Recently, 68 leaders of children's hospitals across the U.S. signed their names to a full-page public letter in the New York Times urging the nation's leaders and general public to help protect children from effects of the pandemic.

Dr. Randall Flick, of Mayo Clinic Children's Center, was among them. He joined his professional colleagues in a call for all eligible populations to be vaccinated; for everyone to "mask responsibly," particularly during school and while attending large gatherings; and for everyone to adhere to proven safe practices of social distancing and hand-washing.

"Together, we can keep our children safer," the ad reads in part. "They need our support, our care and our commitment to their future. They need it now."

Dr. Flick recently answered questions in two short interviews about his participation in the letter and his views on this present moment in the pandemic. This interview was edited for brevity and clarity.

For children, how does this current threat posed by the Delta variant compare with the last wave?

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The current Delta variant is more infectious than the previous variant. And it would appear that we see more cases in children with Delta than previously. They still are of much less severity, on average, than (in) adults. The hospitalization rate is really quite low and and mortality in children is very rare, and remains rare.

With the return to school, what sort of rise, or do you anticipate a rise, in cases among children?

Well, the answer to that is clearly yes, we're seeing that increase -- locally, regionally and nationally. So there isn't any doubt that the number of cases is going up. The question is what will the consequences of that be over time? And that, I think, remains to be seen. But again, I would emphasize that the hospitalization rate remains low and the mortality rate remains low in children.

Even a small percentage of a large number can produce a large number, and there have been 500 pediatric deaths from COVID-19. I don't know that there is another disease in the United States that killed that number of children in the last year.

Let's just recognize that the death of any child, for any reason, is a tragedy. And this is no less a tragedy when when we see childhood deaths from COVID. We are like our colleagues around the state and around the country, doing everything we can to take the best care possible of every child who we may see in our hospital or in our outpatient setting with COVID.

Are you optimistic that there might be a change in public policy along the lines of what's being called for in the public letter?

Which public policy are you referring to?

Well, it calls on leaders in the public and private sectors to help protect children. All eligible populations should be vaccinated. Everyone should mask responsibly. A lot of these things are still very much the subject of public debate -- individually and at a higher level publicly. Even just today (Sept. 7), the Olmsted County Health Board met, and there was some debate over mask requirements and those sorts of things.

Well, I don't think it's for me to get engaged in political debate. We signed on to that letter because we believe strongly in those fundamental principles -- that all eligible populations should be vaccinated, that everyone should mask responsibly. Who defines "responsibly" is not is not for me or for us to say. Those are political decisions. Those decisions are based in science, and I think we can be helpful with the science.

Do you support a vaccine mandate for people who work with children every day -- teachers, daycare workers, even police officers who are in the schools?

Again, those are political kind of questions that really are not for me to decide, nor for us to decide. We provide scientific information. We interpret science and when asked for advice, we can provide that advice. But whether there should be a mandate or not, I think that's a political decision that belongs elsewhere.

You indicated in response to one of my earlier questions that you anticipate there to be a rise in cases among children. Now that school is back in session, what can you tell me about preparations that Mayo Clinic is undertaking to be ready for whatever may happen?

We have a very robust process here, not just for children, but possibly across the organization for planning for eventuality. That is an ongoing process, regardless of COVID. We have to be prepared to surge our hospital bed capacity for a variety of reasons. That planning process is an ongoing process, and we certainly account for COVID and, to be honest with you, as I'm sure you've read, that non-COVID respiratory problems are as likely to be the problem in children as is COVID.

You are a parent and grandparent. Speaking from that role with the people in your life, and then as a medical expert as well, what are the steps that you might advise to parents to best protect their children?

The advice that I would give my son and daughter-in-law about my grandson would really be no different than the advice I would give anyone else -- that children are best in schools. We know that young children can't be vaccinated, and in order to protect them to the extent that we possibly can, they should be masked. We know that masks work. We know that masks work in children, we know that masks work in the school setting. The science is there, so we want to make sure that we protect children.

You and I talked yesterday about the growing rate of COVID affecting children. I would encourage you to go to the American Academy of Pediatrics site. I think they probably show the rise in COVID cases in children, which is roughly -- I looked at it yesterday -- I think it's roughly what it was in mid-summer last year. And that's an underestimate, because there are several large states like Texas that don't reliably report. So, you know, COVID is really taking off in children, as I said yesterday, and I'll re emphasize that the vast majority of kids do fine. But there is that very small percentage of children who will end up in the hospital or the intensive care unit, or worse. And so we want to do whatever we can to avoid that while we're waiting for the vaccine to be approved down to age 2, which I think we'll see late this year, maybe in November.


I mean, that's just conjecture on my part. But I think we're hopeful that we'll see it this year, and maybe sooner than December, but I don't know for sure.

Yesterday, you told me that besides COVID-19, there are some other respiratory viruses presenting problems to children as they return to school.

Absolutely. I participate in a listserv of all the of children's hospital leaders around the country, and COVID certainly is a problem, but an additional concern and potentially a greater concern are other respiratory viruses, like respiratory syncytial virus, usually called RSV. Influenza, for sure -- this could be a severe influenza season. It's difficult to predict, obviously. And then there are a variety of other viruses that act like RSV in young children.

RSV is a virus that is common among adults and children during the winter months, but in children and especially infants, it can cause severe pneumonia, a particular type of pneumonia called bronchiolitis. This is one of the most common reasons for admission of infants to children's hospitals around the country every winter. Since we have been isolated and masked, and kids have not been in school for the last year or so, we don't have a lot of immunity in the community to RSV. RSV immunity lasts for a season, typically. If you get it this year, you can get it again next year.

We don't know what's going to happen, but we do know that RSV admissions to children's hospitals are way up, and this is not the time of year where we typically see that. We have children in the hospital here with RSV. I know in in the Twin Cities, they have children in the hospital with RSV, and around the country. We're seeing a surge in children being admitted to the hospital with RSV. So COVID is a big problem. It will undoubtedly get worse before it gets better. But it's not the only problem, especially for children's hospitals.

Do you feel people are, generally speaking, getting good information to help protect themselves and their children?

I can't know, obviously, what particular kind of information any individual may or may not be getting. I do know that there is very good quality information available from the places where we would expect good information: Mayo Clinic, the CDC, the Department of Health, the American Academy of Pediatrics, the Children's Hospital Association. All of these places are sources of high-quality information for patients and families. And the advice, there's really no disconnect between any of those sources of information. I think, as you know, they're all recommending the same things that were contained in that letter: Get vaccinated if you're eligible to get vaccinated, wear a mask when it's appropriate to wear a mask, and wash your hands. Socially distance. All those things are kind of mundane and boring, but they are the key to the end of this very challenging situation that we find ourselves in that's increasingly affecting children. That's something that we didn't see last year, but this year we're seeing with the Delta variant. I hope that people begin to think very seriously about taking the advice that they're getting from those really high-quality sources.