The pandemic has forced Dr. Megan Washington to become a negotiator. Persuasion is already a significant part of patient care, but as a pediatrician at Madison’s Trust Care Kids clinic in the pandemic era, she regularly navigates the now sensitive topic of preventative health and vaccines with parents.
“First off, I ask what their concern is,” Washington told the Mississippi Free Press in an interview. “Inevitably, it tends to be that they heard a rumor on Facebook. (That the vaccine) causes infertility, or it causes myocarditis.” The pediatrician starts from the beginning, explaining the long history of mRNA vaccines, which scientists hypothesized not long after the discovery of mRNA in the 1960s.
Now, with COVID vaccines finally available and recommended for all infants and children aged 6 months or older, communicating their safety and efficacy is the last mile for many families eligible for the shot.
“Vaccines are one of the most well-studied intricacies of medicine … (and this is) part of the reason we were able to so quickly develop this COVID vaccine. Because the science was already there. We just took it and manipulated it to work for COVID,” Washington said.
The trials necessary to ensure the safety of the vaccines for adults and children are immense and complex. “The studies are showing that it’s safe. Can it cause fever? Yes. Can it cause soreness in the arm? Absolutely … the (incidence) of myocarditis with an actual COVID infection is infinitely higher,” she added.
Beyond the trials, Washington concluded that time itself had been the judge of the vaccines’ safety and efficacy.
“As we continue to do research, we know that vaccine side effects are typically noticed within two months of giving the actual vaccine,” she said. “And now that we have made it well past that two month mark, and so many of these vaccines have been given, we should have seen all the side effects that we’re going to see.”
‘Swept Under the Rug’
Washington does her part in communicating the safety of the vaccine to her patients, but Mississippi still has miles to go in vaccinating even a majority of children.
Mississippi State Department of Health data from July 5 show only 39% of 12- to 17-year-olds are fully vaccinated. For children age 5-11, that percentage is only 13%. Data for infants and children under 5 are not available, but with only weeks of eligibility thus far, that age group is certain to be widely unvaccinated.
In part these data reflect the relative threat of lethality, with mortality rates for the elderly far outstripping the threat of severe disease and death for the young, and especially for children. But Washington is clear on this point especially: the risk of COVID in young children is real, and vaccines can mitigate it.
“It’s striking to me—the pediatric deaths that have occurred from COVID that have been swept under the rug,” Washington said. “(You hear) ‘oh, only 442 children have died.’ That’s 442 children that should be alive. And that’s only the children under the age of 4.”
At a recent July press event, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and Chief Medical Adviser to President Joe Biden summed up the daily grind of the pandemic even months after the delta and omicron peaks.
“Currently, there’s about a hundred thousand cases of COVID being reported each day in the U.S.” Fauci explained. “Around one in eight are among children. These remain largely concerning numbers … while hospitalizations have declined substantially as well, they are still at an unacceptably high level. About 4,700 people are hospitalized each day, including, unfortunately, 240 children.”
But relying upon the data for the most severe possible cases resulting in hospitalizations or deaths misses a swathe of dangerous consequences for many of infected adults and children as well.
“More than 8,500 children with COVID have been diagnosed with (multisystem inflammatory syndrome), that may affect the heart, lungs, kidney, brain, skin, eyes or GI tract,” Fauci said. “Additionally, just like adults, children can develop persistent symptoms—Long COVID. Among these sobering statistics, the news of vaccines being available to protect the youngest members of our community is welcome.”
Children Experiencing Long COVID
Washington has experienced very young children with deeply troubling chronic symptoms following their bout with COVID.
“Within our clinic, we definitely had patients admitted for MIS-C, for myocarditis—that has been related to COVID infection, not from any COVID vaccine,” Washington said.
The lingering symptoms are broad and often dramatic, especially for young children not used to serious illness. “We’ve had numerous patients—more than I can count—that are coming in with complaints of fatigue, of dizziness, that are long lasting. It’s preventing them from doing their daily activities, things like sports or gymnastics,” she continued.
Some of the same bizarre conditions of Long COVID involving cognition and the senses are replicated in children. “I’ve had patients who are almost a year out of COVID who still have not regained normal taste and smell. It’s affected their diet, and in turn affected their health negatively. Some have gained weight simply because healthy foods now taste bad—now the only things that are tasting good are things that are more calorically dense,” Washington reported.
These issues are not merely occurring in the elderly, or the previously chronically ill. “I’ve had young patients come in complaining with chronic headaches after mild cases of COVID,” Washington said. “These patients have never had headaches before, have never had major illness. And now they’re having long term chronic issues that we can only relate to their recent COVID infection.”
Any protection from COVID infection is, by design, protection against lingering symptoms after the virus. But even for those who have had breakthrough infections, studies are emerging that show a decreased likelihood of chronic sequelae for those who are fully vaccinated.
‘Use The Vaccine You Have’
As COVID continues to develop and evolve, the expectation that every individual would eventually face the risk of a single bout with the virus or a vaccination has evaporated. With new variants like omicron and its growing family of sublineages, the threat of breakthrough infections for the vaccinated and reinfections for those previously exposed is real.
“It’s very clear to me that reinfections do occur. We have (data from) other countries such as South Africa, Israel and England, but also in our own country. When you’ve been infected with one variant, but you have the evolution of another variant, there is a possibility of getting reinfected—even if you were vaccinated,” Fauci explained to the Mississippi Free Press.
But while antibody resistance wanes, opening the door to reinfections after vaccination or exposure, Fauci reiterated that deeper forms of immunity provide lasting protection against the worst manifestations of the virus. “The severity of the second infection is very muted compared to the first, very likely. Because of the underlying degree of immune response that you generated with a prior vaccine and or a prior infection,” he said.
New vaccines are under development: a hypothesized nasal vaccine may be better at preventing transmission, and it’s possible that in the future there may be updated boosters for specific strains, or pan-coronavirus vaccines that experts like Dr. Eric Topol have posited could end the ongoing duel with evolving variants.
In light of these future possibilities, the Mississippi Free Press asked Fauci directly if parents should consider waiting for a new formulation to vaccinate their children.
Fauci’s response was clear: the best vaccine is the one you have. “There’s a certain rule in vaccinology that when you have a vaccine in hand, use it. Particularly when you’re having an outbreak. That’s exactly what’s going on right now,” Fauci said.
The current numbers mean parents who wait are likely to allow their child’s first or second exposure to be a natural infection, far more dangerous than any vaccine. “If you look at the numbers … we’re having over 100,000 cases a day. Now is not the time to wait. We have a very highly effective and safe vaccine for children in that age group. The most important thing for us to do is utilize it,” he concluded.
Other vaccines are coming, but Fauci argued that the time for parents with newly eligible children is now. “We’ll worry about different variants as we go into the future. Right now, we need to protect our children immediately,” he said.
Washington agreed. “(Child deaths are only) a small number when you’re looking at it at the millions of children within the United States. But if your child is one of those, that number is huge. If you can protect your child from death, from hospitalization, from those severe outcomes, with a vaccine that is safe, that is readily available … I think it’s a no brainer. As soon as it was available to my children, they were first in line,” she finished.