How omicron is affecting children more than previous strains

More children are being hospitalized from omicron, but is it because it's so contagious or more severe?

By Nicole Karlis

Senior Writer

Published January 13, 2022 5:45AM (EST)

A young girl sick in bed (Sac C Wat'hn Buy Thna Thwi Phl / EyeEm / Getty Images)
A young girl sick in bed (Sac C Wat'hn Buy Thna Thwi Phl / EyeEm / Getty Images)

Last week, the number of hospitalized children infected with COVID-19 rose to the highest levels seen since the beginning of the pandemic.

According to data released by the Centers for Disease Control and Prevention, the increase was most significant in children who were 4 and younger — an age group that is still not eligible for vaccination. An estimated more than 4 in 100,000 children under the age 5 were hospitalized with COVID-19 as of January 1, 2022, which is double the rate reported a month ago and about three times the rate of children under 5 being hospitalized this time last year. Since the beginning of the pandemic, 8.5 million children have tested positive for COVID-19. Nearly 11% of those cases were added in the past two weeks.

"There is an urgent need to collect more age-specific data to assess the severity of illness related to new variants as well as potential longer-term effects," the American Academy of Pediatrics stated in a recent report. "It is important to recognize there are immediate effects of the pandemic on children's health, but importantly we need to identify and address the long-lasting impacts on the physical, mental, and social well-being of this generation of children and youth."

Is it possible that, unlike previous variants of the coronavirus that caused mild COVID-19 cases in children, omicron is causing more severe infection in children — especially those who are unvaccinated?

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Fortunately, not exactly. Doctors tell Salon they don't believe that's the case because those who are being hospitalized typically have less severe hospitalized cases compared to those hospitalized during the delta wave, even though there weren't as many children being hospitalized at that time. However, omicron does appear to be anecdotally affecting children differently.

"What we're seeing is that children who are being admitted to the hospital with COVID-19 now are younger, and generally don't have as severe of symptoms as previous surges," said Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California, Davis. "During the surge last winter, and during delta, we were seeing more teenagers admitted to the hospital and they had pneumonia, lower respiratory tract disease, and they were being admitted to the ICU because they needed to be on the ventilator or other oxygen support."

When asked if the omicron variant affects children differently than other variants, Dr. Natasha Burgert, a pediatrician and spokesperson for the American Academy of Pediatrics, told Salon in her offices, they are seeing "similar symptoms and illness severity as we have during previous waves." Meaning, that in non-hospitalized patients, the symptoms don't appear to be any more severe in children than with previous strains.

"Most kids in our area are presenting with sore throat, congestion, fatigue, cough and fever. less commonly they are presenting with vomiting and diarrhea, the difference with omicron is the sheer number of kids that are getting sick at the same time," Burgert said. "I've never seen an illness that is able to so quickly take down all members of a family, and since it's so tough to take care of a sick kid when you are not feeling well yourself — it's making this wave feel particularly daunting."

Indeed, scientists believe that omicron is two to three times as likely to spread as delta, but they don't exactly know why that's the case. A team of British scientists found that omicron excels at infecting cells in the nose, suggesting that when people breathe out through their noses, they release new viruses. The variant is also better than previous ones at escaping antibodies produced by previous infections and vaccines, which could factor into its increased contagiousness. However, it's the increased transmissibility of the variant which makes doctors believe is the cause of more children being hospitalized with this variant.

"Omicron has proven to be the most contagious variant of the pandemic so far," Burgert said. "With people being able to spread and contract the disease so easily, it's not a surprise that so many children are getting infected."

But there could be differences due to the properties of the variant, as Blumberg said, that mean the variant is affecting children differently than before. Blumberg told Salon that these younger patients, often under the age of five, "have more complications that we commonly see with other respiratory viruses that are transmitted in the community."

"Things like bronchiolitis, or croup, that you can see with any common respiratory virus such as parainfluenza virus, adenovirus, RSV, and others," Blumberg said. "So it does seem to be different and I don't know if that's because the virus itself is behaving differently or that children under 5 are more susceptible because they're not eligible for vaccination."

There is mounting laboratory evidence suggesting that omicron is less dangerous than delta because it doesn't appear to infect cells in the lungs. Instead, it is more efficient at affecting cells in the upper respiratory tract. According to one study, in the first 24 hours, researchers observed omicron multiplying about 70 times faster inside the respiratory-tract tissue. As one coronavirus researcher explained to StatNews: "If your lungs don't work, then your heart has to work harder, your kidneys have to work harder; there's a big difference between pneumonia and an upper respiratory-tract infection." Hence, why upper respiratory-tract infections like the barking cough croup and bronchiolitis are appearing in children with omicron when they hadn't previously.

Blumberg cautions that while omicron is likely more mild, there is so much to learn about how omicron affects children — adding that he fears there is a lot of "mixed messaging" is a bit confusing.

"On the one hand, I think people are saying, it's not so bad, it might result in a lot of immunity in the population, and so it may be our way out of the pandemic," Blumberg said. "On the other hand, the kids who get COVID can be severely infected, and there can be a long-term impact."

For example, a report from the Centers for Disease Control and Prevention stated that children with COVID-19 could be twice as likely to be diagnosed with diabetes after a coronavirus infection, compared to those who had not had the virus. And then there's long COVID-19 in children, which has yet to be fully understood. Doctors still don't know if omicron will lead to long COVID in kids.

"We won't have that answer for weeks," Burgert said. "In addition, we won't know how much immunity people are getting from the disease for quite some time."

Blumberg said to protect younger, unvaccinated kids, parents can "double down" on what we know works to protect them.

"And that's to ensure that everybody in the household is fully vaccinated and boosted, and that's anybody who's eligible for vaccination, that people wear masks when they're indoors and around people outside of their usual households," Blumberg said. "And kids as young as two can mask safely and can learn to do that consistently and routinely."

Read more on kids and COVID-19:

By Nicole Karlis

Nicole Karlis is a senior writer at Salon, specializing in health and science. Tweet her @nicolekarlis.

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