WHY childhood vaccines are important

For each generation, keeping your kids safe has meant something a little different. I was a child of the 1970s – no seatbelts, lots of bike time without a helmet, eating colors and chemicals we never questioned, and lawn darts. ‘Nuff said. There was so much that we did not know – then and today. I have no doubt that my parents loved me and did their best to keep me safe, including making sure my siblings and I received the recommended immunizations. To this day, I have a copy of my original vaccination record showing that my mother protected me from MMR, polio and tetanus.

Times have obviously changed. We don’t let our kids wander out of the neighborhood as much as we used to. We put helmets on their heads and belt them into car seats. We continue to do everything we can to keep them safe, including making sure that they receive their childhood vaccines. What has also changed, however, is the comfort level that some parents have now in refusing vaccines. After decades of eradicating polio, tetanus, and measles from our country, no one remembers the impact that these diseases had on children. We have lost our fear, so we consider not giving the shots.

One of the standard pediatric shots is the MMR, which includes protection against measles, mumps and rubella (“German measles”). Though the United States successfully campaigned early on to eliminate measles, it took much longer to make vaccines available across the world. In 1980, 2.6 million people died (in that one year) from measles. The numbers went down as vaccine programs rolled out. In 1990, 545,000 people died of measles, and by 2014, the count was down to 73,000.

Because of vaccine refusal, we are now seeing outbreaks of these rare diseases in our country. In 2019, we had a measles outbreak in the US of 1274 cases of which a majority were unvaccinated people. Though mumps is not as serious (just incredibly uncomfortable for most of us), we had less than 500 cases yearly over the past few decades. Suddenly, between 2015-2020, we had a big bump in those numbers with more than 20,000 US cases.

And now we have polio in detected in our wastewater in New York. Polio was eliminated in our country with ZERO cases for the past 30 years—until now. Our grandparents and many of our parents were terrified of polio. Until the 1950s, polio outbreaks caused more than 15,000 cases of paralysis every year. Once vaccines were released, cases with paralysis fell to less than 100 in the 1960s and 10 in the 1970s. Vaccines work.

As we slowly limp away from the last two years of lockdowns and virtual school, most of us are really hopeful for a fabulous, in person, safe school year for our kids. We buy them new clothes, clip them into their seatbelts in the car, and bring them to a school that we hope will protect them and teach them. We make sure they have their helmets on when riding bikes, scooters, and ATVs. We watch them closely in the pool for the last few days of summer. And no lawn darts.

In keeping our kids safe, please do not forget to talk to your pediatrician about vaccines and boosters that may be due. This is one of the most tested and effective ways of protecting our kids. Especially as your kids get older and do more traveling, remember that all the diseases that we have worked so hard to eliminate in the United States are still circulating globally. It only takes one traveler to bring a deadly disease back home.

Lastly, when you are talking to your health care provider, please ask about and consider the new pediatric Covid vaccine. Early on in the pandemic, children only made up about 4% of all Covid cases with minimal hospitalization and almost no reported mortality. We now know that children were protected against the early strains due to differences in their innate immunity. Unfortunately, mutations have created new strains that are now defeating the pediatric immune system. We are seeing an increase over the last surge with kids making up 25% of all new cases. Over 12 million children have now tested positive with most of these in the last few months. Children remain vulnerable to post-Covid disease like MIS-C (multi-system inflammatory syndrome) and long Covid which both result in disruption to physical and mental health.

This fall, let’s unite again to do the right thing, and keep our kids safe.

Submitted for publication in The Galena Times August, 2022:





Photo credit:

WHY the masks are going back on

It’s back, people. It slipped in when we had our guard down. We had a good run there of feeling like life was getting back to normal. We have been out and around, flying without masks, gathering at parties, going to concerts. Most of us are vaccinated now, even boosted once or twice. The fear of the vaccine has decreased as more and more people miraculously survive the shot (it’s safe, really!). We are less nervous to be around strangers as it is now more likely they are vaccinated. Additionally, many of us have had Covid19 this year (2022), so we have embraced our natural immunity. But guess what? It turns out BA.5 doesn’t care. It is taking us down.

The latest Covid19 Omicron strain, BA.5, was discovered in South Africa earlier this year. Spreading faster than the speed of light, it is now the most prevalent strain in the U.S. just a month after gracing our shores. Mayo Clinic just called it “hypercontagious”. Confirming our suspicions, a new study published in Nature this week (see all refs below) found that BA.5 is four times more resistant to our current vaccines than any other previous strain. These variants are different due to mutations in the spike proteins which make it more difficult for the antibodies (that many of us carry against Covid19) to neutralize (stop) the virus.

It’s still worse for the unvaccinated. According to Dr Gregory Polland, head of Mayo Clinic’s Vaccine Research Group:

“… among the unvaccinated with this variant, they’re about fivefold more likely to get infected than people who have been vaccinated and boosted, about 7½ times more likely to be hospitalized, and about 14 to 15 times more likely to die if they get infected.”

Dr Poland also notes that even though vaccinated people are more likely to get mild to moderate symptoms from BA.5, they are still well protected against hospitalization. As before, even with vaccination, there are still high risk populations who have a really hard time with this virus and may quickly develop severe symptoms. Hospitalizations are up 23% just in the past week and have doubled since May. There are still people dying every day in our country due to Covid19, though not at the same rate we saw with previous variants. We always see cases peak, then hospitalizations, then deaths. We don’t know, yet, what the impact of BA.5 will be. (See Florida reference below–they have had BA.5 for a while and are now seeing an increase in deaths). The other challenging part of recent statistics is that so many people are doing home tests. A positive home test doesn’t show up in the local and national numbers. This means that we actually have no idea what the current rate of infection is — it might be much higher than we think.

The best way to prevent getting sick at all is to put a mask on. In my hospital, masks are still required in all hallways and clinical (patient) areas– we never stopped wearing them. Based on CDC guidelines, however, I did stop wearing my mask out in public. Of course, as soon as I went on my first trip without a mask (a dude ranch in Arizona!), I came home with Omicron. I thought I would be safe after vaccination and a booster, but I was very wrong. Since then, I have even had a second booster — about 90 days after my infection. I’m disappointed to hear that BA.5 might still get me despite all of that!

CDC guidance has been confusing and has changed so many times that many people have given up trying to follow the current guidelines.


If you are one of those people, then let me get you up to date with the current recommendations. Instead of putting the whole country on lockdown at once, the CDC has now officially recognized that different areas of the country are seeing surges in infection at different times. Because of this, they now have an easy tool and traffic light warning system for people to follow depending on where they live.

As an example, I live in Washoe County in the state of Nevada. I can go to the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html

I pick “Nevada” on their drop down menu, then “Washoe County”, and I currently find this:

On the same website, you can see the three levels of recommendation which are determined by evaluating the number of Covid cases being reported to the local county health department, the number of local hospital beds being used, and the number of hospital admissions. These are the current traffic lights depending on the level of activity in your county:

It’s a good idea to check this website before you travel. I might be more comfortable walking into a restaurant without a mask in a town that is “green” then in my current neighborhood.

My last thought today – this is HARD. We’ve had our masks off in Washoe County for a long time. Now, I’m putting it back on to go to Walmart or waiting at the airport. I had Covid in February, and it kicked my ass. I really don’t want it again. There are many cases of people who had Covid in March and April getting BA.5 now and getting just as sick as the first time around. I repeat, I don’t want it again. So, I put on my mask and dust off my bottles of hand sanitizer to carry around again. I don’t need anyone else to tell me to do this. I can see the writing on the wall.

I also do this so that I don’t get my elderly parents sick or anyone else around me that might not have the nice immune system that I have. We know that we can spread Covid a day before we even get symptoms. I feel like it is inevitable at this point to get Covid every once in a while, but I don’t want to be responsible for getting someone else really sick. I will wear my mask again.

Please “like” or comment with any questions or concerns. Share with others who need all of this info summarized every once in a while! Let me know what you would like to hear more about, and I will do my best to post about it. Thanks for reading and for all of your support!


Wang, Q., Guo, Y., Iketani, S. et al. Antibody evasion by SARS-CoV-2 Omicron subvariants BA.2.12.1, BA.4, & BA.5. Nature (2022).






WHY do our kids need a Covid19 vaccine?

This morning (June 18th), the CDC (Centers for Disease Control and Prevention) is meeting to decide on final approval for two new Covid vaccines for children ages 6 months to 5 years. The FDA (US Food and Drug Organization) authorized both vaccines under the Emergency Use Act (EUA) yesterday, but the release of the shots now sits with the CDC. For many of us in healthcare, this is the end to a long wait as we continue to admit young kids to our pediatric hospitals. There have been over 400 deaths so far due to Covid in the under 5 year old age group. This vaccine will prevent many bad outcomes in children as the variants continue to emerge and this virus becomes a villian that we will have to continue to live with.

Parents will likely have a choice to make as it appears that both Pfizer (Comirnaty) and Moderna (Spikevax) have developed effective vaccines at this time. We were all hopeful for a baby vaccine late last year, but further rigorous testing revealed that the doses and schedule did not provide enough protection to children to justify putting them through a vaccine regimen. Through further testing and hard work on the part of many children’s hospitals and clinics, it looks like we have a couple winners. I will also take a minute to appreciate the thousands of parents who brought their children in for these experimental vaccines which made it possible for the rest of us to benefit from the risks they took. Thank you.

Here’s what I know about these two new vaccines (clipped from the FDA site referenced below):

The Moderna COVID-19 Vaccine is administered as a primary series of two doses, one month apart, to individuals 6 months through 17 years of age. The vaccine is also authorized to provide a third primary series dose at least one month following the second dose for individuals in this age group who have been determined to have certain kinds of immunocompromise. 

The Pfizer-BioNTech COVID-19 Vaccine is administered as a primary series of three doses in which the initial two doses are administered three weeks apart followed by a third dose administered at least eight weeks after the second dose in individuals 6 months through 4 years of age. 

Moderna was previously only approved for 18 years and older, so this new authorization will give adolescents an additional option for vaccination. The Moderna series is completed for most kids in one month with an additional third dose a month later recommended for kids with any sort of immunocompromise. The Pfizer series will take a bit longer — 11 weeks — to complete and there have been more reports of fever associated with this vaccine. However, early data is also indicating that the Pfizer vaccine may be slightly more effective than Moderna.

Dosing notes: for 6 months up to the 5th birthday, the Pfizer injection contains a 3 microgram dose of mRNA. If a child is 4 years old and turning 5 before completion of the series, they have an option to take the 2-dose 10 microgram series instead. The Moderna vaccine is a 25 microgram mRNA dose for children ages 6 months up to the 6th birthday, and 50 microgram dose for those 6 years and older. For children turning 6 years during the series, they can choose either series.

In reviewing the side effects reported in test subjects for both options, the most common complaints were redness at the site, tenderness and mild swelling with crying and irritability. There were scattered reports of difficulty sleeping and decreased appetite — all very common for most vaccines. Pfizer additionally reported fever, headache and chills for some of the younger children. There was no signal in this age group of an increase in myocarditis or pericarditis, though they will continue to follow this as more children are vaccinated.

Either vaccine is a good choice. Both will decrease the rate of moderate to severe Covid19 infection in children and decrease the risk of hospitalization for our kids. As noted in the CDC reference below, 9 of 10 patients aged 5 to 11 years of age hospitalized during the Omicron surge were NOT vaccinated. 19% of these kids ended up in an intensive care unit. As we have seen with the adult population, kids will continue to contract the virus (a vaccine can’t eliminate that possibility for everyone), but the vaccine will decrease symptoms and duration of that infection. So far, it has been evident that children tend to experience less severe disease from Covid19 than adults. However, which each variant, we have seen an increase in the cases in kids. Five times more children aged 0-4 years were hospitalized with the Omicron variant when compared to hospitalizations during Delta. The concern is that the virus continues to evolve and find ways to overcome even our children’s healthy immune systems.

Typically, the “respiratory season” runs from November through March with children filling the beds of our pediatric hospitals with a variety of viruses. Masking, lockdowns, and this novel virus has absolutely changed the game and trashed that predictability and seasons. My floor and ED is currently filling with Influenza A cases and beginning to fill with the latest variant of Omicron. Normally, we would not be seeing Flu cases until late fall. Many of our kids are testing positive for more than one virus (i.e. Flu and Covid19) which can create more severe illness and damage to previously healthy lungs.

It is important for families to get these vaccines administered as soon as possible so that when the real “respiratory season” hits, our kids will be more protected and less likely to end up in the hospital. It is also likely, based on recent studies like the one referenced below in JAMA, that a booster dose will be needed after the initial series to ensure the most optimal protection.

Take homes from me:

  • vaccines for kids against COVID19 are safe and effective
  • vaccines will likely be available as early as next week in your pediatrician’s office and at your county health department
  • talk to your provider about the risks and benefits of the different vaccines for your child

Photo credit: Loyola Medicine






WHY Florida’s New COVID-19 Vaccination Guidance Could Hurt Kids

This time, Time says it best. Posting this here for your review:


via @Jamie_Ducharme and thank you to my friend, Dr Mobeen Rathore for standing up for the children of Florida!

Florida Surgeon General Dr. Joseph Ladapo sparked controversy this week by recommending against COVID-19 vaccination for healthy children—contrary to the advice of health organizations and plenty of data that suggest the shots are safe and effective.

Florida “is going to be the first state to officially recommend against the COVID-19 vaccines for healthy children,” Ladapo said at a roundtable on March 7.

Official guidance released the next day softened that stance somewhat, saying that “healthy children aged 5 to 17 may not benefit from receiving the currently available COVID-19 vaccine” due to their low risk of severe disease and the possibility of rare side effects. Parents of kids with underlying medical conditions should consult their pediatricians, the guidance says.

While the guidance does not prevent parents in Florida from vaccinating their children if they wish, some doctors fear it could have a chilling effect on a pediatric vaccine campaign that has already moved more slowly than experts had hoped.

“The Florida Surgeon General’s decision to recommend against COVID-19 vaccination for healthy children flies in the face of the best medical guidance and only serves to further sow distrust in vaccines that have proven to be the safest, most effective defense against severe COVID-19 disease, hospitalization, and death,” said Dr. Daniel McQuillen, president of the Infectious Diseases Society of America, in a statement.

Dr. Mobeen Rathore, past president of the Florida Chapter of the American Academy of Pediatrics and associate chair of the University of Florida Health Jacksonville’s department of pediatrics, calls Ladapo’s remarks dangerous. “Any time people in power…make a statement, some people will believe that,” he says. “This could result in some children dying.”

He recommends that pediatricians in Florida and elsewhere encourage vaccination among all patients who are eligible. “All children should be vaccinated,” he says. “This is the only way we’re going to get out of this morass of the pandemic.”

Read MoreMy Kids Can’t Get Vaccinated Yet, and I’m Barely Keeping It Together

Following the U.S. Food and Drug Administration (FDA)’s authorization of Pfizer-BioNTech’s COVID-19 vaccine for 5- to 11-year-old children last fall, the CDC recommended COVID-19 vaccination for everyone in the U.S. ages 5 and older, as did the American Academy of Pediatrics. However, just 26% of children ages 5 to 11 are now fully vaccinated. The vaccination rate for 12- to 17-year-old children is higher, at 58%, but that’s still well below the adult rate of 75%.

Reports from the Kaiser Family Foundation (KFF), which has tracked attitudes toward vaccination throughout the pandemic, suggest that many parents fear side effects and unknown, hypothetical harms of COVID-19 vaccines, despite numerous studies that have found both the two-dose series and the boosters to be safe and effective. “The younger the age group, the more cautious [parents] are in terms of proceeding with vaccination,” says Liz Hamel, KFF’s vice president and director for public opinion and survey research.

In February, KFF asked U.S. parents if they felt they had enough information about the safety and effectiveness of COVID-19 vaccines. Of parents with kids ages 12 to 17, 66% said they did, compared to 61% of parents with kids ages 5 to 11 and 43% of parents with kids younger than 5.

The hesitation is understandable among parents of very young children, given that vaccines have not yet been authorized for kids under 5 and the FDA recently delayed its review of Pfizer’s shot while waiting for more data. (Early indications suggest it is safe for young children, but there are outstanding questions about its efficacy.) Among older age groups, though, COVID-19 shots have proven safe “not only in research, but also in the real world,” Rathore says.

Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and a member of the FDA’s vaccine advisory committee, says that much of the reluctance among parents stems from the belief that children—especially those without preexisting medical conditions—do not need to be inoculated because they are very unlikely to get severely ill or die from COVID-19.

That rationale came up during the roundtable at which Ladapo recommended against COVID-19 vaccination for healthy kids. Ladapo also mentioned a recent preprint study from New York, which found that, during the Omicron wave, vaccine protection waned more quickly among 5- to 11-year-old children than it did among older kids—perhaps because of the smaller dose given to the younger age group.

However, a CDC report based on data from 10 states (and published shortly after the New York study) concluded that differences between age groups could be explained by timing. Omicron, which is extra-contagious and better at outsmarting vaccines than previous variants, emerged shortly after vaccines became available for 5- to 11-year-old kids. While both papers found that vaccines get worse at blocking infections over time, particularly against the highly transmissible Omicron variant, the CDC report estimated that they were between 73% and 94% effective at preventing COVID-19 hospitalization.

That benefit alone makes vaccination worthwhile, Offit says. It’s true that kids develop severe disease much less often than adults, but exceptions happen. More than 100,000 kids have been hospitalized with COVID-19 since the pandemic began, according to CDC data, while others have developed complications including Long COVID and the inflammatory disorder MIS-C.

“When I was working in the hospital in the middle of December, we admitted 18 children that week,” Offit says. “Five of them went to the intensive care unit. If you can avoid that safely [through vaccination], then avoid it.”

Offit, however, doubts that Florida’s guidance will have a major effect on pediatric vaccination rates in the state or more broadly. It’s “a political statement” more than a public-health policy, he says, and most people have by now made up their minds about whether they plan to vaccinate their children. “I don’t know what people are waiting for, at this point,” he says.

But data show that at least some parents are still undecided. As of February, 10% of parents with 5- to 11-year-old kids said they were going to “wait and see” about vaccination, according to a recent KFF report. That suggests there is still some wiggle room—and anything that further confuses or concerns parents could sway them against vaccination, Rathore says.

One-on-one conversations with loved ones and trusted sources—which, for parents, often means their child’s pediatrician—can make the biggest difference in vaccine intentions, Hamel says. “One big question is, how do pediatricians interpret [Florida’s] advice and filter that to their patients?” she says.

On Twitter, several Florida pediatricians voiced support for vaccination. “As a Florida pediatrician I could not recommend the covid vaccine for eligible children more,” tweeted Dr. Chelsea Torres. “I am beyond myself as a pediatrician in Florida,” tweeted Dr. Lindsay Thompson. “This will have ripple effects on all vaccines and children will end up suffering and dying.”

Rathore says he hopes his colleagues ignore the guidance. “Anyone who cares for children, advocates for them, and stands for them,” he says, “would want them to get vaccinated and get protected.”

WHY Covid may be hardest on the kids

The last two years have been challenging for all and devastating for many. No one could have predicted that a virus reported in China at the end of 2019 would result in months of prolonged lockdowns, store and office closures, and virtual school for Americans. Though we have all been victims of this pandemic, there is a massive spectrum of impact across our country. While the adults slowly crawl out from under mask mandates and office reorganization, there is a growing concern that the kids have been left behind and many will continue to struggle to catch up. We do not yet know the final consequences of the pandemic on our children, but there are some early clues that what they have lost academically, socially, and psychologically may cause long-term damage.

In Nevada, where graduation rates were already lower than most other states but had been trending up, we saw a critical 1.3% drop from 2020 to 2021 (from 82.6% to 81.3%). Washoe County, where I live, reported a graduate drop of 2.6%. The 2021 class only had a year of pandemic to deal with. As we approach graduation day 2022, we are crossing our fingers and hoping that we have been successful in supporting our seniors through two years of off and on instruction.

On the other end of the spectrum, kindergarteners started this school year without the benefit of socialization through daycares and preschools. Teachers have been reporting a return to basics with this year focused on learning to sit in chairs and follow basic rules. Major analyses have shown that K-12 students finished last year up to five months behind in math and 4 months behind in reading compared to previous scores. Just when schools started to catch up again this year, the Omicron variant rolled in and disrupted things all over again.

Studies are beginning to roll out internationally showing decreased engagement and increased behavioral issues in K-12 kids. Rates of depression and anxiety were already growing prior to the pandemic. The isolation of lockdown and increased screen time has done nothing to improve this trend. In 2021, there was a 31% increase in teenage suicide attempts seen in our emergency rooms across the country. Add to this stress a lack of school psychologists– about one for every 5000 students in Nevada. Across the country, Maine is the only state that currently meets the recommendation of one professional for every 500 students.

Academic success requires both physical well-being and mental health support. In order to lift our students up, we must return them to school and their friends with strong bodies and minds. The good news is that due to the mental health crisis, there is now more attention being given and less stigma attached to having mental health issues. Everyone is talking about the deficiencies in services, and resources are slowly being directed to mental health. It will require our entire village to prioritize and contribute to the recognition and treatment of depression and anxiety for our kids and their caregivers.

On the physical health side, we have a long way to go, but the solutions are in reach. Early on in the pandemic, children only made up about 4% of all Covid cases with minimal hospitalization and almost no reported mortality. We now know that children were protected against the early strains due to differences in their innate immunity. Unfortunately, mutations have created new strains that are now defeating the pediatric immune system. We are now seeing an increase over the last surge with kids making up 25% of all new cases. Over 12 million children have now tested positive with most of these in the last few months. Children remain vulnerable to post-Covid disease like MIS-C (multi-system inflammatory syndrome) and long Covid which both result in disruption to physical and mental health.

Vaccination, masking, and testing programs have been proven this year to be effective methods of keeping kids in school and healthy. We now have examples of school districts who focused money and resources on vaccination and testing and survived this year without school closures. Adults have protected themselves — over 85% of Americans over age 18 have received at least one vaccine dose and 74% are “fully vaccinated”. We have not done so well by our children, however. Only about 56% of 12-17 year-olds and 23% of 5-11 year-olds are fully vaccinated as of February 2022.

A study in Pediatrics in January 2022 found that kids most at risk for severe Covid are those with chronic disease, obesity and diabetes. If we can at least start with protecting our most vulnerable with vaccination, then we will be making progress. I encourage everyone to pay attention to our little ones, promote increased services and resources for children and schools, and do what you can to protect our kids before they become the next “lost generation”.

Picture credit: Allen J. Schaben Los Angeles Times via Getty Images









WHY do some people get long COVID?

As if it isn’t bad enough to get sick with COVID (caused by the SARS-CoV-2 virus) and have to take a few days off work or school, more and more people are reporting ongoing symptoms lasting for weeks and even months. These symptoms can range from body aches to fatigue, chronic cough, “brain fog”, loss of taste and smell, and heart problems. This is being called “long Covid” in the press, or post-acute sequelae of Covid (PASC) by physicians. With the big volume surge of Omicron, I am predicting that more people will be diagnosed with long Covid in the next couple months.

First of all, if this is happening to you right now — YOU ARE NOT CRAZY! Many of these symptoms are noted in other autoimmune and poorly researched diseases like chronic fatigue syndrome, fibromyalgia, and POTS (postural orthostatic tachycardia syndrome). Many of us in medicine have been skeptical of these diseases in recent years, but I am ready to stand corrected. Something about the Covid virus seems to be setting off our own immune systems and causing many inflammatory and autoimmune-type diseases. As I have said before – it’s not always the cancer that kills you, but often the chemo. Same with Covid – it’s not always the virus, but instead, your body’s reaction to it, that makes you sick. Yes – that means that in the end, the cancer and the Covid started everything. But some of us respond differently to the initial insult than others. Some reports state that 10-30% of people who get infected with Covid will experience chronic symptoms. This equates to about 15 million people in the US and even more globally. The average age of these patients, according to the CDC, is 40 years old.

So why do some of us get so sick while others just get a runny nose? Researchers are currently scrambling to figure this out. Hot off the presses this week is a study published in the journal, Cell (all references below), that is proposing that there may be four factors that put some people more at risk for long Covid than others:

  1. Having type 2 diabetes
  2. Having EBV (Epstein Barr Virus – causes “mono”) in your system – either a recent infection or reactivated one when you are sick with Covid
  3. Having a high viral load at time of Covid diagnosis – most of us just test positive or negative, but labs can determine your “viral load” on a PCR test, if requested
  4. Having a strong autoantibody response to Covid infection – the strongest factor of all of these

Obviously, there is nothing that you can control about any of these things. It is what it is. If you have type 2 diabetes, or have a family history of autoimmune disease, you may be more at risk for more chronic symptoms. What is interesting about this study is the new understanding that if you have a patient with this underlying risk factor, and you then make the effort to measure their viral load at time of diagnosis, then you may be able to recognize an “at risk” patient. Or maybe we need to measure everyone’s viral load (not just those with autoimmune disease) and their autoantibody levels to determine if they are “at risk”.

The next research question could then be: what if your “at risk” patient was then able to receive additional therapies to decrease their risk of chronic infection? We have yet to do the outcomes research (study of the data) on this, but I can only imagine the impact that long Covid is having on individuals, their families, the companies they work for, and the national economy. As of this month, over 100 million people worldwide and over 15 million in the US have been reported with and are being followed or treated for long Covid. This number likely underestimates the actual number as not everyone is seeking care for their symptoms. 15 million people who are previously young and healthy suddenly having symptoms that disrupt their ability to work or care for their families is a devastating blow to our workplaces and households. The financial impact of this must be compared to the cost of lab testing of patients at time of diagnosis and providing them with novel therapies. My guess is that we could save a lot of money at the local and national level by determining and treating “at risk” patients.

Of course, the treatment of long Covid is still being researched and trialed. There are teams treating long Covid patients with everything from vitamin supplements to Covid vaccines to monoclonal antibodies. There has been some research that shows that with or without treatment, long Covid symptoms are improving after three to four months. Other studies show a much longer duration of disability.

Per the CDC: As of July 2021, “long COVID,” also known as post-COVID conditions, can be considered a disability under the Americans with Disabilities Act (ADA). Learn more: https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/guidance-long-covid-disability/index.html#footnote10_0ac8mdc



Logue JK, Franko NM, McCulloch DJ, et al. Sequelae in adults at 6 months after COVID-19 infection. JAMA Netw Open 2021;4(2):e210830-e210830


New journal on PASC: https://www.medrxiv.org/content/10.1101/2021.11.15.21266377v1.full.pdf


WHY is Omicron an issue for kids?

With so much information coming out every day, I have started this blog multiple times and had to immediately give up as something new hit my Twitter feed. I don’t believe that there is any reason for me at this point to educate about Omicron as so much has been posted and argued over already. Instead, today, I would like to summarize a couple of my own opinions and important facts, and leave you with a list of media reports that can help to answer specific questions. I have been grateful to be interviewed for many of these — grateful for the opportunity to share important information and hopefully help parents, schools, and physicians make good decisions for our kids.

First of all… this is what I know:

— Omicron is much more contagious than previous strains, so masks are even more important to protect you as you walk by strangers inside or outside.

— Omicron is a big problem for two specific populations: hospitals (due to the sheer volume of infections) and the un/undervaccinated.

— Omicron is getting into our bodies differently and causing a different type of infection than previous strains. Delta went directly to your lungs and caused a “pneumonitis”, or inflammation of the lungs that was difficult to treat. Patients experienced respiratory failure and often ended up on ventilators. Omicron is causing some upper airway inflammation — this means, congestion, sore throat, slight cough, maybe headache and body aches. Even for those of us that are vaccinated, we can experience many of these symptoms, but we are protected from severe disease and hospitalization. The unvaccinated and undervaccinated are still at risk for severe disease — mostly the high risk immunocompromised and elderly population.

— The first two vaccinations appear to offer some protection, but people who have had a third (“booster”) shot have the best protection against severe disease.

— Even though the sheer numbers of children testing positive for SARS-CoV2 is much higher with Omicron than previous strains, kids continue to fare better than their adult counterparts. Yes, there are more kids being hospitalized. Yes, some of these kids are even ending up in the ICU. Many of these kids, however, are coming into the hospital for different reasons (wintertime is always busy in the PICU) but end up testing positive for COVID. Most of us in the PICU are not seeing the high numbers of acute illness that we were worried about.

— I believe that keeping our children in school is absolutely crucial to their academic potential and emotional health. This pandemic has been unprecedented in the damage it has done to our school age kids — from preschool through college. We are already seeing standardized testing scores fall and mental health admissions surge. Our children deserve to be the focus of ongoing intervention, funding and protection. Otherwise, this will truly be a “lost generation”.

— Each district and school will need to make individual decisions based on support available from their state, county, and community. County supervisors and principals will need to make decisions for their schools based on testing available, space available, and staff available to carry out local mandates. There are school districts who have prioritized aggressive testing (i.e. LA County, SF) and have had very low levels of positivity and almost no school closures or virtual classes required. There are other counties, like mine, who are doing their best but do not have the resources to routinely test. These schools have been more likely to see higher numbers of infections and have more often had to transition to virtual learning.

— The pediatric COVID vaccine is safe. Millions of children have received the vaccine with incredibly low reports of side effects with the lower dose given. However, only 17% of children 5 – 11 years old have been vaccinated nationally (14% in my area, Washoe County). If we can support and educate and promote pediatric vaccination, then schools will stop being a focus of controversy and instead return to centers of learning and socialization. Kids will be able to take their masks off and be kids together again.

— Politicians and political parties have created a black and white spectrum of truth and lies with both sides exaggerating at times to make their points. The truth is usually in the gray. Educate yourself and listen to the science. Ask a doctor, if you know one, to answer your questions. If you don’t know one, feel free to ask me! I will continue to do my best to post the latest science and research in the most unbiased way that I can.

Those are my thoughts today.

I offer more information through these recent media stories:

Good Morning America — I was interviewed by reporter Katie Kendelan about isolation and quarantine for kids with COVID infection or symptoms, Jan 14, 2022: https://www.goodmorningamerica.com/wellness/story/pediatricians-answer-parents-questions-covid-19-isolation-testing-82250739

Low rates of vaccination in kids, Jan 12, 2022, PBS news: https://www.pbs.org/newshour/nation/covid-19-rates-for-children-are-low-experts-say-parents-are-taking-an-enormous-risk

Healthline, Jan 6, 2022 — Julia Ries (@namesjules) on how Omicron is affecting kids:

From Asher Lehrer-Small (@small_asher) in the 74 (@The74) on school issues: https://www.the74million.org/ask-the-doctor-navigating-the-new-math-of-omicron-in-schools/

Medpage today, Jan 12, 2022 — excellent interview with Dr Paul Offit (CHOP, Peds ID) by Emily Hutto (@EmAndEdits): https://www.medpagetoday.com/publichealthpolicy/healthpolicy/96635

Official updates to CDC guidelines on when to isolate and quarantine, Jan 13, 2022:

Parents magazine, Dec 2021 — What Parents need to know about Omicron by Nicole Harris:

Side effects of Covid vaccine for kids in VeryWell Family, Nov 2021 by Wendy Wisner (@WendyWisner): https://www.verywellfamily.com/what-are-the-side-effects-of-the-kids-covid-vaccine-5209790









Picture credit: https://acs-h.assetsadobe.com/is/image//content/dam/cen/99/44/WEB/09944-leadcon-variant-new.jpg/?$responsive$&wid=700&qlt=90,0&resMode=sharp2

WHY will the COVID19 vaccine for babies take longer to be released?

Two posts from me this week as so much information is rolling out about vaccines and variants. First of all, let’s look at the news this week that vaccines for our smallest little people will be delayed. Why is this?

In testing vaccine doses and regimens for children ages 6 months to 5 years of age, researchers have found that the level of immune protection granted by the two-shot interval tested in older children and adults is not as high as expected. In order to understand this, let me step back and review where we are at this point with vaccine intervals and boosters.

In the rush to roll out a safe and effective vaccine for adults last year, initial studies revealed excellent efficacy in study participants after two doses of vaccine. The initial group of adults given 2 doses of either Pfizer or the Moderna vaccine had over 90% protection against moderate to severe disease from COVID19. Whereas many of our traditional vaccine series require a three-dose regimen, there was some excitement around the data showing excellent protection after two shots. There was no time to wait an additional six months to see if there was additional protection with a 3rd booster dose. It was more important to protect our population as quickly as possible and release the vaccine series.

Ongoing studies over the past year have now shown that the effectiveness of the vaccine and protection it provides has decreased. Vaccinated people continue to be protected from severe disease (hospitalization), but breakthroughs with mild to moderate symptoms continue to increase over time. Most of us are not surprised by this. This is consistent with what we see for other vaccine series, i.e. the first two Hepatitis B shots are given a month apart followed by a booster six months later to fully protect against Hepatitis B infection. As we have gained more experience, collected data, and vaccinated billions of people (8.5 billion doses given worldwide as of today), we now know that a third dose given six months after the second dose increases our immune response to the COVID19 virus. This is why a booster shot is now recommended for everyone in our country over the age of 16 (approved Dec 9, 2021)—references below. Adults over the age of 18 years should receive either a Moderna or Pfizer vaccine – mixing and matching is approved and should be guided by your physician and individual health concerns/risks. For 16-17 year olds, only the Pfizer vaccine is approved as a booster. A full dose of Pfizer is given as a 3rd dose, whereas a half dose of Moderna is used as a 3rd dose.

The adult dose of Pfizer-BioNTech vaccine (Comirnaty) is 30 micrograms (mcg) and has full approval from the FDA (August 23, 2021). The pediatric dose of Pfizer was recently approved for emergency use (EUA) on October 29, 2021. Pfizer and BioNTech have recently asked the FDA to fully authorize their vaccine for 12 to 15 year olds. This dose is 10mcg given in a two-dose series. In studies of this dosing regimen reviewed by the CDC and FDA, this series is 90.7% effective at preventing COVID19 infection. It is too early to say if these kids will need a third shot, but my guess is that they will – similar to the adult population and the other vaccines that they receive.

In the background, studies have been ongoing (by Pfizer) to evaluate a safe and effective dose for smaller children – ages 6 months to 5 years of age. These studies have been carefully done due to the variety of weights and vulnerability of these small children. We have heard that a 3mcg dose has been tested in this population, and we were hoping for approval and release of this vaccine in January 2022.

This week, we had some updates from the researchers involved that this two-dose regimen has not been as effective as the others. This is tested by drawing blood from the children given the shots and testing their antibody response post-vaccine. In the 6-month to 2-year-olds tested, there was a good level of immunity produced (data reviewed by internal board, not yet released to the public). However, in the 2- to 5-year-old population, the expected/necessary level of immunity was not seen. Because of this, a third dose has now been added to the vaccine series for this age group. This means it will take additional time to see the outcomes and safety profile of this full series, delaying further review and approval. The last I heard, they are hoping for release in “the first half of 2022”.

One other update for everyone — the CDC has now received 8 reports of myocarditis in 5 to 11 year olds after receiving the Pfizer vaccine. I will update again when more information is released, but the CDC has said that these cases were mild and reported at time when over 7 million doses had been given. Please see my previous posts about post-vaccine myocarditis which discuss this risk, usually in young men.

I fully recognize that parents of young children are absolutely disappointed that they will have to wait longer to protect their kids. However, I am grateful that the researchers are taking the time to get this right and make sure that if we are going to put shots into the arms of our kids, that this shot will be the right dose and interval to protect them.

I hope this helps to clarify some of the confusion around pediatric shots. Please leave me comments if you have any other questions about this (I’ll do my best!) or ideas for further posts – I love hearing from everyone. I will continue to do my best to keep up on the news and research and provide clear summaries on this information in the most nonbiased way that a physician can! Be well!

Photo image credit: UNICEF/UNI346553/Karahoda




Data that 3rd dose increases immunity: https://www.nejm.org/doi/full/10.1056/NEJMoa2114255

Difference between “booster” and “additional dose” language: https://www.muhealth.org/our-stories/covid-19-vaccine-what-you-need-know-about-third-doses-and-booster-shots

Failure of smaller doses in smaller children: https://www.cnn.com/2021/12/17/health/pfizer-vaccine-children/index.html

Omicron info for parents:

Getting flu and COVID19 vaccine for kids: https://www.forbes.com/sites/leahcampbell/2021/10/31/vaccinating-for-flu-and-covid-19-what-parents-need-to-know/?sh=559452c24e63

Myocarditis cases: https://www.reuters.com/world/us/eight-heart-inflammation-cases-seen-among-young-kids-who-got-covid-19-shot-us-2021-12-16/

WHY are so many people afraid of the COVID19 vaccine?

As millions of people across the world are gaining access to and choosing to receive the COVID19 vaccine, I remain hopeful that at some point soon, we will be able to dial back many of the lockdowns and social restrictions that remain in place due to our fear of infection. This fear is real – over 770,000 people in the US have died due to COVID19 infection, and we know that many more died of other causes likely exacerbated by recent infection. This number is the same as the entire population of Northern Nevada (outside of Las Vegas). Every one of those who have died left behind family and friends. Many were elderly and frail, but many were young and healthy, and some were children.

For those of us who have lost, or have been around the losses, the rapid development of a vaccine nine months after initial reports of infection in the US was an absolute miracle. Or at least, incredibly impressive. Many of us in healthcare were the first in line to get the vaccine – I received mine on December 19, 2020. For all of us that chose the jab, the benefits of this new vaccine outweighed the risks of the vaccine and the risks of not being protected. Of course we were concerned – a new vaccine, what was mRNA doing in our bodies?, stories of fever and even allergic reactions – it was all scary. But what we were doing and taking care of in the hospital every day was even scarier. It was a leap of faith, but I chose to trust science and trust the vaccine. As millions of people have now received COVID19 vaccines (over 200 million in the US alone), we continue to learn more about it. For those of us in healthcare, this data has been reassuring. The vaccine is just as safe, or safer, than any of the other vaccines, medications, or therapies that we dispense daily.

Yet, there are still millions of people who are choosing not to get the vaccine. I have chosen to try to understand what the concerns are in an effort to provide facts and education around those fears. Initially, many people felt like this was a political divide. I no longer feel that way as I know intelligent people on both edges of the political spectrum who have decided not to vaccinate. When I ask why, the answers are usually based in fears – fears about the ingredients, the side effects, the long-term effects, and fears around personal health issues. This I can understand. I face these fears every day as I take care of individual patients with lots of questions about their medicines, chemotherapy, antibiotics, radiation, etc. So today, I would like to address some of these fears. Here are some of the concerns:

Medical Reasons. First of all, there is a very small population of people who should not get the shot. Yes, I said that. There are specific diseases and conditions that are absolutely high risk for a reaction to a vaccine. For instance:

  • If you have ever had anaphylactic shock after receiving a vaccine, then you should probably not get this one. I would direct you to your physician to have an important conversation about your specific risks.
  • If you had an acute allergic reaction (anaphylaxis) to a COVID vaccine, then you should not get the same version again – talk to your doc about options.
  • If you just had COVID and had an antibody product (like Regeneron) then you should defer vaccination for 90 days.
  • If you developed myocarditis after your first dose, then you should not get the second.
  • If you are currently acutely ill, then you should wait until you are well.

Religious exemptions. I’m hearing that thousands are checking the “religious exemption” box when faced with an employer mandate. I didn’t realize so many people were Scientologists. Not judging. Just saying that most churches and church leaders nationally are supporting the vaccine to enable their parishioners to safely return to church! There is a specific list of religions here that do object: https://www.vumc.org/health-wellness/news-resource-articles/immunizations-and-religion

Ingredient concerns. Well, I have watched A LOT of videos in the past few months of campaigns, talks, interviews, etc, that are anti-vaccine and warn their audiences of all kinds of badness in the shots. I’ve really tried to listen and understand. I hear some really good information and some really bad information. Some of these speakers found a medical textbook and put a bunch of words together that absolutely make no sense. Others express real concerns about specific ingredients, but don’t seem to understand the dosing or use of these ingredients.

Let’s go through a couple:

  • mRNA. This is the only “active” (meaning has any effect on your body) ingredient in the Pfizer and Moderna vaccines. The few other ingredients (below) are “inactive” and have no impact on your body and are quickly cleared. One of the better descriptions of the mRNA component is here:

“There are rumors that mRNA vaccines will alter our DNA because the RNA molecule can convert information stored in DNA into proteins. That’s simply, not true. It’s critical to note that the mRNA vaccines never enter the nucleus of the cell, where our DNA is stored. After injection, the mRNA from the vaccine is released into the cytoplasm of the cells. Once the viral protein is made and on the surface of the cell, mRNA is broken down and the body permanently gets rid of it, therefore making it impossible to change our DNA.” (ref below)

  • Lipids are used a as a fatty layer to protect the mRNA piece and help it enter the cell. One of the four lipids used is a small piece of cholesterol.
lipid structure
  • The one that has received the most attention is a form of polyethylene glycol. Yes, it’s in the Pfizer shot. A similar substance, polysorbate 80, is in the J&J vaccine. Most of us know it as “PEG” or Miralax. When concentrated, it works well as a laxative. It has thousands of other uses (check Wikipedia!) including thickening uses in toothpaste and shampoo and binding to proteins as a carrier to last longer in the bloodstream. There is a tiny amount used in the lipid wall surrounding the mRNA piece to deliver it to the cells. There was initially concern that people allergic to PEG (or Miralax) may be the ones who have an allergic reaction to the vaccine. I have not found any follow up data on this, but if you have allergies to any medications, please discuss this with your doctor to determine if the vaccine is safe.
  • One of the other lipids used by Moderna that has received A LOT of attention is SM-102. I’ve seen accusations that SM-102 is somehow able to carry GPS signals and even magnets and electrical charges. Pretty impressive, and completely untrue. SM-102 is another little tiny lipid that forms the wall of a coating around the mRNA to protect it from immediate destruction. It’s just not that cool… More info here: https://www.factcheck.org/2021/05/scicheck-vaccine-ingredient-sm-102-is-safe/
  • Salts and sugar. That’s it.

The vaccine does NOT contain:

  • Fetal cells
  • Blood products, like red blood cells, white blood cells, plasma or platelets
  • COVID-19 virus cells
  • Mercury
  • Egg
  • Latex stoppers
  • Pork products
  • Preservatives
  • Microchips      

— Sometimes there are microchips on the outside of a syringe (usually in a bar code), so the health care professional can scan it quickly for digital records. The world’s tiniest microchip is still much too big to insert into an immunization shot.

The oldest and newest fear has been infertility. The doubts came up early and fast due to the possibility that a protein on the placenta, syncytin-1, could be could have a similar spike protein that would cause the body to attack it after vaccine. This miniscule possibility has been evaluated by multiple reproductive health teams and found to be near impossible (one study ref below). I placed a nice article from Missouri below addressing this concern if you would like more references.

Most significant to me, I have had parents tell me that they are worried the vaccine will make their children infertile long-term. Again, I understand the fear — my 18yo and 20yo daughters received the vaccine, and I had to do my research. There is no scientific away, no mechanism of the vaccine, no rare mutation of the mRNA, that can cause infertility in our kids. You know what can cause infertility? Infections. STDs, bacterial sepsis, and …. COVID19. So, if you want to help protect your children’s reproductive future, then educate them appropriately and get them the COVID19 vaccine.

Lastly, the CDC has added a nice “Myths and Facts” page to their website. Check it out: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html

I hope this helps! Happy to take any questions or comments below. If you like this material, I encourage you to hit the “Follow” button as I have been trying to keep up and post weekly. Thanks so much for all of your encouragement!


Full CDC site with ingredients listed in “Appendix C”: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html?s_cid=10492:covid%2019%20vaccine%20ingredients:sem.ga:p:RG:GM:gen:PTN:FY21#Appendix-C

Ingredient breakdown:  https://www.hackensackmeridianhealth.org/HealthU/2021/01/11/a-simple-breakdown-of-the-ingredients-in-the-covid-vaccines/

PEG concerns:  https://www.science.org/doi/full/10.1126/science.371.6524.10

SM-102: https://www.nebraskamed.com/COVID/sm-102-moderna-vaccine


Infertility: https://www.muhealth.org/our-stories/does-covid-19-vaccine-affect-fertility-heres-what-experts-say

syncytin-1 study: https://www.nature.com/articles/s41577-021-00525-y


COVID and pregnancy: https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-covid-19-vaccines-and-pregnancy

Photo credit: Creator: AndreyPopov | Credit: Getty Images/iStockphoto

WHY are pediatricians so excited about childhood COVID19 vaccination?

On November 2, 2021, in a unanimous vote, the CDC Advisory Committee of Immunization Practices (ACIP) recommended approval of the Pfizer vaccine for children ages 5 to 11 years of age. The CDC, and its director, Rochelle Walensky, immediately acted on this approval, and the shots are on the way. For most pediatricians, this is better than our birthdays! We have been waiting for this day. We have been waiting to have more to offer to protect our patients and our communities against COVID19.

Pediatricians are just as tired of the pandemic as everyone else is. There are days that I am wearing an N95 for over 12 hours at a time, pushing big plastic goggles on and off my face, washing my hands until they are red and raw – all to protect myself, my patients, and my families. If there is a magic exit door to this pandemic with a road behind it to normalcy, I will be the first to line up! This vaccine offering for children is now beginning to feel like a dim light at the end of a dark hallway.

As many of you have also, I have had my doubts about vaccinating children. As I have said before, everything that I do in pediatrics comes with risks and benefits. In reviewing all of the data and experience around a protocol, drug, or procedure, I have to be convinced that the benefits of what I am doing to a child or recommending to their parent absolutely outweighs the risks. This pandemic has been a scary time for all of us as there is so much that is unknown and so much that we still need to figure out.

Internationally, 4600 children aged 5 to 11 years of age were included in this latest Pfizer trial—3100 receiving the actual vaccine and 1500 receiving the placebo (blinded). This number was arrived at by epidemiologists (data scientists) as the acceptable number to study in order to get a broad enough range of age, race, and ethnicity, and to be able to see signals of side effects. As the vaccine is released, we will continue to study and follow the effects, and will hopefully soon have hundreds of thousands of children vaccinated providing even more data about the shot. Though different doses were considered and trialed, Pfizer arrived at a 10 microgram dose – one third of the adult dose (30 mcg)—for each vaccine. Children who received this dose then had their blood drawn and were found to have a robust immune response to the vaccine – this means, IT WORKS! They have determined that the efficacy of the vaccine is 91%. This means that in their trials, they found that 91% of these vaccinated children are protected against severe disease and mortality from COVID19.

Just like with the adult trials, we believe that children may still get infected with COVID19 even if they are vaccinated, but with this protection it should not make them very ill or require hospitalization. What we will need to evaluate over time is the effectiveness of the vaccine – or how well it protects the general population in the real world. As we have discovered with the initial adult vaccine rollout, even though the efficacy of the Pfizer vaccine in trials was 96-97%, once it was given out to a wide range of people with exposures to different strains of the virus, we found that the effectiveness of the vaccine has been declining—even to 42% in one study. Despite this, it has still been found to be over 90% protective against severe disease and death. I’ve added a video link to the bottom of this post that has a fantastic explanation of the difference between efficacy and effectiveness.

The best news rolled out this week is that the pediatric vaccine appears to be very safe. There were no cases of myocarditis in this study group (see my previous posts on this). I say “Hallelujah!!!”  This does not mean that there will not be cases reported over the next few months as the vaccine rolls out to hopefully millions of children. We will keep our eyes out and follow and report all concerns. CDC models predict that this childhood vaccination will prevent up to 600,000 infections by next March (2022). Based on the trial data, I feel very comfortable recommending this lower dose vaccine on the 3 week, 2-dose schedule now approved by the FDA and CDC. Pfizer is the only vaccine available for children at this time, but Moderna is quickly seeking approval for their own version. The J&J team is just starting to study their vaccine in children, so this will take much longer to be evaluated.

Quick update on the Pfizer vaccine already available to our 12 to 17 year olds… as we continue to give out vaccines and study their effectiveness in the real world, things are looking good! Vaccination in this age group has decreased the risk of hospitalization by 93%. This new was shared with pediatricians this month if you are interested: https://www.aappublications.org/news/2021/10/19/pfizerhospitalization101921

Today, I am grateful to all of the healthcare workers at major children’s hospitals who enrolled their own children in trials to identify the right dose of vaccine and to evaluate the side effects. These healthcare providers felt strongly enough about this mission to consent to having their own children be the “guinea pigs” in this new world, so that the rest of us didn’t have to be. If no one else says it, I will – THANK YOU!




Dr Fauci on protecting kids: https://www.cnn.com/2021/09/06/health/us-coronavirus-monday/index.html?utm_source=twCNNi&utm_medium=social&utm_content=2021-09-07T03%3A29%3A04&utm_term=link

This is one of the best videos I have seen explaining why “efficacy” is different than “effectiveness”:

This German website (dw.com/science) has some great videos using science, not rumors, to spread information and has another great explanation of the difference.

Photo credit: Creator: gregory_lee | Credit: Getty Images/iStockphoto