Pediatric hospitalizations up under Omicron, but it's not more severe

 New pediatric COVID hospitalizations have hit a record-high in the United States, as children are increasingly swept up in Omicron's lightning spread.

While experts are concerned, and stress the need to step up vaccination among kids, early indications suggest that the new variant's rate of severe disease could in fact be lower, and its extreme contagiousness is behind the rapid rise.

The raw data might also be muddied by coincidental infections that aren't the main cause of a hospital admission.

Numbers spiking

According to the American Academy of Pediatrics, almost 199,000 children were reported infected with COVID-19 in the week ending December 23, the last week for which data is currently available, and a 50 percent rise on figures earlier in the month.

The seven-day-average of COVID hospital admissions for people aged 0-17 was 378 in the week ending December 28, a 66.1 percent increase on the prior week and the highest ever figure, surpassing the previous peak seen during the Delta wave on September 1, per official data.

The only other age group where hospitalizations have hit a new peak are 18-29 year olds.

The rates of severe illness remain however much lower in absolute terms compared to older age groups.

There have been 803 deaths of people aged 0-18 from COVID in the US, out of more than 820,000, since the pandemic began.

Early research out of Hong Kong based on lab testing of tissue samples has shown Omicron replicates up to 70 times faster in the bronchi, the airways leading into the lungs, compared to Delta, which may help explain its extreme spread throughout the population.

"I think at this point, it's a numbers game," Jim Versalovic, a pathologist and immunologist at Texas Children's Hospital, the largest children's hospital in the United States, told AFP.

"Based on what we've gathered today, Omicron is not causing more severe infections, but is infecting many more children. And hence we are seeing more children hospitalized with COVID," he added.

If anything, there appears to be a greater proportion of mild pediatric cases linked to Omicron—which is similar to what has been seen in adults, he added.

Its relative mildness could be explained by the same Hong Kong study that showed Omicron replicated 10 times slower in the lungs compared to Delta, and a hamster study from the University of Tokyo has borne this out.

But "even if you have a small percentage of kids that would have severe disease, a small percentage of a large number is a large number," Henry Bernstein, a pediatrician at Northwell Health hospital system in New York told AFP.

As to why the rate of cases, and thus hospitalizations, are rising faster in younger age groups compared to older, there are several potential factors at play.

President Joe Biden's chief medical advisor Anthony Fauci told reporters this week that "many children are hospitalized with COVID as opposed to because of COVID."

In other words, since hospitals are routinely COVID testing everyone admitted, they are picking up coincidental coronavirus infections.

The vaccination rate is also lowest among children aged 5-11, who were the last group to become eligible, in November.

According to figures from the Centers for Disease Control and Prevention (CDC), only 15 percent of this group is fully vaccinated, compared to 84 percent of people aged 12 and over.

Vaccination strongly recommended

The take home message for parents, according to Versalovic, is "there's no time to waste in getting a vaccine"—and that goes for the whole family, including adults, who could spread to their kids, added Bernstein.

In fact, the hospitalized adolescents Versalovic's hospital has seen are "almost exclusively unvaccinated."

The case for vaccinating young children was strengthened by a new CDC report out Thursday that found serious side effects were exceedingly rare in 5-11 year olds. Feared cases of heart inflammation occurred even less frequently than in males aged 12-29.

Only infants aged 0-5 remain ineligible for vaccines, with expectations for authorization in the coming months.

Versalovic added there was also cause for hope that the spike might recede very quickly in the coming weeks, as was seen in southern Africa.

https://medicalxpress.com/news/2021-12-pediatric-hospitalizations-omicron-severe.html

Severe illness, viral coinfection common in children with COVID-19 hospitalization

 Many pediatric patients with COVID-19-related hospitalization have severe illness, according to research published in the Dec. 31 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

Valentine Wanga, Ph.D., from the CDC COVID-19 Response Team, and colleagues reviewed medical record data for patients younger than 18 years with COVID-19-related hospitalizations during July to August 2021. Of the 915 patients identified, 713 were hospitalized for COVID-19, 177 had an incidental positive severe acute respiratory syndrome coronavirus 2 test result (unrelated to hospitalization), and 25 had multisystem inflammatory syndrome in children.

The researchers found that of the 713 patients hospitalized for COVID-19, 24.7, 17.1, 20.1, and 38.1 percent were aged younger than 1, 1 to 4, 5 to 11, and 12 to 17 years, respectively. About two-thirds (67.5 percent) had one or more underlying medical condition, most commonly obesity (32.4 percent); 61.4 percent of those ages 12 to 17 years had obesity. Overall, 15.8 percent of patients hospitalized for COVID-19 had a viral coinfection (66.4 percent had respiratory syncytial virus infection). Only one of the 272 vaccine-eligible patients hospitalized with COVID-19 was fully vaccinated (0.4 percent). Of the patients hospitalized for COVID-19, 54.0, 29.5, and 1.5 percent received oxygen support, were admitted to the intensive care unit, and died, respectively. Of those requiring respiratory support, 14.5 percent needed invasive mechanical ventilation.

"These data highlight the importance of COVID-19 vaccination for those aged ≥5 years and other prevention strategies to protect children and adolescents from COVID-19, particularly those with obesity and other underlying health conditions," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry; one author reports application of a patent with a pharmaceutical company.

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Severe COVID-19 outcomes not up during Delta predominance

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More information: Abstract/Full Text

Journal information: Morbidity and Mortality Weekly Report 

https://medicalxpress.com/news/2021-12-severe-illness-viral-coinfection-common.html

Immune response to seasonal coronaviruses may offer protection against COVID-19

 A research group led by Shin-ichiro Fujii of the RIKEN Center for Integrative Medical Sciences have found that individuals with a certain HLA type may be able to mount a killer T cell response to COVID-19, thanks to the T cells responding to a portion of the virus's spike protein that is also present in seasonal coronaviruses that cause the common cold. This work, published in Communications Biology, could help explain the different responses between populations, and could potentially be used as a way to develop a new type of vaccine against the disease.

Up until now, most of researchers have focused on the antibody response to the virus, which prevents initial infection. However, once the virus infects cells, to eliminate viruses quickly, effector lymphocytes—NK cells or memory T cells—become critical. Based on the consideration that NK cell response should be relatively similar across people, they decided to focus on memory killer T cells, which lead an attack against viruses that they "remember."

The authors chose to look at individuals with HLA type A24, a type that is relatively common in Japanese and some populations in other countries including several Asian countries. According to Fujii, this choice was made because it was easy to find individuals with this HLA type, as others are much less common, and also because they felt it might offer insights into why some populations in Asia have appeared to be less susceptible to the infections.

The group began by using in silico analysis to look for parts of the SARS-CoV-2 spike protein that can bind highly with HLA-A24. As a result, they identified six potential epitopes—sequences of amino acids that immune cells respond to. They then looked at the reaction of peripheral immune cells in people with the HLA-A24 type who had not been infected with SARS-CoV-2, to see whether they had memory killer T cells that would respond to antigens from the virus. In fact, around 80 percent of uninfected healthy donors with the A24 type HLA did show a reaction for a single peptide—a sequence they called the QYI epitope—which they identified. Finally, they found that QYI-specific memory killer T cells from donors with the A24 serotype showed cross-reactivity against the relevant epitopes, which are relatively conserved from human coronaviruses including seasonal coronaviruses.

The group then looked at the response in patients with blood cancers, who are known to be particularly susceptible to serious COVID-19. The response was much smaller than those from non-exposed healthy individuals. Importantly, however, the group discovered that even in patients with blood cancers, there is a "hotspot," located in the spike protein of the virus—a sequence of 27 amino acids around the QYI epitope—and that T cells responding to this can still mount a vigorous immune response. For the hotspot, 100 percent of healthy people and 65 percent of blood cancer patients responded. According to Fujii, "This leads to the hope of developing vaccines that could boost the immune response even in immunocompromised patients.

The real goal of this work, says Fujii, is not to find differences between population but rather to find ways to prevent people from dying of the disease. "The real hope," he says, "is that we will be able to develop vaccines that can stimulate a strongly targeted reaction by T cells against the infection. We have demonstrated that this could be possible in this particular HLA group, but now need to look at other types."

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Study shows vaccines may protect against new COVID-19 strains—and maybe the common cold

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More information: Kanako Shimizu et al, Identification of TCR repertoires in functionally competent cytotoxic T cells cross-reactive to SARS-CoV-2, Communications Biology (2021). DOI: 10.1038/s42003-021-02885-6

https://medicalxpress.com/news/2021-12-immune-response-seasonal-coronaviruses-covid-.html

NYC private schools preparing for COVID-19 upheaval when students return

 The city’s top private schools are bracing for COVID upheaval with classes set to resume next week amid a surge in cases.

Elite bastions including Spence and Horace Mann are implementing new vaccine mandates, specifying acceptable mask types and requiring negative COVID-19 to for kids to return to school.

Spence canceled classes Monday to provide parents a free day for kids to get tested.

“I realize how challenging a no-school call can be for families, and I appreciate your support and understanding,” wrote Spence chief Bodie Brizendine in a letter to families. “For all of us this is about staying safe and staying in school, and this is the best possible option for both.

The Collegiate School in Manhattan is joining other city private schools in requiring eligible students to get fully vaccinated — and boosted — to remain eligible for enrollment.

The school is also mandating that students get a negative COVID-19 test at the beginning of each week in order to come to class.

Collegiate is increasing student testing each week and updated its masking policy.

Horace Mann School in the Bronx will be providing COVID-19 tests to children before classes begin.

James Messerschmidt

“Masking continues to be required, yet cloth masks are no longer sufficient during this highly transmissible Omicron surge,” said head of school David Lourie, who noted that there were 23 cases reported among students and staff over the winter break. “Everyone must wear a medical-grade disposable mask, such as an N95, KN95, KJ94 or a surgical mask.”

Collegiate will also “expedite” lunch to minimize the amount of time students take off their masks in order to consume their food.

The Collegiate School in Manhattan plans on shortening lunch breaks when students are allowed to remove their masks.

Robert Miller

Horace Mann Head of School Thomas Kelly told parents that the Bronx school will offer COVID-19 tests to kids on Sunday and Monday at the school before classes resume on Tuesday.

Meanwhile, an increasing number of teachers unions have pressed to transition to remote learning due to the coronavirus resurgence.

Chicago’s teachers union has threatened to strike if officials don’t agree to implement remote learning and to increase recurrent testing.

Collegiate School head David Lourie says students must wear a “medical-grade disposable mask” to stop the Omicron variant from spreading.

Stephen Yang

A total of six New Jersey districts will have kids learning from home when classes resume next week.

The city announced new testing protocols for students this week — but incoming Mayor Eric Adams has said that he doesn’t foresee closing schools or switching to remote learning.

https://nypost.com/2021/12/31/nyc-private-schools-preparing-for-covid-19-surge-after-holidays/

Sinovac COVID-19 shot with Pfizer booster less effective against Omicron - study

 Sinovac's two-dose COVID-19 vaccine followed by a booster Pfizer-BioNTech shot showed a lower immune response against the Omicron variant compared with other strains, according to a study by researchers.

The study, which has not been peer-reviewed yet, was conducted by researchers from Yale University, the Dominican Republic's Ministry of Health and other institutions.

The Sinovac two-dose regimen along with the Pfizer shot produced an antibody response similar to a two-dose mRNA vaccine, according to the study. Antibody levels against Omicron were 6.3-fold lower when compared with the ancestral variant and 2.7-fold lower when compared with Delta.

Akiko Iwasaki, one of the authors of the study, said https://twitter.com/VirusesImmunity/status/1476549105270808578 on Twitter that CoronaVac recipients may need two additional booster doses to achieve protective levels needed against Omicron.

The two-dose Sinovac vaccine alone did not show any detectable neutralization against Omicron, according to the study that analysed plasma samples from 101 participants in the Dominican Republic.

A study from Hong Kong last week said that even three doses of the Sinovac vaccine did not produce enough antibody response against Omicron and that it had to be boosted by a Pfizer-BioNTech shot to achieve "protective levels."

Sinovac's CoronaVac and state-owned Sinopharm's BBIBP-CorV vaccine are the two most-used vaccines in China and the leading COVID-19 shots exported by the country. Hong Kong has been using the Sinovac and Pfizer-BioNTech vaccines.

https://www.marketscreener.com/quote/stock/SINOVAC-BIOTECH-LTD-5714593/news/Sinovac-COVID-19-shot-with-Pfizer-booster-less-effective-against-Omicron-study-37445981/

Airlines file emergency request asking FCC to delay 5G rollout

 A top airlines trade group on Thursday filed an emergency request for the Federal Communications Commission (FCC) to delay the rollout of 5G wireless service, citing concerns that the technology could cause disruptions for flights.

Airlines for America, which represents cargo airlines and passenger airlines in the U.S, requested that the agency delay the use of the service near airports such as George Bush Airport in Houston, John F. Kennedy in New York and Newark Liberty in New Jersey, according to Bloomberg News.

AT&T and Verizon Communications were given authorization by the FCC earlier this year to deploy C-band spectrum 5G wireless with a rollout scheduled for Jan. 5. The Federal Aviation Administration, as well as CEOs of Boeing and Airbus Americas, pushed back on the agreement, noting that 5G could cause potential flight diversions and delays.

On Thursday, Airlines for America said that the FCC “has never provided a reasoned analysis of why it has rejected the evidence submitted by the aviation interests,” Bloomberg News reported.

Wireless companies agreed to roll out the 5G service at reduced power for a temporary amount of time in order to compromise with airline groups, but Airlines for America said that would not be enough, the news outlet noted.

“Despite these meritless claims, the wireless industry continues to collaborate in good faith with the aviation industry, the FAA and the FCC, and remains confident that a positive resolution can be reached,” the group reportedly said in a statement.

https://thehill.com/policy/transportation/aviation/587807-airlines-file-emergency-request-asking-fcc-to-delay-5g-rollout

Mass. denies teacher union request to keep schools closed for COVID testing

 Massachusetts officials have denied a teacher union’s request to keep schools closed for COVID-19 testing.

The Massachusetts Teachers Association made the request to close schools for COVID testing with the input from their environmental health and safety committee and public health experts, according to a report by the Associated Press.

But Massachusetts’ Executive Office of Education spokesperson Colleen Quinn told the AP that the department will not close schools on Monday. 

“The commissioner is not going to close schools Monday, and asks teachers to be patient as we work to get tests in their hands this weekend,” Quinn said in a statement. “It is disappointing that once again the MTA is trying to find a way to close schools, which we know is to the extreme detriment of our children.” 

Schools set to resume classes after a holiday break next week are doing so as the highly-contagious omicron variant of the coronavirus hits the United States hard. 

The nation has been breaking records for daily positive tests, though data suggests the omicron variant is not leading to serious cases of COVID-19 that end in hospitalization or death.

The leading teachers union in Massachusetts had argued it would be safer to keep schools closed as more is learned about the variant.“To protect the public health and the safety of our communities, it is urgent to allow districts to use Jan. 3 for administering COVID-19 tests to school staff and analyzing the resulting data,” MTA union president Merrie Najimy said in a statement. 

Najimy acknowledged that delaying the start of school would pose a hardship for some families, but told the AP there would be no hesitation in the case of a storm. Najimy added that making Monday a COVID-19 test day will help school districts make staffing decisions and ensure that in-person learning continues. 

Massachusetts’ Department of Elementary and Secondary Education earlier this week said it purchased 200,000 COVID-19 rapid tests which will be disturbed across the state for faculty and staff testing, the AP noted.

https://thehill.com/homenews/state-watch/587841-massachusetts-denies-teacher-unions-request-to-keep-schools-closed-for