Students arrive at the Haggerty School in Strawberry Hill on Sept. 9. (Photo: Marc Levy)

Cambridge children 5 to 11 are getting infected with Covid-19 at the highest rate of any age group in the city and those numbers have shot up in the last month, figures disclosed by the city health department on Monday show. It was the first time the Cambridge Public Health Department has revealed the case rates – numbers of infections per 1,000 population – by age and the first time the department has broken down the under-20 age group into smaller segments.

At the end of November, case rates for kids in the three youngest age groups were far higher than the rates for older residents. Children from 5 to 11 had the top rate; kids from 12 to 15 were second; and those under 5 were third, interim chief public health officer Sue Breen told city councillors at their regular meeting. The rate for each of the three youngest age groups greatly exceeded those for older residents. Breen called the numbers “more disturbing” than figures showing the surge in cases overall.

“This is one of the reasons why we are continuing to prioritize pediatric vaccination clinics,” Breen said. Adding to the concern, Breen said statewide hospitalization figures as of Wednesday showed that “a small number of young adults and children are becoming severely ill from Covid,” though most people hospitalized with the virus are still over 60.

While Breen spoke of vaccinations for children, City Manager Louis A. DePasquale told councillors he has decided not to require that city employees be immunized despite demands from the council for a mandate. “I think government has to be careful on what role they play in terms of people’s private lives,” he said. “And at this point in time, I am not mandating city employees be vaccinated, because what’s going to happen is termination. And then when that happens it’s going to be why are we terminating? So there is no easy solution here. I don’t feel at this point I’m ready to terminate employees over this.”

His statement, the most emphatic in the four months since the council voted to request a mandate, brought a not-so-veiled warning from councillor Marc McGovern. “I really do not want us to be in a position where someone we’re serving, whether it’s a young person or an older person in particular, ends up with a bad result because people working with them from the city are not vaccinated,” McGovern said. “I think that would be a pretty horrible thing.”

As for children, kids under 5 cannot yet be vaccinated; those from 5 to 11 became eligible for the Pfizer vaccine only on Nov. 2. The city scheduled its first vaccination clinic focusing on the newly eligible kids Nov. 10, though others could get a shot. Workers also administered flu shots. On Wednesday, a second clinic restricted appointments to second shots for residents, mostly kids, who got their first shot at the Nov. 10 session.

On Dec. 15 the health department will hold another clinic at Cambridge Rindge and Latin School, restricted to children and adults needing a first shot of vaccine. The clinic will also offer the pediatric flu vaccine, FluMist. No boosters will be available. The city is planning more clinics for first responders, homeless people and residents who can’t leave their homes; on Tuesday it added three vaccine booster clinics.

Covid among the young

Weekly vaccination figures show the number of kids from 5 to 11 with at least one shot surged after they became eligible but is now leveling off. As of Thursday, 58 percent had received at least one shot. As for the 12-to-15 age group, 90 percent were fully vaccinated as of Thursday; the percentage hardly changed in the previous three weeks.

Breen didn’t say why one of the most highly vaccinated age groups in the city, the 12- to 15-year-olds, also has the second-highest rate of Covid-19 infections, and councillors didn’t question her on it. These children, as well as those from 5 to 11, are attending school in person, and cases there have been rising rapidly.

In all of November there were 59 new cases in schools, including 46 students, according to the school department’s Covid-19 data dashboard. In just the first six days of December, there were 25 new cases with 17 student cases.

Breen said the health department has seen “some school-based clusters”; data from the schools dashboard said eight cases have likely been caused by in-school transmission since schools opened in September. No schools or classrooms have been closed.

Neither the state nor the city has reported the age groups of people who test positive for the virus after being fully vaccinated. And statistically, the Covid-19 case rate for kids from 12 to 15, as well as the vaccination rate, could be affected by the fact that the population in that age group is the smallest of any in Cambridge.

Daunting picture

Overall, Breen presented a daunting picture of Covid challenges facing the city as she gave her final report to the council sine coming out of retirement to fill in when the former health department head, Claude Jacob, left in July to head the regional health department in San Antonio. Another Texas public health official, Derrick Neal, who headed several county and city health departments in that state, will take over as chief public health officer of Cambridge this week, DePasquale said. Neal had accepted an offer to head the Sonoma County, California, health department in late October but reportedly withdrew because of concern over treatment of department heads who are people of color.

Breen said the number of new Covid-19 cases among Cambridge residents has risen sharply to a rate of 36.6 cases per 100,000 population on Monday, higher than the peak of the recent delta variant and “on par” with last winter’s surge. (The case count continued upward Tuesday with 63 new cases). She mentioned the new omicron variant – and even presented a slide showing how to pronounce the word – but echoed scientists’ caution that little definitive information is known about its transmissibility, severity and resistance to vaccines and natural immunity.

The state reported the first known Massachusetts case of the variant on Sunday: a Middlesex County woman in her 20s who had traveled outside the state. Spokespersons for the Cambridge Public Health Department didn’t respond when asked whether the woman lives in Cambridge.

Contract tracing changes

While cases rise, the state Department of Public Health is scaling back investigation and contact tracing of new cases. It decided to end a program in which an outside contractor helped local health boards and departments reach out to newly infected people and trace their contacts and is now telling communities they can stop calling new cases if they don’t reach them on the first try – and just leave a message. Local workers can also ask new cases to notify their contacts themselves. Investigators can ignore cases diagnosed more than five days previously and stop working on clusters where cases aren’t rising.The state also wants local departments to prioritize certain settings for investigation such as schools, while the state will step in to focus on others such as nursing homes.

State health department spokespeople didn’t respond when asked how these changes would affect the state’s response to the Omicron variant.

Cambridge Public Health Department spokesperson Dawn Baxter said the city is still working with three other communities that have received a state grant to regionalize contact tracing “to be responsive to the new guidelines and to finalize protocols.” She said the city is watching the omicron variant “and will consider protocol adjustments if warranted as more information becomes available.” Four new epidemiologists have been hired with the state grant and will start work “any day now,” Breen said.

As cases rise, it would be difficult if not impossible to contact, trace and monitor everyone. Cambridge reported 305 new cases in the week ending Saturday, Breen said. As of Monday there were 581 residents who are infected. Some experts have said that the value of contact tracing diminishes when cases pile up.

Vaccination rate adds flexibility

Anna Kaplan, chief epidemiologist for the Cambridge department, during a Monday call with city councillors.

Anna Kaplan, chief epidemiologist for the Cambridge department and the lead official for contact tracing, said it’s “one of the key building blocks of mitigation” and that it’s “proven to be effective.” Still, with Cambridge’s “high vaccination rates” (71 percent fully vaccinated as of Thursday), health workers can “be a little more flexible”; not everyone needs to quarantine if they’re exposed to the virus, Kaplan said.

Kaplan indicated that the city may already be following some new state protocols. For example, she said having newly infected people notify their contacts themselves is “well established in communicable disease investigation guidelines.” She said that for Covid-19, the health department will “reach out to everyone via text or phone call” but didn’t say workers will keep trying until they talk to the person. Meanwhile, Kaplan said, “we are always available for questions if people are unsure on safe isolation and quarantine practices, but we are encouraging people to also be part of the process and help us notify their contacts.”

Kaplan said she feels “comfortable with that from an epidemiological perspective” given the city’s vaccination rates.

Speaking of when Cambridge might relax its indoor mask mandate and other Covid-19 precautions, Breen indicated it won’t be now. “We have a high transmission. Yes, we are vaccinating more children 5 to 11. We’re still not vaccinating children under 5. They do get Covid,” she said.

Continuing to tick off the indicators, Breen said: “Yes, we have available vaccine, but it’s getting tight for boosters. And yes, we are in the middle of a current holiday surge … And of course there is probably no more to say than the new variant of concern [is] omicron.”