Covid-19, Still a Threat: Masks, Moderna, and Kids

An Ethnic Media Services briefing, April 29, held a roundtable discussion to address three major topics:

• The removal of mask mandates on public transportation. Are we making more vulnerable already-vulnerable populations? Who is being left behind?
• Moderna’s new bivalent vaccine, and its potential to protect against variants. Do we need a new and better vaccine, given the large number of symptomatic infections in people who are vaccinated and boosted? Are what we previously called “breakthrough infections” the new normal?
• Long-term Covid in people infected with Omicron.

Experts – Dr Eric Feigl-Ding, Co-Founder and Board Member of the World Health Network, and Chief of COVID Task Force at the New England Complex Systems Institute; Dr Ben Neuman, Professor of Biology and Chief Virologist of the Global Health Research Complex, Texas A&M University; Dr Manisha Newaskar, Pediatric Pulmonologist, Stanford Children’s Health; Dr William Schaffner, Professor of Preventive Medicine in the Department of Health Policy and Professor of Medicine in the Division of Infectious Diseases, Vanderbilt University School of Medicine – shared their opinions on the three topics.

Starting out with opinion on the announcement made by Moderna, April 28, who is seeking approval of its vaccine for five and under, an issue that has long plagued parents, the first speaker was Dr Newaskar.

“Though the data still needs full review, but my understanding is that the under-five age group was submitted, April 28, it takes a few weeks for the FDA to do full review and we want them to look at the data very closely and make sure that it is safe and efficacious for our little ones. Hopefully by June, maybe we will see some announcements.” said Dr Newaskar.

“We will definitely have to do work as pediatricians to inform the safety and efficacy data to our parents and we have seen that our youngest of the patients are getting sick and hospitalized with COVID, and with the previous data, we have seen that even previously healthy kids can develop complications and multi-system inflammatory syndrome so we have to educate our young families and encourage them to get our young ones vaccinated.

“I am confident with proper education our families will be able to vaccinate their little ones,” said Dr Newaskar.

“Data Moderna had submitted previously for the older kids, 5 to 12, and the teenagers, and then they resubmitted updated information recently, particularly addressing the question of myocarditis, so this is definitely on top of everyone’s mind, and something I would be looking at closely,” said Dr Newaskar.

“The risk of myocarditis appears to be lower as we go down the age range so although we haven’t seen the data we certainly hope that that will continue to be. The two vaccines are both mRNA vaccines and so we would anticipate that they both work in a very similar fashion,” said Dr Schaffner.

“We want to have solid information about effectiveness and about safety and so there will be some, what we call, bridging information. We have a lot of information now about older middle-aged and younger adults and older children so I think the body of data will be somewhat smaller as we move into these younger children because we’ve had so much experience with these vaccines.

“Previously, both companies had to work very carefully on the dose they wanted to make sure for these tiny children that the dose was correct, didn’t want to give too much, didn’t want to give too little, so they did dose ranging studies initially.

“They have data both from the laboratory and from the field regarding the immunogenicity and the effectiveness of these vaccines, and then for the group that’s been studied, obviously the other side of the coin is safety.

“We give these vaccines to healthy children who don’t have COVID and we want to make sure that when we communicate to parents, we have very clearly in mind that these are vaccines that are safe comparable to the vaccines that we give in pediatric practice every day,” said Dr Schaffner.

“We’re using a very different criteria for approving kids vaccines and adults because adults vaccines were approved using data of infection from mid to late 2020 and that was mostly the Wuhan strain, and the Wuhan strain and very other, very similar early strains which we know that respond very well to the Wuhan 1.0 version spike protein than which all of our current vaccines are based.

“We’re inherently doing injustice to our kids because it’s not like today we would rescind all these previous vaccine authorization approvals even though it’s now Omicron that’s the dominant string, but for the same reason, the efficacy against Omicron today is much lower but we don’t rescind it for adults, we should use the same criteria.

“The efficacy may be lower today in these studies, but it is probably comparable to what adult efficacies currently are with two shots and therefore if it’s comparable to current adult efficacy against omicron current prevailing strength, we should therefore approve it for kids because it is the fair thing to do,” said Dr Feigl-Ding.

“Schools may have a role to play in getting the vaccine out there, so in terms of death per year, meningitis, bacterial meningitis, is one of the things that schools would normally require vaccination against. That does about 500 deaths per year which are preventable for the most part. COVID-19 is around 350 deaths in the same age group in roughly the span of a year, so it is roughly the same size problem and it’s a reasonable solution to have this be one of the vaccines that are part of what makes school work, and how we handle it. I’m not a public health person but just in terms of the magnitude of the problem, I think that would be a reasonable solution,” said Dr Neuman.

“We’ve done a good job in holding the virus down with our past actions but looking at our current actions we are not doing much that would slow or stop the virus and we are already seeing a very large outbreak of BA.2 in Puerto Rico and a medium-sized outbreak on the east coast centered around New York. It’s a matter of time, if we do nothing before this becomes a larger problem again, and at some point yes it seems like this should no longer be a surprise to us that it’s just like leaving a fire burning and saying well it’s only this big, this big a fire is something I can live with and you forget viruses and fires grow and viruses unlike fires change constantly and usually in a way that makes them a little more difficult.

“People that are talking about vaccine efficacy in the childhood vaccine and saying it’s not as good and Dr Feigl-Ding’s point about it being against a different strain is very correct but at the same time this is something we’ve done to ourselves. If you’re on a construction site and they hand you a hard hat, and say, put it on so things don’t fall on your head, and then you don’t and something does fall on your head, who really is responsible?

“Unfortunately, the case is that we’re all collectively at risk, so yes, this is a situation that is not tackled very well by a series of individual judgments and actions and can probably only be tackled by working together and decisions like this one undermine our ability to work together or at least the will to do that and so that worries,” said Dr Neuman.

“We are really endangering a lot of our kids. Last year, when people were touting Omicron is mild, Omicron is mild, they failed to point out that the same study in South Africa that Omicron is milder, not that much milder, but slightly milder, was only in adults, they, in the same study, found that it was 20 percent more severe in children.

“We’ve really neglected our children and in terms of protecting children it also involves vaccinating adults and adults taking precaution but right now we’ve thrown precaution through the wind just like with all the mask lifting and other mitigation requirements. Even if you’re boosted, you may have 90-95 percent protection against hospitalization and death but your protection against an infection is only about 45 percent after 10 weeks of waning of the booster and probably even more than that beyond 10 weeks, and the problem with that is it’s pretend you’re like a four-lane highway bridge your bridge is not going to collapse you’re not going to die but with 45 percent you know symptomatic transmission efficacy and probably even lower for asymptomatic you basically only close about two lanes of a four-lane highway and furthermore people adults now are going out to gatherings parties, bars, restaurants, nightclubs, even more than before when they were precautious so now you’re also increasing the doses and exposure frequencies and likelihood of transmitting.

“Who gets, who is most vulnerable? – The kids. Even if you’re a group of 10 adults who are fully vaccinated and boosted, even if no one is seated at a certain table is going to die, someone has children at home immunocompromised, or family members at home who could succumb and have a severe outcome and let’s not forget long COVID.

“Long COVID is potentially 20-30 percent of unvaccinated and five to ten percent of vaccinated will still suffer long COVID and those are huge numbers given the size of the Omicron waves we’ve seen so far. We’ve neglected our children and other vulnerable people.

“My recommendation would be to continue masking in public transportation and places. Let’s take the precautions we can,” said Dr Feigl-Ding.

The main take of the briefing was unanimous. All the doctors have advised boosters, precautions, and masks to continue for all age groups, irrespective of what anyone or even CDC states. They think that is the only way to deal with the problem of COVID. Parents should consider vaccinating their kids based on availability of vaccines with utmost priority and be vigilant about when each age group is approved for the vaccine and boosters.