Its been a loooooong winter of COVID19 from my vantage point. I have become very close with some of you- and together we have navigated the hiccups of parenting during a quarantined life. It appears that many people do not truly contemplate spending 4-6 weeks separated from the world when they make decisions to travel and gather in groups. For this reason, I share what many parents wish they had known sooner:
- If you or your child has cough, shortness of breath, or loss of taste/smell, please call me. You can assume that the loss of taste or smell means you have COVID19. There is no fee for PCR testing with results in 24 hours. For a 75 dollar lab fee I can have the courier come for same day testing. I am extremely gentle and have never had a child cry after swabbing. I only use PCR testing. Antibody testing comes back in 24 hours as well. No fee for our patients.
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If there is an exposure in your family, please let me know so I can help guide you with the next steps. Do not spend money or time on rapid tests unless you have symptoms. There are thousands of cheap tests sold to you at >400% cost. Many are never confirmed by third parties to be of any utility. Worse- you may get a false positive or false negative. See graph from JAMA below.
- At one's most contagious point of illness, the gold standard PCR tests fail more than 20% of time. Talk to hospitalists; they have sick patients on ventilators that only test positive on the 5th swab. This virus likes to be in the lungs with a short appearance in the nasal passages. No one should market PCR or Antigen testing as 99.9% accurate. If this is true the pandemic would be over. People advertising testing want your money. Talk to your doctor first.
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If you are sick, please do not assume you are free of COVID19 infection unless you talk to a doctor and get a second test.
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People are most contagious before symptoms. We are in a surge. Now of all times practice social distance, masking and do not gather with people outside your home.
- Several families have been exposed by their nanny. Please tell your nanny they too need to limit their contacnts. Have them stay home 3 days if they visit with anyone outside their home. Then have them check that all contacts are well before they Tell them it is just for the surge if this is not your standard.
- ~50% of COVID-19 transmission occurs from presymptomatic patients.
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What ages has the COVID-19 vaccine been approved for?
Pfizer- 16 and up. Moderna - 18 and up.
Teens who are old enough to receive Pfizer’s COVID-19 vaccine will likely be in the final group to receive it.
There are a few exceptions: Individuals ages 16 and up with high-risk health conditions may have the opportunity to get the vaccine sooner, as well as individuals age 16 and up who are essential workers.
What about ages 0 to 15?
With any luck, a full pediatric vaccine will be available by late 2021.
Why isn’t a COVID-19 vaccine available to kids at the same time as adults?
Children’s immune systems are very different from adults’, and their immune responses can be different at different ages, from infancy through the teenage years. So the research that’s been done on the COVID-19 vaccine for ages 16 and up needs to be repeated in children of younger ages.
Both Pfizer and Moderna recently began new vaccine trials including children as young as age 12. If they’re successful, the data will need to go through FDA review. The good news is that an emergency use authorization can then happen as quick as 24-48 hours later. The hiccup comes with the time it takes for production and distribution. This process can take awhile, especially for very young ages, which are usually tested last due to ethical considerations.
How do Pfizer’s and Moderna’s COVID-19 vaccines work?
Both Pfizer and Moderna’s vaccines are made using the same technology: They inject a genetic molecule called mRNA, which causes a person’s cells to create a viral protein (called a “spike”) that triggers the desired immune response. There is no live virus involved – the mRNA molecule is simply a messenger that tells the body how to create an immune response. Then it’s quickly broken down by the body and disappears.
This technology for vaccines was developed over 20 years ago. Because of the mRNA component, which breaks down very easily, the vaccine must be kept cold. The Pfizer vaccine is stored in a freezer at “ultra cold” temperatures, minus-80 degrees Celsius (minus-112 degrees Fahrenheit). The Moderna vaccine can be stored in a regular refrigerator.
Where can I register my family for the vaccine?
Use https://othena.com/individuals.php. Several distributors will use this application and you are not committed to getting the vaccine. Be sure to get a confirmation email and then download the app.
You can also try your luck by showing up at known distribution sites. Be respectful, honest and clear that you are there to see if they have extra vaccine. This has been working for people. Some vaccine lots need to get used up the same day they open them up!
If you are up for a drive, or live in LA or SD, try these sites:
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Pic credit: Patient calling Dr. Vivi with questions and help for her doll |
WHAT DO WE KNOW ABOUT INFECTIONS IN CHILDREN AT THIS POINT?
While some pediatric patients are having some unusual symptoms after contracting COVID19, a majority seem to bounce right back. Why are children managing this illness so much better than the adult population?
factors that might protect children. They list (1) differences in innate and adaptive immunity; (2) more frequent recurrent and concurrent infections; (3) pre-existing immunity to coronaviruses; (4) differences in microbiota; (5) higher levels of melatonin; (6) protective off-target effects of live vaccines and (7) lower intensity of exposure to SARS-CoV-2.
Adults fare worse likely from:
(1) age-related increase in vessel damage and clotting; (2) higher density, increased affinity and different distribution of specific receptors and proteins; (3) pre-existing coronavirus antibodies (including antibody-dependent enhancement) and T cells; (4) immunosenescence and inflammaging, including the effects of chronic cytomegalovirus infection; (5) a higher prevalence of comorbidities associated with severe COVID-19 and (6) lower levels of vitamin D in adults.
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"Should I get vaccinated?"
This is an easy answer for some, and a real struggle for others. It helps to know that mRNA is NOT a new vaccine. It may also help you to carefully read the below information. I got the vaccine inspite of having an autoimmune disease. I inherited Hashimoto's Thyroiditis, and likely passed along to my son a genetic propensity to have autoimmune Type 1 diabetes. Autoimmune disease means that when my body sees foreign pathogens/viruses, it gets overly excited and confuses my own body as foreign. Centuries ago a hyper-responsive immune system conveyed an evolutionary advantage; it saved people from infections. Now it causes more problems than good. Science has greatly advanced us into a new world.
Many people feel that due to an autoimmune disease they do not want to get a vaccine. I understand their fears and it may be in their best interest to see more research. But nonetheless I decided to get the COVID19 vaccine and soon after a potential viral illness contributed to the onset of my son's Type 1 Diabetes. Was his diabetes triggered by COVID19? It is possible. Could it have been several other viruses? Yes. Could it have been a vaccine? Yes. I do know that a vaccine presents 1/20th to 1/100th of the foreign particles (antigens) that are presented to one's body by a real virus. A vaccine induces immune memory without destroying the body. Such science is a privilege and keeps us safe from outbreaks of polio, measles, mumps, chicken pox, and now COVID19.
My job is to protect my patients, my community and my family. Because I am swabbing people for COVID19 more days than not, I blocked a considerable amount of time to look at the data. There are some detailed and technical podcasts by virologists and epidemiologists. Here I leave you with some summaries from the vaccine trials:
Pfizer/BioNtech (mRNA) vaccine trial of >43k participants announces 95% efficacy at primary endpoint and 94% efficacy in age>65, no serious adverse events reported, 170 cases of COVID-19 of which 162 were in the placebo and only 8 in the vaccine group. 10 severe cases (9 in placebo group). 2 series vaccine 21 days apart. Needs storage at -70 C. 50 million doses available in 2020 (half for U.S., 2 doses series means 12.5 mil available in 2020) up to 1.3 billion doses expected by end of 2021. 42% diverse population globally & 30% diverse population nationally.
Moderna (mRNA)vaccine shows 94.5% efficacy, 30k enrolled. There were 95 instances of COVID-19 out of which 5 were in vaccine group (and mild/mod illness) and 90 in placebo group. Severe illness reported in 11 cases (ALL from the placebo group). The vaccine remains stable at refrigerated temperatures for up to 30 days. Shipping and long term storage can be achieved at freezer temps (-4⁰F). Less problematic for distribution and storage. 2 series vaccines 28 days apart.
Oxford/Aztrazeneca (viral vector) phase 3 trial of 24k participants shows ~70% efficacy combined (90% in one dose regimen & 62% in other) no serious adverse events reported. Storage at refrigerator temps.
Since ~50% of COVID-19 transmission occurs from asymptomatic people (asymp/presymptomatic). Aztrazeneca-Oxford vaccine reports reduction in asymptomatic transmission, one of the key factors contributing to a global pandemic of this scale.
Johnson and Johnson This is a one shot adenovirus vaccine.
-Study participants in the trial received a low-dose shot or a high-dose shot.
-Side effects were mild and similar to the other vaccines (injection site soreness, fatigue, and mild fever).
-90% had neutralizing-antibody titers on day 29.
-100% of participants had neutralizing antibodies within 57 days of the shot.
-Antibody levels stayed high for at least 71 days and the study is ongoing to see how long this continues.
-Phase 3 data is currently being analyzed on the larger 45,000 person trial and expected to be released in a few weeks. This could be a game changer since it is only one shot. It also increases the availability of vaccines candidates.
Some facts and some myths about mRNA vaccines:
- mRNA platforms have been studied since the 90's , they have used in cancer therapies and other vaccines such as cmv & zika
- MRNA is the instruction sheet for your body to make proteins (spike) which your body then recognizes and starts making antibodies. The mRNA never enters the nucleus of the cell, so it can not alter your DNA. Once it tells your body to make the protein it gets discarded by body. The reason why these vaccines require extremely cold temperatures & lipid layer is to keep it stable, so its not something that can last for years in your body. The mrna is out of your system in a matter of days.
- If the vaccine was to trigger a hyperinflammatiry response, we would expect that to happen soon after vaccination. The trials have been ongoing for >6months and so far no serious adverse events reported.
- There is no live or weakened virus in mrna vaccines so you can not contract COVID-19 from these vaccines.
- Most common side effect from mRNA vaccines has been pain at injection site, fever, chills,headache & fatigue. Like many vaccinations these are common, however people can experience more severe fever/chills/rigors which will resolve after 1-2 days . This reactogenicity should be expected and will resolve.
- We have data from over 97,000 participants in the first 3 trials and there are several other vaccine candidates approaching phase 3. Shingrix vaccine for shingles only had ~30,000 people in their trials.
- These vaccines have been subject to intense safety scrutiny which has not been compromised during these trials. 9 pharmaceutical companies signed a pledge in Sept to hold themselves to highest safety standards & be transparent with the trials to stand with science & gain public trust. The FDA demanded 2 month data as opposed to 1 month after phase 3 clinical trials (trials started in may)and thats the data we have. The DSMB Data safety monitoring board an independent agency is reviewing all of the clinical trial information as well as the VRBPAC(vaccine & related biological product advisory committee) & ACIP advisory committee on Immunization practices.
For FAQs follow these FB pages:
- Your local epidemiologist
- Dear Pandemic
- Friendly Neighbor Epidemiologist
- Jennifer L Kasten, MD, MSc, MSc
Trusted Resources
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WHAT TO DO IF YOU ARE SICK OR EXPOSED: |
GO TO YOUR DOCTOR for HIGH RISK SYMPTOMS:
- Cough
- Difficulty Breathing
- Loss of Taste or Smell
FOLLOW THE SYMPTOM TREE ATTACHED for LOW RISK SYMPTOMS:
- Fever
- Congestion
- Nausea/Vomiting
- Headache
- Sore Throat
- Body Aches
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Traveling and looking for some protection beyond masking and distance? Consider these nasal sprays that have a proven anti-viral effect:
I am also happy to provide PPE for patients with a family member exposed or those who need N95s for their profession or travel.
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Our tasks and responsibilities at work and in the home are growing as the pandemic surges. We are running on empty. So why and how can you put exercise at the top of your “todo” list?
Consider that athletes have condensed and more restful sleep, heightened immune systems, and a lower risk of depression.
Ways to motivate:
- Taking time out of your day to exercise screams, “I am productive and high achieving.” Clients and co-workers will admire your mental strength and self regulation. Feel free to leave your office for a lunch run without feeling guilty!
- Make sure your office space is adaptable to stretching and changing into workout gear at a moments notice. I always keep spare running and stretching clothes in a bin tucked under a shelf. I am much more likely to workout when I feel like I am sneaking it in. The exercise feels like a treat rather than a task.
- To maximize your chances of exercising mid-day, eat a late morning breakfast or snack. Also time your coffee so that your energy boost comes when you plan to exercise. If you are starving at lunch and your energy is crashing, you will be more interested in eating versus exercising. Bring a packed meal so that you can get back to work right after your workout and eat at your next break.
- Trust that your sore neck, stiff back, and headache will likely improve once you start moving blood through your tissues.
- Get in the mindset:
– Remember that 15-20 mins is better than nothing,
– Use the stairs and park far from the front door,
– Drink plenty of water and use bathroom breaks as a time to stretch,
– Sit on a stool or balance ball at your desk to engage your core,
– When you get a call put in ear pods and stand up and stretch,
– Always carry a workout bag in your car,
– Tell your office mate, friend or spouse of your exercise plan for the day and hold yourself accountable to it!
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Testing and infection.
Blue is PCR from nasal samples (this is the "gold" standard we are using when we swab your nose).
Pink is viral PCR from lung samples for those in the hospital.
Orange is whole virus recovered in the respiratory tract.
Yellow is viral PCR from stool
Purple is IgM immune response
Green is IgG immune response
The time course of PCR positivity and seroconversion may vary in children and other groups (the asymptomatic individuals who go undiagnosed).
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Ideas to keep your young kids busy
- Smithsonian Science Experiments!
- Consider buying an inflatable punching/boxing bag, a trampoline with a safety net, or climbing gym
- Get out to see nature at some of the hidden beaches in Newport. There are so many and I am happy to share my favorite secret spots if you ask
- Get cooking! Whether Pinterest or zoom classes, now that kids are home they can learn how to prepare healthy meals. STEM and fun!
- Do some family yoga as part of your routine. Take turns leading. Let your kids make up their own routines and follow their moves.
- Buy a karaoke microphone for some random energy releasing dance parties!
- Get some cones and hoops and make some rely courses around the house and outside.
- Remind the kids to FaceTime friends!
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Still looking for the ultimate Immune Boosting supplement?
Research suggests that Vitamin D deficiency increases one's risk for complications from COVID19, and of course Vitamin C and Zinc are a must.
You can pick them up from the office or have them shipped to you. I do not make money selling them and they have all of the ingredients that you want in an immune supplement.
-Vitamin C (as Ultra Potent C®) 1200 mg 1,333%
-Vitamin D 125 mcg (5000 IU) = 625% Daily Value
-Niacin 70 mg 438% Daily Value
-Calcium 40 mg 3% Daily Value
-Zinc 30 mg 273% Daily Value
-Quercetin 750 mg
-N-Acetylcysteine 600 mg
-Decaffeinated† Green Tea (Camellia sinensis) Leaf Extract
[standardized to 60% (225 mg) catechins and
40% (150 mg) epigallocatechin gallate (EGCG)] 375 mg
-L-Lysine 33 mg
-Citrus Bioflavonoid Complex [standardized to 45% (14.4 mg) full spectrum bioflavonoids] 32 mg
-Tetrasodium Pyrophosphate 14 mg
-Alpha D-Ribofuranose 13 mg
-Xylitol 9 mg
-L-Cysteine 8 mg
-L-Glutathione 5 mg
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Data is limited and theoretical risk must be weighed against the established benefits. So far CDC, FDA, ACOG, and ABM all recommend vaccination for pregnant and nursing in particular
This is what we have so far...
-Individuals who got pregnant during vaccine trials had no complications from the vaccine
-Pregnant, vaccinated rats did not have any adverse effects on female reproduction, fetal/embryonal development, or postnatal developmental.
-The vaccine mRNA will not reach the baby; it degrades too quickly
-The vaccine is not “live” or “dead” or anything in between, so you won’t get infected with COVID19
-Antibodies do not attack the placenta
-There is no plausible way how the vaccine would cause harm to a breastfed baby
-Pregnant individuals are at higher risk for COVID19 complications
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PATIENT SPOTLIGHT:
Evyn is truly a warrior! She was diagnosed with Emanuel Syndrome which is a rare genetic disease that was present from birth. The Upton's were told that Evyn would never be able to do many things that she has already accomplished. This girl amazes not only her parents, her sister Sydney, but also everyone she meets every single day. She is the happiest, most determined, loving ray of sunshine in their lives!
Inspite of the many therapies and specialists required for her care, her parents will tell you, "We are beyond lucky to be her parents!"
Ashley Upton's tip for these crazy times: "Take it one day at a time. I can’t lose energy worrying about tomorrow, because then it takes away from today and my attitude towards my family. I’ve also worked SUPER hard on my own mental health during all of this. Taking 5/10/20 whatever amount of time I can get to do something for myself like a bath, read a book, go for a walk."
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CHOC'S FAQ PAGE CLICK HERE
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