Author: All Pediatrics

Today I am going to discuss the omicron variant, from three perspectives: contagiousness, vaccination, and the concepts of isolation/quarantine/lock-down.

Omicron is clearly much more contagious than previous variants. However, it is also clearly milder. This is not unexpected. An infection needs hosts in order to replicate and spread, and if it kills off too many hosts, it will not be able to hang around. This is what happened with the Black Death in the 14th century, which eventually disappeared (but not without killing off perhaps 50% of Europe), without our having vaccines, medicine, or even a good understanding of hygiene. I do not expect Omicron to be as deadly as when COVID-19 first appeared, although that does not mean we should underestimate it.

(As an aside, as an indication of how people still do not understand the devastation COVID-19 can bring, I recount the following. Today, I overheard someone telling a friend “Omicron is no big deal. I had it, took some monoclonal antibodies” (which, by the way, were probably not medically indicated), “and only had sniffles. I feel fine now.” I almost expected him to add, “I don’t know why so many people choose to be intubated.”)

That brings me to vaccines. When COVID-19 first appeared, many people, including those in authority who should have known better, dismissed it as just like the flu. They were of course wrong. It was vastly more dangerous, and soon filled up hospitals, with high death rates as well. Omicron, does look more like the flu, being milder, but even so it is still expected to wreak more havoc, and more deaths, than even a bad flu season does. It is also more like the flu regarding vaccine effectiveness.

In a given year, the flu vaccine is perhaps only 50% or so effective at preventing disease. However, it is much more effective at preventing serious illness/complications, and highly effective at preventing death. The current vaccines for COVID-19 seem similar regarding their effectiveness. They do protect against illness, but nowhere near the numbers we would like. However, the vast majority of hospitalizations and deaths are occurring in the unvaccinated (even though they make up a minority of the population), because the vaccine is effective here. Please get yourselves, and your eligible children, vaccinated.

You have seen sports teams throughout the country decimated by the virus, even though, supposedly, the vast majority of athletes are vaccinated. Vaccine remains one component of prevention. With athletes, we have unmasked people in close contact with each other, breathing rapidly as they exercise and thus expelling more germs, and not constantly washing their hands. Hand washing, and particularly mask wearing, remain vitally important, even if not mandated (or even where actively discouraged, as in some parts of the country, which I predict will soon become the hot spots for the virus as it spreads).

Should we have lock-downs again? I hope very much not to have to resort to them this go around, and expect to be able to avoid them with this milder form, relying on methods of reducing, but not eliminating, spread. School lock-downs, in particular, are a major concern for me, and should be avoided if at all possible. They are disruptive to the economy, as parents have to stay home to care for their children. We learned last year that they are poor replacements for in-person learning. Lastly, they have, not unexpectedly, negative consequences on the health of children, not just in mental health (depression rates have risen), but also physical health (obesity, already a major health issue, has become more prevalent as well). Along the lines of keeping schools open, I do note that, in Northern Virginia, many private schools were able to stay open last year, before we had vaccines. They did have the advantage of smaller classes, and it was no doubt easier to enforce mask wearing and hand washing. I take this as an indication that we should be able to keep schools open this year.
The CDC has just recommended shorter quarantine and isolation periods (I will refer to just quarantine from here on out, but the principles are the same for isolation). However, not all jurisdictions are going along with this. The difficulty here is that the variant is new, and we are still collecting data, but decisions have to be made in advance of this, realizing that recommendations will almost certainly change as we learn more. From a point of view of keeping schools, and the rest of society, open, there are obvious advantages to shortening quarantine periods. On a theoretical basis, I am comfortable with the shorter periods, and for this I rely on studies from England starting in the 1940s, which used the ‘common cold unit’. In this, scientists would introduce cold viruses into the noses of volunteers under different conditions, and see what happened.

One discovery was that the temperature of the room did not affect whether a person would then develop a cold. This is why, when parents ask me to tell their child to wear a hat in the winter so they won’t catch a cold, I cannot comply. Colds are more prevalent in the winter not due to feeling cold, but to being indoors and in closer contact with people (less ‘social distancing’, in current parlance).

We also learned that it takes a large number of viruses, not just a handful, to cause a cold. This is true of most, but not all, viruses; measles, for example, can be picked up with a very small inoculum, to use the technical term, which is why it is so highly contagious. When you have a cold, you can start breathing out germs before you have symptoms, which is why you can catch a cold from someone who is not ill at the time. You continue to emit germs for some time, but the number drops rapidly, to an amount below that which tends to cause colds in others, which is why you are not contagious for long with a cold, even though the symptoms may linger for weeks. I expect the same to be true for omicron, although, as stated, we do not have sufficient data to back this up yet. If true, even though you may still be harbouring the virus, and have an antigen test which stays positive for some time, a positive test later on in the illness would not necessarily indicate infectiousness. (In contrast, a negative test, if accurate, does mean no virus, and confirms no contagiousness). The idea is therefore that, after five days, you are not producing enough germs to pass it along, and can come out of quarantine if feeling better. Of course, this is theoretical, and it will still be important to get vaccinated, wear masks, wash hands, and try social distancing when possible, all measures which have clearly been shown to be effective, while we wait for more data to appear.

Most importantly, still, everyone knows what they need to do, and should be doing, to prevent the disease in themselves and their children. Please do your part.
Have a happy and healthy 2022.

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Coronavirus 36

Vaccines are now available for children 5 and up, and they will be coming for younger children, probably in the next few months. I know that the risk for children is, fortunately, much less than with adults. However, if we are to bring the pandemic under control, we will need to achieve herd immunity, and that means vaccinating as many people as we can, children included. Therefore, if not just for their sake, but for the sake of others, please get them, and yourselves, vaccinated.

Today I am going to look at the concept of vaccine mandates. It should not surprise readers that I am in favor of them, and I will give some insight into why I feel this way.

Some people do not want to be vaccinated because they are afraid of needles. As a pediatrician, I can certainly understand this, but I do not consider it a strong enough reason for avoiding vaccination during a public health crisis.
Some people do not want to be vaccinated because the vaccine is neither 100% effective nor 100% safe, (although it is clearly more effective and safer than not being vaccinated), and they do not fully grasp the concept of risk reduction. Again, I understand this, but it is again not a strong enough reason to avoid vaccination.

However, the largest group of people against mandates, which includes people who themselves have been vaccinated, do so because they feel it is a matter of personal choice. Which brings me to drunk driving.

When I was a child, drunk driving was legal in this country, and was a major public health crisis. It was true that if you, for example, killed someone while drunk driving, you could be tried for murder. However, since you were not necessarily legally responsible for your actions if you were too drunk to understand them (similar to temporary insanity), a good lawyer could often get you off. The idea that you were responsible for getting drunk in the first place did not always carry much weight with a jury.

Most drunk drivers make it home safely. Similarly, most people who are not vaccinated will not get COVID, or be very ill if they do (this applies to vaccinated people as well, but the risk is vastly less). Some drunk drivers do have serious injuries, and wind up in the hospital or dead. Similarly, some unvaccinated people do get seriously ill with COVID, and wind up in the hospital or dead. Finally, some drunk drivers can seriously injury or kill non-drunk drivers (and pedestrians). Similarly. some unvaccinated people will give the disease to others, resulting in those people’s death or hospitalizations.

A major difference between drunk driving and COVID is that COVID is a much bigger health menace than drunk driving ever was, killing and injuring inordinately more people per year than drunk driving ever did.

To put this all together, if you believe that not being vaccinated should be a matter of personal choice (even if you yourself choose to be vaccinated), I do indeed understand that. However, if you do not also believe that drunk driving should be legal, and also a matter of personal choice, then your world view is inconsistent, and that I do not understand.

Yes, our physicians and nurse practitioners recommend the COVID-19 vaccine. Our own children have already received the vaccine or will receive the vaccine as soon as they are eligible!

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I will be giving my thoughts on the vaccine’s use in younger children (regular readers should not have any problems predicting my views), but will first cover some other virus items.

The virus has certainly caused major damage in this country.  By comparison, we can look at the three major wars we have fought, all of them four-five years long.  World War I was felt to have cost around 115,000 American lives, World War II 400,000, and the Civil War 650,000.  COVID, in less than two years, has led to over 740,000 deaths, and the number will of course continue to rise.   There is, however, good news lately.  The number of cases of COVID in the DMV has been dropping every week since September 14.  Fairfax County is now classified as having ‘mild activity’, and Prince William County should be there soon.  Vaccines clearly work, as do masks.  For the latter, the most recent quality study I found on the subject indicates that mask-wearing in schools cuts COVID rates by around 50%.  However, this is not a time for complacency.  For example, slacking off on masks and vaccines at this time would be expected to lead to a rise in rates once again.

The FDA has just approved vaccination for children age 5-12.  This may seem to have been rushed, but the data are quite solid, unfortunately due to the large number of cases.   To understand this concept, suppose I developed a vaccine for tularemia, a rare infection.  I could show that the vaccine raised antibody levels, suggesting it was effective, but then to prove it actually worked in practice, I might take 5,000 people and give half of them the vaccine and half not.  I would find no cases of tularemia in either group, given the rarity of the infection, so I would be unable to prove the vaccine worked.  With COVID, when thousands of children are given/not given the vaccine, there are more than enough cases to show the vaccine is effective in real-life as well as in the lab.

Children continue to be relatively spared from the illness, although as more adults become immune from vaccine or disease, children start to make up a larger percentage of cases.  The death rate remains low, but real, with around 700 deaths of children in the United States so far.  I see three main reasons to vaccinate children.  One of them is obviously reducing the risk of illness, hospitalization, and death in children, and adults they may in turn infect.  Another is helping to wipe out COVID in this country, which will best be accomplished with high vaccination rates.   The third is practical, and a scenario I have seen played out a few times in our practice:  a parent comes down with COVID, so the unvaccinated children have to go into quarantine.  Then, when the quarantine is about to end, one of the children comes down with COVID, and the quarantine for the others continues.

Is the vaccine 100% safe and effective?  Of course not; nothing in medicine is.  It’s a question of reducing risks.  You can still die in a car crash with a seat belt, but the chance of that happening goes way down if you are belted in.  Conversely, some smokers do live long lives.  However, if you want to maximize your chances of living into your 80’s, wearing a seat belt and not smoking is clearly the way to go.

With the approval of the vaccine, anti-vaxxers will be out in full force again.  As Garry Trudeau has pointed out in Doonesbury, some anti-vaxxers such as Bob Enyart, Marc Bernier, Phil Valentine, Jimmy DeYoung and Dick Farrel are no longer broadcasting anti-vax screeds – because they have died from COVID.  These were preventable deaths, and tragic no matter how you look at it, but it will not stop others from sprouting lies about the vaccine, opining without evidence to back up their claims, and even making up material with no plausible scientific backing.  An early example of this was seen when the swine flu vaccine came out.  A cheerleader ambassador for the Washington football team got her 15 minutes of fame by showing how the vaccine made it so that the only way she could walk smoothly was by walking backwards.  It turns out that this could go away if she did not realize she was being filmed.

As a more current example, the COVID vaccines are not live vaccines, and cannot cause COVID.  This has not stopped the Centner Academy in Florida (no surprise where the school is located) from ordering those teachers and student who are vaccinated will need to stay out of school for 30 days because the Academy has heard that the vaccine causes COVID.  I can only assume that students there are taught about Sasquatch in science class, and how the earth is flat in geography, other ‘truths’ which can easily be verified with an internet search.  (By the way, a very useful site for exploring whether there may be any truth to a rumor is snopes.com).

(Digressing briefly, to another subject I feel passionate about, related to the power of the media, I saw an advertisement this week for a satellite TV company and video streaming service.  In it, grandparents are wondering how to entertain their infant grandchild, and are so pleased with themselves when they figure out how to find a program for him to watch.  See this and similar content often enough, and you will begin to question your parenting skills if you aren’t plopping your child down in front of a screen).

Bottom line, get the vaccine for everyone in your family who is eligible.  I am not yet sure how we will handle the demand in our office; check our webpage for this.  However, I am also fine with having it given at a local pharmacy.  I don’t much care where it is done, as long as it gets done.

Lastly, on the subject of vaccination, there will be significant cases of the flu this year, now that schools are open and workers are back at work.  We expect there will be several unvaccinated children in our practice who wind up in the hospital.  Make sure to get everyone in your family vaccinated for this as well.  Early on, before we had enough data, it was recommended that no other vaccines be given within a few weeks of the COVID vaccine but further studies have shown this is not a concern, so don’t let a recent COVID vaccine keep you from getting other immunizations, and vice-versa.

Stay healthy.

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