Health officials are reporting record numbers of COVID-19 cases among American children, school officials have been shuttering classrooms over outbreaks, and pediatric hospitals say they're .
Now, the Biden administration says it's ramping up efforts to "to reopen schools safely and keep them open" as the Delta variant drives a surge of infections in the last remaining segment of the country's population that is still ineligible to get vaccinated: children 12 years of age and younger.
Here are answers to some frequently asked questions about children and COVID-19, as kids return to the classroom.
Are more children getting COVID-19 now?
The pace of new COVID-19 cases in children has hit record highs in the past weeks.
There were 243,373 cases reported in children from September 2 - 9, according to data collected by the American Academy of Pediatrics — nearly 29% of the nation's total reported cases that week. The previous week saw the largest weekly increase among kids since the surge of cases over the winter holidays.
Though the rate of child hospitalization remains low compared to adults, the Centers for Disease Control and Prevention's surveillance data showed in tallies of new hospital admissions of Americans under 18 that these cases have more than doubled since the last peak seen in January.
In some regions, the onslaught has overwhelmed pediatricians who were already facing an abnormally large wave of RSV, a mild, cold-like disease that typically increases in the fall and winter.
But the recent uptick of cases in children and in their rate of hospitalization appears to reflect an overall rise in the spread of COVID-19.
"While symptomatic and severe cases in children remain less common than in other age groups, we have seen increases in pediatric cases and hospitalizations over the last few weeks — which is likely the result of overall increases in community transmission generally, and more specifically, the Delta variant's increased transmissibility," CDC Director Rochelle Walensky said at a White House briefing late last month.
Why are more children being hospitalized?
While a surge in hospitalizations triggered fears earlier this year that the Delta variant posed a greater danger to children, federal health officials say their recent data suggests the variant's rapid spread — not more severe disease — is largely to blame for overflowing pediatric wards.
"We're seeing more children in the hospital now because the Delta variant is more readily transmissible among everybody, adults and children," Dr. Anthony Fauci, the president's chief medical adviser, told The New York Times at a virtual event on Thursday.
"When you get a highly transmissible variant like Delta, you're going to get more children infected. And by definition, you're going to get more children in the hospital," said Fauci.
"There's been a dialogue that children do not experience severe infections. I want to dispel that myth, right here, right now," Dr. Lauri Hicks, the CDC COVID-19 Response Team's chief medical officer, told a virtual event hosted by The Conference Board on Friday.
"Nearly 500 kids have died from COVID-19 in this country. I find that unacceptably high. I just can't imagine being a parent and having your child die from COVID-19, or anything else for that matter, that is something that we can mitigate. We can work together to prevent kids from getting exposed to COVID-19," Hicks added.
Are the symptoms of COVID-19 worse in kids with the Delta variant?
Probably not, when compared to previous variants.
Severe COVID-19 symptoms appear to remain relatively rare for the youngest children sickened by the virus. A study released Wednesday by Australia found the majority of school and early childcare cases there resulted in "asymptomatic or mild infection." Health officials in the United Kingdom recently reported similar results, with only around 25% of the youngest children who tested positive for the virus reporting any symptoms.
When kids do develop symptoms from the Delta variant, they are largely similar to previous strains of the virus. The U.K. infection survey found cough and fever were most common in younger children — far more than loss of taste or smell, compared to adults.
The Centers for Disease Control and Prevention reported similar findings earlier this month from a Delta variant outbreak investigation in elementary school students. Fever, cough, headache, and sore throat were among the most frequently reported symptoms in that cluster of cases.
Is the Delta variant of COVID-19 also highly contagious in kids?
It appears that this is the case. When children catch the variant, they seem to spread it.
Even before the Delta variant, a growing body of scientific research questioned assumptions that children were significantly less likely than adults to catch and spread the virus.
On Wednesday, the CDC said it had concluded that "most studies" of transmission found that children had "a similar risk" of transmitting the virus compared to adults. The agency also cited research suggesting children might even be more likely to transmit than seniors older than 60.
Other studies have found rates of infection in children "can be comparable, and in some settings higher, than in adults," concluded a July CDC scientific review that informed the agency's revisions to its school guidance.
Since then, the CDC has seen more evidence pointing to the rapid spread of the Delta variant through children and has urged schools to implement universal masking among students, a measure some school officials in the U.S. and overseas have rejected in lieu of regular COVID-19 testing and other mitigation measures.
At a youth camp in Illinois, where masking and testing were not enforced, the CDC reported were sickened by the variant. The CDC also tracked outbreaks fueled by the Delta variant in elementary school classrooms and from a gymnastics facility into households.
"We are seeing schools that are not following these guidance — specifically not masking, not having — having lower rates of vaccination — are dealing with outbreaks, especially in the context of this very transmissible Delta variant," CDC Director Rochelle Walensky told reporters last month.
When will younger children be able to receive a COVID-19 vaccine?
Likely in the fall or early winter.
Pfizer's COVID-19 vaccine, which is currently allowed for children 12 and older, is expected to be the first to receive regulatory authorization for younger age groups. Moderna is also conducting trials on doses of its vaccine for children.
Pfizer says data from its clinical trials of the vaccine in younger children show a smaller dose is. The company is submitting the data to the Food and Drug Administration in hopes of securing authorization for the shots by October. Moderna is expected to follow suit in the weeks after.
Both companies are experimenting with smaller doses of their vaccine for children, which the manufacturers hope will prompt a sufficient immune response without major side effects.
"Children raise additional questions. They're not small adults. As we've learned over the years, they have to be studied separately. They will need different dosage forms, lower doses, and they might have reactions and safety issues that could be different than adults," acting FDA Commissioner Janet Woodcock told WebMD in an interview earlier this month.
After the FDA's vaccine advisers voiced concern over cases of myopericarditis seen in adolescents after shots of the mRNA vaccines, Moderna expanded enrollment in its trial — which could delay the submission of its study to the FDA.
"It's probably going to be something on the order of weeks, not months," the FDA's top vaccine official Dr. Peter Marks told a webinar hosted by the group Made to Save earlier this month.
Marks and other FDA officials have previously said they aimed to prioritize their review of the shots for younger age groups, but cautioned the process could take longer if trials turned up safety issues that would need to be reviewed by a meeting of the agency's outside vaccine advisers. The regulator will also scrutinize changes to the formulation of the vaccine itself given to younger children.
"One couldn't just simply take the existing formulation and just use it, because the doses are getting too small to give," Marks told USA Today earlier this month.
However, after the FDA concludes its review, the CDC must still convene its own panel of vaccine experts — the Advisory Committee on Immunization Practices — to deliberate on whether to formally recommend the shots.
While the step can often seem like a formality that could delay the recommendation, the U.S. is ahead of other countries in approving the shots for younger patients. The ACIP's counterparts overseas have so far rejected pleas to vaccinate even most healthy adolescents.
"For otherwise healthy 12- to 15-year-old children, their risk of severe COVID-19 disease is small and therefore the potential for benefit from COVID-19 vaccination is also small," Wei Shen Lim, chair of the United Kingdom's Joint Committee on Vaccination and Immunisation, said this month in a statement.
"The JCVI's view is that overall, the health benefits from COVID-19 vaccination to healthy children aged 12 to 15 years are marginally greater than the potential harms," he said.