COVID-19 cases in children under 12 remain high throughout Texas, including in Montgomery County where 2,455 cases were reported in August—an all-time high. Community Impact Newspaper sat down with Dr. Jim Versalovic, the interim chief pediatrician and pathologist in chief at Texas Children’s Hospital in the Woodlands, to talk about the delta variant and how it affects children. The interview has been edited for length and clarity.

How do August COVID-19 numbers reflect what you are seeing in hospitals?

Clearly we are in the midst of the delta surge—with children and adolescents as well as adults—so what we are seeing with adults is certainly playing out with children and adolescents. We're approaching 100% delta cases in August, with our data based on genomic surveillance. That's within the Texas Children's system, which includes children from Montgomery County as well as Harris and other neighboring counties. The delta variant is the most contagious variant known to date. ... It's entirely consistent with the numbers you stated; we've been seeing children, adolescents, even infants. ... No age group has been spared. The vast majority of these children stay out of the hospital, but we are seeing more symptomatic infections during the delta surge. ... It's certainly been the largest surge to date in terms of the number of cases we're seeing.

How does the delta virus affect children differently from adults?

This is still a hot topic for discussion. ... We clearly are seeing, although we're still in the middle of this surge, ... that it does seem that we're seeing a greater percentage of symptomatic infections in children. ... And it does appear that we're seeing more COVID pneumonia in younger children ... in infants, preschool, children under 5. And we are seeing more severe disease among a subset of unvaccinated teenagers. Some of these children and teenagers of course have chronic or underlying conditions that put them more at risk; we've known that since the beginning. ... That stated, we do have children and adolescents who do not have a known underlying condition, so it is difficult to predict.

Other states have reported spikes in cases of respiratory syncytial virus in children—is that applicable here too?

We have seen plenty of RSV during the summer months, one might say it's unprecedented, at least in recent years. We typically see RSV spiking late in the year, but we might see RSV emerge October through December, which is usually the pattern for RSV. It affects mainly young children and infants, but it can cause symptomatic infections in older children, adults and the elderly. It's interesting because we did not see this at all in 2020. We think since children were isolated in 2020, with more masking, virtual learning. ... That played a factor at keeping RSV at bay last year, and it definitely affected this unusual pattern in 2021 in Texas and in neighboring states. It created ample stress in Texas Children's because we had so many children who had either RSV, COVID or both, and that caused concerns because approximately half of these cases required hospitalizations, ... and that can be a serious setback to any child and a serious scare to any family. We do not have a vaccine for RSV currently, but we know we can do our part by keeping children at home if they're sick or diagnosing them rapidly through tests.

For kids hospitalized with COVID-19, how does that treatment look?

With COVID-19, we treat kids differently in terms of the dosing of the medication, just as we do for general treatment. Even though the medications may overlap with adult care, we have to adapt our treatments to children of all ages, and that's exactly why children need to be in children's hospitals for ideal care. ... We keep most of our children out of the ICU in the hospital, and we use a combination of medications just as adults get, including remdisivir and drugs that suppress inflammation. ...The treatment is tailored differently in children, the devil's in the details. ... We have specific triggers for when the child needs ICU-based care or mechanical ventilation. One thing that’s interesting is that we are seeing many children and adolescents present symptoms later in the disease, 5-7 days after the test, so it's important that they get to us sooner rather than later. With a timely diagnosis, we can treat that child sooner and prevent a more serious infection.

What is Texas Children’s doing to address staffing shortages?

We are dealing with a national nursing shortage like many hospitals across the country. We're doing everything we can to maintain staffing at appropriate levels. In late July we fully deployed our surge plans; we evaluated our staffing in terms of nurses and respiratory therapists. ... We looked at all the nurses in our system, made sure they were all deployed in the right places. We did request some nurses to redeploy where the need was greatest, such as pediatric ICUs. ... We expedited our onboarding process for new nurses—not taking shortcuts, but working diligently to provide efficient training and onboarding so that we could get experienced nurses on board as quickly as possible. We expanded our recruiting efforts, working with regional authorities such as the SouthEast Texas Regional Advisory Council (SETRAC). ... That helps us tap nurses from other places in the state on a temporary basis. ... Staffing is an ongoing concern. We are doing our best, but it's certainly been a challenge to maintain those staffing levels, being vigilant.

What are your thoughts on what schools can do to ease the burden on children’s hospitals?

We're all in this together. We need a partnership with local communities to stem the tide. ... Twelve years ago during the swine flu pandemic, we saw a surge of flu cases affecting kids from September through December. We were not talking about masks and we did not have specific vaccines for H1N1 during the summer, and that's worth mentioning because history can repeat itself. We know masking can help prevent transmission and can help keep children and adults safe from being infected. Masks provide an immediate means to protect anyone, and we continue to stand with the American Academy of Pediatrics’ recommendation of masks when children are in schools and other crowded events. Distancing whenever possible, keeping symptomatic children at home, hand hygiene of course. We also know it's important to stress vaccination for those 12 and above. ... If an adolescent is vaccinated today, it will take a minimum of five weeks for protection to kick in.

Is there anything else you would like to add?

We have to stress prevention and timely diagnosis. We will get through this surge, while we protect as many children and adults as possible. We do know that COVID can have a long-term impact. We're not just talking about preventing acute disease over several days, but we're seeing children with persistent fever, abdominal pain, low blood pressure after a seemingly mild fever. And we know that about 10% of children may develop symptoms of long COVID, cardiac, behavioral issues including anxiety and depression. We know what to do and how to diagnose it, but this impact can last for weeks or months, and can seriously impact the quality of life and development of many children and adolescents. If a child is symptomatic ... it's important to seek the help of pediatricians so that they can diagnose the child appropriately. Prevention and timely diagnosis are keystones to helping us get through this surge and hopefully as effectively as we can.