I learned a long time ago the wisest thing I can do is be on my own side, be an advocate for myself and others like me.”- Maya Angelou.
The loudest voices we hear are those who advocate conflict, divisiveness. - John C. Danforth
We all need to do our own research into what is going to get this pandemic under control. Both the Media and Social Media are spending more time on their agendas and not the science. The masks worked before we had vaccines. The vaccines and masks worked when we were dealing with the original SARS Co-V-2.
But now we are dealing with a new variant (Delta) which is 4 variants removed from the original Covid virus, two times as infectious and new variants on the horizon Lambda and Mu which may be stronger and may be resistant to the vaccines.
We cannot be dismissive of this pandemic. It has proven not to be seasonal. It has proven to be adaptive. It has proven to unpredictable. It is not following the rules of other viruses. We must appreciate that we are dealing with a moving target and we must adjust and adapt accordingly. We must modify our approach so that we can develop herd immunity and get this pandemic under control.
Because of the length of time it is taking to get this virus under control, we may be living with this virus in one form or another for a long time. If you think about things logically, the longer this virus can mutate and spread there will come a point where the current vaccines do not and will not work. Part of the reason for the waning immunity is that the virus has been with us for close to two years nonstop and has mutated so much. It was developed for the original COVID virus not the Delta Virus.
I find it interesting that people are willing to role the dice with the decision whether to get vaccinated or not. That getting vaccinated is worse than getting the virus. That being vaccinated is worse than being hospitalized, being placed on a ventilator and possibly dying as a result of catching the Delta variant of the COVID virus.
That vaccines that were considered a God send several months ago and provided a way out of the pandemic is now such a volatile and hot topic full of mistrust and skepticism.
The current vaccines were designed and created to treat the original SARS-CoV-2. Vaccines sensitize our immune systems allowing our bodies to mount a response thereby making us less sick when exposed to a virus. They do not cure a virus. They make our immune system more proactive in mounting a defense when exposed. Understanding how a vaccine works, then it should not come as a surprise that yes, we will see breakthrough infections. It is not a failing of the vaccine. Just like some people get the flu, although a much milder version of it, when they get the flu vaccine.
The science and the data from around the world show that vaccinated people stand a better chance of survival and are less ill than unvaccinated individuals. The science and the data also show that people with co-morbidities that are vaccinated are the ones who experience breakthrough infections. But the data also shows that their illness is not as severe as those infected with the Delta variant who are not vaccinated with the same co=morbidities.
We are very lucky and fortunate that we have three vaccines that have been shown to also work against many of the new variants that have surfaced to date.
Before we were to get rid of our masks earlier this summer and return to a normal life, we needed a minimum of 70% of the ADULT population fully vaccinated. It was thought it could be done by July 4,2021 but that goal fell short.
In spite of the shortfall, we did away with masks, social distancing and all the other mitigating factors that were working. This then has resulted in a decrease in the number of people getting vaccinated because the wrong message of the “virus was under control” was being sent.
Vaccinations continue to decrease despite the increase in the number of positive infections, hospitalizations and deaths going up. It is almost like we are ignoring this reality.
250,000 people had died by this time last year. Now one year later, we are at 683,196 deaths and we could possibly see 800-900,000 by years end. Over 400,000 people died this year alone from rolling the dice about getting vaccinated or not. Sobering numbers. One’s decision has life and death consequences.
On September 16,2021 there were 249,364 positive cases and 3,391 deaths in one day in the U.S.. Does this seem like things are under control? And we still argue over the merits of masks and vaccines. Not based on the science but on whether someone has the “right to tell us” what to do instead of using the common sense God gave us. Decisions about getting vaccinated or not should be between you and your doctor. Not what your favorite cable news or social media site dictates.
Preventable COVID-19 hospitalizations among unvaccinated adults cost an estimated $5.7 billion from June through August, a new Kaiser Family Foundation analysis showed.
Federal health officials moved to avert shortages of COVID-19 monoclonal antibodies, setting new rules that may cut distribution to some states, including seven in the Deep South with high infection rates that are using about 70% of the national supply. (Washington Post)
One in four southern U.S. hospitals said more than 95% of its ICU beds are occupied. (New York Times)
As of September 17,2021, the COVID-19 toll in the U.S. was 42,768,978 positive cases and 690,567 deaths up 249,364 and 3,391 respectively in one day. Does this sound like we have this pandemic under control?
By the Numbers: Many of you have raised questions about COVID and CHILDREN:
How do children get COVID-19? — Early in the pandemic, most cases in children resulted from household exposure, usually with an adult as the index patient. In a case-control study, close contact with persons with COVID-19 (typically a household member), having visitors to the home, and attending gatherings with persons outside the household (eg, social functions, activities with other children) were associated with SARS-CoV-2 infection in children and adolescents.
Do children transmit SARS-CoV-2 to others? — Children of all ages can transmit SARS-CoV-2 to others, but the rate of transmission by young children is uncertain. Older children and adolescents transmit SARS-CoV-2 effectively in household and community settings. Infected children shed SARS-CoV-2 virus with nasopharyngeal viral loads comparable to or higher than those in adults. Viral loads and the risk of transmission appear to be greater in symptomatic than asymptomatic individuals.
Transmission in educational or child care settings – Limited evidence suggests that transmission by preadolescent children occurs but is uncommon in educational or child care settings, particularly if the class size is small, other public health measures are strictly followed, and community transmission is low.
Why do we see children getting breakthrough infections: The following conditions may be associated with increased risk of severe disease in children. Medical complexity, Genetic conditions, Neurologic conditions, Metabolic conditions, Congenital heart disease, Obesity (body mass index [BMI] >95th percentile for age and sex, Diabetes, Asthma or other chronic pulmonary diseases, Sickle cell disease, Immunosuppression and Down syndrome has also been proposed to predispose to severe disease.
In multicenter studies of children admitted to pediatric ICUs, most children had one or more underlying conditions. Among 121 SARS-CoV-2-associated deaths in children and adolescents (<21 years of age) in the United States, 75 percent had ≥1 underlying medical condition and 45 percent had ≥2 underlying conditions. Chronic pulmonary disease (28 percent), obesity (27 percent), neurologic and developmental conditions (22 percent), and cardiovascular conditions (18 percent) were the most frequently reported.
Children and COVID-19: 9/9/21 Summary of State-Level Data: Data from 49 states, NYC, DC, PR, and GU; Analysis by American Academy of Pediatrics and Children’s Hospital Association.
The Cumulative Number of Child COVID-19 Cases: 5,292,837 total child COVID-19 cases reported, and children represented 15.5% (5,292,837/34,198,122) of all cases. Overall rate: 7,032 cases per 100,000 children in the population.
243,373 child COVID-19 cases were reported the past week from 9/2/21-9/9/21 (5,049,465 to 5,292,837) and children represented 28.9% (243,373/840,838) of the weekly reported cases. Over two weeks, 8/26/21-9/9/21, there was a 10% increase in the cumulated number of children COVID-19 cases (495,154 cases added (4,797,683 to 5,292,837)) Testing (11 states reported)
The CDC's COVID-NET provides information about underlying medical conditions in hospitalized children according to age. Among children hospitalized with COVID-19 from 14 states by late July 2020, 42 percent had ≥1 underlying condition, the most common of which were obesity (38 percent of children ≥2 years), chronic pulmonary disease (18 percent), and prematurity (15 percent of children <2 years).
In a systematic review of 9335 children (hospitalized children and outpatients) with laboratory-confirmed COVID-19 and information about comorbidities, 27 percent had an underlying condition [34]. The most common underlying conditions were immunosuppression (16 percent) and lung disease (13 percent).
Hospitalization: Among states reporting, children made up between 11.1%-21.6% of total cumulated state tests, and between 4.9%-17.8% of children tested were tested positive Hospitalizations (24 states and NYC reported). Among states reporting, children ranged from 1.6%-4.0% of their total cumulated hospitalizations, and 0.1%-1.9% of all their child COVID-19 cases resulted in hospitalization
Mortality (45 states, NYC, PR and GU reported): Among states reporting, children were 0.00%-0.27% of all COVID-19 deaths, and 7 states reported zero child deaths. In states reporting, 0.00%-0.03% of all children COVID-19 cases resulted in death.
COVID-19–associated hospitalization rates rose rapidly during late June to mid-August 2021 among U.S. children and adolescents aged 0–17 years; by mid-August, the rate among children aged 0–4 years was nearly 10 times the rate 7 weeks earlier. This increase coincides with widespread circulation of the highly transmissible Delta variant. Not the original COVID-19
Among adolescents aged 12–17 years, the only pediatric age group for whom a COVID-19 vaccine is currently approved, hospitalization rates were approximately 10 times higher in unvaccinated compared with fully vaccinated adolescents, indicating that vaccines were highly effective at preventing serious COVID-19 illness in this age group during a period when the Delta variant predominated.
Similar to another recent analysis, COVID-NET data suggest that indicators of severe disease among hospitalized children during an early period when the Delta variant predominated were generally similar to those observed earlier in the pandemic. Trends in outcomes will need to be monitored closely as more data become available.
Rates of COVID-19–associated hospitalization among children and adolescents increased rapidly from late June to mid-August 2021, coinciding with predominance of the Delta variant. With more activities resuming, including in-person school attendance and a return of younger children to congregate child care settings, preventive measures to reduce the incidence of severe COVID-19 are critical.
So according to the science and the math: While the number of children contracting COVID is alarming, the number of children that are being hospitalized and die is extremely low. Children at the most risk for hospitalization and or death are children who have co morbidities. Therefore, parents should seriously consider vaccinating their children, when they are eligible and after consultation with their physician so an informed logical and scientific decision instead of an emotional decision can be made.
What we know is that there are co morbidities that contribute to the hospitalizations and deaths in both adults and children. We do not know what the long-term effects of contracting COVID will be on the health and development of children if they contract COVID and therefore a parent should seriously investigate the pros and cons of the vaccine. Do not rely on the media or social media for your health care recommendations.
The same co morbidities that are responsible for hospitalization of children are the same ones being seen in Breakthrough Infections of Adults: The other co morbidity in adults is age. Breakthrough infections are being seen in those 75 years of age and older. Hence the need for Boosters.
In breakthrough infections in both vaccinated adults and children, the number of hospitalizations, ancillary care and deaths when compared to their non vaccinated counterparts is significantly lower. Less than 1% as compared to 99% for the unvaccinated.
Proof Masks Work: A group of scientists from Yale, Stanford, UC Berkeley, and other institutions published the final results of a randomized study of community-wide masking behavior in Bangladesh. The study—now in preprint form—encompassed roughly 350,000 people in 600 villages. The researchers randomly selected certain villages for an intervention that included giving out free masks, paying villagers to remind people to cover their face, and having village leaders and religious figures such as imams emphasize the importance of masks. The researchers also paid villagers to count properly worn masks in public places, including markets and mosques. To gather data on coronavirus transmission, the team asked about symptoms and conducted blood tests to determine who came down with COVID-19 over the course of the study.
Their conclusion: Masks work, period. Surgical masks are particularly effective at preventing coronavirus transmission. And community-wide mask wearing is excellent at protecting older people, who are at much higher risk of severe illness from COVID-19.
The take away message is that COVID is not playing fair and as long as there are variants and continued mutating variants everyone including the children will be at risk. Things that are working worldwide are masks and vaccines based on the medicine and the science.
Until next time, Stay Safe, Stay Well, Practice Mitigation Factors and consider getting vaccinated if you have not already done so.
James A. Vito, D.M.D.