Trust Pediatricians
A Dose of Optimism from a Pediatrician
First, I’d like to thank Dr. McBride for inviting me to write a guest issue of her newsletter. I have found her to be a refreshing voice of reason throughout the pandemic. Dr. McBride approaches medicine in a balanced, thoughtful and evidence-based way. So needless to say, this is truly an honor!
My name is Dr. Jessica Hochman, and I am a practicing pediatrician just outside Los Angeles. I have worked continuously throughout the pandemic—in person—and have cared for many pediatric patients with COVID-19. I truly love what I do, and I greatly value the relationships I have formed with families in my practice. I am also a mother to three public elementary schoolers, ages 5, 8 and 10.
Last December, my husband, our three children, and I all got COVID-19 despite our best efforts to contain the risk. Thankfully, we recovered with relative ease. I describe this to highlight how the coronavirus—and the pending vaccine approval in the 5-11 year old age group—has been a source of many conversations in both my professional and personal life.
As a pediatrician, I have noticed two common and somewhat contradictory themes of concern amongst parents.
“I am worried that my child will get COVID-19.”
“I have concerns about my child getting the covid vaccine.”
Some families worry about both simultaneously. Fortunately I can provide reassurance and good news regarding both of these concerns.
First, with respect to the virus itself, age is one of the strongest predictors of disease outcome, and thankfully children do very well. In fact, many health sources suggest the vast majority of children who test positive for coronavirus have either mild symptoms or are asymptomatic. While many children have tested positive for COVID-19, the chances of a child being hospitalized for COVID-19 after a positive test are less than 1%. In my own experience, I am grateful to report I have treated well over two hundred positive pediatric cases, none of which has resulted in hospitalization.
Another reassuring data point from the CDC: for the week of Oct 9th 2021, the hospitalization rate for the 5 to 11 year old population is 0.6 per 100,000 children. To put that in perspective, in a football stadium with a capacity of 100,000 seats, we would have to fill the stadium more than one and a half times to find 1 child hospitalized with COVID-19.
It is also helpful to keep in mind that the majority of children hospitalized are well enough to return home in under a week from hospital admission. Of course, children with comorbid conditions are at increased risk of hospitalization. A study that evaluated data from patients 18 years and younger, found that 62.9% of children hospitalized with COVID had an underlying condition, such as diabetes Type 1, neurologic disease, and particularly obesity. This is not meant to dismiss children with underlying conditions, but rather to respect the interplay between viruses and children’s overall health. Understanding (and helping mitigate) the risk factors for particularly bad outcomes from any disease is part of my job as a doctor.
It is also helpful to remember that while yes, there is a possibility of harm from COVID-19 to children, the risks from being infected are similar to other respiratory viruses that we coexist with.
For example, each year in the United States approximately 58,000 children are hospitalized for Respiratory Syncytial Virus (RSV), a common respiratory tract illness that infects almost all children by age two years. By comparison with COVID-19, children, especially those under 5 years of age, are much more likely to be hospitalized for RSV. I do not trivialize viruses or take them lightly, however, it is important to put the risk of harm to children into perspective.
As for concerns about getting our children vaccinated, I believe the available COVID-19 vaccinations are a scientific miracle. Recently, many parents are asking me about the data on the vaccine for children, particularly now that the FDA will likely soon extend that authorization to children ages 5-11.
The safety data thus far look excellent! BioNTech/Pfizer studied 2,268 children: two-thirds of whom received one-third of the usual dose (10 mcg as opposed to 30 mcg for adults), while the remaining third received a placebo (no vaccine). Also good news: the study demonstrated that the children who received the vaccine mounted a robust immune response to the SARS-CoV-2 virus. The vaccine was found to be well tolerated, with only minor side effects, such as a few days of flu-like symptoms. There were no reports of myocarditis.
Some parents have appropriately asked follow-up questions. Are 2,268 children in one study enough to provide reassurance? And what about side effects that may develop down the road? While the study demonstrated that children’s immune systems responded to the vaccine, what about data to demonstrate reductions in complications from COVID-19 such as hospitalizations, or long term side effects?
Despite the small sample size and short study follow up, there is reason to be reassured. First, the fact that millions of older children, ages 12-18, have now been vaccinated with the Pfizer vaccine, at the full adult dose, is a good predictor of safety. Furthermore, for previous childhood vaccines, side effects have almost uniformly been detected within the first 6-8 weeks after administration. In other words, while I am eager to see larger data sets covering longer time periods for children, we have every reason to be optimistic.
So where does this leave us? First, and perhaps most importantly, we can be grateful that, for most healthy children, the risks of COVID-19 are small.
Second, for parents who are concerned about their child’s risk, we have every reason to believe the vaccine is safe. For most healthy children, the benefits of this vaccine will likely prove to be modest, for the simple reason that severe complications in healthy children are rare. In my view, the greatest potential for the vaccine will likely be for children with comorbid conditions. Vaccinating children may also play a public health role to help limit the spread to the more vulnerable in our population. And in general, even if the risks of major complications are low, I do believe it is better to avoid the illness entirely, so widespread vaccination in children may ultimately prove worthwhile.
While I am grateful to be able to offer COVID-19 vaccine to my pediatric patients, I remain sympathetic to parents who still have questions. A September 2021 Kaiser Family Foundation survey revealed that while one-third of parents are ready to vaccinate their children, ages 5-11, there are an additional one-third of parents that would like to “wait and see.” Many parents have expressed concern that they do not feel comfortable discussing their questions for fear of being viewed as “anti vaxx” or “not believing in science.”
To me, it is important to hold space for families who still have questions. Science is not absolute; it evolves as we learn and study, and, in order to make improvements, it is imperative to keep an open mind. For example, we are learning that the second dose of the mRNA vaccine for older boys (16-30 years of age) has been linked to very rare cases of myocarditis. While vaccine-induced myocarditis is almost always effectively treatable, I believe it is important to continue reviewing longitudinal data. For example, dose adjustments may lower the risks. Or perhaps we will discover that for adolescent males, a single mRNA vaccine dose may be optimal. Similarly, among previously infected children, we are already learning that a single booster dose may be sufficient.
For all these reasons, I believe that we parents have every reason to be optimistic. Cases are declining; overall, children fare very well, and for those who want them, vaccines are on the horizon.
I hope this has been helpful! For more pediatric updates, you can find me on:
Instagram: @askdrjessica
YouTube: Ask Dr Jessica
And anywhere you listen to Podcasts: Ask Dr Jessica