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

Sun Sentinel logoSun Sentinel 1/22/2022 Cindy Krischer Goodman, South Florida Sun-Sentinel

Florida’s doctors are seeing a surge of 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 18 and under with COVID in Florida hospitals, the most of any other day of the pandemic. The previous high was 227 on Aug. 29, the peak of the delta wave.

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

Mixed messages are coming from all directions, confusing parents such as Weber about whether the virus is mild for children, whether vaccines make a difference and whether there’s a long-term risk for children who get 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, chief medical officer at Joe DiMaggio Children’s Hospital in Hollywood, and Dr. Sonja A. Rasmussen, a professor in the departments of pediatrics and epidemiology at the UF College of Medicine.

Here is what they see happening.

How mild is COVID in children at this time?

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

But for others, who end up admitted at Joe DiMaggio, Ford says their respiratory symptoms can be severe and become pneumonia. With omicron, the hospital has had an overall higher number of children coming to the Emergency Department who test positive than in prior waves, but a lower number admitted.

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

Ford says the December crush of parents and children coming to the Emergency Department to get tested has subsided some. As of Wednesday, 16 children are in his hospital with COVID compared to 14 on Jan. 3.

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

Dr. Ford: We haven’t seen it yet with omicron but it’s still a little bit early to know how that’s going to pan out.

We haven’t seen reports from Europe about big surges of MIS-C, and they’ve been dealing with omicron longer.

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

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

Dr. Rasmussen: We know kids are at lower risk but they certainly are not at no risk. I have taken care of kids for years and when they end up in a hospital, they are very sick. It’s a big deal for a kid to end up in the hospital. ... It’s scary for parents and children.

I don’t want to downplay COVID just because it’s less severe in children than adults. Around 1,000 kids have died of COVID-19, including nearly 100 children ages 5-11 years. Kids with underlying conditions such as obesity, diabetes and asthma are at the highest risk for severe disease but about one-quarter of COVID-19 deaths among children were in previously healthy children.

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

Dr. Rasmussen: At the end of 2021, over 18 million doses of the Pfizer vaccine had been given to children and teens ages 12 to 15.

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 typically mild and last one to three days.

For younger children 5 to 11, side effects include a sore arm, 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 tackle COVID-19 in the future.

Children 5 to 11 still remain the least vaccinated age group in Florida. What are we seeing as far as breakthrough cases in the hospital?

Dr. Ford: It’s hard to make sense of 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 unvaccinated a predominance of children 2 and under who have tested positive. It’s hard to make sense of the impact of vaccinations from the limited data I have with that population. I can’t give you any meaningful conclusion.

Nationally we have heard a lot about pediatric hospitalizations rising with omicron. Have we seen that trend in Florida?

Dr. Ford: We definitely saw an increase over the last month of children coming to the hospital and certainly those coming in with COVID.

We are still seeing a fair number of these kids being admitted.

However, our numbers have been holding between 6 and 16 COVID patients.

About 40% of those testing positive are in the hospital for other reasons.

Are you concerned about long COVID and children, symptoms that linger or arise after an initial infection?

Dr. Ford: It is a big unknown how COVID is going to affect kids over the long term.

I’ve seen reports of adolescents who have had similar courses of illness to what’s being called long COVID in adults.

We don’t have the research to know if children who have omicron are going to respond the same way.

The CDC recently unveiled new research showing an increased risk for diabetes in children who contract COVID-19. However, it is not clear yet, 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 noted about a year ago that they were seeing a large influx of new diabetics in their young population, much higher than what they expected. I know they are working on a paper.

I don’t know that we have an explanation for it. ... We don’t have the cause and effect put together yet. We don’t know whether it’s truly something with the virus itself, something the virus changes or whether with schools being closed and kids being generally more sedentary if that had something to do with it.

Are a lot of babies being born with COVID?

Dr. Ford: Certainly, we have had a lot of COVID positive moms deliver and not all those babies are positive. We have had some babies with COVID so far, but most of those babies are not sick. In fact, we have a lot of healthy newborns that test positive.

There has been some thought that children don’t 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 kids that are symptomatic who may need to be quarantined if they test positive. That’s a wonderful reason to test them. I don’t know that testing kids who had an exposure if they don’t have symptoms is necessary.

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

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

We now have information on millions of teens who have received the Pfizer vaccine. In the group with the highest risk (males 18-26 years), 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 higher than the chance of getting it from the vaccine.

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

Dr. Rasmussen: The dose of the vaccine for children ages 5-11 years is one-third of what is used in adolescents and adults.

This dose was shown to result in a strong immune response, based on the measurement of antibodies one month after the second dose of vaccine.

The results were similar to those seen in people 16-25 years of age who received the higher adult dose of the vaccine.

There is no need to ask for a different dose based on your child’s weight. For some medications (such as Tylenol), a dose for children is calculated based on their weight but that is not necessary for this vaccine. Typically medications work by entering the bloodstream, while a COVID vaccine works by making an immune response at or near the injection site.

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

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

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

If a child has had a previous COVID infection, will that protect him or her from a future infection? Is there still a need to get vaccinated?

Dr. Rasmussen: Kids who have had COVID in the past will get some protection, but it appears not strong protection.

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

If your child had COVID, it’s important to get them vaccinated because it’s unlikely they have enough immunity still around to protect against omicron.

Is there anything you can tell parents who are on the fence about getting their young kids vaccinated?

Dr. Ford: My thought is that we don’t know what the next phase of this pandemic will look like, and we certainly are not over 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 just about zero by the way.

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

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