COVID-19 Update from 411 Pediatrics: August 2021
Welcome back to another information-packed COVID-19 update! We know you have lots of questions. If we miss something, let us know and we will try to cover it in the next update or on Instagram @411pediatrics.
A few quick notes before we tackle the questions:
*We require everyone to wear masks in the office, even if you are vaccinated. Most of our patients are too young to be vaccinated and we need to protect them.
*Our COVID-19 Pfizer vaccine supply is coming soon (really!) See more below.
How contagious is the Delta variant of COVID-19?
Very! The Delta variant is twice as contagious than the original Alpha strain because infected people have a much higher number of viral particles in their nose, which are transmitted into the air. One Delta-infected person can infect 8-10 other people. The incubation period between exposure and infection also seems to be shorter (3-5 days on average). And, people may shed viral particles for a longer period of time.
Is the Delta variant causing more serious infection?
Yes. Anecdotally, medical providers are reporting that hospitalized patients are younger than in previous surges, become more ill, and experience more rapid deterioration with the Delta variant.
Do we need to take special precautions or change our vacation plans?
When Delta (or any future variant) circulates at high levels in our community/country, it’s important to be more vigilant. Observe social distancing, avoid large gatherings indoors, and mask up (everyone—vaccinated or not) when attending a group indoor activity with non-household contacts. Assess your family’s individual risk (immunocompromised, young children, vacation destination) to decide on your vacation plans.
Are the current vaccines effective against the Delta variant?
Yes! The goal of vaccination has always been to protect against severe disease or death from COVID-19 and all three COVID-19 vaccines do that. Most people (97%) hospitalized or dying from COVID-19 are unvaccinated. Delta variant is different because more vaccinated people are getting infected with it and are more likely to spread it to others compared to the original Alpha strain. Most vaccinated people who experience COVID-19 infection have mild symptoms or are symptom-free, which is the true goal of a successful vaccine.
If my child is infected and does not have symptoms, do they still need to isolate?
Yes. It is true that many children have mild/no symptoms with COVID-19. However, they are still capable of shedding the virus and infecting others. All people who test positive for COVID-19 should isolate for 10 days after the onset of symptoms (or a positive test result).
VACCINES
Does your office have COVID-19 vaccine yet?
No, but we should receive our first shipment of the Pfizer vaccine in the next few weeks! We will be ready to go when the vaccine is approved for kids ages 5 and up. Because of logistical issues and our desire to avoid wasting vaccines, we will run special COVID-19 vaccine clinics (like our flu shot clinics) and offer vaccine at specific times during the regular office hours. Stay tuned for a special newsletter for all the details!
When will kids under age 12 be eligible for COVID-19 vaccine?
Pfizer is the closest to completing their COVID-19 studies in children. Initially, Pfizer divided the study of over 4500 participants into three different age groups. The FDA recently requested Pfizer (and Moderna) to include a minimum of 3000 study participants in each age group and four to six months of data, which explains why it is taking so long to see these results. The participants received varying doses of the vaccine based on their age:
6 months to under age 5 years receive 3-mcg dose
5 years up to 11 years of age receive 10-mcg dose
By comparison, the dose for 12 years and up is a 30-mcg dose.
Pfizer expects to have safety and immune response data on the 5 to 11 year olds in September and will seek FDA Emergency Use Authorization at that point. The 2 to 5 year old data will be released soon after, but the infant and toddler data will be available closer to the end of 2021.
We want our child vaccinated before school starts. Can we cheat and get our 10 or 11 year old vaccinated before FDA Emergency Use Authorization?
This is a very common question and the official answer is no. However, because tweens and teens vary in their pubertal development, some 10 or 11 year olds are at the same weight or physical maturation of some 12 year olds. So, presumably they would do fine with the 30-mcg dose. But Pfizer’s current vaccine study is using a 10-mcg dose (1/3 of the adult dose) for the 5 to 11 year olds. That does not mean it is risky to give the higher dose to a 10 or 11 year old, it just means we don’t know. When we receive our vaccine shipment, we will follow the CDC/FDA guidelines because we have to document the vaccination into the state immunization registry with your child’s birthdate.
What is the risk for myocarditis?
The numbers are very low for heart inflammation after vaccination (13/1 million) and most cases are mild and self-resolving. And, know that COVID-19 infection can also cause myocarditis. A JAMA article showed that 15% of athletes in the study experienced myocarditis even after mild infection. Infectious disease experts feel that vaccination is definitely the safer choice.
Would it be safer to just give 1 dose of mRNA (Pfizer) vaccine since myocarditis is seen more after the 2nd dose?
No. The first dose of mRNA vaccine primes the immune system to recognize the virus. The second dose increases the antibody response by over 10 times, which is needed for prolonged immunity.
Is there a concern for long-term side effects with vaccination?
No. With all vaccines, untoward side effects and adverse reactions occur within two months of being vaccinated. While anti-vaccine activists blame vaccines (including COVID-19) for chronic health conditions and infertility, there is no data and no plausible science to support these concerns—even for vaccines that have been used for decades. Over 161 million Americans received COVID-19 vaccine over the past seven months (and over a year ago for participants in the original vaccination studies). It is unlikely a chronic adverse event will arise now and it is very likely one will get infected if a person is unvaccinated.
Will we need a booster shot?
Probably, but the US has no recommendation for it yet. Pfizer, Moderna, and J & J have excellent protection against severe COVID-19 disease, including the Delta variant. However, studies in Israel demonstrate that the level of immunity may drop after at least six months of receiving the Pfizer vaccine. As a result, Israel recently starting giving booster doses to immunocompromised patients and people over age 60. Remember, the goal of vaccination is to protect against severe disease and the two-dose series still does that. There is no downside to getting a booster (3rd) dose but right now, 97% of hospitalized patients are unvaccinated. Recommendations could change if more vaccinated people become seriously ill.
RISKS
Is it safe for my child to attend preschool/childcare?
This is a challenge with no easy or risk-free answer. It will be several months before the youngest children (6 months to 2 years of age) can be vaccinated. There have been several COVID-19 outbreaks in local preschools over the past few weeks. The delta variant is significantly more contagious, more young children are getting infected, and they are spreading it. Most children have mild illness compared to adults, but some children are ill enough to require hospitalization so their health outcomes should not be ignored. If your toddler (under age 3) goes to preschool purely for socialization and developmental stimulation, consider that toddlers may enjoy preschool, but they don’t need it. They need a loving caregiver who will provide developmental stimulation. So, your child will be developmentally fine either way. Kids who are 3 and 4 years of age do benefit from preschool, so this deserves more careful risk/benefit consideration. If your child attends daycare, it’s appropriate to ask if all the caregivers are vaccinated and if mask policies for staff are in place.
Should my child wear a mask in school?
Yes. It is the safest thing to do for optimal protection. Our kids really need to be in school and the most effective way to have them there safely is for them to wear masks, especially since most of them are too young to be vaccinated right now.
What are the current stats on COVID-19 disease in children?
Cases are rising in children and the Delta variant is more contagious in children. While adults have more infections and deaths, the disease burden in children is significant. To date, over 4 million cases of COVID-19 have been documented in American kids (the actual numbers are probably higher than that). This represents about 14% of the total number of cases in the US. There have been over 400 deaths. In Texas, children’s hospitals are reporting a steep rise in pediatric COVID-19 hospitalizations and ICU admissions in the past month.
We wish the news was better, but stay healthy and we will keep you posted with continued updates.
Dr Ari Brown and the 411 Pediatrics Team
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