Today we are going to talk about KIDS.

I know many parents out there with little kids are living in Limbo Land and feel neglected and constantly afraid and as if there’s no right answer, so let’s talk about the kids under 12 and Covid. 

Just a note: this isn’t about kids and school or kids and lunch or kids and sports — this is just about the science we know and the science we are working on. 

Let us first keep in mind that a terribly small number of 5-11-year-olds in the US have been vaccinated — under 20%.  This is utterly heartbreaking since it’s the unvaccinated 5-11 year-olds who mostly end up in the hospital. 

The very most important thing you can do to protect your 5-11 year olds is to have them vaccinated — and all the adults around them as well.

Okay,  lets talk about what to expect if your kids get Covid.

First off, I find among all the horrifying headlines about rising rates in children, it is crucial to remember: kids almost never die of Covid.  It is vanishingly rare. It is way lower than what we see with adults. It is lower than the death rates with childhood cancer or accidents. 

If numbers help you, then consider that out of about 9 million kids getting Covid so far “only” about a thousand kids have died.

Now it is totally true that there is no “only” here and that every child death is an unspeakable forever tragedy and every one is seared into our hearts and brains for all of eternity. I know this. We know this.

But the reality is the chances of YOUR CHILD dying of Covid is in the teeny tiny decimal points.  I hope this helps you put that particular fear to the side.

The chance of your child getting a serious illness with Covid is not zero, but it is low.  t is also probably lower with Omicron, although full data is still coming in. It is WAY lower when your child is vaccinated. 

Very few kids get super sick with Covid; for the majority it is a short period of fussiness, fatigue and feeling lousy, or less.  Only about 1% of kids end up in the hospital. And, happily, this seems to be lower with Omicron.

The impact of vaccines: 

Brief science (feel free to skip ;-):  It seems like what is happening with Omicron for vaccinated kids (and adults) is that it escapes the vaccines and lands in the nose and throat.  How does it escape the vaccines? It escapes either because we dont have enough or good enough B-cell-produced antibodies from our vaccines or the viruses outnumber or slip past the antibodies we do have.

So the viruses go lodge in our nose/throat and we get some local symptoms (sore throat, runny nose, sinus pain, sneezing, post-nasal drip) from that.  Or maybe we get a headache or fatigue or body aches, or a dry or croupy cough, or occasionally theres GI symptoms.

But then, fortunately, what we think happens next is that most of the time our T cell immune system kicks in and essentially stops very many viruses from going to our lungs.  This is why vaccinated people— and our kids — rarely get pneumonia or serious blood clots or awful breathing issues.

If your child is too young to be vaccinated:

People who are unvaccinated dont have any B-cell-produced Covid antibodies or a T-cell response.  Also, if you are immunocompromised maybe you cant make any antibodies. 

In both these cases,  the viruses can reproduce like crazy in the nose/throat and move to the lungs. This is part of how adults get so sick.

Fortunately disease moving to the lungs appears to be pretty uncommon with little unvaccinated kids — they seem to get milder disease overall. When Omicron, it tends to show up as croup or something called bronchiolitis which can usually be treated at home or sometimes the ER — but mostly doesn’t require hospitalization. 

So most little unvaccinated kids with Omicron have mild illness and are tended to at home.  On occasion, like 1% of the time, they can end up in the hospital which can be ugly and scary and super disruptive for everybody involved.  This usually happens when the virus goes to the lungs. Sometimes it happens when a child has a lot of diarrhea or is too sick to eat or drink and they get dehydrated.

How do you know when you need to take your little one to the doctor or ER?  

To paraphrase one of my favorite pediatricians: “Covid advice is basically identical to flu advice:  Your child might want to take more naps, might not want to eat or drink as much as usual.  But when they’re awake, they should feel well enough to play a quiet game, read a book, watch a show, etc.  Call me if the child:

            —is not reasonably active and alert between naps

            —looks like they are working harder to breathe

            —is not drinking enough to pee at least every six hours

            —seems way too sleepy for the time of day

            —is difficult to wake up

            —is so cranky they don’t even want to be held”

What about MIS-C?  This is also rare, with about 6000 US cases reported. This is undoubtedly an underreported number, but even if it’s double or triple that, we still have only a tiny fraction of infected kids getting MIS-C. We don’t know whether we will see more or less MIS-C with Omicron.  There have been recent papers showing a decreased risk in vaccinated kids. We hate every single case, but again, so far the odds of it happening to YOUR CHILD are small.

What about long-haul Covid?  We don’t know numbers for sure (we need more time to pass to see the exact rates) but with previous variants kids seemed to get long-haul at a rate of 1/3 to 1/2 that of adults.  We can’t yet have any real idea about whether there is more or less long-haul with Omicron. There is some good recent science showing vaccination decreases the risk. 

What about the vaccine for the under 5s?  It’s a ways away. We may well be looking at late spring. It’s been super complicated to show vaccines will be a huge giant help for these little ones because a) it’s hard to show a benefit when so few get really sick and  b) the immune system changes so much between the newborn and kindergarten years.

How can I protect my under 5s who cant get the vaccine?  There are things you can do:

            —Get everybody around them vaccinated.

            —Get your pregnant self vaccinated so you can pass along antibodies to your infant.                             

        —Cocoon kids away from the unvaccinated (yes, that includes Uncle Maskless) and the symptomatic.

            —Don’t expose them to strangers who are eating (ie restaurants) in high-transmission areas.

            —Mask the over-twos whenever possible.

The data about Omicron is evolving. We don’t know everything about this variant yet and there may be new trends. But so far we can say:

  • A lot of our kids are going to get Covid during this surge because Omicron is so contagious.
  • The vaccinated children 5-11 seem to be highly protected against serious disease and dying.
  • The unvaccinated children 5-11are at higher risk to get serious disease but they still are doing better than adults and fine overall.
  • Our unvaccinated babies and toddlers — the 0 to 4.9 year olds — worry us all.  But the reality is many of them don’t get symptoms, and the ones who do tend to do well and not end up in the hospital. In the meantime, we need to build our wall of vaccinated people and protection around them.
  • For children under 12, even if they do end up being part of the 1% who gets hospitalized, so far most end up completely recovering.
  • Chance of long-haul: we don’t know exactly except it seems definitely lower than adults.  We won’t know about Omicron’s impact for a while.

So: so far, chances of children being hospitalized are very small, chances of MIS-C are extremely small, chances of dying incredibly super small.

As awful as this pandemic has been, we’ve been lucky lucky lucky with the kids.  And fortunately with Omicron so far there are many signs our luck is holding.