And how are the children?

Dr. Elizabeth Mack
American Academy of Pediatrics (TNS)
It is time for us all to lead courageously and put the health of our children first during the pandemic. (Mario Tama/Getty Images/TNS)

The Maasai in Africa greet each other with “Kasserian Ingera” meaning, “And how are the children?” Tribal members, even those without children, respond, “All the children are well,” indicating the society has prioritized protection of the young, which reflects the community’s wellness.

I’m a pediatric critical care physician and the chair of the American Academy of Pediatrics Section on Critical Care, and hearing parents beg for vaccinations for their children and mask mandates in schools after their children are admitted to the ICU with COVID-19 is a humbling and heartbreaking experience. But it’s too late to protect these children from COVID-19 and the often grim outcomes for those who aren’t vaccinated.

I have not met any parents of children with COVID-19 or multisystem inflammatory syndrome in children who are anti-ventilator or anti-critical care. I have not cared for any child in the ICU who needed critical care for a vaccine reaction, and I have not cared for a single child with COVID-19 or inflammatory syndrome who was vaccinated against COVID-19 (note that about half of those admitted are too young to get the vaccine at this time).

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As someone with a master’s degree in biostatistics and epidemiology, I understand rates and statistics, but as a human who has the privilege of caring for critically ill children, I understand your most precious gift is your child.

Let’s talk about misconceptions.

Are these critically ill children infected with COVID-19 otherwise healthy?

Let’s shut down conversation about whether these children have any underlying conditions. Yes, we are seeing healthy children become critically ill with COVID-19. Yes, we are also caring for children with other medical conditions. In the U.S., about 20% of children are overweight and 7% of children have asthma, and both are risk factors for progression to severe COVID-19 disease. All our children matter. Children with other chronic conditions are no less and deserve no less than children without chronic conditions.

Do parents or elected officials have the right to put children in harm’s way?

No. The legal precedent is clear that the rights of parents come second to the protection of children. The U.S. Supreme Court stated in Prince v. Massachusetts that “parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”

Examples in all 50 states include school immunization requirements and child passenger safety laws. In Phillips v. City of New York, a federal appeals court held that non-immunized children could be excluded from attending school during “an outbreak of vaccine-preventable disease,” regardless of exemptions. Simply put, masking can be required in schools.

Do masks cause discomfort, pain, rise in carbon dioxide or other issues?

No. Immunocompromised children, down to toddler years, have been masking for decades without problems. Surgeons have masked up for many years with no ill effects. These concerns have been studied and masking is known to be safe and effective. In fact, masking not only prevents the spread of COVID-19 but also other serious and potentially deadly viruses that affect children, including influenza, RSV, and others that typically fill our ICUs in the wintertime.

Does the COVID-19 vaccine cause infertility, early puberty or COVID-19?

No. These issues have also been studied. It is not scientifically possible to get COVID-19 from the vaccine as these are not live vaccines. Vaccines have been studied and are safe and effective in the prevention of hospitalization and death related to COVID-19.

Are health care workers exaggerating the numbers?

No. We have zero incentive to dramatize this crisis; in fact, reporting the severity of the situation has the potential to negatively impact the health care business in terms of elective procedures and visits. In many cases the people trying to save our children are also crunching data every morning to be shared with the community in hopes that the gravity of this crisis will be understood, and that human behavior will change. We wish we could give you a tour of our ICUs so you could see the crisis that is upon us. We have dedicated our lives to the well-being of children. Health care workers are not the enemy. We are not benefiting financially or otherwise in terms of recommending testing, vaccines, treatment; we only want to prevent unnecessary illness and death.

How many more preventable deaths, ICU admissions, COVID complications will it take for our behavior to change? Consider these children your own; our children are at the mercy of adult behavioral choices.

The way out of this nightmare is not a mystery: vaccination of all those who are eligible (ages 12 and up right now) and universal masking for those older than 2 years in schools. As of late July, the CDC reported that only 25% of 12- to 15-year-olds were considered fully vaccinated against COVID in the U.S., the lowest coverage of any age group recommended for the vaccine.

It is time for us all to lead courageously and put the health of our children first. Our children depend on us and our concern for them to keep them healthy through actions based on good science and sound judgment when faced with such a terrible disease as COVID-19.

Our children are NOT well.

— Dr. Elizabeth H. Mack is a pediatric critical care physician in South Carolina.