For Texas children, COVID-19 hospitalizations are outpacing vaccinations

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There’s a little list of things that Richmond, Texas, mom Vanessa Lui promised her daughter Zoe they could do after the third grader got her COVID-19 vaccine.

A visit to Barnes & Noble. An afternoon at the local museum.

Going back to school in person is also on the list, but schoolwork isn’t really what Zoe misses after attending school entirely online for the past year and a half.

“I’ve only been missing my friends, because I don’t really like to do work, it’s sort of annoying,” the 8-year-old told The Texas Tribune in an interview. “Sometimes we played at recess, and we went down the slide.”

That’s why, in November, she was among the first Texas children in her age group to roll up her sleeve and get inoculated against COVID-19, appearing with her mom, her aunt and her cousin at the Texas Children’s Hospital in Houston after the federal government approved the Pfizer shot for kids ages 5-11.

Since then, 693,345 Texas elementary-age children have received at least one dose of the vaccine, accounting for about 24% of the state’s 2.9 million children ages 5-11 — and a figure in line with the national rate. Nearly 390,000 of the 5-11 group are fully vaccinated, while more than half of Texans ages 12-15 are fully vaccinated.

Texas’ child vaccination rate is higher than in many other Southern states, where rates as low as 10% are being recorded. In the first two weeks after the shot was approved for emergency use in the younger age group, some 100,000 children showed up to Texas school clinics, pharmacies and pediatricians’ offices to get inoculated.

Zoe was among them.

“As a family, we were excited,” Lui said. “We need more parents, rather than less parents, to go first.”

But as the omicron variant of COVID-19 drives up cases beyond anything recorded in Texas during the pandemic, Zoe is still waiting to go back to school. She continues to take her classes online as she and her mother wait until staff members stop calling in sick, causing students to switch teachers and classes often.

With omicron raging through the unvaccinated community, children with COVID-19 are turning up in hospitals and pediatricians’ offices in record numbers.

Some pediatricians have had to close for a few days because most of their staff members were out sick, causing parents to shuffle appointments or seek new family doctors for common winter illnesses such as the flu or other non-COVID infections.

“They called us up and said, ‘We have to cancel your appointment today. None of the staff can make it,’” said Houston communications professional Evan Mintz, who had to reschedule an appointment for his young daughter during the holiday break. “It was a one-day delay, and that’s not bad in the grand scheme of things. But nevertheless, it was a shock to us. It was affecting us directly.”

Frisco pediatrician Seth Kaplan has managed to stay open but had to stop accepting new patients temporarily, he said.

“It just got to be overwhelming,” he said.

Omicron hits just as kids get vaccines

At Texas Children’s Hospital in Houston, positive cases among patients went from zero in early December to some 70 patients with COVID-19 a month later, mostly among unvaccinated children, said Dr. Jim Versalovic, pathologist-in-chief for the hospital. Their hospitalizations of children with COVID-19 broke all previous pandemic records, and at breakneck speed, he said. Just weeks after omicron was first detected in Texas, it was causing more than 90% of new cases showing up at his hospital — less than a month after the vaccine was approved for young kids.

“We have staggering numbers here during this omicron surge,” Versalovic said in a news conference in early January.

That same day, the state broke its own record of children hospitalized with COVID-19, reporting 350 — five more than the previous peak a few months before.

On Friday, the state health department released data on 3.8 million confirmed cases of COVID-19 in Texas in the first two years of the pandemic. Almost 19% of them — 722,393 — were diagnosed in residents under age 20. The demographics do not include cases reported in 2022.

During the first week of January, the Texas Department of State Health Services and the Texas Education Agency reported that about 26,500 students and 11,800 staff members had been infected with COVID, according to data released Friday.

While the numbers of student cases are nearing levels not seen since the start of school last fall, there are more cases of COVID-19 among staffers than at any other time in the pandemic. The numbers are likely to increase as more districts report their numbers to the state. The current numbers include only about half of all of the state’s 1,200 districts, and the number of districts reporting any numbers is inconsistent from week to week.

Meanwhile, on Wednesday, the state reported 471 children in Texas hospitals with COVID-19. Most of them are unvaccinated, hospital officials have said. But there is no state data detailing how many COVID-19 child patients are in Texas pediatric intensive care units.

Versalovic said fewer of his COVID-19 patients in the 5-11 age group are winding up in the intensive care unit, compared with previous surges, because they can be vaccinated.

Children under age 5, who aren’t yet eligible to be vaccinated, are still going into the ICU at similar rates as in earlier surges, he said. One in 3 of the hospitalizations of patients with COVID-19 at Texas Children’s were under age 5, Versalovic said.

They’re showing up with serious lung infections, similar to what they might contract with respiratory syncytial virus, or RSV, a more common childhood respiratory illness.

Versolavic cautioned against assuming that omicron is less serious for children, even though it appears to be less severe than delta for adults.

“It is something that we are going to watch very carefully,” he said. “We have no firm evidence that the disease is more severe [in children] with omicron than with delta, at this point. … But we cannot say that this is milder for children because it is, frankly, early. And we just need some time to continue to follow these children and see.”

More ICU beds are available now for all young patients than were free a few months ago, partly because the state is no longer in an unseasonable and simultaneous surge of RSV and influenza, as was seen over the summer, so those patients aren’t using up as many beds, Versalovic said.

A portion of the hospitalized children in the COVID-19 census tested positive for the virus during routine screening after showing up at the hospital for something else, Versalovic said, but identifying the difference can be complicated when comorbidities are involved.

The state does not require that hospitals report which cases are caused by COVID-19 and which are incidental and not the reason the person is hospitalized.

“What I can say is that as we’re examining the data in real time, it’s clear that the majority of cases either have COVID-19 as a primary factor or as a significant contributing factor to their hospitalization,” he said. “That said, of course, we’re going to need to continue to study this to see if we can get firmer numbers on that.”

Less severe cases

There are some encouraging notes this time around, Versalovic said.

“We have learned plenty during this pandemic, and we are in a much better position this January versus last January with vaccinations,” he said.

The possibility that omicron is less severe than its predecessors is keeping children from being vaccinated, as their parents deem it may not be necessary to inoculate their kids right away, said vaccine expert Dr. Peter Hotez, a virologist at Baylor College of Medicine in Houston.

It’s a notion that is putting children at real risk from long-term complications of COVID-19.

Recent studies from London show that 1 in 7 kids with COVID get long-lasting serious or chronic symptoms, known as “long COVID.” A more recent study from the Centers for Disease Control and Prevention pointed to an increased risk of diabetes in infected children.

“Parents are not rushing in to vaccinate their younger kids,” Hotez said. “I think the problem is that the federal government and certainly the state government has not made enough of a case for why kids need to be vaccinated. I think people focus a lot on the low mortality numbers, but the way I look at it is that mortality is just the tip of the iceberg when it comes to pediatric illness with COVID.”

Zoe Lui, for her part, said she was proud to do what she can, as a youngster, to protect herself and her community. And her mom is proud of her.

“I just had that theme, ‘This is your shot,’ running through my head the whole time she was getting it,” Vanessa Lui said. “It was sweet. It was really sweet.”

Kaplan, the Frisco pediatrician, said that although the vaccination numbers could be higher among kids, he hopes that will improve.

“I’ve never heard ‘thank you,’ so much as I have in the past few weeks,” he said. “They really feel a huge, palpable sense of relief that they’re finally able to do this for their kids.”

Mandi Cai contributed to this report.

Disclosure: Texas Children’s Hospital has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.