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A pediatrician's advice to parents on omicron, travel and vaccines

MARY LOUISE KELLY, HOST:

Within weeks of showing up in the United States, the omicron variant has landed record numbers of children in the hospital. Now kids do still represent a small percentage of those being hospitalized with COVID-19, but some parents are understandably anxious, especially those with kids under 5 who can't get vaccinated yet. They're wondering how to navigate life with young children during this surge.

So we have gathered their questions, and we're going to put a few now to Dr. Ibukun Kalu. She's a pediatric infectious disease doctor at Duke University. Dr. Kalu, thanks for being with us.

IBUKUN KALU: Thank you for having me. It's nice to speak with you, Mary Louise.

KELLY: Yeah, and to you. Before we get to the parents' questions, may I ask you just how things are going at your hospital? Are you seeing a lot of kids hospitalized with COVID-19?

KALU: Yes, we are seeing a few more than we saw both with the alpha and delta surges in the past spring and summer of 2021.

KELLY: And what ages are you seeing? And I suppose Part B of that question is, are they vaccinated?

KALU: So we've seen across all age groups. We've seen a couple of small infants, and that may be partially because they have other viral infections spreading in the winter - for example, influenza. And then we're seeing some older kids, older than the age of 5, that should be eligible for one of the vaccines out there. Unfortunately, more of the children that are in the hospital are unvaccinated. However, we have younger children that are not eligible for vaccination and also end up in the hospital with COVID.

KELLY: Yeah. And the ones who are hospitalized, what symptoms do they have? Are the symptoms kids are demonstrating tracking along with adult symptoms or - any differences you can see?

KALU: For the most part, they track along with adult symptoms. So they may have fevers, some issues with breathing, such as shortness of breath. However, our youngest kids, those that are infants, tend to have more gastrointestinal symptoms. They may have vomiting or diarrhea or have issues just maintaining their fluid intake, and they end up in the hospital for some support.

KELLY: Yeah. We have a question along these lines. This is our first parent - Alex McCarty. He has a 4-year-old and an 18-month-old.

ALEX MCCARTY: I'm wondering about the severity and risk of the omicron variant to children. Does it seem to be more dangerous than previous variants or is it about the same or less so?

KELLY: So Dr. Kalu, this is a question adults have been asking. How do the symptoms compare? How does the severity of omicron compare? What do we know specific to children?

KALU: So what we know so far is that omicron is milder than delta in both children and adults, but it's still pretty severe. And it can cause significant symptoms in a small group of children. Not across the board, but a small subset that do end up with more severe symptoms end up in the hospital. If we see more cases, we'll likely see a high number of kids end up in the hospital just by sheer numbers.

KELLY: Do we know yet how the risk compares to something like the flu - and again, specifically for kids?

KALU: In kids, partly because COVID seems to cause the initial infection and then just track through the body and cause post-COVID syndromes, it is worse than influenza. And currently, we are seeing influenza spread in our community, but COVID is just outpacing that across the board.

KELLY: OK, next question. This is on vaccines, and it comes from Oriana Perez, who has a 3-year-old daughter.

ORIANA PEREZ: What was the reason why the vaccine trial for children under 5 failed? Our main concern here in Texas is that a lot of people are going back to normal - basically, not wearing masks in public - and our daughter is still not protected.

KELLY: So I think she may be referring to that - the Pfizer vaccine trial for kids under 5. What more can you tell her about that?

KALU: What I understand about the process so far is that the trial was conducted to ensure that the vaccine is safe and it actually works in children that are younger than 5, and the dose that was chosen did not necessarily trigger a high enough protective response. They were advised, and they chose to go back and adjust the dose to ensure that when they have a viable vaccine option, the dose that's authorized will likely lead to a protective response in kids. So I didn't see it as a failure. I think this is a helpful process for getting a safe and effective vaccine.

KELLY: Let me turn us to a question about even younger children. This comes from Mandy McCaslin, who has a 6-month-old.

MANDY MCCASLIN: How much research has been done for the babies who were in utero when moms were vaccinated or babies who were breastfeeding when moms are vaccinated?

KELLY: So this is a really fascinating one. If a mom who is vaccinated is breastfeeding or was carrying a baby when she was vaccinated, might those babies be protected?

KALU: Yes. The CDC has summarized some of the more recent research, and I will refer to the data they've shared publicly as just a source of information that might be helpful here. But there are also multiple published studies from 2021 that help to address the question she's asking.

Specifically, when they look at mothers that had babies recently, mothers that were vaccinated or those that may have been unvaccinated but got an infection just by nature of having COVID spreading everywhere, they saw that those that were vaccinated were able to pass antibodies or pass protection onto their infants and pass it in such a way that it was both in the blood but also within the mouth and noses of the babies. And this is huge. This is great because if babies get exposed just inadvertently by living in community, they have a layer of protection since they can't mount their own protection.

Some of those that were infected passed some antibodies as well, but it was slightly less than those that were vaccinated. So I think vaccines were safe and effective in pregnant women and they were able to pass it on, which is hugely helpful.

KELLY: OK, one last question. This is from a family that is looking to escape all of this for a little while. Ryan McGhie says his 2-year-old son is great about wearing his mask, wears his mask like a champ, but he is worried about taking a planned vacation to Hawaii.

RYAN MCGHIE: Is it safe to take a five-hour flight with an unvaccinated 2-year-old? Would it be more prudent to postpone our trip? And once we get to our hotel, how safe is it to go to the beach or to the pools? Should we try to encourage mask-wearing while playing in the water?

KELLY: Dr. Kalu, I'm trying to imagine trying to keep a 2-year-old in a mask (laughter) on the beach in Hawaii, but what advice do you have for this family or others trying to figure out if they can travel with really young kids?

KALU: I share the sentiment. It would be nice to find more sun somewhere. But during the current surge - I'm assuming the question's regarding this period we're in - it may be advisable to defer travel since we've seen such high rates of community spread. If you can do it, if it's feasible, push it out a few weeks.

If you're already on the way there or it's just not feasible for you to move that around, encouraging masking will be great. I think that 2-year-olds may struggle a little bit, but also ensure that everyone within your party is vaccinated and has received a booster shot if they're eligible for vaccines. Finally, play outdoors as much as you can. Masks don't necessarily work when you're submerged in water, so I would not expect masking in that setting.

KELLY: All right. Good advice for the beach there from Dr. Ibukun Kalu, pediatric infectious disease doctor at Duke University. Thank you so much for sharing your expertise with us and happy new year.

KALU: Happy new year. Thank you for having me.

(SOUNDBITE OF WILLIAM ORBIT'S "PAVANE POUR UNE INFANTE DEFUNTE") Transcript provided by NPR, Copyright NPR.