Wake County 'Ask the Doc' on kids and COVID-19
Wake County invites parents to join an ongoing "Ask the Doc" live-streaming series for a Q&A on kids and COVID-19.
Yeah. Okay. Alright. Everybody. Welcome to the Wake County asked the doc series. We are, my name is dr Michelle Burn. Well, Wilson and I will be moderating a lively and very educational session on covid 19 vaccination and our Children. All right. So before we get started, I just want to explain that the purpose of tonight's session is to provide an open forum for the weight community and for beyond our community to get your questions answered about the latest and greatest information about covid the covid vaccine and vaccination in our Children uh in our kid population. Um we want to Make sure that we are discussing the newest information that we have about what we expect to be upcoming information about vaccinating our 5 to 11 year olds. Given the upcoming planned meeting of the of the F. D. A. What we know so far is that nationwide Children now account for 25%. That's one in four new cases of COVID-19. And the highly contagious delta variant has sent more Children into hospitals and intensive care units in the past few weeks than at any other time in this pandemic. We know that hospitalizations are overall still lower in among Children. Excuse me. But um compared to adults, but those hospitalizations are rising rapidly all across the southeast According to the North Carolina Department of Health and Human Services for the first time in this pandemic, Children now make up a large number of new cases of COVID-19 in North Carolina. And in Wake County, specifically Children under the age of 18 have accounted for 18% of new cases in the past seven days. All right. Uh, in Wake County, 8% of coronavirus vaccinations are among those 12 to 17. As we know, the Pfizer vaccine is approved for those 12 and up. Um, and those vaccinations make up 8% of the population, 12% of people vaccinated in north Carolina just this past week where Children within that 12 to 17 age group. So upcoming is the FDA advisory committee meeting that will be convening on october 26 to discuss data presented from recent trial of covid 19 vaccination in Children. And the recommendation for emergency use authorization for the vaccine in Children ages 5 to 11 Included in the trial were over 2200 participants who were 5-11 years of age and used a two dose regimen of the vaccine that was administered 21 days apart. This trial used a 10 microgram Pfizer does smaller than the 30 microgram dose that has been used for those who are 12 and older and we'll be getting into this more with our illustrious panel that I'll be introducing in just a moment. But the end, the bottom line is that in participants 5 to 11, 8 of 11 years of age, the vaccine was found to be safe, well tolerated and demonstrated a strong immune response uh, to infection. The Children who got the vaccine produced a strong, uh, not only strong immune response, but their levels were comparable to the levels of antibodies seen in earlier trials of participants that were older age 16-25. All right, so we're going to go into ground rules for this discussion. All right. We are going to have a great informative time, but we do want to make sure that everyone participating in the chat room is respectful of other participants in both your actions and your words. Remember that we are all learning together. So please don't hesitate to be curious and send questions and comments to us through the chat. We want everyone to enjoy themselves and feel safe and we will take appropriate measures to ensure our collective well being. All right, So let me go into introducing our fantastic panel. Um I personally know many of you because of the wonderful work that you've been doing in our community. First up is Doctor Jamila fletcher, who is a native of Raleigh north Carolina. She is a board certified pediatrician who works as a private a partner excuse me in her private practice at Raleigh Children and adolescents and adolescents medicine. In addition to her clinical duty, she also teaches third year unc medical students as an adjunct assistant professor and she was recently inducted into the Academy of Educators. Congratulations for that Dr fleischer. She is also an active member in her church community at baptist Rove church and she is a board member for Big Brothers. Big Sisters of the Triangle and has been actively involved in vaccinating, uh, in our Wake County community, Can you say a little bit more about yourself? Dr fletcher, Thank you so much. Doctor Bin wan Wilson. It's a pleasure to be here. And I'm thankful to the Wake County team for putting on these town halls since february. I know that we've been giving information to combat misinformation and you mentioned that I grew up here in Wake County. So this is personal. I'm what you call a hometown girl. I went to public schools here, carol middle school in low high school. And so this is my home and I also want to say that I'm a mom. I know there's a lot of parents who are logging on. I got the same email you did for Wake County public schools. I know there are lots of parents out there and you're eager to get information. So just know I do have that perspective. So I'm invested as a pediatrician. I've got an eight year old who's in this current cohort. Um, and so I think it's important for you to know that not only do I preach what vaccine vaccine safety and efficacy, but I also practice what I preach. Um, we'll get into it, but my eight year old was enrolled and he was one of the 2200 that you mentioned in the phase three trial for the 5 to 11 year olds and he is not, um blinded. So I cannot say with certainty whether he got the vaccine or not. But I'd be happy to answer any questions about that. Um I would also say as a private pediatrician, my role in this pandemic has been to test quarantine, give advice for return to sports, return to school. Um We are currently as a practice vaccinating our adolescent population. Um So I can answer questions about that. Um We also care and refer unfortunate um long haulers, people who may have had some myocardial tous or cardiac symptoms um as well as dealing as a private practice with safety for our staff. Um So there's a lot of questions that I can try to answer related to that as well. Thank you for having me. Absolutely, thank you for being here. Dr fletcher. Uh Next up is doctor if you couldn't collude. She's an assistant professor of pediatrics in the division of pediatric infectious diseases at Duke University Hospital and she's also the medical director for pediatric infection prevention and hospital epidemiology. Her ongoing efforts in mitigating community spread of of Covid 19 has culminated in a medical expert role on the inaugural Durham recovery and renewal task force which is for focused on comprehensively working with state public health officials, local health systems and local business and community leaders. So welcome to our uh session here Dr Kalu. We are really looking forward to learning a little bit more about you if you wouldn't mind sharing. Thank you. Dr Bernard Wilson. Thanks everyone for joining us tonight. My role initially focused on preventing infections within the hospital. But Covid allowed a lot of us to pivot and I've worked in communities both with vaccine efforts, just education efforts in general and in particular we've sort of worked one on 1 with schools Through the ACC Science collaborative to just help us get back on our feet. Especially in 2020 when we didn't know much about what was going on. Since then there's been a ton of people just over the last year or so and a lot more data. But I feel like as we're heading into the authorization for vaccinations and kids, we now have enough information that we can make educated decision. So I'm happy to be here. Happy to answer questions about managing Covid M. I. S. C. Both within the hospital and in clinic. And of course we'll refer to some of my colleagues on the call about some of the day to day things we have to deal with me getting vaccines and arms and asking questions around vaccinations. Thank you so much. We look forward to learning a lot from you. Uh Next up is a frequent uh participants in these town halls uh Dr Nicole Matsanga, She is the Wake County Governments Associate Medical Director and Epidemiology Program director. She has been on the front lines of preventing COVID-19 spread leading testing and recently vaccinations for the largest county in our state. She is a graduate of indiana University School of Medicine. And before joining Wake County Human Services, Dr Mashchenko was an epidemiologist for the current county public health services department in Bakersfield California. Welcome back dr Matsanga, Would you mind sharing a little bit more information about what your role has been at the Wake County Department of Health? Absolutely, thank you and good evening everyone. Um I am excited to be here tonight to really answer questions um like other Panelist on our group today I am a mother and I have a six year old and a three year old. So this is something that is very near and dear um to me as well as the work that I've been doing. I've been working with Um our team here in Wake County um since March of 2020 and have continued to um continue to be present in seeing what is happening in our communities and going through these different phases of testing and when vaccine is available for each eligible group. Um so tonight I look forward to answering your questions and look forward to continuing to to support our community. Thank you so much. Doctor Matsanga. All right. And finally we have dr Colin or I'm going to introduce you before introducing our doctors who are in the chat room, eagerly waiting an opportunity answer questions. Uh dr Colin or is a general pediatrician and an assistant professor of pediatrics at the university of north Carolina at Chapel Hill dr or obtained his medical medical degree from Columbia University. And after completing his clinical training, he he moved to north Carolina to complete a research fellowship at U. N. C. As well. His research focuses on health disparities among Children and diversity of the pediatric workforce. Welcome doctor or and can you please share a little bit more about your experience uh working within this um our community to combat Covid 19. Yes. Good evening everyone. Thank you for the invitation. Um an opportunity to be here and thank you to all of our viewers who are taking time uh their busy schedules to join us and talk about this really important topic. So you can think about how we can best care and support our community. Um This topic is very near and dear to very near and dear to my heart. Um I have a young child who is not eligible for the covid immunization and every day when we send him to um take care in the back of my mind, I'm always wondering is this today he comes home with a with an illness or is that you are I do to another common pediatric viral infection versus Covid. And how will this progress? So I'm really from a personal standpoint, this is a very important topic and I'm so thankful that we have performed to discuss um to discuss these issues um professionally um a big focus of my of my research and my clinical training is thinking about health equity and health disparities. And I think Covid has really highlighted um systems and societal structures that contribute to most focused mostly on health equity and health disparities. And I think it's important for communities to come together to have these conversations and see if we can overcome and address some of the concerns that contribute to vaccine hesitancy. Um all of course on the spirit of doing what we can to achieve health equity and decrease these disparities and morbidity mortality absolutely could not agree with you more uh for those of you in our audience who are joining us for the first time. The format that we use is that we have our panelists answer questions that are coming into us through the chat room, but we also have additional help to make sure that we answer each and one of every one of your questions. Uh And so in the chat room we also have two additional physicians. I'm going to introduce First Doctor Stephanie etienne, Who is a board certified family physician who's been practicing in the Raleigh area for over 16 years uh for over 12 years. She has served as the lead physician for the Wake County Health Department regional center since clinics, she has been a very frequent and and enthusiastic participant in our volunteer efforts through the Wake Med Covid 19 strike team. Uh and she has been participating in numerous uh covid town halls and forums to inform all of our community members, but specifically with targeted outreach outreach to our minority communities. So, um she is not um on camera with us, she's in our chat room ready to answer your questions. So we thank you for your presence, doctor, it's yet. And also we have dr Jacqueline Hicks who is a board certified osteopathic family medicine physician who was raised in Rocky mount north Carolina. She currently practices at Wake Med North Hospital in Raleigh north Carolina. She has also been in uh eager and uh frequent participate er in our vaccination efforts in our educational efforts throughout Wake County and is included as one of our sister circle of black physicians who has been uh leading some of those teams. So thank you very much for your presence as well. Dr Hicks. All right, we are going to get right into the questions that you have and to start us off. Can we have you dr Michelle, can you kind of just give us a summary of where we are in north Carolina Carolina right now with not only covid rates but where we are as a community with vaccination. Absolutely. So just to give a general update where we currently are, we're in a much better place than where we were a couple months ago, but we still have significant amounts of covid within our community. So I think that's important to remember. Um we are seeing downward trends and key metrics that we track things such as percent positivity, which is the number of tests or individuals that are testing positive. Um Our case rates are actually decreasing. Um but I want to keep that, keep in mind that we were at a very high level of spread and a high level of transmission with the delta variant here in our community. And um we are continuing to see those numbers decreased. So we're headed in the right direction. We're not quite there yet, but we're definitely headed in the right direction. Um I will say for vaccine rates um our community has done really well at getting individuals vaccinated fully vaccinated. We have those that are over the age of 12. We have, we're close to almost 80% of those individuals over the age of 12 being fully vaccinated. Um so very excited for for um what the community has been able to do. Um and we're continuing to see increases um week after week with the number of individuals um that are continuing to get vaccinated. So very exciting time to see and where we're going for Um the next eligible group which would be our 5-11 year olds. Absolutely. We are all looking forward to that. Um dr fletcher. You mentioned that your youngest child was is has actually been a participant in the in the covid trial. Can you comment a little bit more about that and tell us about what his experience has been? Because we have lots of parents in the chat who are concerned about side effects from vaccination and uh effectiveness. And so let me, I I'd like to hear your comments on that. Sure. So um when the original study was available, I signed up right away And the way I want everyone to understand how these trials work. So essentially out of the 2200 Children That were enrolled there 90 sites all over the world. Um, he went to duke for his study, half of them for more than half of them get a vaccine and then a lower percentage get a placebo. So basically a saline and it's blinded. So the people who do the study And the parents and the Children, No one knows what you're getting. And that's to try to preserve the integrity and the data because as you know, as a mom you can have a headache one day and it could be because you just played too hard and you didn't drink enough water. So there is an app that we filled out to describe the side effects. After our study visits, there were two Inteections 21 days apart. And then he also had to get some blood drawn for tigers. And I could, I just know because I'm following so closely as a mom be studies, it does look like the dose is 10 micrograms, which is a third of what you adults and parents got if you were vaccinated and when they look at the tigers of the kids who were vaccinated in that trial, it does produce a similar antibody neutralizing antibody response to the big adult dose. So even though it was a small dose for kids who are smaller, that makes sense. They still had a protective antibody response. Which is good because I think the study designers were built brilliant. They knew parents were not going to tolerate high fevers. Um, a key, you know, lots of side effects. So that's part of the phase one trial is to figure out the safety the dosage and then by phase three, they already know the dose. They already know the safety. Now we're just looking at long term side effects And it is very similar. It looks like to the side effects that adults and adolescents experienced with their dosage. So there could be fevers, there could be headache, achiness and fatigue. But thankfully those are self limited and they go away within 48 hours. Thank you so much for that dr fletcher. Um, I'm gonna take a question from Blair, who posted a question in the chat. Blair's question is I'm interested in hearing discussion regarding child to child transmission. Child to adult transmission and the information available regarding covid vaccine vaccinations and its effect on those transmission rates? Um, I'm gonna turf that question um to doctor or um do you have, what do you tell your patients or the your patients parents when you see them in the office with regard to how likely it is that a child can transmit covid to another child, especially because we have schools that are open and two adults in their family, many of whom can potentially be more susceptible to infection. Yeah, that's a really great question. Um, and I think the answer can be, it can be somewhat complicated and dependent on internal factors to the family and also community level considerations. So I think, most importantly, from a community population health level, we do know that the rate of vaccination of the community does impact the type of or the prevalence or the frequency of person to person spread. And then I think once we think about the rates of transmission between a child to a child or a child to an adult, um, there's a there's a few additional factors which need to be taken into consideration. A few of those factors over the age of the child. Um, and how closely they are interacting with their adult caregivers. Um, if a child is a toddler or a preschooler, they might need to have more direct, closer frequent contact with an adult, which increases their risk of potentially transmitting to an adult. Um, and as you indicated, depending on the comorbidities or medical history of an adult could represent a significant exposure. And so I think it's really difficult to say, but I think one thing that we can say concretely is that vaccinations um do help the larger um higher the number of vaccination in the community. The reduction that you will see in the rates of transmission. That's a really great question. Yes. And thank you to Blair for asking that I'm going to pick up Russell's question um Which is presented in the chat. It is if kids are not dying from Covid and I'm going to give this question to Dr Kalu if kids are not dying from Covid why should kids get vaccinated? Thanks. So the importance of vaccination is not just for prevention of death. We've been lucky this past year. We were extremely worried that as kids transmit every virus you all know about case just exchanging viruses month to month. We expected Covid would be the same. What we've seen a distinctly different patterns in Children which is good. We've been able to keep our Children safe by fairly easy to use mitigation measures. I know there's a lot of conversation about masking in the chat but that's one of them and it's worked. However, we've now seen a higher proportion of positive cases occur in Children and we're starting to see more Children hospitalized coming into the hospital and into the I. C. U. With covid vaccinations can help prevent infection in general. It can help prevent spread. We saw some decreasing that prevention with delta and it's certainly prevent kids come into the hospital with the infection. So getting an infection that's very enough that you need to come into the hospital long term. We also know that vaccinations prevent sort of their household spread. So if Children remain unvaccinated and they're the only group that still have not received vaccines and this virus mutates just enough to start to impact those that are unvaccinated. That can become that small group of rapid spread and it can spread it to other, more vulnerable people such as older adults or those with immune systems that are not not very strong. So I think there are two ways to look at this vaccinations can protect the child. So the individual child from having a severe infection. We do see long term covid and also hospitalizations and Children. And also there's the public health, that's the second one public health effort here where it just helps to reduce the rates of covid in the community. Covid will burn out. We've seen that happen with the pics of the spy peaks and the valleys. So we know that it will spike up and then burn out. But we really don't want to have our Children be the only unvaccinated group that are just waiting for the next variance. Thank you so much for that answer. Dr Pollux such important information to have. Um, there's a question you mentioned masking in your answer and there's a question from mel feeling good uh, in the chat and the question is, should masks be worn both inside and outside of the school building dr fletcher? I know this is probably a question that you get quite often from concerned parents, especially those of young Children who are too young to get vaccinated and are worried about kids were turning back to school, but they're also outside on the playground. There are also lots of school school board communities that have been debating the usefulness of masking. What what do you say with regard to masking in general? But also do we have to have our kids wear mask outside, let's say in general, we know that covid is because of wind and natural ventilation is not as easily spread outside. So if a child is able to socially distance outside, which for the most part you can Um then it is relatively safe, I cannot say it is 100% safe. Um, so if you want to decrease the risk masking outside for an unvaccinated child would be safest. Um, and definitely indoors, you know, if you are in a classroom that ventilation is not as great, they're probably unable to social distance in the cafeteria, potentially in the classroom, potentially, so both all Children need to be masked indoors. Yeah, and that this is such a tough, tough issue for parents because there is a question in the chat from, she'll be um, that I'm going to give to doctor or what if there's a pocket of four students sitting together for lunch inside the classroom? What what can we tell? She'll be about transmission from student to student in that circumstance, which we all we all experience every day because our Children are our eating and interacting with each other at school. Yeah, these are all really great questions. And I think the most important thing is to take the steps that we were able to take in order to reduce the risk that um we that we spread covid unintentionally and I think there's a few things that we can do when we are inside. I think practicing social distancing as much as possible and I know depending on the individual layout of a room or a table that may not always be possible, but always doing our best to kind of increase the distance between ourselves and our and our friends and classmates. And I do think that whenever we're not eating or drinking um to the best of everyone's ability, having a mask on. I think this will all be really important steps that we can take as individuals to reduce the risk of transmission of Covid in these settings. Mhm Thank you so much doctor or there is, there is a question in the chat that I'm going to um present to you dr Matsanga, it's from gen Rose and it says we did test for Covid and it came out positive and again, testing came out positive, but school doesn't consider, what if someone gets negative, false results initially but actually is positive. So I'm going to interpret that question as you know, we tested positive, went ahead and got tested again. Um but the school, I'm not sure what the this particular uh person it means by the school doesn't consider that, but there's an underlying concern that if someone is getting a negative test result, that maybe it's false. Uh and that person actually is positive. So let's just kinda just roll that into a general, more general question. I think about um testing results. What to do if you need to isolate, What are the rules about quarantining? Absolutely. So one of the things that is important to do is if you have tested positive for your child has tested positive. It's important that they isolate and isolate me being away from from others. Um really allowing them, if they have tested positive, that is what we call for isolation. Anyone that has been around them or that has been exposed to them. So, those exposures are individuals that we would have, we would say with quarantine, Um there are some different uh kind of rules and kind of nuances to this. But typically if a person needs, if they test positive and they don't have any symptoms, then they would isolate for 10 days from the date that they tested positive. If they do have symptoms, they would isolate for 10 days since the start of those symptoms. Now with that, those individuals that are around them, potentially household contacts. So mom, dad, brother, their sister. Those individuals are what we would consider close contacts. I imagine they were probably playing together, spending time together. Um, and those close contacts would need to quarantine. What's important is that when you're in your household, there's a continuous exposure happening from that positive person and those individuals that are still in that home. So all of the other siblings and family members would quarantine. There are a couple options for quarantining. Um, there seven, Uh, 10 and 14 day options and depending on the ability of that particular person, um, to continue to monitor themselves, continue to mask or even get tested. Um, would determine which option would be best for them. That quarantine period. What's important to know is that it starts after the person who tested positive has completed their isolation period. The single reason that during that isolation period that's 10 days, there's still potentially infectious and potentially shutting that virus and individuals that come into contact with them could potentially pick that up. And so I know we get a lot of questions about why is the quarantine period so long. Why do I have to quarantine longer than, you know, the person or my child that tested positive? It's because that exposure period is through that 10 day period and then the quarantine starts for any of the siblings or family members or or any of the other close contacts. Thank you so much for providing that kind of clarity Because that has definitely been a huge question that people have been asking, is there a nuance to whether or not if that person is a vaccinated uh you know, household member, what what's the quarantine rule in that case? Absolutely. So if individuals are fully vaccinated, so they've completed both doses of their series or received one dose series, then they would not have to quarantine if they do not have symptoms. Now, if they do have symptoms. Absolutely, they would need to quarantine. But it's just it's so important that individuals that have been exposed, even if they're fully vaccinated, that they get tested um because there are sometimes where they might not be symptomatic and might have been exposed um and could test positive. Thank you so much for that. I'm gonna I have a question here that I've been seeing a lot. Um and this is from Kevin. I'm going to give this question, doctor to you Dr Kalu, my daughter is 11 and has already recovered from Covid she has natural acquired immunity. What data do you have to support her getting a vaccine when she's already naturally protected? When we know there are adverse reactions in Children to the vaccine? First of all. How true is that statement that there are adverse reactions in Children to the vaccine. And what's the point of getting vaccinated if she's already had Covid, there's a two part question that we could talk about four hours. Uh The latter question is about safety of vaccinations in Children. We have more data in our 12 to, I'm going to include our 18 year olds, you know, some 18 18 year olds, I'd like to be considered Children, but 12 to 18 year olds because we vaccinated millions of them in the last couple of months amongst those younger or older Children. Um and some of our young adults, we have seen rare adverse side effects. The key one being myocarditis. However, Covid itself causes way more myocarditis than the vaccine. Most of the cases that were vaccine associated with picked up within. So usually more common after the second dose and picked up within a few few days and most of them were mild. However, that's a risk that's worth discussing. It's extremely rare and getting Covid has worse consequences and so risk benefit discussions. Usually lean towards vaccinations In Children. Less than 12, we only have early data. Some of them have been press releases and were often hesitant to make definite statements based on a press release. So both moderna and Pfizer have done a lot of robust clinical trials and Children younger than 12 Pfizer has released some of their data and they're using a lower dose, partially based on how the younger immune system reacts to vaccines and most of the reports have summarized it as the common side effects with the in adults. So so arms fevers, maybe some tiredness but no adverse effects that no major adverse effect. So, coming to the original question, I should point out here. So most infection, we have tons of vaccines to prevent against infections and some people might actually remember the chicken pox parties and going to some people might actually have gone to those and not have gotten vaccinated against chickenpox. So the concept of natural immunity is not new. You can get infected and be protected naturally. However, that protection can wayne similar to vaccines but what we've learned with Covid in particular and this has been based on adult studies and adults. It shows us that Covid changes rapidly, vaccine gives you a broader protection so that if it changes again and we're dealing with Covid gamma next year, which we all hope or not. The vaccine has almost covered the basis for all of the for most of the changes within despite proteins. So should someone child or adult that has had a prior infection, get vaccinated. The current recommendation is yes. Some providers might suggest that you might not need a booster because you've got in your natural booster. So you got infected after you finished your vaccine series or some providers are given one dose. So you got your natural infection and then you you get your your vaccine as a booster to your natural infection and all of that they are all likely safe. But the current guidance from the CDC which in this public setting is what I'm going to repeat is that if you have been infected before you should get a full series of your vaccination to promote broader protection. Thank you so much. Uh you know that that is that is such a huge concern among parents. Um you know and and also that's a point that we oftentimes here as a reason not to get vaccinated. This idea that that you know natural infection causes lifelong immunity or some version of prolonged immunity and we definitely want to um give the true facts about that. So thank you so much for that. Um a doctor or um there's a question in here about about long term covid symptoms. Um why why is vaccination so important when such a small percentage of deaths are seen in Children. Um what information can you give our parents who are who are really concerned about the effects of long term covid and using that to help them make the decision in getting their Children vaccinated. I think these are all really great questions because I think a big factor of this is shared, shared decision making and making sure that people are informed with the proper data to make the best decision for them and their families and I think the big thing is um although thankfully kids to date have been relatively spared from the worst of covid though they are still getting um impacted. And although the death prevalence among Children may not be at the same rate as adults, we do know that Children are getting admitted to the hospital. We do know that kids are not only getting admitted to the hospital but ending up in the ICU and requiring mechanical ventilation with a breathing tube. And although death is not the thankfully not the most frequent outcome for those situations, the idea of having a child end up in that situation, although they recover um that can leave a physical and emotional scar on the child and Children of the family and the child. And if that can be avoided. I think that is a discussion worth having, especially with an intervention such as vaccination which has a very which has a really strong um and impressive safety track record. So I think that's one of the big reasons is that in order to do our best to prevent some of these long term longer term outcomes and short term consequences such as just a child being sick or being having to go to the E. D. If these outcomes can be prevented with a safe and well tolerated intervention. I think that's a really important thing for us to for families to discuss and strongly consider for their for their family and Children. Absolutely thank you. Um there is a question from a parent who has an asthmatic child and as jesus writes that her 10 year old has asthma and allergies. Aziza has not been confident enough to send her child back to school just yet. Uh and wonders will her child be able to get vaccinated? Dr fletcher? Can you answer that question? Because he's a that's a great question. And obviously it depends on the age of your child. So if your child is in this next court at Cohort 5-11, did she say her age Dr. Ben Wilson? Yeah. She said her child is 10. Okay. So yes, your child will be vaccinated if it is FDA approved under emergency use authorization. And asthma is not a contra indication. In fact, I would say if your child's asthma is poorly controlled, then she would be high risk and should be first in line to be vaccinated. And I'll tell you that as a parent of an asthmatic, I wholeheartedly agree with that. Um that their underlying medical conditions certainly made me even more concerned about contracting covid. And so I was very eager and happy to be able to get my teenagers vaccinated. All right. Um let's there's a question in the chat from Brooke uh with regard to masking. Um and this is about what type of mask might be best. Um and so the question is, is the best mass for adults and Children other than an N 95 a three ply cotton or one that incorporates a filter. Um, let's see doctor doctor or do you want to answer that question? Yeah, there's, this is a really great question in terms of the optimal mask for to prevent the transmission of Covid. And I think that the answer worldly is that a two plier in 95 is going to provide the most protection against the transmission of Covid. But I also think that Amy's mask um is probably better than no mask, especially when we think about the spectrum of Children, we say Children, but that's quite a wide range from two up to 19 with various levels of compliance with with the mass. So I think at the end of the day, it's really important to find the mass that works best for a given child in the family of the situation and leads to increased compliance with that. I think that's probably going to be a really important thing to focus on when determining which mask is best for a child. And I think a mask with a, with a child's favorite animal, frozen spiderman, um something to make the mask fun and engaging can happy a really positive motivator for Children. Absolutely. You know, so basically what you're saying is when we go out into the community and we see people wearing their mask on their chin that I in that case I would agree that those masks are just not effective. Right? Alright. Um dr Matsanga uh they are, there's a question here. Um that says, so this is an interesting question from chad uh there is a reason why Children are usually not in study groups, correct? Same with breastfeeding women and pregnant women. How do you know how safe this vaccine is in real Children? Will you provide parents with informed consent? Do you want to tackle that question? Sure, I can take that. Um I think it's important because what we we have been able to gather lots of data um this what we have seen from the beginning and from vaccines being available is that we've seen this go through adult and we've seen it go through each see each age group and we've been able to track and monitor that data and review that and we have found that the vaccine is safe and that it is effective and um we're continuing to see that and continuing to gain that information. We're seeing very minimal side effects from the vaccine. So I think it's important that we are seeing this. I think just recently we've heard the importance of pregnant women getting vaccinated and how important it is um for them to to prevent severe illness and death and them. Um And so it's it's as as the time goes on and we continue to see what's happening and continue to to collect this, what we call real world data. Real world evidence. Um we're seeing the importance of vaccine and how it is actually preventing these um more severe outcomes in both in pregnant women and and Children. Yeah. And you know, that's absolutely true. And as an obstetrician gynecologist myself, I just want to echo what you just said uh which is uh the importance of vaccination in all of our populations. And we know from the studies have been done. This is the most well studied vaccine that we've ever had. Uh and that includes uh for pregnant women as well. Um, and we now know that it is very safe for pregnant women to get vaccinated in any trimester of pregnancy. Um, and the overall question that this that um this person was asking is, you know, that kind of a kind of just, you know, an assumption that Children are and that and pregnant women are not included in studies. And that's actually not true. And it's very important that we continue to include different populations who have, who are, you know, different in age, different in reproductive status, different uh in regard to, you know, underlying medical conditions so that we can test the safety of certain drugs and vaccines etcetera in those populations. So, um, this is actually a vaccine that is being very well studied. It has been very well studied to date in many different populations. And and now we have more data on Children. And the important thing as well is that we know that these trials are ongoing, right? Where there's not a stop point. Um, we're continuing to look. Um and the and our researchers are continuing to evaluate the data. All right. Um There is a question here and I see a couple of questions and I'm going to go back to you dr Kalu about myocardial itis. Um You know this is this is really a hot topic uh concern for parents. And so the question from chad is how many Children have died from covid myocarditis versus myocardial itis caused by vaccine. So I'm just going to interpret that question is you know kind of being a what what's worse here? And you did answer that. But I think because I'm seeing it a couple of times um let's let's revisit that specifically. So the data is being tracked a couple of weeks. Um The C. D. C. Recently just pushed our data looking at kids well focusing on 12 to 17 year old um that have been hospitalized for covid and looked at the vaccination status and they found out that the and we can share the links and people always want to know but you can also just google this and try and find it up If we find out that most of the kids that are hospitalized with covid are more likely to be unvaccinated. There's always the one case is always the one person that vaccinated ends up in the hospital. Yes but for the most part vaccination vaccination seems to be protected against the effects including myocarditis. We've seen covid marched through the human body even in young Children that have no comorbidities. People have been asking a lot about prior history of this maybe having asthma for example developmental delay but even something as simple as obesity or no prior history of receiving any type of medical care for anything can still land a child with covid in the hospital. And so based on that head to head, the risk of myocarditis and the risk of death from covid is much higher with the actual infection as compared to the vaccine. And that's why providers continue to lean towards vaccinations across the board. Thank you so much for further clarifying that point. Uh dr fletcher there's a question here about our upcoming holidays um and Leslie asked the question let's hope that by thanksgiving the younger kids can at least get one vaccine. What are your thoughts about family gatherings? That's an excellent question. And so you know the timing of this. Anyway um The FDA advisory committee is supposed to meet november um sorry this month on the 26th and historically the C. D. C. Then approves the vaccination within 2 to 3 days. So we're looking at the earliest I believe in wake County vaccines to be distributed and are bigger Um settings like the hospitals bigger private practices by November four at the earliest. So if we fast forward let's say you're the lucky one to get it november 4th november 5th and then three weeks later your child gets a second dose. Were put, we're getting very close to the holidays and you still need two weeks to um for your immune system to boost to the point where you're you're protected fully. So I would say be wise. Um if I would avoid large gatherings and I would also avoid anyone who is immunocompromised. So if grandma has multiple myeloma, cancer survivor, you know, I would be very safe in that situation and do a virtual thanksgiving. Um but if all of the adults are vaccinated, no one is high risk. Then a small gathering um with a child who is unvaccinated and mast is safe. Or you could do it outdoors would be another option. And Dr. Fletcher, I'll share that our entire family is vaccinated. We I do have two kids who are above the age of 12, but when we gather together as a family, we have a new born in our family. We have, you know, people that are really vulnerable. We we also test, where's the role for testing uh in for people who have been vaccinated when you're getting together with people who have not been vaccinated because they can't the role for people who are vaccinated really is if you've got any symptoms. So if you um you know have cough, cannot taste or smell your food. Shortness of breath headache body aches, fever, then certainly get tested. If you've not been exposed and you have no symptoms, then the CDC says there's no role in a fully vaccinated person to be tested. Okay that's great information to have. All right. Um There's a question from Courtney in the chat specifically asking about what's the makeup of the kids in the I. C. U. With covid are they immuno compromised? Is what she asked. I would like to take that one dr Kalu your infectious disease. It was just in the icy that just came off service this past week. And I saw all ranges. So we saw a newborn's that were that were exposed to when their mother was pregnant. So um during pregnancy or right at birth they were exposed to covid and developed covid 19 disease ended up in the ICU. It's our teenagers, healthy teenagers athletes that ended up in the I. C. U. And then so sort of in the middle um elementary school age Children that also ended up in the ICU. They did not all have prior comorbidities. Some did but for example the newborn was full term otherwise healthy and would otherwise have gone home except for having covid and associated symptoms. So we're seeing all ages and we're seeing hospitalizations and ICU admissions even without prior history of any severe medical condition. Thank you so much. There are a number of questions in the chat about you know how what the makeup of the Children who are in the hospital what they what they look like an underlying conditions. So thank you for that. Um so, uh there's a question in here, which I find interesting. Um it's from Todd. Do the doctors support vaccine mandates? It's a hot topic, anybody want to answer? I don't know if I'm going to say a hard yes or no on that as a primary care doctor, I would hope that parents would talk to their trusted family physician pediatrician. Be honest and open about your concerns, your hesitations and address them. Um you know, vaccine mandates, you know, they ultimately the goal for vaccine mandates is herd immunity. And so um if we can get to the point where we stop the next variant that is that's the goal. Um and I think each private um school, each private company right now in the adult population is making that risk and benefit calculation and I think in the future if it comes to the point where there is a variant that's affecting Children harder than adults, that is something our public health officials will need to look into. And let's just be clear, we have already vaccines that are required to be in public school. Um as a pediatrician, I counsel about prosthesis and a council about meningitis and that's because those also were deadly diseases that are currently preventable by vaccines. And so um it's not that we're trying to take choice out of parents hands. We really just want to educate and try to combat whatever misinformation it is that could be making you hesitant. Thank you for that. And I mean I'll say that um I definitely agree that there is a role for mandates there are people who work with people in um as health care workers and um in really vulnerable populations and it's important for us to be able to protect each other. Um And certainly there's a there's there are legitimate concerns about our Children in schools. Um And uh so I definitely think that um if it would be preferable for us to be able to arrive at herd immunity because we consider that it's important as a community. And and to your point, there are lots of other vaccines that are mandated in order to be in school. So um anybody else want to add anything to that? I do. I wanted to add you know what I've been hearing and seeing is that when is this gonna end? When are we going to get to a point where covid is over or um It's not to the level that it currently is. And in order for us to get to a better what we call maybe an endemic state where we're covid is it's more normal and maybe it's more seasonal. We don't just yet. But it's important that our population is vaccinated and as dr fletcher mentioned and you as well dr Benjamin Wilson um being able to get to that herd immunity with vaccination will allow us to get back to a more what we would call the endemic state of covid. Thank you so much. Alright. Shanika has a question in the chat. Um And it's a more general question um And it's about what's in the vaccine uh and what are the side effects we I think you all have touched upon different side effects. But uh can would anybody like to just discuss the differences between the M. R. N. A. And the J. And J. Vaccine? I can take a stop at that. So the because we have so much focus on vaccines. The pharmaceutical companies have been quite public with their information around vaccinations which we appreciate it. They don't usually do. This is not to their interest but it pushed that out and you can find the list of content of vaccine content across all of the different vaccines have been authorized or approved particularly in the United States. What's within the vaccine? So M. R. N. A. Messenger RNA. A. It's a piece of genetic material. Yes but it's from the virus and it just it's a list of instructions. It's a list that tells your body make the spike protein. The virus is a circle has spikes all around it. Your body makes the spike protein. And then you generate antibodies. But this list that instruction list is read and destroy. So as soon as it goes in your body sees it it destroys it immediately. It does not embed into your D. N. A. Doesn't stay. That's not how the technology works. Um and you the antibodies you make. So the protection you make that's what typically lasts much longer because this M. RNA. So that instruction is kind of unstable. Remember it's really destroy it needs buffers so within the vaccine there salt sugar. Um and some some specific elements that help it stay stable in sub zero temperatures. So when we saw it it's still effective. All the information about what specifically in the vaccine can be easily found. We can give you a list um And it's fairly similar between Pfizer Moderna. G. N. J. Is slightly different. So it's still that instruction list the M. R. N. A. But he has a messenger that comes along with it which is kind of say ups Fedex and not no bias with either one. But as soon as he gets into you it's still really and destroy anyway. That messenger is called adenovirus. It's an inactivated form of another virus that is pretty common but it's unable to infect us as humans until it gets into your body and does the exact same thing. You're not a protective response. Again we can provide additional data on all of this but most of the content should not trigger any major allergies but because we know what's in them. If you have known allergies to specific content then that might be a contra indication to the vaccine. Thank you so much. And I will just uh also say to reassure parents that um wherever the vaccines are administered, there are safety protocols in place so that if someone does have an unexpected adverse reaction because of some unknown, you know um risk to one of the components in the vaccine. Um There is someone available to administer like an EpiPen on site. Um and there's there are protocols for getting that person care. So uh we just want to make sure that that's clear as well. Um There there is a statement in here that you know, we hear being communicated um a lot in the community and um the statement is vaccinated individuals spread covid. So how will it stop? Um uh let's let's discuss that statement dr misenga because I think it's important to address misinformation. Absolutely. So vaccinated individuals can get covid that is true. Um the vaccines are there to prevent severe illness, hospitalizations and deaths and it does the vaccines do a great job at doing that. Um But what's interesting too is that individuals that are vaccinated, they have less severe Yeah, Cases of COVID 19. And they also are they don't spread the virus as well for as long as individuals that aren't vaccinated. Um it's it is one of those things where it's you don't want to as being unvaccinated, potentially can have a more severe disease lead to hospitalization and potentially death and not to mention all the other individuals that might be exposed if you're unaware um, of your of your status. So it's important to know that even though vaccinated people can Get COVID-19, their levels of the virus actually decrease much quicker and tend to do much better than individuals that are not fully vaccinated. Thank you so much for that. Um, we are as we're starting to head into the last few questions, there is a question in here and I've seen it um, and presented in a couple of different forms about uh impact of the vaccine with regard to menstrual issues and and girls who want to try to get pregnant later on. So from jennifer, the question is, can we address reports about the vaccine causing issues later with girls trying to get pregnant? And have you heard those? Um, and jennifer almond O B G Y N. And I will um tell you that the there are a number of societies that we look towards uh with regard to looking at all the evidence that is out there and really evaluating it with uh from a lens of reproductive health for young girls, older women who um are, you know trying to get pregnant or women who are pregnant. Um, lots of different, lots of different variations. And the society for maternal fetal medicine, which is the organization that specifically looks at risk of different, different things including this vaccine in pregnant women as well as the um, folks who who treat infertility patients have all agreed that the vaccine is safe in both women who are pregnant as well as women who would like to one day be pregnant. Um And so these studies are going to be ongoing. Um But we do know that covid infection really has a bad negative impact on pregnant women. It also the the effects on sperm with regard to people hoping to have Children in the future are being looked at with regard to covid infection itself. Um Whereas we don't see those risks for the vaccine. So certainly I felt very comfortable getting my teenagers vaccinated. Um and I hope to have grandchildren in decades from now. Mm All right. Um Let's see. All right. Lots and lots of questions and I'm seeing that we're going to try to extend our question and answer period until a little bit later, which is great. Um So there's a question in here. Dr or I'm going to give this to you. It's about the weight based or I'm sorry, not the way you based but the lower dosage that's being proposed for kids. How does a 13 year old that weighs £80 take the same dose as a male. Uh male 58 year old that weighs 300 lb. Oh, I see. Okay. So that's a great question. Um And it really speaks to not only the age range that we're looking at, but the concern with even younger kids who obviously would weigh less. Do you want to tackle that question? Mhm. Absolutely. I'll be sure to to begin to address that question, but I would also defer to my colleagues uh to expand after um if I'm unable to adequately address it, but I think would be um an important thing is that um for a lot of medications, once a child reaches a certain asian certain weight, The way the way-based dozing can look very similar to that of an adult, which can sometimes sound very counterintuitive. But there are medications that we prescribe um and general practice and in the hospital where the dose for a 13 year old can look very similar to that. Um for an adult of oh Of a 58 year old. And so I think this important thing to um to keep in mind is that these trials were designed um and administered to Children had a particular dose and that's the dose that we know will give us a clinical outcome that the clinical trial showed us. And that's why we're operating under the the data from the clinical trial, which is one of the best ways to get an idea of the safety efficacy and impact of various drugs. Does anybody want to add anything to that? All right. I think that was definitely uh that question was addressed. Um And so this is this is an interesting question and you know, we're really committed to taking um some of these tougher questions. Um So one of the questions from asked by harmon harmony um is as doctors. Why when someone has covid do not prescribe us medicine instead you let people suffer. I'm going to give that question to you dr Pollux. Um And in your answer if you can also give us information about the role for monoclonal antibodies. Yes we're certainly hopefully in the business of preventing suffering. Um there are some antiviral options have been studied. The data around treatment is a lot of data is fewer than data around vaccinations but you may have heard of remdesivir for example. And um there's a really really new one called Mona mona Carver that has been has been released but it's not actually available in the hospital. Most people that end up in the hospital may receive some type of treatment particularly if they end up in the I. C. U. That is not to say that the treatment will immediately fix what's going on with covid with covid sometimes the damage happens pretty early on. And so we're trying to manage symptoms because the virus may be gone but there's already a lot of damage and that's why they get a lot of support in the I. C. U. There's another um therapeutic option. It's not exactly treatment it's a it is there are different names for them. It's a monoclonal antibody. So it's an engineered antibody that can be given to you as an infusion. So you have to go to a center get an I. V. Place and get an infusion. There's specific recommendations for who requires this and who shoot and you should be able to have easy access to this in your local community. For the most part if someone has a any immuno compromised condition asthma, even obesity. If you get covid 19 you can get this infusion which is not necessarily treatment I think of it as just preventing worse outcomes. And they've shown some early data down to age 12 particularly if you have household exposures in your house. It's a lot of virus that may be spread in that it prevents you from worse name it's not a fail safe. It's not always 100%. But if you can catch it early and prevent you from getting into the hospital it's a lot better because when she gets in the hospital we have fairly limited options to actually treat SARS cov to the virus that causes covid 19. There's a lot more noise to that. Um And I know there will be resources at the end but that's sort of a more general overview about how we approach treating uh Covid 19. Yeah and I think to your point Doctor Kalu you know there there's kind of a misconception out there that there are quote unquote treatments for covid 19. Um What we have our ways to try to help and try to decrease the burden of disease. Um But we don't have there is no cure. Um and certainly the best thing is to prevent getting infection in the first place. Um But also we do want to be aware of some options, including monoclonal antibodies for people who are high risk that can potentially make the difference between getting more severely ill. Um uh If if someone finds that they are infected and certain high risk categories again as an O. B. G. Y. And I'm gonna always stress that pregnancy in and of itself is a high risk category. Um First step is to get vaccinated but certainly If you get COVID-19 and you have either been vaccinated or not but you have an infection, then you immediately qualify for monoclonal antibodies. Of course. Other people who have high risk conditions um need to also make sure that they call their doctor before they start developing symptoms um within 10 days of a positive test to see whether or not they qualify for monoclonal antibodies. So thank you very much for that. Um And I'll also say dr Kalu, you know I what I hear a lot in the community is people are hesitant to put foreign substances into their body and I'm not sure that we're really talking about how um new some of these other medications that we're giving uh to help treat the damage that Covid covid does. Um some of these medications that you know, you end up having to take long term and blood thinners and and so you're putting a lot more into your body if you get Covid 19 than getting the vaccination to prevent it. So we'll just we'll just say that. All right. So can we uh there's another question here from Harlem uh it says, can you say bye when these vaccines will be FDA approved? We did talk about that at the beginning. But can we say in another couple of words about what we're looking at with regard to the EU and when we will start hopefully vaccinating kids 5 to 11. Uh let me ask um dr Matsanga. Sure. Yeah. So we're expecting that 5 to 11 vaccinations will be available as dr fletcher mentioned in some of the larger sites beginning that first week of november. Um and with other locations and practices um there shortly thereafter. Um so really beginning in November. Um the first couple of weeks of November's, the availability of a vaccine for 5 to 11 year olds will be um should be pretty prevalent within the community. Thank you. There's another question here about masking and I've seen this um a couple of times. What is the plan for mask mandates any plans for when we can do away with masks for the kids. Um dr fletcher, do you want to do you want to try that one? Oh, that one. I'm not sure about that one because that seems to be more of a governmental decision a little higher than my pay grade I'll say. I think there it's going to be driven by data. I do know that I have confidence in our public health officials, Wake county. Um DHHS that they're going to look at the numbers. Um The C. D. C. Is also tracking variants so who knows what the future holds. God forbid. There is a variant that is more contagious than delta. Um But all of the data will will really I think guide that decision. And dr fletcher. I'm gonna ask you to. It also addressed this question. Um One of our parents is asking um that her or mentioning that her daughter has been getting headaches sometimes with wearing a mask. Any any advice or any comments about that? There's there's no I'd say basic scientific data to explain why a mask would contribute to headaches. Um I would speak with your primary care doctor just because a headache that's chronic or intense does need to be evaluated in a pediatric office with a thorough history and physical um So I wouldn't really encourage that individual to reach out to their primary care doctor. Thank you so much. Um And Dr Matsanga. Um there's a question here about prevention um to prevention, to prevent prevention of hospitalization. With regard to the use of vitamins, zinc baby aspirin. Um Can you comment on some of these over the counter medications that people are are potentially using to try to stave off having getting the infection? Yeah. What I can say is that we know the best prevention that we have is vaccinating and getting a vaccine um Along with that taking in other measures, masking social distancing when you're in crowded spaces if you're a vast king if your unvaccinated um and masking even if you are vaccinated in an indoor settings, um I can't necessarily comment directly on on the over the counter medications. But we know um from the data that what we're seeing, the best way to protect yourself and to protect others around you is to get vaccinated. Thank you so much for that. All right. Um And dr Michelle, can you also answer this additional question? Um It's about how long after contracting covid can a person still test positive? Yes. So we have seen this happened and where it has been weeks and sometimes even months where individuals have tested positive after their initial course. Um An initial test. What we do know is that um at least from the public health side. Um We don't really consider things that reinfection Until at least it's been it's been at least 90 days or so since the individual has tested positive. Um And they begin having symptoms but that that's why the recommendation is not for individuals to continue to test after they have initially tested positive. There's no need for you to test again or to test negative. Um Just after you've tested positive remember to isolate um and and wait until your your course and improve your symptoms improved. Oh thank you so much. Um and dr kelly, can you comment? There are a couple of questions here about uh research um and uh discussions about potential upcoming treatments. The the there uh the potential for a new Covid pill. Um Can you can you comment on that? Yes. So the I work in a hospital that runs clinical trials. I don't I'm not participating in clinical trials are getting vaccinations. So we always have ongoing clinical trials. Covid has taken Preeminence in the last year and the trials that have occurred in 5 to 11 year olds, probably similar trials may occur in lower age groups over the next couple of months. The Child's regarding medications both for preventing worse disease after you get infected. And also for treating patients in the hospital have been conducted since 2020. Some of them have results out there. That's how we learned about the use of a type of steroid called dexamethasone in specific patients that end up in