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Hospitalizations of virus-hit kids under 5 way up

Illness in youths too young for vaccine worries doctors by Compiled Democrat-Gazette Staff From Wire Reports | January 8, 2022 at 5:34 a.m.
A Sri Lankan school student receives her first COVID-19 vaccine from a health worker in Colombo, Sri Lanka, Friday, Jan. 7, 2022. Sri Lankan health authorities starting to inoculate the children in the age group of 12 to 15 in it’s latest effort to contain the spreading of COVID-19 as the island nation’s top medical specialists warned of a massive wave of infection driven by the Omicron variant in the coming weeks. (AP Photo/Eranga Jayawardena)

Hospitalizations of U.S. children younger than 5 with covid-19 soared in recent weeks to their highest level since the pandemic began, according to government data released Friday on the only age group not yet eligible for the vaccine.

The worrisome trend underscores the need for older kids and adults to get their shots to help protect those around them, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention.

Since mid-December, with the omicron variant spreading furiously around the country, the hospitalization rate for these youngest kids has surged to more than 4 in 100,000 children, up from 2.5 per 100,000.

The rate among children ages 5-17 is about 1 per 100,000, according to CDC data, which is drawn from more than 250 hospitals in 14 states.

Overall, "pediatric hospitalizations are at their highest rate compared to any prior point in the pandemic," Walensky said.

She noted that just over 50% of children ages 12-18, and only 16% of those 5-11, are fully vaccinated.

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The rise has been noticeable at a number of regional medical centers. The hospitalizations of young children now are "blowing away our previous delta wave at the end of the summer, early fall, which had been our highest prior to that," said Dr. Danielle Zerr, a pediatric infectious diseases expert at Seattle Children's Hospital.

At least part of the increase is a reflection of omicron's surge across all age groups. The nation is now recording roughly 600,000 cases per day, about 1 in 5 of them in children.

"The more kids that get infected, the more you're going to have kids who are going to be sick enough to be hospitalized," said Dr. Yvonne Maldonado, chairperson of the committee on infectious diseases at the American Academy of Pediatrics and a physician at Stanford University.

At Seattle Children's, for example, about 21% of children are testing positive, compared with the average of about 1% and a high during the delta wave of about 3%.

"That is just a game-changer," Zerr said of the recent figures.

One alternative hypothesis for the rise may be that young children are particularly vulnerable to infections in the upper airway -- exactly where omicron is thought to be more concentrated in comparison with other variants.

"They're smaller; their airways are smaller," Dr. Kristin Oliver, a pediatrician at Mount Sinai Hospital in New York, said of young children.

"It does seem reasonable in a disease that if it looks like it's affecting the upper airway more, that they would be more impacted," she said. "They are more at risk for that -- for longer, prolonged cases, as well as the hospitalization that can come along with a more severe case."

The overall hospitalization rate among children and teens is still lower than that of any other age group. And they account for less than 5% of average new daily hospital admissions, according to the CDC.

As of Tuesday, the average number of under-18 patients admitted to the hospital per day was 766, double the figure reported just two weeks ago.

The trend among the very youngest kids is being driven by high hospitalization rates in five states: Georgia, Connecticut, Tennessee, California and Oregon, with the steepest increase in Georgia, the CDC said.

At a briefing, Walensky said the numbers include children hospitalized because of covid-19 and those admitted for other reasons but found to be infected with covid-19.

The CDC also said the surge could be partially attributable to how virus hospitalizations in this age group are defined: a positive test within 14 days of hospitalization for any reason.

The severity of illness among children during the omicron wave seems lower than it was with the delta variant, said Seattle Children's Hospital critical care chief Dr. John McGuire.

"Most of the COVID+ kids in the hospital are actually not here for COVID-19 disease," McGuire said in an email. "They are here for other issues but happen to have tested positive."


The nation's top infectious-disease expert, Dr. Anthony Fauci, said this week that omicron appears to cause less-severe disease across the board, but that the sheer number of infections because of its extreme contagiousness will mean that many more children will get infected, and some of them will wind up in the hospital.

Fauci also said many children hospitalized with covid-19 have other health conditions that make them more susceptible to complications from the virus. That includes obesity, diabetes and lung disease.

Fauci and Walensky have emphasized that one of the best ways to protect the youngest children is to vaccinate everyone else.

The surge in hospitalizations is heightening some parents' worries.

Emily Hojara and Eli Zilke of Sawyer, Mich., are being extraprotective of their daughter Flora, who turns 2 in May. They limit her contact with other children, and no visitors are allowed in the house unless masked, not even grandparents.

"It's been a struggle, and now with this new variant, I feel it's knocked us back," Hojara said.

"It's scary that she can't be vaccinated," she said of her daughter.

Dr. Jennifer Kusma, a pediatrician with Chicago's Lurie Children's Hospital, said she has seen increasing numbers of kids hospitalized with omicron, and while most aren't severely ill, she understands parents' worries.

"I really wish we already had that vaccine for these young kids," Kusma said. But she added that what may seem like a long wait should reassure parents that testing is not being rushed.

Many had hoped the new year might bring a vaccine for young children, but Pfizer announced last month that two doses didn't offer as much protection as hoped for in youngsters ages 2-4.

Pfizer's study has been updated to give everyone younger than 5 a third dose, and data is expected in early spring.

Also Friday, the CDC issued a report showing that Pfizer shots seem to protect older children who develop a serious but rare covid-19-linked condition that involves inflammation of multiple organs.

Among 102 youths ages 12-18 who were hospitalized with the condition, none who had received two Pfizer shots at least 28 days earlier needed a ventilator or other advanced life support. By contrast, 40% of unvaccinated children required such treatment.

The condition, multisystem inflammatory syndrome, causes symptoms that may include persistent fever, abdominal pain and rashes. Most children recover, but 55 deaths have been reported.

Another CDC report found that children who had covid-19 were more than twice as likely to be diagnosed with diabetes as youngsters who had not had the virus. Scientists are investigating why but say the virus seems to attack insulin-producing cells in the pancreas.


Also Friday, U.S. regulators shortened the time that people who received Moderna's vaccine have to wait for a booster -- to five months rather than six.

The two-dose Moderna vaccine is open to Americans ages 18 and older.

The Food and Drug Administration and the CDC concurred in the decision, which is in line with the recommendation for recipients of the Pfizer vaccine.

Initial Pfizer shots are open to anyone 5 or older, but only recipients 12 and older are eligible for boosters, and this week U.S. health authorities said they can get a booster five months after their last shot.

In a statement, FDA vaccine chief Dr. Peter Marks called vaccination "our best defense against covid-19" and said a shortened wait for a booster may help as the country battles a surge of the omicron variant.

For the single-dose Johnson & Johnson vaccine, a booster is urged two months after receiving the shot.


Meanwhile, White House officials are working on a request to Congress for an additional covid-related health spending package as the nation continues to battle the pandemic, three people with knowledge of the matter said.

The administration says no formal request is imminent and that it has sufficient funds to respond to the omicron surge.

But officials in the White House Office of Management and Budget and the Department of Health and Human Services have started putting together a longer-term funding request that is expected to seek tens of billions of dollars more, likely centered on covid therapeutics and ramping up vaccine distribution, the people said.

The request is also expected to include money to assist in global vaccination efforts. The people spoke on condition of anonymity to share details of a plan not yet finalized.

The White House has not said how much it currently has left in health funding to respond to the pandemic, and budget experts say accurate estimates are impossible given publicly available figures.

But the administration officials said White House aides believe an additional funding request to Congress is probably necessary in the coming weeks as the pandemic proves more persistent and deadly than the administration had hoped.

The decision may prove politically fraught for the administration, which has faced a backlash over lack of preparedness in testing, in particular as omicron caused cases to surge across the country. The Washington Post reported Thursday that the administration and the U.S. Postal Service are finalizing plans to ship tests to households as soon as next week.

Asked for comment, an Office of Management and Budget official said the administration has sufficient funding for its "immediate needs" and has nothing further to report about an additional request from Congress.

With health officials increasingly resigned to the reality that the coronavirus will not be eliminated easily by widespread vaccinations, the White House is hoping that therapeutics will help contain the harms.

The administration last year spent more than $5 billion to purchase 10 million courses of Pfizer's antiviral pill regimen, Paxlovid, which works to keep infected patients out of the hospital.

President Joe Biden this week announced that the government would purchase 10 million more courses of the easy-to-use treatment, to be delivered by the end of September, although health officials worry that the total need will surpass the supply.

Administration officials also have looked to ramp up global vaccinations, seeking to head off the possibility of more variants emerging overseas and ravaging the world. More than 3 billion people around the globe have yet to receive a single dose of vaccine, according to data compiled by the University of Oxford's Our World in Data project.


The omicron variant is scrambling the outlook for the global vaccine supply this year, increasing pressure on manufacturers to accelerate production to meet surging demand for booster shots and close the gap between rich and poor nations.

Spiking demand for boosters in wealthy countries -- especially for Pfizer-BioNTech and Moderna, which are considered the most effective vaccines -- will make it all the more difficult for the global south to catch up to wealthier nations anytime soon, advocates and experts said.

And yet the large numbers of people in the developing world who remain unvaccinated make it all the more likely that the coronavirus can mutate and develop new variants, they said.

"We're already seeing countries change approach to their booster rollout. That takes a toll on current supply," said Louise Blair, lead analyst at Airfinity, a British consulting firm that tracks manufacturing data.

The pharmaceutical industry trade group, PhRMA, has pointed to overall global supply as a sign of international success. As of Monday, 9.2 billion shots have been given worldwide.

But global health experts say far more shots are required.

Giving 70% of the world's 8 billion people two shots will require 11 billion shots. Adding a third shot or booster pushes that target to at least 16 billion shots. Moreover, not all shots provide a strong response, particularly against omicron.

Nearly half of all global vaccinations delivered so far are made by Chinese manufacturers. Those shots -- Sinovac and Sinopharm -- are proving much less effective than Pfizer-BioNTech and Moderna's mRNA vaccines against the new variant.

A consortium of advocates and academics Wednesday said the world needs 22 billion shots of mRNA vaccines in 2022 to stem the pandemic -- a threshold that is not achievable under current projections.

"We're in for a rough road," said C. Sola Olopade, a physician, dean of academic affairs and director of international programs at the University of Chicago Pritzker School of Medicine.

"As long as there is this disparity and inequity in being able to vaccinate the whole world, we all are not going to be safe, because this virus is going to keep mutating and we won't be able to predict how dangerous the next mutant is going to be."

Information for this article was contributed by Lindsey Tanner, Mike Stobbe, Carla K. Johnson and additional staff members of The Associated Press; by Apoorva Mandavilli of The New York Times; and by Jeff Stein, Tyler Pager, Dan Diamond and Christopher Rowland of The Washington Post.

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