Omicron is not more severe for children, despite rising hospitalisations

Several states have reported increases of
about 50% in paediatric admissions for COVID-19 in December. New York City has
experienced the most dramatic rise, with 68 children hospitalised last week, a
fourfold jump from two weeks earlier.

But even as experts expressed concern about
a marked jump in hospitalisations — an increase more than double that among
adults — doctors and researchers said they were not seeing evidence that
omicron was more threatening to children.

In fact, preliminary data suggests that
compared with the delta variant, omicron appears to be causing milder illness
in children, similar to early findings for adults.

“I think the important story to tell here
is that severity is way down and the risk for significant severe disease seems
to be lower,” said Dr David Rubin, a researcher at Children’s Hospital of

Instead, much of the rise in paediatric
admissions results from the sheer number of children who are becoming infected
with delta and the more contagious omicron variant, he and other experts said,
as well as low vaccination rates among children older than 5.

Younger children do not yet qualify for
vaccination, and only those age 16 and older qualify for booster shots, which
offer the most effective shield against infection and hospitalisation.

The upshot is that children overall are
somewhat less protected from the virus than adults. In the week ending Dec 23,
about 199,000 childhood cases were reported nationally, a 50% increase compared
with the beginning of December, according to the American Academy of

Roughly 1 in 10 American children has
tested positive for the virus since the beginning of the pandemic, according to
the academy.

Infected children remain far less likely to
become ill compared with adults. But across the country last week, an average
of 1,200 children each day have been hospitalised with the coronavirus, up from
800 at the end of November, according to the Department of Health and Human
Services. (Some of those children arrived at the hospital with other medical

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Those numbers are well below the peaks
reached in September, although experts also fear a wave of paediatric
hospitalisations in the coming weeks, fuelled by omicron’s spread, holiday
gatherings and a return to classrooms after Jan 1.

“We’re just holding our breath and bracing
for a tsunami of impact,” said Dr Patricia Manning, chief of staff at
Cincinnati Children’s Hospital.

Hospital leaders and critical care doctors
said that nearly all the children hospitalised with COVID-19 had one thing in
common: They were unvaccinated or undervaccinated.

“What we’re seeing in our ICU makes it
crystal clear that vaccination is the single most important thing you can do to
protect your kid from getting sick with this virus,” said Dr James Schneider,
chief of paediatric critical care at Cohen’s Children’s Medical Centre in New
York, which serves nearly two dozen hospitals in the Northwell Health system.

In recent days, Schneider said, five to
eight children with COVID-19 were in the intensive care unit, compared with
none or one in November.

It remains unclear to what degree the
omicron variant is responsible for rising hospitalizations. The Centres for
Disease Control and Prevention on Tuesday significantly lowered its estimates
for omicron’s prevalence, to 59% from 73% of all COVID-19 cases in the week
ending Dec 18.

More recent data suggests that omicron is
far more prevalent in some states, especially in the Northeast. In Connecticut,
for example, the variant is responsible for more than 80% of new cases. That
figure is 90% in New York.

Also complicating the picture: Alarming
hospitalisation figures can be misleading because they sometimes include all
children who have tested positive for the coronavirus upon admission.

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Some hospitals around the country have
reported positivity rates as high as 20% among children. But the vast majority
were asymptomatic and arrived at the hospital with other health problems,
officials say.

Rubin said the real-time data he had been
analysing, as a lead investigator with the PolicyLab COVID-19 forecasting
model, indicated that in southwest Pennsylvania, where omicron dominates, the
proportion of paediatric admissions requiring intensive care services had
dropped by half since early fall and has continued to decrease in the past

And the rate of paediatric COVID-19
admissions in much of the country was still below the peak of what is typically
seen with the seasonal flu, he said.

Some of the recent increase, he said, was
most likely tied to delays in seeking medical care for children as infections
soared again, combined with the spread of wintertime viruses that can
complicate the health of medically fragile children and lead to

“While we are definitely seeing more
transmission among children, both vaccinated and unvaccinated, I think we have
to be very careful to avoid sending the message that omicron poses an unusual
risk to kids,” Rubin said.

Even if children are at low risk for
becoming seriously ill, medical experts caution that the coronavirus can on
rare occasions lead to grave outcomes: 790 Americans younger than 18 have died
since the pandemic began.

And despite guarded optimism that the
omicron variant will be even less dangerous to children than its predecessors,
experts acknowledge that it is still too early to know for sure.

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“There are just so many caveats,” said Dr
Rick Malley, a paediatrician at Boston Children’s Hospital, which has not yet
seen an appreciable rise in admissions for COVID-19.

He said he was awaiting more telling data
on the length of hospitalizations and on whether young patients are needing
oxygen or intubation. “It’s premature to predict what’s going to happen with
omicron, because this virus has repeatedly surprised us,” Malley said.

But one thing is beyond dispute: omicron’s
uncanny ability to spread among human hosts, even those who have been fully
vaccinated. At Texas Children’s Hospital in Houston, nearly one-quarter of all
children admitted in recent days have been testing positive, up from 5% during
the height of the delta surge this past summer. Omicron accounts for more than
90% of those infections, according to Dr James Versalovic, the hospital’s chief

But so far, he said, the crush of
infections has not led to a big jump in the number of children who need to be
hospitalised for COVID-19 — about 50 in recent days, down from a peak of 65 a
few months ago.

Although weary from having weathered three
previous waves, Versalovic was somewhat hopeful that advancements in the
treatment of seriously ill patients and an uptick in vaccinations would protect
most children from dire outcomes.

“Sure I’m worried, but I’m also optimistic
that we’re going to be able to blunt the impact of omicron,” he said.

© 2023 The New York Times Company

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