 at school, instead of a quarantine-based model. We call this group tracing.

“California is going to continue leaning heavily in on supporting school communities so this change in masking guidance does not accompany any backing-off of resources and if anything allows us really to focus on longer term prevention strategies.

“As it stands right now, any school in the state that wants to host a vaccine clinic, just needs to contact us and we’ll work with them to sort all the details out and get it done. California has demonstrably mitigated transmission in schools when we compare our outcomes to other states, looking at pediatric hospitalizations, looking at school disruptions, and as we move ahead, we plan on continuing to support safe in-person schooling by really providing the right mitigation framework that supports the active challenges we face,” concluded Dr Sud.

Beth Jarosz of Kids Data spoke about how young children have been doing since the COVID 19 pandemic started. “Both California, and the nation, have less than one-third of children ages 5-11 fully vaccinated. Partnership with trusted community partners, trusted community leaders really seem to have made a big difference, as in the case of Imperial County,” she said.

Dr Veronica Kelly discussed the mental health challenges five to 11-year-olds face during this time. “Our kids ages 5 to 11, for this discussion, have been impacted by COVID 19 in both obvious and less obvious ways. They have experienced an increase in isolation over the past two years because of the way they’ve changed how they attended school, they’re sitting at a kitchen table with a Zoom and they aren’t surrounded with their friends. They interact with their friends and other adults differently and we’ve changed the way in which our children have accessed health care because we haven’t been able to go to the doctor and that may have led to symptoms of increased depression and anxiety. Children lost a parent or co-or caregiver to COVID, additionally our kids have experienced a loss of innocence with a national reckoning over social injustice in our Black and Brown communities, and increased hate crimes in our Asian and Pacific Islander communities, increased violence and polarization of America, so our kids have had to grow up fast and this has resulted in something we called sustained survival mode which means that when we were locked down we didn’t have a whole lot of activities to do, we didn’t have a lot of healthy things to eat. Those continued unhealthy behaviors have led to a decrease in our mental health, decreased physical activity, disrupted sleep, increased weight gain, and a very big increase in concern from parents about their kids’ cognitive development.

“Kids, who have experienced adverse childhood events like abuse, neglect, community violence, and discrimination, family disruption, before and during the pandemic are at a higher risk for continued mental health problems.

“For children 5 to 11, remember that mental health challenges are real they’re common and they’re treatable just like all other health care issues. There are many ways to get better and kids should ask for help, ask someone you trust, if you’re having trouble controlling your emotions, if you feel very sad, feel like you can’t stop crying, then reach out to a trusted adult. The school nurse, a teacher, it takes courage, but it makes a difference, build healthy relationships. Making friends and keeping them is very important.

“For parents and caregivers, pay attention to your own reactions, kids take their cues from how to behave. If we are angry and nervous about masking or vaccination, they will be too. Kids pick up a lot more than we think. Help your kids build strong safe stable relationships with you and other supportive adults because research shows that the most important thing a kid needs to be resilient is a committed relationship with an adult.

“Do your best to provide your kid with a stable environment at home because kids are sponges. They internalize stress so pay attention when you start talking about financial concerns or marital concerns in front of them, try and take kids for a regular medical checkup and look for warning signs and then seek help when needed.

“Distress in kids can show up as irritability, anger, changes in their behavior, changes in their sleep patterns. If you have guns at home, or prescriptions, you need to make sure that they are kept away from kids. Dispose of extra medications that you have in your house, and if you have guns, lock them up and keep the key away from your children. Be attentive to how your kids spend their time on the internet because it is a way to connect but it’s also a way for bullying to happen and for overexposure to happen to very stressful scenarios and finally, be a voice in your community, talk openly about mental health,” concluded Dr Kelley.