Omicron shows signs of being the first variant of the COVID-19 pandemic to cause less severe illness than prior strains—for adults. But differences in this iteration of the virus are proving problematic for children, and compounding symptoms from other winter bugs that plague schools.
A new study released by the Centers for Disease Control and Prevention compared COVID-19 illnesses driven by the most recent omicron variant with those driven by the delta strain this fall and alpha and other strains that were common during outbreaks last winter. While omicron has led to a rise in infections, adults have seen lower ratios of deaths, emergency room visits, and hospitalizations compared to infection rates, and those hospitalized with omicron have had shorter stays and lower risk of needing intensive care. That may suggest COVID-19 will finally follow the evolutionary trend of viruses becoming both more common and less severe over time.
The picture is muddier for those 17 and younger, though. While children and adolescents still comprise less than 15 percent of all COVID-related emergency room visits and little more than 4 percent of all hospitalizations from the coronavirus, both emergency visits and hospitalizations have risen faster for children than adults during omicron.
In part, omicron outbreaks and related hospital visits have spiked because children and adolescents continue to lag adults in getting vaccinated, leaving them more vulnerable to a more infectious strain. Omicron is proving twice as contagious as the delta strain—which itself is estimated to be 80 percent to 90 percent more transmissible than the alpha strain that dominated last winter.
That means a person infected with the most common virus causing COVID-19 in January 2021 infected about 3.5 other people on average, while someone infected with the most common strain this January could infect seven or more people. To put that in context, omicron is about as contagious as the mumps, and nearly six times more contagious than the seasonal flu.
But omicron also affects children differently than other strains, in ways that leave them more vulnerable to other seasonal bugs moving through schools now.
Schools should not neglect traditional health supports
In particular, more children are coming to emergency rooms seemingly for other illnesses—including seasonal illnesses like flu and respiratory syncytial virus, or RSV—only to show underlying COVID-19 infections that complicate their recovery.
“Omicron variant appears to be harbored more frequently in the upper respiratory tract, and any virus with a preference for upper respiratory-tract inflammation causes more issues for children with smaller airways,” said Dr. Ibukun Kalu, an assistant professor of pediatric infectious diseases at Duke University, who studies schools’ efforts to prevent outbreaks.
“We know all the protective mitigation protocols that were in place—masking, social distancing, hand hygiene, et cetera—actually did a lot in 2020 to decrease significantly the amount of respiratory disease that we were seeing from other viruses, whether it was flu, RSV, parainfluenza, and [the common cold],” said Dr. Tina Tan, a pediatric infectious disease doctor at Lurie Children’s Hospital in Chicago and a professor of pediatric infectious disease at Northwestern University. “Once these measures were relaxed, we really started to see increases in the number of viral infections caused by these other viruses.”
The American Academy of Pediatrics has recommended doctors couple flu and COVID-19 vaccines for children, in part because the two respiratory illnesses share so many symptoms among children, including: fever and chills; cough; shortness of breath; body aches; tiredness; sore throat; runny or stuffy nose; and headaches. As of November, only about 1 in 3 children between 6 months to 17 years of age had been vaccinated against seasonal flu.
Kalu said many school districts she works with have responded to omicron-related outbreaks by socially distancing and encouraging students and staff to wear higher-quality masks, but only a few districts have increased broader vaccination drives that go beyond COVID-19.
Tan agreed, noting that while more school districts adopted systemic COVID-19 testing this school year, fewer schools nationwide have held “wellness days” for vaccinations and health screenings during the pandemic. She advised district leaders to ramp up school-based health supports, which research suggests boosts flu vaccination rates.
“People need to remember there are common viruses that continue to circulate besides coronavirus, and they could cause a significant number of kids to be sick,” Tan said.
