Covid Update - 1 August 2021

This week I'm going to do an overview of the current situation with Covid and kids. It was a hard post to write. The data in some areas is pretty sparse. We have no long-term data of any sort. I also don't have kids, so I don't have as much first-hand knowledge of aspects of it all. All in all, I think it's going to be challenging, but it'll work out, but all parents have my deepest empathy for the coming months.

Let's start with the bad news. Vaccines are unlikely to be available for kids under 12 till the winter.

This week the FDA asked Pfizer and Moderna to add significant numbers of children to their trials. The stated rationale is twofold. First, there was some extremely low-level incidence of myocarditis in adolescents. They want more data to see if it happens more often in younger kids. For context, out of the 300 million doses of mRNA vaccines given in the US to date, only 1,200 cases of myocarditis have been documented.

The second reason is that some members of the approving committee feel there should be more data for young children.

This almost certainly pushes the results for 5 to 11-year-olds from September till October or November. With Delta, you need to be fully vaccinated, so a minimum of five weeks from the first dose. This gives us a best case for kids in the 5 - 11-year-old cohort entirely immune at Thanksgiving but more likely Christmas / New Year. The EUA for six months to 5-year-olds is expected to occur a few months after the EUA for 5 - 11-year-olds.

I've found the FDA to be derelict in their duty when it comes to vaccination approval. For instance, it was just this week they begrudgingly announced that they would finally add staff to the full authorization panel to accelerate it. The lack of full approval is one of the top reasons vaccine-hesitant people have said they aren't getting their shots. In contrast, Israel has started to vaccinate all high-risk children over 5 with the dose that Pfizer is using in its trial.

The delay of vaccines means that all school districts will have to run for at least the fall with fully unvaccinated cohorts. With the current amount of Covid in the US and schools to open very soon, kids of all ages will likely have exposure if they are in person this fall.

Worse still, masks and vaccinations in schools are already becoming political. In Texas and Florida, the governors have banned schools from requiring masks. In SF, the Teachers Union has already stated their opposition to mandatory vaccines among the staff members. I suspect teachers' unions across the country will fight to allow unvaccinated, possibly contagious teachers to teach unvaccinated children; it's appalling.

The right decision would be mandatory vaccines for all staff, staff and students wearing masks, weekly testing, and as much outdoor education as possible. However, the devil's brew of anti-vaxxers, politicians, and unions will prevent that in most districts.

The good news is that in children, Covid has not been a significant health concern. At this point, tens of millions of kids under 12 have contracted it globally, so we have good data on the short-term effects. The infection fatality rate for people under 34 is 0.004%. This contrasts with the elderly; if you're over 85 and get Covid unvaccinated, you have over a 25% chance of dying.

In children, there is one rare condition that is believed to be caused by Covid. It's called Multisystem Inflammatory Syndrome in Children (MIS-C). From the CDC, "Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs." We do not yet understand how it is caused or the risk factors for it. However, we do know that it is extremely rare. To date, in the US, there have only been 4,196 cases and 37 death in what is likely millions of cases of Covid in kids.

The UK has given us some high-quality data on kids and Delta. It seems that even in the unvaccinated, there haven't been significant changes in how it affects kids compared to the baseline Covid.

There is some historical precedent for a viral infection causing issues later in life. One example is chickenpox. The virus goes dormant and can come back up decades later as shingles. No one has any data on Covid .

I wish the situation were more straightforward. If kids are in school in the fall, there's a reasonable chance they'll get exposed. However, another six months of remote learning will also have impacts.

There are no great options and no right or wrong answer. There's no canonical "parenting in a pandemic" book. For me, in chaotic, low information situations, I just try to make the best decisions with the data I have. When and if the data changes, I alter my plan and don't feel bad about my prior choices. We're all just doing our best.

Hugs to all the parents out there; this is not an easy situation. As always, just reach out if you have any questions or concerns.