US cases hit another record; pediatric infections up 50% in December — 5 COVID-19 updates

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The U.S. reported nearly 489,000 new COVID-19 cases Dec. 29, nearly twice as high as the worst days from last winter's surge, according to The New York Times database. The new cases brought the seven-day average for new daily cases to more than 301,000, another record. 

While the omicron and delta variants have increased cases substantially, hospitalizations and deaths remain far below levels during last year's winter surge, before vaccines were widely available.  

During a Dec. 29 COVID-19 briefing at the White House, Rochelle Walensky, MD, CDC director, said the seven-day average of hospitalization admissions is about 9,000 per day, about 14 percent higher from the previous week. The seven-day average of daily deaths are about 1,100, a decrease of about 7 percent over the last week. The "comparatively low" hospitalizations and deaths may be due to the fact that hospitalizations tend to lag behind cases by about two weeks "but may also be due to early indications that we’ve seen from other countries like South Africa and United Kingdom of milder disease from omicron, especially among the vaccinated and the boosted," Dr. Walensky said. 

Five more recent updates: 

1. U.S. pediatric hospitalizations are up. An average of 1,200 children were hospitalized with COVID-19 each day last week, up from about 800 at the end of November, according to HHS data cited by The New York Times.

Data from the American Academy of Pediatrics shows nearly 199,000 cases were reported among children for the week ending Dec. 23, a 50 percent increase over the weekly new cases since the start of the month. New York has been particularly hard hit by the surge in pediatric cases, with hospitalizations more than doubling in the last few weeks from 70 as of Dec. 11 to 184 as of Dec. 23. The rise in admissions has been particularly concentrated in New York City, where hospitalizations among children increased from 22 to 109 across the same period. 

Although more children are being treated for COVID-19, it has more to do with low vaccination rates and the sheer number of kids becoming infected with the highly transmissible delta and omicron variants than a higher risk of disease severity, according to health officials. 

"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," David Rubin, MD, physician scientist at Children's Hospital of Philadelphia, told the Times

Nearly all children who are currently hospitalized and severely ill from COVID-19 are unvaccinated, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said during a Dec. 30 NewsNation interview. "Virtually all, not 100 percent but close to that, the children who are seriously ill in our hospitals from COVID-19 are children whose parents decided they did not want to vaccinate them," he said. "That is avoidable." 

About 34 percent of Americans ages 5 to 25 were fully vaccinated as of Dec. 28. Children younger than age 5 are not yet eligible for vaccination. 

2. Hospitalizations, not case counts, should be used as the key metric to gauge virus transmission moving forward, health officials have said. Although omicron has driven an unprecedented rise in case counts, the pandemic is in a different landscape than earlier surges, with vaccines, tests and, soon, the availability of oral treatments. 

"This is the shift we've been waiting for in many ways, where we're moving to a phase where if you're vaccinated, and particularly if you're boosted … you might get an infection. It might be a couple of days of not feeling so great, but you're going to bounce back. That's very different than what we have seen in the past," said Ashish Jha, MD, dean of Brown University's School of Public Health in Providence, R.I.z

And although breakthrough cases are becoming more common, the comparatively low numbers of hospitalizations and deaths indicate vaccines are doing what they were designed to do. "We have to get comfortable with fully vaccinated folks testing positive," Vin Gupta, MD, a physician and affiliate assistant professor of health metrics sciences at Seattle-based University of Washington, said Dec. 16. "The purpose of the vaccines is not to prevent a positive test for a respiratory virus like omicron, but to keep you out of the hospital — and that's exactly what they're doing."

3. Research suggesting omicron is less severe than delta is preliminary, but encouraging, Dr. Fauci said during the White House briefing. He pointed to international animal studies that suggest omicron is less efficient at replicating in the lungs. In the U.S., mouse and hamster studies funded by the National Institutes of Health have also confirmed omicron is less virulent, Dr. Fauci added. 

"The data are encouraging but still, in many respects, preliminary; yet they are getting stronger and stronger as additional data are accumulated," he said. "And it is still unclear how these data will translate to other demographically diverse populations in the United States and elsewhere throughout the world."

4. The CDC updated its isolation and quarantine guidance for healthcare workers Dec. 23, saying asymptomatic healthcare workers can return to work after seven days with a negative test. On Dec. 27, the CDC also shortened the recommended isolation time for all asymptomatic people with COVID-19 from 10 days to five, followed by five days of masking. The agency's goal was to make the new guidelines easier for Americans to follow, according to Dr. Walensky. 

"What we do know is that about 85-90 percent of viral transmission happens in those first five days, which is why we really want people to stay home during that period of time and then mask for the rest of the time to capture that last 10 to 15 percent," she said in a Dec. 29 interview with "CBS Mornings."

5. The omicron surge is fueling a shift away from reusable cloth masks. Many health experts are encouraging Americans to ditch cloth masks in favor of double- or triple-layer masks that might offer more protection against the highly transmissible variant. Rochester, Minn.-based Mayo Clinic said Dec. 29 it will prohibit patients and visitors from wearing certain types of face coverings — including gaiters and bandanas — and discourage people from wearing cloth masks. 

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