Not so mild? Hospitalizations exploding among Utah infants, children with COVID-19′s omicron strain

For kids under 5, the omicron variant is not so “mild,” one pediatric expert says.

“I sorry, Mommy. Mommy hugs, I scared. I don’t like it. Mommy!”

Those were the last words 3-year-old Justin Lee Francis spoke to his mother, Yvonne, before he was sedated and put on a ventilator at Primary Children’s Hospital last week, when he was diagnosed with COVID-19, asthma, pneumonia and other illnesses.

“Those words are burned in my memory,” Yvonne Francis said Thursday from the hospital, where Justin Lee still is on a ventilator, still sedated, and slowly recovering after nearly a week in the intensive care unit. “He was really scared.”

Justin Lee is one of nearly 140 Utah children under age 15 who have been hospitalized with COVID-19 in the past two weeks as the number of serious infections explodes, especially among infants and kids younger than 5.

For very young children, one pediatric specialist said, the omicron variant may not be so much “milder” than previous strains of the virus.

“There is reason to think that omicron acts differently in younger children,” said Dr. Andrew Pavia, a pediatric infectious diseases specialist with Primary Children’s Hospital.

Utahns of all age groups under 45 are being hospitalized with COVID-19 at record-high rates, according to data released this week by the Utah Department of Health. But hospitalizations have risen more sharply for infants than for any other age group in Utah. Not only that, infants are now being hospitalized with COVID-19 at a higher rate per capita than any other age group in Utah except those 65 or older.

“We are seeing the shift towards more disease in younger children; that probably has to do with changes in the virus,” Pavia said.

More than 50 children less than 1 year old were reported as hospitalized with COVID-19 in the past two weeks, according to state data released Thursday. In Salt Lake County alone, 15 children under 5 were hospitalized last week, more than double any other week of the pandemic.

(Christopher Cherrington | The Salt Lake Tribune)

And by the end of last week, Primary Children’s Hospital was caring for a record 22 patients with the coronavirus. During the pandemic’s previous surges, Pavia said, the hospital seldom surpassed a dozen patients with the coronavirus.

The differences with omicron

Of all Utah infants hospitalized for the coronavirus, 26% have been reported since Dec. 30, about a week after omicron became the state’s dominant variant of the coronavirus. That compares to 14% of hospitalizations of kids 1 to 14, 12% for ages 15 to 24, and less than 10% for other age groups.

“The Utah data parallels data from other states showing an increased proportion of all pediatric hospitalizations are among children 0-1 and 1-4 during the omicron era,” Pavia said this week. “The incidence rate of hospitalization in this age group is also much higher than in earlier waves.”

Since the omicron variant took over, the rate of hospitalizations per case has declined slightly for Utah infants, as it has for other age groups. But, as with all age groups, the benefit of the omicron variant’s relative “mildness” is more than overwhelmed by the sheer number of cases — and for infants, the hospitalization rate per positive test has declined less than it has for other age groups.

And it doesn’t simply appear to be a result of vaccines being unavailable to children under 5.

The omicron variant “attacks the [upper] airways more than the lungs, and younger children have smaller airways,” Pavia explained.

Many infants and young kids being admitted in recent weeks have had a barking, “croup-like” cough.

“This is pretty miserable,” Pavia said in a news conference last Friday. “If your child has it, they struggle to breathe, they have a lot of secretions and they need oxygen.”

Pavia noted that those patients, once admitted to the hospital, generally are faring better than hospitalized children did with previous variants of the coronavirus.

“It’s better than a lot of what we saw with delta, which was true pneumonia, where children more often ended up in the ICU, [and] more often ended up on ventilators,” Pavia said.

But Pavia stressed that children hospitalized with COVID-19 are seriously ill — and nearly all of them are seriously ill because of COVID-19. “Incidental hospitalizations” — where a child happens to test positive for COVID-19 when they visit the hospital for an unrelated injury or illness — are “relatively uncommon situations,” Pavia said, echoing reports from doctors nationwide.

In fact, he said, “incidental” hospitalizations of infants actually appear to be rarer with the omicron variant than they were previously.

“In the children 0 to 1 who are being found to have COVID, for the most part in the past, they didn’t have a lot of symptoms,” he said. “With omicron, they are often coming in with breathing difficulty.”

Even among slightly older children, Pavia said, “what’s much more common is that somebody comes in with a disease that’s been exacerbated by COVID.” For example, he said, a child may technically be admitted for worsening asthma — but it’s worse “because they have COVID.”

‘Justin didn’t have any choice’

That appears to be the case for Justin Lee, his mother said. Francis took him to a Taylorsville hospital on Jan. 13 after he choked on a piece of apple because his breathing began showing signs of “retraction,” or the chest pulling in visibly with each breath — a sign of respiratory distress.

Justin Lee hadn’t previously shown signs of asthma or other illnesses, Francis said. In fact, she said, he was perfectly healthy before he began struggling to breathe. She wondered whether he had fully inhaled the bite of apple he choked on — but a bronchoscopy showed Justin Lee’s lungs were so full of secretions that doctors couldn’t see much else, Francis said.

“It went so quickly,” Francis said. “It went from a little bit of a runny nose to, over the course of 12 hours, a horrible wet cough and fever.”

Justin Lee was transferred to Primary Children’s, where doctors added COVID-19, rhinovirus, adenovirus and pneumonia to his initial diagnosis of asthma, Francis said. As doctors and nurses appeared in full protective gear, Justin Lee got more and more scared, which further triggered his asthma, Francis said. “He would visibly try to fight to get out of the bed to get to myself and my husband.”

After he was sedated and placed on a ventilator, it took days for Justin Lee to show much improvement, Francis said. Finally on Thursday, she said, he began breathing a little bit easier and tried to cough a bit more.

“It’s really slow going as he fights off the viruses and the pneumonia,” she said. Family members posted a crowd-funding plea; doctors have told Francis to plan on at least a week or two in the ICU.

COVID-19 “is definitely not an incidental or meaningless finding in young children right now,” Pavia said. “Don’t take this idea that we are finding a few more people who test positive who come in without symptoms of COVID to mean that the hospitalization numbers are vastly inflated. That’s simply not true.”

Meanwhile, Primary Children’s Hospital, like other hospitals in Utah, has been postponing some surgeries due to overcrowding, in part because of an influx in COVID-19 patients and in part because so many hospital employees have been calling in sick as the virus infects record numbers of Utahns.

A record 756 patients were hospitalized with COVID-19 as of Thursday. Intensive care units at Utah’s larger, “referral” hospitals were 93% full — above the 85% threshold that hospital administrators have said is necessary to leave room for unpredictable staffing levels, new patients and availability of specialized equipment and personnel.

In the past two weeks, 139 Utah children younger than 15 have been reported hospitalized with the coronavirus.

Pavia and Francis both noted that many of those children are not eligible to be vaccinated. And that’s something Francis said she hopes vaccine-eligible Utahns will take to heart, as she recalls one of the last things Justin Lee said to her: “I sorry, Mommy.”

“Justin didn’t have any choice in getting sick or not,” Francis said. “He’s part of the population that needed other people to get vaccinated to protect him. I got vaccinated. My husband got vaccinated. Our family members got [vaccinated]. We stayed home, we get groceries delivered. We did everything we could to make sure he interacted with the public as little as possible.

“Now every single health care worker taking care of him is taking a risk as well. ... People have a responsibility to try to protect others. If you don’t want to get the vaccine, you can stay home, too. But that doesn’t seem to be what’s happening.”