Five years later, we reflect on all that has occurred and changed since March 4, 2020. We asked Cook Children’s employees to reflect on their experiences during the COVID-19 lockdown and how they experienced growth, loss, and change.

COVID-19 Heroes and Memorial Day was created to officially recognize the front-line workers whose steadfast commitment kept Texans safe during the COVID-19 pandemic and remember the nearly 95,000 Texans who lost their lives to the disease. Other Texas hospitals also commemorated the day.

At Cook Children's Medical Center - Prosper, employees gathered to receive a blessing and honor those we lost in a moment of silence led by chaplain Amanda Payne Lindsay, M. Div. There was also an opportunity to spend time in a reflective prayer activity and grab a pin to support this day. At Cook Children's Medical Center - Fort Worth, employees similarly gathered to receive a blessing and recognize the day in a moment of silence led by Jennifer Hayes, MDiv, BCC, Director of Spiritual Care at Cook Children’s. There was also a display for employees to participate in by sharing who they are both honoring and remembering today. 

As COVID-19 cases rise at Cook Children's, the Food and Drug Administration has approved an updated COVID vaccine.

The Centers for Disease Control and Prevention recommends that anyone 6 months and older should get the new shot to protect against serious illness.

COVID cases at Cook Children’s Medical Center have been steadily increasing since early July. From the week of Sept. 17 through Sept. 23, the positivity rate is 10% or 69 positive cases out of 679 patients tested.

The new vaccines from Pfizer and Moderna are matched to protect against the most common COVID variants circulating now. Please contact your pediatrician's office to schedule an appointment.

The fall and winter months are a common time for respiratory illnesses to spread in our community; in addition to COVID-19, there is typically a rise in flu and RSV cases.

Schedule you and your child’s flu shot as soon as possible to help prevent severe illness and spread of the flu.

Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. It is the leading cause of hospitalization for infants, who are much more susceptible to the disease.

This year, infants will have a better chance of protection if they receive the new monoclonal antibody injection for the prevention of severe RSV, which has been shown to reduce the risk of hospitalization and health care visits in infants. This one-time injection was recently approved by the FDA and recommended by the CDC. The treatment will be available at Cook Children's pediatrician offices soon.

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, answers some of the top questions from parents regarding these respiratory illnesses, treatment and prevention.

COVID

What are COVID cases like right now? Why should my child get the new COVID vaccine?

Positive COVID cases at Cook Children’s Medical Center have been steadily climbing since the end of June and early July. Across the country, there are higher rates of COVID hospitalizations in both adults and pediatrics. Your child should get a yearly COVID vaccination because we know that this will protect them. People who are vaccinated against COVID have a significantly decreased risk of hospitalization, ICU admission, and death.

What are the symptoms of most COVID cases right now?

Symptoms are mainly upper respiratory symptoms (cough, nasal congestion, sore throat). It’s also causing fevers, muscle aches, and fatigue. And yes, these symptoms are very similar to the flu! 

Should my children and I be wearing face masks? 

You should consider wearing a mask if you, your child, or anyone in your home is at high risk for severe COVID-19 infection. This includes people who are 65 years and older and people with certain medical conditions such as heart conditions, lung disease, diabetes, sickle cell, or a neurologic condition.

During flu, RSV, and COVID-19 seasons, it is very reasonable to wear a mask whenever you are in crowded indoor spaces. This includes pediatric office and emergency room waiting rooms!

My child is involved in many in-person activities this fall. What can we do to protect against COVID?

• Consider wearing a mask
• Get the latest vaccine
• Stay home if you are sick

My child’s classmate tested positive for COVID. What should I do?

• If your child is having symptoms, test immediately. If the initial test is negative, repeat in 48 hours if your child is still symptomatic.
• If your child does not have symptoms, wait five days and take another test.

If my child received a COVID vaccine more than six months ago, should they get the new vaccine?

Yes, they should! The CDC recommends that anyone 6 months and older who is two months out from their last COVID vaccine get the new vaccine.

Will it protect my child against the latest variant?

Yes, the newest vaccine was designed for the currently circulating variants so it should help protect your child.

FLU

What are flu cases like now? When is flu season?

Flu cases are currently low at Cook Children’s. Flu season typically begins in the late fall and stretches into the winter. However, last year we saw unprecedented numbers of influenza very early in the season.

Why should my child get a flu shot?

 Flu vaccines help protect against severe cases of the flu. If your child gets the flu vaccine, they may still get the flu, but they will have more mild symptoms and should not need to be hospitalized with a severe infection.

When will flu shots become available?

Flu shots are currently available at many Cook Children’s pediatrician offices. Check with your pediatrician’s office. Many local pharmacies have them as well.

RSV monoclonal antibody shot

What age groups can get the RSV monoclonal antibody injection?

Infants under 8 months during their first respiratory season and children who are at high risk up to 24 months of age. Talk to your pediatrician about your child’s risk, especially if they have a history of prematurity, heart disease, or chronic lung disease.

What should parents consider with this antibody treatment?

Our babies and infants are the most vulnerable population during cold and flu season so this will give them some protection and lower the chances of having a severe infection.

RSV can cause symptoms ranging from a runny nose to respiratory failure, requiring an ICU admission. It usually causes mild, cold-like symptoms, but it can be serious, especially for infants.

RSV causes bronchiolitis, which can be very serious and sometimes fatal in babies. The new antibody treatment has been shown to reduce the risk of hospitalization by nearly 80%, according to the CDC.

When will the new antibody be available?

The new antibody treatment will be available soon. For newborns, it may be given in the nursery prior to your infants discharge after birth. For older infants, families should reach out to their pediatrician about availability.

Will my child show symptoms once they receive the antibody shot?

Your child may still get symptoms of RSV after receiving the treatment but they are expected to be less severe.

Your doctor will monitor for any signs of a reaction during the infusion and after with your assistance.

How long is it effective?

Since this is an antibody and not a vaccine, it is designed to provide a temporary boost in immunity only. It will provide short-term protection lasting about 5 months which should cover the 2023-2024 RSV season.

If my child previously had RSV, do they have antibodies?

Yes, but the antibodies your body’s immune system makes to RSV last only two to three months. It is very possible for a child to get RSV multiple times in one respiratory season.

Related stories:

• Fighting RSV: Physicians Say New Antibody Shot Could be Game Changer 
• CDC Recommends RSV Shot for Infants. Infectious Disease Doctor Shares What Parents Need to Know 
• Curious About Health and Safety Requirements at Day Care? We Have Answers
  
   

As cases of the flu and RSV decline at Cook Children’s, we are experiencing an increase in positive cases of COVID-19. Families are encouraged to remain vigilant against respiratory illnesses and make sure their children have the latest COVID booster vaccines, especially as a new dominant subvariant appears to be more contagious.

From Dec. 25 to Dec. 31, Cook Children’s saw a COVID positivity rate of 9.2%, which has been increasing since November. From Jan. 1 to Jan. 7, the positivity rate increased to 11.2%.

As children return to school from the holiday break, there could be an increase in respiratory viruses and illnesses over the next two weeks and beyond, so it’s important to remain watchful and proactive. If your child is feeling sick, keep them at home from daycare or school and wear a face mask when in public to stop the spread.

Influenza A and B cases have declined since November. From Jan. 1 to Jan. 7, we had a positivity rate of 9.9% for Influenza A. This doesn’t mean that the flu season is over, it’s possible to see another increase in cases, so be sure to get vaccinated against the flu. The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness.

“It is very encouraging to see cases decline,” said Laura Romano, D.O., hospitalist at Cook Children’s. “However, this does not mean that RSV and flu season is over. There is a very likely possibility of a second peak occurring later this winter.”

Respiratory syncytial virus (RSV) cases are declining compared to high cases in October and November. We currently have a RSV positivity rate of 7%. There are limited treatments for RSV. Right now, there is no vaccine available to prevent RSV. Synagis, a monoclonal antibody, can be given to prevent severe infections but this is reserved for premature infants, etc. We are also seeing positive cases of rhinovirus and adenovirus in our patients.

COVID-19 Subvariant

The World Health Organization said that it’s concerned with how quickly the XBB.1.5 subvariant of COVID is spreading in the northeast U.S. The subvariant makes up 40% of submitted specimens to the national SARS-CoV-2 surveillance system. There's still a lot that is unknown about this subvariant.

“This subvariant may be able to slip past our immune defenses and might be more contagious, but it is not clear yet if it causes more severe disease or if the vaccine can effectively prevent severe infections from this strain,” said Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s. “We do know that masking and good handwashing will still be helpful to avoid infection.”

The Centers for Disease Control and Prevention tracks the community spread of COVID-19. For the week of Jan. 1, Tarrant County is rated “high” transmission spread.

Prevention & Precautions

The biggest thing the community can do to help is to take precautions against COVID-19, including masking indoors if you or your child feel sick, frequent hand washing, and getting the COVID-19 vaccine and booster.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you or your child is sick, wear a mask in public.
• If your child is sick, keep them home from daycare or school. Make sure your child drinks lots of liquids, gets plenty of sleep and takes over-the-counter meds to alleviate symptoms.

Flu vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

There’s no guaranteed way to avoid the flu. But getting the vaccine every year can help. At Cook Children’s, we believe that flu vaccinations are the safest, easiest way to protect everyone age 6 months and older from serious flu symptoms. And a flu vaccination during pregnancy helps protect your newborn baby from flu for several months after birth.

Flu immunizations, COVID-19 immunizations and other services are available at Cook Children’s neighborhood clinics and primary care sites across Fort Worth and beyond. Find a location near you: Primary Care Offices/Neighborhood Clinics (cookchildrens.org)

For COVID, at-home tests and community testing locations are also great options.

Cook Children’s Medical Center has completed its new infectious diseases critical care unit (CCU), meeting the need for a clinical facility dedicated to the treatment of patients with contagious illnesses.

The expansion ensures children with highly infectious diseases will be treated in the safest environment possible. The unit’s design and technology allow for the treatment of the sickest patients while also protecting Cook Children’s staff and the community from the spread of illness.

While the need for the unit first appeared on Cook Children’s radar several years ago when Ebola made its way to U.S. shores, the COVID-19 pandemic shined a light on its importance once again.

“COVID-19 overwhelmed us and we had a hospital full of kids with COVID during the Omicron surge,” said Marc Mazade, M.D., medical director of infection control and prevention at Cook Children’s. “But we only saw a modest number of kids with COVID-19 who really needed care in the pediatric intensive care unit (PICU), and most of them graduated out of the PICU pretty quickly in comparison to the much sicker adolescents with severe lung manifestations that we saw with the first two waves of COVID. We have to be prepared to deal with whatever comes and this new unit will help us to do that.”

The overall expansion for the preparedness of current and future pandemics includes the new six-bed infectious diseases CCU and a 24-hour solutions center with dedicated incident command space. In addition, a new 32-bed medical-surgical unit was added to expand Cook Children’s ability to meet the hospitalization needs of the growing communities it serves.

“I work for a system that pursues whatever is needed to improve a child’s health or save a child’s life,” said Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s. “This new infectious diseases CCU is that next great opportunity and we are all thrilled to be a part of it.”

The pandemic showed us all how important it is to feel close to your family members, even if you can't be in the same room. In September 2020, a Cook Children's dad went viral for dancing in the parking lot during his son's cancer treatments. Due to the COVID-19 restrictions at the time, only one parent or caregiver could attend appointments with patients. 

These new infectious disease critical care units will make seeing family much easier with Virtual Connect – think FaceTime but for hospital rooms. Doctors and clinicians will also be able to visit with patients through Virtual Connect.

This will allow all “dancing dads” to connect with their child if they can't physically be at the Cook Children's Medical Center.

Family-Centered Safety

Since the start of the pandemic, much has been learned about how to maintain safety for staff and guests and expertly care for infectious disease patients now and in the future.

These best practices and protocols are standard design in the infectious diseases units, which feature specialized air ventilation systems, dedicated areas to put on and take off personal protective equipment (PPE), and technology that allows clinicians to closely monitor a patient without having to be directly at the bedside and other heightened protection measures to contain disease spread.

“These units will be used in an effort to place potentially contagious patients in one area,” Dr. Whitworth said. “The goal is to have everybody in one unit with every employee in that specific unit dedicated to being experts in proper PPE donning and doffing, patient and visitor flow and all of the aspects of interrupting the spread of an infectious disease.”

Maintaining a family-centered and supported environment also influenced the design of the new infectious diseases CCU. The decision to limit visitors to Cook Children’s Medical Center during the pandemic was a difficult one for everyone. While Cook Children’s patients have always been allowed at least one family member at their bedside during the outbreak, the spread of the virus demanded that administrators take steps to protect employees and vulnerable patients by restricting the visitation of others within the family unit.

“Segregating families is not who we are as an organization,” said Stan Davis, chief operating officer at Cook Children’s Medical Center. “We promote that when a child is sick and in our hospital, they need family at their bedside to help with treatment and healing. This unit allows our staff to feel comfortable that they’re in the right environment and have the right precautions to be comfortable treating patients, and it allows our community to understand that in addition to having the best nurses, therapists and support folks in the world, we have the right environment to keep families together.”

Each of the new infectious diseases CCU rooms will have a private bathroom, an accommodation not available in the previous critical care space used for contagious patients. This allows parents to stay in the room with their child as long as they would like and reduces the in and out traffic of a parent who may have the same illness as the child due to exposure. Dedicated entrances and exits to these units for staff and visitors will help protect the general hospital environment.

“It’s our responsibility to re-too in order to deal with situations and illnesses such as the re-emergence of SARS which resulted in lots of health care worker deaths in Canada, for COVID-19 variants already circulating, for Middle East respiratory syndrome (MERS), for avian flu, for new and old world hemorrhagic fever viruses, or for bioterrorism-related infections like anthrax,” Dr. Mazade said. “We’re excited to have the facility to do that better than ever.”

To open up space for the infectious diseases CCU, the Cook Children’s simulation lab was relocated. The simulation lab is an educational space where staff practice using new technologies, innovations and research. Last year, Cook Children’s was the first freestanding children’s hospital in the world to receive full accreditation through the Society for Simulation in Healthcare. The relocated lab allows for the future expansion and growth of this program.

System-Wide Solutions

The design of the new 24-hour solutions center was inspired by lessons learned about system-wide coordination and cooperation throughout the pandemic. Members of all 14 of Cook Children’s Health Care System’s entities worked together in the medical center’s incident command center to coordinate a consistent response to COVID-19 across the entire organization. This consolidation and cooperation allowed Cook Children’s to be nimble, flexible and quick to the ever-changing environment.

The new solutions center will operate year-round under the same premise of consolidation, coordination and consistency. It will be a one-stop shop for staff and guests of any one of Cook Children’s entities to report or request assistance with a facility or operations issue.

“The solutions center will be a single touch point for staff, patients and families, in terms of who they contact for assistance with an operations issue at one of our facilities,” Davis said. “The consolidation that will occur is that there will be a joint information system—a communication hub, if you will—that everyone in the system uses, and the issue will be triaged and assigned from there. It’s similar to what you see with a technology help desk.”

Inside the solutions center is a dedicated incident command center equipped with meeting space that accommodates proper social distancing protocols and communication technology that supports real-time global health updates for rapid, informed decision-making. This is a much-needed upgrade from the classroom that doubled as an incident command center during the height of the pandemic.

“We’ve learned with COVID-19 that hospitals can become overwhelmed rapidly,” Dr. Mazade said. “Planning for staff shortages, getting supplies, developing protocols, and getting our teams the most up-to-date information ASAP while combating misinformation is vital to everyone in the organization, to our community partners, and to our community. We need an up-to-date, world-class incident command station built for that.”

Cook Children’s Health Foundation’s Protecting your Tomorrows campaign helped make the expansion and improvements possible. Thanks to the generosity of donors, Cook Children’s is more equipped than ever before to care for children during a pandemic or outbreak of any infectious disease. For more ways to support our patients, staff and families, visit cookchildrenspromise.org. If you’d like to join the Protecting Your Tomorrows fundraising effort, contact Cook Children’s Health Foundation at 682-885-4105.

Since Aug. 30, our ED and UCC have hit record levels. In the last 24 hours, 580 patients were seen at the emergency department and 705 patients were seen at our Urgent Care Centers. This has resulted in extremely long wait times.

Many parents are bringing in children who have been exposed to COVID-19 but show mild to no symptoms. This is putting unnecessary strain on the health care system. It’s also important to note that an average of 5.5% of COVID-19 tests at Cook Children’s are coming back positive at this time.

Parents and caregivers, please call or visit your pediatrician first if your child is experiencing mild symptoms or a minor injury. View the chart below to see when you should bring your child to the ED or UCC.

As you can imagine, long wait times have led to frustration for those seeking care. Our exhausted staff has heard an abundance of complaints and mean comments that are discouraging when they are working so hard to serve our patients and families. Unfortunately, they are outmatched by the demand.  

Here’s what we know:

1. The vast majority of patients in our UCCs and ED have upper respiratory infections like colds.
2.  The vast majority of COVID-19 tests are coming back negative.
3.  All of our pediatrician offices offer COVID testing and it’s safe to wait for one to two days for COVID testing if you plan to keep your child at home.
4. If your pediatrician does not have available appointments for your child’s cold symptoms, there are at-home COVID-19 tests available in stores currently.
5. Minor concerns like sore throat, cough, low-grade fever, diarrhea and other stomach problems are issues your pediatrician can help with.
6. The ED should only be used for severe symptoms and injuries.
7. The UCC should be used for moderate symptoms and injuries.

Media partners: If you are interested in telling this story, please contact Public Relations Manager Kim Brown at Kim.Brown3@cookchildrens.org or at 682-885-1080, 817-266-3728

For information about some common questions we hear, take a look at these articles:

• My Child's Fever Isn't Going Away. Should I Be Worried? (checkupnewsroom.com)
• Fever, Headaches and Stomach Pain. When Should You Be Concerned? (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)
• 5 Reasons Why Your Child's Coughing Is A Good Thing (checkupnewsroom.com)
• Let's Learn About Fevers (checkupnewsroom.com)
• How Much Sickness Is Too Much? (checkupnewsroom.com)

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, recently got her her almost 4-year-old daughter and 20-month-old son vaccinated. She shared advice for how to prepare your young child.

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible. The COVID positivity rate has slowly climbed at Cook Children's Health Care System. On July 19, the daily positivity rate was 30.6%.

Many Cook Children’s primary care offices are offering COVID vaccines. Patient families can check MyChart for online scheduling options or call their pediatrician’s offices.

Moderna's vaccine, for children 6 months through 5 years old, is two shots spaced one month apart.

The Pfizer-BioNTech vaccine, for children 6 months through 4 years old, is three shots over the course of 11 weeks.

Dr. Romano's Tips on How to Prep Your Children for Shots:

1.     Be upfront about what’s going to happen!

• I always tell my children a few days early that they will have a doctor or a dentist appointment!
• I tell them what’s going to happen at each visit. For example, “Jay, you’re going to go see your pediatrician. They’re going to listen to your heart and your tummy!”
• If they’re going to get shots, let them know that as well. “Danielle, we’re going to go see your doctor. You will need two shots at the visit.”

2.     Talk about the immunizations and let them ask questions.

• We talked a lot about the COVID vaccine before my children were even eligible.
• We talked about why it was important in an age-appropriate language.
  • My son, who is 20 months, was told that it was to keep him healthy and strong!
  • My daughter, who just turned 4, knows it’s to protect against a virus called COVID. COVID can make some people very sick so it’s really important that we do everything we can to protect ourselves and others from germs.
• Let them know that it might pinch or hurt for a few minutes but it’ll be all done soon!

3.     If they want, let them play doctor and practice giving a shot.

• My daughter loves to play doctor so our stuffed animals and sometimes our younger brother receives a lot of “check-ups” and sometimes “shots.”

4.     Let them bring a distraction or a friend to make them feel brave at the actual appointment itself.

• We brought my daughter’s favorite stuffed animal best friend, Bear Bear, because he made my daughter feel safe.
• We also had a few songs loaded on our phones in case they needed some extra help.

5.     Let them choose where they want to get the shot and also how they want to get it.

• Do they want Mommy or Daddy to hold them? Do they want to lay down by themselves?

6.     After it’s over, give them lots of hugs and love!

• Sometimes a little bribery goes a long way! Bribery can be in the form of a lollipop, a piece of candy, a new toy, or just a fun new sticker!

7.     After any vaccine, a child might run a low-grade fever (less than 100.5 F) and might have some muscle aches, so please feel free to give them Tylenol and Motrin. This will not blunt an immune response to the vaccine! 

RELATED: COVID-19 Cases Increase at Cook Children’s (checkupnewsroom.com)

As people gather and travel during the summer months, the COVID positivity rate continues to rise. The seven-day average positivity rate reported at Cook Children’s Health Care System is 21% as of Tuesday.

Many Cook Children’s primary care offices are offering COVID vaccines. Patient families can check MyChart for online scheduling options or call their pediatrician’s offices.

In June, the Centers for Disease Control and Prevention and the Food and Drug Administration cleared the way for children 6 months to 5 years old to get the COVID-19 vaccine.

Our health care providers and pediatricians at Cook Children’s strongly recommend that parents get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children.

The COVID positivity rate has slowly increased at Cook Children's.  

Rolling seven-day average positivity rate at Cook Children’s:

• May 5 - 3.5%
• May 16 - 3.3%
• June 5 - 8.4%
• June 20 - 10.6%
• July 6 - 21.6%
• July 11 - 24.5%

On July 6, there was one COVID patient in the ICU and two others in non-ICU beds at Cook Children's.

On Wednesday, Tarrant County Public Health moved the community spread level to High after 774 new COVID cases were reported in the county. 

Positive cases and hospitalizations are increasing across Texas, according to Texas Health and Human Services.

The biggest thing the community can do to help is to take precautions against COVID-19, including masking indoors, hand washing, social distancing and getting the COVID-19 vaccine and booster if eligible.

Not only will this help prevent COVID-19, but it may also prevent multisystem inflammatory syndrome in children (MIS-C), which has continued to affect kids throughout the pandemic.

It’s also important to avoid Cook Children’s urgent cares and emergency department for simple COVID-19 testing. These locations should be used for severe COVID-19 symptoms such as:

• Difficulty breathing
• Difficulty staying hydrated
•  High fever for more than four days

If you need a COVID-19 test for your child, please call your pediatrician’s office to schedule an appointment. At-home tests and community testing locations are also great options when available. Tarrant County’s website is a great resource for finding testing locations.

RELATED:

COVID Vaccine Authorized for Young Children (checkupnewsroom.com)

Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Distribution of the Pfizer-BioNTech and Moderna COVID vaccines for the youngest age group will begin this week. The CDC's Advisory Committee on Immunization Practices’ (ACIP) recommended that all children 6 months through 5 years of age should receive a COVID-19 vaccine.

This expands eligibility for vaccination to nearly 20 million additional children and means that all children ages 6 months and older are now eligible for vaccination, the CDC said.  

Parents may be wondering if they should get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children.

The COVID positivity rate has slowly increased at Cook Children's.  

The rolling seven-day average positivity rate:

• June 20: 10.6%
• June 5: 8.4%
• May 5: 3.5%

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible.

Moderna's vaccine, for children 6 months through 5 years old, is two shots spaced one month apart.

The Pfizer-BioNTech vaccine, for children 6 months through 4 years old, is three shots over the course of 11 weeks.

The vaccines are being distributed and will be available at thousands of pediatric practices, pharmacies, Federally Qualified Health Centers, local health departments, clinics and other locations, the CDC said.

Cook Children’s is currently working on its plan to distribute vaccines to pediatrician offices and will announce details regarding scheduling soon.

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, has two children, an almost 4-year-old daughter and a 20-month-old son.

“My son was exposed and tested positive when he was 10 months old. We were very fortunate because I had received my COVID vaccine when he was 8 weeks old so he had plenty of antibodies and protection from me and my immune system,” Dr. Romano said. “We escaped his illness with two days of congestion and one day of fussiness. I, unfortunately, know that not all families have been as lucky.”

“These are some of our most vulnerable patients, and being able to provide them protection against COVID will be a huge relief to so many parents, including me!” Dr. Romano said. Here are her answers to some frequently asked questions:

Why should my child get the COVID vaccine?

It is extremely important to get everyone who is eligible vaccinated.

Vaccinating against COVID is what will continue to allow everyone to return to a more normal life. 

People who are fully vaccinated are significantly less likely to spread COVID-19 because of their smaller viral load, which means a lower risk of transmission to others. That’s one of the main reasons why I’m so excited to get my children vaccinated against COVID. My father is a type-1 diabetic with rheumatoid arthritis who is immunocompromised due to his medications, and I always worry about accidentally spreading COVID to him.

Additionally, someone who is vaccinated against COVID, even if they are exposed and test positive for COVID, is at a significantly decreased risk for complications such as ICU admissions, the need for life support and death.

Here at Cook Children’s between Dec. 19, 2021 and Jan. 15, 2022, there were more than 14,800 children who tested positive for COVID at their pediatrician’s office, a Cook Children’s Urgent Care, or at the medical center. Out of 321 patients who required hospitalization, only 18 were vaccinated against COVID. Out of the 37 patients admitted to the PICU with COVID, only two were fully vaccinated. This data strongly suggests that the vaccine is effective at preventing hospitalizations and at preventing ICU admissions.

COVID vaccines also help prevent MIS-C, multisystem inflammatory syndrome in children. MIS-C is a potentially very serious complication that we see four to six weeks after a COVID infection or exposure. Out of a large cohort of 21 million vaccinated young adults, only 21 children developed MIS-C after COVID vaccination. This tells us that not only can a COVID vaccine prevent severe illness from an acute infection, but it can also prevent some of the more serious complications following COVID exposure.

COVID vaccinations also prevent long-haul symptoms such as daily headaches and persistent fatigue. Although not common, we do see COVID long-haul symptoms in a pediatric population. Patients who are fully vaccinated against COVID are 50% less likely to develop long-haul symptoms.

COVID vaccines do not affect a woman’s fertility. The American College of OB/GYN, the Society of Reproductive Endocrinology, and the Society for Maternal Fetal Medicine have recommended COVID vaccination for all women whether they are pregnant, or trying to become pregnant, or breastfeeding.

On a more practical aspect, a fully vaccinated person will also have different quarantine requirements after exposure or testing positive for COVID. As someone who lived through a 10-day quarantine, I would not recommend or want to repeat it. A fully vaccinated person can have shorter quarantine periods.

How do we know it’s safe for children 5 and under? 

Despite the name “Operation Warp Speed,” the process to investigate and certify the vaccine did not cut any corners. Throughout the vaccine development process, researchers had to follow the same procedures and regulations as if they were developing a new medicine for headaches or blood pressure.

In addition, both the Pfizer and Moderna studies have increased their sample sizes throughout the process to make sure that side effects or reactions are not being missed. Participants in the study were closely monitored.

Should parents get their children vaccinated, even if their child recently had COVID?

Children should be vaccinated even if they already had COVID. Some studies have suggested a second or a third infection can be associated with more severe disease. More severe disease could mean hospitalization, ICU admission and even death.

Some infectious disease experts recommend waiting three months after COVID infection before being vaccinated so that the vaccine has the maximum effect.

Why should my child be vaccinated if they have already had COVID?

I hear a lot of parents, neighbors and friends say that they tested positive for COVID and only had mild flu-like symptoms. However, this is not always the case. While I’m happy that your first case was mild, please know that your second infection may not be the same.

What if I live in an area with a low number of cases? 

If you live in an area with a low number of cases, please still get your vaccine. With the global nature of our world, you will have plenty of opportunities to come into contact with people who come from areas with high number of cases.

COVID vaccines can also be extremely important if you want to travel. Some countries or cruises require you and your child to be fully vaccinated before travel.

Do I have to vaccinate my baby on schedule if I am breastfeeding him/her?

After a breastfeeding mother is vaccinated against COVID-19, antibodies pass through her breast milk to her baby. Various studies have found that the 87 – 95% of babies were given immunity through their mother’s breast milk against COVID-19. If it’s been more than six months since the mother received her COVID vaccine or booster, she should consider vaccinating her baby at this time.

How soon after the vaccine will my child build immunity?

Immunity will begin after the first shot! Immunity and protection have been demonstrated in Pfizer recipients within 12 – 14 days after the first dose, but this will be very short-lived. Immunity will be more permanent two weeks after the second dose.

Are the side effects of the vaccine different for children?

The main side effects are very similar to adults. There will most likely be injection site tenderness and some muscle aches. There can be redness and swelling along the injection site. Most people report fatigue and malaise that should be resolved within 48 hours.

A very concerning side effect that we saw in young men was myocarditis. However, only saw four cases in every 1 million vaccines in children 5 – 11 years old.

How do I know if my child is eligible for the vaccine?

Children over 6 months old are now eligible for the vaccine!

There are only a few very strict contraindications to receiving the COVID vaccine. The two absolute contraindications are having a severe allergic or anaphylactic reaction to a prior COVID vaccine or a known allergy to a component in the COVID vaccine.

If you have any questions about children with known clotting disorders, heart problems, or prior neurologic processes such as Guillain-Barre Syndrome, please talk to your primary care provider. The CDC recommends that these patients can receive a COVID vaccine with proper precautions.

RELATED: 

How to Help Young Children Cope with Vaccine Anxiety (checkupnewsroom.com)

7 Reasons Why This Doctor Mom’s Kids Will Be First in Line for the COVID Vaccine (checkupnewsroom.com)

Vaccines are the best way to prevent serious illness in people of all ages, including children. Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated and booster shots as soon as they are eligible. Children ages 5 to 11 will now be eligible for the extra dose at least five months after their second shot.

This news comes after the first booster (third dose) of the Pfizer-BioNTech vaccine was approved for children ages 12 to 17.

We asked Nicholas Rister, M.D., of the Cook Children's Infectious Disease team to answer some of the top questions that parents and caregivers might have.

Why should my child get the COVID vaccine booster? 

Children are at risk to get sick from COVID-19 disease, requiring hospitalization, and in rare cases, dying from the infection.  More commonly they will get a mild infection and recover quickly, but vaccination can prevent more severe disease from developing. This is especially true for children with underlying risk factors including obesity, chronic lung disease including asthma, seizure disorders, and immunodeficiency.

How do we know it’s safe for children 5 to 11?  

A pediatric drug trial involving 140 children aged 5 – 11 years was submitted to the FDA showing high efficacy and safety.  Additionally, blood samples showed similar antibody development compared to data in older children and young adults. A large increase in antibodies that specifically target COVID-19 were observed in patients after a third dose of the vaccine, regardless of whether they had previously had COVID disease.

How long until the booster will be available for children 5 to 11?

With formal FDA approval, all children ages 5 to 11 can be offered a Pfizer vaccine. However, be sure to check with your vaccination site if they currently have the Pfizer vaccine available for these children.

If my child recently had COVID, how long should we wait to get the booster vaccine?  

There has been little in the way of formal recommendations regarding when to get booster vaccination following COVID infection. This is largely because there is tremendous variability in different individual’s infection and how robust their antibody response is. It is generally thought that after COVID infection, there is a period of 3 to 6 months during which repeat infection, especially severe infection, is unlikely. However, there is no reason that you or your child needs to wait to get the booster. Whether a booster is given immediately after recovering from the illness or a few months later, the antibody response has been excellent.

What should parents do if they have more questions?

Talk to your pediatrician. They have your child’s medical history and are the best source of information for this topic. They have the latest information available and want to help you make an informed decision.

If your child is eligible for the COVID-19 vaccine, please contact your local pediatrician's office to schedule an appointment.

Parents may be wondering if they should get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children. 

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible.

“It is important to keep our children safe now and in the future," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. "This is one way to safely protect your children AND protect people who they might expose from catching SARS-CoV-2."

We asked Dr. Whitworth to answer some of the big questions and shed a little light on the subject.

Why should my child get the COVID vaccine? 

Children are at risk to get sick from COVID-19 disease, requiring hospitalization, and in rare cases, dying from the infection.  More commonly they will get a mild infection and recover quickly. But while they are contagious they can spread this to others such as vulnerable grandparents.

How do we know it’s safe for children 5 and under?  

The children who participated in the vaccine research had no serious adverse events and we know that the FDA is extremely cautious and will review the data quite carefully before approving this.

Should parents get their children vaccinated, even if their child recently had COVID?  

Yes. Those who have been infected with this virus can get infected again. This second infection may be the same, milder, or more severe – and they are able to transmit SARS-CoV-2 to those who are more vulnerable.

What about if I live in an area with a low number of cases?  

SARS-CoV-2 will not be eradicated.  We will have this infection with us for years to come, just like influenza.  Low numbers now are something to enjoy, but we will all be exposed at some point in the future. 

What should parents do if they have more questions?

Talk to your pediatrician. They have your child’s medical history and are the best source of information for this topic. They have the latest information available and want to help you make an informed decision. 

If your child is eligible for the COVID-19 vaccine, please contact your local pediatrician's office to schedule an appointment.

RELATED: BioNTech Asks the Food and Drug Administration to Authorize COVID-19 Vaccine for Children Under 5

Spring is officially here! Along with the start of spring, allergies are starting back up again as well. However, at Cook Children’s there has been an increase in flu cases at CCHCS this past month and the cold season isn’t over just yet along with the COVID-19 pandemic.

Let’s figure out how to tell if your child has a cold, the flu, allergies or COVID-19.

Right now, your child’s sneezing, cough or fever may just scratch the surface as to which of the four it could be.

“Even though it’s spring, parents need to keep in mind some of those winter viruses are still circulating. There are a lot of respiratory viral illnesses still going around that we associate with the wintertime,” said Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Haslet Office said. “In Texas, the weather is not full on spring, it is still cold outside some days.”

Allergies

Allergies are caused by pollen and the environment.

“Allergies usually do not have any of the symptoms that viruses usually cause fever, body aches, or overall general ill feeling,” Dr. Soria-Olmos said. “Most kids with allergies are going about their normal day other than the nuance of symptoms. The overlapping makes things confusing.”

Cold, Flu or COVID?

Symptoms of the common cold, the flu and COVID are very similar. The main way to tell the difference is through testing.

Each of these is a virus that affects the body and can affect the way kids act. A fever is the most common symptom to monitor between the cold, flu and COVID-19.

Cold and flu typically come with additional symptoms such as a decrease in appetite, fatigue, chills, etc. Sometimes you can have a cold without fever. Flu typically causes an increase in temperature.

Parents of children under the age of 2, should contact their pediatrician if the fever continues for more than 48 to 72 hours. This is to help determine if the doctor should see the child and or if a parent can continue supportive care at home.

Although we have seen fewer COVID-19 cases in the community, it is still something to think about as a cause of fever, cough and nasal congestion or sore throat.  

“Testing is the main way to help us determine between different causes of similar symptoms,” Dr. Soria-Olmos said.

Dr. Soria-Olmos encourages parents to speak with their pediatrician on how to treat their child and identify the cause of their symptoms.

Texas schools received a top score for efforts to promote engagement with families and community partners. The report card also gave high marks to the Lone Star State for taking steps to help school employees recognize students at risk for mental health problems, substance use and suicide.

But the grades for Texas in several other categories – including the extent of Medicaid coverage, well-being checks and the ratio of school psychologists/counselors – came in lower. Findings were issued in February 2022 by the Hopeful Futures Campaign, made up of 17 organizations including the National Alliance on Mental Illness and UNICEF USA. 

“We urge readers to use the report cards as a starting point to spark a dialogue about what is working in their state and what policies and practices are needed to improve school mental health,” according to the introduction.

The Hopeful Futures Campaign describes its analysis as a snapshot of each state’s school mental health structures. Texas earned scores on both the high and low ends, depending on the category.

Just breathe. Open up. You matter. That’s the truth behind the Cook Children’s Joy Campaign, an ongoing rollout of information designed to raise awareness about young people struggling with their mental health. Cook Children’s kicked off the Joy Campaign one year ago in response to an alarming rise in suicide attempts locally and nationally. The Raising Joy podcast and other resources aim to equip families with key messages of resiliency. 

Opportunities for Improvement

According to the report card, staffing for mental health professionals falls short in schools across Texas:

·       1 school psychologist for every 4,962 students (recommended ratio is 1:500)

·       1 school social worker for every 13,604 students (recommended ratio is 1:250)

·       1 school counselor for every 423 students (recommended ratio is 1:250)

The report card’s point about personnel resonated with some of the experts who work every day to help North Texas children and teens.

Michelle Broadwater, assistant director of counseling services at Birdville Independent School District in Haltom City, said 10 crisis intervention counselors share duties at 33 elementary schools in her district. Those counselors are stretched thin with children dealing with trauma, anger, unregulated emotions and lack of social-emotional skills in the 2021-2022 school term, Broadwater said.  

“How to walk down the hall or how to behave in the cafeteria … our behaviors are really a challenge this year,” she said. “The counselors do a lot of putting out fires, constant fires. They’re literally running from one classroom to another.”

Students in the upper grades, Broadwater said, have increased anxiety and stress about falling behind academically due to online learning during the COVID-19 pandemic. The counselors at some BISD middle schools and high schools do as many as 10 suicide risk assessments each day.  

“They feel a little bit inadequate because they see that their students are hurting,” she said. “We talk about students, but our staff are in crisis too, and they’re struggling.”

The Birdville district recently joined the Texas Child Health Access Through Telemedicine service, which provides students with limited mental health care beyond what the school counselors can provide, at no charge. Broadwater credited the BISD Board of Trustees with recognizing the increased need.

Greg Gibbons, a licensed clinical social worker for Wise Health System in Decatur, pointed out that additional counselors on campus would allow more time to build rapport with the students.

“The relationship makes a huge difference. It’s that safe space within the school environment,” to hopefully prevent mental problems from escalating, Gibbons said. “That early intervention would be critical.”

Most of the clients he sees in his practice are elementary and middle school students from Decatur and the outlying rural areas. Gibbons cited ADHD, oppositional defiance, anxiety and depression as the most common complaints that his clients report. To get an appointment, there’s about a six-week waitlist.

Gibbons listed various efforts that could ease the crunch: peer support groups in the schools, social media campaigns to destigmatize mental illness, and more educational conversations like the Parent Cafés organized in Wise County by the Cook Children’s Center for Children’s Health, led by Cook Children’s.

He also emphasized the importance of training teachers to recognize the signs of mental illness, particularly in students who don’t stand out. “Sometimes it’s the shy kid that you don’t know is being bullied on the bus and is just trying to keep to themselves, or it’s the girl who’s hiding her cutting under her hoodie,” he said.

The report card further recommended that Texas adopt annual checks of students and staff members’ mental wellness, excused absences for mental health concerns, and expanded Medicaid coverage.

Progress and Strengths

Meanwhile, the report card gave high scores for these bright spots in Texas schools:

• Inclusion of mental health as part of the K-12 health instruction
• Anti-bullying measures
• Training the teachers to recognize and intervene when a student needs help
• The Texas Education Agency task force was established by the Legislature in 2019 to study the mental and behavioral health climate in the schools
• Policies that foster engagement with families and the community

Blair Williams, a community health analyst at the Cook Children’s Center for Children’s Health, said she heard creative problem-solving ideas from community leaders and partners who participated in our 2021 Community Health Needs Assessment (CHNA). Williams includes coalitions, healthcare systems, clinics, churches, public health experts and nonprofit organizations among the many groups that have stepped up to support schools.   

“The common thread with all of our community partners is that they genuinely want what’s best for children and families, and they’re willing to collaborate and explore partnerships in order to do that,” she said.

Williams highlighted the UNICEF Kid Power® platform as an example of a community collaboration that benefits the physical and mental health of schoolchildren. Through a partnership with Cook Children’s, the Kid Power videos are available free of charge for schools in Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise counties. The videos promote exercise and life skills such as showing respect, making new friends and resolving conflict.

The 2021 CHNA parent survey conducted last year by the Center for Children’s Health yielded data on various health questions. One finding indicated in the survey? That 1 in 3 school-aged children ages 6-17 have at least one of the most commonly diagnosed mental health conditions (ADHD, anxiety, depression or behavioral/conduct problems). Also, more than 63,000 children are going without needed mental health care in the eight-county service area around Cook Children’s.

Williams said the Center shares the CHNA data with local organizations for strategic planning and grant-writing purposes – another example of community teamwork in Fort Worth and the surrounding area. 

Schools are working diligently to address the many variables that impact a child’s mental health and mental well-being, Williams said. The incorporation of social-emotional lessons helps too, she said, built into the school culture or curriculum so that students learn ways to cope and manage their emotions. 

 “We’re all going in the right direction,” she said. “There is a heightened awareness of the mental health needs of children, and many community partners are helping to connect families with available resources in their community.”

Participants in CHNA focus groups reported the challenge of finding providers who take their insurance, or sometimes difficulty with transportation to the appointments. Williams says those barriers make the schools a key location for delivery of mental health services. “Having those resources in the school is a protective factor for child mental health.”

Morgan was born with a very rare and life-threatening condition called Maple Syrup Urine Disease (MSUD). Because of this metabolic disorder, Morgan’s body lacks the enzymes necessary to break down amino acids found in protein. Those amino acids build up, become toxic and cause severe health issues.

Catching COVID-19 could land Morgan in the hospital or cause life-threatening complications. It was a risk his mother wanted to minimize, so when the COVID-19 vaccine became available Sonji jumped at the chance to get vaccinated. After speaking with Morgan’s physician, she wanted the same for him and his brother. But getting Morgan out of the house is a daunting task. He is developmentally delayed, wheelchair dependent and relies on a feeding tube for nutrition. On top of that, Sonji worried about the potential exposure to the virus while out in public to get the vaccine. She found herself in a Catch-22.

Then came a call from the Gentry twins’ insurance provider — Cook Children’s Health Plan (CCHP). The health plan offered to have the COVID-19 vaccine delivered and given to Morgan and Hayden in their home thanks to a unique partnership between CCHP and MedStar, a Tarrant County emergency medical services (EMS) agency.

The partnership is the result of a simple ask.

“I’m trying to sort out options on how to provide COVID vaccinations to our homebound members. Might MedStar be able to assist?” read a text message from Kimberly Aaron, M.D., to her long-time colleague Matt Zavadsky.

Dr. Aaron is the vice president of clinical affairs at CCHP and Zavadsky is the chief transformation officer for MedStar. The two have a history of working together within their various roles in the health care industry.

Zavadsky responded with a quick yes and, within minutes, that single text put into motion a partnership between the two organizations to offer medically fragile and homebound children access to the COVID-19 vaccine without ever having to leave their home.

The program is a unique one, according to Zavadsky.

“I'm pretty well plugged in nationally in EMS circles and this isn't happening in most communities,” he said. “This type of innovation is what Cook Children’s is known for.”

The program targets CCHP STAR Kids members who are either ventilator dependent or technology-dependent for continuous feedings or other medications.

“It’s hard for a child dependent on this type of technology to get out and go to a pharmacy to get a vaccine,” Dr. Aaron explained. “It’s just too cumbersome.”

There’s the issue of exposure, too. These families often do not elect to leave their home for anything other than visits with their health providers because medically complex children are at high risk for severe disease when exposed to any virus, not just COVID-19.

“We wanted to see what we could do to remove these barriers, such that the only barrier was whether or not the family was comfortable getting the vaccine for the child,” Dr. Aaron said.

That’s where MedStar comes in. The nature of their business makes MedStar uniquely suited to help CCHP get vaccinations to their homebound members. After all, who better to take health care to the home front than those who already do it every day?

“We’re used to working in a mobile environment and inside people’s homes,” Zavadsky said. “It’s what we do. It’s a natural fit for us to go into the community and provide medical care.”

Most people know MedStar, especially families with homebound children who have likely had an experience with the agency responding to an emergency call at their residence. They’re a familiar and trusted community service. That trust goes a long way when opening the door to someone offering your child a vaccine.

MedStar is also an authorized vaccine provider. This gives the agency ample access to free vaccine materials directly from the federal government, which means no vaccine cost is passed on to CCHP or its members. Not all EMS agencies in the country have this authorization.

The process is simple. CCHP identifies qualifying members according to their medical condition and makes initial contact with the family to see if they are interested in the service. If yes, CCHP notifies the child’s primary care physician that the family has opted in to receive the vaccination at home. MedStar then makes contact with the family to schedule the home visit where emergency medical technicians (EMTs) administer the vaccine to the child and any other household members, like parents and siblings, who want it. MedStar administered both rounds of Morgan and Hayden’s vaccination and boosted their mom and dad.

The health plan reimburses MedStar for the administration of the vaccine, so it’s all done at no cost to CCHP members. The service is completed by EMTs who wish to pick up extra shifts. No personnel or MedStar units are taken out of normal daily service to make home vaccination visits.

MedStar administered the first in-home vaccination on Dec. 22, for a total of 16 to date.

“For every member we vaccinate, we feel like it’s worth the effort to do our best to make sure these families and their children have access to the vaccine in a way that doesn’t further marginalize them in terms of their ability to get that protection,” Dr. Aaron said.

Response to the program has been positive.

“I love it,” Sonji said. “We don't have to wait in lines. We don't have to be standing or sitting around other people. We get to stay in the privacy of our home. It was very convenient.”

Like the Gentrys, other families participating in the program are grateful for CCHP’s efforts to bring the vaccine to their doorstep and for MedStar going above and beyond to vaccinate other members of the household.

“These families are so appreciative,” Zavadsky said. “In many cases, I've heard from the EMTs that have gone out and given the vaccine that the families are shocked that CCHP would make this arrangement to have someone from MedStar come to their house and do preventive care. They're so used to seeing us when somebody is hurt or having trouble breathing or has an allergic reaction. The fact that we're coming out and doing something that will prevent a 911 call, I think it's like the best partnership ever.”

The CDC recommends a longer interval between the first and second dose for people 12 and up, and recommends a shorter interval for fourth doses for the immunocompromised population.

The CDC emphasized that COVID-19 vaccines have been a critical tool in this pandemic, preventing millions of COVID-19 associated hospitalizations and deaths. To date, hundreds of millions of doses of mRNA COVID-19 vaccines have been given with over a year of closely monitored real-world safety and effectiveness data, the CDC said.

There are known cases of myocarditis in a small number of people ages 18-39 believed due to the mRNA vaccines. Per million second doses administered, 33 cases were reported for Moderna and 24 for Pfizer, according to the CDC. 

Second Dose Recommendations

Recent studies revealed that rates of myocarditis/pericarditis were lower with extended interval between first and second dose of mRNA vaccine primary series.  Extended primary series interval may also improve immunogenicity and vaccine effectiveness. 

Because of this, an eight-week interval for second doses may be optimal for some people ages 12 years and older, especially for males ages 12 to 39 years old, the CDC said.

“In a very tiny number of young people, especially males age 12-39, COVID mRNA vaccines can cause a mild inflammation of the heart muscle," says Pediatrician Diane Arnaout, M.D., of Cook Children’s Pediatrics Forest Park. "This is called myocarditis, and just means that the immune system got really worked up really quickly. Thanks to the ongoing and constant safety studies done on vaccines, this small tweak to the regimen will likely mean less incidents of an already rare problem.”

The CDC still recommends the shorter second-dose interval for people who are moderately or severely immunocompromised; adults 65 years and older; and others who need rapid protection due to increased concern about community transmission or risk of severe disease. That interval is three weeks for Pfizer-BioNTech and 4 weeks for Moderna after receiving your first dose.

The shorter interval is still recommended for:

• People who are at higher risk of having an inadequate response to the first mRNA vaccine dose 
• People who are moderately or severely immunocompromised
• Are at higher risk for severe COVID-19
• Adults ages 65 years and older
• Need rapid protection, such as during high levels of community transmission
• Children ages 5–11 years 

4th Booster Shots for Immunocompromised

People who are moderately or severely immunocompromised should receive a booster dose at least three months after the last (third) dose of an mRNA COVID-19 vaccine, the CDC said this week.  Previously recommendations were set for at least five months.

RELATED: COVID-19 Vaccination for Children 5 to 11: Your Questions Answered (checkupnewsroom.com)

UPDATE

The Food and Drug Administration now says it will wait for Pfizer and its partner, BioNTech, to release data on how well three doses of the vaccine works for children under 5.

The reversal by federal regulators was announced Friday, Feb. 11, after Pfizer-BioNTech requested the delay. The companies said new data from clinical trials showed a higher rate of infection with the omicron variant than previously recorded, highlighting the fact that two doses of the vaccine for this age group were not enough.

For families, this means the COVID-19 vaccine will not be available for this age group until later this spring, possibly April.  

You’ve probably heard the news about Pfizer and its partner, BioNTech, asking the Food and Drug Administration to authorize its COVID-19 vaccine for children under 5. This has raised a lot of questions for parents, and maybe even a little confusion. We asked Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, to answer some of the big questions and shed a little light on the subject.

What is going on with the COVID-19 vaccine for children under the age of 5?

In early February, Pfizer asked the FDA to authorize two doses of their coronavirus vaccine for this age group. This created some confusion because the drug company released a statement in December stating that two doses did not produce the immune response they hoped for in clinical trials of children 2 to 4 years old. I think some people took that to mean the vaccine does not work for this age group, which is not the case. It means children ages 2 to 4 may need a third dose of the vaccine, but that research is still underway.

What’s the difference in the doses for this age group compared to older children and adults?

The dose for children under 5 is much lower than what’s authorized for older kids and adults. Pfizer has been testing 3 microgram doses for this age group while kids 5-11, have been authorized to receive 10 microgram doses. The dose for 12 and up (including adults) is 30 micrograms.

What’s the risk of my child developing myocarditis after receiving the COVID-19 vaccine?

We’re still waiting for the FDA to release their findings, but studies have proven that COVID-19 infection is more likely to cause myocarditis than Pfizer’s COVID-19 vaccine. Many viruses, including the common cold, can cause myocarditis, which is the inflammation of the heart muscle. Most cases, especially in children, are mild. The risk of complications from COVID-19 infection far outweighs the risk of myocarditis from the vaccine. 

What should parents do if they have more questions?

Talk to your pediatrician. They have your child’s medical history and are the best source of information for this topic. They have the latest information available and want to help you make an informed decision. 

That’s why your pediatrician might be recommending that patients with croup get COVID-19 tested to find out whether the SARS-CoV-2 virus caused the illness.  

“Not every child with croup has COVID, but we have to have a high suspicion given the surge” of the omicron variant, said Bianka Soria-Olmos, D.O., with Cook Children’s Pediatrics Haslet. “Croup is around; that is common during the winter months. But the new association with COVID-19 has recently been described. Pediatricians are on heightened alert.”

Croup is an airway inflammation often caused by a parainfluenza virus. It’s a common illness from ages six months to 5 years, and it usually can be treated at home. Dr. Soria-Olmos said some of her patients with the croup cough have been testing positive for COVID-19. 

Parainfluenza or COVID-19? Why does it matter which virus causes the croup? Because doctors say parents need to isolate and watch for other symptoms if their child has COVID-19. As of Thursday, 40 patients were being treated for COVID-19 at Cook Children’s Medical Center, including nine patients in the pediatric intensive care unit. At the peak in mid-January 2022, more patients were hospitalized with COVID-19 at Cook Children’s than at any point of the pandemic.

Dr. Soria-Olmos said croup tends to affect young children because of their smaller airways. The 4 and under age group, for now, remains ineligible for COVID-19 vaccines. 

As the omicron variant spread, media reports in recent weeks have cited a link between COVID-19 and croup. One explanation could be that omicron is believed to settle higher in the respiratory tract.

“It sounds like omicron is doing this where the other variants weren’t presenting in that fashion,” she said. “In my mind it’s COVID croup versus the old-fashioned croup. I cannot tell the difference between the two by examining the child. The only way to tell the difference is by testing.”

What strikes Dr. Soria-Olmos about recent cases among her young patients isn’t the amount of croup but the positive COVID-19 test results. She urges parents to seek out COVID-19 testing if their child starts with the distinctive barky cough.

 “Knowledge is power. Identifying the cause really does help in the situation that we’re living in right now. Hopefully that will persuade people to know that testing isn’t a bad thing. It’s one of the tools we have to start flattening the COVID positive case curve.”

Like Dr. Soria-Olmos, Todd Johnson, M.D., at the new Cook Children’s Pediatrics Allen has treated children whose croup turned out to be a COVID-19 infection. He also recommends a COVID-19 test for croupy children so that the parents can better anticipate what to expect if the test turns out positive. 

“Then they’re able to know, ‘How long do I have to stay home? How long do I have to stay out of work? How long do I avoid family members who might have complex medical issues?’”

 Some of COVID-19’s symptoms might look like croup – but with the potential for other ailments too, such as vomiting, diarrhea, body aches, sore throat, prolonged fever and loss of taste and smell. Recovering from COVID-19 can take longer than getting over typical croup, Dr. Johnson pointed out.

The father of seven children, Dr. Johnson knows firsthand how scary the barky or seal-like cough seems to a parent. He explained that croup causes inflammation in the soft tissue below the vocal cords.

“When that swelling happens, it narrows the airway to the point that makes that musical sound of the high-pitched whistle during the day, and that really barky cough at night.”

The daytime fever, dry cough and runny nose that’s characteristic of mild croup can be treated conservatively with over-the-counter medications.  Although a barky cough at night is typical of mild croup in young children, Dr. Johnson recommended they be evaluated by their pediatrician.  One dose of an oral steroid given at the time of their visit will help reduce the airway swelling, alleviate the nighttime cough and lead to a smoother recovery. 

“Whether it’s croup related to parainfluenza or the omicron or the delta variant, the children still need to be hydrated. With the fevers, they tend lose more fluids. They need fever reducers if the fever’s high and they’re irritable and not drinking and eating as well,” he advised.

Meanwhile, children with stridor (the whistly sound on an inhale) or a barky cough during the daytime, difficulty breathing, abnormal drooling or severe agitation need to be seen urgently, Dr. Johnson said.  An urgent care or ER physician may recommend closer monitoring and potentially an inhaled treatment that can only be administered in a health care setting.

Watch the videos here: 

In a Zoom call with about 20 local reporters this afternoon, Chief Nursing Officer Cheryl Petersen said the situation is nearing crisis level.

“We are at capacity and have been running at capacity for weeks,” Petersen said. “Just because COVID came doesn’t mean that we don’t have other routine hospitalizations and winter illnesses. We’re balancing our admission process and working to provide the best placement for all of our patients.”

The silver lining with the omicron surge is the fact that most children hospitalized with COVID-19 right now do not require critical care. Of the 69 COVID-19 patients, six are in the pediatric intensive care unit (PICU). However, the strain on the health care system is increasing.

In addition to high numbers of hospitalized patients, Cook Children’s Emergency Department and six urgent care locations are experiencing high volumes. Yesterday, 443 children were seen in the emergency room and 1,027 visited the urgent cares.

This high volume also comes as Cook Children’s staff struggle to avoid exposure and isolation from the virus. Currently, 165 employees are out due to positive COVID-19 tests. Although the health care system has more than 7,500 employees, the impact is still noticeable.

“It is similar to what our colleagues are seeing in other hospital systems,” Petersen said. “And that means that somebody else has to do the work. That means that I have managers staffing and, and I bless them and thank them for that.”

She describes the state of the staff at Cook Children’s as “weary beyond words.” 

The biggest thing the community can do to help is to take precautions against COVID-19, including masking, hand washing and getting the COVID-19 vaccine and booster if eligible. Not only will this help prevent COVID-19, but it may also prevent multisystem inflammatory syndrome in children (MIS-C), which has continued to affect kids throughout the pandemic.

“Those children are sick. They are presenting with a multitude of inflammatory symptoms, cardiac arrhythmia and blood clotting issues and require a lot of multidisciplinary care to get them back on the road to recovery,” Petersen says.

It’s also important to avoid Cook Children’s urgent cares and emergency department for simple COVID-19 testing. These locations should be used for severe COVID-19 symptoms such as:

·         Difficulty breathing

·         Difficulty staying hydrated

·         A high fever for more than four days

If you need a COVID-19 test for your child, please call your pediatrician’s office to schedule an appointment. At-home tests and community testing locations are also great options when available. Tarrant County’s website is a great resource for finding testing locations.

Bianka Soria-Olmos, D.O., a pediatrician at Cook Children’s Pediatrics in Haslet, says one difference she's seeing with the latest surge is symptoms resembling croup. 

“They're having upper respiratory symptoms and that signature barking cough,” she said.  “That's different from the lower respiratory symptoms we saw with delta.” 

Dr. Soria-Olmos encourages families to call their child’s doctor if they are concerned. She also says at-home tests, if you can find them, are reliable.

“One thing parents tend to worry about it at-home tests and whether or not they are valid,” said Dr. Soria-Olmos. “If you get a positive result on an at-home test, trust it. You do not need to re-test. However, if you receive a negative result on an at-home test, you need to test again in 48 hours.”

Dr. Soria-Olmos says parents shouldn’t worry too much about a child testing positive, as most children recovery quickly from COVID-19. She encourages everyone to follow guidance from the Centers for Disease Control and Prevention (CDC) which includes isolating for five days and wearing a mask for an additional five days.

As for how long this current surge will last, only time will tell.

“What I am hearing from the epidemiologists is that we will not peak for another three to four weeks,” Petersen said. “Unfortunately, if that holds true, I’ll be coming back to you to say we have a higher number of patients.”

Her mom, Hillary Richard, was concerned, but not overly. She kept an eye on her eldest daughter and monitored her condition. Haylee didn’t have a high fever and the pulse oximeter readings showed her oxygen saturation levels within normal range.

In fact, on Sept. 18, which was the seventh day of being sick, Haylee appeared on the mend, even requesting her favorite Chinese food for dinner. But, without warning, that rapidly changed.

When Hillary went to bed that night, Haylee was asleep, she says. Her daughter had taken a few bites of dinner, but she figured Haylee would wake up to finish it sometime later. But “she took a dive overnight,” Hillary says, adding “she went from OK to not—fast.”

She began feeling weird during the night, Haylee says, and couldn’t sleep. She propped herself up with a mountain of pillows trying to get comfortable. Intense pressure on her chest and lungs made it tough to breathe. She started coughing up bloody phlegm. She checked her oximeter through the night and saw the numbers going down each time. But she was too out-of-it to let her parents—who were sleeping one room over—know how she felt.

“I didn’t really realize what was going on, so I’d try to nod off back to sleep,” Haylee says. “I wasn’t fully present.”

When her mom checked on her the next morning, Haylee didn’t look right. She was extremely pale, Hillary says, and when she checked her oxygen saturation level, it had plummeted to a dangerous 38%. (The normal range is 95% to 100%, and anything under 90% is considered low.)

Her mother immediately called 911 and EMTs arrived within a few minutes. They put Haylee on oxygen and took her by ambulance to the Emergency Department of a local hospital. There, it was determined she had severe Covid-19 pneumonia and needed to be transported to a children’s hospital right away.

At first, they couldn’t find an available bed for her, Hillary says, until Cook Children’s Medical Center offered one. Hillary jumped at it and agreed to a helicopter transport. She wasn’t allowed to accompany Haylee but saw her off, crying as she watched the helicopter take flight with her child inside.

“That’s when it really started sinking in for me,” Hillary says, still emotional as she describes the beginning of Haylee’s battle with COVID-19. “Seeing her take off in that helicopter, and I couldn’t be with her? That was hard, you know? That’s my baby.”

Still in her pajamas, she and her husband, Keith, rushed home, threw some clothes in a bag, jumped back in their truck and barreled toward Fort Worth, the longest most “excruciating ride” she’d ever taken, she says. But the ride ahead was about to become even more rough for her and her family.

Not what a parent wants to hear

Inside the helicopter, Haylee knew her condition wasn’t good, she says, but didn’t grasp the gravity of it. She played on her phone, texting a friend a selfie with the message: “Guess where I am?” Her friend responded, asking what was happening, but Haylee wouldn’t be able to answer that text until almost two weeks later.

“I barely remember anything after arriving on the helicopter,” she says. “I couldn’t stand on my own. I was very weak. My body had kind of given out on me, and the nurses were having to help me into bed. And that’s the last thing I remember.”

Ryan Meyer, M.D., a pediatric intensivist at Cook Children’s, says Haylee was hypoxic (low oxygen levels in the blood) when she arrived. She was put on a BiPAP mask, a noninvasive machine used to oxygenate the blood, and placed in the Intensive Care Unit (ICU).

Initially, Haylee responded to the noninvasive measure, but less than 24 hours later, she began worsening, Dr. Meyer says.

“We take these things one hour at a time, one day at a time. And unfortunately, there came a point when noninvasive therapy was no longer sufficient for her,” he says. “We noticed her breathing was worsening, air movement on her lung exam was worsening and her CO2, meaning her ability to ventilate, was also worsening. Everything continued to decline, including her oxygen saturation.”

Physicians needed to intubate her and put her on a ventilator. But Hillary and her husband initially refused to intubate their daughter.

“You hear the horror stories about people with COVID being intubated and never coming off the ventilator,” she says. “That doctor looked at me and said, ‘Ms. Richard, Haylee’s really sick. If we don’t do this right now, she only has a 10% chance of making it.’

“Wow. I lost it. I just looked at him and said, ‘Save my baby. Please, save my baby,’” she says.

Despite the ventilator, Haylee’s condition continued to wane. In less than an hour, doctors decided she needed to be placed on extracorporeal membrane oxygenation (ECMO), a machine that allows patients’ blood to flow out through a tube into an oxygenator before flowing back into the body, similar to a heart-lung bypass machine used in open-heart surgery.

“Unfortunately, even after she was intubated, there was still great difficulty keeping her oxygen saturation levels at a satisfactory level,” Dr. Meyer says. “We’re not even talking about keeping them in the 90s—we’re talking about keeping them in the 80s.”

Her lungs had gotten too sick to support her oxygen needs, Dr. Meyer says.

“We see this in our teenagers who do wind up being intubated,” he adds. “They have very poor air movement, oftentimes they have white-out of their lungs, and are difficult to manage on a mechanical vent support, even on maximum settings.”

Before her daughter was put on the ventilator, doctors had mentioned the ECMO machine as another possibility if needed, Hillary says. But, in her mind, it was a last resort. Watching Haylee on the ventilator, taking note that her numbers weren’t improving, Hillary knew her daughter was in trouble, she says. Haylee’s respiratory rate remained at about 44 to 48 breaths per minute, she says, more than double the rate it should have been.

She and her husband were taken into a consultation room where a chaplain was waiting to pray with them. The doctor came in, telling them the ventilator wasn’t helping Haylee. They wanted to move forward with ECMO, she says.

“At that point, it’s whatever it takes to save my kid,” Hillary recalls. “He told us there was still only a 40% chance she’d even survive. Those were the worst odds. No parent wants to hear that.”

Eight Long Days

The first few days on ECMO her daughter’s condition remained touch-and-go, Hillary says, adding “she didn’t immediately improve.”

In fact, her daughter started swelling, which scared her. Haylee had an allergy wrist band on, and Hillary would stick her fingers between the band and her daughter’s skin to monitor the swelling.

“I started out with two fingers. It got to where my one finger would barely fit in there,” she says.

Helplessly waiting, Hillary and her husband found themselves staring for hours on end at Haylee and the blinking numbers on the machines connected to their daughter. They slept little and prayed a lot, she says. The doctors prepared them with the possibility Haylee could be on ECMO for six weeks or six months. No one knew for sure.

Hillary fretted over what Haylee might be feeling. They had sedated her daughter, “but they told us she could still hear us,” Hillary says.

“And if she could hear us, I worried about what was going on in her head—was she scared? I didn’t want her to be scared,” she says, even though as a mom, she was terrified seeing her child so ill.

On Day Five a bit of bright news came to the Richard family. An X-ray of Haylee’s lungs showed minor improvement. They shared the hopeful results to their “army” of family and friends who’d been supporting them since Haylee’s hospitalization.

“It felt so good to share some good news,” Hillary says. “So many people were concerned about her and were there for us. We had an army—and we still do.”

On Day Six, another good report came in. The top of Haylee’s lungs opened up. The next day, the left side started opening, Hillary says. The following day, after an X-ray showed her lungs partially cleared, doctors decided to take her off of ECMO.

Haylee stayed on ECMO for eight days—the “longest eight days I’ve ever lived,” Hillary says, adding her daughter stayed on a ventilator another two days after that. She was on ECMO for a shorter period than most patients, Hillary says.

“When they first took out the ventilator, she was able to whisper,” Hillary says. “I will never forget walking into her ICU room, and she says, ‘Hi, Mom.’ And it was like the day she was born all over again, you know. It was the most beautiful sound. I could have had a heaven full of angels singing to me at that point, just to hear her little voice again.”

Hearing Haylee’s voice “gave me that, ‘OK, we’re going to get through this. My baby girl is back,’” she adds.

She attributes Haylee’s recovery to Cook Children’s doctors, nurses, technicians—all who helped during one of her darkest times as a parent.

“They were amazing,” Hillary says. “They made us feel comforted in a time when it was hard to feel good about anything.”

Although Haylee was on the mend, their troubles weren’t entirely over. The medications Haylee received caused side effects, and her blood pressure and blood sugar had to be constantly monitored, Hillary says, but it was so much better than where they’d started out.

The Richard family wasn’t the only ones thrilled to see Haylee off of ECMO. The nursing and medical staff were as well, Dr. Meyer says.

“Haylee was definitely one of our more severe cases. Anyone who goes on ECMO is considered quite ill. You always worry once they’re going on ECMO—is this somebody who’s going to leave the hospital alive?” Dr. Meyer says. “It was exciting to be part of seeing her slowly, every day, get a little bit better, to the point we were able to actually begin trailing her off, then remove the tubes.”

“These times, for any family, are extremely crushing. This is a family who was very supportive of the nursing staff and the medical staff. That was greatly appreciated,” he says. “We’re very thankful that she had the outcome she did. Quite honestly, we feel blessed.”

Here Comes the Sun

Haylee doesn’t remember much about the earlier days of her hospital stay using a BiPAP mask or when she was placed on a ventilator and then ECMO. Most of the time, she was dreaming in “la la land,” she jokes. But it pains her to know her family and friends suffered through it.

“Hearing this, it’s heartbreaking. Even though it’s not my fault, I felt bad about it,” she says. “And I’ve apologized because it’s a hard thing for other people to see. I can’t begin to imagine what my parents and my sister (Bella, 12) went through this entire time.”

She does remember first waking up after they took her off the ECMO machine. Haylee couldn’t speak because she was still intubated on a ventilator, but she was able to write on a whiteboard.

“I was confused—I don’t think I was afraid,” she says. “I had no idea what was going on past showing up at Cook Children’s. Once I found out what had happened and how long it had been, I was grateful—I really was. And I was happy.”

She also recalls a few days later when she left the ICU and moved into Cook Children’s COVID unit. She felt like she hadn’t seen sunlight in days, she says.

“So, when they pushed my bed into the regular room, I looked out the window, and there was the sun, and I started crying,” Haylee says with a smile. “I was overwhelmed and happy just to see the sun.”

She was released Oct. 5 and the family celebrated by staying overnight in Fort Worth. The next morning, they went to a mall as an outing for Haylee, who was in a wheelchair. While in one of the stores she wanted to visit, she had “an odd spell” in which she giggled involuntarily, found it difficult to form words and her heart raced. The employees called an ambulance, but the spell passed, and she felt fine. The family headed home.

Back in Denison, they took Haylee into the house to see her grandma. About 30 minutes later, the teen lay on the floor in the throes of a full seizure. The family called 911 and landed at the local hospital Emergency Department before Hillary requested her daughter be sent back to Cook Children’s. Hillary again found herself watching medical personnel put Haylee on a helicopter bound for Fort Worth.

“But that time I knew she was headed for the right place, and no matter what was going on, they were going to help her. I didn’t want anybody else taking care of her because they were so good to us and so good to her,” Hillary says. “She wouldn’t be here today if it weren’t for Cook Children’s. It’s hard to say out loud, but it’s the truth.”

After three days of testing, Haylee was released. Everything checked out, Hillary says, although they don’t know exactly what caused her daughter’s seizure that day.

Haylee continues to recover, attending physical therapy and catching up with school work online. She sometimes gets overwhelmed mentally, she says, but feels good physically. She hopes to go back to school in-person in the spring and is preparing for the role of Cruella de Vil in her high school theatre’s upcoming musical production of “101 Dalmatians.”

She tries to see the good that came from her near-fatal brush with COVID.

“I wouldn’t be the person I am today if I hadn’t gone through that because it changed me,” Haylee says. “I’ve become a lot more thankful and grateful for everything in life, even the little things, like what I said about the sun. You don’t realize that you take those things for granted. The smallest things—showers, the sun, being able to stand, being able to see your family. It’s life-changing.”

Lessons Learned, A Story to Share

While Hillary is thankful all turned out well, she still feels bad for not letting her daughter get vaccinated even though she had begged her.

“There were a lot of ‘I told you so’s when she woke up,” Hillary says.  “We were scared as parents. There was so much mixed information, and it’s hard to know what is real and what is not. You go through that mind-frame of it’s not going to happen to us—it can’t happen to us. And then it did.”

While Haylee was in the hospital, Hillary says, she mentally beat herself up for not giving her the vaccine and not educating herself about it.

 “You don’t realize how bad it is until you’re in that situation. And then it hits you, and it’s terrifying,” she says. “Your job as a parent is to watch out for your kid and to take care of them and keep them away from harm, and I didn’t feel like I had done that. I felt responsible for her being in that bed.”

Since Haylee is now cleared to receive the vaccine, Hillary and her daughters plan to get vaccinated together at the girls’ upcoming doctor’s appointment on Jan. 7, she says.

Dr. Meyer says he’s a proponent of “getting teenagers vaccinated, especially if they have any other medical conditions, such as diabetes, cardiac conditions, asthma, things of that nature.”

“Even if you have an otherwise healthy teenager, I’m still a fan of getting vaccinated,” he says. “I don’t want to see you in our ICU. I don’t want to have to care for you here. We know now vaccinations are quite safe and very effective.”

Both Hillary and Haylee wanted to share their family’s story to give hope to others who may be facing a COVID hospitalization as parents or as patients. And perhaps their story will help others avoid what happened to them, Hillary says, so some good can come from it.

Hillary also wants other parents to know COVID is a real thing.

“It’s still out there,” she says. “I was the person that it would never happen to—and then it did. I want other people who feel that way to see our story and realize they need to be careful. They need to wear their masks. Use sanitizer. And get the vaccine.”

“You don’t want to go through what Haylee went through,” Hillary adds. “Nobody should have to go through that from a patient’s standpoint or a parent’s either.”

Mixed emotions including frustration, worry and anxiousness (to name a few) fill my being yet again on the eve of the day my kids return back to school. It is no longer a new experience for me or the many other parents who have experienced the same feelings over the last 22 months.

 The significant positivity rate in our community and the marked rapid increase in the pediatric cases and pediatric hospitalizations in the last week and a half (all while kids are out of school) is what causes some of my angst. Unfortunately, now it is not too uncommon to hear situations in which people “did all the right things” but COVID still veered its way in. So while I have been able to shield and protect my own children from being infected during the pandemic so far, I fear that the time will come when the inevitable will happen to my own. What’s different now?

 In the midst of all these emotions, I look for the silver lining in our current situation. My kids are NOW vaccinated! Although we are well aware that even fully vaccinated people are susceptible to infection they are less likely to develop severe disease and the need for hospitalization. So in the midst of the mixed emotions I have come to the point of realization and acceptance that this time around I will not likely be able to shield my own children from becoming infected with the current COVID omicron variant.

 The current significant community positivity rate makes exposure and subsequent infection while attending school more likely in the era of optional masking and confusion regarding isolation/quarantine recommendations. In the midst of an ongoing roller coaster of emotions, I will hold on to what I can control and continue to practice and encourage my own children to practice preventive precautions as best we can, including vaccination (done), hand washing and mask-wearing.

 I make the same recommendations to my own patients and their families including the following disease prevention strategies:

• Eat a balanced diet and exercise regularly
• Get plenty of sleep
• Drink plenty of water
• Do not send sick children to school (regardless of COVID exposures or not). Keeping sick children home is the best way to prevent spread in the school setting. 
• Get yourself/or your child tested if you/they develop any symptoms of COVID-19. Testing and identifying infections and subsequent proper isolation practices will prevent further spread.
• Get vaccinated if you haven't already and get a booster if you or your child are eligible (primary series approved for 5 years old and up, boosters approved from 16 and up and anticipating approval for 12-15 year olds soon).
• Practice good hand hygiene, wear a mask and avoid large crowds.

 Given the ongoing change and updates to guidance regarding isolation/quarantine guidelines for different populations of the community, we know that navigating these situations can become confusing and overwhelming. For questions regarding testing, length of quarantine or isolation, and the COVID-19 vaccine for your child, please ask your pediatrician for guidance.

 Wishing you a Happy and Healthy New Year!

Dr. Soria-Olmos

Get to know Bianka Soria-Olmos, D.O.

Dr. Soria-Olmos is a Cook Children's pediatrician in Haslet. She was born and raised in Fort Worth, Texas, so Cook Children's has always had a special place in her heart. She came to know Cook Children's when she was just a kid herself. She went to the medical center a number of times with her active younger brother, who needed care following several mishaps with broken bones. The visits inspired her to decide, "I want to be a Cook Children’s doctor one day."

In pursuit of her dream, Dr. Soria-Olmos attended Texas Christian University (TCU) for a degree in biology and to fulfill the pre-medical school requirements. After graduating from TCU, she chose to stay local and attended medical school at the University of North Texas Health Science Center/Texas College of Osteopathic Medicine in Fort Worth. She completed part of her pediatric clerkship at Cook Children's, learning about pediatric medicine by attending rounds with pediatric hospitalists. It was then she knew she wanted to be a pediatrician.

She began her career with Cook Children's in 2014 as a pediatric hospitalist caring for sick children admitted to the hospital. Today, she works at Cook Children's primary care office in Haslet. Her special interests include child safety, child development and asthma.

Positive cases now account for 31% of tests throughout Cook Children’s Health Care System, about 600 a day. It’s the highest number seen at Cook Children’s since the pandemic began in March 2020 and surpassing the height of the delta surge in September. As of Tuesday, 33 patients were hospitalized, with three being treated in the Pediatric Intensive Care Unit (PICU).

The latest explosion in COVID-19 cases may be fueled by both the omicron and delta variants at work, according to a report released last week by the Centers for Disease Control and Prevention (CDC). As of the week ending Dec. 25, omicron appeared as the dominant variant, but the delta variant still comprised roughly 40% of reported cases, the report states.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, was interviewed on “CBS Mornings” this week. She says the hospital’s pediatricians and clinics have seen children and teens of all ages testing positive.

“It’s really anywhere on the spectrum,” she says of the recent spike. “We’ve had some babies who were only a few weeks old.”

Other children’s hospitals in Texas and across the country have seen a similar uptick in sick children overwhelming the health care system. More than 325,000 positive cases were reported during the week ending Dec. 30, the American Academy of Pediatrics reported, adding it was the nation’s highest increase in child COVID cases since the pandemic began. The unprecedented number represents a 64% jump from reported cases the previous week.

Top health officials in the country have voiced predictions that a surge may continue as a result of holiday gatherings and vacations but expect it to peak by the end of January based on how the omicron variant behaved in South Africa last month.

With numbers of child cases still on the rise, parents are grappling to address all things COVID. Here’s what families need to know:

How can you tell the difference between COVID and the common cold or the flu? Basically, it’s tough to distinguish between them.

Similar to a cold, the most common symptoms of the omicron variant (found to be much more transmissible) are sore throat, cough, fatigue, congestion and runny nose. The delta variant (thought to cause more severe illness) also generally presents with common cold-like symptoms, such as cough, fever or headache, but also may cause a significant loss of smell.

To complicate matters, COVID-19 also shares some common symptoms with the flu, according to the CDC. Both can show a wide-range of symptoms, including sore throat; fever and chills; headache; cough; shortness of breath or difficulty breathing; fatigue; runny or stuffy nose; body or muscle aches; vomiting and diarrhea; and a change or loss of taste or smell, though that appears more prevalent in COVID.

Since it can be difficult to distinguish between the cause of these symptoms, a test is the best way to determine what it is. COVID testing can be done at home (although tests may be difficult to find right now), at a laboratory or at a test site provided in your area.

 “At this point, it’s probably best to assume you are positive until you are proven otherwise,” says Marc Mazade, M.D., director of Infection Control at Cook Children’s. If family members are having symptoms, they should get tested as soon as possible, which may take longer than usual.

See the CDC website for additional guidelines on who and when someone should get tested.

 Are vaccines the best way to keep my kids from getting seriously ill with COVID-19?

Yes. As it stands, COVID-19 vaccinations are highly effective at preventing severe illness, hospitalizations and death, the CDC reports. And the emergence of the highly contagious variant omicron and its ability for breakthrough infections further emphasizes the importance of vaccination and boosters, the report states.

Children ages 5 and up are eligible for COVID-19 vaccines. This week the Federal Drug Administration (FDA) approved an additional Pfizer booster shot for children ages 12-15, and an additional dose for certain children ages 5-11 if they are immunocompromised.

Cook Children’s pediatrician Diane Arnaout, M.D., encourages eligible children to get COVID-19 vaccines and boosters.

“Don’t let the number of shots worry you,” she says to parents who may have concerns. “There are lots of vaccines that require boosters, and I give them to your kids throughout their early years at timed intervals to make sure they’re protected into adulthood.”

The second, third and fourth shots do what their name says, Dr. Arnaout says. They boost the antibody response to a certain antigen and assure a large portion of the population develops immunity, she says.

“Some shots give us long-term immunity with just two doses and others with five. It just depends on the nature of the vaccine,” she says. “Sometimes viruses mutate so quickly, we need a slightly adjusted vaccine every year to help us fight what’s circulating that year, like the flu shot.”

Although it’s difficult to know at this point, she says, the COVID vaccine may someday become like the annual flu shot.

“Again, we are building this boat as we float in it,” Dr. Arnaout says. “I admire and thank all the scientists, doctors and data collectors who are helping us with this guidance.”

Ayass Bioscience, a testing lab in Frisco, confirmed two cases of the new variant Wednesday night involving a 35 and 40-year-old. Neither has a recent travel history. 

This news comes after the first case was detected in the Houston area on Monday. The first case of omicron in the U.S. was identified on Dec. 1, 2021.

“At this time, we are still waiting for scientific data to answer everyone’s questions about this variant such as whether or not it is more contagious, whether or not it causes worse disease, and whether or not our vaccines can prevent it,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s.

The CDC stresses that “vaccines remain the best public health measure to protect people from COVID-19, slow transmission, and reduce the likelihood of new variants emerging.”

While the vaccine remains the most effective way to combat COVID-19, data from the American Academy of Pediatrics (AAP) released on Dec. 1 found that only 12% of young Texans, ages 5-11 years old are immunized, and 61% of Texas teens have received at least one dose of the vaccine.

Dr. Whitworth and the Centers for Disease Control and Prevention (CDC) recommend that everyone 5 years and older protect themselves from COVID-19 by getting fully vaccinated. They also strongly advise that everyone ages 18 years and older should get a booster shot at least two months after their initial J&J/Janssen vaccine or six months after completing their primary COVID-19 vaccination series of Pfizer-BioNTech or Moderna.

 “COVID-19 vaccines are highly effective at preventing severe illness, hospitalizations, and death,” the CDC adds. “Scientists are currently investigating omicron, including how protected fully vaccinated people will be against infection, hospitalization, and death.”

What we know about the omicron variant (from the CDC):

• How easily does omicron spread? The omicron variant likely will spread more easily than the original SARS-CoV-2 virus and how easily omicron spreads compared to delta remains unknown. CDC expects that anyone with omicron infection can spread the virus to others, even if they are vaccinated or don’t have symptoms.
• Will omicron cause more severe illness? More data is needed to know if omicron infections, and especially reinfections and breakthrough infections in people who are fully vaccinated, cause more severe illness or death than infection with other variants.
• Will vaccines work against omicron? Current vaccines are expected to protect against severe illness, hospitalizations, and deaths due to infection with the omicron variant. However, breakthrough infections in people who are fully vaccinated are likely to occur. With other variants, like delta, vaccines have remained effective at preventing severe illness, hospitalizations, and death. The recent emergence of omicron further emphasizes the importance of vaccination and boosters.
• Will treatments work against omicron? Scientists are working to determine how well existing treatments for COVID-19 work. Based on the changed genetic make-up of omicron, some treatments are likely to remain effective while others may be less effective.

Click here to learn more about the best tools to fight omicron and more general information from the CDC.

It’s not uncommon for kids to be nervous about needles. So the experts at Cook Children’s offer some advice to provide reassurance and support throughout the vaccination process. Honest conversation, creating a comfort plan, and distraction techniques can help put children at ease. Reinforcing a positive mindset helps too: You can do this!

“If you go in with the high expectation that your child can handle this and our staff is going to take good care of your child and make it as comfortable as possible, the kids will rise to the occasion,” said Kim Mangham, M.D. at Cook Children’s Pediatrics Keller Parkway.

The U.S. Centers for Disease Control and Prevention (CDC) on Nov. 2 approved a lower-dose Pfizer-BioNTech vaccine for ages 5-11. Children ages 12 and up were already eligible for immunization against the virus that causes the illness known as COVID-19.

Dr. Mangham said some of her younger patients have been eager for their turn at vaccination. “Some of them are so excited about being protected,” she said.

Clinical coordinator Trish Skelly, LVN estimates she has given hundreds of COVID-19 shots to 12-year-olds and teens through Cook Children’s during the pandemic. It’s a two-shot vaccine, so Skelly gets the chance to follow up when the patients return three weeks later for the second round.

“Usually, I ask how they did after the first one, and they say it was a lot better than they expected,” she said. “They’re handling it much better than the adults with the side effects.”

To help alleviate fears about the shot, Skelly wears her fun nurse’s scrubs and relies on an assortment of aids including stickers, suckers and a topical spray that feels like ice on the skin, relieving the needle’s sting. Most of her patients opt for the nicknamed “Elsa spray” or “magic spray” before the injection. Skelly also answers any questions that come up.

“I explain everything I’m doing when I’m doing it so that there’s no surprises. Most of them don’t even feel it. It’s actually an easier shot than the flu vaccine,” she said.

As coordinator of the Comfort Menu program at Cook Children’s, Whitney Brosey works to educate medical personnel about techniques that can make children feel less leery about going to the doctor. And Brosey promotes the strategies that caregivers can follow – at every point from scheduling the vaccine appointment, to the shot itself, to the 15-minute monitoring period afterward -- for a happier end result. Let’s take a closer look at each stage.

Get Ready, Get Set

Parents should start by informing themselves about the vaccine, Brosey recommended. Next, try to schedule an appointment time that doesn’t interfere with sleep, meals or extracurricular routine so that the child isn’t hungry/cranky and coping poorly.

“If you have to wake them up from a nap or if they have to miss one of their activities, there's going to be added disappointment,” she said. “As much as possible, don't disrupt their normal schedules, so that they don't have added stressors.”

When is the best time to give your child advance notice of a vaccine? It depends, Brosey said, on the child’s personality. Some kids might worry excessively if they know multiple days ahead of the appointment. Brosey informed her 8- and 6-year-old daughters the night before their recent flu shots.

“It’s important to tell kids what is happening to their body. Surprises are fun, but not when it comes to things at the doctor” in order to build trust in medical experiences, she said. “I want to make sure that my kids feel like it's OK to feel nervous or it's OK to be a little bit scared, but to have time to process those feelings so that then there's also time to come up with a plan to help it not be so scary.”

Don’t wait to break the news until you arrive at the doctor's office or vaccination clinic, she said.

More pointers beforehand… Explain in simple words that vaccines help keep our bodies from getting sick. Friendly resources include “Daniel Goes to the Doctor” for younger kid and an animated video from the American Academy of Pediatrics. Allow your child to make appropriate choices, such as whether to bring along a special blankie or stuffed animal from home.

“One of my daughters had dance class after her flu shot, so she wanted to get it on her right leg because she does all of her turns on her left leg,” Brosey said. “That was the control piece for her. She felt empowered.”

And Go

Once at the clinic, parents should talk with the medical staff about the preferred approach for their child’s vaccine. Find out if cold spray or other options are available for comfort. Parents might want to call ahead if the child has developmental delays or sensory needs, Brosey said. Be your child’s advocate.

“Sometimes parents feel like they're being a difficult parent by saying what works, or they think that they're inconveniencing someone, and that is not the case,” she said. “We trust that they know their child best. We want you to communicate with us and have a conversation with us about your child. If you want to hold and hug your child while they're getting their vaccine, then you communicate that with the medical team.”

Distraction is key, according to everyone interviewed for this article. Distract your child by playing a game like I Spy. Sing a song or listen to music. Recite the ABCs backwards. Prompt your child to talk about a favorite memory. Brosey calls this therapeutic conversation.

To keep the child from feeling overwhelmed, only one parent should speak to the child at a time, she said. Reinforce the message of the child’s main job – to hold still. Recognize it’s OK if they cry. If possible, don’t bring siblings who aren’t getting vaccinated, because total attention belongs on the child receiving the shot.

TLC after the Shot

Brosey recommends coloring books or games to pass the time during the 15-minute observation period after the COVID-19 vaccination. Follow up your child: Do you feel like that went well? Or what could we have done differently? Give a treat or some extra one-on-one time later at home.

“It’s so important to help your child return back to baseline after they've gotten nervous or scared. It's almost like the next step in distraction,” she said. “And so I may say, ‘Hey, we can run by the donut shop!’”

Also, let your child know they might experience soreness or other side effects the next day. Brosey said it’s important for the child to report to you if they don’t feel well.

Although CDC approval of the pediatric COVID-19 vaccine is new, kids usually have some familiarity with getting immunized against other illnesses. Brosey said parents should use age-appropriate vocabulary and detail to help explain the purpose of vaccines. The bottom line is to work out a comfort plan, collaborate with the medical team, and stay positive.

“When it comes to coping or how children perceive shots, they're not too big at 11 to be scared,” she said. “We care about our kids' emotional safety. We don't want to have a traumatic experience. We want them to feel safe and we want them to feel heard and seen and acknowledged, and all of that can be done.”

WILL THEY BE SAFE?

I often hear concerns about the safety of the COVID-19 vaccines for children. Some parents are apprehensive because they are different from traditional vaccines that kids have received for decades for things like measles, mumps and chickenpox. But, new advancements make vaccines even safer than they were before. Parents are also concerned that we don’t know enough about COVID-19 vaccines because they were rushed into development. Not really! Yes, the COVID-19 vaccine is the first mRNA vaccine, but the concept for mRNA-based vaccines has been around for more than 30 years. In 2012, experts in vaccine development agreed that mRNA-based vaccines present several safety features. For one, mRNA does not hang around within the body once it has done its job teaching cells how to fight the virus, and it does not change the body’s DNA. These vaccines are also easy to produce in large amounts and very high purity. It just took a while for us to figure out how to put them together and keep the mRNA from breaking down before it gets from the vaccine manufacturing plant into the patient. As anticipated, data from the rollout of the COVID-19 vaccines has shown them to be safe and effective. Still, after millions of doses given world-wide, the CDC and FDA continue to work exceedingly hard to investigate vaccine-associated adverse events. In fact, I am once again responding to my daily CDC post-vaccine booster heath check-up text, and I will be sure to let them know, as often as they want to ask me, just how I am doing.

WILL THEY CHANGE MY CHILD’S DNA?

When my wife and I go to a restaurant, we review the menu and the waiter writes down our orders and takes the ticket to the kitchen. In the kitchen, the chef reviews the ticket and starts making our food. Then, the waiter brings our food to the table. Think of the chef in that kitchen as the ribosomes inside our cells. He reads the ticket and makes the food just like our ribosomes read the mRNA instructions given through the vaccine and make protein strands that eventually find their way to the surface of our cells. These are the COVID-19 spike proteins. These spike proteins are identified by our immune cells, which then triggers our body to form antibodies to protect us from severe illness due to the virus. The nucleus of the cell where our own DNA is housed is not involved in this process. Just like old food tickets are eventually discarded, the mRNA eventually breaks down and is discarded by the body. No change in a person’s genetic make-up occurs.

WHAT ABOUT FERTILITY?

Concerns that vaccination against COVID-19 might somehow be associated with women becoming infertile or being unable to carry a pregnancy circulated on social media, but there is no scientific basis for these concerns. Thankfully, many pregnant women and non-pregnant women of child-bearing age are heeding the advice of their obstetrician-gynecologists to get vaccinated without delay.

WHAT ABOUT THE OTHER INGREDIENTS IN THE VACCINES?

When my eldest daughter was in elementary school, she would come to me occasionally requesting medication for one reason or another. In fun, I would ask her the same things I ask my patients, “Have you ever had a reaction to any of the many ingredients listed on the medication package insert?” After I playfully cross-examined her regarding a few ingredients, she would say, “I don’t have any problem with those things, Dad, I just have a headache.” She wasn’t concerned about the chemicals that made the medication stable or buffered the drug, or the dyes that determined the color of the pill, gelatin capsule or syrup. She just knew the medication would make her feel better in a short time so that she could go back to playing. She trusted that her dad already knew what she needed and how to help her. She knew that he would never intentionally give her something bad. In regards to vaccines, the tiny amounts of these chemicals in vaccines are of no clinical consequence and should be of no concern, with a few extremely rare allergy situations.

WHAT ABOUT SIDE EFFECTS?

Because the entire virus is needed to cause disease, these vaccines can’t give you COVID-19.

Most side effects are due to our immune systems waking up in response to what it’s learning from the vaccine. My family members and I had a few. Like the side effects that many people have, they were mild—fever, achiness, headache, arm pain, etc.—and they didn’t last long. Unlike older adults, especially the elderly, most children have immune systems that need smaller doses to get the immune system revved up and working. The COVID-19 vaccine dosing for young children will likely be lower than the dosing in adolescents and adults. Smaller doses are expected to reduce vaccine side effects in kids.

WHY SHOULD I VACCINATE MY CHILD?

Vaccination is an important part of both personal and community health. So is access to clean drinking water, functional sewage systems, fluoridated toothpaste, healthy food, sunscreen and soap.

In summary, there is no new secret prescription to maintaining good health. Eat right, brush your teeth, wash your hands after going to the bathroom and before handling food, exercise, refill your blood pressure medication, keep all your health and wellness check-ups, do what your doctor says which is founded in good science, and get vaccinated.

IS COVID-19 A THREAT TO MY CHILDREN AND FAMILY?

The virus that causes COVID-19 has evolved and the transmission has escalated. With the first couple of waves we were dealing with a virus that did not transmit between children very well. Now we are dealing with variants that spread five times as easily. Shortly after schools reopened we had sick kids all over the place. Some of the major pediatric hospitals were unable to accept transfers of children who required the kind of advanced care that is only available in a few places. Transmission between children, and from children to adults at home, skyrocketed. Teachers got sick, too. Our ability to care for the sickest kids was pushed to the limit in terms of hospital beds, availability of advanced equipment, and trained staff to provide the care that was needed. While deaths in children due to COVID-19 is uncommon, severe illness is not, especially among children who are overweight, and there are many children who are in that category. Even when children have mild symptoms, they are at risk to develop an inflammatory syndrome after natural infection that can lead to vomiting, abdominal pain, rash, respiratory failure, and shock. We deal with that on a daily basis now. So in short, the answer is yes, it really is.

1. One-third of you will RUN, not walk, to get it.
2. One-third of you will absolutely refuse it, for varying reasons.
3. One-third of you will wait a little bit….to see what other families do, and watch how other kids feel after getting it.

I write this for those of you in the gray zone. And maybe even a few in the “no” zone?

Every family is different. And I get that.

Some of you are really nervous about COVID, and some of you aren’t. I get that.

And some of you are nervous about a “new” vaccine, and some of you aren’t. I get it.

And I’ll never judge you for questioning what goes in your child’s body. It is natural to be skeptical of new knowledge.

But I will be getting it for my kids. And after reviewing every page of the data, here are my reasons:

1. My perspective is unique.

I think this is one of the biggest reasons this decision was easy for me. Being a pediatrician gives me a unique perspective.

I have worked in pediatric ICUs and ERs. I have seen children suffer tremendously and even die at the result of viruses.

I have seen the flu cause a heart infection so bad in a child they required a heart transplant within 7 days of contracting it.

I have seen a “tummy bug” kill an infant in 24 hours.

I have seen the common cold put children on ventilators.

It’s true – COVID is typically very mild in kids. No one disputes that.

But I will give you my perspective: I have seen COVID make kids so sick they need to be in the ICU. Multisystem Inflammatory Syndrome in Children (MIS-C). Double pneumonias. I have watched it torment some kids for months after the initial infection, both physically and psychologically. Let’s not even talk about the anguish of losing a parent or grandparent to COVID.

I hate COVID. And I want to protect my kids against it.

And this vaccine is all I have. This is the only protective measure I can take to protect my kids, now that universal masking and social distancing seems to be merely a fleeting thought in my state. And I’m just as tired of social distancing as you are.

When it comes down to it, the one thing I pray to never experience as a parent is to sit next to a hospital bed, regretting a decision I made for my child. Regretting not getting the only thing that may protect him from this virus. I’ve watched too many parents go through this, and it breaks my heart. And I know what you’re thinking – well what if I have that same regret, except it’s the vaccine’s fault?

Sometimes, when I talk with someone who is nervous about mRNA COVID vaccines, I take for granted the fact that I am a physician. I’ve been trained and educated for years in vaccinations, immunology, how mRNA works, vaccine reactions, statistics, and epidemiology. I am not scared of this vaccine giving my kids COVID, changing my DNA, or giving my kids long-term side effects. Like, at all.

Which leads me to the next component of my decision:

2. Pediatricians know vaccines. Probably better than any other type of physician out there.

As pediatricians, we give thousands of kids vaccines each year. We give more vaccines than any family practitioner or internist, by a landslide. And we field more phone calls and questions about post-vaccine reactions than any other specialty.

We are not worried about this vaccine causing long-term problems in children. Why? Because reactions to vaccines just don’t work that way. If a child is going to have a severe reaction to a vaccine (something so rare I’ve seen literally one time in 12 years of practice– and it was a seizure in a child with a known seizure disorder), it is overwhelmingly going to happen within 6-8 weeks of getting the vaccine.

If the immune system gets “too revved up”, we see the inflammation cause problems – like the rare myocarditis we’ve heard about in young men. And – those few young men who got myocarditis? It was typically mild. They spent a couple days in the hospital and were discharged home, unlike the myocarditis associated with COVID – which is much more common, and can make you much more sick.

The 2000+ children studied in the Pfizer study are now going on over 3 months post-vaccine and are doing great, with not a single severe side effect (including myocarditis). And the dose is 1/3 that of the older kids’ dose, which means it will cause less “revving up”, if you will, while still doing a good job of getting antibodies made.

And let’s not forget the tons of data we already have from adults, and kids 12-15. It looks overwhelmingly positive.

3. I’m not worried about post-vaccine “fertility issues” and you shouldn’t be, either.

Jeez, if there’s one social media myth that I wish would die, it’s this one.

The mRNA COVID vaccines don’t cause infertility.

I’m not diving into the details here, of which there are plenty, but some simple common sense makes me not worried about this for my daughter. As of today, 3.8 BILLION people across the world have had at least one COVID vaccine. The vaccine has been put in human bodies now (starting with the first studies) for over 14 months.

Doesn’t it make sense that if there was this overwhelming effect on fertility, doctors across the world would be noticing? Wouldn’t we notice pregnancy rates going down, miscarriage rates go up, and birth rates drastically reduced? But we haven’t seen that.

“But I’m reading about women whose menstrual cycle changed the month after they got the shot!”

Here’s an insider tip: it’s the immune response that makes cycles a little wonky in the 1-2 months following the COVID vaccine. This is because the menstrual cycle is very sensitive to any change – more exercise, any form of illness, dietary changes – you name it. It is joked in medicine that the wind blowing a certain direction can cause a shift in a woman’s cycles.

Just in case you don’t want to hear it from a pediatrician, I asked my friends, the Obstetricians/Gynecologists over at FENOM Fort Worth, for their input:

Dr. Andrea Palmer: “We see menstrual changes sometimes after vaccination as part of a woman’s immune response. But we’ve seen nothing long term. I’ve seen no increase in infertility in our practice or in nationwide data.”

Dr. Lori Atkins: “The way I like to explain it is, the body will have a natural inflammatory response – and this is short-lived. The lining of the uterus will also respond, so there may be an irregular period for a few months. But there are numerous studies and opinions from reproductive endocrinologists who highly recommend the vaccine as it poses no risk to fertility. At this point, it’s well documented.”

So…I’m just not worried about the vaccine causing fertility issues in my daughter.

4. We have people we love in our family who are immunocompromised.

This point hits a lot closer to home for me, and is something unique to each family’s decision.

We have immunocompromised people in our family whom we love very much, and see often. They are vaccinated. But sometimes, the vaccines don’t work as well in people who are immunocompromised.

Children can spread COVID.

I do not want my children to be the possible source of infection for beloved family members.

Vaccinating my kids will cause less of a chance for them to give others COVID, as there is less of a chance they will carry it or be symptomatic with it (thus less sneezing, coughing, and general viral spread).

5. I care about my community.

I will keep this short and sweet: if vaccinating my kids will lower the chance that your daughter with asthma, or your son with diabetes, or your mother with lupus, will get sick with COVID, then sign me up. I consider this a small part of my journey in trying to love my neighbor (even if we hung different flags on Election Day! Gasp!).

6. My kids are tired of wearing masks.

I mean. Not much else to say here. If my kids are fully vaccinated and the community numbers stay down, we’re eventually going to take them off in school.

7. My kids have missed enough school, and we want to avoid quarantining.

Current CDC recs say if you’re vaccinated and exposed, you don’t have to quarantine unless you’re symptomatic. Less school missed is a great thing.

So there you have it. My many reasons for vaccinating my kids.

I know this was a lot to digest. I think what it whittles down to is this: the most important question in my mind as a mother is: “is the vaccine safer and less risky than COVID infection?”….and I think the answer to that question is yes. Especially when we take family members and community spread into account.

Again, this decision is personal and unique to each family. And I won’t judge you at all if you want to learn more from me before you decide to get it for your kids. I hope my thought process for my own kids helps you with yours.

Cook Children's patient families will be contacted directly via email. 

There is no need for families to call their pediatricians to make appointments. All scheduling will occur through their MyCookChildren’s account and details, including the schedule for the vaccination clinics, will be posted on CookChildrens.org.

A little over 18 months ago, I wrote the article “Everyone is Grieving Something.” So much has happened since that time – so much that none of us could have anticipated. That was only a month into the pandemic, and I had high hopes for the future and the future for my kids. We did our fair share of grieving, and continue to even now; however, I was confident when I told my kids that things would get back to normal for the coming school year. Instead, they started school (2020 – 2021 school year) a month later than expected, and we started online only. As we all signed onto Zoom yet again and took back-to-school pics sitting in front of computers, my mom heart sunk. All I could think was this was not the way it was supposed to be. We all watched as the world divided over a multitude of issues and opinions. We found ourselves making decisions completely different from that of our neighbors and closest friends. Then, trying to explain the differences and decisions to our kids was a whole other mountain to climb. It felt like every day was a new day of making a decision that could possibly become the next subject of a social media debate. As parents and health care professionals, every single day was weighty.

My kids ended up returning to in-person learning when they were invited to, but things were far from normal. We made choices at the time to support the mental health of our particular kids (I recognize this was not the best choice for other families). Yet, our family still found ourselves in counseling this past spring and summer as we trudged through parenting breakdowns and the difficulties that one of our kids in particular experienced during her school year. Some of her challenges were related to the pandemic, but much of it was related to emotional fatigue, unexpected changes (unrelated to the pandemic), and what professionals call adjustment disorder. Basically, the amount of changes was just too much – for all of us. I found that I was barely surviving, emotionally fatigued, and probably have adjustment disorder myself. I was shutting down, pulling away and sitting in the midst of anger for what we had all been experiencing. I kind of looked like a toddler in the corner screaming and throwing a tantrum over the last year.

I’ve realized as I return to work every shift to meet the families in the emergency room, I’m not alone. In fact, while our family has been through a tumultuous time, it is incomparable to the families that has received a new diagnosis, experienced a trauma, or lost a precious loved one on top of enduring a pandemic. Everyone is barely surviving. Everyone has reached the end of themselves at some point. Everyone is needing to recalibrate and reconnect.

We spent most of the summer and the beginning of this school year recalibrating our lives and hearts. We have spent time enduring the yo-yo changes that have come with the pandemic, accepting things we don’t like at all, and truly learning to take each day as it comes as it is. As I have reflected on our lack of coping this past year, I have found myself looking to the future yet again. I am asking questions that I asked at the beginning of the pandemic – questions like: How do I want my kids to remember me and this time? What do I want their overarching takeaway to be from this pandemic experience?

At the end of every day, I want my kids to know that they are loved, valued, and known. I find myself needing to reconnect with my kids in very specific ways so that they can know these things. It takes time and intentionality to communicate this to them. (Trust me, there are many days I feel like I’ve failed at this.) As I have stepped back from my own family and watched the many families I encounter at the hospital, I have been reminded that how we show up matters. These are a few ways that we can show up for our kids and reconnect with them in the midst of constant changes and ongoing challenges:

1. Consistency. Our kids need consistency. Even if just one part of your schedule can be consistent, it will be helpful to your kids. What is one thing that you can do each day or even once a week that your kids can count on? We have the same routine in the car on the way to school that my kids can trust will happen every morning. We have Wednesday ice cream dates after school that they can look forward to each week. They know that we have a movie and pizza night at least once a month. It may be that you do the same bedtime routine each night. Whatever you choose, this will life-giving to your children and create connection with them. When they can count on something in this ever-changing world, it is grounding.
2. Empathy. Author Brene Brown says that empathy is “holding space” with someone. We want to hold space with our kids. We are often tempted to move on to the next thing, distract them from their current emotion or try to exchange their emotion for a new, less sad or intense emotion. But our kids need us to hold the space they find themselves in – to validate and acknowledge the emotion. This doesn’t mean on the back end that we don’t encourage or correct them. It just means that we take time to be in the emotion with them and allow them to feel it. It is truly amazing to me when I take time to connect with my kids’ emotions how quickly they are able to regain composure. It usually looks like me saying something like, “Yes. I can totally understand that feeling. I have felt the same way…” Often times I will try to connect to a time that I have felt that way and share my own story of that emotion.
3. One-on-one time. I have always known how important this time is, but I was challenged once again this summer during counseling to make space for this time with each of my kids. It does not have to be a long time. Even just 10 minutes a day of sitting with your child – just you and them – listening to them and engaging them can have profound impact on your relationship with them. I have taken time to prioritize this over the last month, and I see the impact. I scoop up my kindergartner and put her in my lap and snuggle her and ask her about her day. I often cup their faces in my hands and look them in the eyes and tell them how much I love them. I sit next to my 10 year old and ask her to tell me about her day. This time matters so much to my kids.

I will never again tell my kids that there is an end to the hard and challenging times. What I tell them now is that we will take every day as it comes, you can trust that I’m here with you for the hard moments and great moments, and I’m super proud of you for continuing to show up each day for whatever life brings. We have all endured so much, and one thing is still true that was true at the beginning of the pandemic – we are stronger together. So, scoop up your kiddos and gaze into their faces and tell them that they are loved, valued and known!!!

“This is not a decision our administrative team takes lightly,” said Stan Davis, Chief Operating Officer at Cook Children’s Health Care System. “Elective surgeries are not synonymous with cosmetic or unnecessary procedures. These are children who require surgical intervention to improve their health and wellbeing. We are doing everything in our power to ensure every child who needs us is taken care of.”

In addition to rescheduling elective surgeries, we are having to divert patients away from Cook Children’s when beds are not available. This does not just affect children with COVID-19, but kids with all sorts of medical issues from traumatic accidents to new diagnoses. new onset diabetic ketoacidosis. Children’s hospitals across the state are experiencing a similar situation. To do our part, Cook Children’s is also taking patients from other regions whenever possible.

“It’s unfortunate that we are physically unable to care for all of the children who need us right now. If we have to divert a patient away from Cook Children’s, we ensure we find them an appropriate facility, though that may be several hours away from home or even in another state,” said Cheryl Petersen, Chief Nursing Officer at Cook Children’s.

Right now, we’re asking for patience and understanding as we work to handle the burden COVID-19 is weighing on our health care system. But we need your help. Please get the COVID-19 vaccine for yourself and all eligible children. It is safe and effective. In fact, half of the COVID-19 patients we have treated since the vaccine was approved for children 12 and up have been unvaccinated teenagers. To date, we have not treated a single vaccinated patient for severe COVID-19.

Here are some other steps you can take to help us slow the spread of this virus:

• Send your child to school in a mask. Ask them to keep it on at all times unless outside or eating.
• All children in school over age 2 should be masking indoors. School districts should strive for universal masking right now.
• Quarantine all children who come in contact with a COVID+ child if unmasked and for longer than 15 minutes indoors.
• Please keep your sick children home from school.
• Postpone indoor gatherings.
• If you have to gather, go outside.
• Limit the number of people who can attend sporting or theatrical events at schools so there can be spacing between families.
• Stay at least six feet away from others outside of your immediate family.

For 103 years, our community has supported Cook Children’s to ensure the children in our care have the very best medical treatment. We need your support now more than ever. There is no way out of this dark time without your help.

Let’s imagine a scenario that no parent wants to think about.

Let’s say your child starts acting weird over the past few weeks. She seems tired. She’s sleeping more, and laying around all the time.

She starts to drink more water. It sure does seem like a lot of water – way more than on a hot day outside. She’s starting to pee more often. She’s waking up at night to refill her cup over and over.

She’s starting to lose weight. She’s complaining her vision is blurry. She started to vomit yesterday, and cries today that her stomach hurts. She’s acting exhausted.

You take her to the pediatrician, who checks her blood sugar. The number is so high, the monitor cannot read it. It only says “over 500”.

You rush her to the ER, where you get the diagnosis: diabetic ketoacidosis. Your child is a new diabetic, and you had no idea until this moment. DKA is life-threatening and requires ICU care, the ER physician says.

“The problem is…we don’t have any PICU beds available currently. The unit is completely full.”

In the spirit of our ongoing efforts to be real and transparent with you about the status of children with COVID in Tarrant and surrounding counties, allow me to share with you what my colleagues have shared with me. I asked them, “Are the high numbers of COVID patients in our hospital affecting your other patients?”

The following quotes are nearly word-for-word (though I took to liberty to make a few large medical terms more understandable, and keep patient details anonymous):

Dr. Scott Perry, Neurology: “I’ve got plenty. Several surgeries canceled. Surgeries that could potentially stop seizures in children where their condition is life-threatening. Several workups canceled while we wait for more room. Trying to manage people at home throughout the night so they don’t need the emergency room. I am so exhausted from this, from dealing with the pandemic and the risk of losing highly trained people as a result. The list goes on…”

Dr. Samson Cantu, Gastroenterology: “From the GI standpoint, we have had to second guess our decision to proceed with planning for gastrostomy tube (feeding tube) placement in our failure-to-thrive patients. All new feeding tube placements require hospital admission for 48 to 72 hours. Given the scarcity of inpatient beds, we are very limited in having a scheduled admission, despite a feeding tube being a true life-line for several patients.”

Dr. Charles Saadeh, ENT: “With airway surgery, we have to take into account worst-case-scenario hospital resources that necessitate PICU bed availability. I have had two patients so far that have had a delay in care. Cook has been so very diligent about accommodating patients that need to go when they are delayed, but it’s definitely a case-by-case discussion with each family. We wouldn’t be offering supraglottoplasty (a complicated surgery that allows children with airways disorders to breathe easier) if things weren’t relatively urgent to begin with, so this is certainly a difficult position for us.”

Dr. Teena Thomas, Endocrinology: “More than once last week, when I received a transport call for a new onset, I was not always sure that I would be able to admit a new onset in DKA to the PICU because of the lack of bed availability. On my last day of call, we had to divert a very young new onset to another hospital… I have never not been able to admit a new onset here. I checked on the child the next day and the hospital they went to did not actually have PICU availability either (they had to some shuffling to get the kid to the PICU). Last week, my diabetic patients also had to spend a lot more time in the ER because of lack of bed availability in the PICU or the endocrine floor.”

Dr. Michelle Marcincuk, ENT: “I had an entire day of surgeries cancel because there were no beds to admit the patients to post-op. These were kids with trachs, airway obstruction, swallowing dysfunction. I had a child with a mass on the face that needs a biopsy. Had a little one with a draining fistula on the neck. All had to be postponed. Two kids were hoping to get their trachs out. But had to cancel.”

(Imagine the day finally comes when your child gets the breathing tube taken out of their neck…and your day is yet again postponed, and sometimes for a YEAR. Keep reading.)

MM: “Since the hospital has been full, I can’t say whether we will get to do their surgery the next time they are scheduled. It’s just a complete guess as to whether or not there will be a bed available for them on the day we reschedule. And since we don’t decannulate (breathing tube taken out) kids in the winter, if we don’t get them done soon, they may miss their window of opportunity to get decannulated this year and may have to wait a whole year more for their next chance. That’s a whole additional year with a trach due to COVID. None of my patients have COVID. But their health is being affected by the COVID surge. 

The health of these kids is suffering because of this pandemic. Even though they themselves don’t have it. And their parents have done everything possible to keep them healthy. The parents have taken days off work preparing for this surgery. When the surgery is cancelled, they have to take even more days off for the new surgery date, putting their jobs at risk due to absences. And some patients drive 5-6 hours here for surgery, only to arrive and be told that they can’t have the surgery and have to drive back home because the hospital is full. Then you think of the wasted time the surgeon experiences when this happens. Basically, it’s a day that they can’t see patients because of the last minute, unexpected cancellations. We have a huge list of kids waiting to be seen in clinic, but most of the time these cases are cancelled last minute and it’s too late for new patients to be booked into clinic. So both the surgery patients and the new patient for clinic who are waiting for appointments are affected.”

Dr. John Honeycutt, Neurosurgery: “It is frustrating from several different levels. However, we are ONLY delaying non urgent or elective surgeries. Cases for brain tumors or other surgeries where delay could cause harm we are still full steam. But it is very frustrating to families that have planned, taken off work, mentally prepared and then have to delay. It’s extremely hard for them. Nobody’s outright angry or screaming, all seem to understand, which is so cool. We see all this in media about people screaming and yelling about selfish things, but they miss the vast majority of people that are just trying to get by in life and care for their community and others. They are frustrated, but make the sacrifice for the better of others. That is missed and it is refreshing to see that personally.

As a team, we are so used to being full steam, so for us to transition to a lull is a bit of a challenge (easier for younger docs, harder for me). But we understand too. We see the ICU, ER and hospitalists and nursing staff overworked and stressed. Sad to see.

Finally, our service line has not had our neuro PICU for a year and a half since it is now the COVID unit, and last week we lost our neurosciences floor to be the second COVID floor unit. So we are scrambling hard, being extra sure our patients get what they need since they are now scattered throughout the hospital. Exhausting for our team.

We are fine, just adapting to the new norm which I pray is short lived.

Dr Karthik Srinivasan, Pediatric Hospitalist: “As pediatric hospitalists, we care for children who require hospitalization. I recently took care of a cute infant who was not admitted for COVID and improved within a day. I was excited to discharge him home, as was his mother. We had a pleasant conversation, and the mother was very thankful. She seemed to trust Cook Children’s and all our staff. As I was leaving, I mentioned that her son was too young for the vaccine but wanted to know if family members had received it. “No. No. We’re not going to talk about that” was what I got, and the tone and mood took a 180. There was an awkward silence. The family was out the door within the next 20 minutes. 

As of about two months ago, we were fortunate to have ZERO COVID positive patients admitted to our service. Now, we are up to about 40% of our service as a whole. About 75% of these children are admitted directly because of COVID, not just incidentally being positive. This is very different than in months past.

Clearly, the delta variant has been a game changer that is much more easily transmitted. We recently set our service’s all-time record for the number of hospitalized children we are taking care of, which can be directly attributed to COVID. We started last year utilizing one floor as the typical “COVID unit.” This grew to two floors, and most recently we have started filling up a third floor, anticipating even more as I write this. 

We are seeing children in all age groups being admitted due to COVID. Although we are noting that obesity is a risk factor, we are admitting some children without any apparent predisposing factors. More recently, about 3-4% of older teenagers who are testing positive in the Cook Children’s system are being hospitalized. Beyond infancy, our highest rate of hospitalization and many of our sicker patients are older teenagers, the vast majority who are vaccine eligible but have not received the vaccine.

On a typical call shift, it is not unusual to be called on at least a couple of children who are admitted for COVID and are appearing sicker. And it is a process to see them. For staff member safety and our own protection, there is extensive protective equipment required to see them, and this needs to be worn anew upon entering and completely removed upon exiting the room. Additionally, for some of these sicker children, multiple specialists may be involved in their care, leading to several phone calls. This is all while the Emergency Department anxiously is paging for several additional patients needing to be admitted. Admittedly, in these times, it can be near impossible to return their calls in a timely manner.

As we are stretched thin, the medical care we provide may not be as efficient as you are accustomed to. We need your patience, understanding we are all in this together. If your child gets sick and needs to be hospitalized, we are here for you and your child. But the best weapons we have against this is preventing the illness in the first place. Go back to the basics that have been preached by Cook Children’s physicians for quite some time now. Mask up, socially distance, and get your vaccine if eligible. Even if your child cannot get the vaccine, have family members and friends get it if eligible. Please trust us on this as you do with the care of your child. To be clear, virtually all the physicians at Cook Children’s were vaccinated well before the word mandate was even thrown around. We preach what virtually every major physician organization has advocated for and what we have practiced ourselves. Do it for yourself. Do it for your child. Do it for your neighbors. Do it for us.

We strive to keep our “Promise” to you and your children, but we need your help.

Dr. Christine Ellis, Pediatric Hospitalist: “Page comes through as I barely walk through the doors of the hospital that another one of my patients is in respiratory distress. Seconds later, I hear the “Med Alert” overhead- of course, it’s my patient I was just paged about from the COVID unit. I skip making my morning coffee and checkout from the evening physician and run upstairs to the COVID unit.

I throw down my bag, quickly place on my PPE and walk into the crowded room to see my teenage patient breathing over 60 breaths a minute and oxygen saturations decreasing despite maximum support on a non-rebreather face mask. PICU team arrives shortly and my patient is whisked away to our pediatric ICU for higher level of care. I try to comfort the mother quickly as they start to roll to the elevator for transfer.

I take off my n95 mask, make my coffee and get the rest of my checkout from last night’s physician that stayed late to talk to me. I finally slump into my chair to start rounding on all my other children for the day and all the emotions flood over me. 

SADNESS for the patient and family as they go through this difficult time with a very sick patient.

FEAR for my patient’s respiratory status as I am afraid that he is on a long road that will require possible Bi-Pap or even intubation.

FRUSTRATION sinks in as this patient, like many of my other patients, was eligible for the COVID-19 vaccine and is not currently vaccinated. This child likely would not have these severe complications if he was vaccinated. They were completely healthy except for obesity (which significantly increases chances for complications as well). All of this could of been prevented.

As the day goes on, I go between our now two full non-ICU COVID units and see patient after patient similar to my first child of the day. Some children too young for the vaccine but when I talk to their parents, no one in the house is vaccinated either. I continue to march room to room. EXHAUSTION hits me. My face hurts from my n95 mask but I sign up as the COVID physician the next day.

As I drive home to my family I try to find HOPE. Hope that tomorrow will be a better day. Hope that tomorrow another sweet child does not go to the ICU for a now preventable disease. Hope that our community continues to step up and get vaccinated and wear their masks appropriately. Hope that vaccines are available for our younger children soon so my patients and my own children at home can be more protected.

❤️ Dr. Ellis

Dr. Laura Romano, Pediatric Hospitalist: “Our hospitals are full. Our ICUs are full. Due to the surge from the delta variant, we do not have any beds. This means that patients at outside hospitals or clinics who need specialized care cannot be transferred to our facilities. This means that there are children who have to wait longer for necessary and sometimes life-saving treatment.

I've seen a lot of people say that wearing a mask or getting vaccinated is a "personal choice" or "my body my choice." Your choice to not wear a mask and to not get vaccinated is putting our children and our patients in jeopardy. The time for personal responsibility is over. It has already failed our children and that failing has led to unprecedented COVID spread in a few weeks since schools have returned without mask mandates and without vaccine mandates. This spread will continue unchecked and we won’t have the beds or the space to help our patients. It's simple math at this time.

I've seen people posting that health care professionals need prayers because we are tired and overwhelmed. Yes, we are exhausted. We are tired. We are running on empty and are experiencing burn out that we have never felt before. Yes, we appreciate your thoughts and prayers. But what we need more is for YOU to get vaccinated.

The time for talk is over. You need to get vaccinated. You have to get vaccinated. It is the only way to end this.

If you don't care about your own health and wellbeing, please care about your children's health. Please care about my patients' health. Please care about your nieces and nephews. Please care about your neighbor's children. They need your help. We desperately need your help. 

And if that's too much to ask, if it's too much to ask you to care about a child, then wear a mask. It's literally the least that you can at this point.

The time for talk is over. We need action. We need it now. I know how some of you will react to seeing this: another COVID post. Some of you will say that this is a joke and a political hoax. Some of you will say that this is baseless fear mongering by the mainstream media to make you afraid of what will amount to a slight cold or a flu. Please know that none of those statements are true.

This is virus that spreads easily. This is a virus that is now causing severe and life threatening disease in children. Please, please, please listen to medical professionals who are quite literally begging you to get vaccinated. 

If you don’t want the vaccine for yourself, please get it for your kids, your nieces and nephews, your friends’ kids, or even for the children in your neighborhood since a lot of us don’t have the option to vaccinate our kids against a deadly and fatal virus. 

If you have any questions about the vaccine, please reach out to me or your family doctor. We would love to talk to you about it! You have entrusted your children to us throughout the entire lives. We need you to put your trust and faith in us again. Please get your vaccine. 

And if getting vaccinated is too much to consider, then please just wear a mask. Please. Children are literally dying from this and we have the ability to stop it.

Dr. Bianka Soria-Olmos, Pediatrician at Cook Children's Pediatrics Haslet:

"Se sabe que la variante delta es altamente transmisible, desafortunadamente ha causado que los casos de COVID pediátricos aumenten significativamente recientemente. Esto, a su vez, ha provocado un aumento de las hospitalizaciones por COVID en nuestro propio hospital.Ha habido varias partes diferentes del hospital que se han convertido en unidades dedicadas al tratamiento de niños con COVID-19.Esto significa que a medida que más niños requieren atención para su enfermedad COVID-19, hay menos camas disponibles y personal para cuidar a otros niños que pueden requerir pasar la noche en el hospital por una condición médica no relacionada con COVID-19. El aumento actual está provocando retrasos en los procedimientos que no son de emergencia o electivos, dado que algunos de esos niños requieren habitualmente de hospitalización, seguimiento posoperatorio o recuperación.

Como pediatras y especialistas en pediatría estamos acostumbrados a atender a TODOS los niños de inmediato en el momento en que necesitan intervenciones o tratamiento, lamentablemente nos estamos dando cuenta de que esto puede no ser posible y no podemos evitar sentir una avalancha de emociones: frustración, tristeza, temor. Nosotros también somos humanos y lo que nuestros ojos ven todos los días crea una montaña rusa de sentimientos que tememos que nadie más pueda entender.Sin embargo, tenemos la esperanza de que si compartimos solo un pequeño vistazo de lo que nuestros ojos ven y presencian todos los días, esa bondad y abnegación ganarán y que nuestra comunidad hará lo correcto.Le pedimos a usted (nuestra comunidad) en este momento que considere que sus decisiones y acciones de la vida diaria pueden afectar y afectarán la trayectoria de esta situación.Le pedimos que nos ayude haciendo lo siguiente: vacunen a TODOS los adultos y adolescentes elegibles en su hogar contra el COVID-19 y se use cubreboca cuando estén fuera de su hogar. Estas simples acciones de bondad no solo lo protegen a usted y a sus seres queridos, sino que también pueden comenzar a aplanar la curva de infección de COVID que necesitamos en este momento para ayudarnos a cumplir nuestra promesa a todos los niños del norte de Texas y nuestra comunidad."

Dr. Diane Arnaout, Pediatrician at Cook Children's Pediatrics Forest Park: 

The actions we all take in our daily lives will make a difference for these hardworking doctors, our amazing and exhausted hospital staff, and most importantly, the kids.

Don’t send your kids to school sick. If in doubt, get a test. Move the parties, get-togethers, and playdates outdoors – fall is coming, and it’ll be beautiful out.

With winter approaching, I worry about our already-strained hospital system. COVID is already putting us under pressure – and the flu will bring new challenges for us all. Please get your family vaccinated against the flu now. Kids need to be in masks in school – last year’s nonexistent flu season can attest to how well they work.

We are counting on our community to do what’s right. Please help us help your kids

I ask you to put yourself in the place of the parents of one of these children, who desperately need urgent or critical care, and who may not be able to get it because of the number of patients in our hospital.

There are 41 patients currently in Cook Children’s with COVID. 63 beds and four units that are using vital resources of staff, oxygen, ventilation, life support.

Cook Children’s will always strive to accommodate all of our community’s needs. But I beg to you ask yourself: what can I do to help?

• Send your child to school in a mask. Ask them to keep it on at all times unless outside or eating.
• All children in school over age 2 should be masking indoors. School districts should strive for universal masking right now.
• Quarantine all children who come in contact with a COVID+ child if unmasked and for longer than 15 minutes indoors.
• Get your kiddo the COVID vaccine if they’re over age 12. It’s safe and it’s effective.
• Please keep your sick children home from school.
• Postpone indoor gatherings for now- it’s not going to be forever. Just for now.
• Move the party outside.
• Open windows when you have people over.
• Limit the number of people who can attend sporting or theatrical events at schools so there can be spacing between families.
• Mask up and put at least six feet of distance between you and other people in meetings.

This won’t last forever, but Cook Children’s needs your help to be able to always have a bed available for your child should you ever need one.

As the medical director of our Infectious Diseases department, Dr. Mary “Susi” Whitworth has told us, “we never want to get to the point where we cannot prevent a preventable death.”

What played a role? In some cases, junk food and lack of exercise as the COVID-19 pandemic wears on.

Childhood obesity was already a concern in the United States. In 2018, the Centers for Disease Control (CDC) reported that 19.3% of the 2-19 age group were considered obese. That’s about 14.4 million children and adolescents with excessive weight that could lead to other medical problems like diabetes, heart disease, high blood pressure, and joint pain.

But doctors and dietitians fear obesity has gotten worse due to habits that changed during the COVID-19 lockdown and afterward, continuing today. A study cited by the National Institutes of Health (NIH) even uses the term “covibesity” to describe the phenomenon of rapid weight gain that resulted when people changed their eating and exercise routines during the pandemic.

If the early months of the pandemic set the stage for higher obesity rates, the toll on health is current and ongoing. Consider diabetes, for instance: Cook Children’s has seen 91 new cases of Type 2 diabetes diagnosed already this year.

Escalation in childhood obesity becomes an even more relevant and urgent concern given reports of higher risk of severe COVID-19 symptoms for those with obesity. The CDC points out that excessive weight can cause impaired immune function and decreased lung capacity, which may worsen the illness. The CDC cites one study that linked obesity in pediatric patients to higher rates of hospitalization, admission to intensive care, invasive mechanical ventilation and death from COVID-19. At Cook Children’s Medical Center, this rings true. Many of the patients admitted to the COVID-19 ICU are obese are require life-saving measures.

Alice Phillips, M.D., a pediatrician at Cook Children’s, described the accelerated rise in childhood obesity as an outcome of the dramatic lifestyle changes brought on by the COVID-19 lockdown beginning in 2020. Multiple times a day, Dr. Phillips encounters and counsels patients whose body mass index (BMI) has surged since their last checkup.

When the schools were closed, lots of homebound kids began to snack out of boredom. They watched more TV and did online learning in front of a computer – no walking required. Recess, PE classes and team sports were canceled.

“Parents have been trying to nurture their children during a very difficult time. Food remains a cultural norm of nurture for families, and we are seeing the unexpected consequences,” she said.

Dr. Phillips emphasized it’s appropriate to expect a child to pick up some weight during a growth spurt. Pediatricians track the curve using the BMI calculations, which take a patient’s age, height and gender into consideration. Obesity by definition occurs when BMI reaches the 95^th percentile or higher.

Dr. Phillips and her colleagues at Cook Children’s point out two trends: an increase in patients whose recent weight gain put their BMIs in the 95^th percentile for the first time, and previously obese patients who became even heavier.

“When you see an acute change in the BMI from the 75^th percentile to the 99^th percentile, that’s when it catches your eye and you say, ‘What was different this year that caused that change?’” she said. “All too often during the pandemic the families will say, ‘We haven’t been getting any exercise, and our eating habits are maybe a little worse.’”

She worries about the long-term consequences on their health. When she raises the subject of obesity with her patients, she speaks with sensitivity and tries to help the families feel empowered to set goals they can achieve.

“You have to be very careful that you handle that conversation in an empathetic way,” Dr. Phillips said. “I don’t want how I handle it to be part of the problem for this child.”

Here’s what’s important to know:

• Obesity commonly begins between the ages of 5 and 6, or during adolescence. The causes include overeating, genetic predisposition, stressful life events (such as divorce or a move), depression and low self-esteem.
• Obesity is a chronic disease that adversely affects both physical and mental health. It’s easy to diagnose but hard to treat – potentially setting up a lifetime of complications.
• Studies referenced by the NIH show that a child who is obese between the ages of 10 and 13 has an 80% chance of becoming an adult with obesity.

Susan Hsieh, M.D., a pediatric endocrinologist at Cook Children’s, is seeing more patients diagnosed with obesity-related spinoffs that used to be considered adult diseases: hypertension, high cholesterol and Type 2 diabetes. She also points to the COVID-19 lockdown as a tipping point for kids who gained 30-40 pounds since last year. “The body isn’t designed to take on that much weight in such a short period of time,” Dr. Hsieh said.

She explained that obesity causes insulin resistance, impeding the body’s ability to control the blood sugar. It used to be rare, she said, to see an 8- or 9-year-old diagnosed with Type 2 diabetes. Not anymore.

Data at Cook Children’s show that Type 2 diabetes has been on the rise, with 55 new diagnosed cases in 2018, 107 new cases in 2019, and 126 new cases in 2020. The count so far for 2021 is 91 new cases through early September.

Early onset diabetes, if hyperglycemia is mild, can be treated with oral medications. For those patients who require insulin injections, Dr. Hsieh encourages weight loss as a motivation to wean themselves off the injections. She urges families to address their child’s escalating obesity sooner rather than later.

“In general, it’s easy to gain weight and very hard to lose weight,” Dr. Hsieh said. “The more we educate, the better, because prevention goes a long way.”

The Endocrine Clinic at Cook Children’s offers a program called Risk Evaluation to Achieve Cardiovascular Health (REACH), targeting kids affected by cardiovascular diseases caused by obesity or other factors.

Since the start of the pandemic, registered dietitian Lauren Williams found that her REACH patients and their parents often report more junk food consumption and less physical activity. She counsels them to treat food as a source of nourishment.

Williams’ main message? “We need a healthy relationship with food. We don’t snack throughout the day when we’re not hungry. We move our bodies because our bodies were made to move. Exercise helps our mind; it helps our sleep. Get out and run and play even if it’s just with your siblings in your backyard, having fun.”

Cook Children’s also offers a one-time, free-of-charge class called Healthy Weight Healthy You, which promotes the MyPlate nutrition guide and other tools to eat right. The class is offered in both English and Spanish for children ages 5-18 and their parents. A physician’s referral is needed.

Another resource to fight obesity is the Cook Children’s Outpatient Nutrition Services, available only through referral from physicians in the network. Jean Mankin, a registered dietitian in the outpatient clinic, said the incidence of childhood obesity “exploded” during the COVID-19 pandemic.

“Almost every patient that I’ve seen will admit to boredom eating. And the parents will agree,” Mankin said. “The parents will say ‘I was trying to work… I was there for emergencies but the kids were left to their own devices and they were grazing all day on chips and cookies and crackers.’”

Now she works with families to undo the damage. Bad habits – constant snacking, inactivity -- can be corrected. But it starts with recognizing the problem.

The patients Mankin meets with often arrive with complications tied to the excess weight on their bodies. She lists orthopedic problems, respiratory issues, elevated lipids, elevated liver enzymes and sleep apnea among the ailments.

A one-hour consultation with Mankin encompasses a review of the family’s journal of food intake over several days; guidance on problems she identifies; a packet of information to take home; and lots of encouragement. No one is forced to get on the scale. Mankin says she frames the conversation around the proper nutrition necessary for growth and development -- avoiding the word “obesity” out of sensitivity.

“Some of these little ones and adolescents can easily get their feelings hurt. And when that happens, they shut down. I also encourage parents to be mindful of the language used at home,” she said. “I work really hard to focus on overall health and to keep a positive vibe in my office. Initially, many kids that come to me are somewhat fearful or trepidatious, but most leave with a smile on their face.”

She emphasized that parents must be committed to making changes in the family’s approach to meals and exercise. Improvements don’t usually happen right away. A follow-up visit with the dietitian might be needed after the initial consultation.

If you have a concern about your child’s weight, contact your pediatrician.

Hey friends. Our phone lines are blowing up with exposure and quarantine questions. I love that you guys are calling – it’s the right thing to do! And we are here for ya.

But just wanted to spell out some common scenarios so that you have quick answers:

What does the CDC consider a “close exposure”?

• Being within six feet of someone indoors for more than 15 minutes in a day.
• This is common in classroom settings where kids aren’t masking.
• The CDC does not consider it a “close exposure” if both kids are masked (what a GREAT REASON to mask all kids in school!).

What should I do if my child had a close (classroom or otherwise) exposure to COVID-19?

• Keep your kiddo home for 10-14 days after exposure to the positive person.
• Make sure your child wears a mask in any indoor setting for 14 days, if over age 2.
• An infection could show itself anytime in those 14 days – but if you get to day 10 and the child has zero symptoms, most of the time it’s fine to end quarantine.
• Sometimes a negative test on Days 5-7 will allow return to school on Day 7 of quarantine if no symptoms appear.

What if my child has been vaccinated and then exposed? Does she have to quarantine?

• Nope. If she is symptom-free, she does not have to quarantine.
• The CDC does recommend a COVID-19 test on day 3-5 after exposure though, to be on the safe side.
• Your child should wear a mask indoors for a minimum of 14 days after the exposure, even if vaccinated.

What should I do if someone in my house tests positive for COVID-19?

• Try to keep them in their room as much as possible, and using their own bathroom.
• If they’re older than 2, have them wear a mask in shared spaces.
• Don’t share towels, cups, utensils or bathroom supplies.
• Wash your hands a lot.

What if someone in my home tests positive for COVID? Can my child go to school?

• If your child is VACCINATED and has no symptoms, yes. Get a COVID test 3-5 days after the last close exposure to that person.
• Regardless of vaccine status, have the child wear a mask in indoor spaces (if over age 2) for at least 14 days
• If unvaccinated, they need to quarantine for 10 days after their last exposure to that person. If the COVID+ person cannot isolate (say a parent who must help with childcare), the child must quarantine for 24 days (14 days they could potentially catch it, and 10 days to become non-infectious if they do have it). Again, these times could be shortened with negative testing and no symptoms, as discussed above.

My child has been in close contact with someone who was positive for COVID, and is starting to show symptoms. What do I do?

• Don’t panic. Remember that most of the time, COVID-19 is mild in kids.
• The child must isolate at home for at least 14 days from first symptoms, and must be 24 hours without fever and improving.
• Have the child mask indoors for at least 14 days, if over age 2
• Get your child a test for COVID
• If the test is negative, consider a repeat in 24 hours (or if it was a rapid, consider a PCR)
• COVID is a virus, and will need time to run its course. Typically, the only thing kids need is time.
• If your child is under 3 months old, call your pediatrician.
• Make sure he’s breathing comfortably.
• Make sure he’s drinking enough to urinate every 6-8 hours.
• Make sure he’s acting coherent and normal.
• He’ll probably be more tired, and may be dealing with coughing and congestion.
• Some kids have GI symptoms like vomiting or diarrhea.
• We are okay with fever for up to 5 days. We don’t want fevers trending higher over time.
• We don’t want breathing to become labored, wheezy, or faster.

My child tested positive for COVID-19, but has no symptoms. What do we do?

Your child is infected and needs to be in isolation from others even though they don't have any symptoms.

• You may end your child’s isolation if 10 days pass after the positive test with no symptoms.
• If over age 2, have them mask in indoor spaces for at least 14 days

What if my kid has symptoms of COVID-19, but I don’t know of any positive contacts. What do I do?

• Typically if a child is showing symptoms of COVID-19 (which, let’s face it, can look like a whole lot of other viruses), and they have no known exposures, I will perform a rapid or PCR test on them. If it is negative, they can go back to school as long as fever-free for 24 hours and symptoms are improving.
• If I am VERY suspicious for COVID (let’s say they’re having shortness of breath and have lost their sense of smell), I will ether get a PCR (more accurate than the rapid test), or I will repeat testing in 24 hours.

Quick reminder about RAPID versus PCR testing:

• Rapid testing (the kind we do in the office which is done in 15 minutes) is 80-85% sensitive. This means if it’s negative, and I really think a kid has COVID, I will re-test again in 1-2 days, or send them for a PCR
• PCR testing (often drive-thru or hospital testing that takes a day or two to come back): 99% sensitive! One test is sufficient to rule in/rule out COVID.

I am a doctor.

As a doctor, I enjoy talking with my doctor friends.

I text with other doctors, am in Facebook groups with other doctors, and enjoy sharing a nice meal or drink with them pretty often.

I am a lucky doctor. I have many doctor friends in our Cook Children’s network here in Fort Worth.

I won’t talk much here about the Facebook physician group posts begging for help in our state and others.

“Are there any travel docs willing to come to Florida?” “We need nursing staff so badly, I don’t know how to support this many patients without the staffing.” And let’s not even start with the poor physician who posted asking for any ICU bed in a five-state area for a patient with an urgent abdominal surgical problem (he finally found one…but this is what we are being reduced to – social media comments to find a bed). Let’s look more locally.

It’s important to me that you understand what’s happening in our network and what doctors are seeing.

You deserve to know what’s happening in a children’s hospital near you. So I picked up my phone yesterday.

I talked with Corwin Warmink, M.D., who is the director of the Cook Children’s Emergency Department.

“We saw the largest number of patients in the ER since H1N1 on Monday...587. That is 24 straight hours of a patient arriving every 2.5 minutes. We tested 265 children for Covid on Monday. The vast majority of this increase in volume from usual is back-to-school associated illnesses, of which Covid is a huge part right now. This is mainly a severe illness in the unvaccinated.”

It's true we're also tight on hospital beds too. Capacity has been stretched thin the past few weeks with RSV, COVID-19 as well as other illnesses and injuries. Right now, there are 26 COVID-19 patients in the hospital. Eight of those are in the ICU. RSV also continues to be prevalent. Last week alone, the hospital saw 117 children with positive cases of the respiratory illness. 

Next, I found Kara Starnes, D.O.. She is the medical director for all the Cook Children’s Urgent Cares.

They have been inundated with patients.

“The UCCs have seen more patients each day this week than we did in almost an entire week during the pandemic last summer. This is indicative of the impact that the delta variant of SARS-CoV2 is having on our children. We are doing our very best in the UCCs to fulfill the promise of Cook Children’s to every patient that enters our doors, but there are more patients than we can handle and our staff is exhausted.”

I think it’s important for parents to know that delta seems to be affecting children more rapidly, more frequently, and possibly more severely than past strains.

“We are in desperate need of help from the public. Please wear your mask and have your children over 2 years of age wear theirs everywhere in public. Encourage your children’s school districts to require masking at school to not only prevent the spread of COVID but also RSV, common colds and eventually, the flu. 

All of these illnesses mimic COVID and will require testing and potential quarantine but all of these illnesses can be prevented with masking and good hand washing. Lastly, please get a vaccine for yourself and your eligible children! Vaccines are safe and they work to keep kids and adults out of the hospital.”

I think Dr. Starnes' words are important to let sink in. We can make a difference and not overwhelm our hospitals.

If your child is exposed to COVID, but is feeling fine – there is no need to panic. I wouldn’t run to the urgent care or ER - I’d look into setting up an appointment with your pediatrician, either in-person or virtually, and scheduling a test 3-5 days after the exposure. You can also consider at-home testing.

If your > 3-month-old child is COVID positive and is drinking well, urinating every 6-8 hours, breathing normally, has had fevers for less than 5 days, is coherent and alert, and otherwise seems to be feeling alright – it’s okay to watch them closely and call your pediatrician if you notice any changes.

Masking your child protects others – absolutely. But it also protects your child. I highly recommend sending your kiddos to school in a mask. And think about other small changes:

• Move that birthday party from indoor to outdoor.
• Consider postponing the family gathering until the numbers start going down again.
• Open windows more.
• Move that playdate to a park.
• Be flexible in your plans.

I know it’s hard, but medical professionals are exhausted, and one death of a child is one too many.

Like Dr. Starnes says, “We are all in this together and we will not get out of this pandemic without working as a collective group. Think of this as the biggest, most important group project that you have ever been in, and be the group member that everyone wants to be with!”

I went to the ER yesterday to take some photographs. I couldn’t find a single chair available in the waiting room, at 1pm on a Wednesday in August – typically a time that is very quiet. I felt completely in the way – people were rushing all around me. I walked out heavy-hearted. Not because I didn’t get the photos I wanted – but because this was all preventable. Let’s do better, Fort Worth. We’re in this together.

Beginning today, the following changes will take place:

• All Cook Children’s Urgent Care Center locations are available for walk-in only. At this time, the UCCs are not taking online check-ins.
• The outlying Cook Children’s Urgent Care locations will close at 9 p.m. and the Fort Worth location will close at midnight. 
• Urgent Care Center locations will offer two options for patients.
  • One option will strictly be a lab-only visit for those patients that simply need a COVID-19 test but don’t need to be seen for an urgent care visit.
  • The other option will be the usual urgent care visit for all other patient needs.

These changes are taking place to keep up with the high demand of recent patient volume. Yesterday, our seven UCC locations saw more than 1,000 patients in one day. Prior to the recent surge in patient volume, the average number of patients seen in one day was about 600.

The Urgent Care Clinics and Cook Children's Emergency Department are seeing a big influx of parents bringing in children who have been exposed to COVID-19 but show no symptoms. Please avoid using the Emergency Department for testing if your child is not showing symptoms. Click here to read more.

Today’s announcement means the public can be very confident that this vaccine is safe, effective and meets the highest standards for manufacturing quality. Since becoming available for emergency use in individuals 16 years of age and older in Dec. 2020, more than 92 million people in the U.S. have received two doses of this vaccine. The Food and Drug Administration (FDA) spent the past several months reviewing updated data from clinical trials, which supported the emergency use authorization (EUA) late last year. This data showed the vaccine to be 91% effective in preventing COVID-19 disease. The most common reported side effects were pain, redness and swelling at the injection site, fatigue, headache, muscle or joint pain, chills, and fever. It also proved the vaccine is effective in preventing COVID-19 and potentially serious outcomes including hospitalization and death. With full FDA approval, the Pfizer-BioNTech vaccine will be marketed under the name Comirnaty (koe-mir’-na-tee).

What age is the vaccine fully approved for?

Comirnaty is fully approved for individuals 16 years of age and older. The vaccine also continues to be available under the EUA for kids 12 through 15 years of age, and for the administration of a third dose in certain immunocompromised individuals.

Why is the vaccine still under EUA for individuals under 16?

While the vaccine became available under EUA for 16 years and older in Dec. 2020, authorization was not expanded for 12-15 year olds until May 2021. Much like the emergency authorization process, the FDA will need more time to review data for this younger population before it can grant full approval.

Do you still recommend the vaccine for kids under 16?

Yes, Pfizer-BioNTech’s COVID-19 vaccine is recommended for children 12 years and older. Many people mistakenly believe that children cannot become ill from COVID-19 and this is simply not true. Unfortunately, children and teens can become very ill from the virus and need hospitalizations, even intensive and life-saving care. The Pfizer-BioNTech vaccine is safe for children and teens, and protects them from potentially developing severe illness and long-term issues.

What does this approval mean for children under 12?

At this time, no COVID-19 vaccine has been authorized for children under the age of 12. This means it’s vitally important for this population to wear a mask around non-family members, stay six feet apart from others and practice frequent handwashing. Families can also protect these children by ensuring those closest to the child (parents, older siblings, grandparents) are all vaccinated. This will help decrease the chances of the child becoming exposed to COVID-19.

Watch the video above to hear Nicholas Rister, M.D., pediatric infectious diseases specialist at Cook Children's, answer these questions and more. 

“If your child needs emergency care treatment, our Emergency Department is here for you. That’s why we’re here,” said Natalie Carpenter, director of Emergency Services at Cook Children's. “But please don’t come to the emergency department for a simple COVID test.”

Carpenter said many parents have come to Cook Children’s ED in a panic because their child was exposed to a classmate at school who tested positive for COVID-19. The parents often bring younger siblings too, so that the whole family can be tested in the ED. High volumes of non-emergency patients puts unnecessary strain on the department.

“It pulls away staffing from the critically-injured and ill and it takes away bed space,” she said. 

As an example, Carpenter said, of the 361 patients seen in the ED on Tuesday, almost half were considered less urgent or non-emergent. Many of the patients could have been seen at a pediatrician’s office or clinic.

 The U.S. Centers for Disease Control and Prevention (CDC) lists these COVID-19 symptoms requiring emergency care:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

With schools reopening and COVID-19 cases on the rise, parents should encourage their children and teens to wear masks, social distance, wash their hands frequently, and follow guidance for quarantining. Carpenter encouraged parents who suspect their child might have COVID-19, and are not exhibiting symptoms, to get tested at drive-thru centers or other designated testing facilities. 

It’s important to know that Cook Children’s urgent care clinics are unable to perform rapid COVID-19 testing on a child who doesn’t show symptoms. Cook Children’s does have drive-thru testing sites, but those appointments are scheduled only through a Cook Children’s pediatrician and for specific times and locations.

Kara Starnes, D.O., medical director of Cook Children’s Urgent Care, said patient numbers and wait times have dramatically increased recently. Dr. Starnes said 737 patients came to urgent care on Tuesday – compared to a previous maximum of about 650 patients.

“The usual surge that comes when school starts is usually about two to four weeks post back-to-school,” she said. “We’re seeing strep infections, common colds and pink eye as well as the expected substantial increase in COVID cases as kids are now congregating together at school, often without masks.”

Where do you go when your child needs to be seen by a doctor? Here’s a guide:

• Go to the emergency room if your child has trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition.

• Call your health care provider if your child has ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns. The pediatrician ’s office can help you decide what steps to take.

• If you can’t get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

For more information, visit www.cookchildrens.org/coronavirus.

Angie, Cason's mom, told Good Morning America that she worries her son might get reinfected with the novel coronavirus at school. She’s urging students to wear masks for the sake of her immunocompromised son, and all kids under age 12 who can’t yet get vaccinated for COVID-19.

Read the full GMA story here.

Staring up at this totally massive wave of COVID-19Δ, upper classmen and student leaders need to take charge of their own future. To keep schools open, student athletes, student council members, section leaders, club officers, and trendsetters are going to have to model the socially responsible things that have to be done - like social distancing, wearing masks, getting vaccinated, and encouraging friends and classmates to join in.

Even before the runny nose, cough, headache, chest pain, and difficulty breathing develop, clouds of viruses fill the spaces around infected people while hanging out and talking. But this time around, rather than two new cases developing from a COVID-19 infected person, five new cases are projected to develop.

For all you STEM kids, considering a fully susceptible population with no guardrails, like masking, (and making the unrealistic assumption that no one either enters or leaves the population, infected or otherwise), we previously projected a disease prevalence of 2ⁿ or 32 infections after 5 cycles of transmission. However, we are now looking at 5ⁿ or 3125 new infections after the 5th cycle of transmission. You could do some calculus and quickly find the sum of all people affected in that 40+ days (1+5+25+125+625+3125), but the school year is young, and that lesson is still to come…

Goodbye stadiums and gyms full of loyal and adoring fans! Goodbye homecoming parade! Am I right?

So how do vaccination rates and guardrail practices impact the pandemic and why should I care? Well, let’s start by looking at delta in India. Most people were unvaccinated, there were high transmission rates and dense populations, so everyone got sick really fast. That resulted in a huge, narrow spike followed by a rapid decline in cases, since, after a very short period of time, few susceptible people were walking around. Now let’s take the same virus and transplant it into a population with modest vaccination rates and inconsistent guardrail practices. Now we have “fattened” the curve over time, still with huge numbers of people affected, but an epidemic progressing over a much longer time, flaming up now and then, but always burning.

Goodbye ski trip! Goodbye Prom! Goodbye graduation party! Got me?

But, it doesn’t have to be that way. We could take a fat curve and just slice off the back half. That’s what we started to do when vaccines first entered the picture and we all still had our guardrails up. But to do it in this climate will take strong leadership. How will you lead? How will you use your language, your social media savvy, and your own individual sphere of influence to do something for your teammates, friends, teachers, parents, and grandparents? Besides, where would you rather be when your big moment comes - sitting home shivering, holding a box of tissues, or hoisting the UIL district trophy with everyone else who followed your example?

We, the physicians at Cook Children’s Health Care System, are directly connected to the district or school either as concerned parents or as pediatricians who care for the children we mutually share with your district/school.

We are writing to you to express our concerns about the Delta Variant of COVID-19 and to recommend that our school district implement safety protocols beyond those that have been in place this summer to address this exigent threat. The rapid increases in COVID-19 cases, hospitalizations and deaths locally and throughout the US in recent weeks are alarming and require an appropriate response. Indeed, we are seeing rising COVID-19 cases in our practices.

Please find below the Cook Children’s 10-Point Guide for Safely Reopening Schools crafted by Marc Mazade, M.D., Medical Director of Infection Control and Prevention at Cook Children’s Medical Center.

We stress key recommendations to mitigate the spread of this infectious new variant of the COVID-19 virus with the start of this school year:

• Strongly encourage universal masking for students and staff in accordance with CDC and American Academy of Pediatrics recommendations.
• Minimize contacts for each student to the greatest degree possible.
• Encourage and support all opportunities for eligible children to receive COVID-19 vaccination.

The Cook Children’s Promise states: “Knowing that every child’s life is sacred, it is the Promise of Cook Children’s to improve the health of every child through the prevention and treatment of illness, disease and injury.” Please help us honor the health and sanctity of our children’s lives through your sincere attention to these recommendations. We would welcome the opportunity to collaborate with the district/school in promoting the health and safety of our community during this new and troubling phase of the pandemic. We will gladly provide additional data if it would be helpful, and we are available to answer any questions that arise.

We appreciate your time and look forward to further conversation on this important topic.

With respect and care,

Cook Children's Physicians

The rising number of COVID-19 cases in North Texas is due to the delta variant, which is more contagious than other strains of COVID-19, and a significant number of unvaccinated people. With Texas doing away with virtual learning this school year and the COVID-19 vaccine not yet available for those under 12, many parents and children are understandably feeling anxious.

Amanda Jordan, Psy.D., a licensed psychologist at Cook Children’s Alliance, can relate. She has a child starting kindergarten in the fall and is experiencing similar feelings.

“I want parents to understand you can’t take care of others if you don’t take care of yourself first,” Dr. Jordan said. “You have to check in with yourself first to see how you’re feeling because you don’t want your children to pick up on your negative energy.”

As for parents, Dr. Jordan says it is important to engage with other parents, make sure to create and maintain their own schedule, talk with their partner/spouse and seek professional help when necessary.

Dr. Jordan says once parents have worked through their anxiety, it is good to start preparing children for their ‘new normal’ as early as possible. She says it’s important to pose open-ended questions such as, “I wonder what your first day will be like?” or “I wonder who your teacher will be this year?” These types of questions allow your child to open up about how they’re feeling and can lead to other questions or concerns they may have.

Dr. Jordan also stresses the importance of establishing a routine as school beings again because many children have been off of their schedule for more than a year. This routine includes bedtimes, meal times, changing eating habits, etc.

“There has been so much flexibility with virtual learning,” Dr. Jordan said. “Children have been going to bed and waking up later than normal, and could do their work at their own pace.”

She says starting a ‘school year’ routine before school officially starts can help ease some of the anxiety on the parents and children.

Another technique Dr. Jordan recommends to parents is called ‘Name it to tame it.’

“It is important to help children put a name on their feelings,” she said. “As parents, we want to fix things and say things like ‘don’t be scared’ or ‘you’re going to be fine,’ but you must validate their feelings.”

Dr. Jordan says to respond to children by validating their feelings and letting them know you understand how they feel and let them know they always have a safe space to express their feelings.

Along with the anxiety of returning to school, medical professionals at Cook Children’s are also getting questions about children wearing masks in the classrooms. Alice Phillips, M.D., a Cook Children’s pediatrician at Cook Children’s Cityview says she stands behind the recent recommendations from the American Association of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), that all children K-12 should wear masks in classrooms this school year.

“I believe children need to be in school for their social skills, mental health, and other key personal connections,” Dr. Phillips said. “I recognize it’s a hot topic, but for students to stay in school without shutdowns or quarantines, we must do it safely.”

Dr. Phillips says the new delta variant is spreading rapidly in our unvaccinated population. At Cook Children’s we have seen a rise in the number of children testing positive for COVID as well as an increase in the number of children being hospitalized. For this reason, she believes it is even more important to make sure all children have masks on in the classroom, no matter their vaccination status.

“Parents have to begin modeling mask-wearing behavior at home, and support their children if they feel pressured to do otherwise by their peers,” Dr. Phillips said.

To prepare children to wear masks in the classroom, she says it’s important to explain to children the reality of doing ‘hard things,’  for our friends and communities. Equally important is providing encouragement to children when they're doing the right thing.

“I understand that it’s hard to be brave sometimes,” Dr. Phillips said. “The best we can do is encourage, support, and validate children’s feelings and let them know the ‘why’ behind masking and the importance of keeping themselves and others safe.”

Dr. Phillips says her advice to all adults is to get vaccinated and be an example. She advises all adults to wear a mask when they are in the grocery store and other public settings as recommended by the current CDC guidelines, 

“If parents are vaccinated and their children are not, I still advise the entire family to mask up to support the child and protect them,” she said.

If you have any questions about preparing for your children to head back to the classroom or need guidance for masking, contact your child’s pediatrician.

Read more about preparing for the upcoming school year here:

Cook Children's 10-Point Guide for Safely Reopening Schools

Should My Child Wear a Mask to School this Fall? 

This means all employees, physicians, providers, credentialed staff, students, volunteers, contractors and on-site vendors will have to receive either one dose of the Johnson & Johnson vaccine or two doses of the Moderna or Pfizer vaccine by the deadline.

Why is Cook Children’s taking this step?

Because COVID-19 is spreading like wildfire among unvaccinated people in Tarrant County and surrounding areas. The highly contagious delta variant has taken hold and is driving up hospitalizations across age groups.

“We are seeing more children sick with COVID-19 than we have seen in months,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “We were very hopeful that the worst was behind us but that may not be true. The rate of COVID-19 cases being diagnosed at Cook Children’s is alarming. This is not a slow upward trend, it is a rapid and dramatic rise in cases not seen since November of 2020.”

As of Tuesday, 23 patients were being treated for COVID-19 at Cook Children’s, which is a figure not seen since the height of the pandemic in January. On top of that, nearly 100 new cases are being diagnosed in children each day. The rate of positive COVID-19 cases seen at Cook Children’s in a seven day period is now 11.2%. On June 2, that number was 1%.

“What’s happening at Cook Children’s is a reflection of what’s happening across the county and region,” said Dr. Whitworth. “With vaccination rates in the community below 50%, and the delta variant spreading rapidly, the stage is set for an outbreak similar to, if not worse than, last winter.”

Dr. Whitworth says it’s also important to recall that children under the age of 12 are not yet able to get vaccinated. While most children do not typically get as sick from COVID-19 as adults, that is not the case for all kids. It’s a myth that children don’t get severely ill from COVID-19. In fact, Cook Children’s treated hundreds of hospitalized patients with the virus over the past 17 months.

Kids are also at risk of developing multisystem inflammatory syndrome in children (MIS-C), which usually develops about four weeks after a COVID-19 infection (even if the child never had any symptoms). Initial symptoms of MIS-C include fever, rashes, red eyes, diarrhea and vomiting. The inflammation from MIS-C can affect the heart, blood vessels and other organs, making it essential for them to receive high level medical care.

For Rick W. Merrill, president and CEO of Cook Children’s, the decision to mandate the COVID-19 vaccine among the health care system’s workforce was made with children in mind.

“The delta variant is very contagious and many of our patients are vulnerable to COVID-19 because they can’t get vaccinated at this time,” said Merrill. “I personally received the vaccine in December, as did more than 95% of our physicians and two thirds of our employees. Given how close we are to critically-ill children, we know this is the right decision for our system and ultimately our patients.”

While Cook Children’s is doing its part to lower the spread of the virus through mandatory vaccination, now is the time for everyone in the community to do what they can as well. This means getting vaccinated, wearing a mask, social distancing and practicing good hand hygiene. Together, we can slow the spread of COVID-19.

COVID-19 Cases Across Cook Children's Health Care System - August 4, 2021

In an email to more than 8,000 Cook Children’s employees, President and CEO Rick W. Merrill attributed the decision to the increasing rates of COVID-19 in Tarrant County. Public health officials in the region say community spread of the virus is once again considered ‘high’ due to the surging delta variant.

“The delta variant is very contagious and many of our patients are vulnerable to COVID-19 because they can’t get vaccinated at this time,” said Merrill. “I personally received the vaccine in December, as did more than 95% of our physicians and two thirds of our employees. Given how close we are to critically-ill children, we know this is the right decision for our system and ultimately our patients.”

The number of COVID-19 cases among patients at Cook Children’s has increased dramatically over the past few weeks. There are currently 24 children being treated at Cook Children’s Medical Center for COVID-19. The rate of positive cases seen across the health care system over the past week is now 11.3%. On June 2, that rate was 1%.

With the mandate in place, Cook Children’s joins several hospital systems in Dallas-Fort Worth and dozens of health care institutions across the U.S. requiring COVID-19 vaccination for its workforce. Such mandates regarding the COVID-19 vaccine and health care workers are supported by organizations such as the Children’s Hospital Association, American Hospital Association, American Nursing Association, American Medical Association and Texas Nurses Association.

About Cook Children’s

Cook Children’s Health Care System embraces an inspiring Promise – to improve the health of every child in our region through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community.

Our not-for-profit organization encompasses nine companies – a medical center, two surgery centers, a physician network, home health services and a health plan. It also includes Child Study Center at Cook Children's, Cook Children's Health Services Inc., and Cook Children's Health Foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet their unique needs.

We’ve worked to improve the health of children from across our primary service area of Denton, Hood, Johnson, Parker, Tarrant and Wise counties for more than 100 years. Based on the exceptional care we provide, patients travel to Cook Children’s from around the country and the globe to receive life-saving pediatric care built on leading technology, extraordinary collaboration and the art of caring.

For more information, visit cookchildrens.org.

1. Make sure all children are up to date on the routine childhood vaccinations needed for school entry. Access to medical offices, fear of leaving home and of waiting room exposures, and closed schedules of weary medical providers taking long-awaited vacations could result in a drop in vaccination rates against measles, mumps, rubella, pertussis, and the bacteria causing meningitis. A slight drop in vaccine coverage for measles, pertussis, and mumps translates quickly to a loss of herd immunity and outbreaks of serious, vaccine-preventable illnesses.

2. Revisit the latest masking decisions in light of the recent surge in COVID-19 cases. The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) advocate for masking in schools, especially in areas with moderate to high transmission of COVID-19. Follow guidance from your local health department which will be in line with the current state of the pandemic and regional community health recommendations.  We have learned during the pandemic that most children, 2 years of age and older, can wear a mask.

3. Encourage COVID-19 vaccination of all eligible children and adults. COVID-19 efficiently spreads from adults and teenagers to younger children, not often the reverse. The key to keeping schools open during the COVID-19 pandemic is getting unimmunized parents and all eligible family members vaccinated.

4. Arrange for mobile COVID-19 vaccination units to be present during orientation and events such as 'meet–the-teacher' nights. Gains in U.S. vaccine acceptance are likely to come amidst the group of people who don’t have a solid reason to avoid vaccination. Surveys reveal that most of these people were hoping that the pandemic was wrapping up and that they would not have to take a risk by taking an “untested” vaccine. They are reasonable people who describe themselves as cautious, slow adopters of things that are new. Most are not necessarily opposed to vaccination philosophically. They were just hoping to wait out the pandemic while relying on social distancing, masking, and herd immunity to keep them from having to getting a vaccine. With the loosening of restrictions and the surge in cases due to the Delta variant, many are now ready to stop holding out.

5. Continue to utilize strategies promoting social distancing in the classroom (by using partitions, separating desks, and cohorting of student groups), during passing periods (by keeping them short to discourage standing around in small groups and conversing), and during meal times (by moving meals outside in the fresh air, limiting line length for meal service, and by observing social distancing).

6. Re-enforce good hand-hygiene practices and cleaning of shared workstation areas with demonstrations that highlight effective hand hygiene and disinfection techniques.

7. Quarantine unvaccinated children and school staff members exposed to COVID-19 per CDC guidance. Vaccinated exposed persons may still get sick with COVID-19 and could be contagious, though their risk of hospitalization and severe disease is extremely low. Quarantine exposed, vaccinated persons if they develop symptoms of COVID-19 until testing results are available.

8. Provide interactive and technologically sound, distance-learning alternatives for immunocompromised students who should not be in the classroom during the pandemic.

9. Encourage precautions for bus riders like masking and opening windows to promote adequate ventilation and reduce the transmission of COVID-19 while traveling to and from school.

10. Above all, send recurring reminders to parents not to send ill children to daycare and to school. Many parents are returning to the workplace for the first time in over a year. They may be experiencing pressures to be physically present, rather than staying home with an ill child. Memories are short when pressures are high. However, we are still in the midst of a global COVID-19 pandemic that has already claimed the lives of more than 600,000 people in the U.S.

The American Academy of Pediatrics is recommending that all children over age 2 wear masks in school this fall. The internet rejoiced, everyone agreed it was a great plan, scientists and politicians shook hands, and no one had anything to say about it.

Ha. Kidding. I promptly picked up some curly fries and wine when I heard about it and laid face-down on my office floor. Not the most sanitary place to do some deep breathing, but whatever.

I hate to joke about serious things like this, but if I don’t, I may cry. The idea of a uniform and agreed-upon plan for halting the spread of a disease that could prevent the deaths of many seems like a pipe dream at this point.

Let’s walk through this and see if I can help you with your decisions this fall.

What did the American Academy of Pediatrics recommend?

• “Everything possible must be done to keep school in-person.” This is because the rates of academic struggle, obesity, and mental health crisis all rose tremendously this past year. Kids need to be in school. We all agree on that.
• They recommend all eligible kids receive the COVID vaccine (12 and up currently)
• Universal masking for anyone in school over age 2 (all students and all staff)
• Flexibility in policy – COVID is an ever-changing scenario and if something isn’t working well, schools need to recognize it and change it
• Attendance of students should be closely watched, and mental health resources for both students and staff should be available
• There should be ongoing federal, state, and local funding to schools to help them with all this.

Why is the AAP recommending all kids wear masks this Fall?

• The AAP is asking all students to wear masks in order to not only protect those that cannot be vaccinated yet, but also the families of these children, and the community as a whole.
• The AAP advocates for children. ALL children. Not just your kid. The wealthy ones. The poor ones. The sick ones. The healthy ones. The physically and mentally challenged. The kid who is being raised by his elderly grandmother and doesn’t have the means or transportation to get that vaccine yet. The kid who doesn’t have enough food at home but gets 2 good meals at school. The child who doesn’t have access to the fancy laptop or functioning internet. The AAP gives us advice based on what will help our community better support and protect our kids.
• Guess what? Last year, we masked in schools. We washed hands more. We asked sick kids to stay home. And schools were then found to not contribute significantly to the spread of COVID-19. (Click here for more information)
• We also noticed a pleasant, NONEXISTENT flu and RSV season as an added side-bonus.
• What happened this summer? We took our masks off, had playdates, saw friends, had parties. And now have plunged into a winter-sized scourge of viral illness. My office has been booked days in advance. The hospital is full. In July. These school strategies work not only in regards to COVID, but all viral illness– both focused studies and my own practice numbers have proven this.

What is the “Delta variant”?

• The COVID virus is mutating (as we expected), and this is the newest and most common version of it in the U.S. right now
• It is crazy, freaking contagious. More so than the original bad boy.
• Verdict’s out on whether it makes you sicker. I suspect it will put a larger burden on hospitals just given the number of unvaccinated people who may be infected.
• Vaccines seem to be working well against it.
• A recent study from the United Kingdom showed that children and adults under 50 were 2.5 times more likely to become infected with Delta.

Why should my vaccinated kid wear a mask?

• Because keeping track of who is vaccinated and who isn’t is a huge burden on schools. And trust me, they have already suffered enough burden.
• Because many kids cannot have the vaccine yet, or haven’t had access to it.
• Because we don’t yet know how well the vaccines work against the new COVID variants and until we are more comfortable with seeing how effective it will be, this is the most low-risk and safe thing we can do.

Will masking harm my kid? Why are all these people saying these awful things about masks?

• Putting a piece of thin cloth on your child’s face does not harm your child.
• I have written one mask exemption this entire year. One. It was for a child with a very rare lung disease. The child’s lungs are anatomically and physiologically very different than a normal child’s and keeping oxygen levels up even without a mask was a struggle for this kiddo.
• The worst I’ve seen is a mild face rash here and there. Otherwise, don’t believe the hype. Masks are not causing TMJ problems, lost social development, increased CO2 levels, increased illness, etc etc. It’s a lot of weak arguments with no evidence and as a pediatrician who saw and examined thousands of children this past year: the kids are fine.

Does masking protect other people? Or me?

• Both.
• Even if your child is the only child wearing a mask in the class, it will protect him. (Click here for more information)
• This all works better if everyone masks.
• If an unmasked sneeze happens nearby, a mask prevents your child from inhaling AS MUCH virus into his airway – and there is brewing evidence that the MORE virus particles you inhale into your body, the more severe the subsequent illness may be.
• I also think it really keeps kids from touching their face, picking their nose, putting fingers in mouth, etc. Our absolute lack of flu and RSV last winter can attest to this.

What if only some kids are wearing masks? Will my kids get bullied?

• I don’t know. I doubt it. We did a whole year where everyone masked and school-aged and young kids were generally pretty cool and flexible about it. Most don’t seem to care either way. The bullies in this scenario often seem to be the adults.

When are the vaccines for the younger kids going to be ready?

• Pfizer’s clinical trial data for children age 5 to 11 is likely coming in September. If approved, shots for kids this age will be available within 1-2 weeks after that.
• Ages 2 to under 5 coming soon after that, in October.
• 6 months to 2 years soon after that.

What about my child under 2 who can’t wear a mask?

• It’s okay. Send them to daycare. Send them to mother’s day out. Do the swim lesson. Get the speech therapy. You need it to work, thrive, survive. COVID seems to be milder in young kids. And while I can never guarantee anything in life 100%, I think the benefits outweigh the risks for kids in this age group.

What if the daycare doesn’t require their staff to be masked? Vaccinated?

• I’m hopeful that daycare centers will strongly encourage their staffs to vaccinate and mask up, but I know that not all will. I think you should ask the questions and expect answers from childcare centers. You can certainly make that a part of your decision-making process when choosing where to place your child.

Do kids really get severely sick with COVID?

• COVID in children is mostly mild. No one debates that. But kids (especially the older kids) contribute to the spread in the community.
• Let’s not forget the times it’s not mild. I’ve seen kids with post-COVID chronic fatigue, long-term smell and taste change or loss, multisystem inflammatory problems, psychosis, and cardiac issues that have kept them out of sports for the year.
• We are still learning about the long-term consequences of COVID infection. There is thought that up to 30% of people who have had COVID will develop long-term medical problems.
• I talked to one of the Cook Children’s Pediatric ICU doctors the other day, Dr. Linda Thompson. I wanted her input about kids with more severe illness as she has seen much more of it than I. She said she’s seen more severe illness in older children compared to the younger ages. She also mentioned “please let everyone know I vaccinated my 14-year-old as soon as I could.”

What do you recommend, Dr. Diane? What will you be doing with your kids?

My kids (6 and 7 years old) will be going to school in-person this fall. They will be wearing masks regardless of what the other children are doing. They can take them off when outside. We will talk about it a lot before it happens, and expectations will be clear.

We will practice wearing them while we watch our screen time to get used to them again on our faces. We will pick the favorite fabrics. If our community numbers drop and my children are able to safely get vaccinated this winter, I can’t wait to tell them to take ‘em off.

But until enough of us get vaccinated, COVID is not going away. And it will likely surge again this winter.

As long as the numbers keep climbing in the community, we have to protect not only the kids, but all of us. Remember those hospital numbers in January? Remember the goal of not over-straining our medical resources? Remember Uncle Pete who had a heart attack and there wasn’t a single hospital bed available for him last winter?

I’ve said it before and I’ll say it again: we are building this boat as we float in it. We don’t know what the future holds for us and we are making the best decisions we can in a situation that no one has yet conquered. Having patience as we gather the data and learn from our successes and mistakes is the beautiful and necessary process of science.

In an interview with WFAA, pediatric infectious diseases physician Nicholas Rister, M.D. said, “We are seeing more numbers, which means we're seeing more sick kids, and the expectation over the next coming weeks and months is that we'll likely see more of that.” 

Dr. Rister advises parents to watch out for the typical symptoms of COVID-19, including fever, cough and shortness of breath, as well as gastrointestinal or abdominal symptoms, which “can be pretty prominent.” 

“It's not that adults can't have that, but we do have a fair number of kids who primarily present with like, 'my stomach hurts or I have diarrhea,'” Dr. Rister explained.

North Texas medical experts continue to encourage people to get vaccinated.

“For the kids that are old enough to get the vaccine, we're highly recommending that. We're asking people to be aware that COVID still exists,” Dr. Rister said.

According to the DFW Hospital Council, there are currently 605 COVID-19 hospitalizations in the 19 county region known as TSA-E. 

The highest numbers are as follows: 

• TARRANT = 222
• DALLAS = 173
• COLLIN = 96
• DENTON = 25

Read the entire story here.

It’s a good question and one that Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s understands.

“It can be confusing because there are viruses that you can catch that trigger long-term immunity,” she said. “However, COVID-19 is not one of them.”

She explains it this way – COVID-19 is in the coronavirus family. We all get a coronavirus each year and it usually feels like a cold. Even though we catch a coronavirus, our immunity is temporary so we may catch it again the next year, and the year after that. COVID-19 is the same. Even though you’ve had it once doesn’t mean you won’t catch it again.

“It’s very different from, say, the measles where you probably won’t catch the measles twice in your lifetime. Coronaviruses are different,” said Dr. Whitworth.

So what about the COVID-19 vaccine? We don’t know how long immunity lasts with it either, but Dr. Whitworth says it does appear to provide protection for a longer period of time than getting COVID-19. She points to this study released by the Centers for Disease Control and Prevention (CDC) that examined two outbreaks at a nursing home in Kentucky. The first outbreak in July sickened 20 residents and killed five. Three months later in October, another outbreak hit the same nursing home. There were 12 residents who tested positive the first time who were still living at the facility. Five tested positive again.

“Three of those five had no symptoms during the first outbreak. This means those three were made worse by the second infection,” said Dr. Whitworth. “So, we know our immunity wears off after getting the virus.”

Another CDC study released in June shows people who had COVID-19, but didn’t get very sick, likely didn’t build up a strong antibody response, likely making them more susceptible to catching it again.

“The good news about this study is that it shows if you had COVID-19 and you got the vaccine, your protective antibodies will be even higher than someone who only got the vaccine,” she said. “The bottom line is that a lot of people who get COVID disease, but aren’t very sick, do not develop very good antibodies.”

Still, she knows a lot of people are worried about the potential side effects of the COVID-19 vaccine. It is a new vaccine, but scientists have been following the data and risks for seven months now. At this point, more than 155 million people in the U.S. have been fully vaccinated. That’s a lot of people. However, no vaccine is 100% effective. According to the CDC, 4,115 vaccinated people have been hospitalized or died with COVID-19 as of June 21. Of those “breakthrough infections,” 750 were asymptomatic.

“About 20% of the deaths in this group were not related to COVID-19. They were car wrecks, heart attacks, other things that people died from,” said Dr. Whitworth. “All of this is to say, it’s incredible how safe and effective this vaccine is. There’s not another one on earth like it. It’s as good of a vaccine as there has ever been.”

Recent reports about myocarditis, or inflammation of the heart, in young people have raised new concerns about the COVID-19 vaccine. Since April, there have been more than 1,000 reports of myocarditis in people who received one of the two COVID-19 mRNA vaccines (Pfizer and Moderna).

The CDC reports:

• Confirmed cases have occurred:
  • Mostly in male adolescents and young adults age 16 years or older
  • More often after getting the second dose than after the first dose of one of these two mRNA COVID-19 vaccines
  • Typically within several days after COVID-19 vaccination
• Patients can usually return to their normal daily activities after their symptoms improve. They should speak with their doctor about return to exercise or sports.
• CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older, given the risk of COVID-19 illness and related, possibly severe complications.

While this can sound scary, especially for parents trying to make the right decision for their child, Dr. Whitworth shares this:

• The number of vaccinated people who have contracted myocarditis is about one in 10,000 to 50,000.
• The NCAA tracked rates of myocarditis among its athletes who contracted COVID-19 before the vaccine was available. Thirty-seven, or 2.3%, of 1,597 Big Ten college athletes were found to have myocarditis through regular EKGs and MRIs.
• The risk of myocarditis from contracting COVID-19 infection is much higher than from the vaccine.

She adds that, like other coronaviruses, COVID-19 isn’t going anywhere anytime soon. She fully expects to see it circulating for years to come, making it even more important to get vaccinated. And if you think it’s easy to be the bearer of bad news day after day, it’s not. She’s going on 17 months of advising us about preventing COVID-19.

“It’s a lot of pressure sharing these opinions all the time, but I’m not scared of telling people to get the vaccine. I saw so much heartbreak watching the adult hospitals in Fort Worth have to call in morgue trucks because they ran out of places to keep the bodies. And we’ve held a lot of scared families’ hands here whose children required ICU care,” she said. “I got the Pfizer vaccine the week after it received emergency use authorization. My adult children got vaccinated. My parents were vaccinated. I firmly believe that it’s safe and it’s our best protection.”

The Center for Children’s Health, led by Cook Children’s, developed the seven-video project along with three partner agencies: Tarrant County Public Health, the Early Learning Alliance and the University of North Texas Health Science Center (UNTHSC). The videos feature leaders from diverse professional, racial and religious backgrounds who talk about the science behind the COVID-19 vaccines. But they also speak from the heart in sharing their personal and relatable experiences.

The series showcases several doctors from Cook Children’s as well as Dr. Kenton Murthy, assistant medical director at Tarrant County Public Health. The physicians explain the vaccine’s development and its safe and effective track record. You’ll also see and hear from nonmedical people too, including clergy and promoters of day care and parenting education – and even the chief of the Fort Worth Fire Department. The videos come across with respect and empathy that acknowledges the complexities involved in deciding whether to receive the vaccine.

“We’re living in a very politically polarized time right now, and this is a very sensitive topic for a lot of people,” said Breanna Anderson, program manager for the Center for Children’s Health. “And so the fact that they were willing to speak out as leaders in their own community and speak about their own perspective, it was really brave on their part.”

Some of the panelists on video #4, for instance, discuss why they initially felt suspicious and opposed to the vaccine. Other panelists discuss how they jumped at the chance to get vaccinated against the virus that causes COVID-19. They talk about rumors on social media, objections from a religious standpoint, and lack of trust rooted in historical instances of racism in health care. The panel discussion was facilitated by Cook Children’s own Chief Diversity Officer Winifred King.

Anderson said the videos give viewers access to a candid dialogue among people representing various perspectives. The webinar aims to provide factual content in plain language to help viewers make an informed decision.

“We need to be prepared to educate our folks and get them answers to the questions they’re asking, and then provide encouragement and support,” said Fire Chief Jim Davis on video #4, who called the vaccine “the right thing to do. It provided me with a little bit more of a sense of security. I wasn’t somebody who could do my work from home.”

Or consider Misty Wilder, program director at the UNTHSC’s Healthy Start, who said she hesitated at first because she worried about possible side effects. Now fully vaccinated, she speaks out as an example to the pregnant women and new moms at Healthy Start. “For me, I’m leading the way for my team, because my team is those younger people who say, ‘I ain’t getting it,’” Wilder said on the video.

The Centers for Disease Control (CDC) reports that 65.7% of Americans have received at least one shot of the COVID-19 vaccine. The CDC recommends the vaccine for people ages 12 and up. Doses are free and available at retail pharmacies and other locations. In a pilot program at Cook Children’s, three pediatrician offices in the network now offer the vaccine to eligible patients. But the vaccination rate has slowed in recent months even as virus variants became more widespread. Click here to find a vaccine near you. 

Information about the vaccines can be confusing, and people need help sorting it out, which is where the idea for the webinar originated. Back in March, Dr. J’Vonnah Maryman, associate director for Family Health Services at Tarrant County Public Health, pitched the suggestion to the Center for Children’s Health as a collaboration. Dr. Maryman proposed a video that would target parenting educators and daycare operators, who could then explain the vaccine’s benefits to their clients.

“It was a train-the-trainer sort of concept, but we needed it to be at a level that was relatable and not too technical that people didn’t feel comfortable passing the information along,” she said. “A lot of information is still shared by word of mouth.”

The scope of the project grew when the collaborators realized they needed more than one video to address a range of vaccine issues. They saw the webinar series as filling an information gap and potentially reaching a wider audience, distributed through organizations and faith groups. So they drew up these goals:

• Provide reliable information and practical resources
• Answer questions and acknowledge the obstacles for some people, such as language barriers or lack of transportation to a vaccine site
• Include a diverse mix of presenters
• Make the videos short, accessible online, and easy to understand

Video #1, for instance, features Mary Suzanne Whitworth, M.D., medical director of pediatric infectious diseases at Cook Children’s. Dr. Whitworth explains some of the technical concepts – spike proteins, antibodies, clinical trials – using illustrations and conversational wording: “Just to compare it for you … Look at this top bar with me … The point of this slide is to let you know …”

Other videos in the webinar series cover topics such as how to find a vaccine site in Tarrant County and what to expect afterward. Video #5 addresses some of the popular myths, including claims that the vaccine causes infertility or gives you COVID-19 (no and no).

Dawn Hood-Patterson, Ph.D., program manager for the Center for Children’s Health, praised the presenters for not trivializing the myths. “They weren’t flippant about it. They didn’t brush it off as silly,” she said. “They spoke about it seriously not only from their expertise as a professional, but they spoke from their expertise as a human being.”

The webinar intentionally includes people of different races and walks of life in order to appeal to a wide audience. Why? Because representation matters, and viewers need to trust and connect to the presenters on the screen. When it came to religion, for instance, the videos included the perspectives of a Baptist pastor, a Catholic bioethics professor, a Muslim imam and a hospital chaplain.

“Do your research. Pray for our government. Seek wise counsel. Engage in conversation with those around you who have different opinions. Listen with integrity,” advised Pam Foster, director of pastoral care at Cook Children’s, on video #5.

Developers of the webinar series hope the information helps not only the undecided unvaccinated crowd, but also those who already are vaccinated when it comes to explaining the vaccine’s benefits. Advocates for the vaccine can learn to approach the subject with greater understanding.

The series “gives me a good tool when I speak to people in the community who are less interested, who are hesitant, who are resistant to the vaccine,” Dr. Hood-Patterson said. “It’s given me the capacity to think more critically about how do I address the issue of vaccination with the people I come into contact with.”

An overview video in Spanish is in the works, with a version in Vietnamese under consideration. Closed captioning is available.

Anderson said that the cooperation by the Center for Children’s Health and its three other partners in the webinar series shows the benefit of working together. Stronger relationships and better rapport can develop among the groups, for the good of everyone involved.

“It’s a huge thing to move toward not working in silos within our own areas,” she said. “We’re able to elevate all of our programs across the board to better serve our community.”

The onset of loneliness, anxiety and depression in teens and adolescents during the COVID-19 pandemic has fueled a sharp rise in reports of dangerous eating behaviors.

The National Eating Disorders Association (NEDA) helpline saw a 54% spike in calls for support and resources to treat anorexia nervosa, bulimia, binge eating and other illnesses. Experts blame the surge on factors including stress, isolation and excessive use of social media during the coronavirus lockdown beginning last year.

Health care professionals have long known that eating disorders can be brought on by major life changes. Specialists say that for some young people who already were predisposed, the disruptions from COVID-19 triggered a full-fledged illness or a relapse from their recovery.

“Eating disorders are somewhat of a secret disorder. The more isolated you are at home, the more these types of disorders thrive,” said Joy Crabtree, a licensed psychologist at Cook Children’s. “These disorders often go hand-in-hand with anxiety disorder and depression, and the pandemic has played a role in that.”

At Cook Children’s, we initiated the Joy Campaign – a weekly series of stories addressing mental health issues in children and teens – in response to an alarming rise in suicide attempts in the past year. Eating disorders carry an elevated risk of suicide, particularly in those who suffer from anorexia. One out every of five deaths among anorexics is by suicide, according to the NEDA.

But the hopeful news: Although serious and complex, eating disorders can be treated through a combination of medical, behavioral and psychological tactics. Early diagnosis and intervention lead to better outcomes, Crabtree said.

Keep in mind a few key points:

• Eating disorders cover a spectrum of mental and physical illnesses that in the most severe cases lead to death. Anorexia typically involves severely restricted calorie intake, dramatic weight loss and distorted body image. Binge eating involves rapid and often secretive consumption of large amounts of food. Bulimia causes cycles of binge eating followed by forced vomiting, misuse of laxatives and/or excessive exercise. More information and other types of eating disorders are listed here.
• Eating disorders happen more commonly in girls and women, although boys and men can struggle too. The disorders affect people regardless of age, race or body shape.
• The American Academy of Pediatrics reported the estimate that 0.5% of adolescent females in the United States have anorexia nervosa, and that 1-5% meet criteria for bulimia.

Depression often co-exists with eating disorders. When it comes to adolescents, studies cited by the National Library of Medicine recommend a strategy of aggressively treating the depression and not just the unhealthy eating behaviors alone. Studies also recommend routine monitoring for signs of suicidal ideation, which surface when someone doesn’t want to live anymore.

The reported rise in new or recurrent eating disorders remains a relevant story, even as many of the COVID-19 restrictions have ended, because these illnesses require specialized and sometimes long-term care. As one dietitian put it … eating disorders don’t go away overnight. Treatment options range from outpatient visits to residential care to hospitalization for complications from severe malnutrition (heart disease, organ failure and electrolyte imbalance in the most extreme cases). But access to treatment isn’t always available.

In the past year, inquiries about eating disorders have trended up at Cook Children’s, although the medical center’s behavioral health Intake department doesn’t keep an exact count. Crabtree sees a tie-in to the general anxiety and depression that the COVID-19 pandemic inflicted. She listed contributing factors such as last year’s school closures, cancelation of extracurricular activities and separation from friends.

What else came into play during the pandemic? Lack of routine for sleeping and meals. Poor coping skills. Messages about food hoarding. Fears about weight gain. Pressure to look thin in social media photos and on the Zoom screen.

“Seeing yourself on camera, seeing others on camera, making those comparisons has played a role” in the rise of eating disorders, Crabtree said. “It was kind of a perfect storm, all this focus on food and bodies. It was very overwhelming.”

She urged parents to watch for signs of eating disorders in kids. Red flags include preoccupation with dieting, dramatic weight loss, withdrawal from friends, fatigue, dizziness, fainting, anemia, hair loss and menstrual irregularities. Anyone with concerns should contact their child’s pediatrician or call Cook Children’s to discuss referral options or possible psychological or psychiatric treatment, Crabtree said.

Getting started on treatment

Jean Mankin, a registered dietitian with Cook Children’s Outpatient Nutrition Services, works with primary care physicians to help with food allergies, obesity, picky eating and other issues. When it comes to someone with significant weight loss, Mankin starts by trying to determine whether the patient’s weight fluctuation is intentional.

“If you feel like they’re purposefully withholding food or telling you that they’re binge eating or purging, it’s important to get help,” she said. “A lot of kids are finding themselves having issues they didn’t have prior to the pandemic.”

Mankin emphasized that adolescents need to eat a well-balanced and sufficient diet because all vital organs and bone are rapidly growing and developing at this stage. Anxiety and depression can cause a dramatic decrease in appetite for some, and for others it can lead to stress eating or binging. As long as mental health problems go unresolved, the eating behaviors won’t improve, she said.

At Cook Children’s, patients with suspected eating disorders are referred to local specialists such as Carol Ann Darwin, a registered dietitian in Fort Worth who has met over her career with clients from age 8 to age 70. In April 2020, Darwin started seeing a big increase in anorexia and bulimia mainly among the 13- to 17-year-old set. She called the pandemic a nightmare.

“I went from working three days a week to working six days a week just to get these kiddos in,” Darwin said. Some individuals with eating disorders had to be hospitalized with feeding tubes until spots opened up in residential treatment centers, she said. Dietitians, therapists and treatment centers in North Texas and nationally still have waiting lists up to a month, Darwin reported.

The pandemic caused an onslaught of maladies that Darwin’s youngest clients bring up: isolation, stressful dynamics in a quarantined household, frustration with online school, loss of control. Food became a crutch to comfort and to alleviate loneliness. The challenges that were particular to 2020 compounded the usual causes of eating disorders, such as genetic predisposition and being bullied.

There’s no quick fix; Darwin typically meets with her clients in weekly nutrition consultations for two or three years – although the time frame can be less for those whose underlying depression and anxiety are mild. She said she prefers to use “gentle nudging,” rather than scare tactics, to motivate her clients to start eating appropriately.

“I’ve had several (clients) where I thought, ‘Would this have happened if COVID hadn’t come along?’ Maybe not,” she said.

Disconnection and disappointments

Dawn Dillon, a therapist in Fort Worth who has specialized in eating disorders since 1998, characterized the current demand for mental health services as an explosion. Disordered eating can come from the instinct to take action during times of uncertainty and fear, Dillon said. She drew an analogy to the people who rushed out to buy toilet paper in the early days of the pandemic. The same instinct applies to food and body image.

“We take all these things that are messy, uncertain or scary, and we manifest it through our body,” Dillon said. “Instead of saying ‘I’m scared, I don’t know what to do,’ it gets put onto the body as ‘I’m fat. There’s something to do with that – I can lose weight. I can sculpt. Or I can tone.’”

Eating disorders can originate out of a misplaced attempt to manage distress when someone feels stuck or trapped. Dillon listed a variety of scenarios that particularly applied to life for teens and young adults during the height of the COVID shutdown: Disconnection from social support. Disappointment when prom and graduation got called off. When will colleges and dorms reopen? So many unknowns.

Additionally, refusal to eat can be a way that teens, like toddlers, exert their separate identity. “In a home with no personal space and no autonomy, a lot of times eating disorders will creep up because it’s a way to assert boundaries,” she said.

Once a patient’s medical condition and food intake have stabilized, Dillon said, the mental health piece of treatment becomes vital to get to the root of the anorexia, bulimia or binge eating. Everyone involved in treatment stays vigilant for warning signs of suicide.

No one chooses to develop an eating disorder. Dillon’s current clientele includes first-timers as well as patients with persistent struggles in and out of treatment. Some patients who were handling recovery well prior to COVID-19 had to return for more therapy.

“From the research, we know that life-stage transitions are high-risk times,” she said. “You look at this pandemic, and it was a huge transition that nobody planned for, nobody expected, and nobody knew how to do it. So it makes sense that there would be a rise” in cases.

Dillon acknowledges it can be a terrifying experience for families to go through. Don’t blame yourself or make it a power struggle, she advised. “It’s hard on parents on a fundamental level, but it’s not their fault. The goal is to be aligned with your loved one as the two of you fight against the eating disorder together rather than the two of you fighting with each other.”

“You don’t typically have two viral epidemics at the same time,” Dr. Whitworth said. “We’ve never had an RSV outbreak in June.”

Dr. Whitworth says the medical center began to see RSV patients in early May. Over the last few weeks, there has been an increase in RSV patients and the number is rising each week.

“The numbers reflect inpatient and outpatient testing done at the medical center,” Dr. Whitworth explained. “It looks like we could have an RSV season ahead of us at an unexpected time of year.”

According to Dr. Whitworth, RSV is a very common respiratory virus that we all get every one or two years throughout our lifetimes. The first time you get it, you might be sicker and some children require hospitalization, but most do not. In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or episodes where they stop breathing with or without fever. In older infants and young children, a runny nose and decreased appetite may appear one to three days before cough, often followed by sneezing, fever, and sometimes wheezing. Symptoms in adults are typically consistent with upper respiratory tract infections, including runny nose, sore throat, cough, headache, fatigue, and fever. RSV can be a very serious illness for anyone who is immunocompromised. But for most children, it is a minor upper respiratory infection.

“The virus is spread by respiratory droplets and can be spread from person to person very easily,” Dr. Whitworth said.

If parents begin to see any RSV symptoms in their child, Dr. Whitworth says it is important to keep them well hydrated.

“They can use Tylenol if they have a fever,” she said. “Cough and cold medicines are not routinely recommended for children two years old or younger because of the side effects.”

She says if parents are worried that their child is having difficulty breathing, or if they are concerned that their child is lethargic, not eating or drinking enough, or irritable, they should call their primary care physician.

Dr. Whitworth says the most important thing to stress is, “RSV is common, and most children don’t require any treatment at all.”

This trend at Cook Children’s is a part of a larger RSV outbreak across the South. Late last week, the Centers for Disease Control and Prevention (CDC) issued a Health Advisory Network warning to health care providers to be on alert for the virus.

Important to note:

Cook Children Urgent Care facilities do NOT test for RSV. Please discuss any questions with your child’s medical team.