The fast-spreading coronavirus delta variant has Tanaisha Smith scared for her daughter — not because of the threat of some mystery illness that she hasn't endured — but because of the damage COVID-19 already has done.
Four-year-old Bless Graham suffered heart complications and a 10-day hospitalization in June 2020 because of COVID-19 and could be at risk again because she is too young for a vaccine and natural immunity from last year's infection has likely worn off.
"It's just a fear right now. It's a panic — like 'Don't touch anything, wash your hands, get in the tub,' " said Smith, 38, of Minneapolis. "I just wish I could get my kids vaccinated."
Parent anxiety has spiked along with the delta variant, which is responsible for an estimated 95% of new coronavirus infections in Minnesota. Some parents are concerned about infection risks in children 11 and younger who are ineligible for vaccine, while others fear an overreaction to an ill-timed pandemic wave that will have schoolchildren wearing masks again this fall and losing social and learning opportunities.
It doesn't help that Minnesotans enjoyed a largely mask-free summer with COVID-19 rates on the decline until mid-July, when the delta variant exploited gaps in vaccination coverage in the U.S.
"A little taste of freedom and then having to shut down again is going to be just a really difficult pill to swallow," said Kevin Coleman, a clinical psychologist with Children's Minnesota, who predicted the reversal could result in more childhood depression and anxiety.
There is little question that COVID-19 is back. COVID-19 hospitalizations in Minnesota have increased from 90 in mid-July to 389 on Thursday, while the positivity rate of diagnostic testing has increased from 1.1% to more than 5% — a caution level for viral transmission.
State Health Commissioner Jan Malcolm said COVID-19 deaths and hospitalizations remain "far more likely in older people," but she encouraged parents to get children vaccinated, wear masks in high-risk areas, and follow local community and school strategies to limit viral spread.
"No parent wants to have their child suffer needlessly," she said, "so we all need to work together to limit the transmission of the virus."
The appropriate level of protection for children is a controversial topic, especially when Minnesotans 19 and younger have suffered 5% of COVID-19 hospitalizations and three of the state's more than 7,700 COVID-19 deaths.
Proof hasn't emerged that the delta variant produces more severe illness in children, though the Minnesota Department of Health on Friday reported that 2.2% of infections among people younger than 19 have resulted in hospitalizations over the past two months, up from .7% last fall.
The variant does produce higher viral loads in the people it infects, though, making it easier to spread than earlier forms of the coronavirus, said Dr. Bazak Sharon, director of M Health Fairview's pediatric COVID-19 clinic. While the variant is not as infectious as the chickenpox virus, some virologists think it is close.
"Is it more dangerous or not? I don't really know, but I do know that if something is more contagious, more people are going to get it," he said. "Even if it's not more severe, just by the fact that you now have more people getting it, you are going to get more sick people. It's simple math."
Pediatric hospitals in Southern states are reporting record COVID-19 admissions this summer, though the increases are proportionate to infection growth rather than signs that the delta variant is more severe. Hope of a less severe delta wave in Minnesota rests on the state's elevated vaccination rate and, perhaps, its severe COVID-19 alpha variant wave this spring that circulated among youth sports teams and presumably left infected people with some short-term immunity.
However, doctors said they are seeing some adult-level respiratory problems in older teens with COVID-19 this summer and are prescribing medications such as remdesivir that mostly had been for adults in the past. An organ complication known as multisystem inflammatory syndrome in children (MIS-C) remains a concern of COVID-19 illness as well, having been identified in 97 children in Minnesota.
Even rare complications in children are upsetting, said Dr. Beth Thielen, a pediatric infectious disease physician at M Health Fairview. "Any rate of that happening above baseline is worrisome because they are supposed to be of an age where these things are not happening to them."
The chance of severe COVID-19 in a few children is stacked for some parents against the harm of pandemic restrictions to all children and their emotional and social well-being. At a Waconia school board meeting last week, Martin Cole argued against a mask requirement for students because he said masks offered only cosmetic benefits and inhibited his youngest daughter, who has a speech impediment, from talking in class. The board voted not to require masks.
"When COVID is almost zero risk to kids — and adults, if they want to get a vaccine, they can get a vaccine — then let's take into account the mental health of the kids, too," said Cole, whose daughters are 11 and 9. "I think wearing masks, it impacts their mental health."
Cole took his oldest daughter for scheduled meningitis and tetanus boosters but hasn't gotten COVID-19 vaccine himself and won't seek it for his daughters when they become old enough or the eligibility age drops below 12.
"I'm a big believer in vaccination. I'm not a believer in the COVID vaccination," he said.
Smith on the other hand has made it clear to her children, 9 and 4 — if they want to leave the house, they wear masks.
Her daughter was diagnosed with MIS-C in June 2020 and needed three days in intensive care because her heart wasn't pumping sufficiently. She gradually healed, but the girl has had nightmares from her hospitalization of being surrounded by medical personnel wearing protective suits, helmets and masks.
Parents who haven't vaccinated eligible children are frustrating, Smith said. "People usually don't do anything until it hits close to home. Maybe if this didn't happen to my daughter, I wouldn't have gotten vaccinated as quickly. But now I'm doing anything I can to prevent them from getting sick."
Sharon, the Fairview COVID-19 pediatrician, suspects that school closures in spring 2020 were an overreaction to pandemic risks at the time, but he said there is little question that vaccination of eligible people in combination with mask-wearing in schools can reduce risks now.
Parents might be concerned about causing harm to their children if they schedule vaccinations that produce disabling side effects, but he said the odds of those effects are far lower than the odds of severe COVID-19 if they aren't vaccinated. Sharon said severe pediatric cases "were the sickest patients I've taken care of this year outside of bone marrow transplants" and that their parents had plenty of guilt.
"This is such an easy risk-benefit analysis to make," he argued. "You do not want to be on the other side of that. You do not want to be in a situation where your child gets sick, and gets really sick … and in the back of your mind you're like, 'Wow, I could have done something to prevent that.' That's not a nice place to be."
Schools haven't so much driven viral spread as they have reflected the amount taking place in communities, Thielen said. However, she said she supports vaccination of eligible schoolchildren and aggressive school policies such as mask requirements to reduce viral transmission, because the increase in delta cases could overwhelm hospitals if left unchecked.
"We are acting on incomplete data but we need to think ahead. To use the sports analogy, we need to go where the ball is going, not where it is right now — knowing that it may be overkill," she said.
An added complication has been the atypical increase this summer in children with respiratory syncytial virus (RSV), which normally emerges in the winter but might have surged after mask-wearing and social distancing orders were lifted.
"It could be the whole viral ecology is just totally thrown off" by the pandemic, said Dr. Anu Kalaskar, a pediatric infectious diseases specialist. "There really is a very big concern that the transmission is going to continue, not only of COVID but of other viruses, especially as we go into school starting and other events like the State Fair."
Coleman, the Children's Minnesota psychologist, said the longevity of the pandemic could add anxiety for kids, regardless of masks or restrictions or even a return to distance learning. He urged parents to identify and build on their kids' strengths and coping skills.
"My inclination isn't to just give kids hope, but actually use this as an opportunity to say, 'This is just one of many things in life that will kind of come,' " he said. " 'My job isn't to assuage your anxiety and convince you that everything is going to be fine. My job is to convince you that you have the tools and ability … to navigate them.' "
Jeremy Olson • 612-673-7744