That’s why your pediatrician might be recommending that patients with croup get COVID-19 tested to find out whether the SARS-CoV-2 virus caused the illness.  

“Not every child with croup has COVID, but we have to have a high suspicion given the surge” of the omicron variant, said Bianka Soria-Olmos, D.O., with Cook Children’s Pediatrics Haslet. “Croup is around; that is common during the winter months. But the new association with COVID-19 has recently been described. Pediatricians are on heightened alert.”

Croup is an airway inflammation often caused by a parainfluenza virus. It’s a common illness from ages six months to 5 years, and it usually can be treated at home. Dr. Soria-Olmos said some of her patients with the croup cough have been testing positive for COVID-19. 

Parainfluenza or COVID-19? Why does it matter which virus causes the croup? Because doctors say parents need to isolate and watch for other symptoms if their child has COVID-19. As of Thursday, 40 patients were being treated for COVID-19 at Cook Children’s Medical Center, including nine patients in the pediatric intensive care unit. At the peak in mid-January 2022, more patients were hospitalized with COVID-19 at Cook Children’s than at any point of the pandemic.

Dr. Soria-Olmos said croup tends to affect young children because of their smaller airways. The 4 and under age group, for now, remains ineligible for COVID-19 vaccines. 

As the omicron variant spread, media reports in recent weeks have cited a link between COVID-19 and croup. One explanation could be that omicron is believed to settle higher in the respiratory tract.

“It sounds like omicron is doing this where the other variants weren’t presenting in that fashion,” she said. “In my mind it’s COVID croup versus the old-fashioned croup. I cannot tell the difference between the two by examining the child. The only way to tell the difference is by testing.”

What strikes Dr. Soria-Olmos about recent cases among her young patients isn’t the amount of croup but the positive COVID-19 test results. She urges parents to seek out COVID-19 testing if their child starts with the distinctive barky cough.

 “Knowledge is power. Identifying the cause really does help in the situation that we’re living in right now. Hopefully that will persuade people to know that testing isn’t a bad thing. It’s one of the tools we have to start flattening the COVID positive case curve.”

Like Dr. Soria-Olmos, Todd Johnson, M.D., at the new Cook Children’s Pediatrics Allen has treated children whose croup turned out to be a COVID-19 infection. He also recommends a COVID-19 test for croupy children so that the parents can better anticipate what to expect if the test turns out positive. 

“Then they’re able to know, ‘How long do I have to stay home? How long do I have to stay out of work? How long do I avoid family members who might have complex medical issues?’”

 Some of COVID-19’s symptoms might look like croup – but with the potential for other ailments too, such as vomiting, diarrhea, body aches, sore throat, prolonged fever and loss of taste and smell. Recovering from COVID-19 can take longer than getting over typical croup, Dr. Johnson pointed out.

The father of seven children, Dr. Johnson knows firsthand how scary the barky or seal-like cough seems to a parent. He explained that croup causes inflammation in the soft tissue below the vocal cords.

“When that swelling happens, it narrows the airway to the point that makes that musical sound of the high-pitched whistle during the day, and that really barky cough at night.”

The daytime fever, dry cough and runny nose that’s characteristic of mild croup can be treated conservatively with over-the-counter medications.  Although a barky cough at night is typical of mild croup in young children, Dr. Johnson recommended they be evaluated by their pediatrician.  One dose of an oral steroid given at the time of their visit will help reduce the airway swelling, alleviate the nighttime cough and lead to a smoother recovery. 

“Whether it’s croup related to parainfluenza or the omicron or the delta variant, the children still need to be hydrated. With the fevers, they tend lose more fluids. They need fever reducers if the fever’s high and they’re irritable and not drinking and eating as well,” he advised.

Meanwhile, children with stridor (the whistly sound on an inhale) or a barky cough during the daytime, difficulty breathing, abnormal drooling or severe agitation need to be seen urgently, Dr. Johnson said.  An urgent care or ER physician may recommend closer monitoring and potentially an inhaled treatment that can only be administered in a health care setting.

In a Zoom call with about 20 local reporters this afternoon, Chief Nursing Officer Cheryl Petersen said the situation is nearing crisis level.

“We are at capacity and have been running at capacity for weeks,” Petersen said. “Just because COVID came doesn’t mean that we don’t have other routine hospitalizations and winter illnesses. We’re balancing our admission process and working to provide the best placement for all of our patients.”

The silver lining with the omicron surge is the fact that most children hospitalized with COVID-19 right now do not require critical care. Of the 69 COVID-19 patients, six are in the pediatric intensive care unit (PICU). However, the strain on the health care system is increasing.

In addition to high numbers of hospitalized patients, Cook Children’s Emergency Department and six urgent care locations are experiencing high volumes. Yesterday, 443 children were seen in the emergency room and 1,027 visited the urgent cares.

This high volume also comes as Cook Children’s staff struggle to avoid exposure and isolation from the virus. Currently, 165 employees are out due to positive COVID-19 tests. Although the health care system has more than 7,500 employees, the impact is still noticeable.

“It is similar to what our colleagues are seeing in other hospital systems,” Petersen said. “And that means that somebody else has to do the work. That means that I have managers staffing and, and I bless them and thank them for that.”

She describes the state of the staff at Cook Children’s as “weary beyond words.” 

The biggest thing the community can do to help is to take precautions against COVID-19, including masking, hand washing and getting the COVID-19 vaccine and booster if eligible. Not only will this help prevent COVID-19, but it may also prevent multisystem inflammatory syndrome in children (MIS-C), which has continued to affect kids throughout the pandemic.

“Those children are sick. They are presenting with a multitude of inflammatory symptoms, cardiac arrhythmia and blood clotting issues and require a lot of multidisciplinary care to get them back on the road to recovery,” Petersen says.

It’s also important to avoid Cook Children’s urgent cares and emergency department for simple COVID-19 testing. These locations should be used for severe COVID-19 symptoms such as:

·         Difficulty breathing

·         Difficulty staying hydrated

·         A high fever for more than four days

If you need a COVID-19 test for your child, please call your pediatrician’s office to schedule an appointment. At-home tests and community testing locations are also great options when available. Tarrant County’s website is a great resource for finding testing locations.

Bianka Soria-Olmos, D.O., a pediatrician at Cook Children’s Pediatrics in Haslet, says one difference she's seeing with the latest surge is symptoms resembling croup. 

“They're having upper respiratory symptoms and that signature barking cough,” she said.  “That's different from the lower respiratory symptoms we saw with delta.” 

Dr. Soria-Olmos encourages families to call their child’s doctor if they are concerned. She also says at-home tests, if you can find them, are reliable.

“One thing parents tend to worry about it at-home tests and whether or not they are valid,” said Dr. Soria-Olmos. “If you get a positive result on an at-home test, trust it. You do not need to re-test. However, if you receive a negative result on an at-home test, you need to test again in 48 hours.”

Dr. Soria-Olmos says parents shouldn’t worry too much about a child testing positive, as most children recovery quickly from COVID-19. She encourages everyone to follow guidance from the Centers for Disease Control and Prevention (CDC) which includes isolating for five days and wearing a mask for an additional five days.

As for how long this current surge will last, only time will tell.

“What I am hearing from the epidemiologists is that we will not peak for another three to four weeks,” Petersen said. “Unfortunately, if that holds true, I’ll be coming back to you to say we have a higher number of patients.”

Mixed emotions including frustration, worry and anxiousness (to name a few) fill my being yet again on the eve of the day my kids return back to school. It is no longer a new experience for me or the many other parents who have experienced the same feelings over the last 22 months.

 The significant positivity rate in our community and the marked rapid increase in the pediatric cases and pediatric hospitalizations in the last week and a half (all while kids are out of school) is what causes some of my angst. Unfortunately, now it is not too uncommon to hear situations in which people “did all the right things” but COVID still veered its way in. So while I have been able to shield and protect my own children from being infected during the pandemic so far, I fear that the time will come when the inevitable will happen to my own. What’s different now?

 In the midst of all these emotions, I look for the silver lining in our current situation. My kids are NOW vaccinated! Although we are well aware that even fully vaccinated people are susceptible to infection they are less likely to develop severe disease and the need for hospitalization. So in the midst of the mixed emotions I have come to the point of realization and acceptance that this time around I will not likely be able to shield my own children from becoming infected with the current COVID omicron variant.

 The current significant community positivity rate makes exposure and subsequent infection while attending school more likely in the era of optional masking and confusion regarding isolation/quarantine recommendations. In the midst of an ongoing roller coaster of emotions, I will hold on to what I can control and continue to practice and encourage my own children to practice preventive precautions as best we can, including vaccination (done), hand washing and mask-wearing.

 I make the same recommendations to my own patients and their families including the following disease prevention strategies:

• Eat a balanced diet and exercise regularly
• Get plenty of sleep
• Drink plenty of water
• Do not send sick children to school (regardless of COVID exposures or not). Keeping sick children home is the best way to prevent spread in the school setting. 
• Get yourself/or your child tested if you/they develop any symptoms of COVID-19. Testing and identifying infections and subsequent proper isolation practices will prevent further spread.
• Get vaccinated if you haven't already and get a booster if you or your child are eligible (primary series approved for 5 years old and up, boosters approved from 16 and up and anticipating approval for 12-15 year olds soon).
• Practice good hand hygiene, wear a mask and avoid large crowds.

 Given the ongoing change and updates to guidance regarding isolation/quarantine guidelines for different populations of the community, we know that navigating these situations can become confusing and overwhelming. For questions regarding testing, length of quarantine or isolation, and the COVID-19 vaccine for your child, please ask your pediatrician for guidance.

 Wishing you a Happy and Healthy New Year!

Dr. Soria-Olmos

Get to know Bianka Soria-Olmos, D.O.

Dr. Soria-Olmos is a Cook Children's pediatrician in Haslet. She was born and raised in Fort Worth, Texas, so Cook Children's has always had a special place in her heart. She came to know Cook Children's when she was just a kid herself. She went to the medical center a number of times with her active younger brother, who needed care following several mishaps with broken bones. The visits inspired her to decide, "I want to be a Cook Children’s doctor one day."

In pursuit of her dream, Dr. Soria-Olmos attended Texas Christian University (TCU) for a degree in biology and to fulfill the pre-medical school requirements. After graduating from TCU, she chose to stay local and attended medical school at the University of North Texas Health Science Center/Texas College of Osteopathic Medicine in Fort Worth. She completed part of her pediatric clerkship at Cook Children's, learning about pediatric medicine by attending rounds with pediatric hospitalists. It was then she knew she wanted to be a pediatrician.

She began her career with Cook Children's in 2014 as a pediatric hospitalist caring for sick children admitted to the hospital. Today, she works at Cook Children's primary care office in Haslet. Her special interests include child safety, child development and asthma.

The rate of children testing positive for COVID-19 across Cook Children’s Health Care System has more quadrupled since Dec. 21. Last week, 5.7% of COVID tests were returning positive. Now, that number is 22.1%.

“We are seeing upwards of 400 positive COVID-19 cases among children per day,” said Dr. Whitworth. “This is similar to where we were in early September when delta was spreading rapidly in our area.”

Dr. Whitworth says she is concerned that the numbers will continue to rise, especially as children head back to school from the winter break. She hopes parents of children ages 5 and up will make vaccination against COVID-19 a priority.

“I think masks in schools are a very good idea, but realistically kids are going to end up being around people who aren’t masked throughout the day,” she said. “The COVID-19 vaccine is excellent, so the chances of a vaccinated child winding up in the hospital or getting severely ill is very, very low. You can still catch a cold or flu-like illness from omicron, so it’s still a good idea to keep the mask on.”

She believes the current spike in cases is likely due to holiday gatherings and travel, and says it is different from the COVID-19 variants we’ve seen in the past.

“It felt like with delta, things ramped up over a few weeks. The rise on the curve was a more gentle slope,” Dr. Whitworth explained. “This time the surge is a vertical slope. That's what they saw in South Africa. That's what's been seeing nationally. This is not a hill, it's a vertical climb in number of cases… more rapid than before.”

One question Dr. Whitworth has frequently received lately is how long children need to quarantine before going back to school. According to new guidelines released by the Centers for Diseases Control and Prevention (CDC) on Monday, Dec. 27, people diagnosed with COVID-19 need to isolate for five days, if they do not have any symptoms on day five and have not had a fever for 24 hours (without the use of fever-reducing medications). This is a change from the previous recommendation of isolation for 10 days. The new recommendations are the same for adults and children.

“The CDC is making this change in response to new information about the omicron variant,” Dr. Whitworth said. “Researchers have found that people are most contagious in the couple days prior to symptoms and two to three days after.”

The CDC recommends those diagnosed with COVID-19 wear a mask for five days after isolation when around others.

What if your child has been exposed to COVID-19, but not diagnosed? The CDC has also changed their recommendations for what to do. If your child has not received the COVID-19 vaccine, or if they are due for a booster but have not yet received it, they should follow the same recommendations as if they have tested positive. This means quarantining for five days followed by five days of strict mask use.

Anyone exposed to COVID-19 should wear a mask for at least 10 days and seek a test five days after exposure.

As for the dramatic rise in COVID-19 cases among children, Dr. Whitworth says it’s time to get back to the basics with social distancing, hand washing and of course, vaccination (as soon as possible).

“Do I feel concerned? Of course I do, but I hope that this spring semester, for the first time, we have the kindergarten through sixth grade group vaccinated. I think that's going to make our elementary schools safer.”

Ayass Bioscience, a testing lab in Frisco, confirmed two cases of the new variant Wednesday night involving a 35 and 40-year-old. Neither has a recent travel history. 

This news comes after the first case was detected in the Houston area on Monday. The first case of omicron in the U.S. was identified on Dec. 1, 2021.

“At this time, we are still waiting for scientific data to answer everyone’s questions about this variant such as whether or not it is more contagious, whether or not it causes worse disease, and whether or not our vaccines can prevent it,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s.

The CDC stresses that “vaccines remain the best public health measure to protect people from COVID-19, slow transmission, and reduce the likelihood of new variants emerging.”

While the vaccine remains the most effective way to combat COVID-19, data from the American Academy of Pediatrics (AAP) released on Dec. 1 found that only 12% of young Texans, ages 5-11 years old are immunized, and 61% of Texas teens have received at least one dose of the vaccine.

Dr. Whitworth and the Centers for Disease Control and Prevention (CDC) recommend that everyone 5 years and older protect themselves from COVID-19 by getting fully vaccinated. They also strongly advise that everyone ages 18 years and older should get a booster shot at least two months after their initial J&J/Janssen vaccine or six months after completing their primary COVID-19 vaccination series of Pfizer-BioNTech or Moderna.

 “COVID-19 vaccines are highly effective at preventing severe illness, hospitalizations, and death,” the CDC adds. “Scientists are currently investigating omicron, including how protected fully vaccinated people will be against infection, hospitalization, and death.”

What we know about the omicron variant (from the CDC):

• How easily does omicron spread? The omicron variant likely will spread more easily than the original SARS-CoV-2 virus and how easily omicron spreads compared to delta remains unknown. CDC expects that anyone with omicron infection can spread the virus to others, even if they are vaccinated or don’t have symptoms.
• Will omicron cause more severe illness? More data is needed to know if omicron infections, and especially reinfections and breakthrough infections in people who are fully vaccinated, cause more severe illness or death than infection with other variants.
• Will vaccines work against omicron? Current vaccines are expected to protect against severe illness, hospitalizations, and deaths due to infection with the omicron variant. However, breakthrough infections in people who are fully vaccinated are likely to occur. With other variants, like delta, vaccines have remained effective at preventing severe illness, hospitalizations, and death. The recent emergence of omicron further emphasizes the importance of vaccination and boosters.
• Will treatments work against omicron? Scientists are working to determine how well existing treatments for COVID-19 work. Based on the changed genetic make-up of omicron, some treatments are likely to remain effective while others may be less effective.

Click here to learn more about the best tools to fight omicron and more general information from the CDC.