children COVID

All Children in Study Show Blood Vessel Damage from COVID-19

From the onset of the coronavirus pandemic, it became clear the majority of those most affected by COVID-19 infections were adults over the age of 65. The severity of the illness and deaths decreases in younger people. Many began to believe we didn’t have to worry about children when it came to the virus.

Children may be carriers and able to infect others. But many thought if they should become ill, in most cases they’ll exhibit either mild symptoms or none at all.

Dangerous misconception

Our concierge doctors want to warn you that this is a misconception. At least 120 children in the U.S. have died from COVID-19. And a new study last month at the Children’s Hospital of Philadelphia (CHOP) found a disturbing result of coronavirus infection in children. They found elevated levels of a biomarker (C5b9) related to blood vessel damage, even in those with minimal or no symptoms.

They also found a high proportion of children with SARS-CoV-2, the coronavirus that causes COVID-19, were also diagnosed with a condition called thrombotic microangiopathy (TMA). TMA leads to clots in small blood vessel. It has been linked to severe COVID-19 symptoms in adults.

“We do not yet know the clinical implications of this elevated biomarker in children with COVID-19 and no symptoms or minimal symptoms,” co-senior study author David T. Teachey, MD, said in a news release. Teachey is the Director of Clinical Research at the Center for Childhood Cancer Research at CHOP.

“We should continue testing and monitoring children with SARS-CoV-2 so that we can better understand how the virus affects them in both the short and long term,” he added.

The unknowns

There’s still a great deal we don’t yet know about this novel coronavirus, including why it affects both children and adults in varying degrees. At least 30-40 percent of adults, for example, show minimal or no symptoms at all. They still can transmit the infection to others, however.

Despite having a higher viral load, children are even less likely to exhibit symptoms. This means children tend to have a larger amount of the virus in their upper respiratory tracts than adults. Does that mean they can transmit the virus even more readily than adults? 

Again, we don’t know for sure. But a recent Harvard Health paper warns “the presence of high viral loads in infected children does increase the concern that children, even those without symptoms, could readily spread the infection to others.”

One thing we do know is a small number of children can have severe effects. One of these is a new condition. The Centers for Disease Control and Prevention (CDC) calls it “multisystem inflammatory syndrome in children,” or MIS-C. It now seems to have affected approximately 300 children in the U.S, at least five of whom have died.

Long-term implications

Originally, doctors thought there was an unusual outbreak of a rare form of Kawasaki’s disease. The symptoms reported were similar (persistent fever, rash, and inflammation of the blood vessels). It has now, though, been connected specifically with the SARS-CoV-2 virus.

“This [MIS-C] is a new childhood disease that is believed to be associated with [COVID-19], and it can be lethal because it affects multiple organ systems [including] the heart and the lungs, gastrointestinal system or neurologic system,” neonatologist Alvaro Moreira said in a statement. Moreira is an assistant professor of pediatrics at The University of Texas Health Science Center at San Antonio.

His team reviewed 662 cases of MIS-C worldwide between January and July of last year. They found more than half of the children studied suffered heart damage as a result of the condition. These children may require lifelong care and treatment, United Press International (UPI) reported in September.

“Evidence suggests that [these] children . . . have immense inflammation and potential tissue injury to the heart, and we will need to follow [them] closely to understand what implications they may have in the long term,” Moreira concluded.

Further study needed

Researchers in the CHOP study were surprised to find the biomarker C5b9 present. They found it not only in children with severe symptoms of COVID-19 and MIS-C, but also in those with minimal or no symptoms.

“Although most children with COVID-19 do not have severe disease, our study shows that there may be other effects of SARS-Cov-2 that are worthy of investigation,” Teachey said.

“The most important takeaway from this study is we have more to learn about SARS-Cov-2,” he concluded. “We should not make guesses about the short- and long-term impact of infection.”

Neither of the two vaccines approved for adults have been tested in children under age 12. It could be a long wait until kids get protection from the virus.

In the meantime, we urge parents to take the same precautions with their children that they do with themselves. Socially isolate as much as possible, frequently wash your hands, and wear masks when outside the family circle.

covid vaccine

MMR Vaccine May Protect Against COVID-19

With all the excitement and hope surrounding the rollout of the coronavirus vaccines, our concierge doctors want to highlight other vaccines that could also prove to be lifesavers. Particularly in the case of childhood vaccinations, we have seen a significant reduction in the numbers of children receiving routine immunizations.

And we are not alone. In one of the more troubling results of the pandemic, experts across the country saw a marked decline in children being vaccinated. According to a report released this month by the Wellmark Blue Cross Blue Shield Association, nearly nine million children have received fewer vaccinations than normal. There is a 26 percent decline from last year. This is partly due to the restrictions put in place to combat COVID-19. But, it’s also due to a growing resistance by some parents toward vaccines in general.

Kids need vaccines

Experts warn this drop could result in a renewed outbreak of childhood diseases. We could see resurgences of diphtheria, whooping cough, measles, and even polio.

“Although we don’t want to cause alarm, we do want to be mindful of what a drop in vaccination levels could mean,” Dr. Tim Gutshall, Wellmark’s chief medical officer, said in a statement to The Iowa Gazette. “If we dip below the [Centers for Disease Control and Prevention] benchmarks for immunity, we could wind up with an epidemic of vaccine-preventable diseases.

“The good news is the trend can be reversed if parents and guardians ensure these vital immunizations are up to date,” he added.

COVID-19 vaccine already here?

Now it appears there may be an even better reason for children to receive at least one type of vaccine: the MMR (for measles, mumps, and rubella). It’s been rumored since the start of the pandemic that the MMR vaccine might protect those who become infected with SARS-CoV-2, the virus that causes COVID-19. This is due to the similarity of both viruses.

Now a new study, published last month in the journal of the American Society for Microbiology, shows promise. It found patients vaccinated against mumps had less severe COVID-19 infections than those not vaccinated.

“We found a statistically significant inverse correlation between mumps titer levels and COVID-19 severity in people under age 42 who have had MMR II vaccinations,” lead study author Jeffrey E. Gold said in a media release. [Titer levels measure the amount of protective antibodies in the blood.]

“This adds to other associations demonstrating that the MMR vaccine may be protective against COVID-19. It also may explain why children have a much lower COVID-19 case rate than adults, as well as a much lower death rate. The majority of children get their first MMR vaccination around 12 to 15 months of age and a second one from four to six years of age.”

The study

Researchers split 80 participants into two groups. The first group included 50 Americans under age 42. This group received most of their MMR antibodies through the MMR II vaccine. The second group comprised those who had no record of ever having received vaccines and reported they had the measles, mumps, or rubella.

Those who actually contracted the mumps did not seem to show any protective effect against COVID-19. Those who showed high levels of mumps titers resulting from the MMR II vaccine were either asymptomatic (showed no symptoms at all) or were functionally immune from the virus, just as if they’d received one of the new coronavirus vaccines.

Researcher’s conclusions

This was a relatively small observational study. But study coauthor David J. Hurley, PhD, professor and microbiologist at the University of Georgia, appeared impressed by its findings.

“The MMR II vaccine is considered a safe vaccine with very few side effects,” he wrote in a statement. “If it has the ultimate benefit of preventing infection from COVID-19, preventing the spread of COVID-19, reducing the severity of it, or a combination of any or all of those, it is a very high reward-low risk ratio intervention.”

In fact, he suggested while the country is waiting for wider distribution of the newly approved coronavirus vaccines, the MMR II vaccine could stand in in the interim.

“Based upon our study, it would be prudent to vaccinate those over 40 regardless of whether or not they already have high serum MMR titers.”

Further studies coming

Our concierge doctors aren’t necessarily ready to start vaccinating all our older patients based on a single study. But we think it bears watching. That’s because—based on prior anecdotal evidence—other studies along these lines are already underway.

One of those is funded by a $9 million grant from the Bill and Melinda Gates Foundation, Wellcome Trust, MasterCard, and others. It plans to recruit as many as 30,000 healthcare workers worldwide in a clinical study. This would measure immunity to COVID-19 against those who receive the MMR II vaccine vs. those who receive a placebo injection.

It’s heartening to realize the best scientific brains around the world are working so diligently to conquer the scourge of COVID-19. There is hope on the horizon.

Meanwhile, please keep playing defense as much as possible:

  • wear a face mask around people outside your household
  • avoid indoor spaces as much as possible
  • wash your hands frequently

It won’t be much longer until this nightmare is a distant memory. And be sure your children are up to date on their vaccinations!

flu shot twindemic

Flu Shots Can Help Avert a ‘Twindemic’

The U.S. Centers for Disease Control and Prevention (CDC) recommends all adults and children older than six months receive a flu shot by the end of this month. The CDC says it takes at least two weeks for the vaccine to become effective. Then it won’t reach its peak effectiveness until another week after that. And children who are being vaccinated for the first time need two vaccines spaced a month apart to become fully protected.

Therefore, our concierge doctors suggest you get your flu shot for the 2020-21 influenza season as soon as possible. While there have been scattered reports of shortages around the country, The Washington Post recently reported a record number of flu vaccine doses—between 194 million and 198 million—have been ordered. Because the vaccine is shipped in stages, more is on the way.

“This year I think everyone is wanting to get their vaccine and maybe wanting it earlier than usual. If you’re not able to get your vaccination now, don’t get frustrated. Just keep trying.”

The CDC’s Dr. Daniel Jernigan, to the Associated Press (AP).

COVID-19 and flu overlap: a ‘twindemic’

We were fortunate the 2019-20 flu season was winding down this spring as the coronavirus crisis began to hit the country. This year, however, we’ll be looking at the possibility of a “twindemic”—both waves hitting at once.

So it’s especially important that as many people as possible get vaccinated for the flu this year. The flu shot won’t prevent COVID-19, but it can help reduce the strain on our already overburdened health care system.

“Since hospitals and doctors’ offices are going to be very busy caring for COVID-19 patients, a flu vaccine can help decrease burdens on the health care system and make sure that those who need medical care are able to get it.”

Dr. Susan Bailey, president of the American Medical Association (AMA) and an immunologist in Fort Worth, Texas, told CNN.

Last year, the CDC estimated that the flu killed 22,000 Americans, and resulted in hospitalization of an additional 400,000. By contrast, at least 215,000 Americans have died of COVID-19 since March.

Hopeful signs

Health experts are hopeful the precautions we’ve been taking to avert COVID-19—hand washing, social distancing, and wearing masks—will mean this season’s flu won’t take as severe a toll as in previous years. But they all insist that widespread vaccinations are necessary.

Even if the flu vaccine isn’t 100 percent effective in preventing influenza, it has been shown to reduce the length and severity of the illness in those who contract it. In addition, if you’re unlucky enough to contract COVID-19, you won’t want your body’s defenses to be weakened by a prior bout with the flu.

This is already present in the Southern Hemisphere, where each season’s flu strikes over the summer. From South Africa to Australia, public health experts reported remarkably low levels of influenza among their populations. They attributed this partly to coronavirus lockdowns and to extremely high participation in influenza vaccinations.

One pharmacy in Cape Town, South Africa, for example, reported that the demand for flu shots was four times higher than in previous years. People were trying to avoid the co-morbidity (simultaneous presence of two or more diseases) of contracting the flu in addition to COVID-19.

“People were lined up outside the pharmacy down to the corner of the street waiting to get their injections. We had to prevent people from coming into the store.”

Ellis Henen, owner of Sunset Pharmacy, told The Post.

Additional benefits of the flu shot

We hope Americans will have the same attitude to this year’s flu shot.

Some people think they’re still protected from the one they received last year. But having received a flu shot last year won’t protect you from this season’s strains of the virus. This is because your immunity from a year ago has deteriorated by now. In addition, manufacturers create a new vaccine each year based on which strains the World Health Organization (WHO) expects to be predominate. This is based on which strains were seen over the summer in the Southern Hemisphere. So this year’s shot will include strains different from those in last year’s inoculation.

It’s important to remember, even if you contract influenza after receiving the shot, it’s likely to be less serious than if you’d skipped being inoculated. And the flu vaccine offers additional benefits, especially among the elderly. For older people and those with chronic health conditions, recent studies show the extra benefits of a flu shot. It’s as effective in preventing a heart attack as quitting smoking, using cholesterol-lowering drugs, or taking blood pressure medications.

So be sure to let us know if you’re interested in getting a flu shot. If you encounter a shortage, we may be able to help you locate a supply nearby.

How to Protect Your Kids from This Year’s Flu

Our VIP concierge doctors at MD 2.0 in Jupiter have seen the results of this year’s flu outbreak, and it’s especially difficult because so many of those affected are children. The Centers for Disease Control and Prevention (CDC) reports that, so far this year, there have been twice as many pediatric flu deaths than at the same time last year. This year, 54 children have died; at the same point in the 2018-19 flu season, 16 children had died.

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Get Your Flu Shot by Halloween

Halloween is full of scary fun. But here’s something to really be scared about: not getting a flu shot. While you’re planning your costume and your parties, remember to carve out a moment to get protected against this dangerous disease.

The Centers for Disease Control and Prevention (CDC) has recommended that all adults and children over the age of six months receive their flu shot by the end of October, and our concierge family doctors in Jupiter second that advice.

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Another Weapon In the War Against Flu

The flu killed 80,000 Americans last year and was responsible for the hospitalization of another 960,000. Then there are those whose symptoms didn’t reach such drastic levels, but who spent many miserable days suffering the effects.

So our concierge family practice doctors in Jupiter, FL, at MD 2.0, were pleased to note that last month the U.S. Food and Drug Administration (FDA) for the first time in 20 years approved a new drug designed to help alleviate the symptoms of the flu. Xofluza (baloxavir marboxil) is a single-dose oral prescription drug intended for patients 12 years of age and older who have been experiencing symptoms for no more than 48 hours.

The difference in Xofluza

Just in time for flu season, Xofluza joins other antiviral treatments currently available, including Tamiflu and Relenza. The difference between Xofluza and other antiviral drugs is in the way it’s administered. It is the only antiviral that can be taken as a single dose to be effective. Others must be taken over several days or inhaled as a powder. While Xofluza did not work any better in clinical trials than its competitors already on the market, it’s the convenience of the single oral dose that sets it apart. The most common reported side effects of Xofluza were diarrhea and bronchitis.

“With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical,” FDA Commissioner Scott Gottlieb, M.D., said in a statement. “This novel drug provides an important, additional treatment option.” Xofluza was expected to be available “within the next several weeks.”

“Xofluza is unique in that it acts to inhibit replication of the flu virus in the first place, at a step much earlier than the current medications available . . . which only block release of virus that has already been produced from a host cell,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City told CBS News.

Dr. Debra Birnkrant, director of the Division of Antiviral Products in the FDA’s Center for Drug Evaluation and Research, hailed the addition of Xofluza to the arsenal of weapons against the flu.

“Having more treatment options that work in different ways to attack the virus is important because flu viruses can become resistant to antiviral drugs,” she said on the FDA’s website.

You still need a flu shot

While the antiviral medications, including Xofluza, can reduce symptoms and help them recede faster than a placebo, they are not an instant curative. Nor do they prevent the flu or prevent you passing it on to others. If you contract the flu, you will still have to endure several days of misery, and you will still be contagious while exhibiting symptoms. So it’s best not to catch it all all.

“[S]easonal flu vaccine is one of the most effective and safest ways to protect yourself, your family, and your community from the flu and serious flu-related complications,” Gottlieb said. “Yearly vaccination is the primary means of preventing and controlling flu outbreaks.”

We concur. Last month the Centers for Disease Control and Prevention (CDC) released a report showing that less than 40 percent of adults in the U.S. received flu shots last winter, the lowest rate in seven years and probably one reason that last season’s flu outbreak was the deadliest since the 1970s. Of the 183 children who died last year, 80 percent had not been vaccinated.

You can help boost your immunity by exercising, eating healthfully, washing your hands often, and getting enough sleep, but there’s still no better way to prevent the flu, or lessening symptoms and its complications, than by receiving a flu shot.

“Yearly vaccination is the primary means of preventing and controlling flu outbreaks,” said Gottlieb.

And if you or your children do come down with the flu, contact us immediately. The sooner you receive Xofluza or other antiviral medications, the better they will work.

flu shots

Time Your Flu Shot Right

Last year, 80,000 Americans died from complications of the flu, according to the Centers for Disease Control and Prevention (CDC). The 2017-18 flu season death toll was the highest in nearly 40 years, and almost twice as high as what health experts would typically consider a “bad” flu season. It also lasted longer—from November to March—than any recent flu outbreak.

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