Residents line up for COVID-19 tests
A COVID-19 testing center in D.C. Credit: Darrow Montgomery

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When school let out for summer vacation the world seemed a little more normal. Masks and social distancing were not required if you were vaccinated. But now children have returned to D.C.’s public and charter schools with many of the same precautions in place. Masks are back and social distancing is recommended—the difference is there is no option for virtual learning. Many families worry about the delta variant, which brings the (extremely low) risk of spreading the virus to vaccinated family members. All this is complicated further by the fact that children under the age of 12 can’t get vaccinated. Pfizer’s director, Scott Gottlieb, says emergency use authorization of the vaccine for those ages 5 to 11 may occur in late fall or early winter. That’s months away.

The Data

Today we’re going to break down the state of COVID-19 in the DMV’s youth population with Dr. Sarah Ash Combs. Combs is the pediatric emergency medicine attending and director of outreach for the emergency department at Children’s National Hospital.

Combs says that, as of last Thursday, 11 DMV children are hospitalized with COVID. (Children’s Hospital serves the entire metropolitan area.)  Of those 11, six are in intensive care. While Combs says that may not seem like a lot, the hospital’s peak since the beginning of the pandemic was 19 patients. She adds there’s been an uptick in positive COVID-19 tests.

“We were actually reaching zero on many days back in June, even into July,” she said. “We are on an upwards trend.”

That upward trend matches that of the country. The American Academy of Pediatrics said U.S. cases of COVID-19 in kids increased “five-fold” in the last month—with 204,000 new cases this past week. Combs said peaks in adult cases will eventually make their way to children. While most will only have a light cough in the upper airway, some kids have developed issues deeper in their lungs, like COVID pneumonia, which makes it harder to breathe.

Cause of Spread

Combs said one of the largest causes is the delta variant. It’s more transmissible with a higher viral load.

“There’s a stronger virus out there. What we know about viruses is that they mutate, and they mutate until they can be really persistent,” she said.

But she acknowledges there’s a sociological component too. We’re all tired of wearing masks and social distancing. After our brief return to normalcy she understands the fatigue—especially in this ungodly D.C. humidity.

“It’s pretty miserable wearing a mask, I’m not gonna lie,” she said. “ I go out and about, and I chase after a rambunctious toddler, and doing that wearing a mask and sweating—it’s not a pretty situation.”

But she adds that COVID-19 protocols have been proven to work and says we’ll likely have to “buckle down” to bring cases back to where they were months ago.


A mother herself, Combs says she understands how reopened schools can cause concerns with parents. However, she says simple protocols can bring down the spread. For instance, two children wearing a properly fitting mask can bring down the likelihood of spread by 95 percent. When you throw on building ventilation, distancing, and staying home when sick, she says in-person learning can be safe. She adds that there’s much more nuance because keeping schools closed can also be harmful to children. There was a rise in children’s mental health problems, obesity, and nutrition issues when schools were held online.

“As long as we follow the measures, we should be able to open school safely, get the kids the advantages they need, get them back in classrooms, learning in person and still keep them safe and healthy.”

Vaccines for Children

Even though vaccines aren’t available for children to take personally, they can still be protected by vaccines. Combs says the best way to protect children from the virus is to get vaccinated yourself and to get the booster shot whenever it becomes available to you.

“Please, please go ahead and get yourself vaccinated,” she says. “If we give vaccines to all those eligible, everyone who is age 12 and older, those under 12 who aren’t eligible will be protected by virtue of those around them being vaccinated.”

Additionally, vaccine trials are ongoing. Combs says children as young as 6 months are in vaccination studies.

“We in the pediatrics world are pushing to get it approved,” she said.

While it may seem like we’re returning to the COVID times of yore, Combs says her team feels more prepared after a year and a half of dealing with this virus. 

“We’ve learned a lot over the past … 18 months. We now have some additional treatments we can give to children even with severe COVID, including things like steroids. Even though I think there’s obviously going to be some levels of anxiety, anticipation … preparing yourself for potential increase in cases, there’s less of that complete unknown box,” she says. “We know we have some things in our momentum, we know what to do.”

Combs says that anxiety is why Children’s National and the American Academy of Pediatrics is pushing a message that masking and protocols won’t be forever, as the idea of their return could potentially lead to distrust in health experts.

“We weren’t wrong. We weren’t lying. It’s just we were trying our best to balance proportions with everyday life,” she says. “Unfortunately, what we’ve realized is we’re still not through this, we still have more waves to come.

But she adds: “A​​t the same time, that is coupled with some hope that we know things we can do: to make it better, to ameliorate the situation, and to keep our kids in the region safe and healthy.”

A line from this story about how many positive PCR tests showed the delta variant has been removed because it contained inaccurate information from Children’s National HospitalA representative for the hospital says they do not have enough data to say all cases tested are ‘100 percent’ delta.

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