Kids and COVID 19: An Update on Transmission Rates, Schools Reopening, Variants, Vaccines, and MIS-

Board certified pediatrician and lactation consultation, Dr. Amna Husain is re-visiting COVID 19 and our kids, this time to provide you an update on transmission rates, schools reopening safely, variants, vaccines, and MIS-C. Video Chapters: 0:00- Intro 0:49- Why don't kids get infected as severely? 02:19- Would re-infection be more severe? 02:38 -Are new variants causing a rise in hospitalizations? 03:16- Review of current vaccine research in kids 05:01-How safe are schools and daycare centers? 08:03- Questions to ask daycares 08:40-CDC resources on sending to school 09:28-My personal top 5 items for schools reopening safely 11:27- Symptoms of MISC to be aware of 12:19 -MISC statistics and treatment For further reading and resources: Latest update, per Dr. Fauci: https://www.cbsnews.com/news/covid-19-vaccine-kids-school/ Exclusive Interview With Pfizer CEO Albert Bourla | NBC Nightly News: https://www.youtube.com/watch?v=IAzIfqFI3cM CDC Resources on Deciding to Go Back to School: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/decision-tool.html AAP's COVID 19 Update-d 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/ To see my other content, follow me- Instagram: https://www.instagram.com/dr.amnahusain/ Tiktok: https://www.tiktok.com/@dr.amnahusain?lang=en ***The information in this video is intended to serve as educational information and can not be construed as a substitute for professional medical advice, diagnosis, or treatment of you or your child. Content within this video is for information purposes only and does not replace a consultation with your own doctor or your child's doctor.

TRANSCRIPTION

lactation consultant and mom. So today I thought we'd talk about something incredibly prevalent. Coronavirus, prevalent in our lives for almost a year now, but let's focus in on kids and what we know today. So I'm wearing my educated and vaccinated shirt, but today we're actually going to talk about more than just vaccines. We're going to definitely talk about of course, where we are in vaccine trials with kids. But I thought we'd talk about where we stand with COVID and variants, where we stand with schools and where we stand with MIS-C at this point.

So I'm recycling a few questions from my Instagram Q&A, so let's get started. So in terms of what we know about this infection and in kids, why don't children get it as severe? There's a couple of theories that we have, and it might be a combination of all the above, but we don't have one set reason per se. So one theory is that the virus infects and binds to the ACE2 receptor, when it causes the initial infection and children just don't present and have very many of those ACE2 receptors. Second theory being that children have some cross-immunity from other coronaviruses. So coronavirus, I know many people until today have not, or until this year had not heard that term, but coronavirus is actually a family of viruses. So there might be cross-immunity from other coronaviruses that cause symptoms just like the common cold that a child might have.

The third theory is that children have a very robust and strong immune system. Think about it. Elderly, just have a weakening immune system, as they get older. We know this, we also know that they need boosters of things like the pneumococcal vaccine, as they get older. Their immunity, their titers, they start to wane. Children have a very robust immune system. Perhaps that's one reason why. And then fourth is something that perhaps physically, maybe where they are and their height. When we are talking, we know coronavirus is spread by droplet. That the transmission is just, they're not getting, just based off of how tall they are, wide majority of the respiratory droplets that are maybe coming from an adult's mouth. So there's a couple of different theories why that is.

At this time we don't have any evidence that a re-infection could be more severe. Certainly we've seen re-infections be more severe. We've seen them be less severe. We've even had them be asymptomatic. So it's hard to say that in general, they're going to be more severe in that and especially in children, that they're going to necessarily be more severe. Now, in terms of variants, the variants are not more what we use in medicine virulent, or more deadly by any means. They are however, strong enough that these mutations essentially, it takes fewer particles to infect and cause the symptoms. So, that's what we mean when we say it's more contagious. Now it's contagious across all age groups. So your children, your young adults, you're older, middle-aged adults and you're elderly. So it's not more contagious and going to impact children more than any of the other groups, but everybody will be impacted. So you might be seeing more cases of children. So this is a really good question. So in the initial trials, they did have 12 to 15 year olds for Pfizer.

The FDA did not approve it for that age group at that time, but Pfizer is approved for teens as young as 16. So if you have a 16 year old, who's an essential employee or essential healthcare worker, for example, they would absolutely be able to get this vaccine. Now, the data we have from the 12 to 15 year olds who were included in Pfizer's trial, is actually really great data. We're actually just wanting to compile a few more, a lot more actually, individuals and participants for the trials. So currently Pfizer has approximately 2000 children or adolescents enrolled right now. And again, it's going to be 12 to 15 year olds who are going to be enrolled, Moderna also has children as young as 12 years of age, that they're enrolling in trials as well. AstraZeneca, I'm sure we'll also be doing something similar as will Johnson & Johnson.

This is the way trials do commence. We usually do not include pregnant women and young children in trials the first time around. We make sure that these vaccines are safe for the general public before we necessarily put what we call the vulnerable populations in trials. That being said, there are trials going on, even in China right now with a viral vector vaccine. So, that's basically similar to what the Johnson & Johnson vaccine is. And they're enrolling children as young as three years of age. And so far there have been no serious consequences or adverse events from those vaccine trials. So I am thinking and hoping, luckily actually, and I believe Dr. Fauci recently released a statement as well, that we will likely have data from these trials of the 12 and up age groups by probably early summer. And then hopefully by mid to late summer, FDA approval, hopefully by the fall of 2021 or the start of the academic school year of 2021 to 2022, we are going to hopefully be able to vaccinate adolescents.

So this is a really good question. A lot of parents are concerned about sending their kids to daycares and sending their kids to school. So we just talked about in terms of vaccines and what to expect for what age group getting vaccinated, but parents are worried about their younger age groups, because those are the ones who touch their nose and their mouth and put everything in their mouth and maybe more difficult to wash hands. A silver lining that we have seen and that the American Academy of Pediatrics has noted is that children less than 10 years of age are less likely to become infected and transmit this virus. And recently they also put out a new statement on guidelines and sort of what we can expect going into the school year, what we can do to have our children be safe in school, because we do find that that's the best place for children to be.

That's where they'll optimize their learning, their socialization, their mental health. So what can we do to make things safe as possible? And I've always equated this to sort of a Swiss cheese model. So when it's children this young, let's say children less than two should not be wearing masks, but children over two years of age, who can wear masks, we should also have them washing their hands, have them working in smaller groups, have the adults definitely always wearing masks when they're around them. But maybe you can also have things like staggered pickups and drop-offs. Temperature screenings as well. I know a lot of daycares and schools also don't allow the parents to come inside. So you're also trying to limit how many people are really going to be in close contact. And then as you get older, the school-aged children, you can actually have their desks about three feet apart, which can help a lot.

You can also remember they're going to be wearing masks and these children are going to likely remember not to touch their nose and mouth and not to pull down their masks or anything like that. They're a little bit more reliable as you move into the more older age groups, the things that you'll be looking at. So lockers, probably trying to limit the use of lockers, trying to make sure that the hallway flow of traffic is really one direction so that we're not having mingling. Setting up physical barriers. These are all things that the document by the AAP, which I'll link below in the show notes, are laying out. Adolescents, that's actually the highest age group. So just like I mentioned, the 10 and younger is actually not as high risk of getting infected and transmitting, but we know that adolescents actually might even transmit this virus just as well as adults do.

So adolescents are at risk and they are also going to be at risk more for MIS-C. At least that's what we see in terms of the children who are more likely to get it. There's a wide range, which we'll discuss in the future, but mostly the eight to nine years of age as a median age and going up to sort of like early adolescents, is where we're seeing MIS-C. Now again, what works in our favor is the maturity of the individual. So when you're an adolescent, you're much more likely to remember your mask, washing your hands, maintaining distancing, all of those good things that we know help, hand hygiene. So, I think that if we can find a silver lining in this pandemic, that's one of the things that you can think about. Now what should you as a parent be looking at in terms of daycares?

Well, I think that's a really good question to ask. So what are your drop-off, pickup policies? What are your policies for, if somebody does get infected, what are their cleaning policies? How often are they having the kids wash their hands? When the kids pull down their mask, which they inevitably will do, if they're doing mealtimes, let's say, what are you guys doing? Are you separating the kids apart? Are we separating the caregivers from the children at that time? How small are the classes? How large are the classrooms? I think those are all good things to ask. And then in terms of, once we get into warmer weather, how many of the classes are actually being held outdoors? Because that definitely also can lessen the risk of transmission. One thing I'll also mention is I understand that sending your child to school is not an easy decision.

And we talk about this a lot, that the CDC is a great hub for a lot of resources, but really it truly is. So I'm going to link a few items below in the show notes, but they really have an excellent checklist for basically assessing your household risk. So is your child immunocompromised, or have a chronic health condition? Do you have an elderly person living in your home? It helps you assess your risk for if you wanted to send your child to school. They also have checklists for a school. So if you want to send your child to school, you as a parent can objectively assess your emotions and comfort levels. So you can say, I am comfortable with the way the school communicates with me, if there's an outbreak. I am comfortable with the mitigation strategies that are in place at the school.

The top, I call it the big five mitigation strategies. So it's going to be masking, distancing, hand hygiene, contact tracing, and testing. Those are all the things that really need to be in place to have schools running in a successful manner. And then likewise, you have a checklist for virtual learning. If you do feel comfortable with virtual learning, you can actually ask yourself that, you know, is my child thriving still with virtual learning? Are they staying engaged? Are they academically doing well? They also have a checklist for, if your child is on... needs resources from the school, has special needs. If they have an individualized education plan. If you're somebody who depends on the school for nutritional meals, there's checklists in place for you, because we want you to objectively try to assess your emotions and your feelings in a way for your personalized household to see what's right for you. I can't make the decision for you.

Your pediatrician can't make the decision for you, but we can help guide you at least and help you determine what's really the safest route for you and your child at this point. Now, one thing I want to let families know as well is that schools are not driving community transmission. So school-based transmission does not drive community-based transmission. And this is something that the AAP has laid out in multiple ways, but community transmission can drive school transmission. So what that means is from what we've seen, that if there's an outbreak at school, that doesn't mean that it's going to create a wildfire outbreak in the community.

That's typically not what we're seeing actually, but we're seeing the opposite where there's a lot of maybe a high surge in the community and perhaps a parent has it, or is an asymptomatic carrier and their child goes to school. And then that drives school transmission. So it's something that's reassuring that even if we open up our schools, that's why we don't see cases spike upward. And that's why pediatricians are really in favor of opening up schools, but doing it in a safe manner. Again, remember the top big five that I mentioned.

So let's talk about MIS-C. Typically, it develops about four to six weeks after the initial COVID infection. Of course there's been reports where you can actually have it acutely at the time that you are infected with COVID. But typically majority of the cases, and from what we've seen when it first started in the UK and from what we've seen here in the US, that it is a more of a delayed, hyper-immune response by the body. So for example, you guys have seen the surges in COVID cases around Thanksgiving, Christmas, New Years and now we're seeing a rise in MIS-C, because it's a delayed response.

So, typically it will happen a few weeks after the initial onset, almost all the children, 99% of them have either had a COVID PCR test or antibodies, or the 1% who's been exposed to somebody who has, so maybe somebody in their household has had COVID. Now I want to assure families that as scary as this disease sound, it's pretty rare. So as of January, I believe eighth, we have a little over 1000 cases and 26 deaths. So that's a fraction of a fraction of a fraction of the, probably a little over 2 million cases in children that we know about. Again, we know that there's probably an underestimate, actually where children are likely way more than 2 million in case counts, but children are just less likely to be tested early on in the pandemic. And again, they may be asymptomatic when they do have the infection.

So I want to assure parents that as scary as the syndrome sounds, and MIS-C, if anybody doesn't know is Multi Inflammatory Syndrome in children, it is pretty rare. Now, what are the things that you should be looking for? So fever, mucocutaneous involvement. So what that means is involvement of basically the mucus membrane. So their lips may be chapped. They might have conjunctivitis or redness of their eyes. You might also see lymphadenopathy so their lymph nodes might be swollen. In this syndrome we also see a lot of GI involvements with severe stomach pain, a lot of neurologic involvement as well, possibly. And cardiovascular involvement is one of the scarier aspects of it. So that's why being aware, hypervigilant so that you can get your child to the pediatrician's office, or if your pediatrician can triage you appropriately over the phone and get you to the hospital where they need to be is so important.

Overall, again, these children do well, but it is a scary moment for families. And we understand that. So that's what I wanted to go over, what are the symptoms that you can look for? So we talked about fever, we talked about lymphadenopathy, but we also talked about just feeling really crummy, fatigued, GI symptoms. And again, if you have any concern that your child's energy levels or something may not be the way they used to be, or maybe they have had a moment where they're feeling faint or week-ish, then you should definitely call 911, or go to the hospital because we want to make sure we're not catching cardiovascular symptoms as well. Now, again, treatment for this is actually pretty well standardized. At some point, now we are doing something that we call IVIG or intravenous immunoglobulin. We're also combating like the hyper inflammation that we're seeing. So we use a lot of rheumatologic medications, the children do sometimes need to be in the ICU, oftentimes, but overall again, they do very well.

All right, guys, I know that wasn't all of the questions that you have. I'm sure that doesn't even really touch the tip of the iceberg, but I hope you're able to cover some important data, but please remember that more data is unrolling weekly, monthly. I mean, the next thing that I'm sort of looking at the horizon for is, more data, at least from MIS-C cases. Because as I mentioned, cases are surging a little bit more of that as a delayed response to the surges we saw of COVID around the holidays. I'm also looking at the vaccine trials. So likely hopefully some data by early summer. And again, I think vaccines are going to be our way out of this, especially with the variants. You know, that's really the only way I think that we can stop transmission and really halt it before this virus continues to mutate, mutate and mutate. I hope that helps? Make sure you tune in next Monday. New videos will be on Monday. If this video was helpful, please give it a thumbs up and subscribe below.