Parents and doctors are looking for new strategies to help adolescents with obesity. One controversial approach drawing the interest of some families is intermittent fasting, which limits people to eating for just a part of the day or week.
Intermittent fasting has gained traction among adults who use it to try to manage weight and improve health. Doctors have largely avoided trying it with adolescents out of concern that introducing a fasting period to their schedules might result in nutritional gaps or trigger eating disorders when teens are rapidly growing and developing.
Now, a small number of doctors and researchers are evaluating types of intermittent fasting in adolescents, searching for solutions as rates of obesity and Type 2 diabetes rise. One pediatric endocrinologist in Los Angeles is launching a clinical trial looking at eating within a set time window in adolescents with obesity. Researchers in Australia are completing a separate trial, the results of which they expect to publish later this year.
Roughly one-fifth of children in the U.S. are considered obese, according to data from the Centers for Disease Control and Prevention. Pediatricians are so concerned that the American Academy of Pediatrics for the first timethis month recommended physicians offer weight-loss drugs for children with obesity.
Any approach that limits when and how an adolescent eats must be handled cautiously, doctors say.
Families and doctors need to be very careful with any form of intermittent fasting in youth as it can be a slippery slope with a potential risk of eating disorders, says
Jason Nagata,
a pediatrician and eating-disorder specialist at the University of California, San Francisco. Doctors have also raised questions about the potential long-term effects of intermittent fasting on developing bodies.
Courtney Peterson,
an associate professor of nutrition sciences at the University of Alabama at Birmingham who studies intermittent fasting in adults, says she would be worried about adolescents’ getting enough nutrients. “I think it’s worth testing but testing with caution,” she says.
Her research has found that adults with obesity who ate between 7 a.m. and 3 p.m. lost on average an extra 5 pounds more than a control group eating over 12 hours or more, and adults with prediabetes who ate over a six-hour period starting early in the day showed improvements in blood-sugar levels.
Intermittent fasting is an umbrella term for eating strategies that involve fasting. One such strategy, time-restricted eating, or TRE, limits eating to a set number of hours a day—often eight—with no limitations on what or how much you eat. In the remaining hours, you refrain from eating or drinking except for water.
Alaina Vidmar,
a pediatric endocrinologist and obesity-medicine specialist at Children’s Hospital Los Angeles, is starting a clinical trial to evaluate whether an eight-hour window of eating, from 11 a.m. to 7 p.m., results in changes in insulin and glucose response for teens with obesity.
The researchers are also looking at weight loss and body-fat mass, as well as blood pressure and cholesterol.
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The research stems from conversations Dr. Vidmar had with families of patients with obesity in recent years. Some had asked her about time-restricted eating, or had tried it and said they liked it. She tested the concept in teenagers with obesity to see if setting an eight-hour window of eating was feasible in a pilot study published in the journal Nutrients in 2021.
“They enjoyed doing it, they felt like their whole family could do it, and over time they were losing weight,” Dr. Vidmar says of the teens.
Now, her lab is enrolling 100 youth between 12 and 21 years old with Type 2 diabetes and obesity in a 12-week trial. Participants are screened and monitored for any negative eating behaviors, she says. So far, she hasn’t found that time-limited eating “impacts eating behaviors or worsens disordered eating in any way,” she says.
In Australia, researchers are studying how teens with obesity respond to a different form of fasting called intermittent energy restriction.
In this approach, for three days a week you eat roughly one-quarter of the calories you normally do, says
Natalie Lister,
a researcher and dietitian at the University of Sydney. On the other four days, you have no calorie limits.
Dr. Lister says she and colleagues started looking into intermittent fasting in adolescents with obesity a few years ago when patients started asking about it. They conducted a pilot trial with 30 adolescents, published in 2019. Now, the researchers are completing a trial whose results they expect to publish later this year.
The health team monitors for eating disorders and depression, and the study doesn’t enroll anyone with a high risk of disordered eating, says Dr. Lister. Dietitians provide guidelines to help ensure participants are meeting nutritional requirements.
In adults with obesity, the data on TRE is mixed when it comes to weight loss, but two systematic reviews of the existing research both found a modest weight-loss benefit overall, says Dr. Peterson. Studies have also found that adults experience improvements in measures such as insulin resistance, reducing blood-glucose levels, particularly when their eating window starts early in the day.
Matthew Muros, a 15-year-old in Carson, Calif., struggles with his weight and prediabetes. Matthew participated in Dr. Vidmar’s pilot studies last year. The first two weeks were challenging, he notes.
“I did feel really hungry. I just kept on drinking water,” he says.
He says it got easier, and when the study was over he decided to stick with the schedule. He has lost about 30 pounds, and his blood-glucose levels have improved.
He has also changed his diet, having less soda, fast food and carbohydrates. “I’m trying to eat a little bit more healthy,” he says.
High rates of hospitalization with RSV are hitting the youngest children especially hard, part of an unseasonably early surge in respiratory infections.
Some 3.0 people for every 100,000 were hospitalized with respiratory syncytial virus the week ended Nov. 5, according to federal data from 12 states. The rate is the highest since the winter just before the pandemic, when some 2.7 people per 100,000 were hospitalized in January 2020. The hospitalization rate declined from 3.4 hospitalizations per 100,000 in the week ended Oct. 29.
Babies under six months old have the highest RSV-related hospitalization rate, data from the Centers for Disease Control and Prevention show, at 145 hospitalizations per 100,000 infants. Infants six to 12 months old were hospitalized at a rate of 63 for every 100,000 children that age. For adults, the hospitalization rate is 0.6 per 100,000 people.
RSV is a common virus that most children encounter by their second birthday. Reinfections can occur at any age. Most people experience mild, cold-like symptoms and recover in a week or two. But RSV can be serious for some infants and older adults, causing bronchitis and pneumonia.
Younger children tend to be at higher risk, in part because their airways are smaller and get more easily clogged when they are inflamed, said Dana Free, a travel nurse with a company called Trustaff, working in a pediatric intensive-care unit in Danville, Pa.
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“If you think of it as a straw, and that’s your normal breathing, that’s fine,” Ms. Free said. “You coat it in congestion, essentially snot and mucus, you’re making that airway much smaller.”
Emergency rooms and pediatric hospitals across the U.S. have reported strain due to increased cases of RSV and other common respiratory viruses. Some recent closures of pediatric units have compounded the issue, doctors said, and staff are stretched thin.
Some hospitals in the Northeast are postponing elective surgeries or sending older children to adult hospitals, said Connecticut Department of Public Health Commissioner Manisha Juthani. Those strategies aren’t as effective for pediatric care because fewer children have elective surgeries than adults and hospitalization rates among older children are lower, she said.
Children’s Hospital New Orleans is getting calls from doctors in Mississippi, Alabama and Texas looking for beds for patients, said pediatric infectious disease specialist Mark Kline. “You’re talking about kids who have critical illness because they’re in respiratory failure,” Dr. Kline said. “They’re not occasional calls. It’s every day.”
Schools in states including Kentucky and Ohio temporarily suspended classes or switched to remote learning at least one day this week because students and staff were out sick.
RSV usually spreads from the fall through winter, peaking sometime between late December and mid-February. But with the onset of the Covid-19 pandemic, RSV cases practically disappeared, likely because of Covid-19 mitigation measures including masking that appear to have restricted the spread of a range of viruses.
RSV came back in the summer of 2021, unusual for that time of year, eventually reaching a hospitalization rate of 1.3 per 100,000 people in mid-December. The virus continued circulating this year throughout the spring and summer and surged in recent weeks.
Physicians are reporting high numbers of respiratory illnesses like RSV and the flu earlier than the typical winter peak. WSJ’s Brianna Abbott explains what the early surge means for the coming winter months. Photo illustration: Kaitlyn Wang
“RSV has done something similar in the previous two seasons where it started early, but nothing to this extent and nothing as widespread as now,” said William Schaffner, medical director at the National Foundation for Infectious Diseases.
Many younger infants might not have been exposed to RSV, in part because of Covid-19 mitigation efforts that kept other viruses in check, doctors said. Mitigation measures have largely been dropped at places including schools and daycare centers, and the relative lack of exposure compared with prior seasons created a wider pool of susceptible people, some public-health experts said.
“This increased number of cases is to be expected, given the number of individuals that are susceptible to the virus at this time,” José Romero, director for the National Center for Immunization and Respiratory Diseases at the CDC, said last week. There aren’t any indications at this time that the cases are more severe, Dr. Romero said.
There aren’t any specific RSV treatments, but some over-the-counter medications can help manage pain and fever, and patients should stay hydrated, doctors said. Most adults and infants without other health conditions don’t need to be hospitalized, the CDC said.
People should seek medical attention if they have trouble breathing, aren’t drinking enough fluids or have worsening symptoms, the CDC said. Some might need additional oxygen, fluids or a breathing tube. Hospitalization tends to last a few days.
Among children under the age of 5, an estimated 100 to 300 RSV-related deaths occur each year in the U.S. while some 6,000 to 10,000 deaths occur among adults 65 and older, according to the CDC. The RSV-hospitalization rate for people 65 and older is per 100,000 people, according to CDC data.
The CDC said it doesn’t have real-time death data because RSV reporting isn’t mandatory.
Areas including the Southeast and South-Central parts of the U.S. last week recorded declines in the proportion of tests positive for RSV, Dr. Romero said. In Connecticut, children’s hospitals reported a stable or slightly lower number of children admitted to the hospital compared with the week prior, the state health department’s Dr. Juthani said.
“I’m hoping that we’ve somewhat plateaued in the Connecticut area,” Dr. Juthani said. “The downside is that flu is taking off.”
Doctors and health officials said they are watching how flu and Covid-19 might collide with RSV trends this winter.
“We likely have not peaked,” said Amanda Castel, an infectious-disease epidemiologist at the George Washington University Milken Institute School of Public Health.
All children should be screened for anxiety starting as young as 8 years old, government-backed experts recommended, providing fresh guidance as doctors and parents warn of a worsening mental-health crisis among young people in the pandemic’s wake.
The draft guidance marks the first time the U.S. Preventive Services Task Force has made a recommendation on screening children and adolescents for anxiety. The task force, a panel of independent, volunteer experts that makes recommendations on matters such as screening for diabetes and cancer, also reiterated on Tuesday its 2016 guidance that children between ages 12 and 18 years old should be screened for major depressive disorder.
Omicron is pushing Covid-19 hospital admissions among children to record levels in the U.S. and the U.K. Doctors say the variant’s infectiousness—and not any increased severity—is probably mostly responsible.
Throughout the pandemic, children have been much less likely than adults to suffer severe illness from Covid-19, and doctors say that this appears to be true for Omicron, too. But sky-high case numbers mean that more children are ending up in the hospital both with Covid-19 and because of the disease, underscoring how a likely milder variant can still do more damage, simply by infecting more people.
In England, 576 children ages 5 and under were admitted to hospitals with Covid-19 in the week to Jan. 9, well above the previous peak of around 160 in August. Separate data, from a study that tracks admissions in detail from around half the hospitals in the U.K., show that the rise is being driven by under-ones. Admissions for those ages 6 to 17 are also at a high. By contrast, Covid-19 hospitalizations among adults are still significantly below the peaks of earlier waves, thanks in large part to vaccination.
Those numbers appear alarming, but doctors say there are no clear signs, so far, that Omicron is afflicting children worse than earlier variants. What is likely contributing to the pattern is that the unprecedented number of infections across the country means that more children have it when entering hospitals, often for respiratory diseases they commonly get in winter. In other words, the proportion of children going into hospitals with Covid-19 rather than because of the disease is likely significantly higher than in adults.
Hospitals in the U.S. are struggling to staff medical facilities as a wave of Covid-19 cases sidelines healthcare workers. Some hospital administrators are being forced to turn to last-resort measures to ensure quality of care. Photo: Joseph Prezioso/AFP/Getty Images
The rate of Covid-19 hospital admission among children ages 5 and under, at around 15 per 100,000 for the week to Jan. 9, is still lower than in adults, where rates range from 17 per 100,000 among those ages 18 to 64, to 179 per 100,000 in those 85 and older.
But the figures don’t say much about how much Covid-19 is responsible for sending children to the hospital. They encompass those there primarily for another reason—such as a broken leg—who have tested positive for the virus before or after they were admitted. They also include those in the hospital for other infections or illnesses where Covid-19 might have played a part.
Covid-19 vaccines aren’t routinely offered to children under the age of 12 in the U.K., but it isn’t known, doctors say, whether this plays a significant role.
“It would be rather surprising if we didn’t see large numbers of hospital admissions with the infection,” because of the high level of cases in the community, said Adam Finn, professor of pediatrics at the University of Bristol. “The tricky bit is trying to figure out how much the infection is actually contributing to the reason for the child being in hospital,” he added. “It’s not cut and dried.”
Doctors say that more children are being treated primarily for Covid-19, but no more than would be expected given the sheer number of infections Omicron is causing. Separate data show that overall case numbers in those ages 4 and below in England have quadrupled since the beginning of November.
And Omicron doesn’t appear to be leading to a surge in the most severe cases among children. Data from the U.K. Health Security Agency show that intensive-care-unit admissions for those ages 4 and below didn’t rise significantly during December, despite a quadrupling in hospital admissions among that group.
“These are not particularly sick infants,” said Calum Semple, professor in child health and outbreak medicine at the University of Liverpool, one of the researchers on the hospital admissions study. They are being admitted for shorter periods in this wave and requiring less oxygen than in previous surges of the virus, he said. The proportion taken to ICU has slowed over time and the numbers on mechanical ventilation are incredibly low and continue to fall, he added.
A 15-year-old receives a Covid-19 vaccine in Glasgow.
Photo:
Jane Barlow/Zuma Press
Edward Dallas, a consultant pediatrician in the emergency room in a London hospital, said he is probably seeing more children with Covid-19 in this wave than at any time in the pandemic, but didn’t think that was because Omicron is affecting children more severely, just affecting more children.
He added that the most common symptoms of Omicron infection in children appeared to be runny nose and cough but that it didn’t typically lead to lung infection.
“It’s just a pure numbers game,” said Chethan Sathya, a pediatric surgeon at Northwell Health’s Cohen Children’s Medical Center in New York, where cases are also surging. “If you look at the positivity rates, they’re through the roof.”
Another complicating factor is that it is common during the winter for young children to go to hospitals for respiratory illnesses and test positive for several different viruses, making it impossible to determine which is the root cause.
“Over time we see more Covid co-infection,” said Ronny Cheung, a consultant pediatrician at a hospital in London. “Anyone who tries to say [the illness] is because of Covid or another respiratory infection is making it up as they go along.”
Staff at a school in Halifax, northern England, process Covid-19 rapid tests.
Photo:
oli scarff/Agence France-Presse/Getty Images
Hospital admissions among babies are especially likely to move in lockstep with the background infection rate because the threshold for admission is low in very young children. For instance, children six months and under who got to the hospital with a fever are typically admitted for routine tests and monitoring, as a precaution. The hospital admissions study found that babies made up a larger proportion of hospital admissions among children, around 42%, in the past four weeks, up from around 30% during the Delta wave.
“We know Covid gives you a fever and if you are febrile and an infant you are going to go through an investigation cycle,” said Damian Roland, honorary professor of pediatric emergency medicine at the University of Leicester. “It doesn’t necessarily mean Covid is any worse or particularly harmful.”
“Just like any other virus, when you’ve got more of it around you’ll see more children coming in, and more will tip the threshold for needing admission,” said Jane Bayreuther, chair of the U.K.’s Association of Paediatric Emergency Medicine. There has been no increase in the overall severity, she added.
Still, it’s too early to tell the full extent of the impact of the new variant in children, according to Chinedu Nwokoro, a consultant respiratory and general pediatrician in a London hospital.
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An “Omicron-sized blip” in any condition linked to infection with Covid-19 in children, including long Covid and multisystem inflammatory syndrome, or MIS-C—a rare inflammatory condition affecting some children around six weeks after infection with the virus—is “in itself is going to be a problem,” Dr. Nwokoro said.
“Given [MIS-C cases] tend to present several weeks after the initial infection, we are bracing ourselves for a bigger rise over coming weeks,” said Dr. Cheung. “The question is: Will Omicron do something different?”
Analysis of the health records of more than 14,000 children under 5 years old in the U.S. comparing those infected with Omicron with those who had Delta found the newer variant was significantly less likely to lead to severe outcomes. The study, from researchers at the Center for Artificial Intelligence in Drug Discovery in Cleveland, hasn’t been peer reviewed.
At Advocate Children’s Hospital, which is run out of two sites near Chicago, Covid-19-related hospitalizations increased more than threefold in the 30 days to Jan. 6, according to chief medical officer Frank Belmonte. Around a quarter of patients on average each day are ending up in pediatric intensive-care units, he added, up from around 10% on average in previous waves.
Some of the children in Advocate’s intensive-care unit didn’t have prior risk factors for Covid-19, according to Nekaiya Jacobs, a pediatric critical-care physician at the hospital. “There continues to be this misconception that Covid is always mild in children or teens or that children just don’t get sick,” she said.
Write to Denise Roland at Denise.Roland@wsj.com and Joanna Sugden at joanna.sugden@wsj.com
Covid-19 vaccinations for children 5 to 11 years old are off to a slow start in many parts of the U.S., federal data show, underscoring the challenges health officials face in persuading parents to inoculate their children.
Roughly five million, or 18%, of the estimated 28.4 million U.S. children in the 5-to-11 age bracket have gotten at least one shot in the five weeks since they were cleared to get vaccinated, the data show. The picture varies by region, with rates in several New England states above 30% and some states in the South far off the national pace, an analysis by The Wall Street Journal of the data shows.
About three in 10 parents reported they had gotten their 5- to 11-year-olds a shot or said they planned to right away, according to polling of parents’ views from the Kaiser Family Foundation released Thursday, while 32% said they were going to wait and see, 7% said they would only if required and 29% said they definitely wouldn’t.
A health worker administered a Covid-19 test Tuesday on a child outside a pharmacy in Providence, R.I.
Photo:
David Goldman/Associated Press
Other analysis from the foundation, published Wednesday, found the pace of vaccinations for 5- to 11-year-olds nationally had slowed significantly after initial high demand. Health authorities in some slower-moving states said they thought they could still get most parents on board, though it may take time.
“The biggest challenge we have here, which is probably across broader Appalachia as well, is the messaging has to come from a trusted medical provider or a trusted individual in the family,” said
James Hoyer,
who leads the Joint Interagency Task Force for Covid-19 in West Virginia.
“So it’s going to be a much longer lead time for us to get people comfortable,” he said.
State data recently showed about 15,300, or 11%, of the 140,000 children aged 5 to 11 in West Virginia have gotten at least one shot.
Vermont leads the U.S. with at least 47% of its children in the 5-to-11 bracket having received a shot, the Journal analysis of the federal data shows. Vermont, where nearly 84% of adults are fully vaccinated, has long been a fast adopter of Covid-19 vaccines. Massachusetts, Maine and Rhode Island also are high on the list for young children, as they are with adults. Alabama, Louisiana and Mississippi have started slowly with children in the 5-to-11 age group, echoing the South’s broader vaccine-uptake trends.
Children aged 5 to 11 started getting their first doses of Covid-19 vaccines on Nov. 3, after the CDC recommended use of the Pfizer-BioNTech shot for that age group. Some parents said they were eager for kids to get vaccinated and return to normal life. Photo: Maddie McGarvey/WSJ
State vaccination data and Centers for Disease Control and Prevention data may differ in some cases, in part because of reporting lags.
Most infectious-disease experts have encouraged vaccines for children. While they typically experience milder cases than adults if they get Covid-19, children can and do get sick from it. They are also a part of the puzzle when it comes to achieving broad, communitywide protection.
Researchers haven’t found evidence the vaccines pose additional or different risks to children than to adults. Parents still often approach the shots cautiously, some pediatricians said. The new poll found safety and potential side effects were prominent concerns among parents.
“The younger a child is, the more a family tends to want to sit down with a medical professional they trust and talk through their questions,” said
Lee Beers,
president of the American Academy of Pediatrics.
Covid-19 can cause heart-inflammation conditions. The conditions have also been reported in a smaller number of people who got an mRNA vaccine, most commonly in male adolescents and young adults.
The new Kaiser Family Foundation poll, of roughly 1,200 parents with a child under 18, was conducted between Nov. 8 and Nov. 23, before the Omicron variant hit the news, and included. The margin of error is 4 percentage points for the full sample and 5 points for parents with children in the 5-to-11 group.
Vaccine acceptance continues to break along political lines. About half of polled parents who self-identified as Republican said they wouldn’t vaccinate eligible children, compared with 7% of parents who self-identified as Democrats. Among self-identified independents, 33% said they wouldn’t vaccinate children aged 12 to 17 and 26% said they wouldn’t vaccinate those 5 to 11.
The polling also shows vaccine uptake among adolescents aged 12 to 17 has slowed after an initial surge. Parents of children in the 5-to-11 group seem less eager than parents of adolescents, according to the poll.
A family with young children signed up Tuesday for booster shots and vaccinations in Stamford, Conn.
Photo:
Amir Hamja for The Wall Street Journal
Louisiana recently reported that about 7% of its 5- to 11-year-olds had gotten at least one vaccine shot. The full vaccination rate for all Louisianans, about 49%, also lags behind the nation’s 60% level, federal data show.
Kimberly Hood,
assistant secretary of public health in Louisiana’s Department of Health, said she thought most parents could be persuaded, and that health authorities were trying to make inroads where they could. A recent clinic at a Baton Rouge arcade delivered about 480 new vaccine shots.
“We do feel there’s that movable middle that just wants information,” Ms. Hood said.
Now that the Food and Drug Administration has authorized the Pfizer -BioNTech vaccine for 5- to 11-year-olds, expect a wave of Covid-19 vaccine mandates for children. San Francisco announced last week that the city will require children in that age group to show proof of vaccination to enter restaurants, sporting events, swimming pools and more. New York’s School of American Ballet informed parents via email on Nov. 4 that all students—the school enrolls children as young as 6—must receive a Covid vaccine by January.
While parents may choose to vaccinate their own children, these mandates are unethical and unlawful. Advocates of mandating Covid vaccines equate them with standard childhood shots against polio, chickenpox, TDaP (tetanus, diphtheria and pertussis) and MMR (measles, mumps and rubella). But those decades-old vaccines have gone through the full FDA testing regime. The Covid vaccine has received only emergency-use authorization for this age group, meaning its safety and efficacy have not yet been established to the FDA’s satisfaction.
Carole Funk gets a flu shot most years and is up-to-date on all her other vaccines. She refuses to get the Covid-19 shot.
A nurse practitioner for nearly 10 years, she believes Covid-19 can kill—she knows people who have died. Still, she lost her job running an urgent-care clinic in Strasburg, Va., in September due to her refusal to vaccinate, and remains unmoved. “Getting fired is not enough for me to overcome my fear that the side effects or adverse events of these vaccines are grossly underreported,” Ms. Funk said.
Ms. Funk, 50 years old, is among more than 200 workers at Virginia and West Virginia-based Valley Health System who resigned or were fired over requirements that the company’s 6,200 employees be vaccinated. They belong to a group of people who have made up their minds that Covid-19 vaccines could harm their health or infringe on their liberties.
There’s no evidence of the kind of underreporting Ms. Funk cited, doctors and public-health experts say.
The fact that these holdouts are healthcare workers makes them one of the most confounding challenges for the vaccination drive. Around one-third of the eligible population in the U.S. remains unvaccinated against Covid-19. Some of the vaccine holdouts, health officials believe, will ultimately be persuaded to get the shot—the so-called movable middle. Others might never be persuaded. Their resistance and potential influence threaten public-health efforts to defeat the virus, say epidemiologists and other health experts.
Carole Funk, at home in Virginia, is a nurse practitioner who lost her job running an urgent-care clinic because she refuses to be vaccinated.
“We want to get the virus to a point where we can manage it,” said Ali Mokdad, professor of health metrics sciences at the Institute for Health Metrics and Evaluation at the University of Washington.
He estimates that 85% of the population will need to be vaccinated before that is the case, and even the relatively small percentage of people who are opposed to getting the vaccine could be a barrier to that, considering it isn’t known when children under the age of five will be eligible. Shots for those between five and 11 years old could be approved within the month.
Most healthcare workers are required by employers to get immunizations for other infectious diseases, such as measles, mumps, rubella and chickenpox. Why are some resisting the Covid-19 vaccine?
The Valley Health urgent-care clinic where Ms. Funk worked in Strasburg, Va.
After years of experiencing federal oversight and health regulation up close, some nurses and other medical workers are skeptical of the system. They say they are overworked and burned out and have taken on enough risk during the pandemic without adding the dangers they perceive in vaccines they consider unproven.
Some believe the vaccine’s development was too rushed and are worried about the possible unknown long-term effects on their health.
The Covid-19 vaccines, with unprecedented investment and international focus, were developed faster than any other vaccines, with the next fastest being the four-year process to develop the mumps vaccine, licensed in the 1960s.
Eventually, those who refuse to get a vaccine will likely get some immunity by getting infected themselves, epidemiologists say. But they are more likely to face a serious case of Covid-19 and long-term symptoms than those who are vaccinated. They also pose a threat to those who are immunocompromised or not yet able to get the shot, such as very young children or infants, public-health experts say.
Nurses and other staff who refuse to get vaccinated have a double impact on the pandemic response because healthcare workers are already in short supply. Two Valley Health urgent-care clinics, including Ms. Funk’s former workplace, temporarily closed after several staff members left or were terminated for refusing to get vaccinated. Valley Health plans to shift vaccinated employees into the vacancies and reopen the clinics in the late fall.
The vast majority of Valley Health employees complied with a requirement to get at least a first shot by Sept. 7, according to Chief Executive Officer Mark Nantz. He said he was troubled that a group of medically trained workers would rather lose their jobs. He said he is partly relieved that people opposed to such effective vaccines are no longer treating Valley Health patients.
“The idea that they feel their individual rights trump a global pandemic that’s killed so many Americans—I can’t reconcile that,” Mr. Nantz said. “It makes me incredibly sad.”
Mark Nantz, President and CEO of Valley Health System, which required its staff to be vaccinated against Covid-19.
Valley Health’s departed workers cited a range of reasons for their refusal, such as the belief that pharmaceutical companies have undue influence over vaccine policy. Others believe health authorities haven’t thoroughly investigated reports of post-vaccination health problems to the Centers for Disease Control and Prevention’s adverse-event reporting system.
Katherine Hart, 32, a nurse practitioner at a Valley Health clinic in Martinsburg, W.Va., said her own refusal to get the vaccine is motivated by mistrust in the government and frustration with mandates and restrictions—such as economic shutdowns and vaccine mandates—that have disrupted her and her girlfriend’s lives for more than a year and a half.
Her own mistrust in the government comes from a conservative upbringing and worldview, she said, one that emphasizes individual rights and personal autonomy. “The government shouldn’t be telling us what to do,” she said.
Nurse practitioners, unlike registered nurses, can prescribe treatments, order tests and diagnose patients—duties normally carried out by doctors.
Ms. Hart came down with Covid-19 in November 2020, she said, and believes there is no need for her to get the vaccine because she thinks she is unlikely to get infected again. She also wears a mask and washes her hands when working, which she said offers additional protection in addition to her immunity from prior infection.
Research suggests that unvaccinated people are more than twice as likely than people who are fully vaccinated to be reinfected.
Ms. Hart said she gets the flu shot every year and is up-to-date on all her other vaccines. The Covid-19 vaccine is different, she said, because she feels that she is being forced to get it. She is also suspicious of the public-messaging around the vaccine, calling it propaganda.
She submitted what she called a “very half-assed religious exemption” to keep her job. “My Body is my temple and taking this shot/vaccine would not glorify Him,” she wrote in the request. She was granted an exemption.
Ms. Watson and Ms. Hart walked their dogs last week.
Valley Health granted exemptions to 300 employees, Mr. Nantz said, about half for religious reasons and half on medical grounds. The majority of medical exemptions were for women who were pregnant, trying to get pregnant or breast-feeding, who were worried about the possible effects of the vaccine on their fertility or baby. Many said they would get the vaccine later. The CDC has encouraged pregnant women to get the shots, citing studies indicating that they are safe.
Those who were granted a religious exemption had to demonstrate a “closely held belief, even if it’s not fact based,” said Mr. Nantz. Most were approved, and rejected applications were often clearly political, he said.
Ms. Hart’s fiancée, Brittany Watson, 32, a registered nurse at Valley Health who was also granted a religious exemption, is currently on strike. The two have led picketing efforts outside Valley Health’s Winchester Medical Center in Virginia protesting vaccine mandates and gathered like-minded supporters on Facebook and TikTok. One TikTok video shows a montage of the picketing sessions, with healthcare workers holding up signs declaring “My Body, My Choice.”
A colleague of Ms. Hart’s, a vaccinated nurse practitioner, said she sympathized with Ms. Hart’s conviction that people should be able to decide what goes into their bodies without fear of reprisal. She also said she believes it’s vital for medical workers to be vaccinated to keep their patients safe, and that she would want vaccinated workers taking care of her own family.
She added, though, it was a loss to have good health providers leave jobs because of the mandate.
Mr. Nantz said Valley Health had worked to limit disruptions to staffing and patient care. Months before the vaccine deadline, managers estimated how many people might leave and made more than 300 hires. The departure of 210 employees who refused to be vaccinated among 6,200 total employees hasn’t hurt Valley Health’s ability to care for patients, he said.
Robbie Dusing, a nursing director at Valley Health, said he listens to concerns that some nurses have about the vaccine and shares information to try to persuade them.
Robbie Dusing, a nursing director at Valley Health’s Winchester Medical Center, said he got his second vaccination shot in early January. He said he had been hospitalized with Covid-19 in March 2020 and continues to have heart problems related to the infection.
The 36-year-old said he has shared that experience in some of the many conversations he has had with his staff about getting inoculated. He listens to the concerns some nurses have, shares available research and cites expert opinions. Some remained unmoved. Many of those say they need more time to decide, while with others, “There’s this feeling of, ‘You can’t tell me what to do,’ ” he said.
Ms. Hart and Ms. Watson oversee a
Facebook
group in which 2,400 healthcare workers and their supporters urge each other to “hold the line” against vaccine mandates. Some post messages praising immunity to Covid-19 through infection over immunity through vaccination.
Research has shown that getting inoculated boosts immunity even in people who were infected earlier, and that vaccine-induced immunity generally appears to be stronger and longer-lasting than immunity conferred by natural infection.
Some members promote Ivermectin, an antiparasitic drug that some conservative media outlets have promoted to treat Covid-19. It is ineffective against Covid-19 and can be dangerous when used improperly, doctors and health officials have said.
“Just because you’re in healthcare doesn’t mean that science drives your core values,” said
Leana Wen,
former Baltimore City Health Commissioner and health policy professor at George Washington University. “There are other factors in people’s lives—family members, close friends, other beliefs and sources of information.”
Ms. Funk said she thinks media and officials are withholding relevant information about the vaccine.
Ms. Funk, who has been offered a telehealth nurse-practitioner job since being fired from Valley Health, occasionally shares videos and articles in the Facebook group, including one of a family physician who pushed back against masking and vaccination requirements at a school board meeting. YouTube has since removed the video for violating community guidelines.
Ms. Funk said her mind is made up for now on the Covid-19 vaccine, though she said she might get the shot in the years ahead if “any negative information about the vaccine isn’t actively being scrubbed.” She believes that now, mainstream media outlets, tech firms and public-health officials are withholding relevant information about the vaccine.
Public-health experts say they may never persuade people as skeptical as Ms. Funk to get the vaccine.
The proportion of adults saying they wanted to “wait and see” before getting the vaccine shrank to 7% in September from 39% last December, according to a recent poll by the Kaiser Family Foundation. However, the proportion of people who say they will “definitely not” get the vaccine has only dropped to 12% in September from 15% last December.
Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, thinks the best way to raise vaccination rates is to make connections with people still on the fence and address their concerns, to keep them from taking guidance from people who are against vaccinations.
Ms. Hart doesn’t believe she and her peers are spreading lies or conspiracy theories. People should be able to trade information they have come across and talk about what has worked for them, she said.
“We’re Americans, and there shouldn’t be any censorship,” she said. More than 230 people joined her Facebook group in the past four weeks. She and Ms. Watson are hoping to hold another picketing event before the end of the month.
Ms. Watson and Ms. Hart showed signs they have used during protests of Valley Health’s vaccine mandate.
Hospitals in the South and Midwest say they are treating more children with Covid-19 than ever and are preparing for worse surges to come.
Cases there have jumped over the past six weeks as the highly contagious Delta variant spreads primarily among unvaccinated people. That is leading to more sick kids in places where community spread of the variant is high, public-health experts say.
Children under age 12 aren’t yet eligible to be vaccinated, and vaccination rates for those between 12 and 17 remain relatively low, according to data compiled by the American Academy of Pediatrics. Although children are much less likely than adults to develop severe Covid-19 or die from the virus, recent data from the Department of Health and Human Services show pediatric hospitalizations for Covid-19 are at the highest point since the agency began tracking them last year, driven by states that have been hit hard by the Delta variant.
Children’s hospitals are bracing for even more cases as schools reopen. They are hiring more nurses, reworking discharge protocols, speeding up room cleanings, laying contingency plans to expand bed capacity and preparing staff for an uptick in multisystem inflammatory syndrome in children, or MIS-C. A rare condition that can occur several weeks after Covid-19 infection, MIS-C can lead to organ damage or even death without the proper diagnosis and management.
It isn’t clear whether the Delta variant is making kids sicker than they would have been if infected with previous strains. Some pediatricians believe that is the case because of the severity of the cases they have treated. Other pediatricians don’t think Delta is causing more severe Covid-19 in children than earlier variants. But with Delta spreading widely, the number of children hospitalized with Covid-19 far outstrips anything they saw in the past.
The vaccination drive among adolescents, a critical part of the wider effort to build society-wide immunity to Covid-19, has slowed, as many parents harbor safety concerns.
Many parents rushed to get their children inoculated in May after regulators widened use of Pfizer Inc.’s Covid-19 shot to children as young as age 12. Yet vaccinations have flagged since. Other parents have held off because of concerns about the shot’s speedy development and a rare side effect, an inflammatory heart condition called myocarditis. They are struggling with how to weigh these risks against research indicating that Covid-19 itself isn’t a significant risk for children.
Some of the reluctant parents are vaccinated themselves, a new challenge for public-health officials trying to overcome more general hesitancy about vaccines, as they race against the Delta variant and prepare for the resumption of schools.
“I’m just going to hold off,” said Jackie Gordon, of O’Fallon, Ill., who hasn’t gotten her 16-year-old son vaccinated, though she and her 18-year-old daughter have taken the shots.
Giving her pause, she said, was uncertainty whether the shot is safe for children like her son with extreme allergies. The Centers for Disease Control and Prevention recommends vaccines for people with severe allergies so long as they aren’t related to shots or injectable medications.
Gloria Kennett is eager to take a long-awaited beach vacation, but she is keeping a watchful eye on new cases of the Covid-19 Delta variant.
Ms. Kennett, a hotel executive in Chicago, is vaccinated, but her 9-month-old daughter isn’t yet eligible. For now they’re planning to go. But if they see a big surge in cases, they’ll hold off. They’re reassured that they can get a refund if they cancel.
The more-infectious Delta variant has quickly spread around the world, and is now the most common strain of the Covid-19 virus circulating in the U.S. An analysis of genetic sequencing data as of June 27 showed that the Delta strain now makes up about 40% of positive Covid-19 test samples, according to Helix, a population genomics company that collects and analyzes test samples from several U.S. states.
The CDC has said that fully vaccinated Americans are well protected, even against variants. But children under the age of 12 aren’t yet eligible for vaccination.
Children are still at far less risk than adults for severe complications or death from the virus. Most children who get Covid-19 still have mild or asymptomatic cases. There is no indication that young adults and children are more vulnerable proportionately to the Delta variant than other age groups, and any pockets of increased transmission mostly reflect the fact that they haven’t been immunized, scientists say. “There’s no evidence it’s more severe in children,” says Monica Gandhi, an infectious-diseases doctor at the University of California, San Francisco.
