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COVID-19 cases are declining, but still high among children. Here's what experts say will end the surge

"I think we have underestimated the impact on children," Dr. Anthony Fauci said.

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After weeks of a troubling COVID-19 surge across the U.S., infection rates are finally on the decline — but experts say there's still work to be done before the tide can be turned, especially when cases remain exceptionally high among children.

"I am worried that we still have some tough days ahead," said Dr. Ashish Jha, the Dean at Brown University School of Public Health. "Even though we're doing reasonably well on vaccines, we've got to do much better because the delta variant is very good at finding people who are unvaccinated and infecting them."

On average, about 89,000 people are reported to have new COVID-19 infections every day, according to data from Johns Hopkins University. That number is about 30,000 less than the average from a week before, and experts are questioning if that decline is an ebb and flow of cases or the beginning of an end to high case counts.

"What's going to determine whether this is the end of this surge or not really is up to us," said Dr. Megan Ranney, the Associate Dean of Strategy and Innovation for the School of Public Health at Brown University.

What's needed is for more people to get vaccinated as well as to wear masks indoors in high-spread areas and get children vaccinated, she said.

Children under 18 make up 22% of the U.S. population but account for 27% of all cases nationwide, according to data published Monday by the American Academy of Pediatrics.

And although those cases are less likely to be severe or result in death, children can end up with long-term symptoms.

"I think we have underestimated the impact on children," Dr. Anthony Fauci said Monday. "Look at the pediatric hospitals throughout the country... they're seeing a lot of children in the hospital with severe infection."

Fauci has said the vast majority of the U.S. will need to be vaccinated to control the spread, but according to data from the Centers for Disease Control and Prevention only 56% of the population is fully vaccinated.

And the Dean of Tropical Medicine at Baylor College of Medicine Dr. Peter Hotez said he is still concerned about the rest of the year. The colder months bring conditions that facilitate the spread of the virus, and the U.S. is still under-vaccinated, he said.

"We're still in for a pretty rough ride for the rest of the year," Hotez said.

Children could have a vaccine by early November, Ranney says

Vaccines, which experts cite as the best protection against the virus, are only available to children as young as 12. But health officials hope that will soon change.

The U.S. Food and Drug Administration said Friday its vaccine advisers will meet Oct. 26 to discuss data from Pfizer's vaccine trial among children 5 to 11.

There are still a few steps on the vaccine's way to authorization. The FDA vaccine advisers would have to first make a recommendation, and the FDA would vote on it.

Then, the CDC would have to sign off before children ages 5 to 11 could start getting vaccinated.

"Most of us in the public health community are expecting that we'll see approvals of vaccines for this younger age groups sometime in early November," Ranney said.

And once a vaccine is made available to younger children, it would be up to parents to decide, which may prove to be an obstacle.

Only around one-third — 34% — of parents of 5- to 11-year-olds say that they will vaccinate their child as soon as a COVID-19 vaccine becomes available for that age group, according to Kaiser Family Foundation Vaccine Monitor results published Thursday

Pre-teens and teens still have the lowest COVID-19 vaccination rates of any age group, according to the CDC. And Hotez told CNN that in the South only about a third of 12 to 17-year-old have been vaccinated.

"We have a lot of education to do around these mRNA vaccines," Hotez said.

A promising new anti-viral

An anti-viral drug promises to reduce impacts of the infection, but experts warn that it is not a replacement for vaccines.

On Friday, the pharmaceutical company Merck said molnupiravir, an investigational antiviral drug made by Merck and Ridgeback Biotherapeutics, can reduce the risk of hospitalization or death from COVID-19 by half.

But full data from the molnupiravir trial had not yet been released or peer-reviewed. And it's not clear if or when the pill might be authorized by the FDA to fight COVID-19.

"This pill is terrific and, as an ER doctor, I cannot wait to have this as another tool in my toolbox to give to patients who are sick with COVID-19," Ranney said. "But better than taking a pill is not getting sick in the first place which means getting vaccinated."