Covid-19 hospitalizations among children in the US are soaring, fueled by the Omicron variant and the holidays, and adding pressure to already-strained health systems and schools.
An average of 672 children were being hospitalized every day in the US, as of 2 January - more than double the average just a week before. And the rate is rapidly increasing.
Cases are also rising. There were more than 325,000 new cases among kids in the week ending 23 December, a 64% increase from the previous week and nearly double the cases two weeks earlier, the American Academy of Pediatrics reported on Monday.
The increases appear to be driven by the more contagious nature of the Omicron variant and low vaccination rates among children over the age of five years old. As with adults, early evidence appears to show that Omicron also largely causes mild illness in kids.
Nonetheless, experts are urging the use of every possible precaution, including tests, masks, vaccinations and even temporary delays in reopening schools to curb both cases and staff shortages.
“We have about four times as many children admitted currently as we have had in any other wave,” Dr Elaine Cox, the chief medical officer for Riley Children’s Health in Indiana, told reporters on Tuesday.
They are also seeing the severity rise among the children who are admitted to the hospital, Cox said. “So there are more of them, and they are sicker.”
More than half the hospitalized children have had to spend time in the intensive care unit, and at least 40% of those kids need to be put on a ventilator, she said.
More than 1,000 kids have died in the US from Covid during the pandemic so far, according to data from the Centers for Disease Control and Prevention (CDC). More than 830,000 people have died in the US from Covid so far.
In New York, hospitalizations among kids quadrupled. In Washington DC, children’s hospital admissions have roughly doubled. In Texas, children’s hospitalizations were described as “staggering”. In Alabama, cases were “like a rocket ship”. In Louisiana, one doctor said: “We’ve never seen anything like it.” In Ohio, one associate professor of internal medicine and pediatrics critical care recently told ABC news: “We’re on fire.”
Hospitals are shooting past the peaks of previous surges, many of them driven by the Omicron variant. In South Africa, children and teens accounted for 17% of hospital admissions during the Omicron wave, compared to 4% during the second wave and 3.5% during the third, which was fueled by the Delta variant.
Cox said she had also seen a sharp uptick in cases among pregnant people and newborns.
In addition to Covid, hospitals are also seeing a dangerous wave of RSV (respiratory syncytial virus) and the flu this year, creating a triple threat of respiratory illness.
At the same time, health workers are also getting breakthrough infections with Omicron, creating staff shortages. “We have significant numbers of our staff who are becoming ill with Covid, so they can’t work,” Cox said. Indiana is one of the states calling in the national guard to help with hospital care and logistics.
School systems across the country are also balancing soaring cases, among students and staff, and weighing virtual options. Leaders of Chicago public schools, the country’s third-largest school network, canceled classes on Wednesday after the teachers’ union voted to switch to remote learning due to the surge in Covid cases.
In late December, Joe Biden urged the widespread use of tools to combat the virus, including tests and vaccines. “We can keep our K-through-12 schools open, and that’s exactly what we should be doing,” he said.
In Washington DC, which has some of the highest rates of Covid in the country, all students and staff are now required to take a rapid test before returning to school – one of the few districts in the country with this requirement.
But schools in neighboring Montgomery county, Maryland, which has also been hit hard with new cases and hospitalizations, are recommending, not requiring, tests for students and staff. Tests have been difficult to find in many places.
“We have tools now that we didn’t have last year, that will allow us to keep schools open if we deploy those tools in the best possible way,” said Brian Castrucci, who is the president and CEO of the de Beaumont Foundation, a former state and local health official, and the parent to school-aged kids in Montgomery county.
“We’re dealing with trying to make sure that schools are operational, that there are enough bus drivers, there are enough teachers,” Castrucci said.
Educators and health officials worry that a return to school during a time of unprecedented spread could lead to the involuntary closure of schools due to staff shortages and contribute to rising cases, especially in places that aren’t able or willing to institute precautions.
“It is mind-boggling some states have a [mask] mandate ban, or do not do enough to keep our kids safe,” said Tony Yang, executive director of the Center for Health Policy and Media Engagement at George Washington University, who has researched mask mandates in schools.
Yang strongly favors in-person school with precautions in place. “Students should go to school in person,” he said. “But you have to do that safely.”
In places where cases are particularly high, even where some precautions are in place, schools could choose to extend winter break to avoid staff shortages during the worst of the January peak, Castrucci said.
“The number one thing is, we have to use every resource we have to keep kids in school in person over the long term,” he said. “And right now, we have to make a risk calculation as to whether this is the right moment to bring kids back from the holiday.”
Vaccines are another key tool, said Diego Hijano, a pediatric infectious disease doctor at St Jude children’s research hospital in Memphis, Tennessee.
“Vaccination matters in terms of hospitalization and outcomes,” he said. Most of the hospitalized kids around the country are unvaccinated, and Hijano had not seen a vaccinated child hospitalized for Covid – even though he works with many children who are at risk because of other medical conditions.
Hospitals overwhelmed by Covid can lead to worse care and outcomes for children suffering from other causes, he said.
“If a kid has appendicitis and needs a bed for the surgery, they may not get it because the hospital is flooded with Covid,” Hijano said.
“As a country and society, we shouldn’t allow even one death that could be prevented.”
