Facts over Fear- What You Need to Know about Kids and COVID | Dr. Amna Husain

Dr. Amna Husain, MD breaks down myths, misinformation, and urban legends to help families know FACTS over FEAR when making choices and understanding Covid in kids. Facts over Fear: What You Need to Know about Kids and Covid Video Chapters 0:00- Intro 1:00- "Unvaccinated Kids aren't a Risk to Anyone." 3:22- "Kids don't get as badly affected by Covid." 6:07- "If your child gets COVID, they are prone to get Kawasaki." 6:54- "Pediatric cancer kids are beating COVID-19." 9:08- "Kids don't pass Covid to others." 11:00- "If whole house is vaccinated but you have kids, you count as a vaccinated household." 11:30- "Kids are basically vaccinated, and they need to be back in school." 13:47- "Air purifiers can protect against COVID." 15:30- "Babies who breastfeed post vaccine can get chemical burns." 17:14- "Kids don't necessarily need the vaccine, just like the flu shot." For more reading and resources: -Article in The Atlantic: https://www.theatlantic.com/ideas/archive/2021/03/go-ahead-plan-family-vacation-your-unvaccinated-kids/618313/?utm_content=edit-promo&utm_medium=social&utm_term=2021-03-18T10%3A00%3A56&utm_campaign=the-atlantic&utm_source=facebook&fbclid=IwAR3MM_p8H7WjvwAVsZgWYxNnyauZciIRM5B7zSRMilWgMSptwYTUVZiPxdA -AAP Covid 19 Guidance for safe schools: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/ -CDC Input on HEPA filters: https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html -

TRANSCRIPTION

Dr. Amna Husain: Hi everybody. Dr. Amna Husain here, board certified pediatrician, board certified lactation consultant, and mom. Welcome back. So today we're talking about, again, kids and COVID, but I thought we'd do a little spin on it. Maybe this time we talk about the myths, the misinformation and urban legends that you've seen, read or heard. Not only just talk about if they're false, but maybe there is some truth to them and we can dissect that and find out where they came from, and if they're really worth putting any weight into.

One thing I want to mention is this data is up to date as of March 31st, 2021. It's crazy. April's happening tomorrow. I feel like 2021 is flying by, whereas March, of 2020, do you guys remember March, of 2020? When this pandemic first started and how it just dragged on? Well, here we are, one year in, so let's revisit what we know now and see what we can learn. Okay. First myth, that your unvaccinated child isn't a risk to anyone. This one's false. And I think we know where it came from. So the Atlantic published an article a few weeks ago by Emily Oster, and it had a very interesting title stating, Your Unvaccinated Kid is Like Vaccinated Grandma. So I have a few problems with this. First of all, I don't like blanket statements when it comes to health. And saying that your unvaccinated child is like a vaccinated grandparent. Well, we have no data to go on that.

The author also states the MIS-C is rare, which is true, but she goes on to say that being a child is a really great vaccine. That's a very wild assumption to make. If it's your child, then the numbers don't matter. So we can't just make blanket statements like that and say, children are a really great vaccine, or an unvaccinated kid is just like a vaccinated grandparent. There's literally no data there to prove that. The article also goes on to say that herd immunity comes in time to save the summer. Herd immunity is when you have at least 70% of the population vaccinated. And I sincerely hope we are there at the summertime, but I don't know if we are going to be there. And so I would say that let's be cautiously optimistic, but again, caution.

Not to say that I don't understand why she didn't write this article and I can see why people would believe this. I have a three-year-old who is likely not going to be able to receive the COVID vaccine this year. We are just enrolling children six months to 11 years of age and Pfizer and Moderna right now. Likely she again, will not receive the vaccine this year, maybe by early 2022. So I feel your anguish. I want my child to be able to do certain things as well. I hate masks and I don't want to wear them either. But I think that this statement that unvaccinated children aren't a risk, or your unvaccinated child is just like a vaccinated grandma, is just totally really missing the mark here, and we're maybe moving backwards, or in the wrong direction. Maybe we're just throwing caution to the wind and it can cause issues like potentially increasing in case loads.

[inaudible] this one. Kids don't get as badly affected by COVID. All right. So I'm a science person. I love numbers and being objective. So let's talk about the numbers. When we talk about COVID-19, the scariest risk is MIS-C, and I actually have a video on kids and COVID another one where we do discuss MIS-C. I will link it here, but let's talk about where the numbers are with MIS-C as of now. So this data is up-to-date on the CDC's website as of March, 2021. Total MIS-C cases meeting definition are 2,617. Total MIS-C related deaths, meeting case definition, are 33. Now in general, the number of children who have been infected with COVID-19 is 3.4 million as of the AAP, or the American Academy of Pediatrics estimates.

Now I likely think this is a gross underestimate because we weren't, and sometimes even now, are not testing children and pushing for children to get tested as much as adults can potentially get tested. Adults have much easier access to testing than children do. Even as a pediatric testing site, I'm seeing that a lot of children are not getting access to testing. So I likely think that, that 3.4 million is an underestimate. Now, of course, if you add it up, 2,600 something cases out of 3.4 million is a very small number. So yes, children aren't as badly affected. And 33 deaths related to MIS-C, gosh, that's a pretty small number compared to 3.4 million children who've been affected, but that doesn't mean that your child doesn't get affected. When your child is that number, the statistics they're hard to really interpret and apply.

Most cases occur between the ages of one to 14 with the median age being nine. Most cases have occurred in Hispanic, Latino, and Black children. More than half of the cases were to male children. And in general, 99% of the individuals who had MIS-C did have a positive SARS-CoV-2 test. The other 1% were actually around somebody who was COVID-19 positive. Say that kids aren't as badly affected, well, probably yes if you looked at the gross data that 2,600 out of 3.4 million is not a large number, but that doesn't mean children aren't affected by it, especially if your child is one of the 2,617, especially if your child is one of the 33 who's died from MIS-C. So I think it's really important to take the numbers and data into context.

Going off of this. What about Kawasaki? This myth that if your child gets COVID they're prone to Kawasaki disease. This likely comes from MIS-C's relation to COVID-19. So MIS-C is multisystem inflammatory syndrome in children. It does share some overlap with Kawasaki disease, which is a well-known vasculitic phenomenon that we've seen in children, but it's not Kawasaki disease. And having COVID-19 does not put you at risk of Kawasaki disease. Does put your child at risk of potentially contracting MIS-C, which we really hope does not happen, but that's why we pediatricians and those in public health are raising awareness about this, so that parents and clinicians know what to look for if a child does contract COVID-19.

Okay. So what about this one? Pediatric cancer kids are beating COVID-19. This one's interesting, and I'll tell you why. So MIS-C is actually, like I've mentioned, a multisystem inflammatory syndrome. So what drives the inflammation? Well, it's actually not the virus itself, it's the body's reaction to the virus. So not only do we produce all these different cell signaling factors, we call those cytokines. We also have other cell signaling factors, interferons, immunoglobulins, that set up a very intense inflammatory cascade in the body, and it'll affect different organs. So the heart, the GI tract, the brain, the kidneys, all these different organs are being impacted in MIS-C, but it's again, inflammation driven.

Now, if you are a child who is on an immunosuppressive regimen like chemotherapy, your body's not able to produce such an intense inflammatory reaction. So if I get sick with a cold, or my child gets sick with a cold, they get a fever, fever is an immune response, they're able to really fight off the infection. But if a child is immunosuppressed, or on chemotherapy and they get a fever, well, we wake them up and start potentially antibiotics and antivirals on them to really protect them as much as we can, because they don't have as strong or prime to have an immune system to fight that infection.

Well, that's what we are seeing sometimes in children who are immunosuppressed, that they don't really have those cell signaling factors because they are so immunosuppressed to be able to mount an MIS-C response. And that's not a hard thing to hang your hat on. In fact, I don't even think there's really any data that we can say that has been done in this, but it's something that we are noting. So it's anecdotal that we have seen it that potentially actually those who are immunosuppressed may not mount such an intense immune response when it comes to MIS-C, and having that strong of an inflammatory reaction. All right. What about this one, that kids can't pass COVID to others? Well, I've discussed this in the past. And again, I'm going to link the video right here, we talked about a number of different reasons why we think children, typically 10 and under, so the younger age groups, don't transmit COVID as well.

So this is true that we think that children definitely 10 and younger don't transmit as well, maybe 10 and older, definitely the adolescents and those in high school seem to transmit the infection just as well as adults would. Why do we think that is? Well, there's a couple of different reasons. And again, I recommend checking out this video that we've done in the past on kids and COVID, but one, we think that perhaps there might be some cross-immunity from other coronaviruses. So coronavirus is a family of viruses. Two, so the ACE2 receptor that the virus needs to enter, children just don't produce it and express enough of it. Three, so where viral droplets are and where they're shed, children are a lot shorter, so maybe they're just not coming in contact with as many viral droplets. So there's a number of reasons why, but to say a blanket statement that kids can't pass it to others, well, no that's not really a true case.

Again, I've already mentioned from the AAP, we have that at least 3.4 million children have been positive with COVID-19 at this point. In fact, over 64,000 cases were just reported in the week alone ending March 25th, 2021. So we can't say that these children are not passing infection. No, they definitely are passing infection. There's some age groups that pass it a little bit more efficiently than other age groups, but certainly kids can transmit COVID. I don't want to say it's a blanket statement that they can't, but perhaps some age groups don't transmit it as effectively. So if the whole house is vaccinated, but you have kids, you count as a vaccinated household. What? This makes no sense. If your child's not vaccinated, they're not a vaccinated household. We've already talked about this in so many different ways. Definitely, I think some kids transmit the virus better than others, but you cannot say that your unvaccinated kid counts as a vaccinated individual. That's just not true.

Okay. So what about this one? Right. So kids are basically vaccinated and it's okay for them to go back to school in-person. All right. What a loaded topic. So definitely many pediatricians, me included, are very vocal advocates of getting kids back in school safely and following public health measures. I've talked about this again before in our kids and COVID video that we've done in the past. Now, that is to say the AAP actually has pretty mounting evidence that you can get kids back in school safely. There doesn't seem to be very high transmission rates at all in schools, even in communities that do have high transmission rates. So within schools overall, there's still low transmission. That is contingent upon a couple of different factors though.

So it has to be a multi-pronged layered approach. You always hear me talk about this Swiss cheese model. As kids get older, we add more and more fail-safes in place with not only just the students, but also the teachers and the staff. So that would mean universal mask use, disinfecting, cleaning, distancing, and good ventilation, just to start. And let's also talk about hand hygiene, all of these important things, trying to minimize mingling. So hallway traffic, lockers, et cetera. So I'm actually going to attach right here in the show notes an AAP report that shows that some schools have been able to successfully open without adhering to the six foot rule.

So I know that was a really big deal for many, the six foot rule, especially when the CDC came out and said that three feet is okay. And it's actually not something new if you read the AAP guidelines, briefs and updates that we've put out for schools, and I've definitely discussed in the past and linked again in my kids and COVID videos that I've done in the past, we actually do say for school age children, you should have their desks about three feet apart, because feasibly it's very difficult to put desks about six feet apart. And we have data that shows that three feet apart seems to do just as well.

Again, think about your age group, think about what risk factors they carry, and their transmission rates. The updated AAP guidelines also mention improved ventilation within schools, which brings me to this one, which I found really interesting. Can air purifiers protect against COVID? So this one I had to read up on a little bit, but let's talk about it. So there's a lot of air purifiers out there. Let's talk about HEPA filters. So high-efficiency particulate arresting. So as the name suggests, these filters are really good at pulling things out of air and holding them so that they don't continue to recirculate within the year. The fibers within HEPA filters are actually designed to catch items as small as 0.01 microns in diameter. So, that's pretty small. And again, very efficient.

So the coronavirus is actually on the lower end of what the HEPA filter can really take in and hold onto. So it probably won't be as effective on a single pass, but probably over time, I think it could be helpful. Certainly the CDC has some data that likely if you want to set up a few HEPA filters, so not just one big large unit, but a few HEPA filters and possibly a place like the nurses station, that could be somewhat helpful for trying to remove and take out SARS-CoV-2 virus particles. However, that's why we use negative air pressure rooms for any patients that are hospitalized with COVID-19.

So I think a good HEPA filter air purifier might not be a bad idea. I don't think it's a magic bullet. I think it could be something that you could add to your toolkit and keep within your house, for example, especially as we're all spending time in the house, I have two to three HEPA filter air purifiers in my home, because we have terrible allergies, but by no means am I banking on that taking coronavirus out of my household's air. So I think it's something that you could add to your repertoire, but I wouldn't bank on it necessarily being the magic bullet for you. This one totally caught me off guard. Chemical burns in a baby's mouth after mom, I believe, received the vaccine. So obviously babies are not getting the vaccine. So if you are anywhere 11 and under, obviously, and breastfeeding, you probably aren't qualifying for this. So I'm likely sure that they're talking about the mom got the vaccine and the baby breastfed and possibly is getting chemical burns.

Let's talk about first what chemical burns are. So they could be caused by a caustic substance. They could be acid or base. For these to occur in the mouth, I'm not even sure how that's possible. So I've done a video before on the COVID vaccine and breastfeeding, we talked about the vaccine being injected intramuscular, it circulates within the bloodstream as you are trying to mount an immune response, but it doesn't necessarily transfer into your breast milk. So I'm not sure exactly what they mean by this. I know it's not at all possible actually. And this is totally urban legend, sounds like anti-vaxxers that are trying to scare families.

Really the only thing that your breastfed baby could get after you get the vaccine are IGA antibodies. And we, again, have really good data. I'm going to link the video again for breastfeeding mothers who are interested in getting the COVID vaccine. I break down the data and we go through what the safety is, what the efficacy is of what we know as of that time. But chemical burns in your mouth. That's not possible after getting the COVID vaccine. So this one hurts my heart as a pediatrician, that the COVID vaccine is like the flu vaccine and it's not really something important. Okay. So this last respiratory season, we saw actually very little flu because people were distancing, washing their hands and actually wearing a mask. Now, up till this point you've heard me say a lot that yes, kids aren't great transmitters, especially young kids of SARS-CoV-2. They are excellent transmitters of influenza.

We have really good data too, that not only does the flu vaccine decrease the risk of getting the flu, but it also decreases the severity of symptoms. And no, no, no. You cannot get the flu from the flu vaccine, because the flu vaccine, especially the intramuscular version, contains a killed virus. So it can't actually mutate to cause symptoms of the flu in you. It's not possible. You can't get the flu from a killed virus. Now, the other thing to think about is the flu is something that's pretty common and unpredictable. So if you could protect yourself from the flu virus, I highly, highly recommend it, especially with our young kids right now. So we're still in flu season. We are really. We're still in flu season, and if you could provide that protection to your child where you can't provide COVID-19 vaccination protection, why wouldn't you want to protect your child and give them that extra level of comfort and security, especially in the cold flu winter season. So that one definitely going to be a myth for me.

I am pro-vaccine if I could protect my six month old child going into cold and flu season, I will certainly protect them from the flu and then hope to one day protect them from COVID-19 once we have more data, for sure. So that pretty much wraps up some of the most common ones I saw, definitely some of the craziest ones I saw like chemical burns after breastfeeding. Not true, but I would love to hear what questions you guys have. So if this video was helpful, please do give it a thumbs up. Definitely subscribe, share this video with somebody who might need to hear it, especially if they believe some of these urban myths and legends regarding kids and COVID-19, and make sure you tune in next Monday, we will have new videos every week.