Omicron Sparks Surge In Pediatric Hospitalizations

IRA FLATOW: This is Science Friday. I’m Ira Flatow. Omicron’s rapid spread has many parents and caregivers of young children on edge. The most recent CDC data shows 5.3 cases per 100,000 children under four are hospitalized with COVID in the US. That’s the highest number since the pandemic started, and kids under five still aren’t eligible to be vaccinated.

You know, when word went out that we were going to answer questions about COVID and kids, we were flooded with questions from you, our listeners. It was a tsunami. So to help us better understand exactly what’s going on and how to keep our kids safe, are my guests– Dr. Yvonne Maldonado, pediatrician and professor of global health and infectious diseases at Stanford University, and chair of the American Academy of Pediatrics Committee on Infectious Diseases; and Dr. Rick Malley, infectious diseases specialist at Boston Children’s Hospital, professor of pediatrics at Harvard Med School. Welcome to Science Friday.

YVONNE MALDONADO: It’s a pleasure to be here. Thank you, Ira.

RICK MALLEY: A real pleasure. Thanks.

IRA FLATOW: You’re welcome. Dr. Malley, let me begin with you. In the CDC data, echoing what Dr. Fauci has said, some of the kids who’ve tested positive for COVID in hospitals were in for something else, right? And then they tested positive. So the numbers aren’t necessarily as high as we might think.

RICK MALLEY: I mean, as far as we know, the percentage of children that are hospitalized right now in whom we’ve detected the presence of the virus is a significant portion of the kids that we are calling “admitted with COVID.” And what that means, of course, is that when you look at numbers skyrocketing of kids hospitalized with COVID, in fact, a large proportion of those are undoubtedly children who were admitted for another reason. It could be a broken bone, it could be appendicitis, or something unrelated, but in fact, as a part of the hospitalization procedure, we test all these children. And we found that some of them were infected with SARS-CoV-2, but probably asymptomatically.

So far, despite early reports that made many of us worry, it doesn’t seem that Omicron is any worse or better in children than other forms of– other variants of the virus. As I think your listeners probably heard, early on, when the numbers of hospitalizations of children with COVID seemed to be going so high both in South Africa and then in the US, people were worried that Omicron might be for some reason milder in adults, but more severe in children. And I think as we’ve sort of learned through a little bit of this surge, that turns out not to be the case. And in fact, Omicron does not seem to be any more severe in children than previous variants.

YVONNE MALDONADO: So let me just make a comment here, because that’s not exactly the experience that we’re finding from colleagues around the country. And I have town halls through the American Academy of Pediatrics, and what we’re finding is that the proportion of kids who are coming in with versus for COVID is definitely there, but we’re clearly seeing more children who are coming in with symptoms and coming in because of symptoms, not just because it’s an incidental finding. So it does happen, but it is not the majority of kids.

RICK MALLEY: Both are true. In other words, there’s so much virus circulating that even if a virus is not particularly more dangerous than previous variants in children, because of the sheer number of infections, you are in fact going to see more children hospitalized because of COVID. But I think the key point here is not so much whether we’re seeing some kids in the hospital who are hospitalized because of COVID, but whether this variant is more dangerous than previous variants.

And in that case, the simple answer is no. However, there are so many cases of COVID, of SARS-CoV-2, in the community that some of these, of course, end up causing illness in children. And those, of course, some of them end up being hospitalized in greater numbers than what we saw with Delta or prior variants.

IRA FLATOW: So Dr. Maldonado, how do you know when to bring your child into the hospital. If your kid has– is asymptomatic with COVID, even if they test positive, how do you know if and when to bring that child to the hospital?

YVONNE MALDONADO: Well, first of all, if your child has been exposed to somebody and isn’t symptomatic, at that point, you will get guidance from your county, from your local health department, and you can also check in with your pediatrician to find out what you need to do. But there is most likely not always going to be a need to bring a child in at that point. If, however, your child develops a fever, cough, especially if they have chest pain or shortness of breath, obviously those would be reasons to bring your child in, either to your regular provider or to the emergency department.

IRA FLATOW: Why are more kids under four being hospitalized with Omicron, but not kids aged five to 11?

YVONNE MALDONADO: If you look at the data from the beginning of the pandemic, children under five have always been the highest proportion of children hospitalized. But as you heard before, because this virus is more infectious, there’s just a larger number of kids. We don’t really know why children under four are more likely to be hospitalized, but that’s been the pattern all along.

IRA FLATOW: Now, some parents already feel it’s inevitable that their kid will get COVID. And I remember back in the day when parents would have chickenpox parties to expose their kids. There’s this rumor going around that people are already thinking about this– why not bring kids together and, quote, “get it over with”?

RICK MALLEY: Well, we’ve been asked that question, I think, since the beginning of the pandemic. And I do think that it’s very important to emphasize that that is not a good strategy. The so-called “let it rip” strategy that we’re reading about and you might see on Twitter or on Facebook or other forms of social media really is taking an attitude that I think is not scientific and in fact quite dangerous.

One way, perhaps, to say it is that all of us have been or will be exposed to SARS-CoV-2, to the causative agent of COVID-19. Some of us might be symptomatic. Some of us may not be. But the idea that we should all try to get it all at once, now, in an already overstressed medical system where providers are exhausted, where resources are limited, where emergency rooms are packed with patients with COVID or for other reasons, really would be a public health threat. It’s just not a serious approach.

IRA FLATOW: Dr. Maldonado, from Twitter, a question– “How likely is it that parents will bring Omicron home to their toddlers, and what should we do to protect against that?”

YVONNE MALDONADO: We need to vaccinate as many people as possible who are five and older and who are eligible. And that is the vast majority of the US population. There are more and more studies that are demonstrating indirect evidence that vaccinated people are going to be less likely to transmit the virus. That would be a very easy strategy, is make sure that everybody around the child is vaccinated.

Absolutely, parents can bring the virus home to their children. And make sure that you are preventing yourself from getting infected at work or social areas. The other approach to preventing infection in kids is making sure that they’re not in social events with large numbers of people or people who aren’t in their normal social circles, because community transmission is really going to be the major way that this virus is going to continue to spread.

IRA FLATOW: Now, if parents test positive and bring the virus home to their children who are negative and don’t have it, I mean, who’s to take care of the children? What can you recommend? You can’t expose someone from outside to come into your home and take care of your kids, can you?

YVONNE MALDONADO: Well, that’s the issue that I think has been so difficult. And that really– this whole economic support for parents and giving them more opportunities to hire caregivers is really coming to play here, because you’re talking about one infected parent– hopefully only one, maybe both– who would now need to mask and distance. So the parents are going to need to struggle to find somebody else. And there may be– the situations that are hardest to do that will be people who are economically constrained.

So it is a difficult time right now with the funds running out to support COVID relief. But if there are other family members that can help with the children, the parents should stay away. And we know as well that the current guidelines– because Omicron does seem to spike earlier in terms of infectiousness, earlier and taper off faster. There are some data to suggest that that’s true. The parents can actually, especially if they’re not symptomatic, can mask and distance as much as possible and still be in the household if they need to be.

IRA FLATOW: A real challenge to that. Let me ask you this question, Dr. Maldonado. I know you’re overseeing the Pfizer vaccine trial for kids under five at Stanford. Currently, you’re working on a three-dose trial for young kids versus the two-dose adults. Why might that work better?

YVONNE MALDONADO: Now, the way the trials were done, the vaccine was given at a particular dose in adults. And that happened to be, for the Pfizer vaccine, 30 micrograms. And for the five- to 11-year-olds, the 10-microgram dose, or a third of the adult dose, seemed to give just as good of an antibody and protective response as the higher dose that adults received.

Now, in the younger children, the children under five, the 10-microgram dose, which was the dose for the five to 11-year-olds, produced higher fevers in that age group. So you’re talking about a lower dose of the vaccine, and it’s actually a 10th of the adult dose and a third of the five- to 11-year-old dose. So it is going to be a smaller amount of vaccine that’s given, and that may be one of the reasons why the antibody response in the younger children was not as potent. But we also know that for many other vaccines of childhood, you have to give more than one dose. So most of them require two, three, and sometimes even five doses.

IRA FLATOW: Got it. Let me see how fast I can get through some questions we have from our listeners. This one– “How effective are antibodies passed through breast milk?”

RICK MALLEY: It’s an interesting question. It’s a difficult one to study, but in general, the possibility that maternally transferred antibodies from breast milk to a child could actually confer some either local protection in the mucosa or systemic protection against disease is something that is very intriguing and possible, so much so that I think it’s very reasonable and very important for women in pregnancy to consider, of course, very strongly, getting the vaccine, not just for that reason, but maybe even more importantly because pregnancy, as we know, is a condition where COVID-19, unfortunately, can be much more severe. And this is even true for several months after the birth of the child. So for all those reasons, including the theoretical possibility that breast milk with antibodies to COVID-19 could be protective to the child, I think reinforces the need to vaccinate women in pregnancy.

IRA FLATOW: Well, is the converse true? If a pregnant mother has COVID, can the baby in utero also get COVID?

YVONNE MALDONADO: You know, that’s an interesting question. You know, I’m not sure I have seen that that’s been the case. In fact, actually, I’m thinking back to the beginning of the pandemic. There was an early study of about 30 pregnant women who did get COVID, and none of the babies actually were– I think maybe one of the babies had evidence of antibodies, but none of them were infected, or otherwise were infected, and none of them had symptoms. We have, however, in our hospital, seen young babies, newborns, whose mothers were infected, and then the babies became infected later. So that is a possibility.

IRA FLATOW: This is Science Friday from WNYC Studios. Here’s a question on Facebook from Tammy, who says, “Can you speculate about the long-term effects of Omicron for vaccinated kids? And I’m thinking about studies like the one that said that kids who had COVID were more likely to get Type 1 diabetes. My son tested positive today and feels fine, but he’s petrified that this infection will have long-term effects on his health.”

YVONNE MALDONADO: Well, Ira, I’m part of something called NICHD Council. It’s the National Institute of Child Health and Human Development, and we just had our two-day meeting this week. And we were talking about this issue. And there are networks that are being set up now to really try to enroll children and understand whether there will be long COVID.

We do know that this virus– not necessarily Omicron as much as, say, the previous variants do seem to have an affinity for more than just the lungs. They can affect other organs. And there’s some thought that this is the reason why some of these children are developing diabetes.

But the other issue to remember is that there’s some studies now looking in human brains, as well as in animals, and it looks like the virus does seem to affect– through an inflammatory response, does seem to affect some of the way the brain cells work. Those data are really primarily from Delta. We don’t really know what’s going to happen with Omicron. So this is, again, another important reason why people who are eligible should be vaccinated, because we think you can prevent this type of inflammatory response which seemed to have been so important in the Delta surge. And hopefully not as important with Omicron, but we’ll still need to follow these studies and find out what’s going on with these kids as time moves on.

IRA FLATOW: Here’s a question I got from a lot of people, and it says, “This time of the year, a lot of kids are getting upper respiratory infections. As RSV rates are on the rise, how can we parents differentiate between Omicron and RSV, as they are both respiratory? Are the symptoms different? Tell us what we can do.”

RICK MALLEY: It’s a conundrum that parents have, that primary care providers have, emergency room physicians and nurses have. It’s very difficult, because very often the symptoms of RSV or other winter viruses and the symptoms of COVID-19 in children really overlap very well. I think the good news, if we can try to find good news in these situations, is that, by and large, the same measures that are effective at reducing the likelihood of catching SARS-CoV-2 and getting COVID are the same measures that we would be using to reduce the risk of catching RSV, influenza, or other respiratory viruses.

So for parents who are worried that their child has symptoms and trying to figure out whether it’s COVID or something else, of course, the answer is to contact their health care provider and, if need be, get tested, because testing will of course differentiate across all these different viruses. But at the same time, all the measures that we’ve been following for the last two years should be reinforced in an era where we have RSV and flu and Omicron, because essentially, those measures will work regardless of which virus you’re talking about.

IRA FLATOW: That’s about all the time we have. So many questions. Dr. Yvonne Maldonado, pediatrician and professor of global health and infectious diseases, Stanford University, and chair of the American Academy of Pediatrics Committee on Infectious Diseases, and Dr. Rick Malley, infectious disease specialist at Boston Children’s Hospital, professor of pediatrics at Harvard Medical School. Thank you both for taking time to be with us today.

YVONNE MALDONADO: Thank you. It was a pleasure.

RICK MALLEY: Thank you very much.

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