By Miriam Raftery
October 24, 2021 (San Diego) – “Just a couple of weeks ago, a quarter of a million kids were getting COVID,” says Dr. William Tseng, area assistant medical director of Kaiser Permanente and Kaiser’s vaccine expert. That’s according to the American Academy of Pediatrics' new site tracking COVID cases in U.S. children. Deaths of children due to COVID have occurred in 48 of 50 states.
In an exclusive interview via Zoom on October, the day the U.S. Centers for Disease Control (CDC) broadly expanded eligibility of COVID-19 booster shots, East County Magazine interviewed Dr. Tseng on who should get boosters and what parents should know about COVID vaccines for children ages 5-11, which are likely to be approved in early November. The answers may surprise you!
Click the image at left to view the full interview (which will also air on KNSJ radio) or click "read more' and scroll down to read highlights.
The Moderna booster, like the Pfizer booster, is now approved for six months after the second shot in the two shot series. Those over 65 are eligible, as well as those over 18 with certain underlying conditions, compromised immune systems, or with living conditions or jobs that put them at high risk. Dr. Tseng said he is “most concerned” about people in long-term care facilities and those who are immune compromised.
Johnson & Johnson’s booster is approved for everyone of all ages, regardless of health conditions, just two months after the initial vaccine was given because of sharply waning immunities.
Consumers have the option to mix and max, getting a different booster than their original vaccine(s). So should J&J recipients switch?
The answer isn’t clear, as there are arguments on both sides.
“Johnson & Johnson had a trial for a second dose. What they found out was after the second dose…protection against hospitalization or significant disease was actually 100 percent,” Dr. Tseng told ECM. But he adds that immunity will likely wane over time. “We don’t know how long.”
On the other hand, limited testing of 150 patients found that among patients who mixed and matched vaccines and boosters, regardless of which types, “you get slightly higher immunity levels.,” Dr. Tseng says. “What we do know is if you get a booster shot, you will have a higher antibody level that an prevent you from getting COVID.”
COVID deaths and long-term effects in adults and kids
The death rate from COVID has improved from 5 percent early in the pandemic to between 1 and 2 percent today, thanks to improved treatments. However, 20 to 30 percent of survivors wind up with long COVID, meaning serious symptoms that last for six months or longer. “That can include kids, teenagers, and young adults,” Dr. Tseng emphasizes.
Booster shots for those eligible should be available in our region starting this weekend.
Kids and COVID
Contrary to popular belief, with the rapidly spreading Delta variant and kids back in school, kids are catching COVID—sometimes at very high rates.
Dr. Tseng cited two studies by the CDC. In the first case studied, an unvaccinated teacher took off her mask to read to school children. “Fifty percent (half) of the kids in that classroom caught COVID,” says Dr. Tseng. “Every kid in the front row caught it.” In addition, some infected children brought COVID home to family members, some of whom may be more vulnerable to serious complications or death.
The second study compared two summer camps for children. The first had nine camp locations and a 93 percent vaccination rate among camp teachers and counselors. They had 9 cases of COVID among over 7,000 campers and staff. The other camp had 28 camps but had no recommendations for masking or vaccinations. Out of 3,000 people, 321 got COVID.
“That’s 10% vs. .1%,” Dr. Tseng observes, adding that vaccinations and masking “really works. Our goal is to really save lives and make sure you don’t get it [COVID]. Certainly if there’s a reason you can’t get it, I understand, but we should help each other prevent the spread of COVID and prevent unnecessary deaths.”
He adds that yet another study found that the very youngest children were most apt to transmit the disease to family members, perhaps because “you want to hug and cuddle them.”
Currently, only the Pfizer vaccine has been approved for ages 12 and up, though other vaccine makers have applied for approvals.
Next up, vaccines for children ages 5-11 will be discussed on Oct. 26 and will likely be approved by the FDA soon; the CDC has a meeting the first week of November and is likely to approve at least one vaccine for children in this age range.
The doses for young children will be smaller than for adults. The good news is that “even with a smaller dose, we’re getting the sae amount of neutralizing antibodies,” Dr. Tseng says. He adds, “We really do want to be extra safe with children.”
Studies are still ongoing, but Dr. Tseng says both safety and effectiveness “so far looks good” based on preliminary results. He adds that he is “excited” about the prospect of children soon being able to get vaccines to protect them and their families against COVID, a milestone towards ending the pandemic.
Risks of vaccines vs. risks of COVID
Dr. Tseng notes that the COVID vaccine is known as a protective vaccine, because while it may not prevent you from getting COVID, it provides strong protection against severe complications or death. It’s not perfect, he acknowledges, but adds, “It’s like wearing a bullet proof vest. Yes you can still get hit and crack a rib,” but the vest protects you from dying if struck in the chest by a bullet.
“Look at the real risk, not the perceived risk,” he advises.
So what are the real risks?
Anaphylactic shock, a severe allergic reaction, occurs in about 5 in a million cases of COVID-19 vaccinations – or about 1 in 200,000. The good news? “It’s 100% treatable…we know exactly what to do,” Dr. Tseng assures.
Pericarditis, an inflammation of the heart, has occurred with Modern and to a lesser extent, Pfizer and are also very rare. Fortunately, this condition also goes away after treatment with aspirin or ibuprofen, though it may persist for a few weeks. But Dr. Tseng says put that in perspective with this fact: “You are 16 times more likely to get pericarditis if you get COVID than from the vaccine.”
A rare type of blood clot has occurred with Johnson & Johnson’s vaccine. When this first occurred, five people died as a result, according to the CDC. But now, doctors are prepared. “We also know exactly what to do in these cases. These are different types of clots. WE don’t give blood thinners,” Dr. Tseng says, adding that there is a different treatment for these clots that occur in only a handful of every million vaccine doses given.
Dr. Tseng says side effects from booster shots are “about the same as after the second shot.” The vast majority of people have only local inflammation of the arm, which can be eased with hot compresses. Some also have fever and body aches, but he says, “That’s normal and means your body’s immune response is working.”
The recent death of former Secretary of State from COVID-19 shows that even a fully vaccinated person can be vulnerable if they are immune-compromised. Powell was 84 and had been treated for blood cancer, so his immunities were reduced.
“What if everyone around Colin Powell had been vaccinated?” Tseng asks. “He did not have to die.”
He urges people to think not only of themselves, but family members and neighbors. “If we do that, we can get through this pandemic…If we can eradicate this virus off the face of the earth, we will be better off,” he says.
What if you’ve already had COVID?
ECM asked Dr. Tseng about a legislative proposal by Congressman Darrell Issa that would give people who’ve recovered from COVID an option to show proof of antibody testing instead of proof of vaccination. He addressed the scientific question this poses.
“If you’ve been infected and you develop antibodies, those antibodies are not as specific – not as good at protecting against COVID as the vaccine,” Dr. Tseng says. Antibodies can last about nine months. But he cautions that if you’ve been infected with COVID and don’t get vaccinated, “you’re over two to three times higher risk to get COVID again” than a person who had COVID and gets vaccinated.
Local cases drop as vaccination rates soar
“We are definitely seeing a decline in cases,” Dr. Tseng says when asked about the local situation in San Diego County. “About 88 to 90 percent of those winding up in hospitals now are unvaccinated. Unfortunately the major burdens of this disease are now on the unvaccinated.”
Dr. Tseng says he is “very proud of San Diego. Our Health and Human Services and our health system really rose together to get us up to 89-90 percent vaccinated with their first dose and 80% fully vaccinated” among those age 12 and up who are eligible across San Diego County.
Asked what else he wants the public to know, Dr. Tseng concludes, “Everybody stay safe out there! Get vaccinated – and the vaccine is how we are going to end this pandemic.”