Omicron's full burden on children is still unknown, Texas Children's leader says

Children's hospitals nationwide have seen record levels of COVID-19 patients amid the omicron surge, despite children having the lowest risk of hospitalization from the virus.

Among 24 states reporting age-specific hospitalization data to the American Academy of Pediatrics, children accounted for just 1.7 percent to 4.4 percent of the states' total hospitalizations in the week ending Jan. 13. The sheer volume of omicron cases emerging this winter, however, has still brought pediatric hospitalizations to record-high levels.

"The percentages matter less when the absolute numbers are greater," Jim Versalovic, MD, PhD, pathologist-in-chief and COVID-19 command center co-leader at Houston-based Texas Children's Hospital, told Becker's. "When you get to a point where so many people are infected by any disease, condition or crisis, it's important to keep in mind that those absolute numbers become the story."

The seven-day average for new pediatric COVID-19 admission peaked at 914 for the week ending Jan. 16, according to CDC data. As of Jan. 19, the rate of new admissions for children ages zero to 17 was 1.22 per 100,000 population, up from a previous peak of .47 per 100,000 on Sept. 4, 2021.

The need for cautious optimism

As of last week, COVID-19 hospitalizations were still rising at Texas Children's, the largest children's hospital in the country. More than 50 percent of children presenting with symptoms or an exposure are testing positive for COVID-19, and more than 90 percent of confirmed cases are due to the omicron variant.

As of Jan. 18, more than 80 children were hospitalized with COVID-19, a figure that surpasses peak hospitalizations seen during the delta wave. The hospital's seven-day positivity rate average also hit a record high on Jan. 18, exceeding 36 percent. Dr. Versalovic said the hospital's positivity rate does seem to be plateauing, though it's a very high plateau and still larger than figures seen during the previous surge.

"It's reassuring that we seem to be cresting and plateauing in terms of positivity," he said. "I expect we'll see that play out in our hospitalization numbers in the next few days. … We're either rapidly approaching the peak or at the peak."

Some parts of the U.S. are already seeing positivity rates and hospitalizations fall, but Dr. Versalovic expressed the need for cautious optimism, since the situation could be different for children, a majority of whom are still unvaccinated.

"It's very important for parents to not get complacent and think, 'Omicron is milder; it will just go away,'" he said, as it can be difficult to predict which children with COVID-19 may need hospitalization.

Omicron's burden on children

As with previous surges, most hospitalizations at Texas Children's involve unvaccinated children. Children under 5 who do not have access to the vaccine yet are making up a larger percentage of patients than Texas Children's has seen in the past.

"As we've been tracking our pediatric hospitalizations during the omicron surge, up to 40 percent of hospitalizations have occurred in children under 5 and, notably, quite a few under 2," Dr. Versalovic said, though he noted the hospital is still seeing pediatric COVID-19 patients of all ages.

Despite record hospitalization levels, the omicron surge has not strained Texas Children's intensive care unit capacity as much as past surges. That's because the region is not experiencing a "twindemic" or other viral surge alongside COVID-19, according to Dr. Versalovic. Last summer, many parts of the U.S. saw a spike in respiratory syncytial virus cases alongside the delta surge, which put a greater strain on hospital capacity.

Flu vs. omicron

Amid record pediatric hospitalization levels, discussions have emerged about how these figures compare to historical flu hospitalization rates for children. Dr. Versalovic said pediatric omicron hospitalizations may be lower than historical flu hospitalizations for children, but cautioned against putting too much weight on this comparison. Data is still emerging and must be carefully stratified between adolescents age 12 and up, who've had access to the vaccine since May 2021; school-aged children ages 5-11, who've only had access since early November; and children under 5, who are wholly unvaccinated.

Comparing early omicron hospitalization rates to pediatric flu rates may also not provide a full picture into COVID-19's burden on children, as it doesn't account for two factors that remain to be seen with this surge: long COVID-19 and multisystem inflammatory syndrome in children.

"MIS-C had a devastating impact on many children during delta," Dr. Versalovic said. "We are just now looking at that to see its effect with omicron because it occurs three to six weeks after initial infection."

And up to 10 percent of children have had prolonged COVID-19 symptoms, some of which could curtail their development or cause neurological and cardiac issues that require long-term monitoring by a specialist.

"When we talk about a disease being less severe, you have to think about chronic disease, not just the acute viral pneumonia," Dr. Versalovic said. "Hospitalization rates for omicron may be lower than flu hospitalization rates, though it also depends on the age group and following these other potential complications of COVID-19."

While there is room for cautious optimism that omicron's peak is near, parents, clinicians and hospitals must remain vigilant, according to Dr. Versalovic. He stressed the importance of masking and vaccination, among other mitigation measures, to control the spread of viruses.

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