MDedge Infectious Disease

Booster shots to ramp up protection against COVID-19 infection are slated to begin the week of Sept. 20, the Biden administration announced at a press briefing August 18.

Those who received the Pfizer-BioNTech and Moderna vaccines would be eligible to get a booster shot 8 months after they received the second dose of those vaccines, officials said. Information on boosters for those who got the one-dose Johnson & Johnson vaccine will be forthcoming.

“We anticipate a booster will [also] likely be needed,” said U.S. Surgeon General Vivek Murthy, MD. The J&J vaccine was not available in the U.S. until March, he said, and ‘’we expect more data on J&J in the coming weeks, so that plan is coming.”

The plan for boosters for the two mRNA vaccines is pending the FDA’s conducting of an independent review and authorizing the third dose of the Moderna and Pfizer-BioNTech vaccines, as well as an advisory committee of the CDC making the recommendation.

“We know that even highly effective vaccines become less effective over time,” Dr. Murthy said. “Having reviewed the most current data, it is now our clinical judgment that the time to lay out a plan for the COVID-19 boosters is now.”

Research released Aug. 18 shows waning effectiveness of the two mRNA vaccines.

At the briefing, Dr. Murthy and others continually reassured listeners that while effectiveness against infection declines, the vaccines continue to protect against severe infections, hospitalizations, and death.

“If you are fully vaccinated, you still have a high degree of protection against the worst outcomes,” Dr. Murthy said.
 

Data driving the plan

CDC Director Rochelle Walensky, MD, cited three research studies published Aug. 18 in the CDC’s Morbidity and Mortality Weekly Report that helped to drive the decision to recommend boosters.

Analysis of nursing home COVID-19 data from the CDC’s National Healthcare Safety Network showed a significant decline in the effectiveness of the full mRNA vaccine against lab-confirmed COVID-19 infection, from 74.7% before the Delta variant (March 1-May 9, 2021) to 53% when the Delta variant became predominant in the United States. The analysis during the Delta dominant period included 85,000 weekly reports from nearly 15,000 facilities.

Another study looked at more than 10 million New York adults who had been fully vaccinated with either the Moderna, Pfizer, or J&J vaccine by July 25. During the period from May 3 to July 25, overall, the age-adjusted vaccine effectiveness against infection decreased from 91.7% to 79.8%.

Vaccine effectiveness against hospitalization remains high, another study found. An analysis of 1,129 patients who had gotten two doses of an mRNA vaccine showed vaccine effectiveness against hospitalization after 24 weeks. It was 86% at weeks 2-12 and 84% at weeks 13-24.
 

Immunologic facts

Immunologic information also points to the need for a booster, said Anthony Fauci, MD, the chief medical advisor to the president and director of the National Institute of Allergy and Infectious Diseases.

“Antibody levels decline over time,” he said, “and higher antibody levels are associated with higher efficacy of the vaccine. Higher levels of antibody may be needed to protect against Delta.”

A booster increased antibody levels by ‘’at least tenfold and possibly more,” he said. And higher levels of antibody may be required to protect against Delta. Taken together, he said, the data support the use of a booster to increase the overall level of protection.
 

Booster details

“We will make sure it is convenient and easy to get the booster shot,” said Jeff Zients, the White House COVID-19 response coordinator. As with the previous immunization, he said, the booster will be free, and no one will be asked about immigration status.

The plan for booster shots is an attempt to stay ahead of the virus, officials stressed
 

Big picture

Not everyone agrees with the booster dose idea. At a World Health Organization briefing Aug. 18, WHO’s Chief Scientist Soumya Swaminathan, MD, an Indian pediatrician, said that the right thing to do right now ‘’is to wait for the science to tell us when boosters, which groups of people, and which vaccines need boosters.”

Like others, she also broached the ‘’moral and ethical argument of giving people third doses, when they’re already well protected and while the rest of the world is waiting for their primary immunization.”

Dr. Swaminathan does see a role for boosters to protect immunocompromised people but noted that ‘’that’s a small number of people.” Widespread boosters ‘’will only lead to more variants, to more escape variants, and perhaps we’re heading into more dire situations.”



A version of this article first appeared on WebMD.com.

Booster shots to ramp up protection against COVID-19 infection are slated to begin the week of Sept. 20, the Biden administration announced at a press briefing August 18.

Those who received the Pfizer-BioNTech and Moderna vaccines would be eligible to get a booster shot 8 months after they received the second dose of those vaccines, officials said. Information on boosters for those who got the one-dose Johnson & Johnson vaccine will be forthcoming.

“We anticipate a booster will [also] likely be needed,” said U.S. Surgeon General Vivek Murthy, MD. The J&J vaccine was not available in the U.S. until March, he said, and ‘’we expect more data on J&J in the coming weeks, so that plan is coming.”

The plan for boosters for the two mRNA vaccines is pending the FDA’s conducting of an independent review and authorizing the third dose of the Moderna and Pfizer-BioNTech vaccines, as well as an advisory committee of the CDC making the recommendation.

“We know that even highly effective vaccines become less effective over time,” Dr. Murthy said. “Having reviewed the most current data, it is now our clinical judgment that the time to lay out a plan for the COVID-19 boosters is now.”

Research released Aug. 18 shows waning effectiveness of the two mRNA vaccines.

At the briefing, Dr. Murthy and others continually reassured listeners that while effectiveness against infection declines, the vaccines continue to protect against severe infections, hospitalizations, and death.

“If you are fully vaccinated, you still have a high degree of protection against the worst outcomes,” Dr. Murthy said.
 

Data driving the plan

CDC Director Rochelle Walensky, MD, cited three research studies published Aug. 18 in the CDC’s Morbidity and Mortality Weekly Report that helped to drive the decision to recommend boosters.

Analysis of nursing home COVID-19 data from the CDC’s National Healthcare Safety Network showed a significant decline in the effectiveness of the full mRNA vaccine against lab-confirmed COVID-19 infection, from 74.7% before the Delta variant (March 1-May 9, 2021) to 53% when the Delta variant became predominant in the United States. The analysis during the Delta dominant period included 85,000 weekly reports from nearly 15,000 facilities.

Another study looked at more than 10 million New York adults who had been fully vaccinated with either the Moderna, Pfizer, or J&J vaccine by July 25. During the period from May 3 to July 25, overall, the age-adjusted vaccine effectiveness against infection decreased from 91.7% to 79.8%.

Vaccine effectiveness against hospitalization remains high, another study found. An analysis of 1,129 patients who had gotten two doses of an mRNA vaccine showed vaccine effectiveness against hospitalization after 24 weeks. It was 86% at weeks 2-12 and 84% at weeks 13-24.
 

Immunologic facts

Immunologic information also points to the need for a booster, said Anthony Fauci, MD, the chief medical advisor to the president and director of the National Institute of Allergy and Infectious Diseases.

“Antibody levels decline over time,” he said, “and higher antibody levels are associated with higher efficacy of the vaccine. Higher levels of antibody may be needed to protect against Delta.”

A booster increased antibody levels by ‘’at least tenfold and possibly more,” he said. And higher levels of antibody may be required to protect against Delta. Taken together, he said, the data support the use of a booster to increase the overall level of protection.
 

Booster details

“We will make sure it is convenient and easy to get the booster shot,” said Jeff Zients, the White House COVID-19 response coordinator. As with the previous immunization, he said, the booster will be free, and no one will be asked about immigration status.

The plan for booster shots is an attempt to stay ahead of the virus, officials stressed
 

Big picture

Not everyone agrees with the booster dose idea. At a World Health Organization briefing Aug. 18, WHO’s Chief Scientist Soumya Swaminathan, MD, an Indian pediatrician, said that the right thing to do right now ‘’is to wait for the science to tell us when boosters, which groups of people, and which vaccines need boosters.”

Like others, she also broached the ‘’moral and ethical argument of giving people third doses, when they’re already well protected and while the rest of the world is waiting for their primary immunization.”

Dr. Swaminathan does see a role for boosters to protect immunocompromised people but noted that ‘’that’s a small number of people.” Widespread boosters ‘’will only lead to more variants, to more escape variants, and perhaps we’re heading into more dire situations.”



A version of this article first appeared on WebMD.com.

Booster shots to ramp up protection against COVID-19 infection are slated to begin the week of Sept. 20, the Biden administration announced at a press briefing August 18.

Those who received the Pfizer-BioNTech and Moderna vaccines would be eligible to get a booster shot 8 months after they received the second dose of those vaccines, officials said. Information on boosters for those who got the one-dose Johnson & Johnson vaccine will be forthcoming.

“We anticipate a booster will [also] likely be needed,” said U.S. Surgeon General Vivek Murthy, MD. The J&J vaccine was not available in the U.S. until March, he said, and ‘’we expect more data on J&J in the coming weeks, so that plan is coming.”

The plan for boosters for the two mRNA vaccines is pending the FDA’s conducting of an independent review and authorizing the third dose of the Moderna and Pfizer-BioNTech vaccines, as well as an advisory committee of the CDC making the recommendation.

“We know that even highly effective vaccines become less effective over time,” Dr. Murthy said. “Having reviewed the most current data, it is now our clinical judgment that the time to lay out a plan for the COVID-19 boosters is now.”

Research released Aug. 18 shows waning effectiveness of the two mRNA vaccines.

At the briefing, Dr. Murthy and others continually reassured listeners that while effectiveness against infection declines, the vaccines continue to protect against severe infections, hospitalizations, and death.

“If you are fully vaccinated, you still have a high degree of protection against the worst outcomes,” Dr. Murthy said.
 

Data driving the plan

CDC Director Rochelle Walensky, MD, cited three research studies published Aug. 18 in the CDC’s Morbidity and Mortality Weekly Report that helped to drive the decision to recommend boosters.

Analysis of nursing home COVID-19 data from the CDC’s National Healthcare Safety Network showed a significant decline in the effectiveness of the full mRNA vaccine against lab-confirmed COVID-19 infection, from 74.7% before the Delta variant (March 1-May 9, 2021) to 53% when the Delta variant became predominant in the United States. The analysis during the Delta dominant period included 85,000 weekly reports from nearly 15,000 facilities.

Another study looked at more than 10 million New York adults who had been fully vaccinated with either the Moderna, Pfizer, or J&J vaccine by July 25. During the period from May 3 to July 25, overall, the age-adjusted vaccine effectiveness against infection decreased from 91.7% to 79.8%.

Vaccine effectiveness against hospitalization remains high, another study found. An analysis of 1,129 patients who had gotten two doses of an mRNA vaccine showed vaccine effectiveness against hospitalization after 24 weeks. It was 86% at weeks 2-12 and 84% at weeks 13-24.
 

Immunologic facts

Immunologic information also points to the need for a booster, said Anthony Fauci, MD, the chief medical advisor to the president and director of the National Institute of Allergy and Infectious Diseases.

“Antibody levels decline over time,” he said, “and higher antibody levels are associated with higher efficacy of the vaccine. Higher levels of antibody may be needed to protect against Delta.”

A booster increased antibody levels by ‘’at least tenfold and possibly more,” he said. And higher levels of antibody may be required to protect against Delta. Taken together, he said, the data support the use of a booster to increase the overall level of protection.
 

Booster details

“We will make sure it is convenient and easy to get the booster shot,” said Jeff Zients, the White House COVID-19 response coordinator. As with the previous immunization, he said, the booster will be free, and no one will be asked about immigration status.

The plan for booster shots is an attempt to stay ahead of the virus, officials stressed
 

Big picture

Not everyone agrees with the booster dose idea. At a World Health Organization briefing Aug. 18, WHO’s Chief Scientist Soumya Swaminathan, MD, an Indian pediatrician, said that the right thing to do right now ‘’is to wait for the science to tell us when boosters, which groups of people, and which vaccines need boosters.”

Like others, she also broached the ‘’moral and ethical argument of giving people third doses, when they’re already well protected and while the rest of the world is waiting for their primary immunization.”

Dr. Swaminathan does see a role for boosters to protect immunocompromised people but noted that ‘’that’s a small number of people.” Widespread boosters ‘’will only lead to more variants, to more escape variants, and perhaps we’re heading into more dire situations.”



A version of this article first appeared on WebMD.com.

Preliminary data from seven states suggests that breakthrough COVID-19 infections among vaccinated people may be on the rise because of the more contagious Delta variant.

Breakthrough cases accounted for about one in five newly diagnosed cases in six of the states, according to the New York Times. Hospitalizations and deaths among vaccinated people may be higher than previously thought as well.

“Remember when the early vaccine studies came out, it was like nobody gets hospitalized, nobody dies,” Robert Wachter, MD, chairman of the department of medicine at the University of California, San Francisco, said in an interview. “That clearly is not true.”

The New York Times analyzed data in seven states – California, Colorado, Massachusetts, Oregon, Utah, Vermont, and Virginia – that are tracking the most detailed information. The trends in these states may not reflect the numbers throughout the country, the newspaper reported.

Even still, the numbers back up the idea that vaccinated people may need booster shots this fall to support their earlier vaccine doses. Federal health officials are scheduled to approve the extra shots in coming weeks, potentially in September. The first people to receive booster shots will likely be health care workers and nursing home residents who took the first vaccines in December and January.

“If the chances of a breakthrough infection have gone up considerably, and I think the evidence is clear that they have, and the level of protection against severe illness is no longer as robust as it was, I think the case for boosters goes up pretty quickly,” Dr. Wachter said.

Previous analyses of breakthrough cases included data from June and earlier, the newspaper reported. But since July, COVID-19 cases have soared again because of the Delta variant, and the most recent numbers show an uptick among vaccinated people. In Los Angeles County, for instance, fully vaccinated people account for 20% of new COVID-19 cases, which is up from 11% in May, 5% in April, and 2% in March, according to a late July report from the Los Angeles County Department of Public Health.

What’s more, breakthrough infections in the seven states accounted for 12%-24% of COVID-19 hospitalizations in those states. About 8,000 breakthrough hospitalizations have been reported to the CDC. Still, the overall numbers remain low – in California, for instance, about 1,615 people have been hospitalized with breakthrough infections, which accounts for 0.007% of the state’s 22 million vaccinated people, the Times reported.

The breakthrough infections appear to be more severe among vaccinated people who are older or have weakened immune systems. About 74% of breakthrough cases are among adults 65 or older, the CDC reported.

The increase may shift how vaccinated people see their risks for infection and interact with loved ones. Public health officials have suggested that people follow some COVID-19 safety protocols again, such as wearing masks in public indoor spaces regardless of vaccination status.

As the Delta variant continues to circulate this fall, public health researchers will be researching more about breakthrough cases among vaccinated people, including whether they have prolonged symptoms and how easily they may pass the virus to others.

“I think some of us have been challenged by the numbers of clusters that we’ve seen,” Michael Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told this news organization.

“I think that really needs to be examined more,” he said.

A version of this article first appeared on WebMD.com.

Preliminary data from seven states suggests that breakthrough COVID-19 infections among vaccinated people may be on the rise because of the more contagious Delta variant.

Breakthrough cases accounted for about one in five newly diagnosed cases in six of the states, according to the New York Times. Hospitalizations and deaths among vaccinated people may be higher than previously thought as well.

“Remember when the early vaccine studies came out, it was like nobody gets hospitalized, nobody dies,” Robert Wachter, MD, chairman of the department of medicine at the University of California, San Francisco, said in an interview. “That clearly is not true.”

The New York Times analyzed data in seven states – California, Colorado, Massachusetts, Oregon, Utah, Vermont, and Virginia – that are tracking the most detailed information. The trends in these states may not reflect the numbers throughout the country, the newspaper reported.

Even still, the numbers back up the idea that vaccinated people may need booster shots this fall to support their earlier vaccine doses. Federal health officials are scheduled to approve the extra shots in coming weeks, potentially in September. The first people to receive booster shots will likely be health care workers and nursing home residents who took the first vaccines in December and January.

“If the chances of a breakthrough infection have gone up considerably, and I think the evidence is clear that they have, and the level of protection against severe illness is no longer as robust as it was, I think the case for boosters goes up pretty quickly,” Dr. Wachter said.

Previous analyses of breakthrough cases included data from June and earlier, the newspaper reported. But since July, COVID-19 cases have soared again because of the Delta variant, and the most recent numbers show an uptick among vaccinated people. In Los Angeles County, for instance, fully vaccinated people account for 20% of new COVID-19 cases, which is up from 11% in May, 5% in April, and 2% in March, according to a late July report from the Los Angeles County Department of Public Health.

What’s more, breakthrough infections in the seven states accounted for 12%-24% of COVID-19 hospitalizations in those states. About 8,000 breakthrough hospitalizations have been reported to the CDC. Still, the overall numbers remain low – in California, for instance, about 1,615 people have been hospitalized with breakthrough infections, which accounts for 0.007% of the state’s 22 million vaccinated people, the Times reported.

The breakthrough infections appear to be more severe among vaccinated people who are older or have weakened immune systems. About 74% of breakthrough cases are among adults 65 or older, the CDC reported.

The increase may shift how vaccinated people see their risks for infection and interact with loved ones. Public health officials have suggested that people follow some COVID-19 safety protocols again, such as wearing masks in public indoor spaces regardless of vaccination status.

As the Delta variant continues to circulate this fall, public health researchers will be researching more about breakthrough cases among vaccinated people, including whether they have prolonged symptoms and how easily they may pass the virus to others.

“I think some of us have been challenged by the numbers of clusters that we’ve seen,” Michael Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told this news organization.

“I think that really needs to be examined more,” he said.

A version of this article first appeared on WebMD.com.

Preliminary data from seven states suggests that breakthrough COVID-19 infections among vaccinated people may be on the rise because of the more contagious Delta variant.

Breakthrough cases accounted for about one in five newly diagnosed cases in six of the states, according to the New York Times. Hospitalizations and deaths among vaccinated people may be higher than previously thought as well.

“Remember when the early vaccine studies came out, it was like nobody gets hospitalized, nobody dies,” Robert Wachter, MD, chairman of the department of medicine at the University of California, San Francisco, said in an interview. “That clearly is not true.”

The New York Times analyzed data in seven states – California, Colorado, Massachusetts, Oregon, Utah, Vermont, and Virginia – that are tracking the most detailed information. The trends in these states may not reflect the numbers throughout the country, the newspaper reported.

Even still, the numbers back up the idea that vaccinated people may need booster shots this fall to support their earlier vaccine doses. Federal health officials are scheduled to approve the extra shots in coming weeks, potentially in September. The first people to receive booster shots will likely be health care workers and nursing home residents who took the first vaccines in December and January.

“If the chances of a breakthrough infection have gone up considerably, and I think the evidence is clear that they have, and the level of protection against severe illness is no longer as robust as it was, I think the case for boosters goes up pretty quickly,” Dr. Wachter said.

Previous analyses of breakthrough cases included data from June and earlier, the newspaper reported. But since July, COVID-19 cases have soared again because of the Delta variant, and the most recent numbers show an uptick among vaccinated people. In Los Angeles County, for instance, fully vaccinated people account for 20% of new COVID-19 cases, which is up from 11% in May, 5% in April, and 2% in March, according to a late July report from the Los Angeles County Department of Public Health.

What’s more, breakthrough infections in the seven states accounted for 12%-24% of COVID-19 hospitalizations in those states. About 8,000 breakthrough hospitalizations have been reported to the CDC. Still, the overall numbers remain low – in California, for instance, about 1,615 people have been hospitalized with breakthrough infections, which accounts for 0.007% of the state’s 22 million vaccinated people, the Times reported.

The breakthrough infections appear to be more severe among vaccinated people who are older or have weakened immune systems. About 74% of breakthrough cases are among adults 65 or older, the CDC reported.

The increase may shift how vaccinated people see their risks for infection and interact with loved ones. Public health officials have suggested that people follow some COVID-19 safety protocols again, such as wearing masks in public indoor spaces regardless of vaccination status.

As the Delta variant continues to circulate this fall, public health researchers will be researching more about breakthrough cases among vaccinated people, including whether they have prolonged symptoms and how easily they may pass the virus to others.

“I think some of us have been challenged by the numbers of clusters that we’ve seen,” Michael Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told this news organization.

“I think that really needs to be examined more,” he said.

A version of this article first appeared on WebMD.com.

With the Delta variant surging across the country, already spread-thin health care workers are facing even sicker –and younger – Americans affected by COVID-19 than at the start of the pandemic.

While the exact toll the pandemic will take on essential workers will remain unknown, one thing is clear: The COVID-19 outbreak they’re experiencing right now on the front lines is a far cry from the original strain. They’re scared, exasperated, and crying out for us to pay attention and get vaccinated.

Five health care workers told this news organization about their experiences working the front lines amid the recent surge and what they think needs to happen – fast.
 

COVID-19 perspective from a paramedic in Connecticut

Michael Battistelli has been an emergency medical services worker for over 20 years and a licensed paramedic in Stratford, Conn., for a decade. He’s also the father of a 5-year-old daughter who isn’t eligible for a vaccination yet. For him, every day has been the same since the start of the pandemic: Surgical mask, N95 mask, face shield, change clothes before going home, and shower as soon as he walks in the door. He’s worried about Delta right now and wants you to be, too.

What keeps him up at night: “It seems like the last time, COVID-19 hit the Pacific Northwest and Northeast first. I hope it’s not the reverse and that it isn’t working its way back up to us here in Connecticut. I’ll add that if we start seeing young people dying, that might be it for me. That might be my final stand as an EMS.”

Why he’s frustrated: “For people to say COVID-19 isn’t real is mind-blowing. I’ve been at this for over a year, and all I think about is how to keep my daughter safe and protect my parents, especially my mom, who is a cancer survivor. When this first started, I brought people into the hospital who thought they would be fine after a day or week in the hospital. They ended up being on ventilators for months – and these were healthy people.”

What he wants to see: “I try not to judge people, but please understand how hard health care workers are working. We’re fatigued and burned out, and we are begging you: Please get vaccinated.”
 

COVID-19 perspective from an ICU director in Tennessee

Todd Rice, MD, FCCP, is an associate professor of medicine in the division of allergy, pulmonary and critical care at Vanderbilt Medical Center in Nashville, Tenn. While this father of two – ages 15 and 17 – trained for a pandemic, specifically Ebola and H1N1, the sheer volume of young COVID-19 patients in the ICU right now is taking a huge toll on him and his staff.

Why he’s frustrated: “First, there are a group of people that are adamantly against getting vaccinated. It doesn’t matter what we do or say. Second, a lot of people are confused and tell me that they don’t have somebody they trust to answer their questions about the vaccine. Third, some of this is driven by our colleagues: In the last 2 weeks, eight pregnant women with COVID-19 were admitted to our ICU. At least six said that their [obstetrician] told them not to get the vaccine while pregnant. That myth is still out there.”

What’s going on in the ICU: “I want people to know that our unvaccinated infected COVID-19 patients are the sickest patients we take care of. Their condition can change on a dime. We think they’re getting better, and suddenly we turn around and they’re near death or they die in seconds. What’s hard for our staff is that many of these patients have been with us for several weeks, and we get to know them. So when this happens, it hurts us even more because we’ve gotten to know them.”

What we need to do: “While it may take time, we have to talk to vaccine-hesitant people one by one and ask them what questions they have and then provide them with the answers they need. I think the next 6 months is going to be all about getting people who are still movable on this and get them to be comfortable that the vaccine is safe, that we didn’t cut corners. Yes, it was developed faster than anything we’ve ever done before, but that’s because it had to be.”
 

COVID-19 perspective from a cardiopulmonary doctor in Florida

Yvonne Billings, MD, director of cardiopulmonary medicine at Cleveland Clinic Martin Health in Stuart, Fla., says the “explosion” of COVID-19 cases right after July 4 has left her and her staff emotionally and physically overwhelmed.

What worries her: “We have great PPE, but we’re all worries because Delta is so contagious, and our colleagues have gotten it. We’ll eat lunch next to each other – socially distanced, of course – and we won’t know if we’ve gotten it by just sitting down to eat.”

What she wants us to do – now: “Everyone needs to listen to the real medical science and understand how much this is impacting everyone’s care. For example, if you need to come to the hospital for something other than COVID-19, you will receive slower care because everyone is so tied up caring for COVID-19 patients.”

Health care workers need to get on board, too: “I look at some of my respiratory therapists who chose not to be vaccinated until this last surge. Many told me that when the younger patients started coming in, they could relate to that. One said: ‘I see this gentleman is 27. I’m 27. I could be in the exact same position.’ I don’t want to see anyone get sick, but I’m hoping that when people see that this affects anyone at any age, they can push politics and what they thought was true about the vaccine aside, and make different choices and move forward.”
 

COVID-19 perspective from a registered nurse in Louisiana

Gina McNemar, 37, an ICU nurse at Baton Rouge General Medical Center in Baton Rouge, La., is wiped out. Her ICU unit is currently full of COVID-19 patients. This mom of 5-year-old twins is so upset about the onslaught of patients in her unit that she sent an email to the CEO of the hospital, which he then shared on Facebook with hundreds of followers. From the email: “This Covid is different. Let me repeat myself: THIS COVID IS NOT THE SAME. ... For the first time since April 2020, I kneeled on top of a patient in the middle of CPR and saw myself. She was 41 years old, no comorbidities, a full life ahead of her. The first time we fought Covid, everyone was old and sickly. They weren’t ‘me.’ This sweet woman was ‘me.’ We ran a full code on her for 1 hour and 26 minutes in front of her fiancé. He cried out to God to save her. He cried out to us to save her. We did everything in our power to save her. We weren’t able to. Three nurses, a pharmacy tech, an x-ray tech, and our HMG doctor hugged, prayed, and cried together after. She was living her life, got Covid, and died.”

Why she wants people to pay attention: “Our COVID-19 patients are young, they’re healthy, they’re able to answer our questions and immediately crash. We don’t have time to catch our breath between one code to the next. This COVID-19 is a much more violent disease, and I can no longer keep quiet. Someone has to say it. Someone has to say, ‘You can believe what you want to believe,’ but I’m seeing it with my own eyes, I’m holding their hands while they die, I’m bagging their body for the morgue. See this crisis through my eyes – please!”

What’s happening with her coworkers: “We’ve had some pretty bad days. We’re all crying and we’re afraid for each other now. We feel like it could be any of us at any point. I’m feeling that I don’t want to let it get to me, but it is. At home, we pray every night. The other night, one of my twins said: ‘I pray that you don’t get coronavirus and die.’ I can’t help but think: 5-year-olds should pray for unicorns and rainbows, not that their mom could die at work.”

Please stop playing politics: “America has become so divided and the vaccine somehow became the evil thing instead of the fact that the vaccine is the savior. I waited in line to get my vaccine because the scientists came up with something to end all this, but not everyone sees it that way. I feel like people don’t want to see and it shouldn’t matter if you’re a Republican or Democrat – after all, Biden is vaccinated [and] Trump is vaccinated.”
 

COVID-19 perspective from an ED doctor in New York City

Amanda Smith, MD, an ED doctor at Staten Island University Hospital in New York, says she’s sensing a “slow wave coming” when it comes to the Delta variant. The mom of three kids (she has 10-year-old twins and a 12-year-old) thinks often of the first signs of COVID-19 in 2020 and hopes that there won’t be a repeat surge like the initial one in New York City.

It’s hard not to feel frustrated: “I’m annoyed about the Delta variant. Of course, I’ve experienced the ‘I’m not getting the vaccine’ argument, and I’ve been at this long enough that I’m able to compartmentalize my own feelings, but I’m worn down, and I’m aware that I have compassion fatigue. When people complain about their COVID-19 symptoms and say things like ‘If I knew I would feel this horrible, I would have gotten the vaccine,’ I can’t help but feel that this was avoidable. It’s hard to talk to those people. I want to say ‘600,000 dead people weren’t enough to get vaccinated?’ ”

The people avoiding the vaccine: “There are the absolute deniers who will never get vaccinated and aren’t going to change their minds. Then there are the people who feel invincible, and then there are the folks who think that COVID-19 isn’t that bad, it’s just like the flu, it’s only old people dying and they’re not getting information from an appropriate source. It’s not the flu, it does kill you. Delta kills younger people, and it’s very easy to spread. Every one person who was infected with the original strain could infect two to three others. The Delta variant can infect 8-9, and measles, at 13, is the most contagious, so we need to keep reminding people about this.”

It’s not just about you: “Vaccination campaigns were never about the individual. We live together in a civilized society, and the vaccine is something you do for each other. People don’t understand the importance of breaking the chain of transmission and doing this to help each other and eradicate the spread. I just don’t understand what happened to us that we forgot this.”

A version of this article first appeared on WebMD.com.

With the Delta variant surging across the country, already spread-thin health care workers are facing even sicker –and younger – Americans affected by COVID-19 than at the start of the pandemic.

While the exact toll the pandemic will take on essential workers will remain unknown, one thing is clear: The COVID-19 outbreak they’re experiencing right now on the front lines is a far cry from the original strain. They’re scared, exasperated, and crying out for us to pay attention and get vaccinated.

Five health care workers told this news organization about their experiences working the front lines amid the recent surge and what they think needs to happen – fast.
 

COVID-19 perspective from a paramedic in Connecticut

Michael Battistelli has been an emergency medical services worker for over 20 years and a licensed paramedic in Stratford, Conn., for a decade. He’s also the father of a 5-year-old daughter who isn’t eligible for a vaccination yet. For him, every day has been the same since the start of the pandemic: Surgical mask, N95 mask, face shield, change clothes before going home, and shower as soon as he walks in the door. He’s worried about Delta right now and wants you to be, too.

What keeps him up at night: “It seems like the last time, COVID-19 hit the Pacific Northwest and Northeast first. I hope it’s not the reverse and that it isn’t working its way back up to us here in Connecticut. I’ll add that if we start seeing young people dying, that might be it for me. That might be my final stand as an EMS.”

Why he’s frustrated: “For people to say COVID-19 isn’t real is mind-blowing. I’ve been at this for over a year, and all I think about is how to keep my daughter safe and protect my parents, especially my mom, who is a cancer survivor. When this first started, I brought people into the hospital who thought they would be fine after a day or week in the hospital. They ended up being on ventilators for months – and these were healthy people.”

What he wants to see: “I try not to judge people, but please understand how hard health care workers are working. We’re fatigued and burned out, and we are begging you: Please get vaccinated.”
 

COVID-19 perspective from an ICU director in Tennessee

Todd Rice, MD, FCCP, is an associate professor of medicine in the division of allergy, pulmonary and critical care at Vanderbilt Medical Center in Nashville, Tenn. While this father of two – ages 15 and 17 – trained for a pandemic, specifically Ebola and H1N1, the sheer volume of young COVID-19 patients in the ICU right now is taking a huge toll on him and his staff.

Why he’s frustrated: “First, there are a group of people that are adamantly against getting vaccinated. It doesn’t matter what we do or say. Second, a lot of people are confused and tell me that they don’t have somebody they trust to answer their questions about the vaccine. Third, some of this is driven by our colleagues: In the last 2 weeks, eight pregnant women with COVID-19 were admitted to our ICU. At least six said that their [obstetrician] told them not to get the vaccine while pregnant. That myth is still out there.”

What’s going on in the ICU: “I want people to know that our unvaccinated infected COVID-19 patients are the sickest patients we take care of. Their condition can change on a dime. We think they’re getting better, and suddenly we turn around and they’re near death or they die in seconds. What’s hard for our staff is that many of these patients have been with us for several weeks, and we get to know them. So when this happens, it hurts us even more because we’ve gotten to know them.”

What we need to do: “While it may take time, we have to talk to vaccine-hesitant people one by one and ask them what questions they have and then provide them with the answers they need. I think the next 6 months is going to be all about getting people who are still movable on this and get them to be comfortable that the vaccine is safe, that we didn’t cut corners. Yes, it was developed faster than anything we’ve ever done before, but that’s because it had to be.”
 

COVID-19 perspective from a cardiopulmonary doctor in Florida

Yvonne Billings, MD, director of cardiopulmonary medicine at Cleveland Clinic Martin Health in Stuart, Fla., says the “explosion” of COVID-19 cases right after July 4 has left her and her staff emotionally and physically overwhelmed.

What worries her: “We have great PPE, but we’re all worries because Delta is so contagious, and our colleagues have gotten it. We’ll eat lunch next to each other – socially distanced, of course – and we won’t know if we’ve gotten it by just sitting down to eat.”

What she wants us to do – now: “Everyone needs to listen to the real medical science and understand how much this is impacting everyone’s care. For example, if you need to come to the hospital for something other than COVID-19, you will receive slower care because everyone is so tied up caring for COVID-19 patients.”

Health care workers need to get on board, too: “I look at some of my respiratory therapists who chose not to be vaccinated until this last surge. Many told me that when the younger patients started coming in, they could relate to that. One said: ‘I see this gentleman is 27. I’m 27. I could be in the exact same position.’ I don’t want to see anyone get sick, but I’m hoping that when people see that this affects anyone at any age, they can push politics and what they thought was true about the vaccine aside, and make different choices and move forward.”
 

COVID-19 perspective from a registered nurse in Louisiana

Gina McNemar, 37, an ICU nurse at Baton Rouge General Medical Center in Baton Rouge, La., is wiped out. Her ICU unit is currently full of COVID-19 patients. This mom of 5-year-old twins is so upset about the onslaught of patients in her unit that she sent an email to the CEO of the hospital, which he then shared on Facebook with hundreds of followers. From the email: “This Covid is different. Let me repeat myself: THIS COVID IS NOT THE SAME. ... For the first time since April 2020, I kneeled on top of a patient in the middle of CPR and saw myself. She was 41 years old, no comorbidities, a full life ahead of her. The first time we fought Covid, everyone was old and sickly. They weren’t ‘me.’ This sweet woman was ‘me.’ We ran a full code on her for 1 hour and 26 minutes in front of her fiancé. He cried out to God to save her. He cried out to us to save her. We did everything in our power to save her. We weren’t able to. Three nurses, a pharmacy tech, an x-ray tech, and our HMG doctor hugged, prayed, and cried together after. She was living her life, got Covid, and died.”

Why she wants people to pay attention: “Our COVID-19 patients are young, they’re healthy, they’re able to answer our questions and immediately crash. We don’t have time to catch our breath between one code to the next. This COVID-19 is a much more violent disease, and I can no longer keep quiet. Someone has to say it. Someone has to say, ‘You can believe what you want to believe,’ but I’m seeing it with my own eyes, I’m holding their hands while they die, I’m bagging their body for the morgue. See this crisis through my eyes – please!”

What’s happening with her coworkers: “We’ve had some pretty bad days. We’re all crying and we’re afraid for each other now. We feel like it could be any of us at any point. I’m feeling that I don’t want to let it get to me, but it is. At home, we pray every night. The other night, one of my twins said: ‘I pray that you don’t get coronavirus and die.’ I can’t help but think: 5-year-olds should pray for unicorns and rainbows, not that their mom could die at work.”

Please stop playing politics: “America has become so divided and the vaccine somehow became the evil thing instead of the fact that the vaccine is the savior. I waited in line to get my vaccine because the scientists came up with something to end all this, but not everyone sees it that way. I feel like people don’t want to see and it shouldn’t matter if you’re a Republican or Democrat – after all, Biden is vaccinated [and] Trump is vaccinated.”
 

COVID-19 perspective from an ED doctor in New York City

Amanda Smith, MD, an ED doctor at Staten Island University Hospital in New York, says she’s sensing a “slow wave coming” when it comes to the Delta variant. The mom of three kids (she has 10-year-old twins and a 12-year-old) thinks often of the first signs of COVID-19 in 2020 and hopes that there won’t be a repeat surge like the initial one in New York City.

It’s hard not to feel frustrated: “I’m annoyed about the Delta variant. Of course, I’ve experienced the ‘I’m not getting the vaccine’ argument, and I’ve been at this long enough that I’m able to compartmentalize my own feelings, but I’m worn down, and I’m aware that I have compassion fatigue. When people complain about their COVID-19 symptoms and say things like ‘If I knew I would feel this horrible, I would have gotten the vaccine,’ I can’t help but feel that this was avoidable. It’s hard to talk to those people. I want to say ‘600,000 dead people weren’t enough to get vaccinated?’ ”

The people avoiding the vaccine: “There are the absolute deniers who will never get vaccinated and aren’t going to change their minds. Then there are the people who feel invincible, and then there are the folks who think that COVID-19 isn’t that bad, it’s just like the flu, it’s only old people dying and they’re not getting information from an appropriate source. It’s not the flu, it does kill you. Delta kills younger people, and it’s very easy to spread. Every one person who was infected with the original strain could infect two to three others. The Delta variant can infect 8-9, and measles, at 13, is the most contagious, so we need to keep reminding people about this.”

It’s not just about you: “Vaccination campaigns were never about the individual. We live together in a civilized society, and the vaccine is something you do for each other. People don’t understand the importance of breaking the chain of transmission and doing this to help each other and eradicate the spread. I just don’t understand what happened to us that we forgot this.”

A version of this article first appeared on WebMD.com.

With the Delta variant surging across the country, already spread-thin health care workers are facing even sicker –and younger – Americans affected by COVID-19 than at the start of the pandemic.

While the exact toll the pandemic will take on essential workers will remain unknown, one thing is clear: The COVID-19 outbreak they’re experiencing right now on the front lines is a far cry from the original strain. They’re scared, exasperated, and crying out for us to pay attention and get vaccinated.

Five health care workers told this news organization about their experiences working the front lines amid the recent surge and what they think needs to happen – fast.
 

COVID-19 perspective from a paramedic in Connecticut

Michael Battistelli has been an emergency medical services worker for over 20 years and a licensed paramedic in Stratford, Conn., for a decade. He’s also the father of a 5-year-old daughter who isn’t eligible for a vaccination yet. For him, every day has been the same since the start of the pandemic: Surgical mask, N95 mask, face shield, change clothes before going home, and shower as soon as he walks in the door. He’s worried about Delta right now and wants you to be, too.

What keeps him up at night: “It seems like the last time, COVID-19 hit the Pacific Northwest and Northeast first. I hope it’s not the reverse and that it isn’t working its way back up to us here in Connecticut. I’ll add that if we start seeing young people dying, that might be it for me. That might be my final stand as an EMS.”

Why he’s frustrated: “For people to say COVID-19 isn’t real is mind-blowing. I’ve been at this for over a year, and all I think about is how to keep my daughter safe and protect my parents, especially my mom, who is a cancer survivor. When this first started, I brought people into the hospital who thought they would be fine after a day or week in the hospital. They ended up being on ventilators for months – and these were healthy people.”

What he wants to see: “I try not to judge people, but please understand how hard health care workers are working. We’re fatigued and burned out, and we are begging you: Please get vaccinated.”
 

COVID-19 perspective from an ICU director in Tennessee

Todd Rice, MD, FCCP, is an associate professor of medicine in the division of allergy, pulmonary and critical care at Vanderbilt Medical Center in Nashville, Tenn. While this father of two – ages 15 and 17 – trained for a pandemic, specifically Ebola and H1N1, the sheer volume of young COVID-19 patients in the ICU right now is taking a huge toll on him and his staff.

Why he’s frustrated: “First, there are a group of people that are adamantly against getting vaccinated. It doesn’t matter what we do or say. Second, a lot of people are confused and tell me that they don’t have somebody they trust to answer their questions about the vaccine. Third, some of this is driven by our colleagues: In the last 2 weeks, eight pregnant women with COVID-19 were admitted to our ICU. At least six said that their [obstetrician] told them not to get the vaccine while pregnant. That myth is still out there.”

What’s going on in the ICU: “I want people to know that our unvaccinated infected COVID-19 patients are the sickest patients we take care of. Their condition can change on a dime. We think they’re getting better, and suddenly we turn around and they’re near death or they die in seconds. What’s hard for our staff is that many of these patients have been with us for several weeks, and we get to know them. So when this happens, it hurts us even more because we’ve gotten to know them.”

What we need to do: “While it may take time, we have to talk to vaccine-hesitant people one by one and ask them what questions they have and then provide them with the answers they need. I think the next 6 months is going to be all about getting people who are still movable on this and get them to be comfortable that the vaccine is safe, that we didn’t cut corners. Yes, it was developed faster than anything we’ve ever done before, but that’s because it had to be.”
 

COVID-19 perspective from a cardiopulmonary doctor in Florida

Yvonne Billings, MD, director of cardiopulmonary medicine at Cleveland Clinic Martin Health in Stuart, Fla., says the “explosion” of COVID-19 cases right after July 4 has left her and her staff emotionally and physically overwhelmed.

What worries her: “We have great PPE, but we’re all worries because Delta is so contagious, and our colleagues have gotten it. We’ll eat lunch next to each other – socially distanced, of course – and we won’t know if we’ve gotten it by just sitting down to eat.”

What she wants us to do – now: “Everyone needs to listen to the real medical science and understand how much this is impacting everyone’s care. For example, if you need to come to the hospital for something other than COVID-19, you will receive slower care because everyone is so tied up caring for COVID-19 patients.”

Health care workers need to get on board, too: “I look at some of my respiratory therapists who chose not to be vaccinated until this last surge. Many told me that when the younger patients started coming in, they could relate to that. One said: ‘I see this gentleman is 27. I’m 27. I could be in the exact same position.’ I don’t want to see anyone get sick, but I’m hoping that when people see that this affects anyone at any age, they can push politics and what they thought was true about the vaccine aside, and make different choices and move forward.”
 

COVID-19 perspective from a registered nurse in Louisiana

Gina McNemar, 37, an ICU nurse at Baton Rouge General Medical Center in Baton Rouge, La., is wiped out. Her ICU unit is currently full of COVID-19 patients. This mom of 5-year-old twins is so upset about the onslaught of patients in her unit that she sent an email to the CEO of the hospital, which he then shared on Facebook with hundreds of followers. From the email: “This Covid is different. Let me repeat myself: THIS COVID IS NOT THE SAME. ... For the first time since April 2020, I kneeled on top of a patient in the middle of CPR and saw myself. She was 41 years old, no comorbidities, a full life ahead of her. The first time we fought Covid, everyone was old and sickly. They weren’t ‘me.’ This sweet woman was ‘me.’ We ran a full code on her for 1 hour and 26 minutes in front of her fiancé. He cried out to God to save her. He cried out to us to save her. We did everything in our power to save her. We weren’t able to. Three nurses, a pharmacy tech, an x-ray tech, and our HMG doctor hugged, prayed, and cried together after. She was living her life, got Covid, and died.”

Why she wants people to pay attention: “Our COVID-19 patients are young, they’re healthy, they’re able to answer our questions and immediately crash. We don’t have time to catch our breath between one code to the next. This COVID-19 is a much more violent disease, and I can no longer keep quiet. Someone has to say it. Someone has to say, ‘You can believe what you want to believe,’ but I’m seeing it with my own eyes, I’m holding their hands while they die, I’m bagging their body for the morgue. See this crisis through my eyes – please!”

What’s happening with her coworkers: “We’ve had some pretty bad days. We’re all crying and we’re afraid for each other now. We feel like it could be any of us at any point. I’m feeling that I don’t want to let it get to me, but it is. At home, we pray every night. The other night, one of my twins said: ‘I pray that you don’t get coronavirus and die.’ I can’t help but think: 5-year-olds should pray for unicorns and rainbows, not that their mom could die at work.”

Please stop playing politics: “America has become so divided and the vaccine somehow became the evil thing instead of the fact that the vaccine is the savior. I waited in line to get my vaccine because the scientists came up with something to end all this, but not everyone sees it that way. I feel like people don’t want to see and it shouldn’t matter if you’re a Republican or Democrat – after all, Biden is vaccinated [and] Trump is vaccinated.”
 

COVID-19 perspective from an ED doctor in New York City

Amanda Smith, MD, an ED doctor at Staten Island University Hospital in New York, says she’s sensing a “slow wave coming” when it comes to the Delta variant. The mom of three kids (she has 10-year-old twins and a 12-year-old) thinks often of the first signs of COVID-19 in 2020 and hopes that there won’t be a repeat surge like the initial one in New York City.

It’s hard not to feel frustrated: “I’m annoyed about the Delta variant. Of course, I’ve experienced the ‘I’m not getting the vaccine’ argument, and I’ve been at this long enough that I’m able to compartmentalize my own feelings, but I’m worn down, and I’m aware that I have compassion fatigue. When people complain about their COVID-19 symptoms and say things like ‘If I knew I would feel this horrible, I would have gotten the vaccine,’ I can’t help but feel that this was avoidable. It’s hard to talk to those people. I want to say ‘600,000 dead people weren’t enough to get vaccinated?’ ”

The people avoiding the vaccine: “There are the absolute deniers who will never get vaccinated and aren’t going to change their minds. Then there are the people who feel invincible, and then there are the folks who think that COVID-19 isn’t that bad, it’s just like the flu, it’s only old people dying and they’re not getting information from an appropriate source. It’s not the flu, it does kill you. Delta kills younger people, and it’s very easy to spread. Every one person who was infected with the original strain could infect two to three others. The Delta variant can infect 8-9, and measles, at 13, is the most contagious, so we need to keep reminding people about this.”

It’s not just about you: “Vaccination campaigns were never about the individual. We live together in a civilized society, and the vaccine is something you do for each other. People don’t understand the importance of breaking the chain of transmission and doing this to help each other and eradicate the spread. I just don’t understand what happened to us that we forgot this.”

A version of this article first appeared on WebMD.com.

The U.S. Food and Drug Administration has approved Pfizer’s TicoVac vaccine for the treatment of tick-borne encephalitis (TBE). The vaccine is approved outside of the United States, and more than 170 million doses have been administered since 1976. The World Health Organization recommends vaccination for everyone in areas where the annual incidence of clinical disease is highly endemic, defined as more than five cases per 100,000 population, which is primarily the Baltic countries of Europe but includes some regions of Central and East Asia.

GlaxoSmithKline’s Encepur is also approved outside the United States, as is a vaccine from China and two from Russia. The efficacy of all the vaccines is greater than 95%. Pfizer’s protection is 98.7% to 100.0% after the three-dose course. With the new approval, American travelers will be able to get immunized before their departure instead of waiting until they are overseas to start the series.

TicoVac can cause injection-site pain, headache, myalgia, and fever, as is typical with many vaccines.
 

Tick-borne encephalitis

TBE is caused by a flavivirus and is transmitted by the bite of an infected Ixodes scapularis, or deer tick. Like the Powassan virus, another flavivirus, infection can be transmitted in minutes through the tick’s saliva, so early removal of the tick might not prevent illness. This is different than Lyme disease, where vigilance and early removal of the tick can prevent transmission.

Reservoirs for the virus include mice, voles, and shrews. Large mammals (deer, sheep, cattle, goats) also serve to support tick multiplication. In addition to tick bites, ingestion of unpasteurized milk from infected mammals can transmit TBE.

TBE symptoms can range from none to severe encephalitis (brain inflammation). One-quarter of infected people develop encephalitis. Most recover fully, but one-third of those infected can develop lifelong damage and paralysis or cognitive deficits. Death is rare, except in those infected with the Russian strain.

The first phase of a TBE infection is typical of viral infections, with nonspecific fever, headache, nausea, and myalgia. The next phase involves an asymptomatic interval of about a week (range, 1 to 33 days), followed by symptoms of a central nervous system infection.

There is no treatment for TBE and no antivirals with proven benefit. However, a recent case report describes the successful treatment of TBE with favipiravir.

For now, if you are unvaccinated, prevention is the only viable option. If you plan to travel to an endemic region and anticipate participating in outdoor activities (such as hunting or hiking), wear permethrin-treated clothes, use an insecticide, and don’t eat or drink unpasteurized dairy products.

Judy Stone, MD, is an infectious disease specialist and author of Resilience: One Family’s Story of Hope and Triumph Over Evil and of Conducting Clinical Research, the essential guide to the topic. You can find her at drjudystone.com or on Twitter @drjudystone.

A version of this article first appeared on Medscape.com.

The U.S. Food and Drug Administration has approved Pfizer’s TicoVac vaccine for the treatment of tick-borne encephalitis (TBE). The vaccine is approved outside of the United States, and more than 170 million doses have been administered since 1976. The World Health Organization recommends vaccination for everyone in areas where the annual incidence of clinical disease is highly endemic, defined as more than five cases per 100,000 population, which is primarily the Baltic countries of Europe but includes some regions of Central and East Asia.

GlaxoSmithKline’s Encepur is also approved outside the United States, as is a vaccine from China and two from Russia. The efficacy of all the vaccines is greater than 95%. Pfizer’s protection is 98.7% to 100.0% after the three-dose course. With the new approval, American travelers will be able to get immunized before their departure instead of waiting until they are overseas to start the series.

TicoVac can cause injection-site pain, headache, myalgia, and fever, as is typical with many vaccines.
 

Tick-borne encephalitis

TBE is caused by a flavivirus and is transmitted by the bite of an infected Ixodes scapularis, or deer tick. Like the Powassan virus, another flavivirus, infection can be transmitted in minutes through the tick’s saliva, so early removal of the tick might not prevent illness. This is different than Lyme disease, where vigilance and early removal of the tick can prevent transmission.

Reservoirs for the virus include mice, voles, and shrews. Large mammals (deer, sheep, cattle, goats) also serve to support tick multiplication. In addition to tick bites, ingestion of unpasteurized milk from infected mammals can transmit TBE.

TBE symptoms can range from none to severe encephalitis (brain inflammation). One-quarter of infected people develop encephalitis. Most recover fully, but one-third of those infected can develop lifelong damage and paralysis or cognitive deficits. Death is rare, except in those infected with the Russian strain.

The first phase of a TBE infection is typical of viral infections, with nonspecific fever, headache, nausea, and myalgia. The next phase involves an asymptomatic interval of about a week (range, 1 to 33 days), followed by symptoms of a central nervous system infection.

There is no treatment for TBE and no antivirals with proven benefit. However, a recent case report describes the successful treatment of TBE with favipiravir.

For now, if you are unvaccinated, prevention is the only viable option. If you plan to travel to an endemic region and anticipate participating in outdoor activities (such as hunting or hiking), wear permethrin-treated clothes, use an insecticide, and don’t eat or drink unpasteurized dairy products.

Judy Stone, MD, is an infectious disease specialist and author of Resilience: One Family’s Story of Hope and Triumph Over Evil and of Conducting Clinical Research, the essential guide to the topic. You can find her at drjudystone.com or on Twitter @drjudystone.

A version of this article first appeared on Medscape.com.

The U.S. Food and Drug Administration has approved Pfizer’s TicoVac vaccine for the treatment of tick-borne encephalitis (TBE). The vaccine is approved outside of the United States, and more than 170 million doses have been administered since 1976. The World Health Organization recommends vaccination for everyone in areas where the annual incidence of clinical disease is highly endemic, defined as more than five cases per 100,000 population, which is primarily the Baltic countries of Europe but includes some regions of Central and East Asia.

GlaxoSmithKline’s Encepur is also approved outside the United States, as is a vaccine from China and two from Russia. The efficacy of all the vaccines is greater than 95%. Pfizer’s protection is 98.7% to 100.0% after the three-dose course. With the new approval, American travelers will be able to get immunized before their departure instead of waiting until they are overseas to start the series.

TicoVac can cause injection-site pain, headache, myalgia, and fever, as is typical with many vaccines.
 

Tick-borne encephalitis

TBE is caused by a flavivirus and is transmitted by the bite of an infected Ixodes scapularis, or deer tick. Like the Powassan virus, another flavivirus, infection can be transmitted in minutes through the tick’s saliva, so early removal of the tick might not prevent illness. This is different than Lyme disease, where vigilance and early removal of the tick can prevent transmission.

Reservoirs for the virus include mice, voles, and shrews. Large mammals (deer, sheep, cattle, goats) also serve to support tick multiplication. In addition to tick bites, ingestion of unpasteurized milk from infected mammals can transmit TBE.

TBE symptoms can range from none to severe encephalitis (brain inflammation). One-quarter of infected people develop encephalitis. Most recover fully, but one-third of those infected can develop lifelong damage and paralysis or cognitive deficits. Death is rare, except in those infected with the Russian strain.

The first phase of a TBE infection is typical of viral infections, with nonspecific fever, headache, nausea, and myalgia. The next phase involves an asymptomatic interval of about a week (range, 1 to 33 days), followed by symptoms of a central nervous system infection.

There is no treatment for TBE and no antivirals with proven benefit. However, a recent case report describes the successful treatment of TBE with favipiravir.

For now, if you are unvaccinated, prevention is the only viable option. If you plan to travel to an endemic region and anticipate participating in outdoor activities (such as hunting or hiking), wear permethrin-treated clothes, use an insecticide, and don’t eat or drink unpasteurized dairy products.

Judy Stone, MD, is an infectious disease specialist and author of Resilience: One Family’s Story of Hope and Triumph Over Evil and of Conducting Clinical Research, the essential guide to the topic. You can find her at drjudystone.com or on Twitter @drjudystone.

A version of this article first appeared on Medscape.com.

Weekly cases of COVID-19 in children topped 100,000 for the first time since early February, according to the American Academy of Pediatrics and the Children’s Hospital Association.

A 29% increase in reported cases over the previous week brought the count for Aug. 6-12 to over 121,000, making it the worst week for new infections in children since Jan. 29 to Feb. 4, the AAP and CHA said in their weekly COVD-19 report. The recent surge in child COVID has also brought a record high in hospitalizations and shortages of pediatric ICU beds in some areas.

The 121,000 new cases represent an increase of almost 1,400% since June 18-24, when the weekly tally was just 8,447 and at its lowest point in over a year, the AAP/CHA data show.

On the vaccination front in the last week (Aug. 10-16), vaccine initiation for 12- to 17-year-olds was fairly robust but still down slightly, compared with the previous week. Just over 402,000 children aged 12-15 years received a first vaccination, which was down slightly from 411,000 the week before but still higher than any of the 6 weeks from June 22 to Aug. 2, based on data from the Centers for Disease Control and Prevention. Vaccinations were down by a similar margin for 15- to-17-year-olds.

Over 10.9 million children aged 12-17 have had at least one dose of COVID-19 vaccine administered, of whom 8.1 million are fully vaccinated. Among those aged 12-15 years, 44.5% have gotten at least one dose and 31.8% are fully vaccinated, with corresponding figures of 53.9% and 42.5% for 16- and 17-year-olds, according to the CDC’s COVID Data Tracker.

The number of COVID-19 cases reported in children since the start of the pandemic is up to 4.4 million, which makes up 14.4% of all cases in the United States, the AAP and CHA said. Other cumulative figures through Aug. 12 include almost 18,000 hospitalizations – reported by 23 states and New York City – and 378 deaths – reported by 43 states, New York City, Puerto Rico, and Guam.

In the latest edition of their ongoing report, compiled using state data since the summer of 2020, the two groups noted that, “in the summer of 2021, some states have revised cases counts previously reported, begun reporting less frequently, or dropped metrics previously reported.” Among those states are Nebraska, which shut down its online COVID dashboard in late June, and Alabama, which stopped reporting cumulative cases and deaths after July 29.

rfranki@mdedge.com

Weekly cases of COVID-19 in children topped 100,000 for the first time since early February, according to the American Academy of Pediatrics and the Children’s Hospital Association.

A 29% increase in reported cases over the previous week brought the count for Aug. 6-12 to over 121,000, making it the worst week for new infections in children since Jan. 29 to Feb. 4, the AAP and CHA said in their weekly COVD-19 report. The recent surge in child COVID has also brought a record high in hospitalizations and shortages of pediatric ICU beds in some areas.

The 121,000 new cases represent an increase of almost 1,400% since June 18-24, when the weekly tally was just 8,447 and at its lowest point in over a year, the AAP/CHA data show.

On the vaccination front in the last week (Aug. 10-16), vaccine initiation for 12- to 17-year-olds was fairly robust but still down slightly, compared with the previous week. Just over 402,000 children aged 12-15 years received a first vaccination, which was down slightly from 411,000 the week before but still higher than any of the 6 weeks from June 22 to Aug. 2, based on data from the Centers for Disease Control and Prevention. Vaccinations were down by a similar margin for 15- to-17-year-olds.

Over 10.9 million children aged 12-17 have had at least one dose of COVID-19 vaccine administered, of whom 8.1 million are fully vaccinated. Among those aged 12-15 years, 44.5% have gotten at least one dose and 31.8% are fully vaccinated, with corresponding figures of 53.9% and 42.5% for 16- and 17-year-olds, according to the CDC’s COVID Data Tracker.

The number of COVID-19 cases reported in children since the start of the pandemic is up to 4.4 million, which makes up 14.4% of all cases in the United States, the AAP and CHA said. Other cumulative figures through Aug. 12 include almost 18,000 hospitalizations – reported by 23 states and New York City – and 378 deaths – reported by 43 states, New York City, Puerto Rico, and Guam.

In the latest edition of their ongoing report, compiled using state data since the summer of 2020, the two groups noted that, “in the summer of 2021, some states have revised cases counts previously reported, begun reporting less frequently, or dropped metrics previously reported.” Among those states are Nebraska, which shut down its online COVID dashboard in late June, and Alabama, which stopped reporting cumulative cases and deaths after July 29.

rfranki@mdedge.com

Weekly cases of COVID-19 in children topped 100,000 for the first time since early February, according to the American Academy of Pediatrics and the Children’s Hospital Association.

A 29% increase in reported cases over the previous week brought the count for Aug. 6-12 to over 121,000, making it the worst week for new infections in children since Jan. 29 to Feb. 4, the AAP and CHA said in their weekly COVD-19 report. The recent surge in child COVID has also brought a record high in hospitalizations and shortages of pediatric ICU beds in some areas.

The 121,000 new cases represent an increase of almost 1,400% since June 18-24, when the weekly tally was just 8,447 and at its lowest point in over a year, the AAP/CHA data show.

On the vaccination front in the last week (Aug. 10-16), vaccine initiation for 12- to 17-year-olds was fairly robust but still down slightly, compared with the previous week. Just over 402,000 children aged 12-15 years received a first vaccination, which was down slightly from 411,000 the week before but still higher than any of the 6 weeks from June 22 to Aug. 2, based on data from the Centers for Disease Control and Prevention. Vaccinations were down by a similar margin for 15- to-17-year-olds.

Over 10.9 million children aged 12-17 have had at least one dose of COVID-19 vaccine administered, of whom 8.1 million are fully vaccinated. Among those aged 12-15 years, 44.5% have gotten at least one dose and 31.8% are fully vaccinated, with corresponding figures of 53.9% and 42.5% for 16- and 17-year-olds, according to the CDC’s COVID Data Tracker.

The number of COVID-19 cases reported in children since the start of the pandemic is up to 4.4 million, which makes up 14.4% of all cases in the United States, the AAP and CHA said. Other cumulative figures through Aug. 12 include almost 18,000 hospitalizations – reported by 23 states and New York City – and 378 deaths – reported by 43 states, New York City, Puerto Rico, and Guam.

In the latest edition of their ongoing report, compiled using state data since the summer of 2020, the two groups noted that, “in the summer of 2021, some states have revised cases counts previously reported, begun reporting less frequently, or dropped metrics previously reported.” Among those states are Nebraska, which shut down its online COVID dashboard in late June, and Alabama, which stopped reporting cumulative cases and deaths after July 29.

rfranki@mdedge.com

Hospitals are reporting record numbers of COVID-19 patients in their 30s, largely because of the contagious Delta variant, according to The Wall Street Journal.

The rate of new hospitalizations for ages 30-39 reached 2.5 per 100,000 people last week, according to the latest CDC data, which is up from the previous peak of 2 per 100,000 people in January.

What’s more, new hospital admissions for patients in their 30s reached an average of 1,113 a day during the last week, which was up from 908 the week before.

“It means Delta is really bad,” James Lawler, MD, an infectious disease doctor and codirector of the Global Center for Health Security at the University of Nebraska Medical Center, told the newspaper.

People in the age group mostly avoided hospitalization throughout the pandemic because of their relatively good health and young age, the newspaper reported. But in recent weeks, those between ages 30 and 39 are contracting the coronavirus because of their active lifestyle – for many in their 30s, these are prime years for working, parenting, and socializing.

Hospitalizations are mostly among unvaccinated adults, according to the Wall Street Journal. Nationally, less than half of those ages 25-39 are fully vaccinated, compared with 61% of all adults, according to CDC data updated Sunday.

“It loves social mobility,” James Fiorica, MD, chief medical officer of Sarasota Memorial Health Care System in Florida, told the newspaper.

“An unvaccinated 30-year-old can be a perfect carrier,” he said.

On top of that, COVID-19 patients in their 30s are arriving at hospitals with more severe disease than in earlier waves, the Journal reported. At the University of Arkansas for Medical Sciences hospital, for instance, doctors are now monitoring younger patients daily with a scoring system for possible organ failure. That wasn’t necessary earlier in the pandemic for people in their 30s.

“This age group pretty much went unscathed,” Nikhil Meena, MD, director of the hospital’s Medical Intensive Care Unit, told the newspaper.

Now, he said, “they’re all out there doing their thing and getting infected and getting sick enough to be in this hospital.”

A version of this article first appeared on WebMD.com.

Hospitals are reporting record numbers of COVID-19 patients in their 30s, largely because of the contagious Delta variant, according to The Wall Street Journal.

The rate of new hospitalizations for ages 30-39 reached 2.5 per 100,000 people last week, according to the latest CDC data, which is up from the previous peak of 2 per 100,000 people in January.

What’s more, new hospital admissions for patients in their 30s reached an average of 1,113 a day during the last week, which was up from 908 the week before.

“It means Delta is really bad,” James Lawler, MD, an infectious disease doctor and codirector of the Global Center for Health Security at the University of Nebraska Medical Center, told the newspaper.

People in the age group mostly avoided hospitalization throughout the pandemic because of their relatively good health and young age, the newspaper reported. But in recent weeks, those between ages 30 and 39 are contracting the coronavirus because of their active lifestyle – for many in their 30s, these are prime years for working, parenting, and socializing.

Hospitalizations are mostly among unvaccinated adults, according to the Wall Street Journal. Nationally, less than half of those ages 25-39 are fully vaccinated, compared with 61% of all adults, according to CDC data updated Sunday.

“It loves social mobility,” James Fiorica, MD, chief medical officer of Sarasota Memorial Health Care System in Florida, told the newspaper.

“An unvaccinated 30-year-old can be a perfect carrier,” he said.

On top of that, COVID-19 patients in their 30s are arriving at hospitals with more severe disease than in earlier waves, the Journal reported. At the University of Arkansas for Medical Sciences hospital, for instance, doctors are now monitoring younger patients daily with a scoring system for possible organ failure. That wasn’t necessary earlier in the pandemic for people in their 30s.

“This age group pretty much went unscathed,” Nikhil Meena, MD, director of the hospital’s Medical Intensive Care Unit, told the newspaper.

Now, he said, “they’re all out there doing their thing and getting infected and getting sick enough to be in this hospital.”

A version of this article first appeared on WebMD.com.

Hospitals are reporting record numbers of COVID-19 patients in their 30s, largely because of the contagious Delta variant, according to The Wall Street Journal.

The rate of new hospitalizations for ages 30-39 reached 2.5 per 100,000 people last week, according to the latest CDC data, which is up from the previous peak of 2 per 100,000 people in January.

What’s more, new hospital admissions for patients in their 30s reached an average of 1,113 a day during the last week, which was up from 908 the week before.

“It means Delta is really bad,” James Lawler, MD, an infectious disease doctor and codirector of the Global Center for Health Security at the University of Nebraska Medical Center, told the newspaper.

People in the age group mostly avoided hospitalization throughout the pandemic because of their relatively good health and young age, the newspaper reported. But in recent weeks, those between ages 30 and 39 are contracting the coronavirus because of their active lifestyle – for many in their 30s, these are prime years for working, parenting, and socializing.

Hospitalizations are mostly among unvaccinated adults, according to the Wall Street Journal. Nationally, less than half of those ages 25-39 are fully vaccinated, compared with 61% of all adults, according to CDC data updated Sunday.

“It loves social mobility,” James Fiorica, MD, chief medical officer of Sarasota Memorial Health Care System in Florida, told the newspaper.

“An unvaccinated 30-year-old can be a perfect carrier,” he said.

On top of that, COVID-19 patients in their 30s are arriving at hospitals with more severe disease than in earlier waves, the Journal reported. At the University of Arkansas for Medical Sciences hospital, for instance, doctors are now monitoring younger patients daily with a scoring system for possible organ failure. That wasn’t necessary earlier in the pandemic for people in their 30s.

“This age group pretty much went unscathed,” Nikhil Meena, MD, director of the hospital’s Medical Intensive Care Unit, told the newspaper.

Now, he said, “they’re all out there doing their thing and getting infected and getting sick enough to be in this hospital.”

A version of this article first appeared on WebMD.com.

Over the course of the pandemic, COVID-19 has been a less serious illness for children than it has been for adults, and that continues to be true. But with the arrival of Delta, the risk for kids is rising, and that’s creating a perilous situation for hospitals across the United States that treat them. 

Roughly 1,800 kids were hospitalized with COVID-19 in the United States last week, a 500% increase in the rate of COVID-19 hospitalizations for children since early July, according to data from the Centers for Disease Control and Prevention.

Emerging data from a large study in Canada suggest that children who test positive for COVID-19 during the Delta wave may be more than twice as likely to be hospitalized as they were when previous variants were dominating transmission. The new data support what many pediatric infectious disease experts say they’ve been seeing: Younger kids with more serious symptoms.

That may sound concerning, but keep in mind that the overall risk of hospitalization for kids who have COVID-19 is still very low – about one child for every hundred who test positive for the virus will end up needing hospital care for their symptoms, according to current statistics maintained by the American Academy of Pediatrics.
 

‘This is different’

At Le Bonheur Children’s Hospital in Memphis, they saw Delta coming.

Since last year, every kid that comes to the emergency department at the hospital gets a screening test for COVID-19. 

In past waves, doctors usually found kids who were infected by accident – they tested positive after coming in for some other problem, a broken leg or appendicitis, said Nick Hysmith, MD, medical director of infection prevention at the hospital. But within the last few weeks, kids with fevers, sore throats, coughs, and runny noses started testing positive for COVID-19.

“We have seen our positive numbers go from, you know, close to about 8%-10% jump up to 20%, and then in recent weeks, we can get as high as 26% or 30%,” Dr. Hysmith said. “Then we started seeing kids sick enough to be admitted.”

“Over the last week, we’ve really seen an increase,” he said. As of August 16, the hospital had 24 children with COVID-19 admitted. Seven of the children were in the PICU, and two were on ventilators.

Arkansas Children’s Hospital had 23 young COVID-19 patients, 10 in intensive care, and five on ventilators, as of Friday, according to the Washington Post. At Children’s of Mississippi, the only hospital for kids in that state, 22 youth were hospitalized as of Monday, with three in intensive care as of August 16, according to the hospital. The nonprofit relief organization Samaritan’s Purse is setting up a second field hospital in the basement of Children’s to expand the hospital’s capacity.

“This is different,” Dr. Hysmith said. “What we’re seeing now is previously healthy kids coming in with symptomatic infection.”

This increased virulence is happening at a bad time. Schools around the United States are reopening for in-person classes, some for the first time in more than a year. Eight states have blocked districts from requiring masks, while many more have made them optional.

Children under 12 still have no access to a vaccine, so they are facing increased exposure to a germ that’s become more dangerous with little protection, especially in schools that have eschewed masks.
 

More than just COVID-19

Then there are the latent effects of the virus to contend with.

“We’re not only seeing more children now with acute SARS-CoV-2 in the hospital, we’re starting also to see an uptick of MISC – or Multisystem Inflammatory Syndrome in Children,” said Charlotte Hobbs, MD, a pediatric infectious disease specialist at Mississippi Children’s Hospital. “We are just beginning to [see] those cases, and we anticipate that’s going to get worse.”

Adding to COVID-19’s misery, another virus is also capitalizing on this increased mixing of kids back into the community. Respiratory syncytial virus (RSV) hospitalizes about 58,000 children under age 5 in the United States each year. The typical RSV season starts in the fall and peaks in February, along with influenza. This year, the RSV season is early, and it is ferocious.

The combination of the two infections is hitting children’s hospitals hard, and it’s layered on top of the indirect effects of the pandemic, such as the increased population of kids and teens who need mental health care in the wake of the crisis.

“It’s all these things happening at the same time,” said Mark Wietecha, CEO of the Children’s Hospital Association. “To have our hospitals this crowded in August is unusual.

And children’s hospitals are grappling with the same workforce shortages as hospitals that treat adults, while their pool of potential staff is much smaller.

“We can’t easily recruit physicians and nurses from adult hospitals in any practical way to staff a kids’ hospital,” Mr. Wietecha said.

Although pediatric doctors and nurses were trained to care for adults before they specialized, clinicians who primarily care for adults typically haven’t been taught how to care for kids.

Clinicians have fewer tools to fight COVID-19 infections in children than are available for adults. 

“There have been many studies in terms of therapies and treatments for acute SARS-CoV-2 infection in adults. We have less data and information in children, and on top of that, some of these treatments aren’t even available under an EUA [emergency use authorization] to children: For example, the monoclonal antibodies,” Dr. Hobbs said. 

Antibody treatments are being widely deployed to ease the pressure on hospitals that treat adults. But these therapies aren’t available for kids.

That means children’s hospitals could quickly become overwhelmed, especially in areas where community transmission is high, vaccination rates are low, and parents are screaming about masks.

“So we really have this constellation of events that really doesn’t favor children under the age of 12,” Dr. Hobbs said.

“Universal masking shouldn’t be a debate, because it’s the one thing, with adult vaccination, that can be done to protect this vulnerable population,” she said.  “This isn’t a political issue. It’s a public health issue. Period.”

A version of this article first appeared on Medscape.com.

Over the course of the pandemic, COVID-19 has been a less serious illness for children than it has been for adults, and that continues to be true. But with the arrival of Delta, the risk for kids is rising, and that’s creating a perilous situation for hospitals across the United States that treat them. 

Roughly 1,800 kids were hospitalized with COVID-19 in the United States last week, a 500% increase in the rate of COVID-19 hospitalizations for children since early July, according to data from the Centers for Disease Control and Prevention.

Emerging data from a large study in Canada suggest that children who test positive for COVID-19 during the Delta wave may be more than twice as likely to be hospitalized as they were when previous variants were dominating transmission. The new data support what many pediatric infectious disease experts say they’ve been seeing: Younger kids with more serious symptoms.

That may sound concerning, but keep in mind that the overall risk of hospitalization for kids who have COVID-19 is still very low – about one child for every hundred who test positive for the virus will end up needing hospital care for their symptoms, according to current statistics maintained by the American Academy of Pediatrics.
 

‘This is different’

At Le Bonheur Children’s Hospital in Memphis, they saw Delta coming.

Since last year, every kid that comes to the emergency department at the hospital gets a screening test for COVID-19. 

In past waves, doctors usually found kids who were infected by accident – they tested positive after coming in for some other problem, a broken leg or appendicitis, said Nick Hysmith, MD, medical director of infection prevention at the hospital. But within the last few weeks, kids with fevers, sore throats, coughs, and runny noses started testing positive for COVID-19.

“We have seen our positive numbers go from, you know, close to about 8%-10% jump up to 20%, and then in recent weeks, we can get as high as 26% or 30%,” Dr. Hysmith said. “Then we started seeing kids sick enough to be admitted.”

“Over the last week, we’ve really seen an increase,” he said. As of August 16, the hospital had 24 children with COVID-19 admitted. Seven of the children were in the PICU, and two were on ventilators.

Arkansas Children’s Hospital had 23 young COVID-19 patients, 10 in intensive care, and five on ventilators, as of Friday, according to the Washington Post. At Children’s of Mississippi, the only hospital for kids in that state, 22 youth were hospitalized as of Monday, with three in intensive care as of August 16, according to the hospital. The nonprofit relief organization Samaritan’s Purse is setting up a second field hospital in the basement of Children’s to expand the hospital’s capacity.

“This is different,” Dr. Hysmith said. “What we’re seeing now is previously healthy kids coming in with symptomatic infection.”

This increased virulence is happening at a bad time. Schools around the United States are reopening for in-person classes, some for the first time in more than a year. Eight states have blocked districts from requiring masks, while many more have made them optional.

Children under 12 still have no access to a vaccine, so they are facing increased exposure to a germ that’s become more dangerous with little protection, especially in schools that have eschewed masks.
 

More than just COVID-19

Then there are the latent effects of the virus to contend with.

“We’re not only seeing more children now with acute SARS-CoV-2 in the hospital, we’re starting also to see an uptick of MISC – or Multisystem Inflammatory Syndrome in Children,” said Charlotte Hobbs, MD, a pediatric infectious disease specialist at Mississippi Children’s Hospital. “We are just beginning to [see] those cases, and we anticipate that’s going to get worse.”

Adding to COVID-19’s misery, another virus is also capitalizing on this increased mixing of kids back into the community. Respiratory syncytial virus (RSV) hospitalizes about 58,000 children under age 5 in the United States each year. The typical RSV season starts in the fall and peaks in February, along with influenza. This year, the RSV season is early, and it is ferocious.

The combination of the two infections is hitting children’s hospitals hard, and it’s layered on top of the indirect effects of the pandemic, such as the increased population of kids and teens who need mental health care in the wake of the crisis.

“It’s all these things happening at the same time,” said Mark Wietecha, CEO of the Children’s Hospital Association. “To have our hospitals this crowded in August is unusual.

And children’s hospitals are grappling with the same workforce shortages as hospitals that treat adults, while their pool of potential staff is much smaller.

“We can’t easily recruit physicians and nurses from adult hospitals in any practical way to staff a kids’ hospital,” Mr. Wietecha said.

Although pediatric doctors and nurses were trained to care for adults before they specialized, clinicians who primarily care for adults typically haven’t been taught how to care for kids.

Clinicians have fewer tools to fight COVID-19 infections in children than are available for adults. 

“There have been many studies in terms of therapies and treatments for acute SARS-CoV-2 infection in adults. We have less data and information in children, and on top of that, some of these treatments aren’t even available under an EUA [emergency use authorization] to children: For example, the monoclonal antibodies,” Dr. Hobbs said. 

Antibody treatments are being widely deployed to ease the pressure on hospitals that treat adults. But these therapies aren’t available for kids.

That means children’s hospitals could quickly become overwhelmed, especially in areas where community transmission is high, vaccination rates are low, and parents are screaming about masks.

“So we really have this constellation of events that really doesn’t favor children under the age of 12,” Dr. Hobbs said.

“Universal masking shouldn’t be a debate, because it’s the one thing, with adult vaccination, that can be done to protect this vulnerable population,” she said.  “This isn’t a political issue. It’s a public health issue. Period.”

A version of this article first appeared on Medscape.com.

Over the course of the pandemic, COVID-19 has been a less serious illness for children than it has been for adults, and that continues to be true. But with the arrival of Delta, the risk for kids is rising, and that’s creating a perilous situation for hospitals across the United States that treat them. 

Roughly 1,800 kids were hospitalized with COVID-19 in the United States last week, a 500% increase in the rate of COVID-19 hospitalizations for children since early July, according to data from the Centers for Disease Control and Prevention.

Emerging data from a large study in Canada suggest that children who test positive for COVID-19 during the Delta wave may be more than twice as likely to be hospitalized as they were when previous variants were dominating transmission. The new data support what many pediatric infectious disease experts say they’ve been seeing: Younger kids with more serious symptoms.

That may sound concerning, but keep in mind that the overall risk of hospitalization for kids who have COVID-19 is still very low – about one child for every hundred who test positive for the virus will end up needing hospital care for their symptoms, according to current statistics maintained by the American Academy of Pediatrics.
 

‘This is different’

At Le Bonheur Children’s Hospital in Memphis, they saw Delta coming.

Since last year, every kid that comes to the emergency department at the hospital gets a screening test for COVID-19. 

In past waves, doctors usually found kids who were infected by accident – they tested positive after coming in for some other problem, a broken leg or appendicitis, said Nick Hysmith, MD, medical director of infection prevention at the hospital. But within the last few weeks, kids with fevers, sore throats, coughs, and runny noses started testing positive for COVID-19.

“We have seen our positive numbers go from, you know, close to about 8%-10% jump up to 20%, and then in recent weeks, we can get as high as 26% or 30%,” Dr. Hysmith said. “Then we started seeing kids sick enough to be admitted.”

“Over the last week, we’ve really seen an increase,” he said. As of August 16, the hospital had 24 children with COVID-19 admitted. Seven of the children were in the PICU, and two were on ventilators.

Arkansas Children’s Hospital had 23 young COVID-19 patients, 10 in intensive care, and five on ventilators, as of Friday, according to the Washington Post. At Children’s of Mississippi, the only hospital for kids in that state, 22 youth were hospitalized as of Monday, with three in intensive care as of August 16, according to the hospital. The nonprofit relief organization Samaritan’s Purse is setting up a second field hospital in the basement of Children’s to expand the hospital’s capacity.

“This is different,” Dr. Hysmith said. “What we’re seeing now is previously healthy kids coming in with symptomatic infection.”

This increased virulence is happening at a bad time. Schools around the United States are reopening for in-person classes, some for the first time in more than a year. Eight states have blocked districts from requiring masks, while many more have made them optional.

Children under 12 still have no access to a vaccine, so they are facing increased exposure to a germ that’s become more dangerous with little protection, especially in schools that have eschewed masks.
 

More than just COVID-19

Then there are the latent effects of the virus to contend with.

“We’re not only seeing more children now with acute SARS-CoV-2 in the hospital, we’re starting also to see an uptick of MISC – or Multisystem Inflammatory Syndrome in Children,” said Charlotte Hobbs, MD, a pediatric infectious disease specialist at Mississippi Children’s Hospital. “We are just beginning to [see] those cases, and we anticipate that’s going to get worse.”

Adding to COVID-19’s misery, another virus is also capitalizing on this increased mixing of kids back into the community. Respiratory syncytial virus (RSV) hospitalizes about 58,000 children under age 5 in the United States each year. The typical RSV season starts in the fall and peaks in February, along with influenza. This year, the RSV season is early, and it is ferocious.

The combination of the two infections is hitting children’s hospitals hard, and it’s layered on top of the indirect effects of the pandemic, such as the increased population of kids and teens who need mental health care in the wake of the crisis.

“It’s all these things happening at the same time,” said Mark Wietecha, CEO of the Children’s Hospital Association. “To have our hospitals this crowded in August is unusual.

And children’s hospitals are grappling with the same workforce shortages as hospitals that treat adults, while their pool of potential staff is much smaller.

“We can’t easily recruit physicians and nurses from adult hospitals in any practical way to staff a kids’ hospital,” Mr. Wietecha said.

Although pediatric doctors and nurses were trained to care for adults before they specialized, clinicians who primarily care for adults typically haven’t been taught how to care for kids.

Clinicians have fewer tools to fight COVID-19 infections in children than are available for adults. 

“There have been many studies in terms of therapies and treatments for acute SARS-CoV-2 infection in adults. We have less data and information in children, and on top of that, some of these treatments aren’t even available under an EUA [emergency use authorization] to children: For example, the monoclonal antibodies,” Dr. Hobbs said. 

Antibody treatments are being widely deployed to ease the pressure on hospitals that treat adults. But these therapies aren’t available for kids.

That means children’s hospitals could quickly become overwhelmed, especially in areas where community transmission is high, vaccination rates are low, and parents are screaming about masks.

“So we really have this constellation of events that really doesn’t favor children under the age of 12,” Dr. Hobbs said.

“Universal masking shouldn’t be a debate, because it’s the one thing, with adult vaccination, that can be done to protect this vulnerable population,” she said.  “This isn’t a political issue. It’s a public health issue. Period.”

A version of this article first appeared on Medscape.com.

Young children are more likely than are their older siblings to transmit SARS-CoV-2 in their households, according to an analysis of public health records in Ontario, Canada – a finding that upends the common belief that children play a minimal role in COVID-19 spread.

The study by researchers from Public Health Ontario, published online in JAMA Pediatrics, found that teenagers (14- to 17-year-olds) were more likely than were their younger siblings to bring the virus into the household, while infants and toddlers (up to age 3) were about 43% more likely than were the older teens to spread it to others in the home.

Children or teens were the source of SARS-CoV-2 in about 1 in 13 Ontario households between June and December 2020, the study shows. The researchers analyzed health records from 6,280 households with a pediatric COVID-19 case and a subset of 1,717 households in which a child up to age 17 was the source of transmission in a household.

When analyzing the data, the researchers controlled for gender differences, month of disease onset, testing delay, and mean family size.

The role of young children in transmission seemed logical to some experts who have been tracking the evolution of the pandemic. “I think what was more surprising was how long the narrative persisted that children weren’t transmitting SARS-CoV-2,” said Samuel Scarpino, PhD, managing director of pathogen surveillance at the Rockefeller Foundation.

Meanwhile, less mask-wearing, the return to school and activities, and the onslaught of the Delta variant have changed the dynamics of spread, said Andrew Pavia, MD, chief of the division of pediatric infectious diseases at the University of Utah.

“Adolescents and high-school-aged kids have had much, much higher rates of infection in the past,” he said. “Now when we look at the rates of school-aged kids, they are the same as high-school-aged kids, and we’re seeing more and more in the preschool age groups.”
 

Cases may be underestimated

If anything, the study may underestimate the role young children play in spreading COVID-19 in families, since it included only symptomatic cases as the initial source and young children are more likely to be asymptomatic, Dr. Pavia said.

The Delta variant heightens the concern; it is more than twice as infectious as previous strains and has spurred a rise in pediatric cases, including some coinfection with other circulating respiratory diseases, such as respiratory syncytial virus (RSV).

The Ontario study covers a period before vaccination and the spread of the Delta variant. “As the number of pediatric cases increases worldwide, the role of children in household transmission will continue to grow,” the authors concluded.

Following recommended respiratory hygiene is clearly more difficult with very young children. For example, parents, caregivers, and older siblings aren’t going to stay 6 feet away from a sick baby or toddler, Susan Coffin, MD, MPH, a pediatric infectious disease physician, and David Rubin, MD, a pediatrician and director of PolicyLab at Children’s Hospital of Philadelphia, noted in an accompanying commentary.

“Cuddling and touching are part and parcel of taking care of a sick young child, and that will obviously come with an increased risk of transmission to parents as well as to older siblings who may be helping to care for their sick brother or sister,” they wrote.

While parents may wash their hands more frequently when caring for a sick child, they aren’t likely to wear a mask, said William Schaffner, MD, an infectious disease specialist at Vanderbilt University, Nashville, Tenn.

“I imagine some moms even take a sick child into bed with them,” he said. “It’s probably just the extensive contact one has with a sick, very small child that augments their capacity to transmit this infection.”
 

What can be done

What can be done, then, to reduce the household spread of COVID-19? “The obvious solution to protect a household with a sick young infant or toddler is to make sure that all eligible members of the household are vaccinated,” Dr. Coffin and Dr. Rubin stated in their commentary.

The American Academy of Pediatrics recently wrote to Janet Woodcock, MD, acting commissioner of the Food and Drug Administration, asking for the agency to authorize use of SARS-CoV-2 vaccines for children under age 12 “as soon as possible,” noting that “the Delta variant has created a new and pressing risk to children and adolescents across this country, as it has also done for unvaccinated adults.”

The FDA reportedly asked vaccine makers Pfizer and Moderna to expand the clinical trials of children, which may delay authorization for younger age groups. Pfizer has said it plans to submit a request for emergency use authorization of its vaccine for 5- to 11-year-olds in September or October.

As with adult vaccination, hesitancy is likely to be a barrier. Less than half of parents said they are very or somewhat likely to have their children get a COVID-19 vaccine, according to a national survey conducted by researchers at the University of California, Los Angeles.

The Ontario study provides valuable evidence to support taking steps to protect children from transmission in schools, including mask requirements, frequent testing, and improved ventilation, said Dr. Scarpino.

“We’re not going to be able to control COVID without vaccinating younger individuals,” he said.

Dr. Pavia has consulted for GlaxoSmithKline on non–COVID-19–related issues. Sarah Buchan, PhD, study author and scientist at Public Health Ontario, reported grants from the Canadian Institutes of Health Research for research on influenza, RSV, and COVID-19, and grants from the Canadian Immunity Task Force for COVID-19 outside the submitted work. Dr. Coffin reported grants as a Centers for Disease Control and Prevention coinvestigator at a Vaccine and Treatment Evaluation Unit site conducting COVID-19 vaccine trials in children. Dr. Scarpino holds unexercised options in ILiAD Biotechnologies, which is focused on the prevention and treatment of pertussis. Dr. Schaffner is a consultant for VBI Vaccines.

A version of this article first appeared on Medscape.com.

Young children are more likely than are their older siblings to transmit SARS-CoV-2 in their households, according to an analysis of public health records in Ontario, Canada – a finding that upends the common belief that children play a minimal role in COVID-19 spread.

The study by researchers from Public Health Ontario, published online in JAMA Pediatrics, found that teenagers (14- to 17-year-olds) were more likely than were their younger siblings to bring the virus into the household, while infants and toddlers (up to age 3) were about 43% more likely than were the older teens to spread it to others in the home.

Children or teens were the source of SARS-CoV-2 in about 1 in 13 Ontario households between June and December 2020, the study shows. The researchers analyzed health records from 6,280 households with a pediatric COVID-19 case and a subset of 1,717 households in which a child up to age 17 was the source of transmission in a household.

When analyzing the data, the researchers controlled for gender differences, month of disease onset, testing delay, and mean family size.

The role of young children in transmission seemed logical to some experts who have been tracking the evolution of the pandemic. “I think what was more surprising was how long the narrative persisted that children weren’t transmitting SARS-CoV-2,” said Samuel Scarpino, PhD, managing director of pathogen surveillance at the Rockefeller Foundation.

Meanwhile, less mask-wearing, the return to school and activities, and the onslaught of the Delta variant have changed the dynamics of spread, said Andrew Pavia, MD, chief of the division of pediatric infectious diseases at the University of Utah.

“Adolescents and high-school-aged kids have had much, much higher rates of infection in the past,” he said. “Now when we look at the rates of school-aged kids, they are the same as high-school-aged kids, and we’re seeing more and more in the preschool age groups.”
 

Cases may be underestimated

If anything, the study may underestimate the role young children play in spreading COVID-19 in families, since it included only symptomatic cases as the initial source and young children are more likely to be asymptomatic, Dr. Pavia said.

The Delta variant heightens the concern; it is more than twice as infectious as previous strains and has spurred a rise in pediatric cases, including some coinfection with other circulating respiratory diseases, such as respiratory syncytial virus (RSV).

The Ontario study covers a period before vaccination and the spread of the Delta variant. “As the number of pediatric cases increases worldwide, the role of children in household transmission will continue to grow,” the authors concluded.

Following recommended respiratory hygiene is clearly more difficult with very young children. For example, parents, caregivers, and older siblings aren’t going to stay 6 feet away from a sick baby or toddler, Susan Coffin, MD, MPH, a pediatric infectious disease physician, and David Rubin, MD, a pediatrician and director of PolicyLab at Children’s Hospital of Philadelphia, noted in an accompanying commentary.

“Cuddling and touching are part and parcel of taking care of a sick young child, and that will obviously come with an increased risk of transmission to parents as well as to older siblings who may be helping to care for their sick brother or sister,” they wrote.

While parents may wash their hands more frequently when caring for a sick child, they aren’t likely to wear a mask, said William Schaffner, MD, an infectious disease specialist at Vanderbilt University, Nashville, Tenn.

“I imagine some moms even take a sick child into bed with them,” he said. “It’s probably just the extensive contact one has with a sick, very small child that augments their capacity to transmit this infection.”
 

What can be done

What can be done, then, to reduce the household spread of COVID-19? “The obvious solution to protect a household with a sick young infant or toddler is to make sure that all eligible members of the household are vaccinated,” Dr. Coffin and Dr. Rubin stated in their commentary.

The American Academy of Pediatrics recently wrote to Janet Woodcock, MD, acting commissioner of the Food and Drug Administration, asking for the agency to authorize use of SARS-CoV-2 vaccines for children under age 12 “as soon as possible,” noting that “the Delta variant has created a new and pressing risk to children and adolescents across this country, as it has also done for unvaccinated adults.”

The FDA reportedly asked vaccine makers Pfizer and Moderna to expand the clinical trials of children, which may delay authorization for younger age groups. Pfizer has said it plans to submit a request for emergency use authorization of its vaccine for 5- to 11-year-olds in September or October.

As with adult vaccination, hesitancy is likely to be a barrier. Less than half of parents said they are very or somewhat likely to have their children get a COVID-19 vaccine, according to a national survey conducted by researchers at the University of California, Los Angeles.

The Ontario study provides valuable evidence to support taking steps to protect children from transmission in schools, including mask requirements, frequent testing, and improved ventilation, said Dr. Scarpino.

“We’re not going to be able to control COVID without vaccinating younger individuals,” he said.

Dr. Pavia has consulted for GlaxoSmithKline on non–COVID-19–related issues. Sarah Buchan, PhD, study author and scientist at Public Health Ontario, reported grants from the Canadian Institutes of Health Research for research on influenza, RSV, and COVID-19, and grants from the Canadian Immunity Task Force for COVID-19 outside the submitted work. Dr. Coffin reported grants as a Centers for Disease Control and Prevention coinvestigator at a Vaccine and Treatment Evaluation Unit site conducting COVID-19 vaccine trials in children. Dr. Scarpino holds unexercised options in ILiAD Biotechnologies, which is focused on the prevention and treatment of pertussis. Dr. Schaffner is a consultant for VBI Vaccines.

A version of this article first appeared on Medscape.com.

Young children are more likely than are their older siblings to transmit SARS-CoV-2 in their households, according to an analysis of public health records in Ontario, Canada – a finding that upends the common belief that children play a minimal role in COVID-19 spread.

The study by researchers from Public Health Ontario, published online in JAMA Pediatrics, found that teenagers (14- to 17-year-olds) were more likely than were their younger siblings to bring the virus into the household, while infants and toddlers (up to age 3) were about 43% more likely than were the older teens to spread it to others in the home.

Children or teens were the source of SARS-CoV-2 in about 1 in 13 Ontario households between June and December 2020, the study shows. The researchers analyzed health records from 6,280 households with a pediatric COVID-19 case and a subset of 1,717 households in which a child up to age 17 was the source of transmission in a household.

When analyzing the data, the researchers controlled for gender differences, month of disease onset, testing delay, and mean family size.

The role of young children in transmission seemed logical to some experts who have been tracking the evolution of the pandemic. “I think what was more surprising was how long the narrative persisted that children weren’t transmitting SARS-CoV-2,” said Samuel Scarpino, PhD, managing director of pathogen surveillance at the Rockefeller Foundation.

Meanwhile, less mask-wearing, the return to school and activities, and the onslaught of the Delta variant have changed the dynamics of spread, said Andrew Pavia, MD, chief of the division of pediatric infectious diseases at the University of Utah.

“Adolescents and high-school-aged kids have had much, much higher rates of infection in the past,” he said. “Now when we look at the rates of school-aged kids, they are the same as high-school-aged kids, and we’re seeing more and more in the preschool age groups.”
 

Cases may be underestimated

If anything, the study may underestimate the role young children play in spreading COVID-19 in families, since it included only symptomatic cases as the initial source and young children are more likely to be asymptomatic, Dr. Pavia said.

The Delta variant heightens the concern; it is more than twice as infectious as previous strains and has spurred a rise in pediatric cases, including some coinfection with other circulating respiratory diseases, such as respiratory syncytial virus (RSV).

The Ontario study covers a period before vaccination and the spread of the Delta variant. “As the number of pediatric cases increases worldwide, the role of children in household transmission will continue to grow,” the authors concluded.

Following recommended respiratory hygiene is clearly more difficult with very young children. For example, parents, caregivers, and older siblings aren’t going to stay 6 feet away from a sick baby or toddler, Susan Coffin, MD, MPH, a pediatric infectious disease physician, and David Rubin, MD, a pediatrician and director of PolicyLab at Children’s Hospital of Philadelphia, noted in an accompanying commentary.

“Cuddling and touching are part and parcel of taking care of a sick young child, and that will obviously come with an increased risk of transmission to parents as well as to older siblings who may be helping to care for their sick brother or sister,” they wrote.

While parents may wash their hands more frequently when caring for a sick child, they aren’t likely to wear a mask, said William Schaffner, MD, an infectious disease specialist at Vanderbilt University, Nashville, Tenn.

“I imagine some moms even take a sick child into bed with them,” he said. “It’s probably just the extensive contact one has with a sick, very small child that augments their capacity to transmit this infection.”
 

What can be done

What can be done, then, to reduce the household spread of COVID-19? “The obvious solution to protect a household with a sick young infant or toddler is to make sure that all eligible members of the household are vaccinated,” Dr. Coffin and Dr. Rubin stated in their commentary.

The American Academy of Pediatrics recently wrote to Janet Woodcock, MD, acting commissioner of the Food and Drug Administration, asking for the agency to authorize use of SARS-CoV-2 vaccines for children under age 12 “as soon as possible,” noting that “the Delta variant has created a new and pressing risk to children and adolescents across this country, as it has also done for unvaccinated adults.”

The FDA reportedly asked vaccine makers Pfizer and Moderna to expand the clinical trials of children, which may delay authorization for younger age groups. Pfizer has said it plans to submit a request for emergency use authorization of its vaccine for 5- to 11-year-olds in September or October.

As with adult vaccination, hesitancy is likely to be a barrier. Less than half of parents said they are very or somewhat likely to have their children get a COVID-19 vaccine, according to a national survey conducted by researchers at the University of California, Los Angeles.

The Ontario study provides valuable evidence to support taking steps to protect children from transmission in schools, including mask requirements, frequent testing, and improved ventilation, said Dr. Scarpino.

“We’re not going to be able to control COVID without vaccinating younger individuals,” he said.

Dr. Pavia has consulted for GlaxoSmithKline on non–COVID-19–related issues. Sarah Buchan, PhD, study author and scientist at Public Health Ontario, reported grants from the Canadian Institutes of Health Research for research on influenza, RSV, and COVID-19, and grants from the Canadian Immunity Task Force for COVID-19 outside the submitted work. Dr. Coffin reported grants as a Centers for Disease Control and Prevention coinvestigator at a Vaccine and Treatment Evaluation Unit site conducting COVID-19 vaccine trials in children. Dr. Scarpino holds unexercised options in ILiAD Biotechnologies, which is focused on the prevention and treatment of pertussis. Dr. Schaffner is a consultant for VBI Vaccines.

A version of this article first appeared on Medscape.com.

The number of children hospitalized with COVID-19 in the U.S. hit a record high on Aug. 14, with more than 1,900 in hospitals.

Hospitals across the South are running out of beds as the contagious Delta variant spreads, mostly among unvaccinated people. Children make up about 2.4% of the country’s COVID-19 hospitalizations, and those under 12 are particularly vulnerable since they’re not eligible to receive a vaccine.

“This is not last year’s COVID,” Sally Goza, MD, former president of the American Academy of Pediatrics, told CNN on Aug. 14.

“This one is worse, and our children are the ones that are going to be affected by it the most,” she said.

The number of newly hospitalized COVID-19 patients for ages 18-49 also hit record highs during the week of Aug. 9. A fifth of the nation’s hospitalizations are in Florida, where the number of COVID-19 patients hit a record high of 16,100 on Aug. 14. More than 90% of the state’s intensive care unit beds are filled.

More than 90% of the ICU beds in Texas are full as well. On Aug. 13, there were no pediatric ICU beds available in Dallas or the 19 surrounding counties, which means that young patients would be transported father away for care – even Oklahoma City.

“That means if your child’s in a car wreck, if your child has a congenital heart defect or something and needs an ICU bed, or more likely, if they have COVID and need an ICU bed, we don’t have one,” Clay Jenkins, a Dallas County judge, said on Aug. 13.

“Your child will wait for another child to die,” he said.

As children return to classes, educators are talking about the possibility of vaccine mandates. The National Education Association announced its support of mandatory vaccination for its members.

“Our students under 12 can’t get vaccinated,” Becky Pringle, president of the association, told CNN.

“It’s our responsibility to keep them safe,” she said. “Keeping them safe means that everyone who can be vaccinated should be vaccinated.”

The U.S. now has an average of about 129,000 new COVID-19 cases per day, Reuters reported, which has doubled in about 2 weeks. The number of hospitalized patients is at a 6-month high, and about 600 people are dying each day.

Arkansas, Florida, Louisiana, Mississippi, and Oregon have reported record numbers of COVID-19 hospitalizations.

In addition, eight states make up half of all the COVID-19 hospitalizations in the U.S. but only 24% of the nation’s population – Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Nevada, and Texas. These states have vaccination rates lower than the national average, and their COVID-19 patients account for at least 15% of their overall hospitalizations.

To address the surge in hospitalizations, Oregon Gov. Kate Brown has ordered the deployment of up to 1,500 Oregon National Guard members to help health care workers.

“I know this is not the summer many of us envisioned,” Gov. Brown said Aug. 13. “The harsh and frustrating reality is that the Delta variant has changed everything. Delta is highly contagious, and we must take action now.”

A version of this article first appeared on WebMD.com.

The number of children hospitalized with COVID-19 in the U.S. hit a record high on Aug. 14, with more than 1,900 in hospitals.

Hospitals across the South are running out of beds as the contagious Delta variant spreads, mostly among unvaccinated people. Children make up about 2.4% of the country’s COVID-19 hospitalizations, and those under 12 are particularly vulnerable since they’re not eligible to receive a vaccine.

“This is not last year’s COVID,” Sally Goza, MD, former president of the American Academy of Pediatrics, told CNN on Aug. 14.

“This one is worse, and our children are the ones that are going to be affected by it the most,” she said.

The number of newly hospitalized COVID-19 patients for ages 18-49 also hit record highs during the week of Aug. 9. A fifth of the nation’s hospitalizations are in Florida, where the number of COVID-19 patients hit a record high of 16,100 on Aug. 14. More than 90% of the state’s intensive care unit beds are filled.

More than 90% of the ICU beds in Texas are full as well. On Aug. 13, there were no pediatric ICU beds available in Dallas or the 19 surrounding counties, which means that young patients would be transported father away for care – even Oklahoma City.

“That means if your child’s in a car wreck, if your child has a congenital heart defect or something and needs an ICU bed, or more likely, if they have COVID and need an ICU bed, we don’t have one,” Clay Jenkins, a Dallas County judge, said on Aug. 13.

“Your child will wait for another child to die,” he said.

As children return to classes, educators are talking about the possibility of vaccine mandates. The National Education Association announced its support of mandatory vaccination for its members.

“Our students under 12 can’t get vaccinated,” Becky Pringle, president of the association, told CNN.

“It’s our responsibility to keep them safe,” she said. “Keeping them safe means that everyone who can be vaccinated should be vaccinated.”

The U.S. now has an average of about 129,000 new COVID-19 cases per day, Reuters reported, which has doubled in about 2 weeks. The number of hospitalized patients is at a 6-month high, and about 600 people are dying each day.

Arkansas, Florida, Louisiana, Mississippi, and Oregon have reported record numbers of COVID-19 hospitalizations.

In addition, eight states make up half of all the COVID-19 hospitalizations in the U.S. but only 24% of the nation’s population – Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Nevada, and Texas. These states have vaccination rates lower than the national average, and their COVID-19 patients account for at least 15% of their overall hospitalizations.

To address the surge in hospitalizations, Oregon Gov. Kate Brown has ordered the deployment of up to 1,500 Oregon National Guard members to help health care workers.

“I know this is not the summer many of us envisioned,” Gov. Brown said Aug. 13. “The harsh and frustrating reality is that the Delta variant has changed everything. Delta is highly contagious, and we must take action now.”

A version of this article first appeared on WebMD.com.

The number of children hospitalized with COVID-19 in the U.S. hit a record high on Aug. 14, with more than 1,900 in hospitals.

Hospitals across the South are running out of beds as the contagious Delta variant spreads, mostly among unvaccinated people. Children make up about 2.4% of the country’s COVID-19 hospitalizations, and those under 12 are particularly vulnerable since they’re not eligible to receive a vaccine.

“This is not last year’s COVID,” Sally Goza, MD, former president of the American Academy of Pediatrics, told CNN on Aug. 14.

“This one is worse, and our children are the ones that are going to be affected by it the most,” she said.

The number of newly hospitalized COVID-19 patients for ages 18-49 also hit record highs during the week of Aug. 9. A fifth of the nation’s hospitalizations are in Florida, where the number of COVID-19 patients hit a record high of 16,100 on Aug. 14. More than 90% of the state’s intensive care unit beds are filled.

More than 90% of the ICU beds in Texas are full as well. On Aug. 13, there were no pediatric ICU beds available in Dallas or the 19 surrounding counties, which means that young patients would be transported father away for care – even Oklahoma City.

“That means if your child’s in a car wreck, if your child has a congenital heart defect or something and needs an ICU bed, or more likely, if they have COVID and need an ICU bed, we don’t have one,” Clay Jenkins, a Dallas County judge, said on Aug. 13.

“Your child will wait for another child to die,” he said.

As children return to classes, educators are talking about the possibility of vaccine mandates. The National Education Association announced its support of mandatory vaccination for its members.

“Our students under 12 can’t get vaccinated,” Becky Pringle, president of the association, told CNN.

“It’s our responsibility to keep them safe,” she said. “Keeping them safe means that everyone who can be vaccinated should be vaccinated.”

The U.S. now has an average of about 129,000 new COVID-19 cases per day, Reuters reported, which has doubled in about 2 weeks. The number of hospitalized patients is at a 6-month high, and about 600 people are dying each day.

Arkansas, Florida, Louisiana, Mississippi, and Oregon have reported record numbers of COVID-19 hospitalizations.

In addition, eight states make up half of all the COVID-19 hospitalizations in the U.S. but only 24% of the nation’s population – Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Nevada, and Texas. These states have vaccination rates lower than the national average, and their COVID-19 patients account for at least 15% of their overall hospitalizations.

To address the surge in hospitalizations, Oregon Gov. Kate Brown has ordered the deployment of up to 1,500 Oregon National Guard members to help health care workers.

“I know this is not the summer many of us envisioned,” Gov. Brown said Aug. 13. “The harsh and frustrating reality is that the Delta variant has changed everything. Delta is highly contagious, and we must take action now.”

A version of this article first appeared on WebMD.com.

Since the COVID-19 pandemic began, I have received a growing number of inquiries about collection issues. For a variety of reasons, many patients seem increasingly reluctant to pay their medical bills. I’ve written many columns on keeping credit card numbers on file, and other techniques for keeping your accounts receivable in check; but despite your best efforts, there will always be a few deadbeats that you will need to pursue.

For the record, I am not speaking about patients who lost income due to the pandemic and are now struggling with debts, or otherwise have fallen on hard times and are unable to pay. I am addressing the problem of patients who are able to pay, but for whatever reason, do not.

The worst kinds of deadbeats are the ones who rob you twice; they accept payments from insurance companies and keep them. Such crooks must be pursued aggressively, with all the means at your disposal; but to reiterate the point I’ve tried to drive home repeatedly, the best cure is prevention.

You already know that you should collect as many fees as possible at the time of service. For cosmetic procedures you should require a substantial deposit in advance, with the balance due at the time of service. When that is impossible, maximize the chances you will be paid by making sure all available payment mechanisms are in place.

With my credit-card-on-file system that I’ve described many times, patients who fail to pay their credit card bill are the credit card company’s problem, not yours. In cases where you suspect fees might exceed credit card limits, you can arrange a realistic payment schedule in advance and have the patient fill out a credit application. You can find forms for this online at formswift.com, templates.office.com, and many other websites.

In some cases, it may be worth the trouble to run a background check. There are easy and affordable ways to do this. Dunn & Bradstreet, for example, will furnish a report containing payment records and details of any lawsuits, liens, and other legal actions for a nominal fee. The more financial information you have on file, the more leverage you have if a patient later balks at paying his or her balance.

For cosmetic work, always take before and after photos, and have all patients sign a written consent giving permission for the procedure, assuming full financial responsibility, and acknowledging that no guarantees have been given or implied. This defuses the common deadbeat tactics of claiming ignorance of personal financial obligations and professing dissatisfaction with the results.

Despite all your precautions, a deadbeat will inevitably slip through on occasion; but even then, you have options for extracting payment. Collection agencies are the traditional first line of attack for most medical practices. Ideally, your agency should specialize in handling medical accounts, so it will know exactly how much pressure to exert to avoid charges of harassment. Delinquent accounts should be submitted earlier rather than later to maximize the chances of success; my manager never allows an account to age more than 90 days, and if circumstances dictate, she refers them sooner than that.

When collection agencies fail, think about small claims court. You will need to learn the rules in your state, but in most states there is a small filing fee and a limit of $5,000 or so on claims. No attorneys are involved. If your paperwork is in order, the court will nearly always rule in your favor, but it will not provide the means for actual collection. In other words, you will still have to persuade the deadbeat to pay up. However, in many states a court order will give you the authority to attach a lien to property, or garnish wages, which often provides enough leverage to force payment.

What about those double-deadbeats who keep the insurance checks for themselves? First, check your third-party contract; sometimes the insurance company or HMO will be compelled to pay you directly and then go after the patient to get back its money. (They won’t volunteer this service, however – you’ll have to ask for it.)

If that’s not an option, consider reporting the misdirected payment to the Internal Revenue Service as income to the patient, by submitting a 1099 Miscellaneous Income form. Be sure to notify the deadbeat that you will be doing this. Sometimes the threat of such action will convince the individual to pay up; if not, at least you’ll have the satisfaction of knowing he or she will have to pay taxes on the money.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at dermnews@mdedge.com.

Since the COVID-19 pandemic began, I have received a growing number of inquiries about collection issues. For a variety of reasons, many patients seem increasingly reluctant to pay their medical bills. I’ve written many columns on keeping credit card numbers on file, and other techniques for keeping your accounts receivable in check; but despite your best efforts, there will always be a few deadbeats that you will need to pursue.

For the record, I am not speaking about patients who lost income due to the pandemic and are now struggling with debts, or otherwise have fallen on hard times and are unable to pay. I am addressing the problem of patients who are able to pay, but for whatever reason, do not.

The worst kinds of deadbeats are the ones who rob you twice; they accept payments from insurance companies and keep them. Such crooks must be pursued aggressively, with all the means at your disposal; but to reiterate the point I’ve tried to drive home repeatedly, the best cure is prevention.

You already know that you should collect as many fees as possible at the time of service. For cosmetic procedures you should require a substantial deposit in advance, with the balance due at the time of service. When that is impossible, maximize the chances you will be paid by making sure all available payment mechanisms are in place.

With my credit-card-on-file system that I’ve described many times, patients who fail to pay their credit card bill are the credit card company’s problem, not yours. In cases where you suspect fees might exceed credit card limits, you can arrange a realistic payment schedule in advance and have the patient fill out a credit application. You can find forms for this online at formswift.com, templates.office.com, and many other websites.

In some cases, it may be worth the trouble to run a background check. There are easy and affordable ways to do this. Dunn & Bradstreet, for example, will furnish a report containing payment records and details of any lawsuits, liens, and other legal actions for a nominal fee. The more financial information you have on file, the more leverage you have if a patient later balks at paying his or her balance.

For cosmetic work, always take before and after photos, and have all patients sign a written consent giving permission for the procedure, assuming full financial responsibility, and acknowledging that no guarantees have been given or implied. This defuses the common deadbeat tactics of claiming ignorance of personal financial obligations and professing dissatisfaction with the results.

Despite all your precautions, a deadbeat will inevitably slip through on occasion; but even then, you have options for extracting payment. Collection agencies are the traditional first line of attack for most medical practices. Ideally, your agency should specialize in handling medical accounts, so it will know exactly how much pressure to exert to avoid charges of harassment. Delinquent accounts should be submitted earlier rather than later to maximize the chances of success; my manager never allows an account to age more than 90 days, and if circumstances dictate, she refers them sooner than that.

When collection agencies fail, think about small claims court. You will need to learn the rules in your state, but in most states there is a small filing fee and a limit of $5,000 or so on claims. No attorneys are involved. If your paperwork is in order, the court will nearly always rule in your favor, but it will not provide the means for actual collection. In other words, you will still have to persuade the deadbeat to pay up. However, in many states a court order will give you the authority to attach a lien to property, or garnish wages, which often provides enough leverage to force payment.

What about those double-deadbeats who keep the insurance checks for themselves? First, check your third-party contract; sometimes the insurance company or HMO will be compelled to pay you directly and then go after the patient to get back its money. (They won’t volunteer this service, however – you’ll have to ask for it.)

If that’s not an option, consider reporting the misdirected payment to the Internal Revenue Service as income to the patient, by submitting a 1099 Miscellaneous Income form. Be sure to notify the deadbeat that you will be doing this. Sometimes the threat of such action will convince the individual to pay up; if not, at least you’ll have the satisfaction of knowing he or she will have to pay taxes on the money.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at dermnews@mdedge.com.

Since the COVID-19 pandemic began, I have received a growing number of inquiries about collection issues. For a variety of reasons, many patients seem increasingly reluctant to pay their medical bills. I’ve written many columns on keeping credit card numbers on file, and other techniques for keeping your accounts receivable in check; but despite your best efforts, there will always be a few deadbeats that you will need to pursue.

For the record, I am not speaking about patients who lost income due to the pandemic and are now struggling with debts, or otherwise have fallen on hard times and are unable to pay. I am addressing the problem of patients who are able to pay, but for whatever reason, do not.

The worst kinds of deadbeats are the ones who rob you twice; they accept payments from insurance companies and keep them. Such crooks must be pursued aggressively, with all the means at your disposal; but to reiterate the point I’ve tried to drive home repeatedly, the best cure is prevention.

You already know that you should collect as many fees as possible at the time of service. For cosmetic procedures you should require a substantial deposit in advance, with the balance due at the time of service. When that is impossible, maximize the chances you will be paid by making sure all available payment mechanisms are in place.

With my credit-card-on-file system that I’ve described many times, patients who fail to pay their credit card bill are the credit card company’s problem, not yours. In cases where you suspect fees might exceed credit card limits, you can arrange a realistic payment schedule in advance and have the patient fill out a credit application. You can find forms for this online at formswift.com, templates.office.com, and many other websites.

In some cases, it may be worth the trouble to run a background check. There are easy and affordable ways to do this. Dunn & Bradstreet, for example, will furnish a report containing payment records and details of any lawsuits, liens, and other legal actions for a nominal fee. The more financial information you have on file, the more leverage you have if a patient later balks at paying his or her balance.

For cosmetic work, always take before and after photos, and have all patients sign a written consent giving permission for the procedure, assuming full financial responsibility, and acknowledging that no guarantees have been given or implied. This defuses the common deadbeat tactics of claiming ignorance of personal financial obligations and professing dissatisfaction with the results.

Despite all your precautions, a deadbeat will inevitably slip through on occasion; but even then, you have options for extracting payment. Collection agencies are the traditional first line of attack for most medical practices. Ideally, your agency should specialize in handling medical accounts, so it will know exactly how much pressure to exert to avoid charges of harassment. Delinquent accounts should be submitted earlier rather than later to maximize the chances of success; my manager never allows an account to age more than 90 days, and if circumstances dictate, she refers them sooner than that.

When collection agencies fail, think about small claims court. You will need to learn the rules in your state, but in most states there is a small filing fee and a limit of $5,000 or so on claims. No attorneys are involved. If your paperwork is in order, the court will nearly always rule in your favor, but it will not provide the means for actual collection. In other words, you will still have to persuade the deadbeat to pay up. However, in many states a court order will give you the authority to attach a lien to property, or garnish wages, which often provides enough leverage to force payment.

What about those double-deadbeats who keep the insurance checks for themselves? First, check your third-party contract; sometimes the insurance company or HMO will be compelled to pay you directly and then go after the patient to get back its money. (They won’t volunteer this service, however – you’ll have to ask for it.)

If that’s not an option, consider reporting the misdirected payment to the Internal Revenue Service as income to the patient, by submitting a 1099 Miscellaneous Income form. Be sure to notify the deadbeat that you will be doing this. Sometimes the threat of such action will convince the individual to pay up; if not, at least you’ll have the satisfaction of knowing he or she will have to pay taxes on the money.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at dermnews@mdedge.com.