Thread by @drjootz

#MedTwitter #tweetiatrician
I am currently at home in isolation with (mild) COVID. I’ve been thinking about why kids & teen COVID vaccines AND BOOSTERS are really important, right now. Here is my long 🧵:

Pediatricians deeply understand risk/benefit of vaccines. As a peds ID doc, I see kids who fall through the "prevention cracks" including immeasurable suffering from severe tetanus, measles pneumonitis & SSPE, chickenpox encephalitis, pertussis, meningitis, and now COVID.

Situations of telling a gasping teen to “lay prone” are vaccine-preventable. This pt was also alone, because her parents were at home, also sick w COVID pneumonia, and too ill to accompany her on hospital transfer. They were all previously healthy and unvaccinated.

A small-town hospitalist called me about a different teen patient with COVID pneumonia & high oxygen needs. We discussed possible transfer to our hospital (2 hrs away). The challenge? Dad also hospitalized in ICU…

If teen was transferred, Mom must decide: stay w critically ill husband, or go to Portland with daughter? Of note: Mom was the only vaccinated person in family. Other note: this teen also had no underlying conditions.

Some are obsessed w post-vax myocarditis, saying this risk *alone* means withhold vaccine to all kids/boys. Believe me, I was worried about this too…I'm one of the peds who reported 1st non-military myo cases in the US. We didn’t hide it. Our mission is to preserve child health.

Yes, myocarditis is now an established vaccine side effect, but fortunately rare & with a really good recovery. Millions of teen boys have rec’d mRNA vaccine. Not one confirmed post vax myocarditis death. Meanwhile, over 1,000 peds COVID deaths in US, and 30% MIS-C are teens.

Pediatricians KNOW vax benefits & our lens is wide. Some anti-vax docs say that vax / boosting children is not a priority and risks outweigh benefit, because peds hospitalization rare *or* solely b/c of the myocarditis risk. This is a narrow-minded conclusion! SO MANY BENEFITS:

DIRECT CHILD BENEFIT: Peds hospitalizations are skyrocketing RIGHT NOW. Vaccination will decrease severity and hospitalization risk. Boosters will help protect from this immune-evading variant. The pediatric COVID case denominator is surging...more hospitalizations will follow.

PREVENT MIS-C: Sure, a kid may have “mild” or even asymptomatic COVID. But MIS-C is unpredictable and scary as shit, and some of those kids have the worst heart function that I have seen in years…

MIS-C pts can require multiple IV drips to maintain BP and heart muscle function. 55 kids have died of MISC in US. In contrast, my teen patients with post-Pfizer myocarditis have recovered quickly, sometimes w NSAIDS alone. Note: 10% of reported MIS-C cases have been age 16-20.

Another note on MIS-C: There have been teens who had 2 doses of COVID vaccine, developed breakthrough mild COVID many months later, then MIS-C! Argh! So, a 3rd dose will decrease risks of *both* breakthrough COVID *and* subsequent MIS-C.

PREVENT LONG COVID IN KIDS: Our Children’s Hospital now has a multi-disciplinary Pediatric Long COVID Clinic, as a response to influx of community pediatricians' referrals. We might be seeing the tip of the iceberg. Time will tell.

PROTECT PREGNANT WOMEN: Did u know that the primary reason kids get rubella vax ("R" in MMR) is to protect fetuses?! Rubella is a mild illness w fever & rash. BUT rubella while pregnant is terrible: Spontaneous abortion or fetal congenital rubella syndrome which is devastating...

Routine MMR vaccination is a proven vaccine strategy to protect pregnant women from rubella. Similarly, we should vaccinate Moms AND children (thus, prevent COVID transmission to pregnant moms as best possible), in order to protect fetuses from placentitis & stillbirths.

PROTECT IMMUNE COMPROMISED: Kids & teens do not live in a silo. Family members may be immune compromised. My close friend is currently on active chemo, and a mother of 6. They have been first in line for every vax & booster, because she knows that she’s at risk of severe disease.

Again, we should be doing everything we can to prevent children and teens from transmitting COVID. Omicron is incredibly contagious, and we need to create a forcefield of immunity around those who do not have expected immune response from vaccination!

PROTECT THE OLDEST: ~60% of 65+yrs are boosted. Yes we should encourage boosters…for ALL eligible, both elderly & kids. Did u know that pneumococcal disease decreased in the elderly, once we added routine Prevnar vax for all kids <2yo? So cool. Let’s try the same w COVID vaccine

PROTECT THE YOUNGEST: Infants are too young yet for vaccination. But infants are being admitting w COVID bronchiolitis, febrile seizures, resp distress…please cocoon these babes w a vaccinated household! We already follow this strategy with flu and pertussis vaccines!

KEEP KIDS IN SCHOOL: Do you want classrooms open? Me too. Tweeting & yelling “keep schools open!” isn’t enough. A highly vaccinated population of students + staff can help decrease transmission. Omicron is causing breakthrough disease, so boosting must be part of this strategy…

Add a mask requirement, and you’ve got an even better shot at decreasing classroom transmission. My kids attend high schools where >90% of students and 100% of staff are vaccinated, and all are masked. Principals encourages boosters for all who qualify. No plans to close school!

KEEP KIDS HEALTHY: You know what? Plenty of kids out there don’t want to get COVID. Ask them. We keep talking about what *we* parents, doctors, community leaders want for our children. Our kids are not dumb. They are living thru a pandemic too…

They know of the suffering and death. They are not ok. They know people with long COVID. They also know that vaccines can decrease their risk of sickness, allow them to stay in school/sports, and boosting lowers Omicron risk.They’re listening to the radio, TV, & conversations too

VACCINE + MASK: YES they are an important layer of protection for kids! NO they are not harmful! And NO toddler-sized N95 masks do not exist. And YES even if they *did* exist, kids will pull them off their face…just like adults do…because they’re uncomfortable as hell!

Signed,
Every pediatrician I know, including me. /end