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*Story UPDATED on January 4, 2022 to include and append additional interview with Dr. Christina Canody, BayCare Pediatric Service Line Medical Director.
The highly contagious Omicron variant is spreading in ways doctors tell us they never expected, fueled by holiday gatherings and travel…and then there’s back-to-school.
Doctors are urging people to get their COVID-19 vaccine or booster if they haven’t already and to get their children vaccinated if they are eligible. This will give you the best protection against serious illness from the virus.
You can read our in-depth Q&A with local doctors about the COVID-19 vaccine and your child here (including interesting facts about mRNA vaccine technology and side note: doctors tell us your body is introduced to a lot of mRNA anytime you get sick.)
As we send our children back to school after the winter break, we wanted to address some common questions about the latest surge with Dr. Juan Dumois, a pediatric infectious disease physician at Johns Hopkins All Children’s Hospital and Dr. Christina Canody, the Pediatric Service Line Medical Director with BayCare.
*Interviews edited for space and clarification.
Related: Your child has COVID…now what?
Dr. Dumois: Oh, yeah. I was so surprised when in two weeks in the United States, the Omicron variant constituted maybe 1% of all of the cases to 73% of all of the cases. In two weeks. That was surprising and remarkable.
Dr. Dumois: I think it will be similar to Delta where it will last a couple of months. It may peak after a month, but as cases start coming down, there will still be a lot of transmission going on.
Dr. Dumois: Unfortnately the coronaviruseven the Omicron variant– causes symptoms just like the other respiratory viruses including flu and we are starting to see an increase in numbers of children with the flu. The only symptom that is more significantly more likely to occur in kids with Covid is loss of sense of taste and smell, but everything else congestion, cough, fever, achiness, headache, stomach aches [sore throat] those are about the same. So when a kid gets sick, they need to be tested for Covid to see if they have Covid.
Dr. Canody: The things we see a lot in kids– high fever, malaise…they just look achy and miserable and they have what we call the Covid eyes, conjunctivitis, especially in the middle of the eyes and a lot of teenagers have the sinus congestion and headaches. Omicron has seen a lot more vomiting and decreased appetite than previous versions.
Dr. Canody: Research has shown its an average of about 24 hours fasterthe average peak to symptom onset is about 2.5 days after exposure to Omicron. With Delta it was more like 3. 5 days.
Dr. Canody: The truth is, you cant tell the difference by just looking at the patient. There’s such a wide variety of symptoms. Obviously with the Omicron variant, theres a lot more upper respiratory symptoms. This one doesnt seem to be as severe in the lower respiratory tract.
There isnt really a way to tell except for testing because with the exception of loss of taste and smell which is still specific to Covid. It is not a prominent symptom were seeing currently with Omicron and now that Omicron has taken over based on surveillance where were over 90% Omicron variant in this area, truly the only way to tell is by testing.
Dr. Dumois: That unfortunately has been a struggle. The home test kits I think are good, but you cant find them in the drugstores, I sure cant. Until drugstores start getting their new shipments, thats not much of an option.
I think what families should focus on– is their first call is to the pediatrician. Some pediatric offices are doing the tests in their clinics, so that would be the best place to go if they offer that service and they have enough test kits.
If they dont, the pediatrician may have some good suggestions on where they have been recommending people to go.
Related: Where to get a FREE COVID test without an appointment for your family in Tampa Bay
Dr. Canody: We try to put them in different buckets. So number one, if somebody in your household or close contact is positive and you have symptoms that started within 2-3 days of when they got sick, most likely you have Covid. You have Covid until proven otherwise.
If somebody has a negative test and you tested negative, even if its been a couple of days since youve been feeling ill, then chances go down a little bit.
The gold standard is still PCR testing.
The other thing to keep in mind is that rapid testing is still rapid testingits still only about 75% accurate and it isnt very accurate the minute you get symptoms, so its still going to be most accurate when youre a few days in. So, if youre all the sudden, Im sick, Im going to do a rapid test day one”, its probably going to be negative, but that doesnt mean you dont have Covid, you cant rule it out.
Dr. Dumois: The immunity you get from having had Covid–its there, but not as good as the immunity we see after vaccination, and it decreases over time. It is definitely possible to get Covid a second or even third time.
Dr. Canody: Theres not a ton of information, but one study out of Europe shows that if you have antibodies from a previous Delta infection, it is not highly protective against Omicron. But, now what theyve seen in a lab is that people who have had Omicron actually have more cross protection against the other variants. But thats just in a lab and that may not last a long time.
This is where we compare viruses. If you get chicken pox-you get chicken pox once you develop a lifetime immunity. If you get the flu, you can get a different strain of the flu.
I know everybody is thinking were talking about Covid-19, but what were truly talking about is mutations of a virus and different strains of a virus. Being immune to one strain doesnt automatically grant you immunity to other strains.
I think thats the hardest partits like how many vaccines do we need to getis there always going to be a booster and I think at this point in time, were learning as we go but we can without a doubt show that the risk of hospitalization, severe disease, and death is greatly reduced in those who have been vaccinated and we also know that getting your booster six months after your primary series contributes to keeping those tolls reduced.
Dr. Dumois: It is not necessarily milder the next time. In people who have been vaccinatedyes. It seems that Covid is more consistently milder, but people who have not had the vaccine and theyve had Covid before, then their second episode might be milder, but it could also be more severe and put them in the hospital.
Dr. Canody: I think there has always been this question of vaccination immunity versus herd immunity through previous infection that hasnt proven true with Omicron. There have been a lot of breakthrough infections, but the severity has been greatly decreased [in vaccinated patients], but in those who are unvaccinated, that is truly where we are seeing more severity continue.
Dr. Dumois: Even though kids 5 and older can be vaccinated, the vaccination rate in those children are very low, so the unvaccinated kids are completely susceptible to getting sick with Omicron and although most of those children are going to do fine, some of those will end up in the hospital like the few we currently have in the hospital now. [4 patients as of December 30, 2021]
Dr. Canody: The two groups were already starting to see go up in hospitalization are those under a year of age–obviously children who are too young to be vaccinated, and those who are older teenagers and at higher risk and doing more risk activity.
But for those under a year of age, they dont have an option to have a vaccine and they havent necessarily had an infection and have the antibodies to protect them, so in some ways its the same thing we see with the flu, the kids under the age of 2 run the highest risk of hospitalization and severe illness.
Dr. Canody: It is time to get boosters. If its been more than 6 months since you finished your primary vaccination series, then that booster is recommended. That will cut down on the breakthrough infections and it will also ensure that that severity and reduction in hospitalizations and death is maintained in those age groups. Thats especially important in the kids who are high risk.
Dr. Dumois: I would be concerned if the CDC put out guidelines and never changed them. The fact that they are changing recommendations and its based on changes in the science or changes in the culture, at least they are being responsive in trying to adjust to changes that are happening around us. When they dont change, then Im more concerned.
Dr. Canody: I know the quarantine recommendations have truly become like a puzzle for everybody trying to figure out, so my first question is are you vaccinated, yes or no?
My second question is do you have symptoms, yes or no? If youre vaccinated and you dont have symptoms, but you had an exposure, you wear a mask and you protect others around you unless you start having symptoms.
If you are vaccinated and you have symptoms, then you should still test, you should be very cautious for a period of time. If you are negative 5 days into the illness then you should be in the clear if it was PCR.
The problem with Omicron is yes it spreads quite quickly, there have been a lot of breakthrough infections. Its highly protective [the vaccine] against severe infection, hospitalization, and death, but breakthroughs have come a lot higher than what we saw with Delta.
Dr. Canody: I think that in general, we have to look at risks and benefits and I think for a majority of children, especially those who are vaccinated, the benefit of being back in an in-school environment for learning, for their social edification, and for part of continuing what we want to get back to a normal life its extremely important because at this point the behavioral health risk is almost as high as the clinical health. We have to balance that.
I feel like its the same message over and over again over the last couple of years, but I feel confident that for most this variant has proven to be a bad cold. That doesnt mean it cant cause severe illness. Weve seen hospitalization rates go up, but not quite what we saw with the Delta peak.
Dr. Dumois: I can think of maybe three things that parents can do to prepare their kids for going to school.
One is to get them vaccinated if they are old enough to get the vaccine.
The second is for those children who are under 5 who cannot get vaccinated, vaccinate all the adults around them. Everyone in the home and other adults outside the home they may see on a regular basis whether its babysitters, grandparents, care workers.
The third thing is the masks. I think if the children are not already used to wearing a mask, start that at home. Dont have them not used to wearing masks and then send them to school and expect them to feel comfortable wearing a mask all day.
So that involves a few things. Onefinding a mask that fits them well and is comfortable. If it doesnt fit well, then its not going to serve the purpose of protecting them. If its not comfortable they wont be able to wear it when it would be helpful for them in school.
Another way to choose a mask is to let the child design one they like, or you can even decorate a mask if it doesnt have a design on it, or maybe even draw a little design on the side that would appeal to them. That can motivate them to want to wear the mask all day and very often, that is the case.
Dr. Dumois: There are no government sponsored mask mandates for Florida, but schools can still have their own rules about whether they are going to wear masks. Their staff should wear masks. That protects both the children and the staff and that should be highly encouraged.
The children should be taught to wear a maskthis is what we are going to do. We think its good for you and again, it may not be a compulsory rule, its not mandated by the government, but the school can make that decision to highly encourage everyone to wear a mask.
Social distancing is hard in a school setting, so thats not something we try to push as much.
Dr. Dumois: Some masks seem to be better than others at protecting children. Most masks will protect people around you in case youre sick, but some masks are better at protecting you in case you are around someone else who is sick.
And the ones that seem to be best at protecting you from getting someone elses germs, are the N95 masks, KN95 masks or KS94. Those are highly effective at filtering out most of particles that might contain coronavirus when you have to be around other people.
Dr. Dumois: Yes, because a cloth mask is going to be better than no mask if a cloth mask is all they can find or get their child to wear. A two-layer cloth mask is better than a single layer. Not all cloth masks are the same, so thats something they can look for –two layers of fabric.
Related: Your Guide to Masks by the Centers for Disease Control
Dr. Canody: We are seeing an exorbitant amount of cases spreading around and the one thing we know is that masks reduce the spread. Are they perfect? No. Are they always worn properly? No, but helping to mitigate that risk is important to all of us.
My recommendation is something that fits the face well and if its cloth, its double layered.
Weve talked about this time and time againand thats part of the reason why we hope to decrease the transmission.
Viruses are going to replicate and mutate to make themselves contagious and keep themselves going throughout the population and I think we see a perfect example in a spike protein mutation in omicron that became a little more transmissible even for those who are vaccinated, but in exchange for that, not quite as virulent or severe and the vaccination has helped prevent that severity.
Dr. Dumois: The Omicron variant is far more contagious than anything weve seen with this coronavirus, so this is very much a different virus than any of the variants we have seen before.
It is a lot more contagious, so you could be in an outdoor setting and if you are close to someone who isnt wearing a mask and youre not wearing a mask, you can get this in an outdoor setting.
The likelihood of catching the coronavirus in an outdoor setting depends upon so many variables like how close are you to the person who is in infected? Is that person doing all of the talking or are you doing all of the talking? Is that person laughing? Laughing expels a lot more virus than just talking. Is that person singing? That also expels more virus than just talking. How much wind is there? On days that are less windy, you are going to have less dispersal of the virus coming out of someones mouth than on breezy days, so you can catch coronavirus in an outdoor setting.
Indoor environments are inherently more risky because there is less dispersal, less air circulation to disperse virus coming out of someones mouth.
People could get together in indoor environments if they wear masks, but the thing that complicates that is that theyre going to be eating, drinkingthat means they have to remove their masks and that introduces the possibility of exposure. So when there is eating and drinking, outdoor settings are safer.
Dr. Dumois: Definitely. I went to restaurant last night with family that were in townwe ate outdoors.
Dr. Canody: Rest and symptom control. The only treatment we truly have for kids is the Remdesivir, which is the antiviral and thats reserved for those who are hospitalized. The antibody infusions, the monoclonal antibodythere was one approved for younger kids, but those have not proven to be effective at all against Omicron.
Fluids, rest, a box of tissues and TLC.
We still have to watch out for MIS-C (multi-system inflammatory syndrome) as wellthats 2-6 weeks following a peak, so January-February is going to be a really crucial time for parents to watch out if their child had Covid during the winter holidays.
Learn more about MIS-C and the symptoms to watch out for.
Dr. Dumois: Unlike last winter when the flu season didnt really happen, we think that was because people were more careful, they were more afraid of the coronavirus because vaccines were not yet available -and a lot of kids still had not gone back to school so there was a lot less transmission.
This year is totally different. Kids are in school, a lot of people felt coronavirus was going away, they stopped masking, they started attending group events and were now seeing a significant rise in numbers. It is a lot different than last year and we are seeing flu numbers go up because were not being as careful.
Dr. Dumois: For years, based upon the fancy tests weve done with nasal swabbing in children who have come in with breathing symptoms. Weve detected children with 2, 3, 4 even 5 viruses at the same time. So thats not anything new and its definitely possible.
Dr. Dumois: The preparations are closely monitoring the numbers and as we start to see more pressure in increasing numbers of children presenting with Covid and have to be admitted, then theyll start looking at staffing issues. Were okay with PPE and hospital beds.
Dr. Canody: The good news we hope in what weve seen in South Africa, Europe, especially in the UK– is that Omicron went down as fast as it came up. It took us 6-8 weeks to hit the peak rates with Delta in the country and were only 3 weeks into Omicron and weve doubled our peak prior, so were hoping as fast it goes up, its as fast as it burns out–and we see a herd immunity to this strain really quickly because so many people have it.
Dr. Dumois is a Pediatric Infectious Diseases physician at Johns Hopkins All Children’s Hospital. He joined the Hospital in 1993. He helps treat children with a variety of infectious diseases and is the director of their International Adoption Clinic.
Dr. Dumois received his medical degree from the University of South Florida College of Medicine and completed his pediatric residency at All Children’s Hospital/USF, serving as chief resident. He completed his fellowship in pediatric infectious disease at Children’s National Medical Center, Washington, D.C., in a joint program with the National Institutes of Health. He was awarded the Johns Hopkins All Childrens Hospital Physician of the Year Clinical Award in 2016.
Dr. Dumois plays an active role in continuing medical education, chairing the Planning Committee for the annual Florida Suncoast Pediatric Conference and weekly Pediatric Grand Rounds.
A fellow of the American Academy of Pediatrics, Dr. Dumois is board certified in pediatric infectious diseases. He has received the USF Pediatric Attending Teacher of the Year Award and has been included in Best Doctors in America for more than a decade.
Dr. Canody is a dedicated and diligent pediatrician caring for the Tampa, Florida community. Dr. Canody attended West Virginia University, where she received her medical degree. She completed her residency in pediatrics at the University of South Florida. Dr. Canody is a part of BayCare Medical Group. She is board certified by the American Board of Pediatrics. Dr. Canody is dedicated to helping patients receive the treatment they need so they can enjoy a positive and fulfilling lifestyle. She is deeply committed to the well-being of her patients. She takes a thorough and precise approach to her consultations to ensure that she is consistently giving accurate diagnoses.
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