Is Omicron a greater threat to children than previous COVID variants?

Since Omicron became the dominant global variant, paediatric hospitalisations have increased to a level not previously seen during the pandemic.
 
But while the rise in paediatric hospitalisations overseas appears to be driven mostly by the large spike in Omicron case numbers, doctors and researchers are still trying to better understand whether this new strain leads to more severe disease in children.
 
What we do know is that early surveillance data from South Africa, where Omicron was first identified, showed children and teens under the age of 20 represented 17% of all hospital admissions during the Omicron wave. Furthermore, 10% of all admissions were in children younger than five years and we know this represents an unvaccinated population.
 
Now the UK and the US are seeing similar trends in paediatric hospitalisations.
 
According to data from the Centres for Disease Control and Prevention (CDC), an average of 672 children were being hospitalised every day last week in the US.
 
‘We have about four times as many children admitted currently as we have had in any other wave,’ Dr Elaine Cox, Chief Medical Officer for Riley Children’s Health in Indiana, told reporters last week.
 
Dr Cox also said they are seeing a rise in disease severity in those admitted to hospital. More than half of the hospitalised children in her region had been admitted to the intensive care unit for some of their care, and at least 40% of those required ventilatory support.
 
‘There are more of them, and they are sicker,’ she said.
 
NewsGP previously reported on a study predating Omicron which found that 10% of children with COVID-19 under the age of 18 experienced severe gastrointestinal symptoms within 4–6 weeks of infection. Eight per cent of the included cohort had multisystem inflammatory syndrome.
 
A recently published Canadian study, based on data also predating Omicron, found that around 3% of COVID-positive children in emergency ended up with severe outcomes within 14 days. Severe outcomes included, but were not limited to, intensive care interventions, severe organ impairment or death.
 
Published disease severity data to support what is being seen clinically with Omicron in certain areas such as Riley Children’s Health Indiana is scarce, but research is ongoing.
 
However, most experts, including many in Australia, believe Omicron is no more dangerous to children than previous strains.
 
‘On the whole, most children are either asymptomatic or have a very mild illness,’ Dr Asha Bowen, Head of Infectious Disease at Perth Children’s Hospital, told Australian media today.
 
‘Because of the sheer high numbers, there are more children in hospital. But they are still a very small proportion [of overall cases].’
 
This assessment appears to be supported by the Australian experience to date.
 
While NSW Health was unable to provide up-to-date statistics on current paediatric hospitalisations, a Victorian Department of Health spokesperson told newsGP there were eight children aged 0–9 with COVID in state hospitals on Sunday – equivalent to 0.11% of active Victorian cases in that cohort.
 
Some experts have also noted that the rise in hospitalisations with the highly infectious Omicron strain may be due to more children being admitted to hospital for other reasons and then incidentally testing positive for COVID-19 during screening.
 
In the US Dr David Rubin from the Children’s Hospital of Philadelphia recently said there was no solid evidence that Omicron was more threatening to children and much of the rise in admissions was the result of sheer case numbers, as well as low vaccination rates among young children.
 
This seems to be in keeping with other available data showing that the actual risk of hospitalisation from Omicron in children under the age of five has fallen in the US compared to the Delta wave.
 
‘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,’ Dr Rubin said.
 
Reassuringly, children also appear to be at a lower risk of ‘long COVID’, with symptoms rarely persisting beyond 12 weeks.
 
While it remains somewhat unclear whether Omicron has the potential to cause more severe disease in the paediatric population, there is certainly a consensus that vaccination remains one of the best ways of protecting children and keeping them out of hospital.
 
‘What we’re seeing in our ICU makes it crystal clear that vaccination is the single most important thing you can do to protect your kid from getting sick with this virus,’ Dr James Schneider, Chief of Paediatric Critical Care at Cohen’s Children’s Medical Centre in New York, said.
 
This week marks the extension of Australia’s COVID-19 vaccination program to children aged 5–11, with the 12–15 age group being eligible since 15 September. As of 12 January, 74.4% of children in Australia aged 12–15 were fully vaccinated.
 
It is hoped that the paediatric rollout, provided there are no further delays, will ensure the numbers of children ending up in hospital or with severe disease remains as low as possible.
 
Log in below to join the conversation.

children COVID-19 hospitalisation Omicron paediatrics