A4 EZ RE THE WASHINGTON POST.SATURDAY, DECEMBER 25 , 2021
BY ARIANA EUNJUNG CHA
AND JACQUELINE DUPREE
This time last year, Claudia
Hoyen, a pediatric infectious-
disease specialist in Cleveland,
remembers staring at an eerily
empty hospital as Christmas ap-
proached. With many schools
shut and activities canceled, most
children had been sheltered from
the coronavirus. Today, nearly
every bed at the children’s hospi-
tal where she works is full.
“We are in a difficult situation,”
said Hoyen, at University Hospi-
tals Rainbow Babies & Children’s
Hospital. “With omicron, we are
now having this new surge on top
of what was left over from delta.”
Add to that the normal cases of
the flu, broken bones, scheduled
treatments for children with can-
cer and other conditions, and the
hospital is “in a crisis,” she said.
As the United States enters its
third year of the pandemic, fore-
casters are predicting another
ugly winter, but this time, chil-
dren as well as adults are being
affected. Pediatric hospitaliza-
tions for covid-19 are surging in
many parts of the country, along-
side the arrival of omicron — as of
Monday, the dominant strain in
the United States — with about
800 new admissions each day for
the past three days.
Ohio, Texas, Pennsylvania and
New York have been hit particu-
larly hard. As of Thursday, there
were 1,987 confirmed or suspect-
ed pediatric covid-19 patients
hospitalized nationally, a 31 per-
cent jump in 10 days, according to
a Washington Post analysis. Since
the pandemic began, nearly
7.4 million children and adoles-
cents have been infected, with
170,000 more added to that total
in the last week alone, according
to the American Academy of Pedi-
atrics.
U.S. doctors interviewed this
week said that while they are
seeing record numbers of positive
results from children’s coronavi-
rus tests, the vast majority of
cases so far have been mild and
look a lot like the common cold.
Indeed, several studies, includ-
ing a pair published this week
from Scotland and England, sug-
gest omicron is sending fewer
people to hospitals overall — wel-
come news. But public health
officials have been on high alert
about one group, children under
5, who make up the last group
ineligible for vaccines in the Unit-
ed States. Earlier this month
South Africa reported big jumps
in hospital admissions for that
age group. The accuracy and sig-
nificance of the South African
data is unclear, but on Thursday,
Britain released data showing a
bump in admissions for that age
group, too. Hospital admissions
ending Dec. 19 were at 3.64 per
100,000 for children ages 0 to 4 —
three times the rate for those ages
5 to 14.
That trend is not yet evident in
the United States. Doctors and
officials at eight children’s hospi-
tals in areas with mounting infec-
tions said most of their patients
are unvaccinated adolescents
with underlying health condi-
tions, as has been the case for
most of the pandemic, although
on any given day, a wide range of
ages may be represented.
Still, Aaron Glatt, chief of infec-
tious diseases at Mount Sinai
South Nassau, acknowledged col-
leagues are monitoring a “signal”
of a possible increase in hospital-
izations of children under age 2:
“It’s unknown yet whether the
lack of severity that seems to be
present in adults will also be true
in children,” he said.
Even with less severe disease
projected overall as a result of
omicron, pediatric specialists say
they fear more children may be
admitted to hospitals in coming
weeks, given the sheer number
likely to be infected.
Adrienne Randolph, a critical
care physician and anesthesiolo-
gist at Boston Children’s Hospital
who leads a network of research-
ers studying the coronavirus in
children, said that now is the time
for parents who have hesitated
about getting eligible children
vaccinated to schedule the shots.
“Everybody is getting prepared
for the worst at the moment,” she
said.Cold-like symptoms
In March 2020, when the pan-
demic was declared in the United
States, the initial presentation of
covid in children tended to be
somewhat distinct — with many
reporting a headache, stomach
pain, or loss of smell or taste.
With omicron, physicians de-
scribe messier symptoms that
mimic those of cold and flu. In
Britain, health officials have re-
ported that most children with
omicron infections experienced
headaches, sore throats, nasal
congestion and fever, with those
symptoms usually lasting about
three days.
In Maryland, pediatrician Aar-
on Milstone with Johns Hopkins
University School of Medicine
said emergency visits are ex-
tremely high, but few of the chil-
dren have been sick enough to be
admitted to the hospital thus far.
He said he has seen more fevers in
children with omicron infections
than with past variants and urged
parents who have children with
“cold” symptoms to assume “it’s
omicron until proven otherwise.”
“Parents have to recognize that
yes, there is cold and flu and RSV,”
Milstone said. “But right now the
dominant cause of symptoms
that look like cold is probablycovid.”
Outbreaks of respiratory ill-
nesses like the common cold and
the flu famously tend to hit the
very young and the very old most
severely. The elderly tend to have
more preexisting medical condi-
tions that make them vulnerable.
As for babies and preschoolers,
they have fewer defenses to fight
foreign invaders, said Patty Man-
ning, chief of staff at Cincinnati
Children’s Hospital Medical Cen-
ter.
It’s not just about immature
immune systems, she said, but
also how the children cough and
manage secretions and body tem-
perature less efficiently than
adults, making them more likely
to be felled by colds and the flu.
With previous coronavirus
variants, there appears to be
something protective about that
difference in the young. Why that
is remains one of the biggest
scientific mysteries about the cor-
onavirus even now, two years
after the World Health Organiza-
tion first alerted the world to the
new virus.
Most of the U.S. medical cen-
ters contacted this week said they
are experiencing record volume
and positivity rates among chil-
dren at both their hospitals and
outpatient clinics.
In Ohio, where besieged health
facilities recently took out a full-
page newspaper ad emblazoned
with the word “Help,” and the
governor deployed nearly
1,200 National Guard members to
set up testing sites and help
medical personnel, pediatric cas-
es are surging.Robert McGregor, chief medi-
cal officer for Akron Children’s
Hospital, said the positivity rate
has been so high that “we don’t
know the ramifications.” As of
Wednesday, the hospital had ad-
mitted several kids under 5, in-
cluding two confirmed cases in
infants and two suspected cases
in nursery-age children, but most
of the other 11 were teens.
“There is a sense that kids
progress quicker” to severe ill-
ness, he said.Nathan Hagstrom, chair of pe-
diatrics at the Lehigh Valley
Health Network, which operates
hospitals in the Allentown-
Bethlehem region of Pennsylva-
nia, said 20 to 30 percent of
coronavirus tests on school-age
children and adolescents are
coming back positive. He estimat-
ed that roughly two-thirds are
symptomatic. Hospitalizations of
children are double what they
were at the previous peak last
winter and the highest of thepandemic, but they still represent
a small fraction of all those infect-
ed, he said.
“The good news is the proba-
bility of having serious illness
goes down when you are vacci-
nated across all ages,” he said.
He added that while a large
number of children up to age 5
are testing positive, so far “they
do not appear to be getting severe
illness, or need any interventions
or treatment.”
In Houston, hospitalizations
among children with covid have
doubled in the past week, and
over 20 percent of children at
outpatient clinics are testing pos-
itive for the coronavirus.
“It’s just crazy,” said Stanley
Spinner, chief medical officer and
vice president at Texas Children’s
Pediatrics and Texas Children’s
Urgent Care. “And we are expect-
ing those numbers to go up
through the next couple of
weeks.”
Spinner said infections are oc-
curring in both vaccinated and
unvaccinated children — with
most of those whom have gotten
the shots having “much less sig-
nificant symptoms.”
He has two grandchildren un-
der 5 and said their parents, one
of whom is a cardiac specialist at
Texas Children’s, are isolating
from anyone who has been out in
the community. “If you are not
vaccinated, you are a sitting duck,
and children under 5 are not
eligible,” he explained.
In Pittsburgh, Andrew Nowalk,
a pediatric infectious-disease
doctor at UPMC Children’s Hos-
pital, said he is monitoring newsclosely from the countries hit
with omicron before the United
States. While the data out of
Denmark and Britain is reassur-
ing, he said he remains unsettled
by the South Africa reports of
very young hospitalized children.
He said it’s possible South Africa’s
data reflects differences in the
nutritional status of its children
and rates of various diseases
there, among other factors, that
may not apply in the United
States.
“I look at the South African
data,” he said, “and I say a lot of
prayers.”MIS-C mystery
As pediatric specialists grapple
with omicron, many are also pre-
paring for aftereffects. Those at
long-haul covid clinics at many
hospitals — already bursting with
patients suffering from lingering
symptoms after mild delta infec-
tions — anticipate more children
in the coming months.
At Rainbow Babies & Chil-
dren’s Hospital in Cleveland, one
looming question has been about
the rare post-viral multisystem
inflammatory syndrome, or
MIS-C, associated with covid that
appears in some children four to
six weeks after an infection. As of
Nov. 30, the latest data available
from the Centers for Disease Con-
trol and Prevention, there have
been 5,973 cases and 52 deaths
that meet the MIS-C case defini-
tion. Scientists aren’t sure what
causes the syndrome, but its un-
predictability — most of the chil-
dren are healthy with no underly-
ing conditions — and the sudden-
ness with which it hits have made
doctors and parents anxious.
One study published in Sep-
tember in the Journal of Allergy
and Clinical Immunology,
showed a possible genetic marker
that may make a child susceptible
to the condition, but it is by no
means the full story since the
marker is not present in all pa-
tients, said Randolph, the Boston
Children’s researcher, who is a
co-author.
With Cleveland, just seeing the
tail end of its delta wave doctors
are unsure the extent to which
they should expect new MIS-C
cases. In many other parts of the
country, the dreaded cases did
not materialize in the propor-
tions expected after the delta
wave. Scientists aren’t sure
whether that may be a function of
more vaccinations, exposure to
previous variants, or delta itself.
However, Hoyen, the pediatric
infectious-disease specialist, cau-
tioned that MIS-C has not disap-
peared: “We had two admissions
just this week.”
It’s too soon, she said, to know
about omicron.
[email protected]
[email protected]In parts of the U.S., the omicron variant is filling pediatric hospitals
JACQUELYN MARTIN/ASSOCIATED PRESS
A man and child wearing face masks pass a coronavirus testing line curving through a park in Farragut
Square on Thursday in Washington, D.C. The omicron variant is concerning parents and doctors alike.“If you are not
vaccinated, you are a
sitting duck, and
children under 5 are not
eligible.”
Stanley Spinner, vice president and
chief medical officer at Texas
Children’s Pediatrics and Texas
Children’s Urgent CareHANNAH KNOWLES,
RACHEL WEINER
AND LENNY BERNSTEIN
About 3,800 flights were can-
celed around the globe on Friday
and Saturday, as the fast-spread-
ing omicron variant of the coro-
navirus infected or quarantined
crews and prompted some travel-
ers to change their Christmas
plans.
The last-minute airline disrup-
tions complicated the holiday
hopes of tens of thousands travel-
ers who had planned to gather
with family or friends at the end
of a second pandemic year. Others
appeared to be reconsidering fu-
ture travel as the highly conta-
gious virus spreads, causing air-
lines to pare back flights for the
coming months.
The website FlightAware re-
ported that more than a quarter
of the flights canceled for Christ-
mas Eve and Christmas Day in-
volved travel within, to or out of
the United States, where the omi-
cron variant has helped create a
fifth wave of illness just in time
for the holidays. Another 2,
flights were canceled Thursday.
The seven-day average of new
infections reached more than
189,000 per day Friday, according
to data tracked by The Washing-
ton Post, surpassing the peak of
the delta variant wave in late
August and early September.
Carly McCullough, 23, said she
would miss Christmas Eve baking
cookies and decorating the tree
with her family in Atlanta after
Delta Air Lines canceled her
11:30 a.m. Friday flight from New
York. She said the airline offered
to rebook her on an afternoon
flight with a stop in Cleveland, but
she didn’t want an “all-day fiasco.”
“I don’t want to risk getting
stuck in a different city,” Mc-
Cullough said. Her new plan is an
8 a.m. flight Christmas Day and a
Christmas Eve spent wandering
the city.
Others scrapped travel plans
entirely. Elizabeth Horton, an ar-
chaeologist in Northern Virginia,
was planning to fly Friday to Mis-
souri to see family, after avoiding
planes throughout the pandemic
for fear of infecting her parents,
who are in their 80s.
She booked her ticket in early
December. “And then with the
new variant coming in, it was like,
‘Oh, you know what? No,’ ” Hor-
ton said. She will join the family
festivities over Zoom.
“I hate this so much,” she tweet-
ed Tuesday after canceling her
flight.
Some of the international flight
cancellations did not appear to be
related to the pandemic, and the
overall disruption was modest.
But in the United States, the can-
cellations struck during one of the
busiest travel periods in two
years. Some people who spent last
year’s holidays at home — before
vaccines were rolled out for most
people — were willing to venture
to airports after enduring nearly
two years of restrictions.
The Transportation Security
Administration reported that al-
most 2.2 million people went
through security screening at air-
ports on Thursday — nearly as
many as in 2019, and almost three
times as many as last year on the
same day. From Dec. 16 to Dec. 23,
more than 2 million people
passed through checkpoints al-
most every day — about double
the number recorded on the same
days last year.
Bob Mann, an airline industry
analyst and former airline execu-
tive, said there are typically
20,000 flights a day in the United
States and 115,000 airline flights
globally on a peak day — a figure
that does not include business
jets and general aviation aircraft
operators.“It’s more than it should be; it’s
more than anybody wanted it to
be,” Mann said of the cancella-
tions. “But you know, it’s not the
end of the Earth.”
“If it’s your flight, it is the end of
the Earth,” he added.
United Airlines said in a state-
ment Thursday that it would can-
cel 120 flights on Friday because
the variant has had “a direct im-
pact on our flight crews and the
people who run our operation.” By
midday Friday, FlightAware said
about 190 flights were canceled.
Delta Air Lines said its teams
had “exhausted all options and
resources — including rerouting
and substitutions of aircraft and
crews to cover scheduled flying.”
On Friday morning, Delta said it
had canceled 135 Christmas Eve
flights because of weather and
staffing problems, but still hadnearly 3,100 scheduled for the
day.
American Airlines spokesper-
son Derek Walls said Friday the
company is not experiencing a
greater-than-usual number of
cancellations.
Domestic airlines have asked
the Centers for Disease Control
and Prevention to scale back the
isolation time for vaccinated per-
sonnel with breakthrough infec-
tions, as the agency did Thursday
for health-care workers. But CDC
spokeswoman Kristen Nordlund
said in an email Friday that “at
this time, the only updated guid-
ance on reducing isolation time is
for health care workers.”
Foreign carriers such as Luf-
thansa, Scandinavian Airlines
and Japan-based ANA said they
had also canceled small numbers
of long-haul flights, either be-cause of illness and exposure
among crews, or declining de-
mand.
Tal Muscal, a spokesman for
Lufthansa, said the German air-
line has canceled 33,000 flights
through March based on falling
demand in the new pandemic
wave. But “we’re mainly operat-
ing our normal flight operations
throughout the holiday,” he said,
adding that only about a dozen
flights are canceled over the next
two weeks.
When compared with flight
cancellations this summer and
fall, the Christmas schedule dis-
ruption “is really small,” said avia-
tion analyst Henry Harteveldt. Of
course, he added, “if your flight is
the one that’s been canceled, the
world has just ended. This is not a
meltdown, as some have de-
scribed it, but it is unfortunate.”He said he anticipates similar
cancellation spikes for the next
few weeks, as long as the omicron
wave lasts. “The airlines took a lot
of steps to ensure their airlines
would be healthy and to reduce
the risk that covid would disrupt
their operations, but you can’t
build impenetrable walls,” he
said.
U.S. airlines already have
scaled back international flights
because of travel restrictions to
and from other countries, he said.
The White House announced
Friday that President Biden
would lift restrictions on travel to
eight countries in southern Africa
on Dec. 31, citing new under-
standing of the omicron variant’s
risks and spread.
Biden made the decision on the
recommendation of the CDC,
which cited evidence that corona-
virus vaccines are effective at pre-
venting severe disease from omi-
cron, said a senior administration
official.
“According to our health and
medical experts at the CDC, the
value of country-based interna-
tional travel restrictions is great-
est early in an outbreak, before
the virus or variant has been
widely disseminated,” the White
House said in a statement. “This
value declines as domestic trans-
mission starts to contribute a
larger proportion of case burden.”
Biden placed the travel restric-
tions on eight southern African
nations thought to be the epicen-
ter of the omicron outbreak on
Nov. 26, citing the new variant’s
unknown nature. They barred
most non-U.S. citizens from trav-
eling to the United States if they
had recently been in Botswana,
Eswatini, Lesotho, Malawi, Mo-
zambique, Namibia, South Africa
and Zimbabwe.
[email protected]
[email protected]
[email protected]Dan Diamond, Amanda Finnegan,
Gabe Hiatt and María Luisa Paúl
contributed to this report.Omicron upends holiday travel as rise in cases halts over 3,800 flights
REMKO DE WAAL/EPA-EFE/SHUTTERSTOCK
Travelers at Schiphol Airport in the Netherlands on Thursday. Many flights were canceled on Thursday
and Friday as coronavirus cases continue to rise across the globe with the onset of the omicron variant.Lowered demand, spread
within crews among
reasons for canceled trips