Omicron and Kids: Advice From a Stanford Pediatric Disease Expert

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A 6 year-old kid in a white sweater is about to get a vaccine
Medical assistant Deedee Domino administers a COVID-19 vaccine to Remy, 6, while his mother, Joanna Wan, holds his hand at the United in Health vaccine site in San Francisco's Mission neighborhood on Nov. 9, 2021. (Beth LaBerge/KQED)

For many parents and caregivers of children under 5 years old, the pandemic still feels far from over, with vaccines not yet available for young kids. How worried should we be about the omicron variant? When will the vaccine for kids under 5 be ready? And is my kid safe at school? These are just some of the questions swirling through the minds of parents and caregivers as omicron surges in the Bay Area.

KQED's Brian Watt spoke with Dr. Yvonne Maldonado, a pediatric infectious disease expert at Stanford, about how the variant is affecting children and when we might know more about the vaccine trials for kids under 5 that are currently underway.

The following interview been edited for length and clarity.

KQED's Brian Watt: We know the omicron variant is spreading fast, but it's shown to be less severe in most cases. How is this variant affecting children overall?

Dr. Yvonne Maldonado: It seems to be affecting children very similarly to the way it is affecting adults — it's very transmissible. The incubation period seems to be short. And fortunately, so far, it does not seem to cause more serious illness.

That doesn't mean that children aren't being hospitalized. It just means that the rate of hospitalization does not appear to be higher compared to the delta variant.

How is California doing with regard to kids going to the hospital for COVID, compared to other states?

If you look at the number of infections in kids reported by age, as a fraction of the total population, we are kind of in the middle. We're not seeing the big surge that the Northeast is seeing right now, but we're certainly seeing our fair share of cases in kids.

Do you think we could see the kind of surge that you're talking about in the Northeast?

It's hard to know. I would say that anything is possible at this point.

However, we have data from sewage. One of our Stanford engineers does a Northern California surveillance of sewage samples across different counties. It looks like we started to see this virus in the Bay Area right before Christmas, so we're kind of in our third week right now.

This would put us squarely in the middle of what our surge might be, based on what the South Africans saw. It's possible that this could be our worst week and that things might actually start to, hopefully, slow down after the next week or so.

We are seeing more kids in the hospital. There are places actually that are sending children to big centers like Stanford. But part of that also has to do with the fact that there's not enough staffing.

What we are seeing among adults who get COVID is that the most serious cases are those who are unvaccinated. Is this the same for kids?

It's hard to know. We haven't really seen the data as clearly spelled out. In general, if you look at the data for children across the country since the beginning of the pandemic, hospitalizations are always highest in the 0- to 4-year-old age group for children. And that, of course, is the age group that isn't vaccinated.

It's really hard to know what the impact of the vaccine would have since that group doesn't have access to the vaccine. But overall, what we are generally seeing is that most, but not all, children who are hospitalized have been unvaccinated, so it's really important to get kids their full two doses.

Do you think that the rate of vaccinated 5- to 11-year-olds has to do with parents who really just wonder if their kids are ready for vaccines at that age?

I do think that there was a lot of concern about whether kids that age really needed the vaccine, whether they were going to get sick at all, and whether they would get really sick.

In my view, as a pediatrician and a parent of three kids myself (they're all adults now), we know that we vaccinate kids for less severe diseases and for diseases that cause less hospitalizations and deaths to prevent any risk of hospitalization and death.

I would encourage people to really think about getting their 5- to 11-year-olds vaccinated, because we really don't know — for about half of the kids who are hospitalized they have no underlying risk factors. But the other half? It's really a guess. And so, I would not want to put my child at risk.

If children under 5 have the highest hospitalization rates, when are we getting a vaccine to that age group?

Here at Stanford, we are part of the international pediatric Pfizer vaccine trials. We're doing studies for the under-5's and we've broken up that group into 6 months to 23-month-olds and then 2- to 4-year-olds.

And recently, Pfizer let everyone know that the data on the 6 months to 23-month-olds at a very low dose — a tenth of the adult dose — worked really well in terms of antibody responses, but unfortunately that one-tenth of the dose given twice did not work for 2- to 4-year-olds.

We're going to revamp the study that we did with the two-dose trial and add a third dose for kids under 5 to see if that will boost them.

As a parent you have to be thinking about COVID safety at schools. Do you think that the risk is low enough to be back in person?

I've struggled with this over the last few days because we just saw this surge happen very quickly. This virus is extremely transmissible. I do think that kids can go back to school — if we are careful.

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We should be masking, everyone who can be should be vaccinated, and good cleaning and ventilation. All of the things we've been doing for the last year and a half, I think could really keep kids safe. It also would help if we had better access to rapid at-home testing, but that's something that apparently is going to take some time, and that's really unfortunate.