January 2022: COVID19 Update
It’s a new year and here we are, still dealing with this pandemic. We are all pretty tired and feeling a bit defeated by a tiny virus. But as we reflect on the past two years, we really have come a long way with both prevention and treatment options. That gives us hope for the future.
Here are the latest updates:
- What do I need to know about Omicron?
- Does Omicron cause milder illness? What should we do right now?
- Are children getting COVID19?
- Should 12-15 year olds get a 3rd booster dose?
- Explain the new CDC quarantine guidelines?
- Is rapid testing accurate?
- When will the Pfizer vaccine be available for 2-5 year olds? Under 2?
- When will Moderna vaccine be approved for kids?
- Are there any anti-viral medications for kids?
What do I need to know about the Omicron variant?
The new Omicron variant arrived in the US on December 1 and is circulating rapidly across the US. It is twice as contagious as the Delta variant, which itself, is extremely contagious! The incubation time is also shorter—on average, it takes about 3 days to become infected after exposure to the virus.
Does the Omicron variant cause milder illness?
Yes, we think so. Omicron may be a milder strain because it seems to prefer infecting the nose and throat more than the lungs. But, there are other possible reasons it may be less severe. Vaccinated people experience more breakthrough infection with Omicron than Delta. And, vaccinated people have milder illness because they are vaccinated…thank you, vaccine! In South Africa, younger people were infected, and some already had one COVID19 infection prior to Omicron so that may also explain the milder cases. What we do know is that hospitalization rates are rising so this variant should still be taken seriously. And, most hospitalized patients are unvaccinated.
Since Omicron and Delta variants are everywhere right now, what should we do?
Avoid large indoor gatherings, mask up in public, and get vaccinated/boosted. Yes, your child should return to school but please have your child wear a high quality, well-fitting mask (N95, KN95, KF94 if possible), and if age 5 and up, please get your child vaccinated.
Are children getting COVID-19 infection?
Um, yes! We have seen significantly more patients (as young as 8 months old) test positive with COVID19 infection in the past two weeks. Most of our patients with COVID19 infection experience mild symptoms. Honestly, it is very hard to predict who has COVID19 and who has a garden variety cold virus, flu, Strep throat, or seasonal allergies. Kids with COVID19 may have fever, or no fever, sore throat, body aches, headaches, dizziness, congestion, and cough. With this surge in cases, we assume nothing and test everyone who has symptoms or a known exposure.
The percent of American children with COVID19 infection being ill enough for hospitalization is stable (0.1-1.8%) but the number of hospitalizations are up due to the sheer number of children becoming infected. And, some hospitalized children are diagnosed with COVID19 while hospitalized for another reason. Children with underlying medical conditions are still at the greatest risk of having serious illness with COVID19. Most children who are hospitalized for COVID19 are unvaccinated. There have been almost 6000 cases of MIS-C (Multisystem Inflammatory Syndrome in Children) and 52 deaths. There is still no clear reason why some children have this severe complication after COVID-19 infection.
Should 12—15 year olds get a 3rd dose/booster dose of Pfizer vaccine?
Yes, the FDA is expected to approve a 3rd (booster) dose for this age group next week. And, while official recommendations are pending, the advice will likely be to give the 3rd dose FIVE months after the 2nd dose. Data from Israel suggests that giving the 3rd dose around 4 to 4.5 months after the 2nd dose offers a more robust immune response.
What are the new CDC quarantine guidelines?
The Centers for Disease Control changed their quarantine guidelines to 5 days of isolation and then another 5 days of masking around others IF a person with COVID19 is symptom-free or symptoms are resolving. CDC Director, Dr Rochelle Walensky, says 85-90% of people are most contagious in the 1-2 days prior to symptoms and 2-3 days after symptoms begin.
[The scientific community has given very mixed reviews over this new guidance. My take: There are many factors that led to this change and it would have been nice for the CDC to show the scientific data supporting it. The period of contagiousness may not be the same for everyone. Vaccinated people with breakthrough infections are probably shedding less virus for a shorter period of time than unvaccinated people.]
If you test POSITIVE
- stay home and isolate for 5 days
- if you have no symptoms after 5 days (“or symptoms are resolving”), you can leave your home but wear a mask around others for another 5 days
- if you still have a fever, STAY HOME
[While the CDC has no guidance on negative rapid testing prior to return to work/school, some experts believe it would be useful to reduce transmission rates!]
If you are fully vaccinated (3 doses of Pfizer/Moderna or 2 doses less than 6 months ago or 2 doses of J and J) and EXPOSED
- wear a mask for 10 days
- test on day 5, if possible
If you are not fully vaccinated or unvaccinated and EXPOSED
- stay home for 5 days
- wear a mask for 10 days
- test on day 5, if possible
Is rapid COVID19 testing accurate?
Yes, a positive test is useful. But there will be more false negative rapid antigen tests with Omicron (i.e. you have COVID19 but the test fails to detect it)…the FDA recently cautioned that the rapid tests are less sensitive to identifying the Omicron variant. If you have symptoms of COVID19 and have a negative rapid test, try to do a second rapid test in 24-36 hours. Or, get a PCR/molecular test and stay home until those results are back.
When will the Pfizer vaccine be available for 2-5 year olds?
Not any time soon, unfortunately. The Pfizer study used the lowest dose of vaccine (3mcg) possible to achieve an immune response. That dose was effective for the younger kids (6 months to 23 months old) but not for the 2-5 year old group. So, Pfizer will give a 3rd dose of vaccine to the 2-5 year old study participants and then will reassess their immune response. This takes more time. If that does not work, they have to start a new study with a higher dose of vaccine.
When will the vaccine be available for kids under age 2?
The Pfizer vaccine dose of 3 mcg was effective for 6 months to 23 month olds in their two dose series trial. However, the plan is to roll out the 2-5 year old vaccine first…so we wait.
When will Moderna vaccine be approved for kids?
Moderna vaccine for teens is still in a holding pattern with the FDA due to the theoretical risk of myocarditis as an adverse effect of the vaccine in teenagers. However, Moderna will be releasing the data on their vaccine study in children ages 6 months to 5 years of age in early 2022. It is possible the Moderna vaccine could be approved in this age group before the Pfizer vaccine.
Are there any anti-viral medications for kids?
Yes. Children aged 12 and up are eligible for the monoclonal antibody medication, Sotrovimab (*the supply is currently depleted in Texas). And, the FDA recently gave Pfizer’s oral anti-viral drug, Paxlovid, Emergency Use Authorization. Paxlovid is a prescription medication for people at least 12 years of age and 88 lbs with COVID19 infection and are at high risk of severe disease. The medication is taken as soon as symptoms arise. In studies of unvaccinated people, the risk of hospitalization and death was reduced by 89% if the medication was started within 3 days of symptoms. Note: There are only 65,000 doses of Paxlovid available right now. Pfizer hopes to produce another 200,000 treatment courses in January.
We hope you were able to celebrate the season with your family and friends! We wish you a healthy 2022!
Dr. Ari Brown and the 411 Pediatrics Team @411Pediatrics
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