I've followed Robin on the Arlington Families Facebook group... she tells
it pretty straight.
Here's her latest:
Hi, I'm back as
Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about-Covid. (nd
it’s okay with me if you want to share, either directly from my public FB
page or cut and paste from here.)
11,000 cases/day in the US in June
650,000 cases last Saturday
800,000 today (plus still a gabillion unreported at-home tests)
Today we are going to talk about KIDS.
I know many parents out there with little kids are living in Limbo Land and
feel neglected and constantly afraid and as if there’s no right answer, so
let’s talk about the kids under 12 and Covid.
Just a note: this isn’t about kids and school or kids and lunch or kids and
sports — this is just about the science we know and the science we are
working on.
Let us first keep in mind that a terribly small number of 5-11-year-olds in
the US have been vaccinated — under 20%. This is utterly heartbreaking
since it’s the unvaccinated 5-11 year-olds who mostly end up in the
hospital.
The very most important thing you can do to protect your 5-11 year olds is
to have them vaccinated — and all the adults around them as well.
Okay, let’s talk about what to expect if your kids get Covid.
First off, I find among all the horrifying headlines about rising rates in
children, it is crucial to remember: kids almost never die of Covid. It is
vanishingly rare. It is way lower than what we see with adults. It is lower
than the death rates with childhood cancer or accidents.
If numbers help you, then consider that out of about 9 million kids getting
Covid so far “only” about a thousand kids have died.
Now it is totally true that there is no “only” here and that every child
death is an unspeakable forever tragedy and every one is seared into our
hearts and brains for all of eternity. I know this. We know this.
But the reality is the chances of YOUR CHILD dying of Covid is in the teeny
tiny decimal points. I hope this helps you put that particular fear to the
side.
The chance of your child getting a serious illness with Covid is not zero,
but it is low. It is also probably lower with Omicron, although full data
is still coming in. It is WAY lower when your child is vaccinated.
Very few kids get super sick with Covid; for the majority it is a short
period of fussiness, fatigue and feeling lousy, or less. Only about 1% of
kids end up in the hospital. And, happily, this seems to be lower with
Omicron.
The impact of vaccines:
Brief science (feel free to skip ;-): It seems like what is happening with
Omicron for vaccinated kids (and adults) is that it escapes the vaccines
and lands in the nose and throat. How does it escape the vaccines? It
escapes either because we don’t have enough or good enough B-cell-produced
antibodies from our vaccines or the viruses outnumber or slip past the
antibodies we do have.
So the viruses go lodge in our nose/throat and we get some local symptoms
(sore throat, runny nose, sinus pain, sneezing, post-nasal drip) from
that. Or maybe we get a headache or fatigue or body aches, or a dry or
croupy cough, or occasionally there’s GI symptoms.
But then, fortunately, what we think happens next is that most of the time
our T cell immune system kicks in and essentially stops very many viruses
from going to our lungs. This is why vaccinated people— and our kids —
rarely get pneumonia or serious blood clots or awful breathing issues.
If your child is too young to be vaccinated:
People who are unvaccinated don’t have any B-cell-produced Covid antibodies
or a T-cell response. Also, if you are immunocompromised maybe you can’t
make any antibodies.
In both these cases, the viruses can reproduce like crazy in the
nose/throat and move to the lungs. This is part of how adults get so sick.
Fortunately disease moving to the lungs appears to be pretty uncommon with
little unvaccinated kids — they seem to get milder disease overall. When
Omicron, it tends to show up as croup or something called bronchiolitis
which can usually be treated at home or sometimes the ER — but mostly
doesn’t require hospitalization.
So most little unvaccinated kids with Omicron have mild illness and are
tended to at home. On occasion, like 1% of the time, they can end up in
the hospital which can be ugly and scary and super disruptive for everybody
involved. This usually happens when the virus goes to the lungs. Sometimes
it happens when a child has a lot of diarrhea or is too sick to eat or
drink and they get dehydrated.
How do you know when you need to take your little one to the doctor or ER?
To paraphrase one of my favorite pediatricians: “Covid advice is basically
identical to flu advice: Your child might want to take more naps, might
not want to eat or drink as much as usual. But when they’re awake, they
should feel well enough to play a quiet game, read a book, watch a show,
etc. Call me if the child:
—is not reasonably active and alert between naps
—looks like they are working harder to breathe
—is not drinking enough to pee at least every six hours
—seems way too sleepy for the time of day
—is difficult to wake up
—is so cranky they don’t even want to be held”
What about MIS-C? This is also rare, with about 6000 US cases reported.
This is undoubtedly an underreported number, but even if it’s double or
triple that, we still have only a tiny fraction of infected kids getting
MIS-C. We don’t know whether we will see more or less MIS-C with Omicron.
There have been recent papers showing a decreased risk in vaccinated kids.
We hate every single case, but again, so far the odds of it happening to
YOUR CHILD are small.
What about long-haul Covid? We don’t know numbers for sure (we need more
time to pass to see the exact rates) but with previous variants kids seemed
to get long-haul at a rate of 1/3 to 1/2 that of adults. We can’t yet have
any real idea about whether there is more or less long-haul with Omicron.
There is some good recent science showing vaccination decreases the risk.
What about the vaccine for the under 5’s? It’s a ways away. We may well be
looking at late spring. It’s been super complicated to show vaccines will
be a huge giant help for these little ones because a) it’s hard to show a
benefit when so few get really sick and b) the immune system changes so
much between the newborn and kindergarten years.
How can I protect my under 5s who can’t get the vaccine? There are things
you can do:
—Get everybody around them vaccinated.
—Get your pregnant self vaccinated so you can pass along antibodies to your
infant.
—Cocoon kids away from the unvaccinated (yes, that includes Uncle
Maskless) and the symptomatic.
—Don’t expose them to strangers who are eating (ie restaurants) in
high-transmission areas.
—Mask the over-twos whenever possible.
The data about Omicron is evolving. We don’t know everything about this
variant yet and there may be new trends. But so far we can say:
A lot of our kids are going to get Covid during this surge because Omicron
is so contagious.
The vaccinated children 5-11 seem to be highly protected against serious
disease and dying.
The unvaccinated children 5-11are at higher risk to get serious disease but
they still are doing better than adults and fine overall.
Our unvaccinated babies and toddlers — the 0 to 4.9 year olds — worry us
all. But the reality is many of them don’t get symptoms, and the ones who
do tend to do well and not end up in the hospital. In the meantime, we need
to build our wall of vaccinated people and protection around them.
For children under 12, even if they do end up being part of the 1% who gets
hospitalized, so far most end up completely recovering.
Chance of long-haul: we don’t know exactly except it seems definitely lower
than adults. We won’t know about Omicron’s impact for a while.
So: so far, chances of children being hospitalized are very small, chances
of MIS-C are extremely small, chances of dying incredibly super small.
As awful as this pandemic has been, we’ve been lucky lucky lucky with the
kids. And fortunately with Omicron so far there is every sign our luck is
holding.
--
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