I apologize for the long hiatus from the blog.  As I have always mentioned, family comes first for me.  With various events, obligations, work, and other situations, the ability to find time to simply type a blog post seemed hard to find.  I even had to stop my second podcast show (Kids and COVID) due to a lack of appropriate time available to spend on it – much to my sadness.

But now I am back and just in time to discuss the recent emergency use approval of the Pfizer COVID vaccine for kids aged 5-11.  I actually did a podcast episode about the vaccine safety data last week on my Imperfect Dad MD podcast, but today I simply want to discuss the decision behind vaccinating this age. 

The Conundrum

We live in a time where health care has become almost more polarizing than most political elections.  Discussing vaccines for adults seemed like a reasonable discussion – vaccinate those at higher risk for COVID morbidity, mortality, and spread to hopefully keep things at bay.  Those who chose to get vaccinated did so (some against their wishes due to various mandates), but the hope was we could bring significant damages down in regards to COVID infections.

Then we were able to vaccinate those in the 12-17 year old age group.  Again, we knew that this age group contracted and spread COVID more like the young adult population compared to their elementary aged siblings.  This group had worse outcomes from MIS-C, long COVID symptoms, and heart related problems.  During this vaccine roll out we did see an unknown side effect (myocarditis) appear, however the frequency and severity of this happening still was significantly less than getting COVID in the first place. 

Now, we have the 5-11 age group, and many people are out there asking, “Why?”

Many questions included:

• These kids rarely get sick – why vaccinate them?
• Isn’t the risk of vaccination higher than infection from COVID?
• Haven’t most of these kids gotten COVID already in a milder form? Why bother?

I recognize all these questions and more.  I get it.  I am a parent of a 5 and 8 year old.  This decision now lies on me and my wife as well as you.  Let me take you through my thought process on this and why I currently plan to get our boys vaccinated.

Kids Don’t Get Sick

I have touched on this comment many times in previous posts.  We know kids do not get as sick as adults on the same number scale.   However, those kids that DO get sick get just as sick AS ADULTS.  COVID has become one of the top 10 killers for the pediatric population.  This is behind things like motor vehicle accidents, firearms, and cancer.  We have tackled those three causes with things like seatbelt and carseat laws, firearm regulation topics, and improved cancer management.  KIDS ARE NOT MEANT TO DIE.  As Pediatricians, we focus heavily on preventing that.  So, when a new killer is presented, you better believe we will be the first to finds ways to prevent it. 

30% of New Cases in the Last Week Were in Patients Less Than 19 Years Old in Douglas County

As for this recent wave of COVID?  The week prior to Halloween I reviewed our local county’s COVID dashboard.  I had seen many new COVID cases in kids (we are seeing multiple a day in our clinic), and I was curious what the numbers were showing

The numbers of new cases was indeed going up.  We had just recently gone back above 1000 cases in a week.  However, 30% of those new cases were in kids less than 19 years old!  Let that sink in.  We actually just had a whole elementary school close down for 2 weeks in our area due to an uncontrolled outbreak (and no, they did not have any mask mandate in action).  So yes, kids are catching this, they are getting sick, and it is continuing to spread in our community because of it.    

Only Kids with Comorbidities get REALLY sick, right?

This is also a common comment made on social media, popular podcast shows, and other means of communication.  To put it simply, 30% of pediatric hospitalizations from COVID had NO COMORBIDITIES.  I don’t think we need to say anything else there.

Aren’t the vaccine risks higher than COVID in kids?

We already touched on how COVID affects our pediatric population above.  Many would like to assume this risk is low and vaccination risk is high.  When the FDA looked at the vaccine data, they extrapolated data to see how many hospitalizations, ICU stays, and deaths would be prevented from the vaccine versus kids having the same outcomes from the vaccine-induced myocarditis (the biggest argument against vaccination).  Just for reference, they used the myocarditis rates in the older population and ASSUMED it would be the same for the younger group.  This is very unlikely due to this age’s vaccine having 1/3^rd the amount of mRNA in it when compared to the older group.

In every scenario played out except ONE, the vaccine won out.  What was the one scenario where COVID was better?  Well, it was when practically no COVID was circulating at all – which makes complete sense.

I heard 40% of kids already had COVID.  Is that true?

This information is based off the presumed amount of asymptomatic cases there have been from COVID.  This is possible.  I honestly can’t say.  However, we also do not know when these kids were sick from COVID initially.  Does a kid who was sick in October 2020 have the same innate immunity as one sick in October 2021?  Probably not, but I do not have any data on memory B and T cell responses in these kids to say for sure.  We know that circulating antibodies drop after some time post illness and vaccination (hence why some at-risk adults receive a booster – including myself).  

Since kids have such a low risk from bad outcomes from COVID, isn’t it better to just wait?

Again, I get this question asked a lot; this is my response:  Early in COVID we hoped to have it contained and gone by now.  That didn’t happen.  Now we understand we have to learn to live with it.  Eventually, you will come into contact with this thing and contract the virus.  I would rather my kid have their immune system set up NOW in order to prevent bad outcomes from COVID LATER in life. 

I know we like to use seatbelts in our analogies as Pediatricians, but bear with me – I have never been in a car accident (going to go find some wood to knock on).  However, I always wear my seatbelt.  Why is that?  I trust my driving skills.  I trust that I can almost always avoid another reckless driver.  Yet I know that someday it may not be enough.  At that time, won’t I be happy I wore my seatbelt?  Having a vaccine is the same idea.  None of us WANT to get COVID.  However, I would rather have my kids vaccinated and know they are protected rather than roll the dice down the road. 

Conclusions

In the end, this is obviously a decision each parent needs to make.  I do not see them ever making this a mandated vaccine for this age group (nor at this time do I think they should be).  With data I have I am comfortable with getting our boys the COVID vaccine.  And yes, they are boys, meaning they are at a higher risk of myocarditis than girls.

Imperfect Dad MD

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