As the Omicron variant rages across the state, doctors are preparing to see more children end up in the hospital. But so far, kids make up a tiny share of COVID-19 hospitalizations in Massachusetts, and experts see no signs that children are falling more severely ill.
Most children who become infected have mild symptoms or none at all, and those who get severely ill almost always have underlying health conditions that make them vulnerable, such as congenital heart disease, doctors said.
“We are definitely seeing an increase in children testing positive, which is not surprising, because we’re seeing [an increase in] overall rates of people testing positive,” said Dr. Lloyd Fisher, president of the Massachusetts chapter of the American Academy of Pediatrics. “What we’re not seeing is an increase in severity of infection. Most children that are testing positive have no symptoms at all.”
Still, Boston Children’s Hospital, which cares for the region’s sickest children, had 17 with COVID-19 in the hospital this week, up from six on Nov. 23.
Dr. Richard Malley, an infectious disease physician at Children’s, said he’s watching reports from New York and other areas where increasing numbers of children have been hospitalized with COVID.
“We are preparing ourselves for that possibility” in Boston, he said.
“If Omicron continues to rip through the country and the world as it is now, we’re going to see a certain number of very tragic cases where children are suffering from this virus,” Malley said. “Even if kids are at low risk of severe complications, that risk is not zero.”
According to the most recent data from the state Department of Public Health, 41 people younger than age 20 were hospitalized with COVID-19 between Dec. 5 and Dec. 18, just 1.6 percent of total hospitalizations and a slight increase from the 37 reported in the previous two-week period.
In contrast, when comparing the same two time periods, the number of people age 50 to 69 who were hospitalized with COVID nearly doubled, to 919.
So far, doctors don’t know if Omicron affects children differently from previous variants. But because it is so contagious, it’s infecting huge swaths of the population, and some of those people will need hospitalization.
Most children have mild symptoms such as runny noses, congestion, and cough, Fisher said. “These children are not suffering with their disease if they’re vaccinated,” he said.
Dr. Adrienne Randolph, a critical care specialist at Children’s who leads a network of 70 hospitals tracking COVID-19 complications in children, recently asked the network to update her on Omicron’s effects.
“They’re seeing a lot more admissions,” she said. “The numbers are definitely going up, but it’s sort of in the same population — children with underlying medical conditions.”
Healthy kids rarely get very sick from COVID-19, she said.
The most severe disease occurred in unvaccinated patients, Randolph said, and children throughout New England are benefiting from the high vaccination rates.
According to state data, as of Dec. 21, 77 percent of teens age 16 to 19 had received at least one dose of vaccine; 78 percent of those 12 to 15; and 41 percent of children 5 to 11, who were first eligible to receive shots in early November.
Among children, infants in the first year of life and older teens are most at risk of getting sick from COVID-19, Randolph said. If their mothers were vaccinated while pregnant, infants will be protected for months after birth by antibodies passed along from their mothers, and can continue to receive antibodies from breast milk. And although no vaccine has been authorized for children age 1 to 5, they are at the lowest risk of life-threatening disease, Randolph said.
Parents should still try to keep children from getting infected, she advised, by making sure they’re not around unvaccinated people.
Children’s has been full “for weeks and weeks and weeks,” long before Omicron, Randolph said, and the hospital started limiting elective surgeries before the state required it. COVID is just one factor. A big challenge is the “ongoing and severe” crush of young patients in psychiatric crisis waiting for a bed in a psychiatric unit, sometimes for weeks.
“It’s the loneliness and the psychological effects on these children that leads them to getting admitted, and there’s a big shortage of care facilities,” Randolph said.
Now, the Omicron wave is “going to cause a lot of burden again,” she said.
Dr. Daniel Rauch, chief of pediatric hospital medicine at Tufts Medical Center, said Tufts isn’t yet seeing a major increase in COVID hospitalizations among children. But he is expecting to see more cases of a rare but serious condition known as multisystem inflammatory syndrome, in which COVID-19 infection apparently triggers the immune system to attack various organs.
“We’re definitely expecting an increase in that a couple weeks after this surge starts hitting kids, because that’s what we saw last time,” Rauch said.
The hallmarks of multisystem inflammatory syndrome are fever plus one or more of these symptoms: stomach pain, bloodshot eyes, diarrhea, dizziness, skin rash, or vomiting.
While most children who get COVID-19 have mild or no symptoms, Rauch cautioned that doctors are still learning about the disease’s long-term risks for kids, including heart problems and long COVID, a condition in which symptoms such as fatigue and memory loss persist for months after infection.
“You’d still rather not get the disease. If you’re eligible, get the vaccine,” he said.
Pediatricians noted that some hospitalized children who are counted as COVID-19 cases never actually got sick from it; rather, they came to the hospital with another illness or injury and tested positive when they arrived.
They said it’s important to gather more data on those cases of incidental COVID, including tracking how long children are staying in the hospital. A two-day stay likely means mild disease, while a longer stay indicates a rare severe case of COVID in a child.
Last weekend, four children with COVID-19 were hospitalized at Tufts. But only one was admitted because of the virus; the others tested positive after arriving, Rauch said.
“One of the questions that I think we need to ask as more people have an infection [is] how many of the children are in the hospital because they have COVID, and how many are in the hospital for some other reason and then test positive for COVID?” said Fisher.
Felice J. Freyer can be reached at firstname.lastname@example.org. Follow her on Twitter @felicejfreyer. Priyanka Dayal McCluskey can be reached at email@example.com. Follow her on Twitter @priyanka_dayal.