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In the Bubble with Andy Slavitt: Our Shot
All Podcasts The Omicron Episode for Parents (with Paul Offit)

The Omicron Episode for Parents (with Paul Offit)

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Description

Being a parent is never easy, but has it ever felt as hard as it does right now? Andy talks all things kids and Omicron with pediatrician and vaccinologist Paul Offit. They cover the latest on keeping kids safe at school, how Omicron is affecting young people, and what kind of masks are best for children. Plus, an update on when we can expect a vaccine for kids younger than five.

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Transcript

SPEAKERS

Paul Offit, Andy Slavitt

Andy Slavitt  00:12

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. The frustration of a parent, I can hear the stress and the emotion and the struggle for a solution. And you can hear her trying to be optimistic. The practicality right here that you just heard in the opening is a woman who you can tell is being squeezed by your school district, by teachers, by the schools, probably by other parents, everyone looking for good solutions to their own situation when there really are none at all. And that’s before taking into account their own health, their own jobs thrown ability to do what they need to do for their families. The pandemic hurts a lot of people from a lot of angles, business owners, sports lovers, health care workers, college students, chronically ill. But there’s a certain thing when it comes to parenting and being a parent, that hurts especially differently. If you’re a parent. Or if you think you will be a parent, or you have a parent, it’s all the same. The equation is all the same. Most of us want better for our kids than we had for ourselves. And we feel the pain of our children twice as hard. Because we feel about for them. And then I think we feel our inadequacy as a provider of what we can or can’t do for them.

Andy Slavitt  03:05

That feeling that we get when life is a little unfair to us is frustration. But when our kids can’t get what they need or sick or in harm’s way, or don’t make a team, that frustration moves to seething anger. I know I lose sight of all rationality in those situations. And we’ve seen this all week. In the last few weeks, as school started. Parents really have no good place to go. They’re damned if they do they’re damned if they don’t. They send the kids to school, their kids can get sick, their kids can make them sick, they don’t send their kids to school, they miss out education, they can’t do their jobs. They’re just fundamentally no two ways about it. And the picture isn’t clear. And depending on the age group, kids under five still can’t be vaccinated. So to begin 2022, we’re doing a roundup of all the angles you need to see to manage through Omicron. Monday’s episode was on testing. If you want to hear about testing, you should listen to that episode. I think it’s everything you’ll need to know. Next week, we’ll be looking at indoor air quality and masks. Something that I think all of us can control. And we’re going to be going deep into hospitals. And I think I’ve selected the best possible guests for each of those episodes. Today, it’s the parents’ guide. What do parents need to know? We’re gonna cover vaccinations, school policies, boosters, masks, how the virus affects kids physically, when they get a mild case with those that are hospitalized when they get Omicron. You will not leave the show necessarily with great answers. But a lot more information and a lot more perspective hopefully. No matter how hard I press, I can’t get you the perfect answers that you deserve. Because I can’t find any.

Andy Slavitt 

Paul Offit who is the director of Vaccine Education Center, and […] pediatrics at Children’s Hospital Philadelphia is considered by many to be the best children’s hospital in the country. He’s on the FDA committee that advises the FDA on vaccines is my guest today. And he is incredibly thoughtful. So he goes through all the issues I just laid out, factually, and expresses his opinions based on what he knows. And what I like to try to do with guests, is get them to express not just their facts, but their opinions. What would he do as a pediatrician, what does he recommend as a pediatrician, what’d he do with his own kids? Now, those are his opinions. I want to say this upfront, because as he expresses them, you may have different reactions to them, his attitude towards risk is not necessarily the same as yours. It’s just his. So it is okay if you feel more cautious than him based on what you hear, some of his answers I think are or lean towards the pragmatic, based on what he’s seen. And if you’re more cautious, that’s fine. If you’re less cautious, that’s fine, too. So long as in my view, you’re thinking about all kids and families, not just your own.

Andy Slavitt  06:38

So your own attitude towards your own families, your business, your own attitude towards other families and their kids is everybody’s business. So no matter the age of your kids, I hope you listen to me get something out of it. One other thing, for those of you I’ve been thinking about, especially who can be prone to a little depression, or anxiety from time to time. And let’s face it, who among us isn’t on that list, sometimes. I know how hard this can be. That two years of this can seem bleak that you can feel powerless. And I don’t want to offer you something that comes across as either overly simple. And I hope what I’m about to say doesn’t ring hollow comes from a good place. But do something for yourself today. Something small, but something affirming that there still is joy. All the joy and positive energy in the world that there once was there is I just went outside and picked a lemon today to refresh juice with later today made me happy. Just smiled outside picking a lemon. Now I live in California. So smiling because it’s warm in the winter, maybe you don’t, you got to find your own joy. And you know, what also helps is just to check in on others. Because no matter how we’re feeling there’s others feel the same way or worse. So that’s it, haven’t as good a start to the day as you can. Even if it’s a tough one, we can get through it. And there will be better ones I promise, in my opinion very soon. Finally, just get informed. Get informed, it’ll make you feel better. And that’s what we’ll do now with Paul Offit.

Andy Slavitt  08:34

Boy, what’s it like to be a parent these days? I mean, so tricky and so interesting, Paul, What should parents know is they think about sending their kids back to school to keep their kids safe, their own risk of getting infected with Omicron.

Paul Offit 

Right. Well, if you want to keep your child safe, they should never leave the house, assuming they’re going to leave the house, then the goal is to try and mitigate risk, because you’re not going..

Andy Slavitt 

I got to keep myself safe, I couldn’t have kept myself safe if my kids never left the house.

Paul Offit

So you know, you have to depend on those around you, which is true for adults as well, you’re depending on those around you. So if I sent my child if my children were elementary school age, and let’s say they were between 5 and 12, I know I can vaccinate my child and I would vaccinate my child. But I also know that only about 15% of children between 5 and 11 are vaccinated. So therefore, in all likelihood, most of the children in that class are not vaccinated. So then the only really other option you have is in terms of the other major weapon that you have is to mask. So you would like to think that everybody in that classroom would be masked, that they would do everything they could to social distance to the degree that you can that all the teachers are vaccinated and all the bus drivers are vaccinated, that that’s all true. But again, that’s not going to be likely true either. So you are to some extent taking a risk. I do think it what’s frustrating about this to me is that everybody agrees that kids should go back to school. Everybody agrees that it’s important for socialization that it certainly in Philadelphia in many ways, it’s the only decent meal they get during the day. Certainly child abuse is often picked up in school, distance learning to me, frankly, is a contradiction in terms. You know, we need to get kids in school. We all agree with that. So why don’t we all agree that since this is such a precious thing, that we should do everything we can to make sure that happens for really the next four to six weeks, I do think that we’re going to see a passing of Omicron over the next four to six weeks. And so really, it’s not an infinite amount of time that you have to do this. It’s discrete amount of time.

Andy Slavitt  10:35

So a school board member, a new school board member in Minnetonka, Minnesota, called me this week. He claims he listens to the show, so we’ll find out whether he does if he recognizes this, it was sort of telling me, you know, he ran on a public health platform. He’s telling me that, you know, it’s still very controversial. He believes of the vocal minority, and the school about in the classroom about wearing a mask. So maybe we start there, then he asked me for my advice, but I was thinking you would probably be able to give him better advice. If you were setting policy for a school unmask wearing, what would you say is the right policy when to wear it? And then I think parents probably also deserve some answer for when would they be able to stop having their kids wear masks? Because it’s certainly unpleasant or suboptimal.

Paul Offit 

Right. So I think a three-ply surgical mask, one of those rectangular masks is a value. And it’s not that hard to wear. I think cloth masks although they offer some protection in terms of transmitting or receiving those small droplets, it’s that’s not the optimum. And I think things like the K, N95 masks are just too uncomfortable. So I think for a young child wearing a surgical mask is not that big of a deal. And so that would be my recommendation. And I think that they should wear when they’re inside, when they’re inside among a group of people, when they’re outside. I don’t think they need to wear the mask anymore. But just at least for the next four to six weeks, while community spread is going to be outrageous, I think we need to be able to wear at least wear a mask and obviously preferably be vaccinated.

Andy Slavitt  12:14

And so when community spread goes down, do you think it’s reasonable to say that at that point in time, that mask wearing should also drop? Is it in the sort of 10 per 100,000 cases? Would you go that far? Or is there something intermediate?

Paul Offit

No, I think if you look at last winter, when we have really didn’t have much in the way of vaccines, I mean, they just come out in mid-December. And we didn’t have that much in the way population immunity from natural infection, you saw a pretty dramatic decline in the incidence of this disease by mid-February and that was then, now we have at least 80% population immunity from natural infection or vaccination or both. And so I think we’re gonna see a dramatic decline. Now the Omicron although we keep saying it’s, it’s more contagious, really, it’s not contagious. It’s the contagious index that the CDC used to call R-naught is really not that different than Delta. The difference is that it’s slightly off target from vaccine induced immunity in terms of protection against mild illness. That’s the difference. You’re still protected against serious illness if you’ve been vaccinated. But even if you’ve been vaccinated, you’re not that well protected against mild illness. So that’s what we’re seeing an avalanche of mild illness. So there’s a lot of cases, but not an increased or a proportionate amount of serious cases. So you’ll see like 150,000 cases, 200,000 cases, but say 700 deaths, which is not a proportional increase as it would be would have been for Delta. So that’s so it’s really, it’s immune evasiveness, that’s the problem. There was a study in Denmark that just frankly proved that. So I would say that once that starts to decline, yes, I think you can feel more comfort, realizing you’re still taking a risk. But then also, if your child’s vaccinated, the risk of serious disease is really really small. So that’s good. And even if your child’s not vaccinated, this does appear to be a less virulent virus. I mean, what we’re seeing in our hospital is a lot of upper respiratory tract infections, croup, you know, bronchiolitis, we’re not really seeing the pneumonia that we saw, say with Delta.

Andy Slavitt  14:15

So this Omicron has a trick. Its trick is to fool the vaccines at least for a couple of days until the T-cells can respond. It’s trick is not that it spreads faster. But it does spread faster because it just got more targets, is I think what you’re saying.

Paul Offit 

Yeah, and because, that’s right, because even if you’re vaccinated, even fully vaccinated, I would argue fully vaccinated even boosted you know, a couple months ago. You’re going to you still be at risk of mild illness.

Andy Slavitt

So, as kids go to school, many of whom are not vaccinated, you’ve got masks. I also want to talk about the role of tests and the role of testing. You know, what’s your view as to you know, if a kid tests positive, and they’re pulled out, but they don’t have symptoms with a negative test, can they be admitted back to school, and then over time, can tests begin to substitute for masks. If you’re able to have a regimen where you’re able to test kids, frequently.

Paul Offit

The testing is a mess, to say the least, here’s what I would say. I actually liked the CDC recommendations from about a week and a half ago, when they said, if you’re infected, if you’re if you’re symptomatically, infected, quarantine for five days, if by the end of five days you are asymptomatic, it truly asymptomatic, which is the catch, because you have to trust the people who are truly asymptomatic, then you can go back into the real world and wear a mask for five days. I think that makes the most sense. Because the thing with testing is, is what tests do you use. I mean, if you’re using a PCR, for example, you can be PCR positive for weeks when you’re not really shedding a critical amount of infectious virus. Similarly, with the antigen test, the antigen test may pick you up as being positive, but you’re not necessarily shedding an amount of virus that is critical. I mean, the old days when you know, when I trained in infectious diseases, like in 1905, I mean, the way that we did testing then was, you know, you would swab the nose or swab of the throat, and then you would take it to the virology lab, and they would grow that virus up in cell culture. I mean, so you were really looking at by definition, that infectious virus, you’re not doing that with these tests, you’re looking at the case of the antigen test at a protein, you know, specifically the nuclear protein of the virus, and you can detect the protein, but the critical question is, are you contagious there, and the only way to know that is to correlate that test with context studies, which no one’s going to do and hasn’t done and isn’t going to do. So it puts a lot of value on the test. When you see this happening now, in the National Basketball Association, the National Hockey League, you know, we’re you know, players who are completely asymptomatic, have a positive test and are going to sit until that test is negative, which is probably an extremely conservative thing to do is my guess.

Andy Slavitt 

So if anything, though, you think there’d be more likely to be false and false positives here, where your positive is defined as is infectious and not able to come back. So it’s a few did get a negative test, it would tell even a negative antigen test, it sounds like you’re saying, Paul, though, that would certainly be a good indicator that you don’t have anything infectious.

Paul Offit 

Right. And then again, it’s sort of what you test. I mean, so with the Omicron, it seems like saliva may be as good if not better than the sort of nasal pharyngeal test. And so I’ve been it’s always a sampling issue. And it’s hard to get tests, you know, the, I have a lot of friends who have difficulty getting testing, if you’re living in the United Kingdom, or you’re living in Canada, you’re going to have a much easier time getting testing that my sister who lives in London and has for 30 years visit this weekend she brought with her just the whole packet of antigen detection kits that her National Health Service had given to her for free.

Andy Slavitt  18:17

Be careful your house, your house might get robbed. Okay, parents love their kids, we’re worried about our kids, we don’t want to kids get COVID. But to certain extent, you know, as you say, that’s a gamble that has to be taken for you to send your kids to school isn’t a gamble. And, you know, I think many parents can take solace in the fact that if their kids do get COVID-19, the vast vast majority are going to be either asymptomatic or very, very mild cases, for granted that but the parent never likes to say this. But the parent themselves also doesn’t want to get sick. They don’t want to keep bringing it home from school. And in our little study of our friend group, all of whom have kids at college, or in high school, some younger, every single one of our friends that’s gotten COVID It’s gotten it from their little rascal, they their college kid came home from school. In some cases, quite the case. The parents have gotten it quite seriously. We have a friend who was hospitalized for three weeks in quite bad shape. She’s recovering now she’s out of the hospital, but she got it from her son who came home from college. So what about parents and how do parents manage their home environment in these situation where kids are seeing this very, very contagious environment.

Paul Offit

Well, so obviously, I’m going to show them all these parents are vaccinated because that’s the best thing they can do to prevent serious illness. And I think it’s again for the next four to six weeks when kids are going to school and no doubt are going to be interacting with children who are unvaccinated and possibly children who you’re infected, no doubt, it’s reasonable to be concerned about that if you have vaccinated yourself, and arguably, if you’re to me, if you’re in a high risk category, like, you know, you’re over 65, or you, you know, you have a high risk medical condition, the biggest being obesity, frankly, that you know that you could then when your child comes home, you know, you can say, You know what, while I’m inside, I think I’m going to wear a mask with this here, I’ve sent this person out who’s like a biological terrorist, and is going to pick up a virus and then bring it back to me, you know, you can wear a mask indoors, then for that good. Now you vaccinate yourself, and you’re masking indoors for at least the next four to six weeks, when this will, I think likely come down, but that’s a reasonable choice.

Andy Slavitt  20:39

And did you test too or no, you, again, the antigen test for this purpose,

Paul Offit

I guess I’m not, I just I think when you’re asymptomatic, truly, if you’re infected, and then you’re asymptomatic, truly asymptomatic, I think that the amount of virus that you shed is less I mean, but can I’m not saying you can’t shed asymptomatically, you can’t be contagious, obviously, you can. That’s the heart of this particular virus, which is it is a lot of asymptomatic transmission. But again, I think it’s certainly in a vaccinated person, it’s much less than if someone who’s not vaccinated, who was sick, and then out now is asymptomatic, I do think it’s much, much less virus. And again, we’re masked for five days after that.

Andy Slavitt 

You know, some of this is just causing people to consider their thinking, which had been for many people, I really want to do everything I can to avoid getting COVID in the household, too. You hear a lot of people now saying, well, I probably can avoid it. You know, we’ve had days recently where 1% of the population by estimates have had COVID. If your account for the number of people that don’t have reported positive tests and do some of that math, that’s a lot. And it’s still growing. So do people need to just adjust their thinking if they well, it’s mild. I might get it, but I’ll very likely, you know, live it’ll just be  some unpleasantness is that the reality is that what we’re down to?

Paul Offit  22:01

It’s like trying to prevent the common cold. I mean, this virus is very commonly transmitted, including among people who are vaccinated, because it is immune evasive for protecting against mild illness. And what that booster dose buys you is probably three months of a lesser risk of mild disease, that that’s what that booster does.

Andy Slavitt 

It’s like trying to prevent the common cold, but with a virus that we know can wreak some havoc, including long COVID.

Paul Offit 

Right. And I think that if you have a mild infection, and you’re vaccinated, the chance that you will have long COVID is much, much, much less. So we don’t really have those data yet, we’ll find those out. But your point about how common this is, right now, at our hospital, where we do Children’s Hospital, Philadelphia, is when children come into the hospital for whatever reason, we test them to see whether or not they have COVID. As of last week, that person whether they’re coming in either with COVID, or for COVID, we test them. And the current rate of positivity of children coming into our hospital for anything is 30%. That’s really high, much higher than it was I mean, you know, a couple months goes closer to 4%. Now it’s 30%. So this is a common virus that’s out there. And it’s really you’re right, it’s really hard to avoid it. The only thing I can say is that it is a less virulent strain, it is, its ability to reproduce itself in the upper respiratory tract is much better than its ability to reproduce itself in the lower respiratory tract and cause pneumonia. So what we see in the hospital is we tend to see more croup and bronchiolitis, which is more upper respiratory tract, you know, involving the larynx and the you know, the windpipe and then the first kind of or second branches of the lungs, and not so much pneumonia, and it’s just generally less virulent. Anyway, if you look at South Africa, or even New York, you know, you’ll see this dramatic increase in cases but not as dramatic of an increase in hospitalizations or deaths, as compared to say, in South Africa. The beta variant and the Delta variant are here with the Alpha variant and the Delta and it is less severe. And so there’s going to be a lot of population immunity because of this virus, which is a good thing.

Andy Slavitt  24:03

So fewer people on assisted oxygen, fewer people needing to support a ventilators when they are hospitalized?

Paul Offit 

Yes, that’s right. So see hospitalizations and but not the concomitant increase in really the really, when we see it severely. Meaning I see you it’s always in the unvaccinated.

Andy Slavitt 

Right. Right. So I do want to push a little bit on this point that you made in passing because we had a guest on last week who we talked about, you know, are the chances of long COVID lesser if you get Omicron. And if you’ve been vaccinated, and what he said was, No, not necessarily because the virus likes these neuro pathways. There’s nothing differential about upper and lower respiratory in terms of getting access to those neuro pathways, and that he doesn’t believe that there’s any evidence that you’re less likely to get long COVID If you have with all […]. Now, he did say with vaccination, that that does help, of course, because it reduces replication, but that Omicron is no less likely based on anything that he’s seen to cause long COVID, than delta was sent to you.   be

Paul Offit 

Well, you know, I understand you’re saying, but it is reassuring to me that if you look at people, for example, who’ve been vaccinated who have mild disease compared to them, who were not vaccinated who have mild disease, those who are vaccinated shed less virus for less long, and if you believe our replication is in any sense, related to longer term symptoms, which I think is likely true, then you’re I think you have a lesser chance of doping. Essentially, I feel better about that statement, if I had a much better understanding of what the pathogenesis or disease process is for long COVID. And I don’t, and it may be more than one thing, you know, it may just be a general overarching term for a lot of things. And I think we’re gonna find that out over time.

Andy Slavitt 

Right. Let’s talk about the issues of vaccines and boosters in younger people. The last time you’re on the show, which by the way, was a fantastic episode, you helped explain to folks why the vaccines themselves were proven to be safe in younger age cohorts. So maybe we can just have to take a step back and just look at where the ball has come and where it’s going in terms of different age cohorts as they’ve stepped down. What we’ve learned about vaccinations, what we’re learning now about adding boosters to vaccinations, as you get into the high teens, the low teens, and then of course, the younger age groups, and then I want to finish certainly want to make sure we cover the six month to five-year-old and what we think is happening there.

Paul Offit  26:40

So, we have to ask ourselves the question, what is the goal of this vaccine if the goal of this vaccine is the goal of every other vaccine, which is to prevent serious illness, then two doses of an mRNA vaccine because those are the most common vaccines used in the US Pfizer, Moderna’s vaccine do that. They do that. I mean, the most recent data, and these were about six studies published in the last few days, answered the question, do you continue to have high frequencies of memory B and T-cells now eight months after you’ve gotten your second dose? And the answer is yes. And that comports with the epidemiological studies that have been both published and presented by the CDC, which is a pretty much par for all ages, that you see this persist consistent protection against severe illness. On the other hand, if that’s not the goal, if the goal is to prevent any symptomatic illness, including mild illness, which is a goal we have for no vaccine, and no other similar vaccine, meaning mucosal vaccine, like rotavirus vaccine, or flu vaccine or whooping cough vaccine, that’s a very high bar, because now you’re trying to keep neutralizing antibodies high for a long period of time, which can only happen with frequent boosting, so you can boost now and I think I’m you know, I’m not opposed to boosting, I just want people to understand what you get from that booster dose, what you get from that booster, that dose is that you will decrease your chance clearly decrease your chance of mild illness for about three to four months. That’s what that booster dose buys you.

Paul Offit  28:05

That’s not a long-term strategy. Now, you could argue, okay, well, that booster dose gets me through winter, and then I’ll worry about it next winter, see where things are then. And so there isn’t a value in the booster dose now and I think that’s fine, but just realize that that’s what binds you. Because, you know, I think that it’s been communicated so confusingly, you know, where people are here, you know, I’m not going to be protected. Unless I get that booster dose. That’s not true. You are protected against serious disease; you’re now better protected against mild illness. That’s the difference. And because I think some people are thinking, you know, oh my god, it has been six months since my butcher now I’m not going to be protected against Omicron. I’m in trouble and you’re really not. So as a long-term healthcare strategy, certainly globally, and even in this country, the notion of frequent boosters every, say, four to six months boosters just cannot work. You’re trying to do something that’s really hard, which is keep neutralizing antibody titers high for a long period of time, just the joke and you’ve probably seen it circulated is the little punch card, you know, we’re like, after your eighth booster, you get a free pizza.

Andy Slavitt 

Right. You know, there’s a you made me think that there’s, I feel, is it a psychological thing where we all in to a certain extent, it’s like PTSD, where we think back in 2020. In COVID, we just felt very deadly and out of control. It’s a now we hear, Oh, my God, I got a breakthrough case. I’ve got COVID When you’re vaccinated, or double vaccinated or triple vaccinated, and it’s just not the same thing. It’s just not the same thing anymore. It’s not the thing that was causing such high fatality rates. It’s just not the thing that was causing so many people to go on assisted oxygen, etc. So, you know, I do think we have this place in our memory where it’s it doesn’t yet feel safe or common to get a mild case and then I think the fact that we rolled out vaccines is your point, we I think we got fixated on this first Pfizer study, which said that 95% of people don’t get symptoms. If we were more judicious at the time, we probably would have said, that’s fine. But that’s not what’s important. Let’s focus on the hospitalization number. Now, the fact that at the time that we also thought vaccines would prevent you from spreading COVID that, you know, that is a big deal. And I think, for all of the things we say, that are great about vaccines, we probably have more credibility when we acknowledge things that that are shortcomings relative to our wish list, and our wish list that vaccines would prevent me from spreading COVID to you. That’s a big deal that we don’t have that kind of protection to the extent that we thought we did. So yes, it does the most important thing, yes, we need to do a reset, and know the vaccines aren’t perfect. But, you know, if you’re trying to get as far as you could, and we’re gonna use the biggest tool you could, there seems to be nothing even close to vaccinating the public and giving them for now two doses of an mRNA vaccine. To drive that.

Paul Offit 

No, you’re right. We were seduced by those Pfizer Moderna studies back a year ago in December when you saw 95% efficacy against mild illness. But remember, those were three months studies, those participants had just recently gotten a second dose. So they had high levels of neutralizing antibodies, there was no way that was going to last, that had to fade. And it did. I think the other mistake that we’ve made is using the term breakthrough to describe a mild illness so that not a breakthrough. That’s what you want. You want to be protected against moderate to severe disease. And these vaccines do that. Imagine if we if we use that for flu, if we did what we do here for flu, you’d see there’s a lot of asymptomatic, mildly symptomatic infection. If we call those breakthroughs and quarantined everybody, I think we drive ourselves crazy.

Andy Slavitt 

Yeah, and I couldn’t agree with you more, I think those first impressions have made it much more challenging. Okay, let’s talk about the vaccine and programmed with kids even before considering boosters. What do we know? How are they working in the different age categories? And how well how much are they being used. And let’s talk about the prospects for continued both boosters, and additional coverage down to younger age groups.

Paul Offit  32:46

Right. So months ago, we had a vaccine available for the 12 to 15 year when the vaccine launched back last December, the vaccines were available for 16 and above. So a few months ago, we had a vaccine that was made available for the 12- to 15-year-old, about 50% of 12-to-15-year old’s are now fully vaccinated. Another roughly 10% or 15% have received one dose but there’s a solid 50% of 12-to-15-year old’s who are not fully vaccinated. And so when in our hospital, I was on service couple weeks ago and that’s what you see, when you see the greater than 12-year-old who’s in our hospital are in the ICU, they are not vaccinated, their parents aren’t vaccinated, the siblings aren’t vaccinated, it’s very frustrating. For the5 to 11-year-old the uptake, it’s what happened in adults is what happened to 12-to-15-year old’s is what happens in the 5- to 11-year-old, there’s initially a big uptake and people who want to get the vaccine, and then you exhaust that group that wanted to get it.

Paul Offit 

So with adults, you know what sort of a greater percentage depending on how old you are, the older adult wanted to get it more than the younger adult for the 12- to 15-year-old big uptake and then it’s faded to about 50% with the 5- to 11-year-old, it’s about 15%. So 85% of five- to 11-year-old children have had it such that their parents chose not to vaccinate them. Very frustrating. So when we see the greater than five-year-old in the hospital invariably not vaccinated. Now in terms of just the member, the dose for the 12-year-old and greater was 30 micrograms. The dose for the Pfizer vaccine, which is the only vaccine available for the less than 16-year-old. The dose for the 5- to 11-year-old was 10 micrograms. So it was a third of the dose. The good news there because you really worry about myocarditis, obviously, for children. And the good news is the CDC just presented the data on about almost 500,000 doses in the 5-to-11-year old’s remember, there’s about 28,000,00, 5-to-11-year old’s, and what they found was no evidence of myocarditis. Yeah, so it’s not like that means that there’s going to be no evidence for it. But there was no evidence for it yet, which is heartening.

Andy Slavitt  34:42

Which I will say you predicted, that’s likely to be the case.

Paul Offit

Well, we knew the greatest incidence is 16-17 year old, there the incidence depending on whether you look at Israel and US could be as high as 1 in 5000, 1 in 7500 for the 12 to 15 year old where they also present a data it looked like goes about 1 in 15,000 but again, You know, a little less, because it looks like the 16 to 17 year old male […] is where you see that now for the five to 11 year old, it looks like it’s even less and may be dramatically less, because you’re also giving a third of the dose. So, that’s good. Now for the 6-month-old to 5-year-old, we’ve obviously hit a wall in terms of the studies because what you found with a 5- to 11-year-old is that when you gave this dose of 10 micrograms, it didn’t matter whether you were […], the immune response was the same, the neutralizing antibody response was the same. That’s not true for the younger child, what you saw for the 6-month-old to sort of 5-year-old is whereas here the dose is three micrograms, so it’s a 10th of the dose that’s given to the older adolescent or adult. And so for like the one-year-old, two-year-old, they had a vigorous immune response, but the three-year-old and four-year-old didn’t have as good of an immune response. So now the company is saying, God, well, we’ll try a third dose. I wonder when we’re going to see those data at the FDA Vaccine Advisory Committee meeting. I would be surprised if we saw it before the middle of the year, but we’ll see.

Paul Offit 

So we’re gonna give little kids three doses, if that even works. That feels really challenging for most parents let alone kids.

Paul Offit  36:11

I mean, for young kids who go to the pediatrician, often the rotavirus vaccine is a three-dose vaccine to two, four and six months of age. So we have a number of vaccines that are given as multidose in young children. So it’s not quite that daunting. But you’re right. I think the more it tells us it, the more difficult it is. I agree.

Andy Slavitt 

I mean, I worry about the kids that don’t have regular pediatricians more than I do the kids that do. I also worry that the way they’re conducting this is, is now that they’re just sort of adding a third shot, because it’s a quickest path to kids who’ve already had a couple. But if it’s not enough, I mean, because they’re still way under, you know, is there a chance that you didn’t have kids have? What would it be, I guess it’d be three doses of nine is that what would be three doses of three?

Paul Offit 

But we’ll see it’s, in theory, this all gets worked out in phase one, the Phase One trials, so called dose ranging trials, that’s where you really work out the dose and dosing interval. They were unpleasantly surprised by what they found here. And, you know, it is obviously all arbitrary. I mean, why do we pick 5 to 11? Why do we pick to 12 to 15. You know, why do we pick six months to four, it’s four plus years of age. I mean, it’s just really arbitrary. And, obviously, your immune system at some level, certainly, between birth and two years of age doesn’t mature. So, you know, it’s, I wish this had been worked out in phase one. But again, All I’m telling you is what I’ve read in the papers on the internet. I mean, it’s a science by press release time. So I haven’t seen any of the original data.

Andy Slavitt 

There is a chance that this deck study comes back in where, I guess, I say, what’s the likelihood that with a third dose, you still don’t have an adequate response?

Paul Offit

Possible. I mean, you know, we need this, we’re just trying to figure this out. mRNA technology is novel, we don’t have any previous history of mRNA vaccines and young children. So we’re learning as we go.

 

Andy Slavitt 

I want to make sure I understand except a little bit confused. So it would be three doses of three micrograms?

Paul Offit  38:01

That’s what I’ve read.

Andy Slavitt

And then 5-to-12-year old’s have, how much 10?

Paul Offit 

The 5- to 11-year-old has 10 micrograms as a two-dose vaccine.

Andy Slavitt 

Two of 10. So 20. And so now we’re talking about these younger cohort with have a total of nine as opposed to a total of 20.

Paul Offit 

Or they’ll go back to the drawing board and realize that they shouldn’t have [..] it up that way that the 3- and 4-year-old gets his particular dose at a particular dosing interval on that 6-month-old, 2-year-old get something different. We’ll see how it plays out.

Andy Slavitt 

Are they parallel processing that?

Paul Offit 

Don’t know.

Andy Slavitt 

Okay, so I think parents with kids under 5 are feeling vulnerable. They’re feeling anxious. Now, again, to your point, that’s gonna represent some parents, a lot of parents will not provide the vaccines to their kids. But for those who will. It’s excruciating right? Now, we would all step back and say better to get it right, better to make sure it’s safe. But I can’t help but wonder if the studies are being conducted in the most efficient way possible, to get to that answer as quickly as possible, as opposed to, you know, we’ve sort of given these kids in the trial two, the quickest way there’s going to be to give them a third rather than go back to the drawing board. So bottom line is, unfortunately, if you’ve got a kid under five, it’s gonna require more patience than you probably feel like.

Paul Offit

No, it’s frustrating. I mean, certainly we have children in our Intensive Care Unit now who are less than five years of age. I mean, if I were the parent of a young child, I would want to do I would see them for what they are, which is a vulnerable group and who can’t be vaccinated. So you want to make sure that you put a moat around them of people who are vaccinated, so that you can do the best you can to protect them until there’s a vaccine.

Andy Slavitt 

So can you give us a sense of perspective, if you would, the incidence rate of for kids under five, Omicron obviously, is something that because it is everywhere. Is something that is more likely to have kids under 5 as they’re playing with other kids. But what’s the likelihood that a kid under five is going to get a case? And what’s the likelihood that it’s going to be symptomatic? If we know it, and then the case the likelihood that it’s going to involve something serious enough to go to the hospital?

Paul Offit  40:20

Well, again, it depends on the behavior of the child in terms of degree they’re exposed. But I think that it’s fair to say that as you get to younger and younger age groups, that the virus, the infection occurs less frequently and less severely. It’s true as you move younger and younger. I think that’s true. What surprised me actually, at the FDA vaccine Advisory Committee, we had when we were talking about vaccinating the 5- to 11-year-old, the CDC presented data doing sort of prevalence studies looking at 5- to 11-year-old children, and found that the zero prevalence was 40%, meaning 40% of 5 to 11 years old, had already been infected, which is to say most of them had asymptomatic infection. So that’s heartening, because I think that’s to some extent, will provide protection, I imagined that we would be surprised that 0-to-5-year old’s, were at some level that there’s a certain potential have already been infected, but we didn’t know about it, because they were asymptomatically infected.

Andy Slavitt 

They’re asymptomatic. And let’s face it, they all have runny noses constantly, from what I remember, our kids are a little over. That’s the way this thing, the sick goes around. So just to sum up, what do you most, what are you most concerned about? And what should we be most focus about when it comes to kids right now?

Paul Offit 

I’m most concerned about the next 4 to 6 weeks, I just think it’s gonna be really hard for us for the next 4 to 6 weeks until we get past this. And I just would plead that people do everything they can during this period of time to keep themselves and their children safe. Because it’s not forever. I really do think we get to mid-February at the latest, we’re going to be looking back on this. I think the thing that’s most frustrating for me, if you look at Israel were you know, the percentage of the population that’s vaccinated now is more than 91%, they average two deaths a day in Israel, which in this country, in terms of this, sort of the size differences would amount to about 70 deaths a day, well, less than what we’re seeing, which is to say, they have provided a blueprint for how you can put this pandemic behind you, which is to vaccinate your population, not shockingly, but we just refuse to do it. You know, we have a solid, you know, a third of this country who just doesn’t want to get vaccinated. And I think I live in Philadelphia, where there’s Dr. Eva Stanford, who is an African American pediatric surgeon at Temple who has created this this consortium of like-minded physicians who go into North Philadelphia and have vaccinated 4000 children.

Paul Offit  42:45

And I think for as much as we talk about mandates, either at the federal level or state level, or at the company level, or even at the restaurant level, I think we’re gonna get as far as we can go on mandates and I think what we need to do is have an army of citizen scientists and activists who go into these communities. So the under vaccinated communities like in this area here, the Amish community or the evangelical Christian community, or the Orthodox Jewish communities would tend to be to some extent under vaccinated I’m speaking to a large ultra-orthodox Jewish group next week about their questions, but that’s where it has to happen. It has to happen locally. I mean, she has been really successful at this. And I think that’s where it has happened, because we are not going to get past this until we vaccinate the unvaccinated, which is why the booster dosing story has been, to me a detour. I mean, we talk endlessly about booster dosing. At our hospital. It’s not because that’s the kids because they haven’t gotten a third dose. It’s because they haven’t gotten any doses. And that’s true in the adult hospital as well.

Andy Slavitt 

Interesting. Very interesting. Yeah, those are really impressive stories that this sort of hyperlocal nature of this is really comes out. I guess the place that I would just take some issue with how those numbers are thought of, maybe ask you to think about this in a slightly different perspective, yes we’ve been frustrated every day. And I know I spent some part of the year personally focused on this problem of unvaccinated, but through another lens. If you look at the adult population 85% or so of adults have had at least a first shot. And close number of heads are second. And you know, it’s your point about boosters if you feel that they’re less important, but they’re, you know, that that’s a big drop off, that’s, you know, down to more like 35% or so. So when we get what I have to say this this that’s after one year, I mean, we’ve only been vaccinated people for a year, and 85%, it’s not a horrible number. When we came into office, the Biden ministration, there was the surveys said that only about 40% of Americans were sure they wanted to get a vaccine. And there were another 30% that were on the fence.

Andy Slavitt  44:52

So it’d be at 85% I think is quite an achievement, I guess there’s anything to be embarrassed about. And it’s only one year. Now, what happened in the meantime, is we had the virus changed to the point where I think if we would have been dealing with the original strain of the virus 85%, might have been a more than sufficient number. But with Delta, and with Omicron, I think it both made the vaccines less effective at transmissibility. But it also made that 85% just seem inadequate. Now, where we have issues in terms of vaccination are actually younger people of the adults, the 18 to 30 group is by far the largest group of people focus on is a conservatives, people focus on people of color, it’s actually much more easy to see if you look at 18 to 30. And, and of course, every ascending age group is more and more vaccinated. And then if you go down from 18, you know, you’ve got the same phenomenon that the less visibly severe the disease is, the less likely people appear to be willing to get vaccinated, down to the point where you’ve got, you know, in kids, groups of 20s, or 30s, etc. So I think we missed the forest from the trees, if we think that our problem in this country is only that we’ve got a lot of people who won’t get vaccinated, I think most people, vast majority of people have gotten on board, at least from an adult perspective.

Paul Offit  46:23

Now, that’s a really good point. And I think one way you could arguably try and convince the young or parents of people who have young children, this virus is going to be around for a while. I mean, the fact is, we still immunized every year in this country, for polio, even though we haven’t had polio in this country, since the you know, the 1970s. We do it because polio still exists in the world do people I think you everybody would agree that this virus is going to be circulating in the world for a while. And if that’s true, then we’re going to need to be protected in all the data today, it suggests that if you’ve gotten say two doses of an mRNA vaccine, you are likely to be protected against severe disease for years, so you’re going to grow up to be an older person, and in which case, you’re still gonna be at risk of this virus as long as it’s circulating. So you’re doing something not just for the short term, but for the long term. And I think people are thinking, you know, this is gonna, we’re gonna be past this in a year or two. And that’s very unlikely. So do something, do it for the long term.

Andy Slavitt 

Yeah, that’s right. I have one final question that just I don’t know, if you’ve had a chance to even observe yet at the hospital, or based on the studies you’ve seen, which is whether or not Omicron, having Omicron provides protection against Delta. Talk about what you’ve seen, what you’ve observed or what you believe, to be true here? Because I feel like that, if we think about 2022, at least, that question will be a fundamental shaper of the year.

Paul Offit

I think in terms of protection against severe disease, yes. Because the immunological components, the epitopes, on the T-helper cell, and cytotoxic T-cell epitopes are for the most part conserved between Omicron and Delta. So I have every reason to believe that you’re gonna be protected against severe disease. I mean, what’s changed is protection against mild disease, that’s where Omicron is somewhat off target. And that’s based on neutralizing antibodies. So no, I think you are protected against severe disease, if you are if you’ve gotten Omicron, and now you’re exposed to Delta and vice versa.

Andy Slavitt 

And do you think that would apply to then, by definition to future variants?

Paul Offit 

I think so. I do. This isn’t flu. And I think people need to realize the reason you get a flu vaccine every year is because even if you’ve been naturally infected the year before, even if you’ve been vaccinated the year before, you’re still at risk of serious illness, that doesn’t appear to be true here, although this virus does mutate. I mean, like influenza, it’s the single stranded RNA virus, it does mutate, it doesn’t mutate nearly to the extent that flu does. And so therefore, you are appearing to be you those immunological components, those epitopes for T-helper cell and cytotoxic T-cells, which are critical, I think, for protection against serious illness are relatively conserved. So that’s good. And so therefore, you know, that if you’ve gotten the vaccine get to dose of vaccine that’s going to protect you against serious disease for a while. So yet another sales pitch for getting the vaccine.

Andy Slavitt 

Getting vaccinated. But also, for people who’ve gotten Omicron. If that’s indeed true that there’ll be protected against severe disease even if they are not fully vaccinated. Because let’s face it, we’re going to have regions of the country where we’re just not going to have the same vaccination levels. So we’re gonna have in other regions of the country that’s historically been true. It’s not just true with COVID-19. But it’s true that, you know, go back to smallpox and other things that you know, that Alabama and other there’s other states not to pick on them, but I think they would probably in their state statistics, their public health directors announced this. Do they have difficulty with that? But if we do have Omicron, which is going to have been everywhere, that prevent severe illness, that would be a good thing. Because, you know, I don’t think just because people aren’t vaccinated that they deserve to get illness. Everybody should be protected.

Paul Offit  50:01

You know, […]. No one should suffer. I mean that suffering is that it’s not like a punishment for making a bad choice. And it’s no one shouldn’t be punished that.

Andy Slavitt 

And then people who have been vaccinated can’t get regular medical care because the hospitals can overflow. So it’s good for everybody if indeed that’s the case, we’ll Paul, did I miss anything? Is there anything else you want? Kids or parents to hear?

Paul Offit 

I think we covered the earth. That was good. Thank you.

Andy Slavitt 

You’re awesome. You’re wonderful. Your gifts to families. I know people are gonna get a lot out of out of this episode. So thank you.

Paul Offit

Okay, thank you, take care have a good new year.

Andy Slavitt

Okay, parents, non-parents, kids, grandparents, hope that was helpful to you. Let me tell you the episodes we have coming up because I think they’re gonna be good. The first one, coming next Monday is with two very awesome, dynamic people. We’re going to be talking about indoor air quality and the quality of masks, and how you can protect yourself indoors and outdoors. In your indoor space is Rich Corsi from UC Davis, who is the master of all things, indoor air quality, and one of the best guests we’ve ever had on this show is along with Aaron Collins, who goes by the mask nerd, and we’re going to be talking real detailed stuff about the quality of masks the kind of masks, how to get your airspace, healthy air particle interchange and how all that works with Omicron. Then Wednesday, David Kessler, who runs warp speed for the Biden administration will be on and you’re gonna hear about what’s missing. Why are we not getting the stuff we’re not getting? When are we gonna get it? What are the plans to build it, to develop it? Kessler is a very smart, remarkable guy. And then the following Monday, we’re gonna go inside the hospital to look at the situation here where we have hospitals that are as full as they have ever been during this pandemic. And we’re gonna go to the state right now that has the highest COVID incidence rate in Rhode Island. And Megan Ranney is going to take us inside her hospital a lot of shift and we’re gonna get to hear what that’s like. Hope you enjoy the rest of your week. And I really will look forward to talking to you thank you so much for listening.

CREDITS

Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev and Veronica Rodriguez. Jessica Cordova Kramer and Stephanie Wittels Wachs are the executive producers of the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, please tell your friends and please stay safe, share some joy and we will definitely get through this together.

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