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Experts discuss the rise in COVID-19 cases in kids amid omicron

In New York City, there’s been a noticeable increase in pediatric hospitalizations due to COVID-19.

On Christmas Eve, both of Sarah Barlow's kids tested positive for COVID-19. They were too young to be vaccinated, and their symptoms started with low fevers. For 4-year-old Liam, things never got more severe than that.

But 19-month-old Isla's fever just kept climbing, and she was admitted to the hospital on Christmas Day.

"It's just a complete nightmare," said Barlow, a kindergarten teacher in West Orange, New Jersey. Barlow and her husband are both vaccinated and boosted and she described their behavior as "beyond cautious" throughout the pandemic.

So far, the two of them have tested negative. But after being so careful for so long, seeing their children test positive for COVID-19 was a crushing moment.

“I just felt so defeated,” Barlow said. "You spend almost two years shielding your children from this disaster ... I felt defeated and I felt sad. And I felt bad for them."

Today, after three days isolated in a hospital room where she couldn't receive any visitors other than Barlow, Isla was discharged.

Especially now that omicron is circulating, Barlow implores anyone who is able to get vaccinated to do so to help protect themselves and those around them.

“We have to think about those little babies too. It’s not just about us,” she said. “It’s not that they’re choosing not to be vaccinated, it’s that they can’t.”

Rising rates of COVID-19 cases and hospitalizations in kids

In New York City, there's been a noticeable "uptick" in pediatric hospitalizations due to COVID-19, Dr. Mary T. Bassett, acting commissioner of the New York State Department of Health, said in a press briefing yesterday.

During the week of Dec. 5, there were 22 hospital admissions among kids ages 0 to 18 with COVID-19 in the city and 70 statewide. But during the week of Dec. 19, there were 109 new pediatric hospitalizations in New York City and a total of 184 in the state.

Statewide, the number of pediatric COVID-19 hospitalizations have more than doubled since early December, Bassett said. "But New York City has gone up nearly five-fold."

"We're releasing these data because we want pediatricians to be alert to making the diagnosis of COVID in children. And we also want parents to be alert to the diagnosis," Bassett continued. "Many people continue to think children don't become infected with COVID; this is not true. Children become infected and some will be hospitalized."

The rate of COVID-19 among kids in the U.S. has been increasing since early November, according to data from the American Association of Pediatrics. There were nearly 200,000 new pediatric cases in the week ending Dec. 23, the most recent week for which data are available. That's compared to 164,000 in early December, nearly 252,000 at the peak of the delta surge this past summer and 211,000 at the peak of last winter's surge.

"We have seen an increase in the number of kids being hospitalized with COVID," Dr. Sallie Permar, pediatrician-in-chief at New York-Presbyterian/Weill Cornell Medical Center and New York-Presbyterian Komansky Children's Hospital and chair of the department of pediatrics at Weill Cornell Medicine, told TODAY.

"This is much higher than last year. The numbers I've been hearing for pediatrics are higher than any point during the pandemic," Dr. Aaron Milstone, pediatric infectious diseases specialist at Johns Hopkins Children’s Center, told TODAY.

"Rates right now are kind of through the roof," he said, and if anything, they're probably undercounting actual cases due to the use of at-home tests. Unlike with tests taken at hospitals or urgent care centers, the results from home tests aren't automatically included in the official state counts.

At this time last year, COVID-19 vaccines were not available to the general public, and adults made up most of the serious coronavirus cases in the country. "Now we're seeing that cases may be more common in children because they remain the under-vaccinated population," Permar explained.

Not everyone is seeing the same jump in pediatric cases, though. "We have not had a bump up (in cases) in my hospital," Dr. Jennifer Lighter, hospital epidemiologist and pediatric infectious diseases specialist at NYU Langone Hassenfeld Children’s Hospital, told TODAY.

The spread of omicron is likely contributing to cases in kids

Not every COVID-19 case is sequenced to find out which variant it is, but the data suggests that omicron is quickly becoming the dominant strain in the U.S.

“In the Baltimore area, we saw our first cases of omicron right after Thanksgiving,” Milstone explained. “And between Thanksgiving and Christmas, it literally just flipped from delta dominating to omicron dominating.” 

Permar, in New York City, agreed: "We assume that most of the cases we're admitting are cases of omicron."

Because cases lag behind exposures and hospitalizations lag behind cases, both Milstone and Lighter expect numbers to continue to increase in the coming weeks.

Permar noted that the increase in pediatric hospitalizations likely isn't because omicron infections are inherently more severe in kids. "The rise in pediatric hospitalizations due to COVID is because of the high numbers of cases in the community and the fact that (children) remain under-vaccinated compared to adults," she said.

Although severe outcomes due to COVID-19 are still rare among children, "the problem with rare outcomes is that as the virus becomes more common, we just see more of those," Milstone said. So even if omicron does turn out to cause milder illnesses overall, with the sheer number of cases climbing, doctors expect to see more hospitalizations as well.

"The number of people coming into our hospital has doubled in just a week," he said, noting that non-COVID hospital procedures are being delayed and staff are also getting sick. "That's a really bad place to be in health care." 

What are the symptoms of the omicron variant in kids?

The symptoms associated with the omicron variant may be similar to those of a mild cold, including cough, fatigue and congestion.

And so far, the symptoms in kids seem pretty close to what we've seen with other variants of the coronavirus. "They're still coming in with fever, sore throat, congestion and cough," Milstone said, adding that a scratchy throat and loss of taste and smell are still common symptoms.

"We're also seeing flu and respiratory syncytial virus, but those numbers are dwarfed by the number of COVID cases," Milstone said. "If there's anyone out there right now who thinks they have a cold, (you should assume) that cold is COVID until proven otherwise."

Kids who are eligible should get vaccinated

The Pfizer-BioNTech mRNA COVID-19 vaccine was authorized for use in kids ages 5 to 11 in early November. But only about 14% of children in that age group are actually fully vaccinated, according to data from the Centers for Disease Control and Prevention. Among kids ages 12 to 17, for whom both the Pfizer vaccine and booster shots are now authorized, about 53% are fully vaccinated.

None of the children hospitalized with COVID-19 in New York City were vaccinated, Bassett said in the briefing.

“They’re not seeing any cases of vaccinated children in the hospital. That just shows how powerful vaccination is,” Dr. Taison Bell, assistant professor of medicine in the divisions of infectious diseases and international health and pulmonary and critical care medicine at the University of Virginia, told NBC’s Sam Brock on TODAY.

The current rates of pediatric vaccination are "unacceptable," Lighter said. "Every child 5 and older needs to get vaccinated."

"Parents, I’m calling on you. This is the time," New York Gov. Kathy Hochul urged in the press briefing, noting that kids can get vaccinated at their pediatrician’s office, state-run vaccination sites, pharmacies and urgent care centers. "Please do this for them. Using this time to get this done is really smart," she said.

In addition to vaccines, we can continue to use a "model of layered strategies " involving masks, distancing and holding gatherings outside to keep kids safe, Milstone said.

Exposures can happen at home

It's important to remember that kids can be exposed to COVID-19 by their parents and other family members.

When looking at data from South Africa, "not only were the kids being hospitalized more likely to be unvaccinated, but also the parents were also often unvaccinated," Permar said. "It's just really an observation that underscores how important it is for parents and all family members around a child — especially a child who's too young for a vaccine — to get vaccinated."

That means those who are eligible should get vaccinated and boosted. Families should also prioritize good airflow (and hold gatherings outdoors, if possible) and continue to wear masks indoors when interacting with people outside the household. Taking these now-familiar precautions to keep yourself safe will also help protect those around you, including children too young to get vaccinated yet.