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February 2, 2022

News About Children and Covid: Vaccines and Masks

Two pieces of information to share. 

Vaacines and Vaccinations for 2-4 Year Old Children:  Parents of these young children are very anxious to get them vaccinated.  The FDA now requested that Pfizer submit their ongoing results from the clinical trial for 2-4 year old children so the FDA could start reviewing the data from the clinical trial in this age group. That would mean that the vaccine might be approved for 2-4 year old children by the end of February.  As vaccines are developed for children, scientists need to decrease the amount of the mRNA used in the dose for each younger younger age - always hoping that it would be exactly the right dose.  In the clinical trial the immune response needs to reach the same level of immune response as was seen in the next older age group (called immunobridging).  The dose used in the trial for 2-4 year olds was effective, just not as effective as the immune response in the 5-11 year old group.  The children in the clinical are receiving a 3rd dose and are being followed. Investigators  are currently seeing protection against omicron as they follow the children along.  Meanwhile they are giving the original trial subjects a 3rd dose and collecting data on these children.    The advisory boards, the FDA and the CDC must approve the proposed plan - a 3 dose regimen.    

Masks for Protection of Children in Day Care:  I saw a new prospective scientific study by investigators from Yale and Columbia about the effect of mask wearing by children >2 years of age on the number of closures of  their daycare center.  Professionals from the daycare staff completed 2 surveys about the efficacy of masks: (1) From May 22,2020-June 8 2020 they counted the number of closures as the baseline data. (2) The surveys were then repeated one year later - from May 26-June 23, 2021 to see if there was any effect of better mask wearing on the number of daycare center closures seen.  There was a 14% reduction in the number of closures after 1 yr which was statistically significant.  See Below 

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There are so many opinions about whether there are adverse effects on socialization and learning when children are wearing masks, but parents are equally concerned about the current lack of vaccinations for children of these ages and are happy they are protected with masks..  A study which reported adverse effects of masks for children under 5 was retracted only 17 days after publication.  This usually occurs because of serious problems with data collection.  There are no studies that demonstrate adverse effects on these young children when they are only wearing masks intermittently..  I take my daily walks in my NYC neighborhood early in the morning when parents are walking their children to pre-school, day care, or elementary school and I am impressed that most children, even in strollers, are masked and happily involved in animated discussions with one or another of their parents as they happily go to "school." 

  

January 29, 2022

Omicron Sub Variant - BA.2 - Has Arrived

There is a sub variant of omicron that is spreading and it is now present in 49 countries and at least 20 states, including NY and CT.  The variant was first detected in the Philippines, and Asia. Delta also had sub variants.  As of this week, omicron BA.2 accounts for 65% of the cases in Denmark.  But It is not listed as a variant of concern at this time. 

TESTING: This variant has lots of mutations, but the virus is picked up on PCR tests.  BA.2 is also picked up on rapid antigen tests. 

TRANSMISSION: Might be slightly increased over the current omicron BA.1 variant.  Even though it is now the most common virus in Denmark, they say that infection numbers in the country are still decreasing.

SEVERITY:  There are no increases in the number of cases and hospitalizations in Denmark, but data is still limited.

IMMUNE EVASION:  Will the immunity against omicron BA.1 also protect against  BA.2?  Early reports say yes but it may be too early to know.

See Below: 

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Scientists are saying there is no reason for panic at this time.  In Denmark the overall number of cases are still decreasing in spite of the BA.2 variant.  In addition, are no differences in the age distribution of the cases and the vaccines seem to have the same efficacy- as against omicron BA.1  Management of the infected patients is still the same - and to prevent infection get a booster if you are eligible and wear the N95 or KN95 masks in public.

January 26, 2022

Covid-19 Infection During Pregnancy

Nature Medicine, a premier science journal, just published a paper from Scotland about Pregnancy and Covid-19 infections.  They have a health system that allows scientists to survey large groups of the population and link them to specific therapy and health outcomes in thousands of patients.  Data of this type has not been available previously for pregnancy and Covid-19.  They were able to survey 79,148 deliveries, 80,183 live births (with multiples).  There were 273 stillbirths and 179 neonatal deaths during the SARS-CoV-2 pandemic.    

From Dec 1 2020 to Oct 31, 2021 21,194 (47%) of pregnant patients were vaccinated with 2 doses of Moderna, Astrazeneca, or Pfizer vaccines with equal distribution of vaccination over the 3 trimesters..  Only 5% of these patients received booster doses.  During the same time period 85% of non-pregnant women aged 18-44 years in the general population were vaccinated.  There were 4950 confirmed Sars.CoV-2 infections in pregnant patients and the incidence was very similar in all 3 trimesters.  Of the infections, 77% occurred in the unvaccinated women, 11% in partially vaccinated, and 11% in the fully vaccinated.  Hospitalization occurred in 19.5% of the unvaccinated and 98% of them were in the critical care units.  Only 5.1% of the fully vaccinated were hospitalized and only 0.2% required a critical care unit admission.  See Below for Baby Statistics.    

 

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A total of 2164 babies were born to women who had Covid 19 infection during Mar 1, 2020 and Oct 31, 2021.  There were 11 stillbirths (death after 24th week of pregnancy), 241 were preterm births (<37 weeks gestation), and 8 live babies who died within 28 days of birth. All of the perinatal deaths occurred in women who were unvaccinated.

This was a complicated scientific paper and I tried to pull out the most important data.  The bottom line is that all pregnant women, not previously vaccinated, should get vaccinated during their pregnancy with 2 doses of vaccine plus a booster.  This is the first population wide study to document the value of vaccination to Mother and Baby! Another well-known benefit of maternal vaccination is transfer of Mother's SARS-CoV-2 antibodies through breast milk for months after childbirth.

 

January 22, 2022

Rapid At Home Covid Antigen Tests: Some Information

Rapid antigen home tests are useful to test yourself and/or family members for Covid-19.  These tests detect the presence of the Covid virus proteins not the virus RNA like PCR tests.  They detect virus from the nasal cavity in 15 minutes and correlate well with the period of virus transmission.  Every test comes with complete instructions how to perform the test - and it is important to follow the instructions exactly in order to get a valid result in 15-30 minutes..  There are at least a dozen products available, but during the omicron surge they may be hard to find.  Our government is now sending every HOUSEHOLD 4 free tests.  Order them online at covidtests.gov.

When is the best time to test? 

If you are exposed to a Covid+ person, test 2-3 days after the contact.  If negative test again daily or every other day until at least day 6.  If you are positive isolate immediately.  

If you have Covid symptoms, test, but if negative, repeat again the next day because there may not have been enough virus yet in your nasopharynx the first 24 hours.

If you want to test to make sure you are not infected before you are attending an event, or meeting with older or immune-deficient people, the best time to test is right before you go to the event.  You may be negative in the morning, but positive later in the same day.  The results with omicron can change quickly.  

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There are many sites with information about the Rapid At-Home Antigen tests.  This is a link to one that has information about using the tests and specific brands in case the tests may be hard to get. 

https://www.nytimes.com/wirecutter/reviews/at-home-covid-test-kits/

The tests that will be sent by the government are from iHealth- and they have very complete instructions with the test and on their website .  The test box in my collage has the iHealth box markings.

January 19, 2022

Upgrade Your Masks For Omicron

Help Upgrading Your Masks: Written by my Peds Oncologist Son Jason
 
These days, the most common questions I'm getting are about masks, so let's dig in! As you've now heard from me and others, if you've been relying on cloth masks, it's time to up your game; omicron demands a more robust defense. Your options are N95s, KN95s, and KF94s; let's break down the differences, but my short version is to get yourself a batch of well-fitting KN95s or KF94s.
• N95s are regulated by the CDC. There are *no* N95s with ear loops; the standard mandates head straps to ensure the fit of the masks, so most people find these more restrictive and harder to wear. Usually, these are the most expensive.
• KN95 are regulated by China. They can have ear loops, making them more comfortable but also meaning you have to pay a bit more attention to the fit. They're generally less expensive than N95s; there are a LOT of counterfeit ones on the market.
• KF94 are regulated by South Korea. They generally have ear loops, and have a slightly different shape that some people like more. They're also less expensive than N95s.
See Below for Jason's recommended sources of these masks: 

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I love Vida for both KN95 and KF94 masks; they have them for both adults and kids, you can choose a variety of quantities, and I've been impressed with their delivery speed. Project N95 is also a great resource for finding authentic masks. And finally, I'd avoid Amazon like the plague for masks — everything I read is that Amazon is doing a *terrible* job policing counterfeits.  

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