Shared from the 8/20/2021 San Francisco Chronicle eEdition

Pediatricians stay busy as school year begins

Despite rise in COVID cases, severe illness rare in children

Picture
Photos by Gabrielle Lurie / The Chronicle

Top: Brock-Utne chats with Addison Osmund-sen, 2, during a checkup for 4-month-old sister Savannah, held by mom Amber Osmundsen.

Picture

Above: Dr. Alice Brock-Utne examines 3-month-old George Harms at Pleasant Hill Pediatrics.

Picture
Photos by Gabrielle Lurie / The Chronicle

Dr. Alice Brock-Utne examines Mina Kohler, 14, during a checkup at Pleasant Hill Pediatrics. Brock-Utne says she’s getting many virus inquiries from parents as the school year starts.

Picture

Brock-Utne listens to the heartbeat of Milo Psara, 3. She says that even mild cases of COVID-19 can be difficult for kids.

The boy came into a California Pacific Medical Center emergency room in San Francisco on a recent day with a terrible cough. A test confirmed it was COVID-19. Dr. Vincent Tamariz sent him home to recover under the care of his parents.

“The kid was looking great. He was running around, tearing my ear up — but he had that persistent cough,” said Tamariz, director of pediatric emergency medicine at medical center’s Van Ness campus. “Nobody in the family was vaccinated.”

The start of school for tens of thousands of Bay Area children comes as more people — including kids — have been infected with the coronavirus, a rise fueled by the delta variant, which medical experts say is nearly as contagious as chickenpox and can leave some kids gasping for breath.

In Contra Costa County, for example, the case rate — new cases per day per 100,000 residents — more than quadrupled for children up to age 11 from July 2 to Aug. 2, and more than quintupled for those 12 to 18.

San Francisco had a seven-day average of about 16 daily cases per 100,000 residents age 17 and younger as of Aug. 11, more than twice the average rate of seven a day on July 11. That most recent San Francisco case rate reflects a gradual decline from a peak of 26 as August began. Statewide, new cases recorded in that age group are still climbing, with a seven-day average of about 28 cases a day per 100,000 youths Monday, compared with an average of 5 cases per 100,000 a month earlier.

The Bay Area is doing far better than hot-spot states with low vaccination rates in the South, where pediatric hospitals are overwhelmed and turning patients away. As of last Friday, San Francisco officials said that no children who are city residents were in hospitals because of COVID-19. In part, that probably reflects the city’s high vaccination rate — 71% percent of residents are fully vaccinated — and the mask mandate put in place in July.

And overall cases appear now to be leveling off in the Bay Area, officials say.

Nonetheless, concerns are mounting that a disease that has generally spared children may affect far more kids this fall as the virus rages through unvaccinated populations — including those younger than 12, an age group not yet eligible for the shots.

Pediatricians at top Bay Area hospitals and private practices see more children testing positive for the coronavirus than at any other time in the pandemic. Even so, they are often asymptomatic or have mild fevers and respiratory symptoms. Few need hospitalization.

“The good news is severe disease remains low for children across the board,” said Dr. Tara Greenhow, regional lead of pediatric infectious disease for Kaiser Permanente Northern California. “Even those who we have thought of as being high-risk children have typically done well.”

At least 121,427 COVID-19 cases in children were reported in the United States for the week ending Aug. 12, representing 18% of all weekly reported cases nationwide, according to the American Pediatrics Association.

A half-dozen Bay Area pediatricians interviewed recently said they expect more children will test positive for the virus in the coming weeks. They are cautioning parents to maintain safety practices, such as masking and choosing outdoor over indoor activities for their kids.

But they do not expect the Bay Area to experience the kind of illness surges occurring elsewhere.

“This is a time where we need to maintain our vigilance, we need to be not relaxing our guard,” Tamariz said. “We need to be staying with our pods. We need to be wearing masks.”

Though most children recover from coronavirus infection, there is still much unknown about the disease. The American Academy of Pediatrics recommends that even after a mild infection children be screened for post-COVID-19 conditions such as heart inflammation and physical and psycho-social development issues.

The coronavirus surge has dovetailed with a busy season for pediatricians: the start of the school year when parents are scrambling to schedule regular childhood vaccinations and office visits.

Coughs, fevers, runny noses and other symptoms parents normally treat at home are now leading to calls to the doctor's office to rule out COVID-19.

Dr. Dawn Rosenberg, a pediatrician with Golden Gate Pediatrics, said her office has been inundated with calls from parents seeking guidance for anything from cold symptoms to possible exposures to the virus.

Berkeley pediatrician Dr. Jaleh Niazi said she is seeing more coronavirus cases than in winter or spring. In one case, she said, an unvaccinated tutor gave the virus to a group of children.

Her patients also show a greater variety of symptoms. A child younger than 2 stopped using words he had been able to use before after getting sick, and Niazi speculated even that change potentially could be related to the virus. Dehydration after being feverish was a common complication.

She spends a lot of time trying to convince parents and older children that the vaccine is safe and potentially lifesaving. One girl was convinced by a TikTok video that the vaccine would turn her into an alien, Niazi said. She persuaded the girl, her sister and her mother to get vaccinated.

“I said, ‘Do I look like an alien to you?’ ”Niazi said. “When you have a relationship with families — they are bombarded with nonsense — you can try to get them facts and question that insanity.”

Dr. Alice Brock-Utne, a Pleasant Hill pediatrician with John Muir Medical Group, checked her email after a late shift last week at the urgent care clinic: 50 emails from parents, roughly half seeking a coronavirus test for their children.

“The others were wondering about how to make a decision — decisions around travel, school, visitors coming from other states, all kinds of decisions,” Brock-Utne said.

Even mild cases of COVID-19 can be difficult for kids, said Brock-Utne. She compared it to the misery of a bad cold, something many families were spared during the pandemic lockdown that kept families home. Children often become lethargic and dehydrated when fevers linger, and the experience can be “miserable,” she said.

Brock-Utne said she talks with many parents who are exhausted by pandemic rules and skeptical of the vaccines. She said she uses comparisons that involve easy choices — like comparing masks to wearing closed-toed shoes in the gym.

“What this moment in time means is every parent should circle back to themselves in their role as a caregiver — that’s your No. 1 role,” Brock-Utne said. “The rules of being a good caregiver are: Put your oxygen mask on first. Get vaccinated and stay healthy.”

San Francisco Chronicle staff writer Aidin Vaziri contributed to this report.

Julie Johnson is a San Francisco Chronicle staff writer. Email: julie.johnson@sfchronicle.com Twitter: @juliejohnson

See this article in the e-Edition Here
Edit Privacy