My son received his second dose of the vaccine (see picture). After I wrote about the risk of myocarditis last week, I heard from several friends about whether they should get their children vaccinated or even just go only with the first shot. Based on vaccine safety monitoring systems, the CDC also reported data that “suggests a higher-than-expected number of cases of heart inflammation after the second dose of mRNA COVID-19 vaccines in your men.” Here’s the bottom line: the risk of COVID far outweighs the risk of the vaccine. My son is doing fine and seems to have way less side effects than my wife or daughter experienced.
Although I do not think my son ever worried about getting COVID, certainly our job as parents is to keep our kids safe. The CDC released hospitalization data earlier this week in its MMWR on the adolescent 12-17-year-old age group. Hospitalizations related to COVID are generally thought of as occurring most frequently in older adults but severe disease that requires hospitalization does occur in all age groups. Based on hospital surveillance data, the CDC looked at adolescent hospitalizations related to COVID and also compared to hospitalization rates to previous influenza seasons. There were several interesting findings:
• Adolescent hospitalizations peaked at 2.1 per 100,000 in early January 2021, declined to 0.6 in mid-March and then rose to 1.3 in April. Approximately one third of the hospitalized 12-17-year-olds required admission to the intensive care unit and about 5% required mechanical ventilation. Fortunately, no deaths occurred. That’s a very high ICU percentage.
• Hospitalization rates were similar between the 12-17 and 0-4-year-old age groups. For unknown reasons, the hospitalization rate of the 5-11-year-old age group was a little bit better than the others. The 5–11-year-old age group pretty consistently had a hospitalization rate of about 0.5 per 100,000. You may hear more about this as it may be part of the argument on the safety of schools come fall before kids this age can get vaccinated.
• Hospitalization rates related to COVID were 2.5-3.0 times higher than influenza associated hospitalization rates from the 3 most recent influenza seasons.
• About 70% of adolescence requiring hospitalization had 1 or more underlying medical conditions, ranging from obesity, asthma, and/or neurologic disorders.The increased rate of hospitalization in April speaks to the potential for spread and severe disease among the 12-17-year-old age group. It also speaks to the importance of getting this age group vaccinated. One of the questions that I heard from several people last week was a request to talk about schools and masks this fall. Something we have all learned about COVID is that a lot can change over a few months so making a statement now about returning to school with or without masks is really speaking about a goal. It’s not something that is set in stone. While I am happy to give my take later this summer on whether kids should wear masks or not, ultimately, it will come down to a few things. First is the vaccination rate among the local population. Second becomes the number of new positives on a daily/weekly basis among that same population—new cases per 100,000 population. Third is the percent positive rate among those getting tested.
Another big X factor is the variants. In general, the variants appear more transmissible but not necessarily more serious than the baseline virus. However, we can also see less vaccine effectiveness with the variants though the vaccines, in general, reduce the risk of death and hospitalization. The Alpha variant (first identified in the UK) has increased from 0.2% of cases in December to 66% of cases in the US in mid-April. This is a more transmissible virus than the original COVID. The Gamma variant, first identified in Brazil, is up to 5% of US cases in mid-April, from 0.1% of cases in January. Finally, the Delta variant, first identified in India. While believed to be at least 6% of new cases in the US, this is the primary variant in the UK, representing more than 90% of new cases there. Delta is reported as 64% more transmissible than the Alpha variant and the vaccines are less effective against it, particularly after the first dose. Good news, though, effectiveness 2 weeks out after both Pfizer doses remains strong. There is no data yet for Moderna though it’s believed to be similar to Pfizer. What we don’t know about Delta is how well “natural” immunity (you had COVID previously) protects you. It appears to evade natural immunity in petri dishes but we don’t have real world data yet to confirm this. See image for a review of the variants name and origins.
We know vaccinations work. We have seen a reduction in hospitalizations and deaths among those 65 and older. It’s only a matter of time before the Delta variant is more prevalent in the US and vaccination remains our best strategy to prevent transmission, which also reduces the possibility of creating new variants, and hospitalizations. Although we do not know exactly when vaccines will be approved for those under 12 years of age, both Pfizer and Moderna currently have studies underway. Hopefully data is available by late summer/early fall with approval in September, though possibly needing until the fourth quarter of this year.
Following up on last week’s news regarding the mandatory vaccination requirement of the Houston Methodist Hospital system, they have since suspended about 200 employees for not meeting the vaccination deadline. There were hundreds of employees granted waivers for religious and medical exemptions or granted deferrals for pregnancy and other reasons. The Maryland Hospital Association has advocated for mandating vaccines and both the University of Maryland Medical System and Johns Hopkins Medicine will require them as a condition of employment by the end of summer. Other hospitals also appear likely to require it though may be waiting for the vaccines will have full FDA approval.
One of the more interesting articles I came across this week was on the possibility of getting DNA tested to assess your likelihood of having a severe illness from COVID. About 10 to 15% of people who have COVID will end up in the hospital or die. There is an Australian company that looks at genetic data combined with age and sex and pre-existing medical conditions to predict one’s risk of becoming extremely ill from COVID. This test has not yet been validated and there are many scienctists speaking out against using a test like this. The test is currently listed $175 so it is much cheaper to just get the vaccine, which is free. However, if you are unvaccinated and want to try to assess your risk, this is potentially an option. It is extraordinarily unlikely that a test like this would ever be used in an emergency department to identify ones need for hospitalization if they do test positive. The test was based on identifying DNA from 2200 people hospitalized in the UK to 5400 people who also had the virus but ended up with mild or no symptoms. The company did not seek nor was it required to seek FDA approval for this test. Although I think the science is very interesting, for now, I think it is much safer just to get the vaccine. But certainly, this is the kind of technology that may be game changing for other diseases down the line so I think it’s pretty interesting.
The ER continues to trend towards normal. About 10% of our patients require our COVID enhanced isolation protocol and about one third of them require admission. The number of positive cases we identify remains low, though certainly not zero, and our percent positivity rate is also low and holding steady. The number of people in the hospital with COVID low and similar to previous weeks and is not increasing.
We’ve all said it—It’s good to have some normalcy. We’ve been together with friends, eaten dinner inside at restaurants, and are generally returning to normal. But with large percentages of our population unvaccinated, almost no one wearing masks inside or out regardless of vaccination status, and a rise in more transmissible variants, I don’t think the pandemic is over, particularly for healthcare workers, regardless of whether you want it to be or not. There’s already two cruise ships reporting positive cases even though everyone had to be vaccinated and test negative prior to getting on the ship. Breakthrough cases are expected and they don’t mean we need to lockdown again or will we be in masks forever. However, we should continue to use some common sense and caution and encourage vaccination among your friends and family members that haven’t done so yet.
Science matters. Get vaccinated. Wear a mask when you’re supposed to. We’re almost there.