Hawaii health officials are keeping a close eye on pediatric COVID- 19 cases amid the omicron surge.

Nationally, an uptick in children under the age of 18 being hospitalized, particularly those under age 5, has prompted growing concern. The highly contagious variant also has spread through the isles, but officials say the trend has not been seen to a great extent here yet.

As of Friday the daily number of pediatric patients hospitalized for COVID-19 climbed to seven, according to Lt. Gov. Josh Green, up from six on Thursday and three on Wednesday. That figure does not include a child admitted into intensive care earlier this week for an unrelated medical reason who tested positive for the virus upon screening.

Green on Friday said 231 patients were hospitalized with COVID-19 in Hawaii, with 25 of them in intensive care. None of the children were in intensive care.

“We’re watching this every day,” Green said. “We are aware of the reopening of schools and how it will impact omicron, but keep in mind we were open with schools during delta before children were vaccinated and we did not see a surge of children in the hospitals then.”

Coronavirus case counts surged to record highs in recent days just as public schools resumed in- person classes following the winter break.

“We should be concerned about every single person that goes into the hospital, especially children,” Green said. “However, as of now the idea of completely closing school could very well cause long-term harm to our children. That’s what has to be balanced.”

While he expects there to be more coronavirus cases among children, it’s uncertain whether there will be significantly more hospitalizations.

Approximately 6 out of every 100 children are infected with COVID-19 in Hawaii, ranking the state among the third lowest in the U.S., according to the latest data from the American Academy of Pediatrics and the Children’s Hospital Association. The hospitalization rate, at about 1%, is also low by comparison.

But nationwide, COVID-19 cases among children have reached the highest count since the start of the pandemic nearly two years ago, according to AAP, with over 325,000 cases among children reported for the week ending Dec. 30 — a 64% increase from the previous week.

Some Hawaii pediatricians are reporting an increase in cases among their patients but say there has not been much severe illness so far.

Dr. Brent Tamamoto of Aiea Pediatrics says he has seen more of his patients and their entire families testing positive after exposure to the coronavirus.

“People have gathered over the holidays,” he said. “It’s going to happen in your own home around your own kitchen table. Most people are not wearing masks while sitting in their living room, talking story and eating and drinking. It’s very challenging. It’s going to be extremely difficult to control this in any sort of significant way.”

The good news is that Tamamoto has not seen severe illness among his young patients. Many are experiencing symptoms such as sore throats, headaches, coughs and congestion but are able to recover.

“Certainly, if you’re vaccinated, I think that’s made a difference,” he said. “We’ve had higher-risk patients who are vaccinated and seem to be weathering the illness pretty well. I would certainly continue to encourage people to get vaccinated and boosted if eligible.”

Dr. Joy Dalmon, a pediatrician at Kaiser Permanente Maui, is also seeing more coronavirus infections among her patients — about five to seven cases per day, compared with one to two per day during the delta wave.

“We have a lot more positives in kids,” she said. “Thankfully, not too many are severe illnesses.”

Most are experiencing flu-like symptoms such as fever, body aches, headaches, coughs, runny nose and congestion, according to Dal­mon. There is also fatigue, but fewer are losing their sense of taste and smell.

Children under age 5 tend to have symptoms for about two to three days, then bounce back, she said, while it might take longer for teens to recover.

She advises parents not to ignore symptoms, even if they appear mild, and not to hesitate calling or going in to see their doctor.

“Symptoms, even mild symptoms, could be the beginning of COVID,” she said. “A lot of families are afraid to come in, but we have precautions in place.”

Tamamoto and Dalmon agreed there are significant benefits to children being able to attend school in person.

“Our kids need to be in school,” Tamamoto said. “The psycho-social consequences of not being in school are extremely traumatic. Making it safe for them is obviously a challenging prospect, but we’ve got to find a way to make it work.”

Dr. Scott Miscovich of Premier Medical Group, during his appearance Friday on the Honolulu Star-Advertiser’s “Spotlight Hawaii” live­stream program, said it was “grossly negligent” to have children too young to be vaccinated against COVID-19 — essentially those under the age of 5 — return to in-person learning.

Based on data from other cities and countries, he believes Hawaii will inevitably see a growth in pediatric hospitalizations, particularly among those who do not yet qualify for vaccination.

“If your child hasn’t been vaccinated, I would be very concerned (about sending them back to school),” he said. “If your child has any health conditions whatsoever that will put them at risk — immunosuppression, certain medications, having significant obesity, having diabetes — our state should be obligated to provide them distance learning, period, because they are at risk going into a closed classroom.”

Teachers, likewise, with high-risk health conditions should have an alternative to in-person instruction.

At the same time, Miscovich believes a “test-to-stay” program could be implemented for Hawaii’s public schools to keep kids on campus, but there needs to be statewide coordination and a system that should have been in place before classes resumed this week.

It should be set up on campus and made part of a school’s daily routine. Federal funding is available, according to Miscovich, who piloted a “test-to-stay” program in New Mexico.

Vaccinations among Hawaii’s elementary school-age keiki, meanwhile, could use a boost. Of children ages 5 to 11, only about 23% have completed Pfizer vaccinations, while 33% have received at least one dose.

Of children ages 12 to 17, the numbers are significantly higher, with 70.3% having completed vaccinations and 4.5% having received boosters.

The state Department of Health this week expanded booster eligibility to those ages 12 and older if it has been at least five months since completing their initial vaccine series.

On Friday, DOH reported three new coronavirus- related deaths – two on Hawaii island and one on Oahu — and 3,586 new infections statewide, bringing the state’s totals since the start of the pandemic to 1,101 fatalities and 134,442 cases.

The statewide average positivity rate, or number of people testing positive for the virus, jumped to a new high of 19.4%. On Oahu the rate was even higher at 21.2%.

As of Friday 74.7% of the state’s population had completed COVID-19 vaccinations, with 27% boosted.