Omicron is not more severe for children, despite rising hospitalisations

NEW YORK (NYTIMES) - The latest coronavirus surge sweeping the United States, much of it driven by the highly contagious Omicron variant, has produced a worrisome spike in hospitalisations among children, not to mention heightened anxiety among parents nationwide.

Several states have reported increases of about 50 per cent 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 Philadelphia.

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 five.

Younger children do not yet qualify for vaccination, and only those aged 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 per cent increase compared with the beginning of December, according to the American Academy of Paediatrics.

Roughly one 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 issues.)

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.

Some hospitals around the country have reported positivity rates as high as 20 per cent 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 analysing, as a lead investigator with the PolicyLab Covid-19 forecasting model, indicated that in south-west Pennsylvania, where Omicron dominates, the proportion of paediatric admissions requiring intensive care services had dropped by half since early autumn and has continued to decrease in the past month.

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 hospitalisation.

"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.

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.

"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.