Everything Concerned Parents Need to Know about the Omicron Variant and Their Children

A: The first thing to understand here is that the Omicron strain has been proven to be more transmissible than other previous strains, including Delta. Evidence indicates that it spreads at least 3–4 times faster than other strains. As such, the number of overall infections has risen as this new variant spreads.

Despite some misconceptions, Omicron is not actually more prevalent in children than in adults. However, there have been many news stories about children being infected in other countries, such as England or America, where there has been a huge rise in child cases, but this is simply due to the overall number of cases also increasing. As such, the number of child cases is bound to increase but the proportion of child to adult cases has not changed significantly. In Thailand, we still see that just 10% of all cases during this recent wave have been children. The ratios haven’t changed but the overall numbers have increased due to the greater transmissibility of the Omicron variant.

A: The good news is that most children do not seem to develop severe symptoms. If we compare children with adults, it could appear that symptoms in children are more severe because most adults have received a vaccine at this point, which has reduced the severity of their symptoms significantly. However, looking at the entire population, although this outbreak has spread more quickly and case numbers have risen rapidly around the world, the number of cases requiring hospital treatment is proportionally lower.

A: Vaccines do play a part because, although they have started vaccinating children abroad, there are still only a small number of 5–11-year-olds who have received them. In America, just 20% of that age group have been vaccinated. Hence, those who have not been vaccinated are still more likely to become infected, meaning the rates of infected 5–11-year-olds is still rising.

A: Some people may understandably question whether the vaccine is necessary for young children because, as we have said, children’s symptoms do not tend to be severe. However, if children do not get vaccinated, it could lead to an outbreak in that group as they would be the only unvaccinated group. From an infectious disease perspective, we would be less able to control the outbreak and we may never be able to return to our previous lives because these children need to attend school and meet with their friends outside of school, which would make social distancing impossible. Even though we know vaccines do not offer 100% protection against infection,  if we can achieve a 50 to 70% drop in infections among this group, it would go a long way to limiting the outbreak.

In addition, some children might have underlying health conditions, such as obesity, heart disease, or respiratory conditions, all of which can cause severe symptoms if they become infected. These groups therefore have a need to be vaccinated to ensure an infection would not be dangerous to them. Therefore, parents of children in high-risk groups, should ensure they vaccinate their children when they are offered an opportunity to do so.

A: There’s actually nothing special to prepare. Children should maintain good physical health because a healthy body means a strong immune system. However, the Covid-19 vaccine is like any other vaccine; it should be administered when the body is ready and rested, but there are no specific limitations. 

A: The ingredients are basically the same but the potency is reduced according to age. Children’s vaccines are less concentrated, with ratios of just a third of those used in adults and teenagers. This also means that vaccines intended for children are not suitable for adults, nor can they be diluted for other purposes

A: Only regular symptoms are expected, such as a low fever and pain at the injection site, which are common and would not be any more severe than in other groups. In fact, studies have shown that the relative weakness of children’s vaccines means they cause fewer side effects. Research has now been carried out into the side effects that previously caused concern, such as endocarditis which was shown to affect young teenage boys the most. Findings from America indicate that from the millions of doses administered, this side effect was mostly found in young teenage boys. Among girls aged 5–11, it was found to affect just 2 in every million, compared to 4 in every million boys in this age group. These numbers are 10 times lower than in teenage boys, so the risks are extremely low. Also, when these side effects have occurred, the symptoms were mild and disappeared naturally.

A: The Covid-19 vaccine can be administered around the same time as other scheduled vaccinations. This means that parents can make one appointment for multiple vaccinations. Initially, it was advised that the Covid-19 vaccine should be given at least two weeks apart from other vaccines, but it has now been proven that there is no need to do this, nor are there are any other specific limitations. 

That initial advice was necessary because symptoms had to be monitored, including side effects. However, we already know what these side effects are in common vaccines and we have been able to monitor the side effects in children’s Covid-19 vaccines, and it has been determined that there is no need for concern on that aspect. Nonetheless, the formulation of each vaccine is unique and that is why we have to wait and see if this same advice applies when each new vaccine is made.

A: They have begun offering boosters to children over 12 in other countries. For those who received the Pfizer vaccine, 5 months must have passed since their last dose before they receive a booster with the Pfizer vaccine. For those who have received 2 doses of a vaccine other than the Pfizer vaccine, current recommendations are that they should wait at least 1 month before receiving a dose of the Pfizer vaccine, which will act as a booster.

In Thailand, there are no current plans for boosters in the 5–11 age group as the children in this age group are only just getting their 1st and 2nd doses.

A: Children previously infected are advised to receive a dose of Pfizer one month after they recover from their infection.  You can think of the infection as being the 1st dose and the booster as being the 2nd dose.

A: There is now data available for those aged between 2–5 years. The studies are mostly in relation to the Pfizer vaccine and there are plans to roll out such a vaccine this year. However, they are still researching dose adjustments. They are looking into administering 3 doses but nothing is finalized yet. Studies are ongoing and people are advised to be patient. Announcements are expected later this year and then vaccinations could become available to infants soon after that.

A: The main principles of prevention have not changed but there have been some additions. Based on extensive research, those aged over 2 years are now advised to wear face masks that fit closely around the face. This is vital because this can prevent certain particles entering the respiratory system. Also, the latest studies have shown that the virus is becoming more transmissible as its airborne spread is accelerating. Hence, it is important that the masks must be tight fitting.

Of course, an important consideration is the behavior of young children. We know they will not wear the masks 100% of the time and they are also more prone to touching their faces. As such, we must try to manage their environments. When it is necessary to leave the home, we must do our best to limit the risks. Firstly, confined places should be avoided as much as possible in favor of well-ventilated spaces and outdoor play areas. If young children are required to attend nursery, those working there are advised to get vaccinated, pay special attention to cleaning, and wash their hands regularly.

A: Many schools require regular ATK tests. Unfortunately, however, ATK tests are limited in that they may not show positive results if the patient has no symptoms as fewer virus cells are present in such cases. Others may have symptoms but still return a negative test result. For instance, many cases return a negative ATK test but a positive PCR test on the same day because the sensitivity of the PCR tests is higher. Therefore, relying solely on ATK tests to reduce the spread of the disease is insufficient, and other measures need to be used. For example, if we have had contact with an infected patient, we should self-isolate. We should not rely on ATK tests because they may not detect the virus. 

An ATK test cannot be used in place of other measures as its level of sensitivity is insufficient. If your child has symptoms and they start to feel unwell with a runny nose but they return a negative ATK test, you still should not send them to school. If a child has symptoms, they should be kept at home where their situation can be monitored. If their symptoms do not improve, they might require additional testing but ATK tests are not the sole answer to the problem.

A: The fact that there are so many different types of ATK tests means that we must first assess their safety. In all cases, any test should only be used according to its specific instructions.

First of all, many people have seen doctors or nurses perform deep nasal swabs in hospitals or clinics. However, this is not recommended for home use because the depth to which they go is carefully managed. Some reach the back of the nasal cavity and the very back of the throat. This could be very dangerous if performed at home where those administering the test do not have the relevant expertise. This is especially the case for testing children, who may fidget, flinch, or resist during testing, which can place them in danger of injury. 

For home use, and especially for children, the nasal swabs are still the best because they can be used to test any age. Most of them require you to swab the nostril region using a rotating motion. Some people believe that you can use mucus from blowing their nose but this is not correct because the tests require cells from the nasal cavity. Therefore, it is necessary to swab that area to ensure those cells are gathered and the test is valid. Only testing mucus increases the chance of an invalid test.

Recent studies have found saliva tests to be more convenient as no intrusive swabbing is required and they can be easily done at home using the saliva of the person being tested. However, the test instructions advise that the saliva should be egested into a small bowl, which requires the individual to be able to produce that phlegm from the back of their throat. As such, this may not be suitable for younger children.

In addition, devices which are held in the mouth during testing are not as effective as those that rely on saliva egested from the throat because they may not include tissue cells. Although there is emerging evidence that Omicron is more prevalent in the throat, it is important to understand that testing the throat and testing saliva are not one and the same thing. Throat swabs are distinct from saliva tests.

There is a belief that more of the virus is found when screening saliva but this is unconfirmed. However, the virus is found when swabbing the throat, which is what is used during PCR testing at hospital, where they use two swabs: one for the throat and one for the nasal cavity - neither of which are saliva-based. For home use though, throat swabs are not recommended.

A: A recent study on the issue of ATK test frequency and reducing outbreak severity indicated that around 1–2 tests a week could help identify cases where there are minimal or no symptoms. This would help identify children who should be kept off school to reduce the spread and limit the outbreak, which is what we are aiming for.

A: On the topic of contact, eating nearby an infected person without wearing a mask or spending over 30 minutes with an infected person in a closed room are both considered high-risk exposures. Current guidelines say you should isolate for 7 days following such contact.

You should then test on days 5 and 10. If you test negative on day 5, you can leave home on days 8, 9, and 10, although you must wear a mask when doing so, not taking it off around others and not eating meals with other people. You should also avoid busy areas for at least another 3 days. This also applies only to those who have been fully vaccinated as their risk of transmitting the disease to others is lower.

Some people test immediately after coming into close contact with an infected person but then wonder why they return a negative result. They may believe they can go about their normal lives again without posing a threat of infection as they tested negative, but this is not the case because the virus usually takes at least 3–5 days after contact to gestate and return a positive result.  This is why we advise testing on the 5th day following contact with an infected patient.

A: Older children are similar to adults, so if they have a fever over 39° for longer than 24 hours alongside a cough, breathlessness, or an oxygen monitor reading of less than 60ml, they should be taken to seek medical attention. It is more difficult to diagnose babies and infants, so we look at whether they appear drowsy, if they lose their appetite, and if they look breathless. Such symptoms should necessitate a trip to hospital. 

Additionally, other groups unsuited to home isolation are those with underlying health conditions and the elderly, who should be taken to hospital without delay if infected. A high fever, breathlessness, and a consistent cough require hospital treatment as these are considered yellow category cases at risk of the infection entering the lungs. Individuals of any age with these symptoms need close monitoring.

A: This depends on the age of the child. If the child is older, the risk is reduced, while the risk increases in younger children because they require closer care and contact at a young age. Masks also tend not to be worn at home, so this also increases the risk. If possible, a mask should be worn by both child and parent, although this is easier to sustain in older children. Also, when masks are removed, such as when asleep or eating, social distancing should be practiced, meaning a distance of at least 2 meters should be maintained if at all possible and you should not eat together at the same time. Eating outside is the best option. Inside the house, keep the air con turned off and open your windows as this will ensure good ventilation.

However, it is true that the risk is reduced with each passing day because the virus gradually becomes less transmissible over time. Studies have shown that after 5 days, the chances of transmitting the virus is down to around 6%. This is another reason why the first 5 days are when the most vigilance is required as this is when the virus is most transmissible.