The practice of pediatrics has changed. Children were not supposed to die. Preventable disease and death were just that, preventable. There was no acceptable pediatric body count. At least, not before the first pandemic of the social media age, COVID-19, changed everything.

Of all the myths associated with COVID-19, one of the earliest was that the virus is harmless for children. According to the U.S. Centers for Disease Control and Prevention, 1,536 children aged 0-17 years have died from COVID-19 in just two years. Another 8,210 have suffered from multisystem inflammatory syndrome in children, a serious condition associated with COVID-19. Many thousands more have been hospitalized for acute COVID-19 infection or are experiencing symptoms of long COVID.

These are facts, but pediatricians who mention these numbers on social media are called scaremongers or liars. We are falsely told that children are more likely to be struck by lightning or die from influenza. The fact is that 188 pediatric deaths were reported in our worst-ever U.S. flu season. Five hundred thirty-nine children died from COVID-19 in 2021; just three died from influenza. With no agreement on basic facts, mitigating the risk of COVID-19 in children has been challenging.

Risk mitigation is key to reducing preventable disease and death in childhood. For example, 612 children under age 13 died in automobile accidents in 2019 alone. That number has been reduced by 56% since 1975, thanks in large part to laws requiring use of seat belts and car seats. We don’t prohibit children from riding in cars, we just use common sense measures to reduce the risk.

Masks and vaccines are the metaphorical equivalent of seat belts and car seats. A growing body of evidence documents the effectiveness of masks in preventing COVID-19 transmission in schools. In Arkansas, school districts with universal mask requirements had a 23% lower incidence of COVID-19 among staff and students. A study published in Pediatrics of 1.1 million students and 157,000 staff in 61 school districts across nine states found 72% fewer cases of in-school COVID-19 transmission where there was mandatory masking.

Despite these compelling findings, any mention of masking to reduce risk of COVID-19 in children is harshly rejected on social media, usually by anonymous trolls who deny existing scientific evidence and cite imagined or grossly exaggerated risks associated with masking. Given our desire to be “done” with COVID-19, it’s natural to want to believe that mask-wearing is unnecessary, or even harmful.

The speed with which safe and effective COVID-19 vaccines were developed and produced was unprecedented. More than 220 million people in the U.S. have been fully vaccinated against COVID-19 and more than 102 million have been vaccinated and boosted. Unvaccinated people aged five years or older have 2.8 times the risk of testing positive for COVID-19 and 10 times the risk of dying from COVID-19 compared to people who are vaccinated. Clinical trials and real-world experience in more than 22 million children document the remarkable safety profile of the COVID-19 vaccines authorized for children.

Once again, the playbook for mostly anonymous social media naysayers has been to deny the scientific evidence and to manufacture (often out of thin air) concerns regarding vaccine safety and effectiveness. According to these sources, vaccination doesn’t reduce risk of infection (it does), promotes emergence of variants (it doesn’t), causes infertility (it doesn’t) and has killed more children than COVID-19 itself (false). One hundred thirty-three children have been admitted to Children’s Hospital New Orleans for COVID-19 over the past seven months. Twenty-two required care in our pediatric intensive care unit and five died. Not a single child was hospitalized over that same period with a COVID-19 vaccine-associated complication.

Undeniably, most parents do their best to prioritize their children’s health and safety, but how can an informed parent do that when compelling scientific evidence is discounted by an army of trolls without any real expertise, and true experts are routinely characterized as liars or shills of the pharmaceutical industry?

We may be done with COVID-19, but COVID-19 isn’t done with us. I will continue to put my confidence in the pediatric and public health specialists who have devoted their lives to improving the health and well-being of our children.

Mark W. Kline, M.D., is physician-in-chief, senior vice-president and chief medical officer at Children’s Hospital New Orleans; and professor of pediatrics at the Tulane University School of Medicine and LSU Health Sciences Center in New Orleans.