Lori Townsend: Severe cases of COVID-19 among children are rare.

But as case rates continue to climb across the state school districts are trying to keep staff and students safe with in person learning.

Unknown: There are kids in the hospital with COVID.

There just are.

Lori Townsend: What information do parents and guardians need to help keep their families safe while their children get an education?

We're discussing kids, vaccines and COVID.

Right now on Alaska Insight.

We are a month into the school year and Alaska is experiencing peak COVID-19 cases and a hospital system at max capacity.

Nationally, the COVID vaccination rate among 12 to 17 year olds lags behind the rate for adults.

Alaska Public Media's Jeff Chen looks at what health care professionals in Alaska are doing to try to boost those numbers.

Unknown: Dessa Wells is a seventh grade student at stellar secondary school.

Each day she puts on a mask before heading to class.

It's been mandatory since day one.

My aunt got COVID, my best friend and her family got COVID, and my other aunt's friend got COVID and died from it.

Dessa has another line of defense to a couple shots of the Pfizer COVID-19 vaccine.

I was vaccinated shortly after my 12th birthday.

Because we I really wanted to get vaccinated because COVID is actually horrible.

And I get, and I learn more about it every single dayand I want it to end.

In Alaska, only 36% of kids 12 to 18 were fully vaccinated by the end of August, compared with 58% of all Alaskans 12 and up.

At a recent media briefing, Alaska's Chief Medical Officer shared that places like Mat-Su, Kenai and Delta Junction have a less than 30% teen vaccination rate compared to places like Juneau and Aleutian communities which have a teen vaccination rate of more than 80%.

What you can clearly see here is you see a lot more cases in communities with lower vaccine rates.

So again, vaccines are our best tools to keep kids in school, keep people out of the hospital and keep us all moving forward.

Pediatric cases make up about 19% of all COVID cases in The pediatric ICU right now is full.

That's that's a rare thing Alaska.

But that percentage has increased since school started.

In August and September cases among this demographic made up 26% of all COVID cases.

Dr.

Rob Lovrich is a pediatric ICU p ysician at both Providence and A aska Native Medical Center.

He s ys last winter, with all the ockdowns, it was one of the quietest respiratory seasons in pediatrics in a generation.

He says this September is different.

for this time of year.

Doctors are treating the usual kid viruses, traumas and also COVID.

There are kids in the hospital with COVID.

There just are.

And it's not a myth.

It's not, it's not impossible.

It's not common either.

But it happens.

The CDC says vaccination is the leading public health prevention strategy to end the COVID-19 pandemic and help schools safely return to in-person learning.

If there are any willing ears that are listening, get the vaccine.

It's the one proven effective thing that will keep you from getting sick and dying with COVID.

It's just that simple.

All right.

Here's a quick poll.

Anchorage School District efforts to boost vaccination rates in the city have yielded mixed results.

Thousands of residents got vaccinated earlier this year at the Anchorage School District Education Center.

But at two recent vaccine clinics at anchorage schools, not a single student came by for a vaccine.

In October, they'll try vaccine clinics at parent teacher conferences.

The numbers aren't where we want them to be we would like them to be higher.

And that's why we're putting these events on because we really just want to let people know if they want to get vaccinated we we want to be able to give them that vax, that vaccine.

Meanwhile, seventh grader Dessa Wells thinks schools should remain open but wishes more of her classmates were vaccinated too.

Um it definitely feels more safe, like I can actually be in the place where I am because I'm vaccinated and it won't hurt me.

But like there then there's the sometimes when I'm like, oh no what if I carry at home?

She looks forward to the day her siblings can get the vaccine and the Anchorage School District says when it's available, they want to be the place where kids 12 and under go to get the vaccine.

In Anchorage, I'm Jeff Chen.

Lori Townsend: Joining me tonight to discuss how COVID is affecting younger Alaskans are Coleman Cutchins.

Dr. Cutchins is the lead pharmacist for the Alaska Department of Health and Social Services and a member of the state's COVID-19 response team, and Dr. Monique Child, a pediatrician with Polar Pediatrics in Anchorage is also with us.

Welcome both of you.

Unknown: Thank you for having us.

Lori Townsend: Yes.

Thanks so much for being here.

Dr. Cutchins, start us off, give us an update of what the state's response team is seeing for rates of illness and younger Alaskans and children.

A story this week by KCAW in Sitka said there are more cases in children under 10, than in people over 60 right now.

Unknown: Yes, so I mean, the trend that we're seeing in Alaska with cases and this is around the nation is we're seeing a pretty dramatic increase in the number of cases in our children, specifically those under 12.

Because our kids under 12 aren't eligible for a vaccine yet.

You know, they're our largest population of people who are ineligible to receive protection from the vaccine.

And, you know, we've seen we've seen a much higher increase in those age groups.

You know, the difference with the older population is, you know, we have some of our highest vaccine rates in the state in our patients, in our population of people over 65.

And, you know, are raising those under under 12 is zero, essentially.

Lori Townsend: The Governor announced this week that 400, nurses and nursing assistants on contract will start arriving in Alaska next week.

And that hospitals statewide would now operate under crisis standards of care.

What, talk a little bit about what that means?

And how many children are getting severely ill?

And how is that number changing or growing?

Unknown: So I could talk a little bit about what crisis standards mean, and we have Dr. Childs talk directly about children since she's the pediatrician.

So basically, our hospital and our health care capacity, you know, this is what we've really been trying to avoid the whole time.

You know, when a lot of people get sick for any given reason.

It, it overwhelms our healthcare system, you know.

Here in Alaska, we have limited extra healthcare capacity, our hospitals can get overwhelmed by small events, let alone, you know, right now, 20 to 30% of our hospitalized patients, on any given day are COVID patients.

So you know, to have 20 to 30% of your patients in the hospital for any given reason.

You know, it's very concerning, you know, if 20 to 30%, were there for heart attacks or for traumas, it would be, it would overwhelm the system.

So we are getting, you know, some needed federal assistance.

But but just everyone needs to know.

I mean, our healthcare system is extremely strained statewide at this point.

Lori Townsend: And, and the crisis standards of care that have been now implemented across the state, they were just in a couple of hospitals.

Now, it's across the state.

What changes?

Unknown: So basically, I mean, unfortunately, to be honest, what that means is sometimes tough decisions have to be made.

You know, where if two patients needed the same resource decisions have to be made, where maybe both of them don't get it.

Other things, that it really affects his ability to transfer.

You know, most specialty care services are only available in Anchorage.

You know, delays and transfer that people to get to Anchorage for things like you know, dialysis or other procedures that we only have here, delays in transfers and people getting to, you know, the Lower 48 for services that we don't have here.

And it just means holding on to patients, possibly for longer periods of time, atare smaller hospitals that aren't used to that.

It just basically is an acknowledgment that we are not providing the same level of care, do the same level of services consistently, that we're traditionally doing.

It's not just specific to Alaska, I mean other states are having to do this as well.

Lori Townsend: And so it could mean that to patients that need a similar service, a decision will be made based on survivability of one patient over the other.

Unknown: It could, you know, there's there's committees that are formed there, they're a medical ethics ethics committee.

And they're the people who make these decisions behind closed doors, one degree separated from the patients.

So they don't and they take a very regimented criteria into into consideration for that.

Lori Townsend: Yeah, I'm sure that's a very difficult position to be in.

Doctor Child -- Unknown: It's a position nobody wants to be in.

Lori Townsend: Absolutely absolutely.

Dr. Child, what are you seeing at your practice for rates of children getting COVID and especially compared to earlier in the pandemic?

And what's the trajectory of the severity of the illness in them?

Unknown: I think honestly, the the trajectory is terrifying.

And I don't know that that's being communicated enough to our population.

It's an interesting time to try and practice medicine, you have a group of patients that perhaps are too terrified, and a group of patients that aren't terrified enough.

And so trying to message so that we reinforce the people that are doing the best they can to help prevent the transmission of the incidence of this disease, and to decrease the need of hospital services in the state of Alaska, should really be commended as patriotic, laudable, and really a good thing to be doing for the entire community.

Unfortunately, we're seeing an increased rise that is rapid, and it is affecting children more, I think all of the system is being strained.

And there are a couple of corrections I would make.

In the opening, you said something about the hospitals being at max capacity.

I don't think people are understanding we're past max capacity.

That's why we are overwhelmed.

That's why reinforcements are coming in.

I think we need to be clear that reinforcements are not the same thing as a trained nurse in a hospital that she or he knows with a team that he or she knows, knowing where the supply room is, and knowing what services we have when people are discharged when hopefully they're discharged rather than dying.

And I think what we're not talking about enough is that we went into health care thinking we were working in a first world country, where we had systems and infrastructure that would support the best care for our patients.

And what we're saying clearly now is that we don't have that anymore.

Alaska has always been away from the Lower 48, and so access to health care sometimes required flying down to Seattle or other places, which they themselves are overwhelmed and can't take our transfers.

We here in Anchorage are turning down transfers for other parts of the state.

In a field where you have hundreds of good people, thousands of good people that have dedicated their lives to minimizing the impact of poor health on our patients.

We're now being asked to serve in a community where we cannot provide the standard of care that we've grown accustomed to or for which we were trained.

I don't know that we understand the psychological impact of our workforce in the healthcare community for years to come.

Much less the current impact, and how we get up and go to work, and put ourselves at risk and put our families at risk.

While going to the grocery store the craft store and seeing people without masks.

It's heartbreaking.

It's disconcerting, it's disheartening.

I run out of adjectives in trying to convince people that science is real, that medicine is real, and that there are things that each of us can do to decrease the likelihood of contributing to an overwhelmed system.

So I personally right now, if I have to go to the grocery store, I consider whether or not I can have it delivered instead, if one of us has to go to a store, can it be one person going to the store instead of two or three?

If I'm going to go on a hike, can I do a moderate hike that's close to home so that I'm not on the roads?

Humans aren't really great at assessing risk, and some of the riskiest things we do is driving.

So is there a day that I can spend at home instead of going out, thereby decreasing the risk that I'm going to end up in the ER for something I couldn't have prevented other than just simply avoiding it?

Alright.

COVID is not that, we can prevent it through vaccination.

And at this point, we really need to be talking about non-vaccinators as being non-patriotic, and hurting the community.

Lori Townsend: Are you what kind of questions are you getting from parents about the vaccine for their children?

And how often are you combating you were talking a little about probably leading up to this, but how often are you having to combat misinformation about it?

Unknown: You know, it's, I am so fortunate, I have been fortunate enough to practice medicine in third world countries and in first world countries have worked with the World Health Organization.

And it's really been a beautiful career.

I can say that.

I've been fortunate enough to deliver health care in my setting here at Polar Pediatrics for over a decade.

And I set up a clinic so that I would have time to really create a medical home.

And that was the other thing I was going to correct about the intro.

I think ASD wants to make sure they have a vaccine campaign.

But they would also encourage all of their kids to have a medical home and to be receiving their immunizations at that medical home with a doctor who knows them.

And so I've tried to create that medical home model here.

And so my schedule has always had built-in flexibility.

That was, that surge capacity, if you will was something that got used up in the last 18 months.

And in the last few weeks with delta, I'm past what even I have been able to set up with cushion that cushion is already used and things aren't getting done the way they used to get done.

And it's heartbreaking.

I got a call from a new patient two days ago.

And normally the last 10 years, that call will be returned same day.

And today there's so many questions,so many people calling in with either exposures or coming in from normal things, you know, some 12-year-old decided to try to remove his own tooth.

And so we got to talk to him about, you know, maybe don't do surgery on yourself let doctors and dentists do that, yes.

But so the normal kid things are still happening on top of all of these other calls.

And, you know, I did my best to try to carve off, carve out a day off this week.

And I ended up spending it talking to, you know, fortunately a friend that I've had for years long before she had kids, that then trusted me when she had kids, that still hears all of this disinformation, and creates a slowdown in her willingness to vaccinate her own kids.

Lori Townsend: And so your day off was spent correcting misinformation?

Yep.

Are you seeing kids with more severe levels of illness now, in recent weeks and months?

Unknown: Absolutely.

I've had children that we might be working out because we're concerned that there could be abuse, where the emergency room is so overwhelmed that we can't do that in the emergency room.

And so we're needing to do things, critical things like that, as outpatients, and fortunately, that particular example, that kid was fine.

It did all work out.

But it doesn't always.

And we're going to have some really sad tales in this state and around the world, because we've made a choice as a community to allow ourselves to become overwhelmed.

Because we've allowed 20 or 30% of the population to confuse patriotism with whether or not they get vaccinated.

Lori Townsend: Are you, do you have parents of young children?

I'm sure there's so much anxiety for the parents who are wanting who are vaccinated and want to get their children vaccinated?

Have you had parents of young children ask you to give them a vaccine?

Even though it's not FDA approved yet?

Are you getting those kinds of questions?

Unknown: Again, I have the luxury of time with my patients and experience, they see the same doctor at each visit.

And so my patients follow my advice.

And if they're unable or unwilling to follow my advice, then perhaps I'm not the doctor for them.

And that's okay, I hope they find the care they need somewhere.

But to my patients will be vaccinated when I say it's time to vaccinate children of any age.

At this point, we've got some really early data out of Pfizer that a lower dose for kids five and up might be beneficial.

And it looks like it is very beneficial.

And so I'm hoping that FDA approval comes quickly.

I'm doing my flu shot clinic this weekend.

And I'm including COVID for the parents that aren't vaccinated if your kids over 12 that aren't vaccinated yet.

And I'm hoping to be able to drop that down to five here shortly.

Okay, but it's going to take a little bit for the FDA to sign off on that and make sure we've got all green lights for doing that.

Right.

It's also important right now to make sure we vaccinate any of our high risk health care professionals.

Since some of them got vaccinated in December or January of last year, they may need boosters, their waning immunity.

Yeah, but our best bang for our buck is trying to reach out to our neighbors and family who haven't vaccinated yet for whatever reason vaccinated down and hear their concerns, and do our best to address them and try to get them into the vaccinated column.

Lori Townsend: Yes, thank you.

Dr. Cutchins, I want to turn back to you, as we heard in the lead-in story, there are a few places in Alaska that have more than 80% vaccination rates for younger Alaskans.

12 to 17,18-years-old.

What, what do you know about that?

And what can the taskforce do to try to replicate that success in other parts of the state?

What are they doing so right in those areas?

Unknown: That's a great question.

And we do, I mean, we have communities that are over 90% vaccinated of their 12 to 18 year olds.

Really, what I think it is, is it's a top down buy in from everyone in the community to make the commitment and understand that vaccine is our way out of this pandemic.

You know, Dr. Child that a lot of things really well, and I just can't stress how much vaccines are safe, vaccines are effective.

They're our best tool to combat this type of pandemic.

You know, vaccine was written into the pandemic plan before this pandemic even started.

You know, it really has taken a commitment in every level of those communities to do the right thing to eliminate as much burden of this virus has on our communities.

I will tell you to looking at the state level, and then even when we look at places around the country, places with really high vaccine rates, you know, 8090 plus percent are not having the burden of COVID.

You know, we're on national calls where we're middle or high schools that have you know, 90 plus percent of their kids vaccinated aren't having COVID cases in school.

They're not having kids miss school, they're not having kids miss sports.

You look at our communities with the really high vaccine rates, their hospitals aren't as overwhelmed.

Their testing facilities aren't overwhelmed.

They're not.

It's amazing on one side of it to see the difference, but it's saddening on the other side of it to see the communities with low vaccine rates.

You know, continue to struggle around COVID.

I mean, I've spent most of my career as a clinical specialist in infectious diseases, you know, and infectious disease, the old saying in viral infection, you know, in viral infectious disease, is mitigation, not medication.

Mitigation is the way we treat viruses as a whole.

You know, how many times have you gone to the doctor and they've said, you know, this is the virus, we're gonna have to treat it supportively?

You know, this virus is no different.

So really, you know, vaccine is our best tool.

Now, that being said, even even if everyone who's unvaccinated was to go out and get vaccinated today, it would be great, but it wouldn't help us right now, you know, right now, the things that we can do to help are masking or distancing or avoiding gathering, you know, possibly not going to the places we're going to be indoors around people, not around our households, and every Alaskan, you know, making some of those choices and thinking about, you know, how can I lessen the burden of this virus spreading?

We're the number one state in the country right now, for cases per capita.

I mean, that that's shocking, because we were always one of the lowest.

And I mean, for this huge 180 degree turn, it's just, it's been shocking for all of us.

Lori Townsend: And you, you were talking a bit earlier about the effect, not only in the state and nation, but across the entire planet, that it's affecting people everywhere.

And as we've seen, there have been periodic disruptions in supplies.

We may be seeing more of that again, do you see problems?

As case numbers rise in the younger Alaskans, what kind of supply concerns are there around specialized equipment for very young children that may get COVID?

I would imagine if if a young child needs to be intubated, it's a different setup than it would be for an adult.

Unknown: Yeah, so I mean, I'll be honest, a lot of supply chains are are strained right now, you know, every we have a lot of places in the country surging at one.

So it getting hard to get testing resources.

You know, fortunately, we've been able to keep a pretty good supply chain of that other states, it's not so much we're also starting to see shortages and the drugs used to treat COVID.

You know, monoclonal antibodies just got put on federal allocation last week.

We're starting to see some initial shortages of, you know, some of the meds we use in the hospital.

We're getting, you know, the next thing that even if with all this extra staff, you know, we're not going to have enough beds.

I can tell you what, we don't have a big shortage of right now, is vaccine.

Now, so it's, it's unfortunately, it's going to be an interesting, an interesting time moving forward.

Dr. Child.

I jsut wanted to add to what Dr. Cutchins said, Lori Townsend: Yeah, I want to get back to as well.

Go ahead.

Unknown: I was just gonna add a prevention, an ounce of prevention is worth a pound of cure.

And so preventing this disease is really important.

And Dr. Cutchins is right.

Even if we all got vaccinated today, all our non vaccinators got vaccinated today, it would still take two to four weeks to see that benefit absolute.

In the meantime, masking, social distancing is the best we can do.

Avoiding indoor time with others.

Lori Townsend: Are you seeing, Dr. Child, beyond the direct concern about the virus itself?

other health implications, especially mental health problems cropping up in younger Alaskans, kids?

Because of the anxiety and the stress and the confusion around the pandemic?

And everything that's swirling around it?

Unknown: That's a great question.

I think we also need to talk about the fact that I'm seeing long term COVID signs and symptoms in kids.

And so if you have a sustained heart rate at eight-years-old for months, before it comes back to normal, what does that mean?

Lori Townsend: We're having trouble with your feed right now, Dr. Child, there's some internet issues.

Maybe we'll go back to Dr. Cutchins for a moment.

We just have just a bit of time left here.

Dr. Cutchins?

Would you say that you're, are there concerns about other emerging variants right now?

Or is it just is delta, the main focus and, and that's all you're seeing on the horizon?

Unknown: You know, I think it's important to remember, you know, this family of viruses, you know, RNA based viruses, they don't have good spell checkers, you know, every time and and also, I think it's important to remember, the viruses aren't living things, you know, we use the term live virus, but it's, it's kind of a misnomer.

You know, they don't have their own metabolism.

They're not made of cells, like they're not living, they cannot reproduce without us.

So every single time a new person gets infected, I mean, not to be dramatic, but to be honest, that's a new chance for the virus to mutate.

When a virus infects our body, it goes into our cells, it hijacks pharmacy machinery, it takes over our genetic material to make more of itself.

Then usually, you know, your cell ruptures and it releases a bunch of viruses and it's this chain reaction through your body.

So viruses really do a hostile takeover.

You know, we could have another emerging variant.

Lori Townsend: We'll have to leave it there.

Thank you.

We'll, I'm sure we'll be coming back to this conversation.

I'm sorry that we're out of time.

Thank you so much to Dr. Child and Dr. Cutchins.

Keeping children safe from COVID-19 requires the same protections that all of us need to employ right now.

Wear a mask in public, maintain social distance, and when it's available for kids under 12, make sure they get vaccinated.

That's it for this edition of Alaska Insight.

Be sure to tune in to your local public radio station for Alaska Morning News and Alaska News Nightly every week night.

Be part of important conversations happening on Talk of Alaska every Tuesday morning, and visit our website alaskapublic.org for breaking news and reports from across the state.

While you're there, sign up for our free Daily Digest so you won't miss any of Alaska's top stories of the day.

We'll be back next Friday.

Thanks for joining us this evening.

I'm Lori Townsend.

Good night.