On Sept. 29, 2021, The Children’s Museum hosted a panel of medical experts to discuss parents’ concerns surrounding COVID-19 so you can make informed decisions for your family. You can watch the recording of the conversation here.
Moderated by our own Chief Information Officer Kathy Mathena, RN, MSN, this powerhouse panel was made up of these experts:
- Dr. Virginia Caine
Director of the Marion County Public Health Department
- Dr. Elaine Cox
Chief Medical Officer at Riley Children’s Health
Associate Professor of Medicine, IU School of Medicine, Infectious Disease Division
- Nir Menachemi, PhD, MPH
Chair of Health Policy and Management Department of the Indiana University Richard M. Fairbanks School of Public Health
Scientist at the Regenstrief Institute
Below is a list of the questions that were asked along with a summary of answers provided by the experts on our panel. We hope these answers to your questions will give you the tools you need to help keep your family healthy.
Children and COVID-19
How long do antibodies last in children after they test positive for COVID-19?
What we have found continues to evolve. Most of the data we have about antibodies in children comes from Duke University. In those studies, they saw positive antibodies in children as far as seven months out. We think that is going to persist, much in the same way as it will in adults.
What we’re seeing in children is that they have good antibody response that persists, even if they had a mild case of the disease. So those young immune systems are reacting really well, and we expect their antibodies to last for months and months.
The one thing that is really important to remember is that there are multiple arms of the immune system.The arm that makes antibodies is only one part of it. There are other parts of the immune response that are also protective that are stimulated from the entire process of being vaccinated. We feel that the protection from the vaccine is very good in protecting all people—including children.
What’s the rate of children getting COVID-19 under the age of 5?
Data about children under 5 was not readily available for this panel discussion. In August 2021, however, school-aged children were one of the largest groups of people with cases—diagnosed infections—in the state of Indiana. In August, approximately one in three cases was a school-aged child. In September, it is down to about one in four cases. We believe the mask mandates in most schools slowed down the infection rate in school-aged children. That’s a good thing.
But we also know that children can get really sick. It happens less often than in an adult, but more than 1,600 children in Indiana have been hospitalized for COVID-19 since the pandemic started. About a dozen of them have died. While a small number of them have died, we do know that children can also succumb to this disease. That’s worrisome.
Generally, COVID-19 isn’t as serious in children as it is in adults, but that doesn’t mean there isn’t a risk of really serious illness and even death among children.
Stats from Riley Children’s Hospital in Indianapolis as of August 2021:
- 361 children hospitalized due to COVID-19 in the pediatric unit. The great majority have been between 10 and 17 years old. A few have been younger than 5. Those who are younger than 5 are usually very sick.
- A child’s average length of stay at Riley due to COVID-19 has been about six days, but 60 of those patients have stayed in the hospital longer than 10 days.
- The longest a child has been in the hospital at Riley for COVID-19 is 58 days.
- A small percentage of children with COVID-19 get admitted to the hospital. But when they are admitted at Riley, they are very sick.
Since the vaccine isn’t available for children less than five, it’s really important that everyone who is eligible to get the vaccine gets it. We call that cocooning, where very young people who are not eligible for vaccination are protected by decreasing the amount of COVID-19 they will encounter.
This is the first year of the pandemic when we see the new cases in our children outnumber the adults in Marion County. Last school year, we were averaging anywhere from three to six cases a day on a seven day average. Fast forward to the beginning of this school term and we’ve been seeing an average of between 20 and 25 cases per day in the seven day average for 0–5 year-olds. It’s still the lowest age group in terms of cases, but it’s still significant. The Delta variant is much more contagious than what we had last year. The different mask requirements in the schools have also had an impact.
“How can I talk to my child and answer COVID-related questions in an age-appropriate way?”
Children hear everything and they absorb it. They try to piece it all together—frequently through play. We’re starting to see children playing games about having COVID. That’s how they process information. Try using a doll or a teddy bear to discuss how infections happen. This can work very well with children.
Stick to conversations like this:
- "Sometimes, people get germs. And when people get germs, sometimes they share their germs. The way we don’t share our germs is by covering our mouth when we cough, washing our hands, and wear your mask. We do that so we don’t get sick or make others sick.”
- “When people get sick with this germ, they have to stay home until they get better. We can’t see them while they are getting better.If they get too sick, they’ll go to their doctor. Their doctors will do all kinds of things to help them get better.”
Kids know all about vaccinations. They get about 18 vaccinations within a period of a couple of years. They understand that you get those shots to keep from getting sick.
- “We just have to understand how this shot works in a little person’s body and find out if it works the same as it does in an adult’s body. Doctors are studying that and you will be able to get the COVID shot as soon as we can. Because we want to keep everyone safe.”
For parents, it’s important to know that children are considered part of the vulnerable population category when research is conducted. We are extra-careful about children being enrolled in clinical trials and managing their safety profile. There are certain populations where, because of their age or other vulnerability, we know we have to be extremely careful. In all things, we go above and beyond when it comes to studying these things in children.
It is important to include your child in COVID-related conversations. They are hearing about it in school—even preschool. Their friends are talking about it. Without information, children are frightened. Having them talk through what would happen to their teddy bear if they got sick is often very effective.
Children and the vaccine
"I have a 12 year-old child and we’ve been very compliant with CDC guidelines. We are nervous about the vaccine. What information can you share to help ease our concerns?"
We’re always very nervous about the treatments and the things we expose our children to. That is understandable.
We have hundreds of millions of data points from this vaccine across the world. Historically, there has never been a clinical trial that has this much information. The difference between 12 and 16 and 21 isn’t very different. What we do expect is that young immune systems will have a good response to vaccination. Children are a population that we have vaccinated for many decades.They have done very well.
When you consider the hundreds of millions of doses that have been given, the amount of side effects we’ve seen with this vaccine is extremely small. Yes, there have been reports of myocarditis—heart inflammation—what you see in this very small amount of children who get those side effects is much less than the myocarditis we see in children who actually get a severe COVID infection. In addition to the rarity of all of those side effects that are being reported, they’re also very attenuated, meaning they are very weak compared to those same effects of getting the natural virus. While these side effects are worrisome, the COVID-19 vaccine has been found to be very safe and extremely effective, especially if your child has any other health issues or concerns.
There are very few downsides to this vaccine. Most people focus on the risks of vaccinating, which are very small; and when they do occur, they’re treatable and go away. On the other hand, by not vaccinating you risk getting a very serious illness that could result in death. Even in the best-case scenario where you get a mild case of COVID-19, side effects can lag for months and months and can have unknown effects on brain fog, being able to focus, and all of those other things that we do know occur, but don’t even understand yet why they occur with people who are unvaccinated. When you put all of that into the basket to weigh your decision, there’s no question.
Some of the “long-haul” effects that we’ve seen with the COVID disease have not been seen yet in those that had the vaccine. Even if you are unvaccinated and get a “light case of COVID,” it doesn’t mean those effects won’t be with you for a long time. What we’ve seen with the vaccine is that only the positive effects of protection stays with you for a long time.
Think about vaccines no differently than you think about seat belts or car seats for children. Yes, for a little bit of time, you could probably get away without using them—even though everyone knows you’re supposed to use them. But why take that risk? If more people took that risk, more children would die. One of the leading causes of death in children is car accidents. And one of the easiest ways to prevent those deaths is with seat belts and weight-appropriate, age-appropriate car seats. Vaccines are the same way. They help prevent deaths. Why take a risk if you don’t have to?
“I would recommend vaccination without hesitation.” - Dr. Cox
“My job is to do the research, to scrutinize the data, to understand what the implications are and my family has made the decision (to have their 11 year-old vaccinated as soon as she is eligible).” - Dr. Menachemi
“I would strongly encourage anyone to get their children a vaccine. This is probably one of the most effective tools to protect your loved ones.” - Dr. Caine
“I heard that only 2,000 children have participated in vaccination trials. Is that enough kids for us to understand how it works in younger people?”
When it comes to new drugs, vaccines, or interventions, we don’t have more than a few thousand participants. This is a little different because of the worldwide concern. As a result, tens of thousands of adults have participated in studies. When we got to the younger age groups, we had less, but we also did additional studies comparing the younger kids with the young adults, to see if their bodies were responding differently. We got some really good, really reassuring information that the 12–18 year olds were behaving in a physiological perspective almost the same as the 19–20 year olds, who were part of the adult trials.
We are not leaving any stone unturned with our younger children. This is too big of an issue, too big of a concern, and too dominating of a topic to mess this up. Don’t focus on how many people are in the trial. There are additional studies above and beyond what we usually do because this is a worldwide pandemic.
In the United States, the rigor around any new drug or intervention is really the most significant in the world. The first phase focuses on the question, “Is it safe?” The second phase asks, “Is it effective?” It could be the most effective thing in the world, but if it’s not safe, we’re not going to use it. That’s how the U.S. approaches all new interventions.
At any given time, children are a small percentage of the overall population of the world because they do grow up and move into the “adults’ category. Many things that we use in children are based off large adult studies that are repeated in a smaller number of children than the amount of adults that were in the original studies. When you see that the results are very similar—or even the same—then you can say that the adult data also applies to children.
There are many discoveries and things we’ve done for children that have saved lives and transformed care in children that has to be based off adult data.
“How do we have confidence that we aren’t going to see long-term effects on children who have received the vaccine?”
We know that if you are unvaccinated and get COVID, you can have long-term issues. The way new drugs, vaccines, and therapeutics are studied with the rigorous approach described earlier, assures that we don’t have surprises down the road.
Is it 100% perfect, always, every time, ever? Someone can always find an example from the past where the system broke down and like to use that as an example. In almost all of those cases, it was a fluke. Can a fluke be possible now? Yes. But people who are getting the disease and recovering are immediately showing symptoms that last for a very long time. There is no zero-risk activity on Earth. People have to make a decision for themselves because they cannot protect themselves from random events that might happen. Every medication we take has the potential of side effects.
The absence of sufficient evidence to say that everything is safe under all circumstances is not a reason to say, given the risks and benefits that we know, it’s not important to move forward. People’s minds can play tricks on them sometimes. Some people argue that we shouldn’t use the vaccine because there was never a study conducted about reproductive health. Well, we also never conducted a study on the long-term effects of the vaccine on ear lobe size. That doesn’t mean our ear lobes are going to grow in response to the vaccine.
As with anything, there are a lot of “What ifs” that could happen. But what we do know is that if you get COVID-19 and are unvaccinated, you can die from it right now. That’s just the reality. The risk right now of not having the shot is that you could die. If you survive, there could be long-term effects.
Who knows what could happen over time? We may stamp out COVID. We may have such great vaccination rates that this’ll become like smallpox and someone in the future may decide that we don’t need this vaccine anymore because we’ve whipped this down.
There’s always unknown in the future. Thinking about the extreme risk of serious disease and death right now outweighs any theoretical downside from the vaccine with what we know today.
Whenever there is a new drug or vaccine, the FDA requires the pharmaceutical companies to monitor its recipients in their every day, normal routines, to see if there are people who are having bad outcomes associated with those things. We have assurances in place that protect us against being surprised by such things.
“If I have a child who has COVID, but is asymptomatic, will it harm them to get the vaccine?”
No. In all of the children over 12 whom Riley has vaccinated, there have not been any reports of any long-term issues or any harms that they have had. When you think about the massive numbers of doses that have been given to people all over the world, we are not seeing any shocking or surprising harm from this vaccine.
People keep going back to the data from the initial trials. Inadvertently, this has become the biggest clinical trial that will ever happen. The massive amount of reports of ill-effects at any age are extremely rare.
Sadly, we do continue to hear stories of people who passed on the vaccine, became ill, and now it’s too late. No caregiver wants to be in that position.
There really is miniscule risk.
Adults and the vaccine
"Can the vaccine cause long-term reproductive issues?"
There’s no known way in which the vaccine can impact your reproductive system. If there were something theoretical and plausible, that would be different. But there is no known theoretical, plausible way in which it could happen. If there were, we’d be studying it and should be studying it.
"If you can still get sick after getting two doses of the vaccine and a booster, does the vaccine really protect you?"
Absolutely. When we look at the number of people who have died from a COVID-19 infection and even the long-term complications that can result, this vaccine is one of the most effective vaccines our country has ever created. The Pfizer and Moderna vaccines—the new messenger RNA vaccines—have a 95% effectiveness of preventing infection. It’s almost 100% effective in preventing death. It’s incredible protection.
With this new Delta variant that we’re seeing, you may have a form of infection, but it can prevent hospitalizations and can lower the chance of having to enter into an ICU. The Delta variant is a little bit more virulent and more contagious than the initial strain. It’s extremely important to protect yourself from the COVID-19 infection if you can. The vaccine doesn’t prevent COVID-19, but it certainly lessens the implications.
“Do you still need to get the vaccine if you’ve already had COVID-19?”
Yes. Studies show that having natural immunity from a COVID-19 infection, plus getting vaccinated, boosts your antibodies almost 100-fold and has a much longer lasting effect on immunity. The combination of the two has greater effectiveness than either one alone.
Think about it. The first time you get it, your body says to itself, “Oh. This wasn’t such a great thing. I’m going to try to remember this.” Then you get the vaccine and it’s like redoing a lesson in school. Your body says, “Oh! I’ve seen this before! I know this! I’m going to get an even better response to this so I can just stop it in its tracks.” It kind of grows on itself that way. It is super-protective that way.
“Can vaccinated people still carry or transmit COVID-19? If so, why wouldn’t vaccinated people need weekly COVID tests?”
Yes, it is possible that someone who is vaccinated and becomes infected can spread it further. But they are much less likely to get infected in the first place. They’re also much quicker to get over the infection, so there’s a much smaller window in which they are infectious.
Vaccines are, first and foremost, designed to prevent you from dying or getting really, really sick. They are not designed to prevent you from getting infected.
Consider this analogy:
Imagine each of our bodies as a castle. You have drawbridges and windows and other elements to protect your castle. If there is a surprise attack from a new enemy that you are not aware of. If your castle is vulnerable—the drawbridge is down, the windows are open, none of the guards are ready to fight—any attack can have a devastating effect.
Do you remember what they called this when it first came out? We called it the novel coronavirus. It was a new enemy that no one’s body knew how to protect against.
So what the vaccine does is basically tells your castle, “Let’s be ready for an attack so that we can minimize the damage of the enemy and minimize the amount of time it takes to get rid of the enemy. We’ll have the drawbridge up, the windows closed, and we’ll be less likely to have the enemy come in. And if they do, they’re not going to go very far.” The vaccine prepares you with the lesson on how to defeat this enemy when you encounter it in the wild.
“If vaccinated people can still carry the disease, does that have implications on other precautions, like mask mandates and social distancing?”
Yes, COVID-19 can transmit, but it’s less contagious and there’s less exposure and less time for the virus to spread. With the Delta variant, we’re seeing breakthrough infections—getting infected, despite the fact that you’re vaccinated—we want to continue to encourage people that if you’re in an indoor public setting, it is critical to continue to wear a mask, regardless of vaccinated status.This is to help prevent further infections.
You’re still vulnerable. No vaccine has a 100% protection rate. Because this one has mutated and is a little different from the original strain we produced the vaccine for, it’s important to wear your mask. If possible, try to do as much social distancing of at least three feet—even outdoors.
A lot of the precautions you need to take also depend on the amount of transmissions that are happening in your community.
Right now, if you are vaccinated, you are almost certainly not getting hospitalized or dying. Yes, you might get infected with a breakthrough infection, but you’re not getting sick and dying. Right now, if you’re not vaccinated, some people are getting hospitalized and dying. The only way to prevent hospitalizations and deaths in the unvaccinated is to reduce the amount of spread in the community. The only way, other than vaccines, to reduce the spread is through masks, hand hygiene, and social distancing.
What about sporting events? We’re seeing a lot of outdoor sporting events with large crowds, no masks, and what appears to be minimal social distancing. We recently asked the CDC about this. They have not identified any potential outbreaks that have occurred in that type of outdoor setting. There is a constant airflow outdoors—even when it’s not windy. So you’re not just sitting there in a cloud of people’s exhalant. The chances that you will get infected are reduced. It doesn’t mean it’s zero. It just means it’s reduced.
“I wish I could take all of The Children’s Museum viewers on a field trip to just walk through what it feels like to work in a hospital right now. You have doctors and nurses who are physically and emotionally exhausted. They’ve been working night and day with around the clock shifts. Everyone has had a tough time with this, but frontline healthcare workers have had the rawest deal that the virus has wrought. And almost all of the patients that are the sickest of the sick in the hospital could have been prevented easily. And so, doctors and nurses, who devote their entire careers to try to make it so people are better off with their health, and there is nothing more demoralizing than having to constantly deal with things that are senseless.It shouldn’t be happening. We can prevent and not worry about, and move on to focus on other things. And we’re at the point now where we’re not taking in cancer patients or heart attack patients because we’re overwhelmed with COVID patients who can be vastly preventable. Masks are the only other way to keep the COVID patients from continuing to build up in the hospitals, where the staff cannot deal with them anymore. These are humans who have reached the breaking point of what’s reasonable, what professional training allows for, and we should never put anyone in our community under that level of stress. Masks are unfortunately necessary because vaccination rates are lower than they should be. Those go hand-in-hand.” Dr. Menachemi
“I had an allergic reaction to my first COVID-19 vaccination and have been advised not to get the second dose. Do I still have some protection from the first dose?”
You do have some protection, but it’s much lower. When you look at the efficacy of two doses of a 95% effective vaccine, your effectiveness is reduced to about 54% if you just took one dose. You have some protection, but definitely not the full protection that you would normally see. You would still need to be very cautious, maybe even to the point of considering yourself not vaccinated at all, and conduct your behavior accordingly.
“There’s a lot of discussion about a booster for these vaccines. Who should get a booster? Do they have to get the same brand as their first COVID-19 vaccinations?”
You currently cannot switch brands. If you got a Pfizer vaccination, your booster has to be Pfizer. The FDA and CDC have only approved a booster dose for the Pfizer vaccine. This booster dose is for those in high-risk occupations, in institutional settings, and is encouraged for those who are 65 years and older. People who have certain underlying medical conditions—including heart disease, diabetes, and chronic kidney failure—age 50–64 are also encouraged to receive the booster. People age 18–49 who are at high risk of getting COVID are also eligible for the booster. People age It is recommended that residents in long-term care settings receive their booster shot at least six months after receiving their second Pfizer vaccine dose.
Antibodies wane after about six months, that’s why we have the booster. It really enhances antibody production
"What is herd immunity?"
Viruses are interesting. This one learns quickly and it changes itself. Its goal is to infect as many people as it can. That’s what viruses do. After a certain amount of people in any group have either had the illness itself, or have gotten the vaccine, and you get to a certain level of immunity in a community, the virus will begin to dissipate—or weaken—because it doesn’t have enough hosts in which to live. That’s called herd immunity.
We’ve seen this over and over with viruses. We don’t see smallpox anymore. We don’t see nearly the amount of chicken pox we used to just a few decades ago. We know that in areas where the virus is controlled, the number of new cases goes down. We need to get enough immunity for that to begin to happen so life can go back to something not based around a pandemic. If we’re ever going to get ot herd immunity and knock this pandemic down, all of us to carry some of the burden of vaccination.
It’s Your Shot
On Oct. 5, 2021, The Children’s Museum will host a free COVID-19 vaccination clinic. You can find out more information here. Can’t make it to the clinic? Indiana residents can schedule an appointment here.