Omicron pushes Covid-19 pediatric hospital admissions to record levels in the United States and the United Kingdom. Doctors say the variability of the variant – and not an increased severity – is probably most responsible.
Throughout the pandemic, children have been much less likely than adults to suffer serious Covid-19 disease, and doctors say this seems to be true for Omicron as well. But soaring case numbers mean more children end up in hospital both with Covid-19 and because of the disease, underscoring how a likely milder variant can still do more harm simply by infecting more people.
In the UK, 576 children aged 5 and under were hospitalized with Covid-19 in the week to 9 January, well above the previous peak of around 160 in August. Separate data from a study that tracks admissions in detail from around half of UK hospitals show that the increase is driven by under-ones. Access for those ages 6 to 17 is also high. In contrast, Covid-19 hospital admissions among adults are still significantly below the peak of previous waves, largely thanks to vaccination.
These figures seem alarming, but doctors say there are no clear signs so far that Omicron is hitting children worse than previous variants. What is likely to contribute to the pattern is that the unprecedented number of infections across the country means more children are getting it when they get into hospitals, often for respiratory diseases they often get in the winter. In other words, the proportion of children entering Covid-19 hospitals rather than because of the disease is likely to be significantly higher than in adults.
The incidence of Covid-19 hospitalizations among children aged 5 and under, at about 15 per. 100,000 in the week to January 9, is still lower than in adults, where rates vary from 17 per. 100,000 among the 18-64-year-olds to 179 per. 100,000 in those 85 and older.
But the numbers do not say much about how much Covid-19 is responsible for sending children to the hospital. They include those who, primarily for another reason – such as a broken leg – who have tested positive for the virus before or after they were admitted. They also include those in the hospital for other infections or diseases in which Covid-19 may have played a role.
Covid-19 vaccines are not routinely offered to children under 12 in the UK, but it is not known, doctors say, whether this plays a significant role.
“It would be quite surprising if we did not see a large number of hospitalizations with the infection,” due to the high level of cases in the community, said Adam Finn, professor of pediatrics at the University of Bristol. “The difficult thing is to try to find out how much the infection actually contributes to the reason the child is in the hospital,” he added. “It is not cut and dried.”
Doctors say more children are being treated primarily for Covid-19, but no more than one might expect given the large number of infections Omicron causes. Separate data show that the total number of cases aged 4 and under in the UK has quadrupled since early November.
And Omicron does not appear to be leading to an increase in the most severe cases among children. Data from the UK Health Safety Agency show that admissions to intensive care units for people aged 4 and under did not increase significantly during December, despite a quadrupling of hospital admissions among this group.
“These are not particularly sick infants,” said Calum Semple, professor of pediatric health and outbreak medicine at the University of Liverpool, one of the researchers at the hospitalization study. They are hospitalized for shorter periods in this wave and require less oxygen than in previous increases of the virus, he said. The proportion in the intensive care unit has fallen over time, and the numbers for mechanical ventilation are incredibly low and continue to fall, he added.
Edward Dallas, a consultant pediatrician in the emergency room at a London hospital, said he was likely to see more children with Covid-19 in this wave than at any point in the pandemic, but did not think it was because Omicron was affecting children more seriously, just affects more children.
He added that the most common symptoms of Omicron infection in children appeared to be runny nose and cough, but that it typically did not lead to lung infection.
“It’s just a game of numbers,” said Chethan Sathya, a pediatric surgeon at Northwell Health’s Cohen Children’s Medical Center in New York, where cases are also rising. “If you look at the positivity rates, they are through the roof.”
Another complicating factor is that it is common in the winter for young children to go to hospitals for respiratory diseases and test positive for several different viruses, making it impossible to determine what is the cause.
“Over time, we see more Covid co-infection,” said Ronny Cheung, a consulting pediatrician at a London hospital. “Anyone trying to say [the illness] is due to Covid or another respiratory infection making it up as they go. “
Hospital admissions among infants are particularly prone to move in locking stages with the background infection rate because the threshold for hospitalization is low in very young children. For example, children six months and under who came to the hospital with a fever are typically admitted for routine testing and monitoring as a precautionary measure. The hospitalization survey showed that babies accounted for a greater proportion of hospitalizations among children, about 42%, in the last four weeks, up from about 30% during the Delta wave.
“We know Covid gives you a fever, and if you have a fever and an infant, you must go through a study cycle,” said Damian Roland, an honorary professor of pediatric emergency medicine at the University of Leicester. “That does not necessarily mean that Covid is worse or particularly harmful.”
“Like any other virus, when you have more of it around you, you will see more children come in and more will tip the threshold for needing hospitalization,” said Jane Bayreuther, president of the British Association of Pediatric Emergency Medicine. There has been no increase in overall difficulty, she added.
Still, it is too early to say the full extent of the effect of the new variant in children, according to Chinedu Nwokoro, a consulting respiratory and general pediatrician at a hospital in London.
An “omicron-sized blip” in any condition associated with infection with Covid-19 in children, including long-term Covid-19 and multisystem inflammatory syndrome or MIS-C – a rare inflammatory condition that affects some children about six weeks after infection with the virus – is “in itself will be a problem,” said Dr. Nwokoro.
“Given [MIS-C cases] tends to show up several weeks after the first infection, we are preparing for a major increase in the coming weeks, ”said Dr. Cheung. “The question is: Will Omicron do something different?”
Analysis of the health records of more than 14,000 children under the age of 5 in the United States, comparing those infected with Omicron with those with Delta, found that the newer variant was significantly less likely to lead to severe outcomes. The study, by researchers at the Center for Artificial Intelligence in Drug Discovery in Cleveland, has not been peer reviewed.
At Advocate Children’s Hospital, which has run out of two locations near Chicago, Covid-19-related hospital admissions more than tripled during the 30 days to Jan. 6, according to Chief Medical Officer Frank Belmonte. About a quarter of patients on average end up in pediatric intensive care units every day, he added, up from about 10% on average in previous waves.
Some of the children in Advocate’s intensive care unit did not have previous risk factors for Covid-19, according to Nekaiya Jacobs, a pediatric critical care physician at the hospital. “There remains this misconception that Covid is always mild in children or teens, or that children just do not get sick,” she said.
Write to Denise Roland at Denise.Roland@wsj.com and Joanna Sugden at firstname.lastname@example.org
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