Kids’ Health Correspondent Erin Beck spoke with Dr. Clay Marsh, West Virginia COVID czar, about young people and the rise of the Delta variant in West Virginia. This conversation took place shortly after news the more easily transmissible Delta variant had reached at least 100 cases in West Virginia.  

Since then, the state Department of Health and Human Resources has identified at least 129 cases. However, in an email, DHHR spokeswoman Jessica Holstein explained that state health officials test a sample of cases, not all. So the true number is likely much higher.

This interview has been edited for clarity and readability. 

Erin:  I wanted to write a story specifically about back to school. But just because we’ve seen so much happen (in recent days, related to the rise of the Delta variant in West Virginia), is there any other update that has been decided since the last press conference, any new policies or mandates?

Dr. Marsh: All of us are really, really closely watching all of the data, as we look at cases picking up and think about school. There’s no (new mandate or requirement out there.) Based on the Delta variant’s behavior in other states and other countries, we are anticipating that we will likely see a more rapid slope of people getting sick and have more cases and perhaps, more hospitalizations. I think it starts slower, and then it builds much more rapidly than we’ve seen with other forms of COVID-19. So depending on what happens and what we see, we’ve made appropriate contingency plans to make sure that we’re doing what we can to protect our people and maintain our hospital and health system capacity. If your hospitals get overwhelmed, then people can have bad outcomes from things like heart attacks and infections. 

Erin: We hear a lot about mask mandates, but I don’t hear as much about what else schools can be doing and what kind of assistance the state can provide for things like ventilation. And the CDC has come out with a couple of reports about air purifiers being helpful. Is there anything going on in that area?

Dr. Marsh: I know everybody wants to go in-person. But we also want to make sure that we have options available depending on what happens. I know that we have reached out to the Department of Education to look at how we might be able to help them receive some funding to be able to look at enhancing ventilation tools. Certainly, we recommend windows open (if comfortable).

The CDC has made recommendations for mitigation measures, vaccines,masks, physical distancing, and initially the CDC recommended to mask up if you weren’t fully vaccinated, but they said there was no need for mask if you were fully vaccinated, and the American Academy of Pediatrics came out and said you should be fully masked instead of (teachers) asking whether you’re fully vaccinated or not, because it’s hard to know who. And then later the CDC, after they figured out that the Delta variant was more transmissible, they came out and agreed with the American Academy of Pediatrics. And then there are issues as you mentioned, like ventilation, physical distancing. But there’s also testing, and CDC recommended if you’re in school, and you have not been fully vaccinated, you should be tested weekly, if you’re playing sports, twice a week, or consideration of that. (Writer note:The CDC says in areas with high transmission, high-risk activities should be cancelled. High-risk extracurricular activities are those in which increased exhalation occurs, such as activities that involve singing, shouting, band, or exercise, especially when conducted indoors. Some counties in West Virginia already have high transmission.) (The CDC also recommends) contact tracing, trying to identify people, keeping people home from school who are sick. And then of course, being ready to pivot if you need to, because if you experience an outbreak or a cluster, then even though everybody is committed to in person learning as everybody in West Virginia is because of the importance of that, just the ability to have Plan B if need be is something else that was discussed.

Erin: I feel like I’m pretty clear on the guidance and the recommendations. But what I’m less clear on is, if you’re working with the Department of Education, if you don’t mandate masks, can you either make them do other things like make them have weekly testing events, or make them vaccinate the teachers? Or if you’re not going to make them do it, is there assistance that can be provided? I know we have local control in West Virginia. So it’s a little bit of a patchwork system. 

Dr. Marsh: That would be something that you would probably need to talk to Superintendent (of West Virginia schools Clayton) Burch or Deputy Superintendent Michelle Blatt. (Writer note: at a recent press conference, Burch mentioned that American Rescue Plan funds will assist schools with mitigation measures but that most decisions will be made at the local level.) But my understanding is, as you suggested, that because of the local control on the schools’ decisions, that there’s recommendations that can be made, both from the governor’s office, and from the board, but that the county school boards and the superintendents there make those decisions. I don’t think there’s any such order, or edict at this time, that would instruct and require those counties and local schools to act in any way. But certainly we are both ready to help and ready to help in a response sort of approach if things start to get worse than they were in the previous year.

(writer note: In a press conference last week, education officials said they were leaving decisions about any mandates or shutdowns up to local school districts and were loosening quarantine requirements. I sent an email to DHHR asking how often kids had transmitted COVID to teachers or other school staff last year. DHHR spokeswoman Holstein said: “Disease transmission can be difficult to track in school settings due to multiple potential exposures and factors contributing to exposure.  Based on outbreak data from last school year an overwhelming number of outbreaks were associated with exposure outside of the classroom setting; little transmission occurred in the classroom when layered preventative measures were in place such as social distancing and mask wearing.”)

Erin: I have read that, in some instances,  concern about the Delta variant has encouraged vaccination among people who were previously hesitant. And I think Governor Justice said that we’re still at a kind of a lull with vaccination. Is there any indication of that happening here? Are you hopeful that that might happen?

(writer note: ABC News has since reported that this trend has expanded nationwide.)

Dr. Marsh: We’re hopeful that everybody chooses to get vaccinated. Around the country where the Delta variant has started to cause problems, there is an upswing among certain vaccine-hesitant people to get vaccinated, because this is a much more explosive form of COVID-19. It’s much more easily transmissible, and generally one that impacts children differently than the previous different variances. So there are people that are getting vaccinated. I know there are people that are more concerned. But there are also still a number of people that are not, and we hope they choose to be vaccinated, because we do know in countries that have vaccinated,  that they’ve seen an increase in cases and some increase in hospitalization. But their death rate didn’t really go up very much, which really reflects the impact and the success of the vaccines against most of your consequences of COVID-19, including death and hospitalization. So the people that are not fully vaccinated are at risk for that. We’re worried that we’ll see the people not vaccinated have the brunt of the severe disease. And that’s what we’re seeing around the country, including younger people, being very, very sick from this.

Erin: And speaking of the young people being sick, I had read news articles from several states about kids being more affected by Delta. Are we seeing that yet, with younger children being infected at a higher rate than they were with previous variants? Or is it too too soon to say? 

Dr. Marsh: Well, when we looked at the seven day averages of cases, our case numbers are going up and we see now starting to become more prevalent in younger people. Again, initially, when we first very first started seeing the Delta variant, it was very much more distributed, and perhaps more in the 40 to 60 year old group of West Virginians, and now it’s moved down to the 10 to 19, and the 19 to 28 year old group. And what we’re worried about Erin, is just like every other part of COVID-19, we have not been able to predict exactly what is going to happen around the world. Who would have thought that this virus would have impacted the world in a way that we’ve seen it, both in number of deaths, 611-612,000 people dying in our country (writer note: this total is now up to 614,000), and 4.2 million or so dying in the world, but also with the idea that it’s persisted so long, and it still does not seem to be getting weaker, if anything, it seems to be getting stronger. So while the majority of people who become infected with COVID-19, particularly younger people, will not suffer as serious consequences that we’re talking about, we know that young people are going to be infected by this variant, just like people of every age. And because of that, they’re going to be able to transmit that just as well as adults. And that’s the first time we’ve seen that in the pandemic. And out of the young people that will be infected, then we know that there’s going to be a number of those people, because of their genetics or because of co-existing problems or just bad luck, will get sicker from this than we’ve seen before. This virus spreads like the chickenpox, and can also spread just from breathing the air of somebody who has been infected, like breathing in smoke. And because of that really explosive spread, we know that we’ll see some of those people, even if it’s a real minority, but that’s still a lot of people that are going to get sick, are going to need to be hospitalized and are going to be in the ICU. And because most of the people that are not vaccinated or are not fully vaccinated, are people younger than 50 years old, then we most likely will see an over-representation of those age groups be the people in our hospitals and ICUs. And we really, in our state, haven’t dealt with that problem before.

ErinI watched an exchange between a member of Congress and (CDC Director) Rochelle Walensky where she was talking about how any child dying is too many children, and the politician responded by saying something along the lines of it was his understanding that all of the children had underlying conditions. Is that argument based on facts? And how would you respond to that kind of argument?

Dr. Marsh: Well, we know that America is a relatively sicker country than many other countries. When we look at our outcomes for healthcare, despite spending more than other countries, we have worse outcomes. And we found out during the pandemic the USA lost a year and a half of life, the most years of life that we’ve lost since the world wars. And when we look at the populations who lost the life, Hispanics lost the most life-years, then Black people, and then non-Hispanic white people. And when we look at other westernized countries, we see that they gain years, even during that time. So it may tell us that in America, and we know, in West Virginia, we have more coexisting medical problems than people do in America. And people in America may well be that versus the rest of the world. We may be biologically older than some of our peer countries and peer groups. So when we see children and I think 300 children, last time I read about it, have died of COVID, and about 14,000 to 15,000 have been hospitalized. Three hundred children is a lot of children to die from an infectious disease (writer note: this number is up to 416). And even though that is not nearly as many adults that have died, the concern is that children are going to be infected at a much higher rate with this Delta variant, and that number very well may go up. But I do not know about that particular exchange and those particular children, if there was any evidence that they had coexisting medical disease, I have not seen that.

Erin: That’s a really good point about our state’s health may be predisposing us. And maybe when people hear that underlying conditions make you more susceptible, they might not realize that something that their child has is an underlying condition.

(writer note: In an email, DHHR spokeswoman Jessica Holstein said public health surveillance workers typically don’t collect data about children’s pre-existing conditions when they conduct patient interviews. So it’s unclear what conditions may make West Virginia children more vulnerable).

Dr. Marsh: If you think about vaccines or native immunity, or being young versus being old, or being on chemotherapy versus not, I kind of look at it as a threshold effect. So if we all have protection to a certain level. Let’s say you have a raincoat on and you’re out in the rain. If the rain is not very hard, and the raincoat fits pretty well, then you’re not going to get very wet. You’ll be okay. If the raincoat doesn’t fit as well, or if the rain is very, very hard or torrential or persistent, or if you don’t zip it up right and wear it right, then you’re going to get wet, either sooner or with more intensity. The vaccines give you a higher threshold, being young and healthy gives you a higher threshold. But if you get enough exposure to enough concentration of the virus acutely, then even at a high threshold, you may have that exceeded and you can get sick. And the lower your threshold is, the more different doses of virus may impact you and make you sick, whereas the people are fully vaccinated, even if they are inherently older, or less healthy, they may still have a higher threshold because of the benefit of the vaccination.

Erin: You mentioned behavioral health, I know you guys have promoted different hotlines but since we’re so far into the pandemic now, is there anything new happening to help people, including children, that have experienced this collective trauma?

Dr. Marsh: Well, certainly, there’s a number of programs through the DHHR. And many of the childhood health care groups, pediatrics, etc. and adult groups are very much on the lookout for that. But as you correctly point out, we have seen more problems with substance use disorder, and more problems of people feeling isolated and lonely. We know that some of our young students have really suffered with distance learning versus in-person learning, and because of the stress of everything else, but we have a number of tools and capabilities and programs available for people. I think part of it is people may not know about it or not take advantage of it. But as far as any new program, certainly, we are constantly trying to enhance the offerings that we have. But I do think that this pandemic has been a very big perturbation on a lot of systems, economic, social, medical, etc. and has had a huge impact, sometimes negative and perhaps sometimes on people who have suffered a measurable loss, of their family or friends, or have suffered health care consequences, or burnout or loneliness, isolation, hopelessness, and all that. Whereas other people maybe have found that by changing their environment and behavior, and perhaps working more from home versus driving and going to work and sitting in an office, that they found a higher level of satisfaction. So this pandemic, if nothing else, has really been a huge stress on all of our systems. And it’s induced a lot of change. And that change has a number of downstream reverberations. And I think that we want to continue to offer the programs that people need and want, but also recognize that part and parcel to this pandemic, with the change it’s induced is going to be a level of anxiety. 

Erin: It feels like we could basically now start feeling like we’re going through the same thing, like a repeat of last year all over again. So I was wondering, do you think it would be possible that people could end up back on unemployment again? Do you think that it could get to the point where we’re experiencing a lot of new financial loss?

Dr. Marsh: Well, that’s certainly a question that the governor will be better able to answer than me. But my own thought is that when we look at countries that have a substantial amount of vaccination, and particularly first doses, then we have done reasonably well, and we’re almost 60% first vaccines in our entire population, a little bit less than 50% total vaccine. So it may well be that the real impact of Delta will be at least lessened, versus a country like India, because we have had a number of vaccines, not as many as we like, but still a number of vaccines. And therefore, I think there’s going to be certainly a part of the population that will continue to do fine, even perhaps during this acute challenge with this newest variant of COVID-19. 

The other thing is there’s been a lot of investment in jobs and infrastructure. I have been driving today through a number of different, going down the one lanes in construction zones. We also know that there’s a number of jobs that are available that have not been filled for a variety of reasons. So I don’t see us going back to a complete lockdown. Certainly, I think the job market is pretty robust right now with opportunities. 

(writer note: according to the U.S. Bureau of Labor and Statistics, the national unemployment rate declined by 0.5% to 5.4% in July, and the number of unemployed persons fell by 782,000 to 8.7 million. “These measures are down considerably from their highs at the end of the February-April 2020 recession,” the bureau reported. “However, they remain well above their levels prior to the coronavirus (COVID-19) pandemic [3.5  percent and 5.7 million, respectively, in February 2020]”.)

But again, that’s the reason why the governor makes the decisions and not me, and I would defer certainly to his judgments. And the folks in the economic part of the state’s leadership, they know better than I do. But just like anything else, we constantly are monitoring for what’s happening. 

Erin: I hear what you’re saying about opportunities available, but I kind of would like to see,  if some people are holding off on returning to work because they don’t feel they’re being adequately compensated or they don’t feel like they received appropriate protections at work, I would like to see changes in the workplace. And I think that having a supportive workplace like that does affect your health.

Dr. Marsh: Sure, what you say I resonate with, and I think most employers are trying their very best to accommodate the financial realities with making sure that they’re creating good, safe and nurturing work environments for their people. But again, I want to be really careful about not venturing out of what I’m really trying to help the governor and the state with, which is to not make comments on things I don’t know much about. I’m learning about COVID all the time. I try to stay balanced and, and reflect what I’m learning, and what I think is important for the governor to know. And then, of course, trying to communicate that to the state through people like you. And most everything affects people’s health, for sure. But I think when it comes to policy, and politics, and what people should do, I’ve tried to be very careful to stay out of all that, because I think that will impact the trust and the credibility that I might have to be able to bring the information that is in my lane.

Erin: People do need to have voices that they can trust right now. Is there anything that you would add that you think people need to hear right now?

Dr. Marsh: I do think that we are experiencing, at least for the immediate time-frame, a step up and risk to our people. And I would encourage people to be very thoughtful, certainly if you feel that you are vulnerable, then avoid those kinds of environments as much as possible, feel empowered to wear a mask if that helps you feel more comfortable.

This is a very dangerous time for America and for West Virginia, related to the health of our people, and we just want to help people stay healthy. And if this follows experiences (with Delta) in other parts of the world, it should come and go more rapidly than other phases of this pandemic have done. But during the next, you know, month to two months, maybe a little bit more, we would really encourage people not to be afraid, not to panic, but to be really thoughtful, and be very smart about your environments you’re exposed to and the people (you are exposed to.)

Erin Beck is our Kids’ Health Correspondent. You can follow her on Facebook and Twitter


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