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Staff photo by C.B. Schmelter / Occupational therapist Cori Cohen prepares to enter a patient's room inside the COVID intensive care unit at Erlanger on Monday, Feb. 22, 2021 in Chattanooga, Tenn.

Note: This story was updated at 2 p.m. on July 30 to correct the vaccination rate for Hamilton County.

Children are far less likely than adults to face serious COVID-19 infections, but it can still happen and the spread of the highly infectious delta variant has some worried while researchers work to determine whether the youngest members of society face an increased risk from the latest strain.

Since the pandemic began, 179 children in Tennessee ages 10 and under have been hospitalized and 357 people ages 11 to 20 have been hospitalized. Together, residents ages 20 and under have accounted for 2.3% of the state's more than 22,880 total hospitalizations. Since July 1, nine people ages 20 and under have been hospitalized.

Headlines about a record number of children hospitalized with COVID-19 in Arkansas or the death of a 5-year-old in Whitfield County from the virus have parents worried as the delta variant of the virus causes an uptick in local cases and children are two weeks away from returning to in-person learning in Hamilton County.

(READ MORE: Hamilton County Schools officials stand their ground on optional masks as COVID-19 situation worsens)

At the same time, arguments are again running hot over possible mask requirements in schools. As of Wednesday, Hamilton County Schools said the system would encourage but not require masks in schools, despite indoor mask recommendations from the Hamilton County Health Department and the U.S. Centers for Disease Control and Prevention.

While local data does not reflect the situation affecting children in Arkansas, that state's uptick in cases is several weeks ahead of Tennessee's, and spikes in hospitalizations and deaths in a region come weeks after an increase in cases.

On Thursday, the Hamilton County Health Department reported 188 new infections, the highest single-day total since Jan. 26. The county is averaging 111 new cases a day in the past week and, as of Thursday, 78 people were hospitalized with the virus. The hospitalization total is the highest it has been since Feb. 11.

The youngest residents of Hamilton County, those age 10 and under, account for 8% of the new cases since July 1, when the upward trend began. Comparatively, residents ages 11 to 20 accounted for 14% of the new cases and those ages 21 to 30 accounted for 25%, according to data from the Tennessee Department of Health.

Data from the American Academy of Pediatrics and the Children's Hospital Association shows an increase in childhood infections in nearly every state between July 1 and July 15, with some of the largest increases in the South and Southwest. National health officials have said the vast majority of new infections in the country are from the delta variant.

Bev Fulbright, epidemiology manager for the Hamilton County Health Department, said the department is monitoring four clusters of 10 or more active cases, meaning the cases are linked to the same location. Two of those four clusters are connected to a youth setting, Fulbright said, and the department is also monitoring 15 clusters of less than 10 active cases, of which five are connected to youth settings.

"Due to high levels of exposure in these settings, it is very likely more cases will be identified from these youth settings. The Health Department has recently seen a significant increase in household spread from these youth settings," Fulbright said in a statement.

Researchers cannot say definitively whether the delta variant is more dangerous to children than the original strain of COVID-19, said Jeremy Kamil, associate professor of microbiology and immunology at Louisiana State University in Shreveport. Stories of children on ventilators, or even of children dying, grab attention because they strike deep societal fears, he said.

"We already know that there are a small number of children that get sick from COVID, and I think it's safe to assume that this variant will be more dangerous to children than the original variant just because we know it's more dangerous to adults and it's more transmissible," Kamil said.

The delta variant is more contagious and spreads faster than the original strain of the virus. Someone with the delta variant has a viral load, or the amount of virus detectable that could be spread by coughing or sneezing, around a thousand times greater than the original variant. Research has also shown that people exposed to the delta variant become contagious in around four days on average compared to the typical six days.

Any increase in cases among children and young adults could be aided by the difference in social factors compared to the summer of 2020. Communities have largely stopped following public health measures to slow the spread of any version of the virus, including wearing masks, avoiding large groups and physical distancing. For example, Hamilton County dropped its mask mandate on April 28 and in recent weeks restrictions on gatherings have been lifted.

Without mitigation measures in place, the virus can spread more rapidly and the more a virus is spreading in a community, the more likely it is to spread to all demographic groups, including children, Kamil said.

As the number of people sick with the virus increases, more people will face serious infections and possible death from the disease.

When the original strain of the virus was circulating in Hamilton County, schools went virtual. Summer camps and other youth opportunities closed. For months, children were not as active in the county as adults, and especially not as active as essential workers, so young people were less likely to catch the virus. When they began moving around more, and in larger groups — as school, sports and other activities returned in the fall of 2020 — there was an uptick in cases among children.

Young people may also be getting sick at higher rates than older adults because they are less likely to be vaccinated.

Data from the Hamilton County Health Department shows as of Thursday 26.4% of county residents ages 12 to 15 and 36.8% of residents ages 16 to 20 were at least partially vaccinated. More than 75% of county residents age 61 or older are at least partially vaccinated as of Thursday, according to data from the department. Children under age 12 are not yet eligible for a COVID-19 vaccine.

Countywide, 43% of residents are fully vaccinated, according to data from the Hamilton County Health Department. That compares to 49% for the U.S. as a whole and 39% for Tennessee.

Kamil said stories of breakthrough cases, in which a fully vaccinated person gets infected with COVID-19, may give people the false impression that the vaccines are not effective against the virus or the delta variant. This is not true, he said. The available vaccines are extremely effective in preventing serious disease or death, Kamil said.

"The only reassuring thing we're seeing is that the vaccines really, really do protect against hospitalization and death," he said. "The amount of vaccinated people who are ending up in the hospital is super tiny. It's really the unvaccinated who are clogging up the ICUs. That's sad. It's sort of a pandemic of misinformation that's making people avoid the vaccine or avoid getting it."

Contact Wyatt Massey at wmassey@timesfreepress.com or 423-757-6249. Follow him on Twitter @news4mass.

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