Category: News

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!

Please do not call the office to ask about vaccine updates. As soon as dates and times become available they will be posted on the vaccine info page below.

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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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Our December calendar is now available for booking online.

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It will be available over the phone starting Friday Aug 27th.

Please be aware while searching for an appointment that we are not scheduling well check appointments the last two weeks of December. During the holiday weeks we like to keep our schedules open for sick children.

I had hoped not to have to keep writing these, but circumstances have mandated a further update.

In pediatrics, we are used to the concept of rewarding children for good behaviour.  For example, telling your children when you go on a trip in the car, that if they behave, they can get a treat later.  However, if they don’t behave, and squabble in the back seat, then you are not going to figure out who was responsible, the ruling will be that nobody gets a treat.

The same situation applies to adults being vaccinated.  If everybody who could get vaccinated did, then we would all receive a treat:  no more mask wearing.  However, too many adults didn’t go along, COVID returned with a vengeance (although still not as bad as at its peak in most places), and we lost our treat:  back to mask wearing, even if vaccinated, in many, if not all situations.

Moving on to a subject that has nothing whatsoever to do with adults acting liked spoiled children, I turn to Florida, and Governor DeSantis.   He has declared that no school system in the state can mandate mask wearing. This is despite his state having more new cases and hospitalizations than at any previous period during the entire pandemic.  Public health issues, and the safety of children, are unimportant compared to the right to infect as many people as one wants.  This is not just a Florida issue, however; it impacts on us as well, since it is the underimmunized and maskless states that have fueled the resurgence of COVID-19 in this country, including in Virginia.

How do I feel about going back to school in light of the upsurge in cases?  Schools are vitally important, not just for academic learning but for social learning as well.  On-line learning doesn’t cut it; one does best with an in-person teacher (so I am also comfortable with home schooling, especially if one can find a co-op where all the parents have been vaccinated).  I want children back in school, and if that means wearing a mask for now, so be it.  There will of course be breakthrough infections, but one thing we have learned is that children generally have done well during the pandemic.  They tend not to get very ill.  Furthermore, when there are cases in a classroom, there have rarely been other children infected, and when children do get infected, it is most often from family members.  We also know, contrary to when the pandemic first hit, that the virus is transmitted from people, not objects, so your children are not going to catch it from sitting at a desk someone else used before them.

Cafeteria eating is a concern in schools.  As above, I am not concerned about picking up COVID-19 from a table.  However, masks are off when eating, and social distancing is a problem. I would prefer that children eat in their classrooms with prepackaged meals such as sandwiches, but that is not always doable.  Cohorting children (not mixing classes) as much as possible is preferred.   Enforced handwashing/ hand sanitizing before and after meals should be done.  As the lesser of two evils, I still vote for school with cafeteria eating rather than no school.

Of course, if your child is eligible for a vaccine (12 years and up for now, hopefully expanding to younger children soon). I recommend they get it, even at the risk of side effects, which are much less than those of the disease itself.

For example, consider the risk of Guillain-Barre syndrome from the vaccine, and assume that risk is 1 in 100,000 (it appears to be lower), and furthermore assume that everyone who gets it dies (although almost nobody does).  If we vaccinated every adult in the US, we would expect almost 3000 deaths from this, which sounds terrible, until you compare it with the 600,000+ deaths so far from COVID-19 itself –   a reduction in death of 99.5%.  The vaccine is of course not 100% at preventing infection, but it is highly effective at preventing hospitalization and death, which is why more deaths are now occurring in younger (unvaccinated) adults, rather than in sicker, older, but vaccinated, ones.

People sometimes wonder if they can trust the CDC, since it changes its recommendations often.  This is not flip-flopping.  Medical science adjusts as knowledge and conditions change, and what was true at one point may not be true at another.  Thus, we used to use penicillin for ear infections, for many years, but no longer, as it is ineffective.  This is not because we were wrong in using it 50 years ago, but because the germs have mutated, and we had to adjust our approach accordingly. Similarly, when COVID-19 cases were dropping, it was reasonable to ease up on mask wearing (although I personally never stopped wearing them in stores), but with the resurgence masks again have become an essential component to handling the pandemic.  One thing science can do well, when it is functioning properly, is to acknowledge change, rather than digging in its heels and refusing to face facts, as new facts emerge.

Hopefully, my next blog will be with good news about the pandemic, which has gone on for much longer than it needed to.

Our November calendar is now available for booking online.

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It will be available over the phone starting Thursday July 29th.

Our October calendar is now available for booking online.

Book your appointment directly from our website by clicking here.

You may also use the patient portal or Healow app.

It will be available over the phone starting on July 1st.