NEW YORK (CBSNewYork) — It has been a fast developing few days as we try to understand the COVID-19 pandemic.

Vaccine recommendations are changing with boosters being recommended, while others who are fully vaccinated are seeing breakthrough infections.

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And as CBS2’s Dr. Max Gomez reported Monday, children who are not yet eligible for vaccines are spiking COVID hospitalizations.

It is a sometimes confusing and controversial situation. Children are required to return to in-person learning in most school districts, yet in some districts requiring that staff and children wear masks is either optional or even prohibited.

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That has left vaccines as the only strong protections against COVID infection, yet vaccines are not yet approved for children under age 12.

That could be at least partially responsible for the rate of pediatric hospitalizations in the U.S. There was the first wave in the summer of 2020, followed by a dip in the fall and then the so-called second wave in winter of 2020 and early 2021. That dropped off significantly in early and mid summer, but as businesses opened up and kids started going back to school, often without masks, pediatric hospitalization rates have spiked to the highest rates yet.

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A bright spot in vaccinations is the Food and Drug Administration approval of a third Moderna or Pfizer booster shot for people whose immune systems may not have responded well to their first two doses. Those include people who are immunocompromised, either by cancer treatments or are organ transplant recipients. While these boosters are available now, it’s not clear what, if any, verification of your immune status vaccine sites will require.

Dr. Max Gomez