With a record number of children with COVID in Florida hospitals, here are the answers to omicron’s top questions from parents

Florida doctors are seeing an increase in COVID-19 cases and hospitalizations among children, surpassing numbers from any previous wave of the pandemic.

In January alone, more than 150,000 children under the age of 19 tested positive for COVID-19, according to a weekly report from the Florida Department of Health.

On Thursday, there were 242 children under the age of 18 with COVID in Florida hospitals, the most on any other day in the pandemic. The previous high was 227 on August 29, the peak of the delta wave.

Lauren Weber, a South Florida single mother of 12-year-old twins, said that while the new strain seems milder, she’s still concerned. She doesn’t want to take unnecessary risks for herself or her children. “Just being sick and taking care of two kids alone is not fun,” he said.

Conflicting messages are coming in from all directions, confusing parents like Weber about whether the virus is mild to children, whether vaccines make a difference, and whether there is a long-term risk to children contracting COVID-19.

The South Florida Sun Sentinel reached out to two experts to address the pressing questions on parents’ minds during the spread of omicron. They are Dr. Ronald Ford, medical director of Joe DiMaggio Children’s Hospital in Hollywood, and Dr. Sonja A. Rasmussen, professor in the departments of pediatrics and epidemiology at the UF School of Medicine.

This is what you see happening.

photo-credit="Courtesy of Joe DiMaggio Children's Hospital">

Dr. Ronald Ford of Joe DiMaggio Children’s Hospital offers guidance on COVID-19 and children. (Courtesy of Joe DiMaggio Children’s Hospital)

How mild is COVID in children right now?

For some children, omicron is a mild illness that appears with gastrointestinal symptoms such as vomiting and diarrhea or with cold symptoms such as cough or runny nose.

But for others, who end up in Joe DiMaggio, Ford says their respiratory symptoms can be severe, turning into pneumonia. With omicron, the hospital has had a higher overall number of children presenting to the ED with positive results than in previous waves, but a lower number admitted.

“We definitely had more children sick enough to require ICU level of care during the delta surge than we do now,” says the pediatric hospitalist.

Ford says that the crush of parents and children who come to the Emergency Department to get tested in December has lessened somewhat. As of Wednesday, 16 children are in his hospital with COVID compared to 14 on January 3.

Throughout the pandemic, children have had multisystem inflammatory syndrome (MIS-C) as a result of COVID-19, a serious condition in which different parts of the body can become inflamed. Are you still seeing that?

Dr. Ford: We haven’t seen it with omicron yet, but it’s still a bit early to know how it will turn out.

We haven’t seen any reports from Europe of large increases in MIS-C, and they’ve been dealing with omicron longer.

In terms of our own experience, we’re a little early because MIS-C doesn’t show up until four to six weeks after a surge.

Children are at lower risk of serious illness than adults, so do they really need a vaccine?

Drag. Rasmussen: We know that children are at less risk, but they are certainly at risk. I have cared for children for years and when they end up in a hospital, they are very sick. It is a big problem for a child to end up in the hospital. … It’s terrifying for parents and children.

I don’t want to downplay COVID just because it’s less severe in children than it is in adults. About 1,000 children have died of COVID-19, including nearly 100 children ages 5 to 11. Children with underlying conditions, such as obesity, diabetes and asthma, are at the highest risk of severe illness, but about a quarter of COVID-19 deaths among children have occurred in previously healthy children.

The Centers for Disease Control and Prevention recommended the Pfizer vaccine for children over 5 years old, but can they have side effects? What have been the most common side effects in children ages 5 to 11?

Drag. Rasmussen: By the end of 2021, more than 18 million doses of Pfizer’s vaccine had been administered to children and adolescents aged 12 to 15 years.

The vaccine has been shown to be safe and effective in this age group. Side effects in this age group are similar to those seen in adults. They are usually mild and last one to three days.

For younger children ages 5 to 11, side effects include arm pain, fatigue, muscle aches, headache, or fever. These side effects usually go away in a day or two. These are signs that the immune system is responding to the vaccine, so it is ready to face COVID-19 in the future.

Children ages 5 to 11 remain the least vaccinated age group in Florida. What are we seeing in terms of advancement cases in the hospital?

Dr. Ford: It is difficult to understand the numbers because they are so small. I will say that we have patients who are hospitalized with COVID who are vaccinated and unvaccinated.

We have also seen in terms of the unvaccinated a predominance of children under 2 years of age who have tested positive. It’s hard to understand the impact of vaccines from the limited data I have with that population. I cannot give you any meaningful conclusion.

Nationwide, we’ve heard a lot about the increase in pediatric hospitalizations with omicron. Have we seen that trend in Florida?

Dr. Ford: We definitely saw an increase over the last month of children coming into the hospital and certainly those coming in with COVID. We are still seeing a good number of these children being admitted. However, our numbers have been holding back between 6 and 16 COVID patients. About 40% of those who test positive are in hospital for other reasons.

Are you worried about prolonged symptoms of COVID and children, which persist or arise after an initial infection?

Dr. Ford: How COVID will affect children long-term is a big unknown. I have seen reports of adolescents having illness courses similar to what is called prolonged COVID in adults. We don’t have the research to know if children who have omicron are going to respond in the same way.

The CDC recently released new research showing an increased risk of diabetes in children who contract COVID-19. However, it is not yet clear whether post-COVID diabetes is a chronic or temporary condition. What do you think about these findings?

Dr. Ford: In terms of diabetes, our endocrinologists noticed about a year ago that they were seeing a huge influx of new diabetics in their young population, much more than they expected. I know they’re working on a report.

I don’t know if we have an explanation for it. … We still don’t have cause and effect together. We don’t know if it’s really something to do with the virus itself, something that the virus changes, or if schools are closed and kids are generally more sedentary if that has anything to do with it.

Are many babies being born with COVID?

Dr. Ford: Certainly we’ve had a lot of COVID-positive mothers and not all of those babies are positive. We have had a few babies with COVID so far, but most of those babies are not sick. In fact, we have many healthy newborns who test positive.

It has been thought that children do not need to be tested for COVID-19 because their symptoms are mild. What are your thoughts about testing children for COVID?

Dr. Ford: I think it’s appropriate when there is something actionable to do with the result. Certainly, there are symptomatic children who may need to be quarantined if they test positive. That’s a wonderful reason to try them. I don’t know if it’s necessary to test children who were exposed if they don’t have symptoms.

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UF pediatrics expert Dr. Sonja Rasmussen answers questions about children and COVID vaccines

UF pediatrics expert Dr. Sonja Rasmussen answers questions about children and COVID vaccines

Some people who received vaccines have had myocarditis. What do parents need to know?

Drag. Rasmussen: Myocarditis is an inflammation of the heart muscle that is a very rare condition caused by mRNA (Pfizer and Moderna) COVID-19 vaccines.

We now have information on millions of adolescents who have received the Pfizer vaccine. In the highest-risk group (men ages 18 to 26), the chance of getting myocarditis is about 1 in 10,000 to 20,000. The chance of getting myocarditis from a COVID-19 infection is greater than the chance contracting it from the vaccine.

Compared to adults and adolescents, how well does the COVID-19 vaccine work in children ages 5-11?

Drag. Rasmussen: The dose of the vaccine for children 5 to 11 years of age is one-third that used in adolescents and adults.

This dose was shown to generate a strong immune response, as measured by antibodies one month after the second dose of the vaccine.

The results were similar to those seen in people ages 16 to 25 who received the highest dose of the adult vaccine.

It is not necessary to order a different dose based on your child’s weight. For some drugs (such as Tylenol), a child’s dose is calculated based on their weight, but that is not required for this vaccine. Drugs typically work by entering the bloodstream, while a COVID vaccine works by generating an immune response at or near the injection site.

If my child takes medication for post-vaccine side effects, will that lower the level of immunity that develops?

Drag. Rasmussen: It is not recommended that you give your child a pain reliever before receiving the COVID-19 vaccine to prevent side effects.

Talk to your doctor about what medications your child can take for pain or discomfort after receiving the COVID-19 vaccine.

If a child has had a previous COVID infection, will that protect them from future infection? Is it still necessary to get vaccinated?

Drag. Rasmussen: Children who have had COVID in the past will get some protection, but it seems like it’s not strong protection.

Vaccines offer the best protection and a booster offers the best protection.

If your child has had COVID, it is important to get them vaccinated because it is unlikely that they still have enough immunity to protect against omicron.

Is there anything you can say to parents who are hesitant about getting their young children vaccinated?

Dr. Ford: My thought is that we don’t know what the next phase of this pandemic will look like, and we certainly haven’t gotten through it. The vaccine has been shown to be safe and effective. I think the risk of getting COVID, especially future variants that we don’t know how they will affect children, is greater than the risk of getting the vaccine, which is almost zero by the way.

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