COVID-19 Delta Variant Raises Concerns for Children as School Year Approaches


Although not all children are eligible for vaccination, recommendations for schools include masking, testing, and quarantine policies, as well as vaccinations for anyone eligible.

As children return to in-person schools over the coming weeks, a spike in COVID-19 Delta variant cases among younger children is causing concern among experts.

Although there are still a lack of clinical data suggesting that the Delta variant is more infectious in children, a variety of reasons could be causing the rising number of pediatric patients. Although COVID-19 hospitalization rates for children are still lower than for adults, reporting from the Associated Press showed rates have reached 0.41 per 100,000 children 0 to 17 years of age over the summer compared with 0.31 per 100,000 in January 2021.1

The relaxation of mask mandates and social distancing rules, the lack of COVID-19 vaccines for children 11 years of age and younger, and rising Delta variant cases among all ages could be contributing to these rising cases. Although younger children most likely will not be able to get vaccinated for a few more months, experts still say that ensuring high vaccination rates among adults is the best way to protect children.2

“The most important thing we can do to protect kids under 12 who are not yet eligible to be vaccinated themselves is to ensure that as many people who are around them and who are interacting with them are vaccinated,” Nipunie Rajapakse, MD, a pediatric infectious diseases physician at Mayo Clinic Children’s Center, wrote in a blog post.2

Encouragingly, CDC data have shown that more children and adolescents 12 to 18 years of age are receiving COVID-19 vaccines. According to a summary of CDC data from the American Academy of Pediatrics (AAP), 10.7 million children in the United States have received at least 1 dose, representing 53% of 16- to 17-year-olds and 43% of 12- to 15-year-olds. Furthermore, 8 million of these adolescents are fully vaccinated.3

These vaccination rates are also accelerating, with more than a half-million children receiving the first dose in the week ending August 11, 2021. However, the number of weekly first-dose vaccinations remains significantly below the peak in May, with 1.6 million.3

Furthermore, these vaccination rates vary across states. As of August 11, only 6 states have administered at least 1 dose to 60% or more of children: Vermont, Massachusetts, Hawaii, Connecticut, Rhode Island, and Maryland. The 5 states with the lowest vaccination rates among children (Texas, Utah, Alaska, Florida, and Nebraska) have administered doses to fewer than 45% of children.3

Despite the growing vaccination rates among children and adolescents, experts have urged the implementation of other safety measures in schools. The AAP recommends a “layered approach,” including masking, testing, quarantining, and disinfection policies. Notably, a press release said masks should be required for anyone 2 years of age or older, regardless of vaccination status.4

“We need to prioritize getting children back into school alongside their friends and their teachers—and we all play a role in making sure it happens safely,” said Sonja O’Leary, MD, FAAP, chair of the AAP, in a press release. “The pandemic has taken a heartbreaking toll on children, and it’s not just their education that has suffered but their mental, emotional, and physical health. Combining layers of protection that include vaccinations, masking, and clean hands hygiene will make in-person learning safe and possible for everyone.”4

In addition to mask-wearing and hygiene policies, the recommendations emphasize the need for mental health support as well as accurate and timely COVID-19 testing resources. School policies should also be flexible, the press release said, based on transmission and positivity rates in the community and schools.4

“There are many children and others who cannot be vaccinated,” said Sara Bode, MD, FAAP, chairperson elect of the AAP Council on School Health Executive Committee, in the press release. “This is why it’s important to use every tool in our toolkit to safeguard children from COVID-19.”4


1. Tanner L. Record delta wave hits kids, raises fear as US schools open. Associated Press; August 19, 2021. Accessed August 20, 2021.

2. Mayo Clinic. How the COVID-19 delta variant is impacting younger people. August 13, 2021. Accessed August 20, 2021.

3. Children and COVID-19 Vaccination Trends. American Academy of Pediatrics Analysis of CDC Data. August 11, 2021. Accessed August 20, 2021.

4. American Academy of Pediatrics Updates Recommendations for Opening Schools in Fall 2021. News release. American Academy of Pediatrics; July 19, 2021. Accessed August 20, 2021.

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