Despite rise in hospitalizations of kids with COVID-19, Omicron variant appears less severe

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Pediatricians across Canada say despite a rise in the number of children admitted to hospital with COVID-19 in recent weeks, the Omicron variant does not appear to cause more severe illness in kids than previous forms of the virus.

Concern had been growing that Omicron might lead to more serious outcomes in children as hospitals reported seeing more kids, particularly those younger than 5, with COVID-19 infections. For instance, Ontario statistics show 73 children under 5 were admitted to hospital with COVID-19 from Dec. 30 to Jan. 13, a significant increase from 19 between Dec. 16 and 30.

But 10 physicians working at large pediatric hospitals say while Omicron appears to cause different symptoms in children compared with previous variants, they are so far reassured it’s not causing a higher rate of serious outcomes.

“We now see more children than we saw throughout the fall, because the community transmission is so high,” Ronald Cohn, president and CEO of Toronto’s Hospital for Sick Children, said in an interview. “We do not see an increase in disease severity.”

Dr. Cohn said colleagues at European hospitals report the same trend.

Some children hospitalized with COVID-19 are being treated for symptoms caused by the virus. Other children without symptoms are admitted for reasons such as appendicitis, and learn they are positive after a mandatory COVID-19 test, doctors say.

While any rise in pediatric admissions is cause for concern, some physicians say the current trends are in keeping with what they typically see during a nasty influenza season.

“We’re seeing more kids being admitted, not because [Omicron] is more severe, but just because there are more people” getting infected, said Earl Rubin, director of the infectious-diseases division at the Montreal Children’s Hospital.

Dr. Rubin said about half of admissions at the hospital are owing to COVID-19 and half are unrelated, but those children test positive at the hospital.

On Thursday, SickKids had 19 children with COVID-19, Dr. Cohn said. Of those, four cases were incidental, meaning the children were admitted for other reasons and had few or no symptoms related to the virus.

At the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, most pediatric patients with COVID-19 are admitted for reasons unrelated to the virus, chief of staff Lindy Samson said in an interview.

Andrew Lynk, chief of pediatrics at the IWK Health Centre in Halifax, said in an e-mail that while more children are coming to the hospital infected with Omicron, “acute illness continues to be mild in the vast majority.”

Laura Sauvé, a pediatric infectious-diseases specialist at BC Children’s Hospital, said pediatric admissions have not yet increased, but that could change, because Omicron arrived in that province after places like Quebec and Ontario.

Kids with immune-compromising conditions are more likely to experience serious outcomes. That’s one of the reasons it’s so important for eligible children to be vaccinated against COVID-19, Dr. Samson said.

About two-thirds of children admitted to CHEO with COVID-19 in the past week were unvaccinated, Dr. Samson said. While some would have been admitted for reasons unrelated to the virus, it’s possible that others could have avoided hospitalization if they had been vaccinated, she said.

Uptake of vaccines among children aged 5 to 11 has been sluggish in many parts of Canada. In Alberta, only 40 per cent of that age group has received the first dose, while Ontario isn’t doing much better, at about 48 per cent. Newfoundland and Labrador has the highest rate by far, about 72 per cent.

No COVID-19 vaccine has been approved for children younger than 5 yet. Many provinces say children turning 5 this year have to wait for their birthday to get vaccinated. The Ontario Immunization Advisory Committee has debated the issue and been unable to reach a consensus, co-chair Jeff Pernica said. The committee will tell Ontario’s health ministry it isn’t making a recommendation about whether to allow vaccination by birth year or birth date, and the province will determine what steps to take, Dr. Pernica said.

Children younger than 5 currently have the highest hospitalization rate of all pediatric age groups in Ontario, about 10 per 100,000. In kids 5 to 11, it’s 2 per 100,000, and in those 12-19, the hospitalization rate is 1.7 per 100,000.

Pediatricians say that reflects what they see in the hospital. Unlike previous versions of COVID-19, Omicron appears to cause more symptoms in the upper respiratory tract – the nose and throat – instead of the lungs. Dr. Samson said such viruses typically affect babies and children under 5 more because their airways are smaller.

Dr. Lynk in Halifax said many children infected with Omicron are coming to the hospital with croup, a barking cough caused by upper airway infections, as well as bronchiolitis, a lower respiratory tract infection, which can cause breathing problems.

Dr. Rubin in Montreal said any newborn with a fever will be admitted, which is one reason hospitalization rates in the youngest age group are higher.

“We take fever very seriously in newborns,” Dr. Rubin said. He added that infants with a fever are usually given antibiotics until it is determined whether the infection is bacterial.

Sarangan Uthayalingam, a pediatrician in Brantford and executive member of the pediatrics section of the Ontario Medical Association, said the major challenge for many hospitals in caring for children is not new admissions, but staff shortages.

“Often, we’ll be left with one nurse covering the entire pediatric ward. I’ve never seen that before,” Dr. Uthayalingam said. “We don’t have a pool of nurses to pull from.”

As many provinces prepare to reopen schools after an extended holiday break, pediatricians say they expect a rise in pediatric cases and hospitalizations. But given the negative impact of school closings on child development and mental health, many pediatricians say they support the decision to return to school, adding that safety precautions should be used to help minimize virus spread.

“Not being in school is a danger to children,” said Anthony Crocco, deputy chief of pediatrics at McMaster Children’s Hospital, who is also an emergency pediatrician. “When we think of what is the greater harm, the greater harm is kids being out of school.”

Dr. Uthayalingam said there has been a dramatic increase in patients with anxiety, depression, eating disorders, sedentary behaviour leading to obesity, and other issues stemming from school closings.

“We’re going to see a long-lasting effect of these public-health measures,” he said. “It’s quite tragic.”

With a report from Chen Wang

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