Since the pandemic began, the fact that the coronavirus generally causes milder illness in children has been one constant piece of good news. Serious cases among children are quite rare, mortality even more so. This is also true of omicron; at least so far, there is no medical evidence that the variant causes more violent or dangerous illness in children – or adults – than that caused by the previous variants.
However, infection among children is raising concerns among senior health care officials. Due to the nature of the current infection wave – and primarily omicron's increased infectiousness and rapid spread – the Health Ministry directed hospitals this week to prepare for a spike in the number of children in their COVID wards.
Because most of them are not vaccinated, and due to the close contact they have with their peers in schools and programs, children are the population that is most vulnerable to infection. Even before omicron, children constituted 60 percent of confirmed coronavirus cases in recent months. But most kids fair the waves of infection more easily than adults, and until recently, Israel registered just hundreds of new cases per day. That meant that the pediatric upswing in infection did not make it to the hospital doors.
But this picture is changing rapidly with the new spike in infections. Over the past few days, about one third of those who tested positive for the virus – about 1,300 cases – are children. In Israel there are currently more than 2 million children aged 0 to 18 years. Of these, 730,000 are under 5 years old, and are therefore ineligible for inoculation. This leaves them particularly vulnerable, and even a fraction of a percentage of risk of hospitalization may greatly increase their presence in COVID wards in the event of a mass infection.
Recent figures in countries that are ahead of Israel in the omicron wave show an increase in pediatric hospitalization. A document published by the New York health authorities reported a fourfold rise in such hospitalizations within three weeks. According to the report, about half the children hospitalized were aged 0–5, who are not eligible for vaccination. The data shows that no inoculated children between the ages of 5 and 11 were hospitalized (although only 16 percent of this age group was vaccinated), and in the 12–17 age group, 77 percent of those hospitalized had not been vaccinated.
However, these figures do not differentiate between children hospitalized due to COVID and children who were brought in for other reasons and then tested positive for the virus. Britain and South Africa both reported more pediatric hospitalizations. Doctors interviewed in the American media recently said they are encountering unprecedented numbers of confirmed pediatric COVID cases, but that most of these cases were mild and resembled a common cold.
Dr. Michal Stein, head of the infection diseases unit at Hillel Yaffe Medical Center and chairwoman of the pediatric infectious disease unit, said that children and teenagers experience mass infection at the beginning of these waves, and fewer of them are hospitalized. "Only in the next phase does it reach the older population, and then there’s a problem.”
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She added, “South Africa, the central site of omicron, was the first to report an increase in baby and child hospitalizations up to age 5, and now we're seeing a similar picture play out in Britain and the United States. We are seeing this rise mostly in children aged 0 to 5, who are not vaccinated. This group was not inoculated in the previous waves either, in which we did not see a dramatic rise in child hospitalizations. The variant may cause increased illness in toddlers, like other winter viruses, but the reason is probably because omicron is much more infectious, and the number of those infected is higher, and therefore more extreme cases reach hospitalization."
Widespread coronavirus infection among children is not a new phenomenon for Israel. In September, more than 100,000 cases were diagnosed among children, but they did not lead to a number of hospitalizations that put pediatric units at risk. From the beginning of the pandemic through November, only 398 children were hospitalized in moderate, serious or critical condition. According to a position issued by the Israel Pediatric Association, there is a 1 in 900 chance that a child with COVID will be hospitalized for the disease at any level of severity. The risk of hospitalization due to severe illness from COVID is about two times lower for children than the general population.
But the number of children infected with the omicron variant might be much higher, and some experts believe it will change the balance of hospitalizations. One forecast from a document by the Hebrew University’s pandemic monitoring team a few days ago states that beginning in the last third of January 2022, children ages 0–5 will constitute about 4 percent of seriously ill patients – a much higher rate than seen so far. “Treatment of children is different. In Israel there are about 150 pediatric intensive care beds, most of which are taken. And so the big question is what quantity do we expect to be able to handle when it comes to children,” says Prof. Doron Gazit, a member of the Hebrew University monitoring team.
On Sunday, the Health Ministry called on hospitals to prepare for an increase in infection among children, including preparing staff and beds in wards. The preparations call for them to be ready for more children admitted for other reasons but who are also found to have COVID, who must be hospitalized according to coronavirus patient guidelines, including isolation.
However, the hospitals are not necessarily preparing for serious illness. “There is no solid evidence that the current wave will be more significant among children,” says Prof. Efi Bilavsky a specialist in pediatric infectious diseases at Schneider Children’s Medical Center of Israel.“During the past year and a half, there were a few reports of increased hospitalizations, but my sense was that it is the same and omicron doesn’t cause serious illness, but very mild illness.”
According to Bilavksy, "very few children were admitted [to Schneider] due to COVID, and the few who were – most if not all of them had significant underlying conditions, and any respiratory virus would have knocked them to the ground."