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Recognize the Risk of COVID-19 in Pregnancy and Childhood but Realize the Other Dangers Too

COVID-19 is the worst pandemic since the since the influenza pandemic of 1918-1920, so you should protect yourself and your children from its causative virus, SARS-CoV2, correct? You know it is correct, if you have been reading The Pulse for the past two years. You should be vaccinated against SARS-CoV2, particularly if you are pregnant, because pregnancy in itself is a factor putting you at risk of developing a severe, life-threatening case of COVID-19, if you become infected. Almost a year ago, we discussed how, compared with your non-pregnant, female friends of similar age, if you develop COVID-19, pregnancy makes you more likely to be admitted to the ICU, and more likely to be put on invasive ventilation, meaning on a mechanical ventilator with a tube down the throat, although such treatment is becoming increasingly less common as treatments given to people with mild and moderate COVID-19 are becoming more effective. In that same discussion, we also discussed risks for the fetus; COVID-19 in the mother makes preterm birth three times more likely, thus increasing the likelihood that the newborn will suffer medical problems. So while being a young to middle age woman with no major health conditions makes you very unlikely to die from COVID-19, pregnancy is considered a COVID-19 risk factor, making it all the more important for you to get vaccinated, as soon as vaccination is available to you. Also last year, we discussed how, despite being a disease mostly in older people and in those with various health conditions, such as obesity and heart failure, COVID-19 can strike children, including those without risk factors. We noted that, usually, when children do develop symptoms, they are mild, cold-like symptoms. However, we also said that the percentage of infected children who develop severe disease is not zero. This led us to discuss a rare complication, that can occur subsequent to initial recovery from COVID-19, called multi-system inflammatory syndrome in children (MISC, or MIS-C) and that it is possible for children to lose their lives from this viral disease. Then, as the vaccines became available, first for adults, then for teens and adolescents, then for school-age children, how very important it was, and still is, to get your children vaccinated.

All that we mentioned above is very important, but it is just as important to keep perspective and make sure not to go overboard by worrying to much and being overprotective to the point that it is counterproductive. This relates especially to the children below the age of 5 years, for whom there is not yet a vaccine. It looks as if it will take a while, because the vaccine that Pfizer and BioNTech are testing clinically in children ages 6 months to just under 5 years needs some tweaking, or at least the scheduling looks as if it needs tweaking. Dosed at 3 micrograms, which is just one tenth of the adult dosage, the immunity, the protection against infection of this baby dose vaccine has been disappointing following a series of two doses, spaced one month apart, like the two dose primary series of the pediatric dose vaccine (the one for children ages 5-11 years) and of the adult dose vaccine (ages 12 and up). So researchers are evaluating a 3-dose primary series for the micro-dose toddler jab. This might take a while, so many parents are keeping their children home all the time, and some parents are even anxious about the lack of an approved third shot (‘booster’) for their 5-11 year-old children.

Do not become anxious about this. Although, as we have discussed, the incidence of severe-COVID-19 in children is not zero, it is still very low compared with middle age and especially elderly adults. Do the best that you can to protect your children from getting infected. Get them vaccinated if they are 5 years old or older and understand that the two-dose series is exquisitely effective in protecting against severe COVID-19 disease.

Paul Offit, MD, Professor of Pediatrics and Director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who has been a member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention (CDC), is a world renown vaccine researcher. He co-invented the vaccine that protects children against rotavirus. One cannot have better vaccine credentials than Offit has, and yet Offit himself has stated that young people without health risk factors do not need that third shot; in their case, it is correct to call it a ‘booster’. It will bump up your level of antibodies that can neutralize the virus and thus provide you extra protection for a few months that can make the different between getting  mild COVID-19 or no symptoms at all, if you are exposed to the omicron variant, but Offit means that young, healthy people (generally below the age of 50) have adequate protection against severe disease, and the need to be hospitalized, provided that they have no risk factors. Keep in mind that, as we discussed, pregnancy is a risk factor, so if you are pregnant, or planning pregnancy, you have a good reason to get that third jab. As for your children, for those at least 12 years of age, the third shot is available if you want it. My kids both got that third shot, so they currently have some extra protection, but they’d have very good protection anyway with the two jab series alone.

Though COVID-19 has killed children, keep the numbers in mind when you balance risks. Data collected by the CDC over the course of the pandemic up to November, 2021 show that COVID-19 rose up and came to overtake cerebrovascular diseases (blood vessel problems in the brain), which was the number nine cause of death in children ages 5-11 years during 2019. 5-11 years is the age range that can be vaccinated with the pediatric dose of the Pfizer-BioNTech vaccine and from October 3, 2020 through October 2, 2021, COVID-19 killed 66 children in the United States, according to that CDC report. This is a good reason to get your children vaccinated, but also be aware what things continued to kill more children of that age group during the pandemic. In killing 66 children, COVID-19 tied in eighth place with suicide for causes of death for that age group (5-11), but lagged behind the seven other causes of death, namely: accidents, cancer, congenital malformations and chromosomal abnormalities, homicide (murder), heart disease, chronic lower respiratory disease (such as asthma), and influenza and pneumonia. Looking at the top cause of death, accidents, that killed almost 15 times more children as COVID-19 did. As for death during pregnancy, it turns out that the number one cause is murder. So clearly, as a society, alongside fighting against COVID-19 with effective measures, such as vaccination, we also have a lot of other work to do.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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