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Well here we are, early into 2022 and there is still no shortage of COVID in the community.  Omicron has definitely become the main variant of our region and has been continuing to spread like wildfire.  Now when I test patients, I am shocked when it is negative.  Just this morning, 8 of my 9 results in my inbasket were positive tests.  The other was a positive Influenza A.  No negative tests.

Recently I saw an article posted online from a certain news agency roughly stating kids don’t get very sick from Omicron, but parents should still be watchful.  I hate when news headlines read like this because it gives off completely conflicting opinions, simply just trying to get more readers involved.  I resisted the urge to click on the article and see what they said, knowing it would be similar to most of the other news articles being done in the recent weeks. 

However, how are kids being affected by the Omicron variant?  What are we seeing that is different, both in good and not-so-good ways?  Below is an update on some of this information and what we know so far.

Positive Cases

The rate of positive tests is increasing significantly for all age groups, but kids continue to see a large growth.  This may be due to various reasons, including the variants infectivity, low rates of vaccination in the 5-11 age groups, no vaccines in the <5 year old group, and the various changes in masking and school activities. 

Based on the American Academy of Pediatrics data, at the end of the week of January 6th there were 589,000 COVID cases reported in kids, up from the 325,000 cases add the week prior.  Up to this point in COVID there have been about 8.5 million cases in the pediatric population.  11% of those cases were added in the last 2 weeks (ending 1/6/22).  As we collect data and this blog post gets released, I am sure those numbers will be significantly higher.

Addendum: After I posted this article I went to see what the updated data was on the AAP website – Crazy numbers here. This is directly copy and pasted from their website:

• 981,488 child COVID-19 cases were reported the past week from 1/6/22-1/13/22 (8,471,003 to 9,452,491) and children represented 21.4% (981,488/4,589,630) of the weekly reported cases
• Over two weeks, 12/30/21-1/13/22, there was a 20% increase in the cumulated number of child COVID-19 cases since the beginning of the pandemic (1,561,735 cases added (7,890,756 to 9,452,491))

Hospitalizations

Based on the data reported from 24 states and NYC by the AAP, up to 1.6% of Childhood COVID cases resulted in hospitalization.  This seems like such a small number which is great!  The problem is that even with the percentage being small, the NUMBER of patients getting COVID is dramatically rising.  1.6% of 1000 kids is much different than 1.6% of 1 million kids. This is where the concern of hospital bed capacity and ICU capacity comes into play.  We have had several situations in the last few weeks where our Childrens Hospital is full and kids are requiring being sent to other hospitals in the city or out of state.  Some of this has to do with childhood case numbers, but others are due to staffing shortages in the hospital system due to COVID. 

One common problem we see with an increase in actual COVID cases in kids is that we start to see more complications. This is simply due to a larger sample size. We may start to see rare complications in kids not seen in previous variants. I will touch on this more below.

The other issue here is that these numbers are not exactly accurate.  Many states are not even reporting their numbers; this includes the state I work in.  Home COVID tests that come back positive are not reported to the state which can give us lower numbers than we are actually seeing, which could be inherently affecting the hospitalization rate in various ways.  Again, we are only actually getting data from half of the states, and even then much of it is not accurate or updated. 

Croup

Early on in COVID if a child presented with croup we were pretty confident it wasn’t COVID.  The big change we are seeing now is the Omicron variant is causing significant croup symptoms in all age ranges of kids, from infants to elementary ages (or older).  This leads to further needs for management, including in office steroid administration and possibly racemic epinephrine breathing treatments.  This is a breathing treatment which can only be done in office (not at home) that helps with moderate to severe croup symptoms, many times leading to the need for transport to an ER and admission overnight for observation depending on the severity.  This then significantly affects ER visits, bed capacity, etc. 

Encephalitis

This is a word that scares me.  Encephalitis refers to inflammation of the brain tissue leading to several symptoms, including headaches, confusion, mental status changes, inability to walk, inability to talk, seizures, unresponsiveness, or more.  We did not typically see encephalitis with COVID early on in kids.  However, there has recently been more cases of this condition occurring about 2 weeks after a COVID infection in several hospital systems across our country.  We are unsure how well vaccination protects against it at this time due to the low number of cases thus far.  I am sure we will hear about this more in the weeks to come, but for now the data just isn’t there to make a good estimation on the risk of this debilitating condition.

Schools

Needless to say, kids have missed WAY too much school these last two years.  COVID is not helping us in this matter.  Even with the more recent CDC isolation guidelines, when a child tests positive for COVID they essentially miss a week of school.  Although schools did a good job with remote learning last year, this school year was not designed for it.  Thus, many kids are falling behind.  We still will not know how this affects them until a year or two down the line, but obviously there is concern. 

On top of this many schools are losing teachers and staff. This can be due to positive cases in this population OR those that are simply leaving/retiring from the profession. This in turn has a negative effect on our children and their education as well.

Ending Thoughts

I am honestly tired of the consistent language of “kids just don’t get sick from COVID.” I think I basically say that every time I create a COVID blog post. However, I think it is important that we DO continue to discuss the effects this variant can have on our children. Not to promote fear or anxiety, but to make sure we are aware and knowledgeable when making decisions in our daily lives. This is why we chose for our two boys to get vaccinated. This is also why we allow our boys to attend school, attend some extracurricular activities, allow certain play dates, etc. We want them protected, yet at the same time we want them to have a childhood.

Remember – none of us are going to be perfect when it comes to something we still barely understand.

Simply do your best.

Don’t sweat the small stuff.

Embrace the Imperfections.

Imperfect Dad MD