School has begun, and so far things have not been too bad. We're seeing a steady stream of children with COVID, but none have been terribly ill, and the clinics, hospitals, and schools have not been overwhelmed. Fingers crossed! Below are the latest updates.
As a reminder, here are two excellent resources for you:
The John's Hopkins COVID website: https://coronavirus.jhu.edu/
Videos from Paul Klotman, the President of Baylor College of Medicine. This one is very optimistic: (if the link isn't visible, google Paul Klotman Baylor College of Medicine Week 127).
The Latest:
COVID
Omicron variants account for all the current cases of COVID. The Omicron variant BA.5 accounts for 89% of the total cases, with BA.4.6 being the latest variant and accounting for 8%. https://covid.cdc.gov/covid-data-tracker/#variant-proportions
Although we are seeing many cases of COVID, the children are generally not very sick. Most have cold and flu symptoms. Admissions and deaths across the country and world are trending down, which is a great sign. The concern is that the BA.4.6 and BA.5 variants are more contagious than previous strains and better able to evade immunity from vaccines and previous infection. Fortunately, a third or fourth dose of the COVID vaccine seems to be protective against infection and severe disease.
That gets back to how important it is to be up-to-date on COVID vaccines. A study from Qatar found that the best immunity from Omicron was from hybrid immunity, or those who have been vaccinated and had prior infection. Given that most everyone has had COVID by this point, getting vaccinated is your best shot at not getting it again (no pun intended). https://www.nejm.org/doi/full/...
Masks are no longer required in schools, but two recent studies again confirmed that masks DO reduce the spread of COVID in schools. https://publications.aap.org/p...
Isolation
In January the CDC changed their guidelines for isolation if you are positive for COVID. The previous recommendation was to isolate for 10 days after the start of your symptoms. Because Omicron is less severe (and perhaps due to political pressure), the CDC now says that if you have COVID you should isolate yourself for days 1-5 after the start of symptoms (the first day of symptoms is day zero), and then if you are asymptomatic you can go back out in the world as long as you are constantly wearing a mask for days 6-10. This may be very reasonable and safe for those who are mildly ill and good at wearing a good N95 or surgical mask, but not realistic for children.
Unfortunately, this school year the TEA has joined the CDC in allowing students and staff who are positive to return to school after 5 days if they are feeling better, with no requirement to mask days 6-10. The problem is that recent studies have found that 1/3 of patients are still contagious at 5 days. For that reason, we still recommend that children remain in isolation/quarantine for 10 days after the onset of symptoms or from their last contact with someone who is positive. Here’s a good calculator from the CDC: https://www.cdc.gov/coronaviru...
The reality is that Omicron is so contagious that at some point all everyone's going to have had it, but this defeatist attitude may actually work in our favor by building herd immunity and getting us out of this mess. Bottom line is if you are sick with anything please seek care, test, and stay away from others until you are well.
Vaccine news
Both the Moderna and Pfizer vaccines are approved for children 6 months and up. Studies showed that the vaccines were very safe and effective at preventing severe disease. Side effects are similar to other vaccines, with the Moderna having a slightly higher chance of causing fever or redness and swelling at the injection site. As stated above, COVID vaccine boosters are very effective at preventing infection or severe disease with the new Omicron variants.
Two bits of news: There is a new Omicron-specific booster that will be available this fall. At this point if you are not yet boosted and aren't super-high risk you may want to wait for that one. There is also a new vaccine approved for persons 12 and up. It's made by Novavax, and works like a traditional vaccine by exposing your body to the spike protein. It is not an mRNA vaccine. For those of you who don't like "artificial" ingredients in your body, it is made with spike proteins produced in moths and an adjuvant from tree bark. No word on if side effects include the desire to eat holes in your clothes or express sap. It requires two doses at least 3 weeks apart. It is not authorized as a booster.
Regarding the traditional vaccines, here is how many you should have in order to be fully protected:
Children 6 months through 17 years of age:
Moderna – Two vaccines 4-8 weeks apart.
Pfizer – Three vaccines, with the first two doses 3-8 weeks apart and the third dose 8 weeks after the second dose for children 6 months - 4 years old and third dose 5 months after the second dose for children 5-17.
Adults aged 18 through 49:
Moderna – Three vaccines, with the first two doses 4-8 weeks apart and a booster 5 months after the second dose.
Pfizer – Three vaccines, with the first two doses 3-8 weeks apart, and a booster 5 months after the second dose.
Adults aged 50 and up – Four vaccines, with the fourth administered 4 months after the third dose.
Immunocompromised patients should receive more doses and on a more compressed schedule. It’s best to ask your doctor, because it varies based on your age and which vaccine you have received.
The vaccine continues to prove its value in children. The most common and severe complication of COVID in children is MIS-C, a severe inflammatory condition that can cause problems in many parts of the body, including the heart and kidneys. The vaccine is 91% effective at preventing MIS-C. In a recent study 38 of 97 unvaccinated patients with MIS-C required life support, but NONE of the 5 vaccinated patients did.
Treatment
Up until recently, treatment for COVID involved IV medications or infusions that were typically given in the hospital or to high-risk persons. Many types of treatments have been studied, some legitimate and some not. But now there is a new oral medicine called Paxlovid that works by stopping the virus from being able to replicate, like Tamiflu does for the flu. It is three pills twice a day for 5 days, and must be started within 5 days of becoming ill. Studies found it to be 89% effective in preventing serious illness and death. But it's not for everyone- it is only authorized for patients 12 and up, and is intended to be used only in those who are at high risk of serious illness or death from COVID, meaning those 65 and older or those with high-risk conditions such as cancer, diabetes, immunocompromising conditions, obesity, etc. There can be side-effects, and it has not been studied in children under age 12. Here is an excellent article: https://www.yalemedicine.org/n...
Vaccine information:
Please refer to our post, “Should My Child Get the COVID-19 Vaccine?” for more details on how mRNA vaccines work and why we recommend the COVID vaccine.
Here are the common myths and their updates:
Myth 1: It was developed too quickly.
Scientists have been developing mRNA vaccines for decades to treat or prevent a variety of illnesses and have been preparing for their use to combat a pandemic. There are several factors that allowed the vaccine to be produced so quickly:
1. Because the basic structure and safety of mRNA vaccines was already known, all the companies needed was the genetic information for COVID-19.
2. The government provided resources to help fund the production and eliminate red tape, thus allowing the companies to overlap steps and gather data faster.
3. Tens of thousands of volunteers quickly stepped up to help perform the studies. It usually takes years to gather enough subjects to test a vaccine.
4. mRNA vaccines are easier and faster to produce than regular vaccines, and the data was so solid that the companies were able to start production even before it was approved so that there would be adequate supply after approval.
We’ve learned that due to the “plug and play” nature of mRNA vaccines it only took Moderna 42 days from getting the mRNA code for the spike protein to producing a vaccine. This demonstrates how established and simple the technology behind these vaccines is.
Myth 2: There hasn’t been enough testing.
It usually takes years to get enough volunteers to adequately test a vaccine. In this case, tens of thousands of volunteers signed up for trials, and the virus was so widespread and contagious that it didn’t take long to learn that the vaccine was safe and worked incredibly well. It is about 95% effective at preventing infection, and 99% effective at preventing hospitalization or death. It does not get much better than that. The only thing we do not know is how long the immunity will last, which gets us to Myth 3.
UPDATE – We're now nearly two years past the release of the vaccines and there have been over 12 BILLION doses given worldwide. This vaccine is the largest and most scrutinized medical intervention in the history of the world so there is more data on its safety and effectiveness than any other vaccine in history, all of which suggest the benefits outweigh the risks. A study of 1.7 million people who received the vaccine found it to be much safer than natural infection. https://www.cidrap.umn.edu/new...
Myth 3: It’s not FDA approved so it must not be good.
FDA approval requires detailed data on safety, efficacy (how well it works), duration of immunity, and manufacturing processes. Once enough time has gone by to see how long the immunity lasts the vaccines will receive full FDA approval.
UPDATE - Pfizer received full FDA approval August 23, 2021, and Moderna was fully approved January 31, 2022.
Myth 4: There could be long-term side effects that we’re not aware of.
Vaccine side effects almost always occur within the first days or weeks after vaccination. We are now nearly two years out from full public use. Despite over 12 billion doses administered world-wide, the only serious side effects have been rare anaphylactic reactions, a rare blood clotting disorder called Thrombosis with Thrombocytopenia syndrome (TTS) that is very infrequently seen with the Johnson and Johnson or AstraZeneka vaccine, and some cases of myocarditis or pericarditis with the mRNA vaccines.
With over 12 billion doses administered worldwide and intense scrutiny of the vaccine by scientists and the public, these rare side effects have been quickly identified and addressed. Long-term data on mRNA vaccines does not demonstrate any new side effects appearing more than two months after vaccination.
Thrombosis and Thrombocytopenia Syndrome has an incidence of about 2 per million overall, and seems to be more common in women aged 18-49 where the frequency is 7 per million. It typically occurs within 2 weeks of vaccination. The CDC now recommends getting the Pfizer or Moderna vaccines instead of the J&J, as they have not been found to cause this issue.
Myocarditis or pericarditis has an incidence of about 20 per million, with the greatest incidence in men 30 years of age or younger after their second mRNA vaccine, in which case the incidence is about 100 per million (about the same as the lifetime risk of getting struck by lightning). This typically occurs within days of vaccination and in 98% of cases is mild or moderate. Nearly all of the patients studied had complete recovery. Because infection with COVID has a higher likelihood of causing heart problems than the vaccine, the CDC and AAP still recommend vaccination for this age group. The CDC now recommends males age 12-39 get their second dose 8 weeks after the first in order to minimize this risk. Interestingly, recent data suggests that the risk of myocarditis after the third dose is less than that with the second.
Here's a couple great articles on this subject: https://www.uab.edu/news/healt..
https://bostonreview.net/scien...
https://www.nejm.org/doi/full/...
JAMA Cardiology did a study on patients 15-18 years of age who were hospitalized with myocarditis after their Pfizer vaccine. Of the 15 cases, 14 occurred after the second dose and 14 were males. All patients were discharged within 5 days, none died, and only one had an abnormal echocardiogram after 13 days. They concluded that despite the risks of myocarditis associated with vaccination, the benefits of vaccination likely outweigh risks in children and adolescents. It is estimated that COVID-19 vaccination in males aged 12 to 29 years can prevent 11 000 COVID-19 cases, 560 hospitalizations, 138 intensive care unit admissions, and 6 deaths compared with 39 to 47 expected myocarditis cases. https://jamanetwork.com/journa...
Myth 5: The vaccine causes something called Antibody Dependent Enhancement that will cause those who are vaccinated to become more ill than the unvaccinated.
Antibody dependent enhancement is when a vaccine causes non-neutralizing antibodies to form which can then actually allow the virus to enter cells more easily, thus causing more severe infection. This has been a theoretical issue with coronavirus vaccines and makes people who emphasize it's dangers sound real smart, but it has not been an issue with the COVID-19 vaccine. If this were an actual problem, vaccinated patients who subsequently became infected would have more severe illness than those who were unvaccinated. What we have seen is the exact opposite - the low number of people who are vaccinated but still get infected with COVID do not develop severe disease and very, very rarely are ill enough to require hospitalization, while the unvaccinated are filling hospitals and dying. More information can be found here: https://www.medpagetoday.com/s...
Myth 6: Yeah, but I know (someone) who got the COVID vaccine and then (some horrible thing) happened to them, and it was because of the vaccine.
Odds are that of the millions of Americans getting the vaccine each day something bad will happen to somebody that day or the next. Most stories you hear are coincidental, so it is only by looking at large populations of people that we can learn if these events are actually caused by the vaccine. The only severe side effects that have been attributed to the vaccine are those discussed in Myth 4. Some people were alarmed way back at the beginning of this when the CDC reported 4,434 deaths after covid vaccination. But each of these were investigated and there was no link found between those deaths and the vaccine. It makes sense when you consider there have been over 550 million doses of the covid vaccine given in the US, and each normal day over 7,800 people die each day in the US of routine causes.
With over 12 billion doses given worldwide, odds are something bad will happen to someone within a few days of vaccination. Common side effects such as fever, chills, arm pain, and body aches are well known and short lived. Rare side effects such as swollen lymph nodes, Bell’s palsy and tinnitus have been reported after vaccination, but many reports of other problems are coincidental. The benefits of the vaccine far outweigh any risks.
Myth 7: I shouldn’t get the vaccine if I have allergies.
Although very rare, there have been people who have had anaphylactic allergic reactions to the COVID vaccine. You should consult your physician if you have a history of an allergic reaction to other vaccines or if you are allergic to any component of the COVID vaccine. The COVID vaccine is safe for people with routine food, seasonal, environmental, and latex allergies. The new Novavax vaccine does not contain PEG, which is one other ingredient some people were worried about.
Myth 8: The vaccines don’t work against new variants of the virus.
The spike protein that the mRNA vaccines produce immunity to is common to most strains of the virus, so the vaccine does provide protection against most variants. It is a race, however, because the longer it takes to get everyone vaccinated and get the pandemic under control, the more time the virus has to evolve into a variant that could be more infectious. Omicron has demonstrated the ability to infect those who have been vaccinated, but much less so in those who have had their booster.
The variants are named after the Greek alphabet, and each strain seems to be more contagious than the last. The Delta variant was first identified in India in December 2020 and was first detected in the US in March 2021. It was found to be 75% per infectious than the original strain of COVID-19 and twice as likely to cause hospitalization. This variant doubled in prevalence every 10-14 days and soon caused over 99% of COVID infections in the US. Delta died down in October, but then in November Omicron was discovered. It first appeared in the US in December, and within weeks was responsible for 95% of the new cases in the US. It multiplies up to 70 times faster than Delta and caused record-breaking numbers of infections. Now all cases of COVID are due to various strains of Omicron. The good news is that there is not another variant on the horizon.
The vaccine was less successful at preventing mild infection in children during Omicron, but being boosted with a third dose increased immunity greatly. An Omicron-specific vaccine will be available this fall.
Myth 9: Vaccinated people become ill with and spread/shed COVID more than unvaccinated people do.
Again false. It is true that vaccinated people sometimes do become infected (especially with the Omicron variant), but on average they don't get near as sick as the unvaccinated. Anyone who is infected can spread the virus, and in the early stages of disease both those who are vaccinated and unvaccinated can spread the virus equally. But because vaccinated people do not get as sick and do not stay sick as long as unvaccinated people, those who are vaccinated cause less spread than the unvaccinated.
Myth 10: Getting vaccinated is pointless because we may need booster shots.
We do not yet know how long immunity from the vaccine will last, but this virus may be with us for decades so yes, we'll need boosters - just like we do for every other vaccine. That's how our bodies work.
An article published in the journal Nature found that immunity related to antibody-secreting memory plasma cells can produce immunity from the vaccine that lasts for many years, and possibly a lifetime. Studies are ongoing, particularly related to the new strains.
UPDATE - There are various booster recommendations based on age, health status, and which vaccine you have received. Stay updated here:
https://www.cdc.gov/coronaviru...
The CDC recommends the Pfizer or Moderna vaccines over the J&J for both the initial series and boosters. This is because of the rare blood clotting disorder side effect called Thrombosis with Thrombocytopenia Syndrome. Although there have been only 54 cases of this side effect out of 17 million doses of the vaccine, 36 people required ICU care and 9 died. If you had the J&J originally you can get boosted with the J&J if you like, but studies have shown that getting boosted with an mRNA vaccine may result in much higher antibody levels. See more: https://www.yalemedicine.org/n...
Myth 11: I don't need the COVID vaccine if I've already had COVID.
People vary in their antibody response to COVID and how long their immunity may last, and there are many documented cases of second infections. Immunity from the vaccine is much greater and more predictable than from infection, and studies show that people with previous infection can increase their antibody levels 25-100 fold if they are subsequently vaccinated. One study found those who had natural immunity were 5 times more likely to require hospitalization for reinfection compared to those who received the mRNA vaccines, and another found that vaccination after natural infection was 82% effective at preventing a subsequent infection.
A study found that "hybrid immunity", that is being fully vaccinated and having a history of infection, is the best means of protection: https://www.nejm.org/doi/full/...
It is important to know that you can get the COVID vaccine as soon as you have recovered from the infection, which is usually about 2 weeks. You used to have to delay vaccination 90 days if you received monoclonal antibodies or convalescent plasma to treat COVID, but the CDC recently rescinded this requirement.
Myth 12: If I've had COVID I have to wait 90 days before getting vaccinated.
This is false. The misunderstanding began when the vaccine first came out and was in limited supply. Because people who had COVID within the last 90 days were considered immune, the CDC recommended that they wait to be vaccinated so that the few available vaccines could be prioritized to those who were most at risk. Now that the vaccine is readily available you can get it as soon as you recover from COVID, which is usually about 2 weeks.
Myth 13: You shouldn't get the COVID vaccine if you've recently had other vaccines.
False; there is no restriction regarding the timing of normal childhood vaccines and the COVID vaccine. You can get both on the same day or whenever. You can get your flu shot and COVID vaccine simultaneously also.
Myth 14: I’m young and healthy so I don’t need the vaccine, and neither do my children.
Immunity to COVID is important, and gaining immunity through vaccination is much safer and more reliable that through natural infection. Here's a nice summary: https://www.texmed.org/TexasMe...
It is true that children and young adults are at less risk of serious infection. But we have had several children as young as weeks of age become ill with COVID, and many young adults with no medical problems are in the ICU or have died right here in Lufkin. Many others have been very ill or have lingering symptoms. 70% of those hospitalized have symptoms 5 months later, and 30% of regular COVID patients have symptoms that linger 9 months after infection. A new study has also found a link between infection with COVID and subsequent development of diabetes in children.
Over 200,000 U.S. children have lost a primary caregiver due to COVID. If you are a parent, please get vaccinated to reduce the chance your child has to grow up without you. https://www.washingtonpost.com...
Even if you don’t get very sick, you could still spread it. It seems the new variants are even more infectious and cause more serious disease in younger people.
Besides all that, getting COVID is a hassle. The isolation and quarantining can cause psychological harm and has certainly hurt our children academically this school year. Students who are vaccinated will have a huge advantage in school this year because they'll be less likely to miss class and other activities.
During Delta 94% of people who were hospitalized and dying from COVID were unvaccinated. Being young decreases your risk of severe infection, but during Delta young adults and parents who felt they "didn't need the vaccine" were dying every day right here in Lufkin. You could go from low risk of death to (essentially) NO risk by getting vaccinated. Of the 9000 people in Texas who died from COVID between February and July 2021, only 43 were fully vaccinated. Vaccination nearly guarantees you won't die from COVID. Who will take care of your kids if you're gone?
A CDC report August 24, 2021 during Delta found that the median age of vaccinated patients admitted to the ICU was 64, whereas the median age of unvaccinated ICU patients was 49. The median age of the 24 vaccinated people in the study who died was 78, and 25% of them were immunocompromised. The median age of the 176 unvaccinated people who died was 63.
Myth 15: The vaccine can cause infertility or cause you to have a miscarriage.
This myth arose from a false report on social media, saying that the spike protein on this coronavirus was the same as another spike protein that is involved in the growth and attachment of the placenta during pregnancy. The false report said that getting the COVID-19 vaccine would cause a woman’s body to fight this different spike protein and affect her fertility. The two spike proteins are completely different and distinct, and getting the COVID-19 vaccine will not affect the fertility of women. During the Pfizer vaccine tests, 23 women volunteers in the study became pregnant, and the only one who suffered a pregnancy loss had received a placebo, not the actual vaccine. During natural infection the immune system generates the same antibodies to the spike protein that COVID-19 vaccines would. Thus, if COVID-19 affected fertility, there already would be an increase in miscarriage rates in women infected with COVID-19. This has not happened.
UPDATE – This is still untrue, regardless of what Jessica on Facebook posted. Dying from COVID, on the other hand, does make it difficult to reproduce.
Myth 16: The vaccine will affect my genes and cause birth defects.
That is not true; the mRNA vaccines do not enter the nucleus where your DNA is. If you can't get past this, get the Novavax, which is a traditional vaccine that does not contain mRNA.
Myth 17: I shouldn’t get the vaccine if I’m breastfeeding or pregnant.
The CDC and ACOG both recommend the COVID vaccine for those who are pregnant or breastfeeding. We have had many pregnant women in Lufkin who have been extremely ill or even on the ventilator due to COVID.
Not only is the vaccine safe during pregnancy, but studies show that 99% of babies will have antibodies to COVID at birth. Antibodies also appear in the breast milk. And getting vaccinated while pregnant protects the mother too because pregnant women who get COVID can go into premature labor and are also at higher risk of becoming more ill, needing ICU care and ventilator support, or even dying. https://jamanetwork.com/journa...
This study found that babies born to moms who are vaccinated are much less likely to require hospitalization for COVID. https://publications.aap.org/a...
Another study found that 98% of 2 month-olds born to moms who are vaccinated during pregnancy had antibodies, as did 57% of 6 month-olds. Bottom line: if you want to protect your baby from COVID get vaccinated while you are pregnant. https://consumer.healthday.com...
Myth 18: Bill Gates put a microchip in the vaccine.
This myth started after comments made by Bill Gates about a digital certificate of vaccine records, not a microchip in the vaccine itself. The only microchip tracking you is in your phone.
Myth 19: The vaccine can cause magnets to stick to me.
The vaccines contain mRNA and other normal vaccine ingredients such as fats, salts, and a small amount of sugar. The COVID vaccines were not developed using fetal tissue, and they do not contain heavy metals, preservatives, implants, microchips, or tracking devices. How do people think of these things?!
UPDATE – Don't get your medical advice from tiktok.
Myth 20: The vaccine has fetal cells in it.
Also false. It is true that the J&J vaccine is reproduced in a line of retina cells that were cultivated from a fetus in 1985, but there are no fetal cells or DNA in the vaccine. The mRNA vaccines are produced completely differently and have absolutely no relationship to embryos or fetal cells. The Novavax is also not derived from human cells.
Myth 21: The vaccine is the “mark of the beast” and this is all a sign of the second coming.
God gifted humans with minds that can decipher the world around us and use science to improve it. It is my opinion (Dr. G) that this and other vaccines are gifts from God that have saved millions of lives! It is our duty as Christians to care for “the least of these”. Getting vaccinated not only protects you, but others as well. And anyone who claims to know the date of the second coming is either a liar, crazy, or both.
Myth 22: Why should anyone care if I don’t get vaccinated? You make your choice, and I’ll make mine.
There are three problems with this attitude. One is that the vaccines aren’t 100% effective, so if you get infected there is a small chance you could spread to it someone who has been vaccinated. Second, children under age 5 and people with certain medical conditions cannot get vaccinated, so they are depending on herd immunity to not get ill. Our children are counting on us. Third, the more people who don’t get vaccinated, the longer the virus will circulate and the greater odds it will mutate, become more infectious, and continue to circulate.
Areas of the country with the lowest vaccination rates tend to be the ones that experience the greatest outbreaks. As more contagious variants spread, those who are unvaccinated will spread the virus to others, worsening and prolonging the pandemic. It’s your choice to be part of the solution or contribute to the problem.
Vaccine hesitancy is often associated with mistrust of the pharmaceutical or medical system in general. This article found that people who had Adverse Childhood Experiences (ACEs) were more likely to have low trust in COVID information and vaccines. https://bmjopen.bmj.com/conten...
Myth 23: Alternate therapies for COVID like Ivermectin and vitamins are safer and more effective than the vaccine.
Although eating a healthy diet, exercising, drinking plenty of water, getting enough sleep, and taking a multivitamin every day can help keep your immune system in top-shape, the vaccine is still the best way to protect yourself. There are no legitimate studies that support alternative treatments. In fact, studies have confirmed that Ivermectin provides no benefit compared to placebo. This quote from the article linked below says it best, "Relying on low-quality or questionable studies in the current global climate presents severe and immediate harms. The enormous impact of COVID-19 and the consequent urgent need to demonstrate the clinical efficacy of new therapeutic options provides fertile ground for even poorly evidenced claims of efficacy to be amplified, both in the scientific literature and on social media. This context can lead to the rapid translation of almost any apparently favorable conclusion from a relatively weak trial or set of trials into widespread clinical practice and public policy." In other words, trust your doctor and not a poorly-done study you find on the internet.
https://www.nature.com/article...
If you want something more natural, get the Novavax which is derived from moths and tree bark.
Vaccine availability: The vaccine is available at most local pharmacies and the Angelina County and Cities Health District.
