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COVID Update: Review of Scientific Studies · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

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I'm Holly Wehment, and this is Pediatrics Now, cases, updates,
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and discussions for the busy pediatric practitioner.
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Pediatrics Now is brought to you by University Health's new Women's and Children's
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Hospital and the Department of Pediatrics at UT Health San Antonio.
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Don't forget to click on the link in this podcast for free credit that may include
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CME, MOC, or ethics credit, depending on our topic or podcast.
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We're back today with a fresh interview, a COVID update, review of scientific
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studies, and joining me here on the podcast is a regular contributor.
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He's the first doctor to be double-boarded in neonatology and infectious disease.
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He's a contributing writer for Red Book and has a master's degree in public health.
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And that, of course, is Dr. J.B. Canty. J.B., thank you so much for being here
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today again on Pediatrics Now.
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Thank you for having me. Pleasure to be here. Tell us, what's the latest when
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it comes to COVID shots and kids? What does the science recommend?
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The recommendations have mercifully stabilized a little bit after a lot of changes
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back in the early days of the pandemic.
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And right now, the recommendation is still for all children to be fully vaccinated
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against COVID using the two different available mRNA vaccines.
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And so the current recommendation is to get two doses of one company's vaccine.
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So for instance, either Pfizer or Moderna.
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And then once those two doses are complete to get a crossover dose of the other company.
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So for example, if someone starts with Pfizer vaccine and they get two doses
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of that, they should then get a third and at least for the moment,
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final dose with the Moderna vaccine or vice versa.
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So when is it recommended that
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the kids get these vaccines? Is that now or starting in the fall or when?
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So the COVID vaccine is available all the way down to age six months.
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And at the moment, there's not a seasonality to it.
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Obviously, when the pandemic first hit, you know, that was mostly spring of 2020.
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And then we saw a couple of years of really chaotic seasonality where you could
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get COVID pretty much anytime, anywhere.
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The expectation is that over time, it will fade into a more predictable pattern
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where we see it year round, but more in the fall, winter, and early spring.
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But at the moment, you can get it anytime, anywhere.
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So JB, for example, my children were vaccinated in, it was around December, I think, this year.
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So a little late in the season, but when should they get it,
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their first COVID vaccine again?
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So for people who are fully vaccinated, at the moment,
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until another update comes out, and it's not clear when exactly that will be,
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where there'll be an updated COVID-19 vaccine, when the update comes out,
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there'll be a recommendation, most likely for a booster dose.
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In the meantime, for kids who are fully vaccinated, once they've had their three
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doses, they are off the hook.
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Okay, so to reiterate what you were saying, two doses of, say,
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Moderna, and then have a Pfizer one, a third one eventually. That's right.
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That third dose is a crossover dose for the other company.
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And that's because the antigens that the companies use, the proteins that the
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immune system is going to recognize, are slightly different between the two
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vaccines. So by getting three doses between the two companies,
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you sort of maximize your protection.
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Is that widely known to get three doses? I don't know that it is widely known.
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And this actually came up recently in my day-to-day clinical job where I mentioned that.
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And the person I was talking to kind of looked at me like I had three heads.
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So I'm not sure how well advertised that's been, the crossover.
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And it's also not clear that it's available to everyone. If someone has a primary
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care doc or a pharmacy that they prefer that only carries one strain,
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it can be a little bit challenging to go out of your way to get the other company's dose.
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But if you can, so say if you think your child is fully vaccinated,
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pediatrician listeners, to tell their patients, go ahead, as soon as you can,
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go get a third dose from a different type of vaccine if you can find one. That's right.
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And does it need to be spaced out a certain amount of time or do you want to
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say anything there in terms of these three doses?
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Say if a patient is talking to her pediatrician, the mom is saying,
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well, I haven't, my kids have not had a COVID vaccine this year.
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And then I was also going to ask if or what if you think your child's had COVID?
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Do you need to wait to have the shot? Or if you just don't know, go ahead.
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Maybe it was just a cold, then go ahead once the child's well and get that first dose.
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Yeah, I think that's a great question. If people know that they've been infected with the COVID virus,
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it probably makes sense to wait at least four to eight weeks after the infection
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to get to get the next dose of vaccine to provide the maximum sort of boost.
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And that's the recommendation for the vaccines as well, is that between dose
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one and dose two, they usually recommend four to eight weeks between doses.
5:26
Okay. Okay.
5:28
A lot of pediatricians told me this past season, a lot of families,
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their kids were getting the flu shot, but would decline the COVID shot for some
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reason. Is there anything you want to say about that?
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I think it would depend on why they're declining one versus the other.
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In terms of risk to children, and this is a little bit of a surprise to me that
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this is about to come out of my mouth, But I think where we are now in 2025,
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the risk of morbidity and mortality is actually probably higher with influenza.
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You know, flu can be really, really hard on children, especially younger children.
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And we see, you know, double or triple digit pediatric deaths every year nationally from influenza.
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So I have a healthy respect for flu.
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Not to suggest that I don't have a healthy respect for COVID. I certainly do.
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And we all had a national trauma just a few years ago. But as our vaccine rates
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increase for COVID and as the COVID-19 virus continues to attenuate,
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its severity is, on average, dropping as it cycles through the human population
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and becomes less and less of the killer that it was in 2020.
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So obviously, I would highly recommend people get both. But if people had to
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choose between one or the other, flu is probably the one that's the higher priority.
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But it is a logical fallacy that people have to pick one or the other.
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They're two different, very well studied, very safe vaccines that can be administered
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together. So there's really no reason why people need to be picking one versus the other.
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And again, it's okay to get them at the same time. Yes, absolutely.
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But if a family is hesitant or, but they, the pediatric practitioner feels like
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maybe there's hope to get one vaccine, then really focus on that flu shot.
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I think on average, yes. I think, you know, it obviously depends on where we
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are in the year, because if it's April, you know, COVID's probably higher yield
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because we see, we tend to see influenza during a relatively well-specified season.
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But on average, I think on a case-by-case basis, I think we're seeing more mortality
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from flu now than we are from COVID-19 in children.
7:40
And that is great news about COVID-19, but we're not out of the woods, Right.
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Absolutely not. And it's important to note that, you know, coronaviruses,
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of which COVID is just one of many, coronaviruses historically will do one of two things.
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Either they're so virulent and so aggressive that they literally kill their
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hosts faster than the hosts can spread the virus.
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And we see those viruses either burn themselves out or be very limited in terms
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of their ability to cause a pandemic because they literally burn so hot and
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so aggressively that they can't spread.
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And that was true for the first SARS virus that we now retrospectively called
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SARS-CoV-1, it killed people so quickly that they couldn't propagate it through the community.
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Middle Eastern Respiratory Syndrome, same thing. It tends to be so aggressive
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that those flares tend to be very limited.
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But there are a lot of other coronaviruses that weaken or attenuate over time
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and become a virus that just circulates the globe periodically,
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causing colds and, you know, and croup and upper respiratory infections.
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And there There's four or five common coronaviruses that we test for on the
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nasal swabs that people get at hospitals that were at one point fairly aggressive
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and then have settled over time.
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So my hope is, is that COVID-19, also known as SARS-CoV-2, is going to do that.
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But there's always going to be the next coronavirus. None of us are ready for that yet.
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But there's going to be at some point, five years, 10 years,
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20 years from now, another coronavirus pandemic with a new strain.
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And so people accumulating immunity to coronavirus, people getting their vaccines
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is going to help set them up for when the next one comes along,
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even if it's slightly different.
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Because I love how you said in our last interview with the flu shot or with
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COVID, each immunization that we get, it adds to our lifetime immunity.
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Exactly right. It's basically a library and we're just adding books,
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adding books every time as we live our lives, as we get vaccines,
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as we come into contact with these germs in real life, we learn them.
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And then next time around, it's one less thing where we have to start from scratch.
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I know you say it really well, where there's so much coming at the pediatric
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practitioner and when they don't have a lot of time to necessarily talk about vaccines.
10:06
But say if a parent says, well, I don't want something foreign put into my child's
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body, what do you recommend to say there? Can you give us a refresher?
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Sure. No, I think it's a valid concern. You know, we're literally talking about
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injecting something into our own children.
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But I would just reassure those parents that the immune system is beautifully
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evolved to handle millions and millions of antigens a day.
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And if you walk through an HEB and, you know, you touch the door and you touch
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a couple of cereal boxes and you pass a couple of people who maybe are hopefully
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coughing into their sleeve,
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you or your child is exposed to thousands and thousands and thousands of different
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antigens every day and the immune system just handles it.
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And so a vaccine, which might be five or 10 antigens, is a small,
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small drop in the bucket to what our bodies are meant to do just living our day-to-day lives.
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And even babies, when they're crawling around on the floor, everything they're
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touching, there's just, there's so much foreign substances getting into their
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bodies, but it's a good thing, right? That's exactly right.
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Yes, our bodies are meant to encounter new antigens and process them and file them.
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And we basically have a little FBI agency inside our own immune system that
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keeps files on absolutely everything.
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And so as we encounter germs, we take pictures of them, we dial,
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we catalog them, we memorize them.
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And then if that germ ever comes back with ill intent, our immune system is
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already 75% of the way to kicking its butt because it has a whole big, thick file on them.
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And to avoid vaccines or to avoid letting kids explore the world is just.
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Shortchanging their immune system from some of the advantages that we should be giving it.
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And when parents worry about the side effects of the vaccine,
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that really means the vaccine is working well if the child maybe wants to spend
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the day on the couch watching TV.
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That's right. So our body is meant to slow us down when we are processing new germs, new infections.
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And so if we get flu, we feel achy, we feel sore, we feel crummy.
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And some of that is the virus, but a lot of that is our body just saying,
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shh, why don't you lie on the couch and drink some chicken soup and watch black and white movies?
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Because you got to save your energy to fight this virus.
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When we get vaccines, we get a very small version of that where our arm might
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be a little sore or we might be a little achy or tired for a day or two,
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but that is nothing compared to what we experience when we get the germ for real.
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And it's 10 days of shaking chills and fever and nausea and everything else,
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as opposed to one day of not feeling 100%. And the last time we talked about
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this, that leads well into my next question.
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If we don't get our children vaccinated for the flu or COVID,
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does that mean we're not avoiding flu or COVID?
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That means they will get the full-blown, probably both of those, right?
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And what it means is that if and when they encounter flu or COVID,
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sorry, man, what that means is if and when they come into contact with the real
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virus, they'll be starting from scratch.
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They'll have no immunity, they'll have no protection, and they will feel the
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full force and fury of that virus for five, seven, ten days until their immune
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system catches up to where they would have started if they'd been vaccinated.
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And is it a high likelihood that kids will in the next year get the flu or COVID or both?
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I mean, unfortunately, yes. You
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know, flu season is variable from year to year, but it's never perfect.
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Like, there's always going to be flu every year. COVID's not going anywhere.
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Even though it's gotten weaker, it's certainly still very, very common.
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And so it's, you know, not every child is going to see both germs every year,
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but the vast majority of kids over the next few years are going to come into
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contact with at least one of those viruses, for sure.
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And an otherwise healthy kid could have serious side effects from especially
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the flu, but also maybe from COVID.
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Yeah, unfortunately, yes. I mean, you know, and this is where we always have
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to be very careful because I don't mean this to sound like scare tactics for
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families that are listening.
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You know, the majority of children who get flu are going to not feel great for a few days.
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They might miss a day or two of school, but ultimately they're going to recover.
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And same for COVID. You know, you don't feel great. You don't want to have it,
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but they're going to be fine.
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But one kid in 300, one kid in 500, one kid in 1,000 is going to have some sort of severe reaction.
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And for flu, it can attack the muscles. It can attack the brain.
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It can attack the lining of the heart.
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Like we see these rare but very serious complications of flu.
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And for COVID, same thing. We see not only the severe lung disease,
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rarely from COVID, but we also see the post-infectious syndrome,
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Where after kids have had COVID, they have basically an autoimmune reaction called MIS-C,
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which can affect the heart, which can affect the brain, which can affect other organs.
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And are the odds in each individual kid's favor?
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Absolutely. but there's three million
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people in san antonio of whom you know 700
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000 are kids so one in a thousand is still a lot of kids who are at risk for
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that rare but serious complication and if it if it's if it's one particular
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family's child the one in a thousand means nothing to them it's one and one
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for that particular family and so we want to protect anyone we can from that from that outcome.
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And you run the Okape Clinic at University Hospital for newborns born with diseases.
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How is it going in your clinic? It's, you know, we're busy.
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It's job security, unfortunately. You know, mostly what we see are infections
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that children are either exposed to or born with from the pregnancy.
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So, so mercifully don't see a lot of flu or COVID in that particular clinic.
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But we do know that COVID is perfectly capable of crossing the placenta.
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So it can infect moms who are unimmunized and get COVID.
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That virus can cross through the placenta and the babies can have COVID at the time of delivery.
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So even in that circumstance, we want to try to make sure everyone's immunized.
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Yes. So a lot of our pediatric practitioner listeners, they have,
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of course, pregnant moms as the parents of their patients.
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So can you tell us again, what is the advice there scientifically, bottom line?
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So the bottom line is that COVID vaccine is safe and effective during pregnancy,
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and it protects both mom and baby for the first several months after delivery
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because of mom's antibodies,
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mom's immunity, passing into the baby during the third trimester and shielding
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that baby until they're old enough to get their own COVID vaccine.
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And COVID can become serious for a pregnant woman who has a weakened immune system?
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Absolutely. So pregnancy is a wonderful time, but unfortunately,
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part of pregnancy is an intentional weakening of the T cells,
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the part of the immune system that specifically is designed to fight viruses.
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And the reason for that is when women are carrying a baby, that baby is only 50% genetically them.
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You know, the other 50%, obviously, is the father.
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And the body does not want to attack the fetus as a foreign protein.
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And so what the body does is it intentionally dials down the volume on the immune
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system, it quiets it down.
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And that protects the baby, but it also makes moms more vulnerable to severe
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complications of viral infections.
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And flu and COVID are right there at the top of the list, two infections that
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compared to any other healthy 20 or 30 or 40-year-old woman,
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a pregnant woman is at significantly increased risk for complications from those
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viruses because of the weakened immunity.
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Wow, JB, that's so interesting. I love the way you explained that.
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Thank you. What about if, say, in the fall, if these vaccines,
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either one or both, are not covered by insurance? What's your recommendation there?
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They should be covered by insurance because the cost benefit of vaccines is extremely high.
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So it's a lot cheaper for the insurance companies to pay for a $50 vaccine than
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it is to pay for a $30,000 or $50,000 hospitalization.
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So hopefully all the plans are covered.
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If not, then that's obviously a really tough situation. I would have to see
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if there are opportunities to get those vaccines for free.
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Oftentimes, the public health department or different hospitals or different
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organizations will organize vaccine drives to try to protect their employees
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or protect their students.
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So there may be an opportunity to get it for free with a little bit of creative internet searching.
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But my hope is that all insurance plans will recognize the benefits and continue to cover vaccines.
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I should also say that many, many children in the state of Texas can receive
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vaccines for free through the Vaccines for Children program,
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which is still going strong in terms of its funding and protection.
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And that's if you just look on the Internet, Vaccines for Children program and
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find out where to get, where is the closest location to get the vaccine?
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Yes. And most, a lot of pediatric and family medicine practices are very familiar
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with and enrolled in Vaccine for Children.
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So there's a high probability that your provider participates,
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and if not, they can probably help get information as well.
19:54
JB, can you remind us, when is too young to get the flu shot or COVID shot?
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When, ideally, should babies or children start getting these shots?
20:05
So both flu and COVID are approved all the way down to age six months.
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Younger than six months, it's not recommended that babies be immunized because
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the vaccines were not studied in that population.
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And for mothers who have received flu and or COVID-19 shots,
20:23
their antibody protection of the babies after a term delivery lasts for four to six months.
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So it's really right around the six-month mark that people should start thinking
20:32
about when and where to get their vaccines.
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And say if by chance there's not a new COVID vaccine that comes out this fall,
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and you've already had both Pfizer ones and then a third one from, say, Moderna,
20:48
then wait until a new one comes out? Right.
20:52
If there's no new booster, two or three doses of the existing vaccine gives
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very, very, very high protective titers.
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So there does not seem to be any benefit of a fourth dose of the same vaccine.
21:06
But if a new updated vaccine comes out with new antigens, then it would be beneficial
21:11
to get that vaccine when it's recommended.
21:14
And what about if a parent says, well, I think my child already had COVID,
21:18
so he or she has immunity already?
21:22
So we definitely see high titers after wild-type COVID infection.
21:28
Obviously, we don't want that for anybody, but that is an effective way to get protected.
21:32
Again, the proteins are slightly different between all the different vaccines.
21:36
There may still be some benefit to getting new boosters as they come out,
21:40
but the evidence for the importance of getting a COVID vaccine after you've
21:46
just gotten COVID is pretty murky.
21:49
And JB, what about summer travel? Should we be wearing masks on airplanes, in crowded museums?
21:56
What's your advice there when it comes to COVID and the flu?
22:01
So obviously a fraught topic. So there's definitely objective evidence that
22:07
wearing a surgical mask, So just the regular cotton loop mask that you can buy at, you know,
22:13
Walgreens can slightly but significantly reduce the risk of getting respiratory
22:22
viruses from other people.
22:25
So can people being judicious about not going out in public when they're sick,
22:31
about making sure they cough or sneeze in a protected way where you cough and
22:34
sneeze into your elbow or into your arm so you don't spray droplets everywhere.
22:40
Getting vaccinated, washing your hands well, especially before and after using
22:45
the restroom or before and after eating.
22:46
So there are a lot of tools in our toolkit.
22:50
There are many people who feel comfortable wearing masks.
22:53
Culturally, there's a lot of parts of the world that were masking before COVID-19,
22:57
and there's even more now afterwards.
22:59
People just have to make an individual decision about how big of an inconvenience
23:05
is it going to be if I get a respiratory virus on my trip versus how big of
23:10
an inconvenience is it going to be for me to wear this mask?
23:12
But there certainly shouldn't be anyone discouraging other people from wearing
23:17
masks if that's what makes them feel comfortable as they're out and about this summer.
23:22
But people also need to know that there's lots of things that can help,
23:28
especially hand hygiene, beyond just wearing the mask.
23:31
So if people really feel strongly about not wearing masks, there's other things
23:34
that they can do to keep themselves and other people healthy.
23:37
And sometimes it's not easy to get a teenager or child to wash his or her hands. No, it's not.
23:46
But encouraging that, it's a good battle to fight.
23:50
Absolutely. Hand hygiene, I always say with the students and trainees that I
23:55
work with in the hospital, hand hygiene forgives a lot of other sins.
24:00
So if you're just being good about washing your hands, even if you're not doing
24:04
everything else perfectly, hand hygiene is so, so important.
24:07
So keeping a bottle of Purell in your car or in your purse, hitting that Purell
24:11
when you're at a Buc-ee's or at a restaurant, it pays a lot of dividends.
24:16
And do it before and after eating?
24:20
Certainly before eating and after using the bathroom at a minimum,
24:23
but the more the merrier.
24:25
And any refresher on how long to wash hands and we should be using warm water and soap if available?
24:33
So great question. So if hands are visibly soiled, meaning if you can look down
24:39
at your hands and see dirt or, pardon my language, poop or anything else where
24:45
you're like, ooh, where did I get that on my hands?
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Then soap and water is ideal because you can
24:49
mechanically knock that stuff off if your hands
24:52
are visibly clean then there then there's really
24:55
no difference between soap and water or alcohol based products like purel so
25:00
whatever you feel comfortable with or whatever is easiest but if there's actually
25:03
stuff on your hands soap and water is a good way to get that off and then sorry
25:09
i forgot the other i forgot the other part of the question just is it important
25:12
to use warm water as opposed to cold water?
25:16
Oh, gotcha. No, it doesn't seem to make that big a difference for the water temperature.
25:20
By the time the water is heated up hot enough to really bother the bacteria,
25:25
it's probably going to be pretty uncomfortable to put it on your hands.
25:28
So whatever temperature of water is comfortable for you is probably the right answer.
25:32
And we heard a lot about this during the pandemics, but how long should we aim
25:36
to be washing our hands for?
25:38
How long of a process? The rule of thumb, And it's probably as good a one as
25:43
any is long enough to sing happy birthday through twice.
25:45
So if you ever hear people humming to themselves at the sink,
25:48
that's probably what they're doing.
25:49
But it's what it sounds like. So where COVID, as it's mutating, it's getting...
25:56
Less of a threat. But at some point, it's going to become worse, much worse.
26:01
Like you said, another pandemic five years down the road, probably.
26:04
Right. I mean, one of the unfortunate truths about both influenza and coronavirus
26:08
is the way that their genome works and the fact that they have so many animal reservoirs.
26:16
So, I mean, obviously, we all read more than we ever wanted to about pangolins
26:20
versus birds versus reptiles for COVID.
26:24
Middle Eastern respiratory syndrome is transmitted in part by camels.
26:29
So COVID, like flu does with birds and livestock, swine, cattle,
26:35
because they can jump in and out of animals, because they can rearrange their
26:39
genome, there's always going to be another big mutation coming.
26:43
And some coronavirus that looks totally different from COVID-19 is going to
26:48
infect humans again in our lifetime, and hopefully farther rather than sooner,
26:52
but it's coming for sure.
26:54
Depressing. Depressing, indeed. And it's one of those reasons that the safety
27:00
and efficacy of mRNA vaccines was one of the big silver linings of this COVID pandemic,
27:05
because now our ability to genetically sequence new germs and get vaccines out
27:11
that are safe and effective quickly is going to be one of the legacies of COVID-19.
27:16
So hopefully we have better tools next time around. J.B., it's such an honor to talk to you today.
27:23
Is there anything else you want to mention to the pediatric practitioner listener before we wrap up?
27:29
You know, I think one of the hardest things about talking with families,
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especially families maybe are hesitant or worried about, you know,
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as we've talked about on the show before, every parent who's vaccine hesitant
27:43
is vaccine hesitant because they want to do what's best for their kid.
27:47
You know, no one I have yet to encounter in my career, someone who is maliciously
27:51
withholding vaccines from their children.
27:53
They're trying to protect their kids. So I think one of the points to emphasize
27:58
is if you take the entire CDC vaccine schedule, you take all the diphtheria, tetanus, pertussis.
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Haemophilus, pneumococcus, measles, mumps, rubella, varicella,
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rotavirus, hepatitis B, hepatitis A, COVID, flu.
28:14
If you take all of those vaccines and squeeze them together,
28:18
it's less antigenic weight.
28:21
It's less material that the immune system has to process than one good run through a wheat field.
28:28
The body is meant to take in huge volumes of information and develop immunity
28:35
and develop protection.
28:37
And the vaccines are boiled down to the smallest sum of their parts.
28:42
And so if any parents are listening, it's the equivalent of being able to destroy
28:46
a tank because you happen to know what one screw on the tank looks like.
28:50
These are very, very small vaccines that children, even as young as six months
28:56
old, are very, I'm sorry, that was for flu and COVID.
28:59
Children as young as newborns are very capable of seeing and processing and
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adding to their library without risk of harm, without, you know, major downsides.
29:09
So just really, really, really want to emphasize that the entire vaccine schedule
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is a drop in the bucket to what children experience every day just living their lives.
29:18
Wow, that's an excellent point. And I so admire the pediatricians in the world
29:26
who are fighting the good fight and,
29:29
continue to talk about the importance of vaccinations with their patients because
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it can be so frustrating.
29:36
Yes, absolutely. And again, it's not a lot of time.
29:39
You know, it's so much to do in your average 15 or 20-minute appointment.
29:43
So I know it's hard and hopefully resources like this podcast will help.
29:47
But for parents who are listening, they're safe, safe and effective.
29:52
Yes. And we will have, for our pediatric practitioner listeners,
29:56
will have an episode on this with Dr.
29:58
Canty on Pediatrics Now for Parents.
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That's our sister podcast. It's meant to be one less thing you have to say in
30:05
the exam room, and it can be found anywhere you listen, or it can also be found
30:12
on PediatricsNowforParents.com.
30:14
We also have an episode on motivational interviewing in this news feed for Pediatrics
30:19
Now for the Practitioner, and we talk specifically about talking to the vaccine-hesitant parent.
30:27
Dr. Gercanti, thank you so much for being here today again on Pediatrics Now.
30:32
No, my pleasure. Thank you for having me.
30:36
Pediatrics Now is brought to you by University Health's new Women's and Children's
30:40
Hospital and the Department of Pediatrics at UT Health San Antonio.
30:43
Don't forget to click on the link in this podcast for free credit.
30:47
I'm Holly Wayment, and I'll see you next week. Thank you.