Omicron is pushing Covid-19 hospital admissions in children to record highs in the US and UK. Doctors say the variant’s infectiousness – not increased severity – is likely primarily responsible.
Throughout the pandemic, children have been much less likely than adults to suffer serious illness from Covid-19, and doctors say that seems to be true for Omicron as well. But soaring case numbers mean more children are ending up in hospital with both Covid-19 and the disease, highlighting how a likely milder variant can still do more damage, simply by infecting more of people.
In England, 576 children aged 5 and under were admitted to hospitals with Covid-19 in the week to January 9, well above the previous peak of around 160 in August. Separate data, from a study that tracks admissions in detail to around half of UK hospitals, shows the increase is due to less than one. Admissions for ages 6-17 are also high. In contrast, Covid-19 hospitalizations among adults are still significantly lower than the peaks of previous waves, largely thanks to vaccination.
These numbers sound alarming, but doctors say there are no clear signs, so far, that Omicron is afflicting children any worse than previous variants. What is likely contributing to this trend is that the unprecedented number of infections across the country means that more children are getting them when they enter hospitals, often for respiratory illnesses they commonly contract. in winter. In other words, the proportion of children hospitalized with Covid-19 rather than because of the disease is probably significantly higher than among adults.
The Covid-19 hospital admission rate for children aged 5 and under, at around 15 per 100,000 for the week to January 9, is still lower than for adults, where rates range from 17 per 100,000 among those aged 18 to 64, to 179 per 100,000 among those aged 85 and over.
But the numbers say little about how much Covid-19 is responsible for sending children to hospital. They encompass those who are there primarily for another reason – such as a broken leg – who tested positive for the virus before or after admission. They also include those who are hospitalized for other infections or illnesses where Covid-19 could have played a role.
Covid-19 vaccines are not routinely offered to children under 12 in the UK, but it is unclear, doctors say, if this plays a significant role.
“It would be rather surprising if we didn’t see a large number of hospital admissions 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 tricky part is trying to figure out how much the infection actually contributes to why the child is in hospital,” he added. “It’s not cut and dried.”
Doctors say more children are being treated primarily for Covid-19, but no more than might be expected given the large number of infections caused by Omicron. Separate data shows the total number of cases in people aged 4 and under in England has quadrupled since early November.
And Omicron does not seem to cause an increase in the most severe cases in children. Data from the UK Health Security Agency shows that intensive care unit admissions for people aged 4 and under did not increase significantly in December, despite a fourfold increase in hospital admissions in this group.
“These are not particularly sick infants,” said Calum Semple, professor of child health and outbreak medicine at the University of Liverpool, one of the researchers on the hospital admissions study. They are admitted for shorter periods in this surge and require less oxygen than in previous virus surges, he said. The proportion taken to intensive care has slowed over time and figures on mechanical ventilation are staggeringly low and continuing to fall, he added.
Edward Dallas, a consultant pediatrician in the emergency room at a London hospital, said he was likely seeing more children with Covid-19 in this wave than at any time during the pandemic, but did not think it was because Omicron affected children more. severely, affecting just more children.
He added that the most common symptoms of Omicron infection in children seemed to be a runny nose and cough, but this did not usually lead to a lung infection.
“It’s just a pure numbers game,” 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’re through the roof.”
Another complicating factor is that it’s common during the winter for young children to go to hospital with respiratory illnesses and test positive for several different viruses, making it impossible to determine what the root cause is.
“Over time we see more Covid co-infections,” said Ronny Cheung, a consultant pediatrician at a London hospital. “Anyone who tries to say [the illness] is because of Covid or some other respiratory infection making it up as it goes.
Hospital admissions in babies are particularly likely to move in parallel with background infection rates, as the threshold for admission is low in very young children. For example, children six months and younger who arrived at the hospital with a fever are usually admitted for routine testing and monitoring, as a precautionary measure. The hospital admissions study found that babies made up a greater proportion of hospital admissions among children, around 42%, in the past four weeks, compared to around 30% during the Delta wave. .
“We know Covid gives you a fever and if you’re feverish and you’re an infant, you’re going to go through a cycle of investigation,” said Damian Roland, honorary professor of pediatric emergency medicine at the University. from Leicester. “That doesn’t necessarily mean Covid is worse or particularly harmful.”
“Like any other virus, when you have more of it you will see more children arriving, and more will tip the threshold for admission,” said Jane Bayreuther, president of the British Medical Association of pediatric emergency. There was no increase in overall severity, she added.
Still, it’s too early to tell the full extent of the new variant’s impact in children, according to Chinedu Nwokoro, a consultant respiratory pediatrician and general practitioner at a London hospital.
An ‘Omicron-sized blip’ in any condition linked to Covid-19 infection in children, including long Covid-19 and multisystem inflammatory syndrome, or MIS-C – a rare inflammatory disease affecting some children around six weeks after infection with the virus – is “in itself going to be a problem”, Dr Nwokoro said.
“Given [MIS-C cases] tend to present several weeks after the initial infection, we are preparing for a larger increase over the next few weeks,” said Dr Cheung. “The question is, will Omicron do anything different?
Analysis of the medical records of more than 14,000 children under age 5 in the United States comparing those infected with Omicron to those who had Delta found that the new variant was significantly less likely to cause serious consequences. 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 is run at two sites near Chicago, Covid-19 hospitalizations more than tripled in the 30 days to Jan. 6, according to chief medical officer Frank Belmonte. About a quarter of patients on average each day end up in pediatric intensive care units, he added, compared to about 10% on average in previous waves.
Some of the children in the intensive care unit at Advocate had no previous risk factors for Covid-19, according to Nekaiya Jacobs, a pediatric intensive care physician at the hospital. “There’s always this misconception that Covid is always mild in children or teenagers or that children just don’t get sick,” she said.
Write to Denise Roland at Denise.Roland@wsj.com and Joanna Sugden at email@example.com
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