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Latest wave of Delta-fueled COVID-19 affecting greater proportion of children

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In the beginning of January, the rate of COVID-19 infection ratios for people 19 years and younger were very low. The older the age group, the higher the rate ratio of hospitalizations. Recently, the rate ratio for people ages 0 to 9 and 10 to 19 has changed and it is now increasing. Young people are being hospitalized at a higher rate than they were earlier in the pandemic.

When Virginia – and the rest of the country – experienced a surge in COVID-19 cases that began in November 2020 and continued through the holidays, residents ages 20 to 39 exhibited the highest transmission rates, 0 to 19 the lowest rates. During the current surge (which now seems to be fading) there has been a shift. According to Dr. Brandy Darby, epidemiologist with the Virginia Department of Health, newborns to those 19 years old are seeing transmission rates similar to those 20 to 39.

Darby, who has been involved with the pandemic response since early in 2020, said, “If you get more granular, the highest rates are in children 16 and 17 years old. There is a lower case rate in children 12 to 15, lower still in 5 to 10 years old, and children ages 0 to 4 have experienced the lowest rate of cases.”

Children older than 12 are eligible for a COVID-19 vaccine, yet according to the data, those children are experiencing among the highest rates of coronavirus. Darby sees multiple factors contributing to the trend. “The uptick started in July,” said Darby. “We were looking pretty good over the summer. Maybe families were traveling more than they had been. Then there was back to school, sports and other activities opening back up. The patterns of human interactions, plus the Delta variant – which is two times as transmissible – all came together.”

During the 2020-2021 school year, schools were a safe place for children when it came to COVID-19; infections were low relative to community spread. But cases began to increase with the start of school this fall. Fauquier County schools have seen almost 300 cases in students since school opened two months ago. For the 2020-2021 school year, there were fewer than 100. (Schools were not open five days a week during the 2020- 2021 school year, and many students were engaged in online learning rather than in-person classes.)

Darby said that although COVID-19 outbreaks are very difficult to tease out because children have contacts out of school as well, outbreaks mirror the number of cases. “We have seen an uptick in K-12 settings. The schools that do best are those with layered mitigations in place – masks and social distancing, for instance,” she said.


Darby said that that when children have COVID-19, they still generally experience less-severe consequences than adults.” She cautioned, though, “Because that statement is true, some people think kids are immune. But children can become severely ill with COVID. They can have high fever, shortness of breath. Those who do have to be hospitalized may be really ill.”

Darby also said that children can also experience what’s known as long-COVID. “They may see their symptoms linger, taking a long time to resolve, or they may develop new symptoms over time. Some of these can be mild, but some are significant. Some can affect the heart and lungs long-term.”

“This is still a new disease, and we don’t understand all of the long-term ramifications.”

One example of a serious and longer-term effect of COVID-19 is multi-inflammatory syndrome in children, known as MIS-C. Darby describes the disease as a great wave of inflammation that affects different organs as it progresses. “Depending on what organs it affects, it can make someone very ill; it can take months to get back to normal,” she said.

In the United States, there have been 5,217 cases of MIS-C and 46 deaths as of Oct. 4. In Virginia, there have been 90 cases and no deaths.

The VDH provides these nationwide statistics on MIS-C through Oct. 4:

  • The median age of patients with MIS-C was 9 years. Half of children with MIS-C were between the ages of 5 and 13 years.
  • 61% of the reported patients with race/ethnicity information available occurred in children who are Hispanic/Latino (1,444 patients) or Black, non-Hispanic (1,568 patients).
  • 98% of patients had a positive test result for SARS CoV-2, the virus that causes COVID-19. The remaining 2% of patients had contact with someone with COVID-19.
  • 60% of reported patients were male.


Children under 12 years old are not eligible for vaccinations yet, and vaccination rates are low for those 12 to 18, acknowledged Darby. “We are making efforts to get that population vaccinated, but different parents approach that in different ways. When it was time for my daughter, who is 12, to be vaccinated, I was so excited to be able to protect her in that way. But I can understand where other parents may not feel the way I do. It’s one thing to do it for yourself, but parents want to be extra careful when it comes to protecting their kids.”

Darby emphasized that vaccines are very safe and effective, especially at preventing serious illness and death. “People want to know if vaccinated people can still get the virus, why get the vaccine? Breakthrough cases are very rare.”

According to data released Oct. 8 by VDH, between Jan. 1 and Oct. 2, there have been 34,691 cases of COVID-19 in vaccinated people (0.7% of all those fully vaccinated). There have been 1,287 breakthrough hospitalizations (0.025% of vaccinated people) and 381 deaths (0.007% of vaccinated people).

Darby believes the Pfizer vaccine for children 5 to 12 could be approved by the Food and Drug Administration between Halloween and Thanksgiving. She knows that some people are concerned that the vaccine was developed too quickly to be safe, but she is confident. “I know it was developed more quickly than usual, but that’s because it’s been a more intense, all-hands-on-deck effort. These vaccines have undergone the most intense safety monitoring of any vaccine in history.

“If we weren’t in a pandemic, the process would have been slower because there would have been less urgency. I can assure parents that no steps were skipped; they have just been laser-focused on getting this out the door.”

Darby said it’s important to have pre-vaccination conversations about possible side effects, which can include pain at the injection site, headache, feeling tired, a fever or chills.

Reach Robin Earl at

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