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Thursday, December 30, 2021
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Health|Omicron Is Not More Severe for Children, Despite Rising Hospitalizations

https://www.nytimes.com/2021/12/28/health/omicron-kids-hospitalizations.html
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OMICRON IS NOT MORE SEVERE FOR CHILDREN, DESPITE RISING HOSPITALIZATIONS

More children are being treated for Covid, but a combination of factors,
including low vaccination rates, most likely explains the increase.

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A child received a Covid test at a booth in Brooklyn this month. New York City
reported a fourfold increase in pediatric hospitalizations over the past two
weeks.Credit...Anna Watts for The New York Times

By Andrew Jacobs

Dec. 28, 2021

The latest coronavirus surge sweeping the United States, much of it driven by
the highly contagious Omicron variant, has produced a worrisome rise in
hospitalizations among children, not to mention heightened anxiety among parents
nationwide.

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

But even as experts expressed concern about a marked jump in hospitalizations —
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.



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“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 Philadelphia.

Instead, much of the rise in pediatric admissions results from the sheer number
of children who are becoming infected with both Delta and the more contagious
Omicron variant, he and other experts said, as well as low vaccination rates
among children over age 5.

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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 hospitalization.

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 percent increase compared with the beginning of
December, according to the American Academy of Pediatrics.

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



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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 hospitalized 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 issues.)

Those numbers are well below the peaks reached last September, although experts
also fear a wave of pediatric hospitalizations in the coming weeks, fueled 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.

In interviews, hospital leaders and critical care doctors said that nearly all
the children hospitalized with Covid had one thing in common: They were
unvaccinated or undervaccinated.



“What we’re seeing in our I.C.U. 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, the chief of pediatric critical care
at Cohen’s Children’s Medical Center in New York, which serves nearly two dozen
hospitals in the Northwell Health system.

In recent days, Dr. Schneider said, five to eight children with Covid 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 Centers for Disease Control and Prevention on Tuesday
significantly lowered its estimates for Omicron’s prevalence, to 59 percent from
73 percent of all Covid cases in the week ending Dec. 18.



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

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

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



Dr. Rubin said the real-time data he had been analyzing, as a lead investigator
with the PolicyLab Covid-19 forecasting model, indicated that in southwest
Pennsylvania, where Omicron dominates, the proportion of pediatric admissions
requiring intensive care services had dropped by half since early fall, and has
continued to fall in the last month.

And the rate of pediatric Covid admissions in much of the country was still
below the peak of what is typically seen with the seasonal flu, he added.

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 hospitalization.

“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,” Dr. Rubin said.



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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 under age 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.

“There are just so many caveats,” said Dr. Rick Malley, a pediatrician 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,” Dr. 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 a quarter of all children admitted in recent days have been
testing positive, up from 5 percent during the height of the Delta surge last
summer. Omicron accounts for more than 90 percent of those infections, according
to Dr. James Versalovic, the hospital’s chief pathologist.

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 hospitalized for Covid — about 50 in recent
days, down from a peak of 65 a few months ago.

Although weary from having weathered three previous waves, Dr. 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.







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