Why COVID-19 hospitalizations of Canadian kids — and infants — could keep rising as Omicron spreads
Uptick in admissions tied to fast spread, while respiratory infections linked to variant may hit kids harder
Kids and teens — and even newborns — are now among the rising number of Canadians being hospitalized with COVID-19 as Omicron infections keep surging across the country to unprecedented levels.
Multiple hospitals recently began seeing an uptick in young patients infected with the coronavirus, CBC News has learned, including some of the country's largest pediatric facilities in British Columbia, Ontario, and Quebec.
And on Wednesday, several Ontario hospitals issued a public service announcement stating that between two pediatric sites in Ottawa and Hamilton, six infants had been hospitalized for COVID-19 infections since mid-December, despite the previous rarity of infant admissions.
To be clear, medical experts still stress that COVID-19 remains a mild illness for the vast majority of children; the rise in hospitalizations among youth is likely tied, at least in part, to this variant's uncanny ability to simply infect more people.
However, some physicians are also seeing early signals that Omicron's infection pattern — often impacting the airways more than the lungs — may hit some kids harder than adults.
"The biggest difference is that Omicron is much more respiratory, so kids are presenting with cold-like symptoms, where before it was fever and maybe some gastrointestinal in the earlier waves," pediatric infectious diseases specialist Dr. Fatima Kakkar, of Montreal's Sainte-Justine Hospital, told CBC News.
"Now we're seeing kids, for example, with asthma. Their asthma is getting worse and bringing them into hospital."
Kakkar's hospital, the largest mother-and-child healthcare centre in Canada, reopened its pediatric COVID-19 ward a few weeks back. The team is now seeing admissions on a daily basis, with double the number of patients as the same time last year, she said.
"We're way higher than we were previously. Part of that is because there are so many cases in the community that kids are coming in — some with COVID, some for other reasons — and we're screening COVID on admission," Kakkar explained.
"In previous waves, babies were essentially unaffected by COVID," she continued. "But now we're seeing newborns. So in that first 30 days of life, significant disease."
Omicron linked to respiratory symptoms
The trend of Omicron targeting the airways of both adults and children is evident both in the real world and in laboratory studies, noted Dr. Syra Madad, senior director of special pathogens for the New York City Health System.
"This is where you're seeing more nasal congestion, sore throat — those types of classic influenza-like illness signs and symptoms — than the lower respiratory symptom," she said.
For many healthy, vaccinated adults, a virus that doesn't ravage the lungs often means a less severe course of illness than during previous waves of this pandemic. But Madad stressed it's a different story for kids.
WATCH | Physician explains why some kids might be 'harder hit' by Omicron infections:
"For children, when we see upper respiratory illnesses, they tend to do worse than adults, because it affects them more," she said.
"And so when you look at influenza, when you look at RSV, and you look at some of these other respiratory viruses that are much more common that you see in children ... they take a harder hit, unfortunately."
Those real-world observations follow recent laboratory research, including early findings from American and Japanese scientists that rodents infected with the Omicron variant had reduced lung disease compared to earlier variants — while Hong Kong lab work showed this new form of the virus replicates slower in lung tissue than the original strain, but roughly 70 times faster in the tissue of human airways.
"I think it's going to unfortunately, disproportionately, affect the pediatric population," Madad said.
"But again, we're still so early in this Omicron wave that it's really hard to tell heads from tails of what we're going to actually expect to see because things are still very preliminary."
Uptick in child COVID-19 admissions
In Ontario, where more than 2,000 people of all ages are now hospitalized with COVID-19, the Hospital for Sick Children is among the Canadian facilities already experiencing an uptick in pediatric patients.
Also known as SickKids, the downtown Toronto hospital had fewer than five patients admitted with coronavirus infections a month ago, but that tally hit 14 by Wednesday, including four cases where the infection wasn't their reason for being admitted.
In general, pediatric patients admitted with COVID-19 are "experiencing mild illness and have been admitted for management of symptoms such as fever and dehydration," a SickKids spokesperson said in a statement.
A source with knowledge of recent admissions at the B.C. Children's Hospital in Vancouver, who couldn't comment publicly, said COVID-19 admissions there are also "going up, marginally," compared to recent months before the Omicron surge.
Dr. Jesse Papenburg, a pediatric infectious disease specialist at Montreal Children's Hospital, said his facility is at "peak level," with many children testing positive for the coronavirus during admissions for other conditions.
COVID-19 infections aren't typically severe in kids, "but it's the context of being a newborn or a very young baby, especially during the first month of life, that warrants hospitalization for any fever," Papenburg said.
In the case of multiple infants recently hospitalized for COVID-19 infections at several Ontario hospitals, the Children's Hospital of Eastern Ontario in Ottawa said babies are particularly at risk given their immature immune systems. All six infants were also from unvaccinated mothers, the hospital noted, so they "do not have the protection of maternal antibodies transferred during the third trimester of pregnancy."
Recent Ontario data shows children ranging from newborns to four-years-old — an age group that doesn't yet have an approved vaccine — are the highest hospitalization level of any youth.
As of Wednesday, 38 infants and toddlers had been hospitalized with COVID-19 over the most recently-available two week period, compared to 15 hospitalized kids and teens.
'Alarming' rise in U.S. hospitals
The experience in U.S. hospitals offers a warning to Canada of the potential for an outsized impact on kids, though vaccination rates among American youth do remain lower than the Canadian average, leaving a higher percentage of children vulnerable to infection.
In late December, multiple U.S. states reported rising numbers of kids being admitted to hospital for COVID-19.
The country's largest pediatric healthcare facility, Texas Children's Hospital in Houston, recently treated more than 700 children with the illness during one 24-hour period — and is reporting a more than four-fold increase in child hospitalizations from COVID-19 in just the last two weeks, staff told CNN.
By the week ending Jan. 1, an average of more than 570 children with the illness were admitted to hospitals country-wide every day, according to figures from the U.S. Centers for Disease Control and Prevention (CDC).
CDC data now shows roughly one in 100,000 young Americans under the age of 17 were being admitted for COVID-19 in early January.
"As you're seeing a more transmissible variant plow through our communities, you are seeing more children get infected; primarily those who are unvaccinated," Madad said.
"Unfortunately, a subset of them are ending up in the hospital requiring, sometimes, ICU level care. So that certainly is alarming."
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With files from Christine Birak, Melanie Glanz
