Vaccines vs Variants: our winter COVID Q&A edition
It’s been just over a year since the first confirmed case of COVID-19 arrived in the United States. In the last thirteen months almost ½ a million Americans have lost their lives to this virus.
Let’s just take a breath and sit with that for a hot second.
Imagine if when we all went home last March if someone in Public Health leadership in the US had prepared us for this, if someone had told us the truth of what we were both individually and collectively facing. I believe that at the very least we’d have managed our own anxiety and resources differently. At the most we’d have known how to calibrate our expectations and that sense of constant pivot and reset that so many of us have been living through might have been slowed. Who knows, it doesn’t really matter. This is where we are today. Where we are heading and how long it will take to get there remains unclear.
This piece is being co-written by myself, Sera Bonds, and my superhero Pediatrician husband who cares for kids with special needs, Adam Rosenbloom. I am an activist and social entrepreneur. We both have backgrounds in public health and infectious disease, we met while getting our Master’s degrees in in Boston. I’ve worked in HIV/AIDS, Ebola, and Cholera prevention and Adam was the “bird flu guy” for one of the largest NGO’s in the world in Vietnam in the mid 2000’s when H1N1 was the scariest thing we had to contend with. Those were the days.
This is our 2nd one of these articles we’ve collaborated on. We’ve been collecting questions from friends and family members over the last week and are compiling them here. Like we did in the last article we wrote, we will provide a deeper dive to the topics folks expressed interest in at the top end of the article and direct answers to the questions in a Q&A section that is at the end of the article. We invite you to consume this piece of media in whatever way you’d like.
Why the Clintons invented COVID + how conspiracy theories got us here
Americans seem to have lost our ability to critically process information. Our ability to discern, to reason, to fact check is broken. I am not sure that spending much time on who’s fault that is will be helpful right now but I will assert here that it didn’t just happen with the last administration. Conspiracy theories have been distracting and misinforming us long before a certain public official now banned from Twitter took our attention span away.
That said, some of the advice that we offer discerning folks like yourself when you are trying to determine how to consume media, process information, and assess what risk really means right now is to choose THREE scientific media sources and get your updates there. To not allow yourself more than 15 minutes of COVID related news a day and to trust that all of this is enough.
Our three sources, if you are curious are:
Overwhelming yourself with too much COVID related information does not make you more safe. Be careful about what media you expose yourself to, limit your exposure, and get on with your day.
Mommy, My Eyes Hurt and Other Screen Time Related Tales From The Trenches
We are parents of two tweens who’ve been home, attending public school in Austin where we live, from their bedrooms since March. We, like most of you, spent the first 90% of our careers as parents feeling quite smug in our ability to keep our kids off screens and video games. Then, also like you, we were all sent home to shelter in place a year ago and well, the screens are winning.
We firmly believe that also like you, we are doing our best everyday. Some days will nail it: healthy meals, everyone gets outside to move their bodies, all of the assignments get submitted through the endless number of online platforms the kids are now proficient at navigating, and we even read these items printed on paper left over from a previous lifetime called books. Other days at least one of us cries in a closet, people swear at each other, we eat Oreos for breakfast, and the end of the day finds all us still on our screens seeking comfort and satisfaction.
Parents, you are doing a very hard thing. Your kids are doing a very hard thing. We need grace, not judgment, and we need encouragement, not dogma.
The manta that we’ve adopted in the last few weeks of quarantine Groundhog day is that someday they will be busy again and the screens will not be what drives them. Someday they will have in real time social interactions at places like soccer games, sleep overs, summer camp, and band practice. For now, the screens are the way we remember that there is a world outside of our bedrooms that are now our classrooms and offices. Our screens bring us to each other safely and in this way are a gift. Let’s see this for what it is, a season in our lives, not the totality of them.
Let’s give ourselves and our kids some grace around this.
Go build yourself an island on Island Crossing, learn to play Minecraft, or watch another round of Schitt’s Creek. You are doing a great job, parents. The goal this year is simply to survive. Everything else is gravy.
How To Manage the Boomers
We, the authors of this piece, have baby boomer parents who run the full spectrum of practicing the suggested COVID safety practices and who are now trying to navigate the COVID vaccine race. Many of us GenXers and Millennials are getting our first glimpse at what it will be to full time caretakers to these parents of ours who refuse to admit that aging is happening.
We are a sandwich generation caring for the whole freaking world it feels, somedays. From the barrage of text messages about have I heard about this idea of anti-racism, that sounds like something that I might be interested in, to the emails sent to us with no warm and fuzzy copy just a link about gaining weight in middle age that seems to imply that I should be concerned about that, we are seeing our own parents often succumb to the lack of critical thinking that got us all into this pandemic mismanagement to begin with. They seem unable, often, to determine how to gauge COVID related risk and are having trouble navigating the complicated online vaccination registration forms.
Our Baby Boomer parents need us, the generation of folks learning how to care for them as they need us more and more, to meet their inquiry with grace, humor, and patients. And given how stretched we feel after a day of endless work related zooms while managing our kids at home all day this is harder and harder to do each day. Also, we are worried about them in ways that are new to many of us who’ve enjoyed mostly fit and independent parents refusing to be boxed in by titles such as “Grandma” opting for the hipper titles like Nana, Mimi, and Gigi, who get in their steps everyday, and watch what they eat. We are worried about them and that, too, is exhausting.
The good news is that in the coming weeks as the online vaccination programs roll out it should become easier and easier to register. That said, these Baby Boomer parents of ours will still need help with the risk mitigation that they, and all of us, need to remain vigilant about as herd immunity expands to protect more and more of us.
This is our trial by fire as adult children in our training of how to become caregivers. You are not weak or selfish in your internal dialogues about how hard this is and how you’d rather be doing other stuff. This is, however, our job. In addition to the countless others that we have during pandemic days. Remember the times that they sacrificed for us. The soccer games, the swim meets, the Saturday mornings when they wanted to sleep in but didn’t. Remember all that they went without so that we could be living these lives of ours now. We are getting a glimpse into the caretaking that awaits us when they get sick, when they fall, when a scary diagnosis is revealed. Take notes about what is hard about this for you and get a plan together for yourself so that you, too, can be cared for while being a caretaker.
It’s the least that we can do for them.
The Mothers Are Breaking
This is Sera writing now. I am a small business owner who is also the primary zoom meeting, pod coordinating, and administrative (there are SO many school emails now) manager for our kids. I am one of the millions of women who has lost income, career opportunities, and too much sleep as I try to be everyone to all of the people in my life right now. This is not because Adam isn’t a tremendous father and husband, he is. He was not socially conditioned to carry it all like girls and women are so he doesn’t. But we, the mothers, we do, and it’s breaking us.
Writers and researchers much smarter than me have said this more eloquently so I will not belabor this here but it would also be negligent for me, as a public health professional, not to state clearly that I am worried about us, the mothers.
My BFF is the Director of Early Childhood at The Institute New York Early Childhood Professional Development Institute and wrote this article based on a text I sent to her earlier this week when I was excitedly preparing to get my 2nd COVID vaccine shot because it meant that I was going to lie in bed all day and get a break. She wrote The Moms. We are slowly Breaking, and I encourage you to read it.
We do not have to carry it all. Period. Especially not now. This does mean that we have to face the reality of this bullshit sales pitch we all seem to have bought into about having it all. I call bullshit. We can’t. You can’t. But we can have what we need and even some of what we want. Move that bar way, way down. Down to where you are eating, sleeping, working, breathing, and hopefully laughing, a bit everyday and keep it there. Everything else, truly, can wait.
No one else is going to put down your burdens for you. If you do not want to carry it all, then don’t. What a powerful way to model what a mother is for our kids: put down the stuff that is too heavy on the days when carrying it it all is hurting you. Don’t be mad about having to do so. Just put it down. The world will keep spinning and you will feel lighter. Everyone wins.
Q&A section
Q. Can we plan a 2022 holiday blow out with our family or is that wishful thinking?
A. Hopefully! We are planning a Bar Mitvah for 2022 so we are right there with you on this one.
Q. What do we know now that is good news?
A. This month in the US the number of folks who are vaccinated passed the number of folks who’ve been diagnosed. We know that we can’t get COVID from take-out food. We know that most of us who get sick will recover. We know that we can do hard things, in fact, we are doing them right now.
Q. What are the risks, if any, to getting it while pregnant?
A. Pregnant women are more likely to have severe disease from COVID19 compared to COVID19+ non-pregnant women of reproductive age. Risk factors associated with severe disease or ICU admission included age ≥35 years, obesity, hypertension, and preexisting diabetes.. The risk of miscarriage does not appear to be higher. The chances of delivering preterm appears to be 2 percent higher than non COVID+ pregnant women, and the chance of C-section appears to be about 3 percent higher than non COVID+ pregnant women.
Q. What is the minimum age for the current vaccines?
A. The current FDA Emergency Use Authorization for Moderna is age 18 and for Pfizer age 16.
Q. Risk of taking the vaccine when one is still in the “long haul” state having been sick with COVID?
A. Doctors are still researching why the “long haul” phenomenon occurs, and the CDC has not yet released guidance on whether these patients should receive the vaccine. The current recommendation is to discuss this decision with your personal doctor. It’s likely that as more of these individuals receive the vaccine anyways, we’ll have more data about how it will affect their long haul symptoms.
Q. How safe is it for kids to go to school when the teachers have been vaccinated?
A. This decision remains a personal risk benefit analysis for each individual family, and for whom this decision is safe for. Recent guidance from the CDC is that in general, children going to school is safe for the community, as evidenced in research that in person schooling is not currently driving community COVID cases. In general, the risk remains low that children, especially typically healthy children, will develop severe disease. Families must make decisions also taking into account other family members in the home that may be exposed to transmission from children, especially if those family members have risk factors for severe disease, such as advanced age, obesity, diabetes or high blood pressure. The risk to teachers will be dramatically lower once they can get vaccinated.
Q. What do we know about transmission from parents with vaccinated status to kids that they live with who are not vaccinated?
A. We still don’t know, but in theory, a vaccinated person can still spread the coronavirus. First, the vaccine is not 100% effective, and there is still a 5–10% chance that a vaccinated person can become “infected” and contagious. Importantly, the chances of a vaccinated person developing severe disease are also dramatically lowered. Second, simply put, the vaccine does not kill or destroy the virus if you are exposed. It simply trains your body to successfully fight off the virus so you do not get sick. Some animal studies have shown vaccinated animals can still shed the virus, though for a shorter amount of time. In short, vaccinated people need to continue to practice mask wearing and social distancing.
Q. Thoughts on efficacy and mutations?
A. This science is still coming in and is likely to continue to do so over the spring and summer as the new strands spread and we study it. The thing that we can do about this, individually, is that if the vaccination is available to you please get it. The more folks who can no longer play host to the virus means that that is one less opportunity for a mutation to occur and spread. Regarding efficacy, we are still learning about that, also, regarding the protection available when a body is vaccinated. Looks that the two vaccines available in the US have a 90% efficacy for the basic COVID virus, and regarding the mutations, well, the science just isn’t in on that yet. Stay tuned!
Q. Do I need to upgrade my masks based on the new mutations?
A. We do know social distancing reduces the risk of transmitting the virus by 90%, and wearing masks decreases the risk by 65%. Continuing to take measures to incrementally reduce the risk of transmission to protect yourself, your loved ones and your community is always encouraged. As the new variants are more easily communicated ensuring that when we are out that we are wearing triple layered cloth masks or a N95 should be sufficient.
Q. How low risk are outdoor settings, truly?
A. Studies have shown that indoor transmission is 19 times more likely than outdoor transmission, but the chances of outdoor transmission is not zero. Outdoor transmission, by some estimates, accounts for 10% of new cases. In general, factors such as duration and frequency of personal contact, lack of personal protective equipment, and occasional indoor gathering during a largely outdoor experience were associated with outdoor reports of infection.
Q. What is the vaccination rate that we are aiming for?
A. 100% of the eligible population, but experts suggest that reaching 80–90% of the population can achieve “herd immunity”.
Q. Are the low vaccine appointments due to poor logistics? Low inventory?
A. All of the above and they are improving. The roll out is going well given that we’ve never done anything like this in the US before in the modern era. Patience and diligence is required of all of us. This is not an instacart or netflix situation, vaccination programs don’t happen overnight. This is more like training for a marathon that requires us to check lists everyday, continue to stay vigilant in our exposure practices, and stay the course.
Q. Will there be seasonal boosters moving forward?
A. Maybe, that seems like a very likely outcome.
Q. What changes (or not) when all the adults in our circle, but not the children, are fully vaccinated
A. Increased peace of mind that the vaccinated adults are not likely to get sick. Nothing else.
Q. My grandpa just got a call from the state of CA informing him of his positive test also being positive for a variant specific to his county. They noted he was 1 of 4. I attempted to google what they mentioned, but how do we keep track of these strains and how do they start?
A. New strains occur because the virus is mutating. Viruses (and humans) mutate all the time. Nearly all of the time, mutations do not confer an advantage. But when they do, such as allowing the virus to become more contagious, or spread despite a vaccination, Darwin takes over and they become more dominant in the population.
Only about 1.5% of cases in the US are sequenced for strains. Even this low amount of sampling can provide scientists with information of predominant circulating strains. As we learn more about these strains, their susceptibility to current vaccines, their transmissibility and their potential for severity, we can be more informed about making good public health recommendations.
Q. Tiny kids going to daycare/school, can they take stuff (blankets, stuffed animals)?
A. Talk with your daycare school about their policy. It’s probably best that children have “home” stuffies and “school” stuffies that stay at school.
Q. Why did the Clintons invent Covid?
A. To cover up a satanic worshiping scheme to shoot laser beams at California from space.
Q. How to quarantine in your house when you’ve tested positive/been exposed but your family has not?
A. If possible, put the exposed person in a bedroom and bathroom by themself. Everyone needs to be masked until they have been symptom free for 72 hours. Lots of hand-washing, keeping away from each other, and resting because this is hard and stressful and we need to care for ourselves.
Q. Is it unethical for me to get a vaccine when others who are more at risk are unable to get one?
A. If we all enjoyed the reality of living in a country where equity was the foundation of public health programming then we would not be faced with this question . We do not. Most of the people who’ve died of COVID related complications in the US are Black and Brown demonstrating that we do not all experience this virus in the same way.
If the vaccination roll out had been designed to prioritize those most at risk, then the Black and Brown members of our communities, along with teachers, food service workers, and public workers, would be at the front of the line. We all know, however, that this is not what is happening.
If a vaccine is available to you, please get it. The more people who get vaccinated means that there are fewer bodies where the virus can mutate, thus spreading new variants. This is not a situation where passing on a vaccination so that someone more “deserving” can get it. That is not how this works. This isn’t like a scholarship program or career advancement. This is about beating a virus and for this we need as many bodies vaccinated as possible.
What we can all do is volunteer to help Black and Brown folks who don’t know how to find appointments, find them and sign up. We can volunteer to staff vaccination sites in underserved communities. We can give money to organizations working to reach Black and Brown people with vaccinations. We can continue to do our own work on our implicit bias, to give reparations, and to be better allies by listening. We can vote. We can wear masks and practice social distancing. These things all help to keep Black and Brown people safer.
