Stats, Vaccine for Children and During Pregnancy, Boosters & Treatments: A COVID-19 Town Hall

Stats, Vaccine for Children and During Pregnancy, Boosters & Treatments: A COVID-19 Town Hall

Content derived from “Situation Update: COVID Town Hall,” a virtual town hall with
Dr. Mike Hori of Valley Medical Center and Dr. Michael Myint of MultiCare, on October 19, 2021.

COVID-19 Stats as of October 2021

  • More than 241 million people in the world have had a validated or verified COVID-19 infection, resulting in nearly 5 million deaths across the world.
  • This number is likely much higher, as it only reflects verified cases, and does not include the numbers in many developing countries that do not have the same testing capability as the United States.
  • Across the planet, 6.6 billion doses of the COVID-19 vaccine have been administered.
  • The delta variant is more than twice as contagious as the original strain of COVID-19 and represents more than 99% of the cases in the United States.
  • As long as cases develop, the virus will continue to evolve. Any one human infected with COVID-19 has one trillion replications of the virus in their body, and every one of those replications has a chance of mutating and making the virus more contagious and more resistant to immunity.
  • In September 2021, COVID-19 was the number two cause of death in Washington state, just behind heart disease. During the peak in January 2021, it was the leading cause of death in Washington state.
  • Vaccinated individuals are nine times less likely to get COVID-19, 48 times less likely to be hospitalized from COVID-19, and 69 times less likely to die from COVID-19.
  • Roughly 175,000 children in the United States have experienced the death of a primary caregiver as a result of COVID-19, and 22,000 children have experienced the death of a secondary caregiver. Children in racial ethnic minority groups have been disproportionately affected.

Why are vaccines important?

  1. It reduces your risk of getting really sick and reduces the severity of your symptoms. A study recently published in California surveyed people who’d gotten COVID-19 several months after they’d recovered, and they asked if they had any lingering problems from the disease. About 1/3 of the people survey reported one or two of their symptoms remained two or more months after having the disease, including severe fatigue, loss of taste and smell, shortness of breath, nagging cough, jackhammer headaches, and chronic muscle and joint pains. As we get farther out with this epidemic, people continue to get sick for longer and longer periods of time.
  2. You spread the disease less if you don’t have it. Not only does vaccination make you less likely to get COVID-19 and spread it to others, but it also makes you 50% less likely to spread it even if you do get COVID-19. Unvaccinated individuals with COVID-19 are often contagious for as long as a week, whereas vaccinated individuals are often only contagious for about three days. This is important because being able to stop the spread of this disease will bring us out of this epidemic.

How can we trust that the vaccine is safe when it felt so rushed?
These vaccinations were created using MRNA technology. This technology has been actively studied in vaccinations for at least a decade in other diseases like rabies, Ebola and influenza. During that time, it has been tested on multiple occasions, and been shown to be safe and effective in those studies. One of the downsides to this technology is that it’s very expensive in comparison to other available technologies.

When it became clear that the COVID-19 pandemic was a worldwide crisis, the Trump administration put a lot of money toward the creation of a vaccine and initiated operation Warp Speed. This was a bipartisan development program that immediately began to look at five different leading technologies for vaccines to decide which of them was the most safe and effective way to get a vaccine to the public. In addition to this research, they began simultaneously creating a manufacturing process for making the vaccines, so as soon as they had a safe vaccine, they could immediately begin making it. In a non-pandemic world, the manufacturing process alone can take several years. 

So, though the process moved more quickly than we would normally see, it is not because important safety measures were skipped, it is because the normal financial barriers were removed. The Food and Drug administration still required these vaccines to go through all the normal steps for approval, but because the need for vaccinations was urgent, a lot of money was put into their development by both public and private partnerships and government sectors.

Another important thing to consider, when looking at individual fears about potential vaccine side effects, is that this has been the most well-studied vaccine rollout in the history of vaccines. This means we have more information, right from the start, than we’ve had on any other vaccine in history and that it why we hear about those rare side effects. This is the first time we’ve ever had an app on our phone that is constantly asking us how we’re doing and what we’re experiencing after receiving a vaccine. Also, if side effects are going to occur as a result of the vaccine, most of the time, they occur early on in the vaccine timeline. It’s been over a year and half since the initial study group received the vaccine and other than what we already know, no other adverse events have been identified in those individuals, in the most rigorous vaccine follow-up we’ve ever had.

It is remarkable that we’ve been able to identify such rare side effects from these vaccines because it allows us to make well-informed risk benefit analysis, and from a scientific medical perspective, when we look at everything we’ve learned, the benefits of getting vaccinated still clearly outweigh the risk.

If I’ve had COVID-19 and developed my own natural antibodies, why do I need to get vaccinated?
Though natural immunity from infection is very good, it only protects you from the strain of COVID-19 you contracted. As we know, this virus continues to grow and evolve, creating new and more-contagious strains that natural immunity will not protect you from. An example of this, from an infectious epidemiology perspective, is the annual flu vaccine. The flu continues to mutate and change from year to year, so we continue to develop the vaccine to include the subsequent strains we see. Not only does the vaccination help to protect you from those additional strains, but combining vaccination antibodies and antibodies from natural immunity, provides you the highest possible level of protection from getting COVID-19 and will help to neutralize this virus.

What should I know about vaccine boosters and why are they recommended?
The first important thing to understand is the difference between a booster vaccine and a third dose. Vaccine boosters are given to individuals who are fully vaccinated, but at a higher risk of getting COVID because of things like work exposure or immunocompromising factors. Third doses are given to individuals who do not receive the same level of immunity as the average population with the normal two-doses and require a third dose to be considered fully protected.

Currently, there are three reasons someone may get a third COVID-19 vaccine.

  1. Individuals who are vaccinated but receive less immunity from it than the average population. This is often those that have underlying medical conditions that cause immunosuppression, like those who have had an organ transplant or those who have cancer and may be receiving things like chemotherapy. Studies have shown that in this population, individuals do better and have higher immunity, if they receive a third vaccination. These individuals require a third dose for full immunization.
  2. Individuals who had a good immune response from the vaccine, but their antibodies are waning with time. This booster is important because it helps to reduce infection and reducing infection and spread in our communities is how we get out of this pandemic.
  3. Individuals who regularly work with sick people. Though these individuals are part of the second category, their risk of contracting and spreading the disease is a lot higher than the average population. It is vital that this population of individuals maintains high immunity and remains protected so they can continue to protect our sicker communities with more-debilitated immune systems.

What should people know about vaccines and children, the concerns about in-person classes, kids that are too young to receive the vaccine, etc.
There is no question that in-person classes are a greater benefit to both children and parents. When children have an opportunity to be around other people and children, they can focus better on their education, and there is a lot more structure in their day. It’s better for parents because they’re able to go out and pursue their occupations, which leads to less financial struggle.

From a large study done in Utah in the spring of 2020 we learned that it is absolutely possible for children to return to school safely with the right precautions in place. Schools that participated in this study were able to safely open their doors to students when they focused on mask wearing, thorough hand washing, and keeping children at least three feet apart as much as possible. Everything we’ve been doing to socially mitigate this disease are the exact same things that allow children to return to school safely. This study also included tracking children who had returned to school after getting a COVID-19 infection at home. They studied how significantly these students spread the infection throughout the school and found, with the appropriate preventive measures, the spread of disease from these students was less than 1%.

What should people know about the possible treatments being discussed, like the use of ivermectin or the new pill, created by the Merck?
There is a lot of information available, and everyone must make their own risk-benefit analysis for themselves and their families. We make decisions like this every day. Should I eat a donut, knowing it contributes to heart disease? How can I add exercise to my life to minimize my risk of stroke and heart attack? More than minimizing my risks, how can I eliminate them altogether?

Looking at the information available for COVID-19, we focus on traditional medical literature. Over the last 18 months, more than 2,000 articles have been published on COVID-19. When considering these studies, it’s important to remember that some of the therapies used for other significant diseases may work well in a test tube, or in mice, but don’t always translate into effectiveness in humans. Ivermectin is a great example of that. Though it shows promise in some studies, it has not shown enough benefit across the board to be able to say it is safe and effective to use in people. It’s important the FDA ensures vaccines and treatments go through all the appropriate steps and processes for safe approval, and ivermectin has not been able to pass those approvals and safety measures yet.

Molnupiravir, a possible medication to treat COVID-19, has been submitted to the FDA for review by Merck. Like ivermectin, this treatment has shown some efficacy in small studies, but the FDA is going through the traditional process of evaluating their evidence, the safety and effectiveness of the treatment, and whether this is a viable and valuable solution for our communities. Until that evaluation is complete, we don’t know enough to be able to say this medication is safe enough to begin widespread distribution.

COVID-19 vaccine and pregnancy—is it safe and will it affect fertility?
Getting vaccinated is important for pregnant people for several reasons. Pregnant people are five to six times more likely to be admitted to the hospital as a result of COVID-19 symptoms, 10 to 14 times more likely to be put on a mechanical ventilator, and 10 to 15 times more likely to die, than non-pregnant people of the same age, so pregnant people are at a higher risk of more significant effect from this disease. This is because our bodies have to turn down our normal level of immunity in order to have a baby.

We also know that the babies have worse outcomes when unvaccinated pregnant people get COVID-19. In those instances, infants tend to have a lower birth weight, they’re two times more likely to be born premature, and two times more likely to be stillborn. Of the studies done on vaccinations in pregnant individuals, there have been no major evidence of complication. Additionally, the CDC is specifically tracking the symptoms and responses of pregnant individuals who have been vaccinated and again, they have found no serious adverse effects specific to pregnancy, associated with vaccinations. After birth, infants are shown to have high levels of COVID-19 antibodies when you’re pregnant and vaccinated, protecting them for as long as six months after they’re born.

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