Posted by Michael Barber, August 26, 2021 (last updated on August 31, 2021)
Our purpose at Solv is to free everyone from the stress of everyday health care. Usually that takes the form of same-day, next-day bookings at care clinics and labs around the corner. On August 25, 2021, we took a new approach, engaging an expert to answer the tough questions about COVID that are on the minds of parents and Solv users around the country. Solv CEO Heather M. Fernandez had an insightful and fact-driven conversation with Dr. Isaac Thomsen, a pediatric infectious disease specialist at Vanderbilt University Medical Center. As both a doctor and father of 3, Dr. Thomsen lends his scientific expertise and no-nonsense approach to keeping your kids healthy. Watch the full recorded session here:
- We are dealing with a three-part pandemic right now, that combined is making us more vulnerable: the viral pandemic that is COVID-19, the COVID-fatigue pandemic since we’re all tired of this, and a pandemic of misinformation.
- Going to in-person school is imperative and we can reduce the risk for our kids if we take the right precautions. These steps include: everyone in the community wearing masks to prevent the spread of COVID-19 and vaccinating everyone who is eligible (over 12 years-old).
- Here’s how the Delta variant is different: younger, faster, sicker. More kids are getting sick from Delta than with previous variants. 20% of all new infections are in children. The virus is spreading faster, particularly amongst the unvaccinated. And among unvaccinated individuals who are getting infected with Delta, they are exhibiting more severe symptoms for longer.
- Getting vaccinated reduces your chance of spreading the virus, even if you get a breakthrough case. With prior variants, the average COVID positive person would infect one to two people, and with Delta the average COVID positive person who is unvaccinated will infect five to seven people.
- We can save the holidays if we can convince more eligible, unvaccinated adults to get vaccinated now. The best way to keep our kids safe now and through the holiday season is to ensure the adult communities around them are fully vaccinated. We would worry a lot less about when the vaccine will become available for kids under 12 if we can increase vaccination rates among eligible adults.
Isaac P. Thomsen, MD, MSCI
Associate Professor Pediatric Infectious Diseases; Director, Vanderbilt Vaccine Research Program Laboratory
Dr. Thomsen is a medicine/pediatrics trained physician with advanced training in pediatric infectious diseases and clinical research (MSCI). His work focuses on defining the humoral response to staphylococcal infections in children and adults, evaluating best management strategies for pediatric osteomyelitis, and leading clinical trials of new vaccines and therapeutics. He also contributes significantly to the vaccine safety mission of the VVRP, serving as a subject matter expert and co-investigator in the CDC-sponsored Clinical Immunization Safety Assessment (CISA) network.
Co-founder and CEO of Solv
Heather Fernandez is the CEO and co-founder of Solv. As a mom of three, she founded Solv to free consumers from the stress of everyday healthcare by creating a national network of providers to make quality care accessible to anyone. Prior to Solv, Heather served as Senior Vice President and General Manager of Business Services at Trulia, through its acquisition by Zillow in 2015. She is a graduate of the University of California, Berkeley and Stanford University Graduate School of Business.
Hello everyone, welcome to today's webinar. I'm Heather Fernandez, the CEO and co-founder of a company named Solv. At Solv, we believe that consumers deserve to be free from the stress of everyday healthcare. We reduce that stress by connecting consumers to high-quality, same-day care that's available to everyone across the country.
I'm really excited to have Dr. Isaac Thomsen with me today. He's an associate professor of pediatric infectious diseases at Vanderbilt University Medical Center in Nashville, TN. He's also the director of the Vanderbilt Vaccine Research Program. He is a pediatrician, and importantly he's the father of three elementary school children, which makes today's topic relevant not only in his professional life, but also in his personal life.
Before I get started, I want to welcome all of the Bümo Parents who joined us today. They were founded to make life easier for busy parents around the world. Visit www.bumoparent.com to learn more and sign up for their weekly newsletter.
And finally, one more administrative note: if you're on this livestream today and you think it would be particularly useful for any friends in your network, you can go ahead and invite them to join live on Solv’s Facebook page and invite them to watch.
Okay, with all of that, Dr. Thomsen, the topic today is how do we keep kids healthy in the face of COVID-19 and Delta. I'm sure you've been talking about this a bit here and there.
I actually dropped my three kids off for school in the past two weeks, and I will tell you that my personal stress levels have been very high. It's not just that there is COVID and Delta, it's just all confusing — and I know that I'm not alone, because in this webinar we had so many registrants and over 500 questions submitted that we've gone through. I've broken them into a number of categories to cover as much ground as possible.
So, let's start with the basics: why is the Delta variant worse for our kids than the original COVID that we were dealing with last year?
Isaac Thomsen, MD
That’s certainly a very important question. First off, thanks for having me and thanks to your team for doing this. However we can get information out there, we need to. As you said, it’s all very confusing right now, so I and many of my colleagues are trying to get families actual information that's not filtered through media sources or bias, to say “Here’s the situation.” Hopefully this will be useful for people who care about kids and their health, which I would hope would be almost everyone.
Delta, the situation we’re all in right now, is a different, more serious phase of this pandemic. And as a parent, it’s the scariest part of this pandemic so far.
This one is different in large part because of how incredibly infectious this variant of the virus is, and how able it is to infect kids. As parents, a lot of us say things like, “Do what you want to me, but don’t mess with my kids.” If a tornado’s coming to the house, I’m not worried about my own safety — I’m worried about my kids. And in earlier phases of the pandemic, I often said to my friends and family that one silver lining of this otherwise terrible virus is it's largely leaving kids alone. That’s not the case anymore. There are a couple things to say about why that’s so, and the biggest thing is that the virus has changed.
We’re not just in a randomly different part of this or having a bad luck streak: it's a different virus now. It’s evolved, which is exactly what it was trying to do. The goal of the virus is to spread, to infect as many people as it can.
Think of the virus particle like a soccer ball, and then studded all around the surface of that is a protein. It’s called the spike protein, with little spikes all around the surface. The spike's job is to stick to our cells when we breathe: it sticks and causes an infection that helps it spread to our other cells. That spike protein is changing over time. Because there's so much virus continuing to circulate, we're selecting for better spike proteins on this virus that stick to us better.
And so now we know two things. One, it takes a smaller amount of virus that you breathe in to infect you, so you need less of it to become sick. And, people that are infected with Delta are shedding about 1,000 times the amount of virus out of their nose, their throat, their cough, and when they're talking, yelling, laughing, whatever.
It’s a really dangerous combination: you’re shedding a lot more, and it takes less to infect someone else. That one-two punch is what’s causing it to spread like wildfire, and it's much more capable of infecting kids that way.
That’s right. You know, my eldest is 13, and on the second day of availability we got her vaccinated. And yet, I've been reading about breakthrough cases with Delta, where my belief was if you have the vaccine, you would be protected. Help me understand what it is about Delta that gets past whatever protection we had with the vaccine.
Isaac Thomsen, MD
That's a super important topic and I think honestly, a major source of misinformation or misunderstanding about the vaccine. Because I think one of the ways it can be portrayed in the media is, “Oh, the vaccine’s not working as well as we thought it did because we're seeing all these breakthrough cases.” I think it's really important to understand how vaccines actually work and how they protect us from COVID. What we're seeing is actually the continued success of the vaccine, in that hospitalization, serious illness, and certainly deaths are overwhelmingly in the unvaccinated population.
Now that, of course, includes children under 12, because there's not a vaccine for them yet. But it also sadly, frustratingly includes many, many, many adults, so why is that? Why are we seeing this breakthrough now?
We have to think about where immunity from a vaccine actually lives. When you get the shot, you're building an immune response that's in your blood, your lymph nodes: it's in your body, so the antibodies that are circulating in your blood cells are trained now to recognize this virus. But that's not where the virus infects us. It doesn't go straight to our blood. It's a respiratory virus: we breathe it in, it lands in our nose and in our throat.
The vaccine’s okay at protecting us from getting initially infected, but that's not its main job. An analogy I’m fond of is, think of a security system in a house, and what the vaccine really does is it locks down the house, it keeps it protected. But it also builds a little bit of a fence in the yard that's sort of breathing in the virus in previous variants (alpha and sort of the initial strains).
They really couldn't even get past that initial fence. They weren't doing anything. Delta's better, it's stronger, and it's much more capable of getting in and binding to ourselves. It can get through the fence, it can get in the yard, it might even steal your lawn mower. But it's not getting in the house that’s right there, still locked down, so what we get is something that's more like a cold if you're vaccinated. That vaccine’s not going to prevent that initial binding of those cells in the nose, so we get runny noses and feeling bad and fevers. But the serious illness, the hospitalizations, the deaths, the vaccine is still working there. As we continue to see the evolution of COVID, we have to be mindful of this.
And so what happens from here? Does Delta just continue to evolve and there's a new variant which requires more and better vaccines and immunities? From a parent's standpoint, I’m tired. We’re tired of being scared all the time, and certainty is hard to come by. How does this evolve from here?
Isaac Thomsen, MD
There have been a lot of surprises with this virus, but I think there's a couple things that we can be pretty confident about. As long as we have a substantial portion of our population that's unvaccinated, this highly contagious, easily spreadable virus is going to continue to spread and infect people, and it's going to continue to evolve. That's science, that's what happens. It's going to continue to gain the ability to infect people more effectively. And unfortunately, we may well begin to select for variants that go around our vaccine defenses even more. So as a society, we’ve got to lock down the circulation and spread vaccination as fast as we can. We've got to get shots into arms as quickly as we can.
That's right. And as I look at some of our data, since we enable consumers to find vaccination sites, unfortunately it does not seem like we are succeeding as a country and really spiking that demand.
Isaac Thomsen, MD
I think that's where we've just got to get the information out. I think, Heather, the challenge right now is we're in a very vulnerable place in our society. In my view, we're dealing with three pandemics at the same time. We've got the virus that we've been dealing with since early 2020. We also now have —and this is surging heavily— a covert fatigue pandemic. We're so tired of this, we're over it as parents. We’re so tired of the constant calculus of, “Can my kid do this? and what about this?” and I have to think through that and it's exhausting and we're ready to give up. And that is incredibly advantageous for the virus when we get to that situation.
The third one is a misinformation or disinformation pandemic, and I think that's why we're here tonight. I can't do anything about the first pandemic, the virus, but we can talk about some things we can do as a society. I certainly can't do anything to help the covert fatigue pandemic, because I greatly suffer from it myself, as we all do. I'm so tired of talking about this. But I think we can help the misinformation.
You know, there are very few topics that I can talk about here today and say “Here's accurate information and here's an opinion that I really think you should trust.” I’m a big believer in folks staying in their lane and expertise mattering. I can talk to you about a recipe for a ribeye steak on a smoker that I feel like is essentially flawless. And I can talk to you about pediatric infectious diseases and vaccines for kids. And so I would ask the folks listening to trust us, just as you hope that folks trust you in the craft that you've honed for a decade to 15 years of working on the same thing. We're trying to get information out, however we can.
Thank you for that. So let's get into the weeds of some of these questions. First, elementary school children. The benefits of in-person learning are very clear, and yet we all have different circumstances. We all live in different school districts, we all have different priorities. We did receive a number of questions in the bucket of, “is it really safe for my kids to be in school for in person learning given Delta?”
We don't even need to spend time on talking about why in person is important, right? I think we're essentially unanimous on that, be it a pediatrician, educator, or parent. But how do we make it happen?
Isaac Thomsen, MD
I think there are two major approaches. The first is vaccine, vaccine, vaccine. I guess that was three, but that's still part one. We’ve got to get vaccine coverage for kids 12 and older that are eligible.
We are at something like 20 to 30% of vaccine eligible to kids 12 and older have been vaccinated. That is devastating to me as a pediatric infectious diseases physician. If I can just take a moment, maybe, to address anyone that's listening to this and has a child that's 12 and over that's not vaccinated against COVID.
I would speak directly to you and say that I understand you're trying to do the right thing, that you want to protect your kids. But if your child's not vaccinated against COVID, you're thinking about it the wrong way. You’ve got to stop thinking about protecting your child from the vaccine.You need to protect your child from this devastating virus. I know that there are lots of concerns about theoretical possible long-term safety and things like that, and we’ll get to that, but they're not based on any rational basis.
What we do have is immediate, significant danger right in front of us. Whatever you're worried about from the vaccine, the virus is far worse. Our hospitals are full. Children's hospitals are full of kids with COVID right now, and so, if we want kids to be in person in school we've got to vaccinate whoever we can, or schools are going to be closed and the kids are going to be in the hospital instead of in school.
So vaccines are number one. And the second thing is masks. Masks are clearly shown to reduce the spread of COVID in school settings of all ages. And until we have case rates low enough that there's not significant community spread and or until we have widespread vaccination, kids have got to be masking. The thing is, this is not magic and these aren't guesses. It’s just science, and you just watch things play out the only way they could. Which is that the counties near to where I live in Tennessee that are largely unmasked are already closed because they’re overrun by COVID among the students, the teachers, and the staff at the school. So many are out on quarantine that they've shut down already and they started two weeks ago. Meanwhile, the school where my children attend, which is masks for all, they had a case last week that came in from the outside. A child who got infected at home came to school was found to be positive.
With home quarantine there's no secondary spread, everyone was wearing a mask, and everything else continues as it should. It’s very simple, and I wish we didn't have to do it, but we have to do hard things when it's hard.
I, like you, live in a school district where masks are required, there is weekly rapid antigen testing, and all of the teachers are required to be vaccinated. But many of the people who are on this call don't live, potentially, with that mix of precautions. And so what advice do you have to the parent who lives in a community where those precautions are not in place, who wants to send their kids to in-person school, in order to keep them safe?
Isaac Thomsen, MD
It’s really difficult because we have to remember that masking is something that really works if everyone does it right. When I put on a mask, yes, primarily to prevent me from shedding to others if I don't know that i'm infected, it is a little bit of a protection for me, but it's mostly protection for others. And so, if a whole classroom is masking, then we're in terrific shape, we're not going to have spread. But if you do have a class where three or four kids are masked and the rest are not, tragically, those three to four kids that are masked, they're the heroes. They’re the ones protecting other kids in there and they're getting no help from their classmates, and so that's heartbreaking to me as a parent and as a pediatrician.
A great solution for that (other than, again, trying to get this word out that we are not making this up,) is to let people know that vaccines are safe and effective masking in schools works and that's what we have to do. I really can't tell you a good Plan B, because plan A works, and we should be able to do it.
Right! So when it comes to kids and transmission, is there anything different about how kids transmit to one another, whether it's symptomatic or asymptomatic? There are a number of questions wondering if asymptomatic transmission was higher with children or how to think about that in the school context.
Isaac Thomsen, MD
What we know is that we shed the most virus, and therefore we are the most infectious, from about 48 hours before symptoms start til about 48 hours after they start. Now, you said what if you never develop symptoms, what if you're asymptomatic? Well, there's still a period of shedding of infection where that virus is there, it's just harder to pinpoint when that would be because it's not pinned towards symptoms. So the main way we know who has a virus is actually sampling, just counting the amount of virus that people have in their noses and mouths.
Again, the more virus is coming out and more other people are inhaling. But what's so dangerous about this virus is even if you're going to develop symptoms, you're shedding before you even know that. So when we have a contact that says, I started getting sick on Saturday, got my COVID test on Sunday found out, it was COVID Thursday and Friday prior to that and whoever they were around got exposed to it.
And remember, with prior variants the average person with COVID would infect one to two other people. With Delta, that's five to seven. The average person with Delta is going to infect five to seven people if they're not vaccinated. That number plummets if both parties are vaccinated.
So we can't just say, oh, quarantine if you feel sick. You’re definitely going to expose people in that setting, so the answers are vaccine and mask until rates are down.
So let's get specific when you get kids in school. Then come all the activities. They're playing soccer, there are playdates that they're being invited to, they're riding the bus. How do parents best assess the risk of each of these types of situations that you inevitably have when your kids are in person learning?
Isaac Thomsen, MD
I think about this in terms of layers of protection, or what's going to help things work in my favor against the virus versus what's going to work in the virus's favor.
You mentioned buses. I think riding on a bus, if all parties are masked and they're spaced a little bit, you know, maybe one per seat, instead of right next to each other, that's a pretty safe environment. You tend to have air circulation, you've got masking, and that's okay. Again, as a parent, this is a constant conversation in our household and those of our friends.
I think we have to take everything on a case by case basis and we have to remember a couple of things: outdoors is always heavily favorable compared to any. Spacing always matters, and then masking if you can. One example would be baseball. I just met the other day with the board of a little league in my town to talk about what baseball will look like for this season. And you know, baseball's got a lot going for it. It's outdoors by definition, it's spaced out with kids way out there in the outfield, but then they all pile into the dugout. Most of the games are fine and then there's a transmission that occurs, so we can think of solutions to help most of baseball go okay. For example, don't jam into the dugout, have a bench and have bleachers to spread kids out.
So we can solve these things to find the sweet spot, because we've got to be able to continue to do things for mental health. We can find solutions in many cases. Sometimes it might be a little bit harder to do that, and that's okay: we do hard things during a pandemic.
What I appreciate about what you're saying is you're not suggesting let's get down to zero risk. In the same way that during flu season when it's not COVID we get a flu shot, we might have a higher risk of getting sick. Now this is of course more severe, and yet there's sort of a balance and risk assessment in each of these environments that you're suggesting, which I think as a parent is comforting.
Isaac Thomsen, MD
I think school is the biggest example. The safest thing to do from a viral standpoint would be to close all the schools and do virtual, and we're not doing that. We want kids to be in school, so we take measures to allow it to happen. And so I think similarly, thinking about birthday parties, maybe someone had a vision of a big twelve-kid sleepover. It’s not the time to do that. And I'm sorry, that's too bad, but that doesn't mean we give up and just say, never mind. We can have a smaller gathering that's outdoors with space, and we can still come up with things that are within reason. So we're pushing forward, we're not locking down in a bubble, but we've got to do things that are safe. Because with this Delta wave, again, I really want to emphasize how badly kids are being affected. Pediatric ICUs are full. This is bad, so we are going to have to make hard decisions. I do think that, to some degree, we're going to regret less maybe skipping something that didn't feel safe versus how much we regret it if we go to it and have an event and spread the virus.
But I do think it's worth trying to find solutions with smaller numbers that are outside. What I do for my family is, we hang out on the porch with another family or so that I know is vaccinated and is overall careful. We have a barbeque and have a nice time, and we're avoiding these higher risk situations.
A theme that we're going to keep talking about throughout this is, “I have a 10 year old that looks like he could be 13.” I've certainly heard other parents talk about whether or not they should be getting their kids vaccinated in advance of the approval of the vaccine. Is that a good idea? It's very remarkable to me how we've got the situation where we've got a huge chunk of the population begging parents to get their older kids vaccinated: please vaccinate your teenager, please vaccinate your teenager. Then we've got the other families who were first in line for that and they're saying, “how do I get my nine year old vaccinated?” It's just incredible.
And so I’m hearing this all the time: “my 11 year old is kind of tall, can I just sneak them in there?”
Isaac Thomsen, MD
We've got to wait and have the process be appropriate, for one thing. What's being studied right now are lower doses in younger kids, and we need to make sure we're using the right dose. Almost certainly, it appears that it's going to be a smaller vaccine dose, which is important, because that will reduce the risk of side effects, and we want to be very, very confident of safety. So you know, I’m desperate for all three of my kids, who are too young to get vaccinated right now, to get the vaccine. But we've got to wait to make sure we know the right dose, that we have the right safety profiles, and we don't want to make assumptions. We just have to blanket those kids that are too young to get vaccinated with protection from the community from those who can be vaccinated.
So you're telling me to wait.
Isaac Thomsen, MD
I would strongly recommend waiting until it's at least emergency authorized for kids under 12 years old, but I definitely admire their interest in getting it sooner.
You know, we received a lot of questions around, “I contracted COVID and have antibodies” or “my child got COVID in the last wave and has antibodies. Do we still need to be vaccinated at this point?”
Isaac Thomsen, MD
Terrific question, and the answer is very much so. Here’s another thing I don't think a lot of people have appreciation of: when you're infected with the COVID-19, the virus starts to weaken your own immune system. Yes, you'll form a little bit of an immune response, but the virus actually drives down our ability to respond to it. It's one of the mechanisms that allows this virus to propagate so well. It doesn't allow you to generate a thorough immune response. Without getting into all the immunology weeds of the different cell lines that are involved, the vaccine generates a much better, longer lasting, more effective immune response, than infection itself. I don't know that a lot of people realize that, and so we've seen that with the data, your chances of being reinfected after just natural COVID are much higher than your odds of being infected after the vaccine. So yes, we highly recommend it. It cuts by two to three fold your chances of a second infection, if you have infection plus vaccine versus just infection.
You don't need to do it right away, so if someone has COVID right now, next week is not the time to get the vaccine. They can wait a little bit to let everything cool off. But if you had it back in the fall or the winter and you're holding out, go tomorrow and get vaccinated right.
And so let's move to young children. As a mom, I'm thankful I don't have toddlers for many reasons, they're very difficult and wonderful. I think COVID and Delta provide a particularly confusing time for them, either those in daycare who can't wear masks or those in preschool who presumably will be playing with masks all day. Does that actually make it worse for them to try and wear the mask?
Isaac Thomsen, MD
One thing I'll say right at first, and some of this is having had a three to four year old at the early time in the pandemic, is that I don't think we gave our young kids enough credit. I don't know how many times I heard, “Oh, a four year old can't wear a mask right.” And I don't know, maybe that was reasonable to guess based on other decision making of a four year old, but they really do it. I think any parent of a four and five year old right now can say that they're used to it. It's not perfect, but gosh it's better than nothing, and it really works. Our daughter attended daycare continuously throughout the pandemic and they never had a single transmission event. So I'm a big advocate of giving the kids you know credit, because they can handle it.
The other aspect is protecting the younger kids through vaccines. When we look at the kids that come in really sick to our hospital, five to 10-12 year olds who are too young to get vaccinated, many of them acquired their infection at home from an unvaccinated family member, often an adult or a teenage sibling. This is really important, and this is another thing I don't know that everyone has a good appreciation of, so I think it's worth taking a second.
One of the things that determines how sick you get with COVID is how much virus you took in a dose. So we think about doses of medications, but there are also doses of virus. If you just get barely enough virus to get sick, you'll probably have a milder case. If you're in a household with someone that's shedding for 24 or 48 hours before they even know they have COVID, you're getting a ton of virus and you're going to do worse. You're going to be sicker, and so that's why household transmission is such a risk. Because we know the little kids that are getting millions of viral particles are because it's just constantly shed for four days before they know it.
And that's much different than getting a milder exposure. So again, vaccinated family members are going to shed less for a shorter amount of time and it's going to be much safer for their contacts that are unvaccinated.
It used to be, when we first were learning about the vaccine, that a 15-minute exposure was enough to get you. Has that number changed with Delta, in the context of kids in the schools or in the home
Isaac Thomsen, MD
It’s always tough with these “magic numbers.” The 15 minute rule we heard all the time was a nice rule of thumb. But is 14 minutes wildly different from 16 minutes? Of course not, you know they're very similar. We do know that Delta is much more infectious. It takes a smaller amount of virus in a given period of time.
Let's say throughout the day, if you inhale let's say around 1,000 viral particles from droplets, sometimes that's enough to get infected. A small amount from a lot of different people which maybe is what happens at a conference or a concert or something like that, or it could be all of it from one person that's right next to you — it doesn't matter, you know it's all the same virus.
And so it's just the rule of thumb that a little bit of space makes a huge difference. The virus disperses in the air, and so the difference from one foot, two feet, three feet, is exponential in terms of how much less exposure you have. A little bit of space, a little bit of distance through a mask in there, and you've radically reduced the amount of virus you're being exposed to.
And so back to the little kids, let's get to the really little ones. There are questions around new moms who are breastfeeding, who received the virus. Are they passing those antibodies on to their breastfeeding child and protecting them in the process?
Isaac Thomsen, MD
Vaccinated mothers, absolutely. One of the benefits of breastfeeding in general is that immunity is passed through the breast milk. Antibodies for COVID are passing in breast milk. We’ve assumed it for a long time, but there's actually recent data and some nice studies that were done in Florida, and it showed that yes, COVID antibodies are safely passed through breast milk, and a layer of protection for young children too.
If I may, I want to say something about pregnant women in general, because I think this is a huge, huge issue right now. I know this call is more about kids, but some of the parents on the call may be about to have more kids.
If you ask any of my colleagues in intensive care units in hospitals across this country, “what's been one of the most devastating aspects of this recent wave of Delta?”, they’ll all tell you it's the number of pregnant women that are coming in critically ill. Tragic, tragic cases, one after the other. Pregnant women are at a very high risk of severe COVID. And only about 23% of pregnant women are getting vaccinated right now. We've got to get that up.
I want to say something very clearly. I understand early on, nine months ago, when this vaccine was starting to roll out, some pregnant women were nervous. They wanted to see more. Now we can definitely say it’s safe. Not only do we have overwhelming evidence of safety of the COVID vaccine in pregnancy, but we have tragic, overwhelming evidence that COVID is more severe in pregnant women. Many of them, even if they’re surviving, are losing their babies, or they're in hospitals or on life support for a long time.
The infertility myth was an early mess with this vaccine. It's based on nothing, it's non-scientific, it's been roundly disproven, it's not a thing. Anyone that's at all considering getting pregnant should be the first in line for the vaccine because they're about to be more vulnerable.
Thank you for saying that. Let's talk about some vaccine myths. The first one is, does the vaccine cause infertility?
Isaac Thomsen, MD
You know, there was a fraudulent piece of what we would call pseudoscience, where somebody takes some words that sound like they mean something and tries to make a case not based on anything actual. It was this paper that talks about this protein that mimicked protein in the placenta, and none of it’s true, none of it's accurate, and we know it's false biologically early on. Because we've had 200 million Americans vaccinated and many of those are women of childbearing age, many of which are pregnant, we have all the data we need. There's no increased risk of miscarriage, there's no in fertility issue. Pregnancy rates are equal across groups, so it's just simply false. Some of these myths tend to hang around, but I don't know how to get rid of it, other than to say we know that it's not true and it's been overwhelmingly proven.
Another one that I actually saw in the chat was, does it cause problems with the menstruation cycle for children?
Isaac Thomsen, MD
It doesn’t. And again, with a lot of these things you can craft any number of “what about this, what about growth or development or puberty, etcetera.” And sure, as a parent, we worry about all of those things. But if you understand enough about the vaccine —and I'm fully aware that not everybody has the opportunity to take a years-long immunology course and training on all that—you know that it couldn't be the case.
This is a tiny molecule. There’s only a little bit in the shoulder muscle for a few days and it's gone, and then you generate an immune response, and you have antibodies that are there. Just like after other infections, it's just an immune response, that's all. And I hate saying it's “just” that, because it's amazing, beautiful, elegant science that’s saving millions of lives. But it's not going to have these sort of mystery effects. You could say that about anything. When we see a new cereal on the shelf, do we ask if the cereal will affect menstruation? No, because that's not how cereal works. It’s the same type of thing.
Okay, so it does not impact menstruation.
Isaac Thomsen, MD
For sure, no impact on menstruation.
What’s another big vaccine myth that you feel like you're confronting that people listening now should know about?
Isaac Thomsen, MD
The other one that I feel like we're still hearing a lot is, “oh, it's experimental, and it was a rushed deal.” In December, nine months ago, when we got emergency authorization of Pfizer's vaccine, I totally understand that folks said, “Hey, you know, I'd like a few other people to go first. This is new.” But we know that what happened, Heather, is that every single physician that had been treating COVID patients for almost a year went first because they saw how devastating this was. My colleagues went NUTS: they were waiting in line and running out of meetings to go get vaccinated.
So it should tell everybody something that the people who know the most about this because they're on the front lines and they're seeing this every day, they went first. We’re still alright. So every physician that's treating COVID patients is now vaccinated.
I still want some more people to go first. Well, hundreds of millions of people have gone first now. It's preposterous to me at this point to say “this is new, and I want some other people to go first.” Honestly, it's so disappointing to me to hear that, because I know how the trials were done: my colleagues and my friends ran these. I know how they were designed.
It's an absolute triumph of modern medicine that these were done. An unprecedented amount of resources went into this, and the largest enrollments and clinical trials that have ever been done in history. This is something we should be celebrating! Vaccines are incredible. We’ve eradicated smallpox, we’ve almost eradicated polio, and this is another absolute triumph of a vaccine. It honestly breaks my heart to hear the skepticism that persists, based on nothing.
So I would say to everybody, we’ve got to stop saying it's new, we've got to stop saying it's experimental. Now that the Pfizer vaccine is fully FDA approved, the “timing” talking point doesn’t hold water anymore.
And so let's talk about the vaccine for our kids. There are so many questions like “why is it taking so long?” and “when will it be available?” And, of course, there was some news around an impact or risk for boys. Maybe you can talk about how that might have extended the amount of time that it's taking a kids’ vaccine to be available.
Isaac Thomsen, MD
So we always know there’s a sort of standard on how trials are always done for new vaccines. We start older and we move into younger populations. And it is taking a little bit longer in part because we're testing different doses. If we can use a smaller dose and still have as much effectiveness of the vaccine, then that's terrific because we have lower side effects. You know, the fever and the aches and all the misery after the vaccine that some of us felt for a day or so after we got the shot? If we can reduce that, that's great.
And then the FDA asked both Moderna and Pfizer to expand their sample size to try to catch if there's even more rare events. There’s one specific potential side effect of the vaccines in young adults —adolescent boys and young males— called myocarditis, an inflammation of the heart. So yes, we should talk about that. There's been an incredible amount of investigation and discussion about this. Remember that spike protein that we mentioned earlier? All viruses have that sort of spike protein, which has an affinity, or a sort of a homing for, the heart.
So the virus itself — and we’re not talking about the vaccine right now, just the actual virus— attacks the heart. And it causes myocarditis, which is our term for inflammation or irritation of the heart. There was a study actually of college athletes in the Big 10: 2% of Big 10 college athletes with COVID had myocarditis, even if they had minimally or mildly symptomatic disease. (And I mean, you want to talk about a healthy fit person!)
So you’re saying they had it, not because of the vaccine itself.
Isaac Thomsen, MD
Yes, COVID itself causes myocarditis in a significant number of people. The vaccine also has a little bit of that spike protein, and it can irritate the heart a little bit, more than 1,000-fold less than COVID itself does and much milder. It's different from a virus because it's not actually invading a heart muscle, it's just sort of irritating the surface of it. We see very rarely, again 1,000-fold less than what COVID itself does, a temporary, reversible irritation of the heart.
So what I would say is: if we had eradicated COVID and you know it's gone, don't get the vaccine. Why risk an extremely rare side effect if there's no benefit? But what we actually have now is a dangerous variant that’s spreading like wildfire that itself affects the heart, far more than the vaccine. It’s one of the things I was referring to earlier when I said, “whatever it is you're worried about with the safety of the vaccine, COVID is worse.” This is a major example of that. You can have a rare, mild, reversible side effect from the vaccine or a much more serious, maybe less reversible, much more common effect from the virus itself.
Thank you for that. And so, when you are on your email chains with your friends in the industry, are you all talking about vaccines becoming available for those under 12?
Isaac Thomsen, MD
Yes, I would say the party line, right now, is that the very best case may be October-ish, more likely around December, with a range being October to January and most likely November to December. And that’s likely to be five year olds to 12 year olds.
Okay, and so a personal question. Putting on your dad hat, when it becomes available will you be getting the vaccine for your three children?
Isaac Thomsen, MD
You know, they're not going to like me saying this because two of them aren't fans of needles or shots, but all three kids will be there the first day that we can get them there. I yearn for the day when our kids get invited to a birthday party and I know that they're vaccinated, and the end of my mental calculus is “What time is it and where do I go?” And it's none of these other hoops. You’re right, we're so tired of jumping through hoops, and the path forward is getting [kids] vaccinated. We’ll all see the data that were reviewed, and if the FDA says everything is safe and effective, then here we go: where do I sign up?
That's awesome to hear, because whenever I'm sitting in front of a doctor and they tell me a bunch of things about science, which I appreciate very much, the question I always actually want to ask is “what would you do in the same scenario?” Actions speak louder than words.
So the last big chunk of questions is around long COVID in kids: what is it, is it worse than in adults, and how should we as parents be thinking about it. The truth is, we don't know yet some of those comparisons because again, in earlier waves infection rates were so much lower in kids. This time, right now, is the first time that over 20% of new COVID cases are in children.
Isaac Thomsen, MD
Yes, this is the first time over 20% of new cases are kids. And as of a week ago, we had surpassed the record of the entire pandemic of how many kids are in the hospital from COVID — and it's still going up. Unfortunately, we now are accumulating numbers of COVID cases in kids that we didn't before now.
We don’t have a lot of information on long COVID in kids, but what we do know so far is that one of the most common symptoms involve what’s called brain fog. There's a really compelling piece about that. I saw an adolescent who was no longer able to retain things in math class, and even though it was just short-term memory, it’s really devastating for folks. It's taking over their lives, and we don't yet know the rates in kids. We have no idea how long it’s gonna last. This is a prime example of the things that terrify me as a parent, and why I gave that plea to those that have kids 12 and older that are not vaccinated.
This is why the unpredictability of this virus scares us that study these things, because we don't know why it's lasting so long. We don't know why it's so bad. And we know the vaccine is safe and effective. We have clear evidence for that, so I don't want to try experiments with my kids and see what happens with long COVID and all that. So again, it all routes back to vaccines. We don't have enough data because kids were not infected before. We will have it eventually.
They are being infected now and, therefore, the answer is vaccines. Let me get back to a couple more vaccine questions. That same email talks about the best case for kids’ vaccine approval being October and maybe more like December for kids 5 to 12. What about those under five?
Isaac Thomsen, MD
I'd say a few months after that. That's going to be spring. You know the one silver lining about that is, that does tend to be the group that overall does really well with COVID. In infants young babies will see them get pretty sick and that's where again if the moms are vaccinated and breastfeeding, and can pass them immunity that way.
But the one to five sort of age group does still seem to be the least severe from these infections. They certainly can get it, they certainly can spread it. Their biggest issue probably is spreading it in households and so, if everybody else in the household is vaccinated, I do feel a little bit lower sense of urgency for say, a three year old to get vaccinated, especially if everybody else around them is vaccinated.
They might get it, but it is typically a less severe case so far. Who knows what three variants from now will look like, but for Delta, it does still seem to be that, while it's landing many, many more kids in the hospital, that it’s adolescent, older kids. It's still not appearing to be as severe in that very young age group.
There have been a number of questions around specific conditions that kids have: newborns, preemies, asthma or specific conditions. Does it make them more likely to get COVID? Or more risky to get the vaccine? How can parents best understand, is it okay for my kid with special underlying medical concerns?
Isaac Thomsen, MD
We know that underlying lung diseases or immune system issues certainly are higher risk. Those are many of the kids that we see have a much tougher time in the hospital. We do have underlying issues though that is in and of itself, probably the single biggest risk factor for kids is obesity so kids that are overweight, have a much higher chance of hospitalization of critical illness and pre-Delta, I would say, four months ago, the only kids in the hospital from COVID are either kids with chronic lung disease, they’re immunosuppressed, they're obese. Delta now is also landing kids in the hospital, but I can't explain why, and that scares me because I don't even understand why they got so sick.
But still, the overwhelming majority have some other factor like obesity or underlying lung disease or immune system issues, and so, for specific questions, this is where somebody's pediatrician or family doctor can help. There’s literature out about this now, and hopefully folks are doing their best while their clinics are swamped with 200 kids needing a COVID test. You can try to stay on top of some of this literature to help folks make individualized decisions.
If you're old enough, you should get vaccinated. None of those problems that we listed should prevent that. In fact, if anything, you should be more likely to get vaccinated if you have one of those conditions. If you’re not old enough, then the people around you need to vaccinate and you need to mask. If I had a kid in my house with an immune deficiency, I’d redouble my safety efforts to protect them with a web of vaccination and masking and distancing.
I'm so thankful for this time. As you can tell from the questions we're getting through the chat, there's a never-ending list of questions for medical professionals. And yet, in the beginning when you talked about the triple pandemic, one of the pandemics is one of misinformation. Where do you advise that parents go to read what is real? I understand going to your pediatrician, although, as you said, pediatricians have variable schedules. If there were a place where you could wave a magic wand and get the truth, all of us parents would be going there.
Isaac Thomsen, MD
I really do think it comes back to trust in medical professionals, whether it's the local Department of Health or the CDC guidance. CDC guidance is good, but it does tend to lag behind a little bit and can be slower to change. There are a lot of good news outlets, but news outlets are not healthcare providers: they’re for-profit institutions trying to get advertisers. So I really think what I trust is people that are on the frontlines, seeing this day in and day out, and that’s medical professionals. I think that’s part of why we have this misinformation pandemic. I'm talking about this with you now when I've driven up to my office at eight o'clock in the evening Central time. I’m not getting paid to do this, and this is what it takes. We just have to get information out there, however we can.
Tell me your favorite bottle of wine and we’ll send it to you! But the real thanks is all the helpful information you’re sharing with parents. To close, what are the three simple takeaways every parent should know from the past 52 minutes talking about Delta and kids?
Isaac Thomsen, MD
We've got to protect our kids. Delta is different: it's worse, it's making kids sicker, and it's landing them in the hospital more. And the protection comes primarily from vaccines. If your kid is old enough to get vaccinated and they haven't been, I know you’re trying to protect them — but you’re thinking about it the wrong way. You can protect them from COVID by giving them a safe and effective vaccine. We’ve got to get those vaccination rates up.
Number two is, in-person school is crucial, and there are safe ways to make that happen. Everyone who’s around kids at an educator level definitely needs to be vaccinated, and masking is safe and effective.
Number three, to end on a hopeful note, vaccine rates are on the rise again. A week ago now, we vaccinated a million people in the US for the first time in a few months, and that's continuing to rise, so the message is getting out there. It breaks my heart that it took filling every hospital in the American South and many other places completely to the brink and the point of collapse, which is where they are now. I hate that it took that, but all we can do is move forward. People are getting vaccinated, we've just got to keep getting the word out. There’s some hope on the horizon.
I appreciate you ending on a positive note. I'm delighted that we got to get you on this webcast so that we can share the information far and wide, so thank you again.
Isaac Thomsen, MD
Thanks to you all, and your team for helping get the word out.
Thank you everybody. And thank you Dr. Thomsen!