Do children now eligible for a COVID-19 shot get the same vaccine dose as adults? Medical experts answer our questions.
Will children ages 5 to 11 get the same vaccine dose as adults?
The FDA noted that in the U.S., 39% of COVID-19 cases in people younger than 18 are in children 5 through 11 years old, and about 8,300 COVID-19 cases resulted in hospitalization in this younger age group. As of Oct. 17, according to the FDA, 691 deaths from COVID-19 had been reported in the U.S. in people under age 18; 146 of these deaths were of children 5 to 11.
— Alison Bowen
I’m pregnant and concerned about mixing vaccines. Is a booster OK during pregnancy? Is there anything women should consider when deciding when and which to get?
According to Dr. Emily Miller, assistant professor in the Division of Maternal-Fetal Medicine at Northwestern Medicine’s Feinberg School of Medicine, while there is no data about vaccine mixing or boosters, specific to pregnant people, there is great data that the vaccine itself is safe in pregnancy.
“There’s no reason with the first doses of the vaccine and the data on safety to suspect that the booster would be unsafe,” Lewis said. “Through the lens of protecting pregnant people from getting critically ill, the booster is the best way to do that.”
While the U.S. Food and Drug Administration issued Emergency Use Authorization for the Pfizer-BioNTech and Moderna vaccines in December 2020 (the Johnson & Johnson vaccine in February 2021), it wasn’t until August 2021 that vaccines in pregnant people were recommended by the CDC. The CDC recommended Pfizer, Moderna and J&J booster shots Oct. 21, 2021. The new CDC guidance allows recipients to “mix and match” their original vaccine brand with a booster of their choice.
Some reasons to switch to a different brand might be if the individual had a particularly bad reaction to the mRNA technology included in both Moderna or Pfizer vaccines or if availability of their initial series is limited.
For those who initially received the Moderna or Pfizer vaccine, officials said one generally should stick with the same vaccine series, primarily because there is no evidence of marked benefits, though the FDA announcement made no recommendation to that effect. For those who took the one-dose J&J vaccine, early research suggests taking the Moderna vaccine as a booster yielded the greatest antibody increase. The study showed that a second shot using the Moderna vaccine triggered a 76-fold increase in antibody levels. By contrast, a Pfizer booster increased antibody levels 35-fold, and the coordinating J&J booster yielded only a fourfold increase. (Read more about what you need to know about mixing or matching your booster shots.)
Miller said it took months from when the initial vaccination was introduced to the public to gather enough data to find out if it was safe enough to put vaccines in the arm of a pregnant person. But boosters are a little bit less of a stretch. Research continues, however.
“Pregnant people are on the list of those who are at a higher risk of severe morbidity related to SARS-CoV-2 infection, so that’s why pregnancy itself would be a reason to get a booster,” Miller said.
Miller added that trying to time the immunization, to optimize passage of antibodies and the placenta is not necessary.
“The sooner we can protect you from getting sick, whatever trimester you’re in, the better,” Miller said. “Your baby’s going to get antibodies in breast milk, if you decide to breastfeed, and they will cross across the placenta regardless of when you get it. Most important thing they can do for their babies is to not get critically ill during pregnancy. Every week that you’re not completely as immune as you possibly can be is a week that there’s a risk of you needing to go to the hospital or are getting critically ill.”
— Darcel Rockett
Yes. Dr. Sharon Welbel, Cook County Health’s system director of infection control and hospital epidemiology, urged us not to waste anytime getting our flu shots. Welbel said she has not heard anecdotally of anyone having complications from getting both vaccines together. Those getting both during the same visit can expect to get one shot in each arm, Welbel said.
“Children have always gotten multiple vaccines at the same time, but if someone has concerns, and has the luxury of going in to their provider twice, that is certainly an option,” Welbel said.
Before the pandemic, the typical flu season would peak from December through February, but the flu can be contracted any time from October though May, making it imperative to get a flu shot as soon as possible, especially as some experts anticipate a particularly rough flu season.
“We don’t know exactly what will happen this year, but we do know that we had a record-breaking, low number of cases last year, which means that the population largely does not have immunity to influenza,” Welbel said.
Many adults and children were working and learning remotely last fall, avoiding large gatherings and following strict mitigation strategies. But a year later, schools have fully re-opened, and an increasing number of organizations are bringing their employees back into the office. That all adds up to an increased risk of exposure, she said.
“There’s been some modeling done that suggests that this year’s flu season will likely start earlier, and potentially be a severe season, so we’re urging everyone to get their flu shots as soon as possible to protect themselves and those around them,” Welbel said.
This year’s vaccine covers four different types of the flu virus, including two types of influenza A and two types of influenza B, Welbel said.
The flu shot is recommended for everyone ages 6 months and older, with adults 65 and older and those with weakened immune systems typically getting an enhanced flu vaccine if available.
Children 8 and younger will typically require two doses of flu vaccine with the doses delivered a month apart, Welbel said.
— Karen Ann Cullotta
Dr. John Segreti, medical director of infection control and prevention at Rush University Medical Center, said this is something we will continue to study, and it’s possible that side effects might be similar to initial vaccinations.
But he noted that even if people experience things like possible tiredness, headache, muscle pain or slight fever, “The benefits will far outweigh the risks.”
— Alison Bowen
What do we know about the experimental COVID-19 pill?
On Oct. 1, drugmaker Merck said that it had an experimental COVID-19 pill that reduced hospitalizations and deaths by half in people recently infected with coronavirus, if given within five days of symptoms. Merck’s pill, called molnupiravir, works by interfering with the coronavirus’ ability to copy its genetic code and reproduce itself.
The study, by Merck and its partner Ridgeback Biotherapeutics, looked at nearly 800 unvaccinated adults with mild to moderate COVID-19 who were considered higher risk for severe disease due to health problems such as obesity, diabetes or heart disease. Earlier study results showed the drug did not benefit patients who were already hospitalized with severe disease.
The company asked health officials in the U.S. to authorize the pill’s use. If the pill is cleared by the U.S. Food and Drug Administration, it would be the first pill shown to treat COVID-19. The U.S. has approved Remdesivir specifically for COVID-19, and allowed emergency use of three antibody therapies that help the immune system fight the virus. But all those drugs have to be given by IV or injection at hospitals or medical clinics.
“I’m very excited about it,” said Dr. Jennifer Pisano, UChicago Medicine’s interim chief for the section of Infectious Diseases & Global Health, about the pill. “It gives us another option. I would be more excited if everyone got their primary series of vaccinations because that still remains the biggest therapy against COVID-19 in prevention and helping people manage it. But I do think this is very exciting. And for a lot of the community who don’t have a normal immune response to a vaccine because of the medications they take or they’ve had a transplant or cancer, this drug … could be life-saving.”
Cook County Health infectious disease specialist Dr. Gregory Huhn, said that although studies are being conducted, he doesn’t know if and when the pill will be available to the masses. But given that Merck filed for emergency use authorization, it’s just a matter of the FDA assembling its experts and taking a close look at the trial data.
“With 50% efficacy in preventing hospitalizations, and no one died in the group that got the pills, this is a very effective intervention to prevent complications of COVID-19,” Huhn said. “We don’t know at this point if the FDA is going to license it for emergency use for anyone with COVID-19 or those just with high risk and unvaccinated. The ideal way to deliver this pill would be for somebody that’s not at disease severity that they would need hospitalization, that either they could access it through their primary care doctor, or potentially if they went to the emergency department, did not need to be admitted, that they could get the pill there as they’re discharged home.”
Huhn said the pill would be one more piece in the health care industry’s expanding toolkit to combat COVID-19 — a toolkit that might have more oral agents and antibodies in it as drug development continues.
“We’re in a time when we want to have all the types of scientific discoveries centered in on COVID in order to end the pandemic,” he said.
Pisano said a lot of people in the health field are looking at the Merck pill like “Tamiflu is to the flu” in helping fight influenza, where if you take it in the first 48 to 72 hours of having symptoms, you might see some really good outcomes with the COVID-19 virus. Pisano said the first time she heard about the pill was this summer.
“It’s become pretty apparent that by the time people get in the hospital, we’ve kind of missed the window to treat the virus, and that we need an outpatient therapy that’s easier to administer than the monoclonal antibodies in order to keep people out of the hospital,” she said. “By the time people get into the hospital, the viral phase is decreasing and it’s the immune system response that’s increasing, which is why Dexamethasone and Tocilizumab have had such success with people in the hospital. We really need to shift the focus to outpatients and monoclonal antibodies work; there’s an education gap for people in knowing when and how to access those.”
If authorized by the FDA, Merck has said it can produce 10 million doses by the end of the year. But Pisano reiterates that a pill like Merck’s will not be a stopgap when it comes to COVID-19.
“There’s a lot of steps on the continuum to getting this drug,” she said. “I think we need people to recognize their symptoms could be secondary to COVID very early, be able to get access to testing and then be able to get quick testing, to be able to get this drug. I think there are still some problem areas in the continuum of being able to get it. There’s some chatter about maybe being able to use this to prevent infection or as post-exposure prophylaxis, so if you live in a house or you come into contact with someone with COVID maybe you could take this pill to prevent infection, but I think all that data remains to be seen. There are many different ways we could potentially use the drug.”
— Darcel Rockett and The Associated Press
Do vaccinated students have to quarantine if they are exposed to COVID-19?
No. According to Emily Young, a spokeswoman with the Lake County Health Department, they should get tested 3-5 days after exposure and mask around others until they receive a negative result. Vaccinated students who test positive do have to isolate for 10 days from onset of symptoms, or the test date if they are asymptomatic.
Why should students opt in to saliva-based screenings?
The Illinois Department of Public Health and U.S. Centers for Disease Control and Prevention recommend screening testing for unvaccinated students. But people who are fully vaccinated or who have recovered from COVID-19 in the past three months should be exempt from screening, according to guidance from IDPH and the Illinois School Board of Eduction.
According to CDC guidance, “regular screening testing helps protect students, staff, family members, and others who are not currently vaccinated against COVID-19 or are otherwise at risk for getting seriously sick from COVID-19.”
“In schools, screening testing can help promptly identify and isolate cases, quarantine those who may have been exposed to COVID-19 and are not fully vaccinated, and identify clusters to reduce the risk to in-person education. Testing programs, like test-to-stay, help keep students in the classroom and allow them to take part in the other activities they love,” the guidance says.
How does test-to-stay work?
When unvaccinated or partially vaccinated students or staff members are exposed to COVID-19 in a school setting, they may be eligible for test-to-stay depending on the circumstances of the exposure. Test-to-stay may apply if:
o The exposure occurred at a school activity;
o Both the case and the close contact were wearing well-fitting masks at the time of exposure;
o The school has resources to test on site. Students and staff eligible for test-to-stay will be informed by the school that they may continue attending school if they test on days 1, 3, 5, and 7 following exposure.
If at any point the student or staff member tests positive or develops symptoms during test-to-stay, they must inform the school and isolate immediately. While in test-to-stay, close contacts must quarantine from activities outside of school. Test-to-stay is used in schools because it is a controlled environment, where it is easier to enforce things like masking, social distancing and hand hygiene.
— Karen Ann Cullotta
Should I be worried about injury from ongoing COVID-19 swab testing?
Dr. Michael Friedman, an otolaryngologist and medical director for Chicago ENT, says any single swab has some potential for injury, either a nosebleed or an abrasion.
“It’s very dependent on the technique of the swabber,” Friedman said. “If it’s done properly, with a gentle touch, I don’t think there’s any real concern about repeat swabbing. If you’re doing it once a week or twice a week, you’re just multiplying that potential. But if done properly, the risk is very minimal. I don’t think we can say that there’s zero risk of injury, but proper swabbing in itself, repeating it on a frequent basis, I don’t think becomes a problem.”
Friedman adds that many places let patients do their own swabs, so when it becomes uncomfortable, patients can pull back. But if you aren’t allowed to swab yourself, ask the person doing the swab to be gentle.
“I think most people are not going to opt for the weekly swabbing instead of the vaccination, but you never know, they might be more apprehensive about the vaccination than swabbing,” he said. “I think anytime you have somebody putting something inside your body there’s some risk, but it’s not that terribly a common problem.”
When asked about injury to the cribriform plate (the thin plate between the brain and nose) after nasal swab testing for COVID-19, Friedman said that is a major complication from a nose swab.
“It doesn’t take much to break through it. And if it’s broken, that means, brain fluid leaks through the nose. That’s brain fluid. And it’s a major, major operation to close that leak,” he said. “Given the fact that most swabbers are essentially ignorant of the anatomy and intricacies of the nose, I think that does create that risk. But to break through the plate you have to be going in the wrong direction and you have to be pushing harder than you should be pushing.”
— Darcel Rockett
I received the J&J vaccine. What’s next when it comes to booster shots and mixing and matching vaccines?
Health officials still are collecting data on possible boosters for those who got the Johnson & Johnson vaccine, as U.S. officials plan boosters as early as fall. Here’s what people who got the J&J vaccine should know:
2. Mixing and matching vaccines might be OK, but experts counsel patience. The Centers for Disease Control and Prevention discourages J&J recipients from getting a booster of another vaccine. Earlier guidance from the CDC said in situations where the first dose was received but the patient could not complete the series with the same vaccine, consideration can be given to vaccination with a J&J vaccine, under the supervision of a health care provider.
3. If you are immunocompromised, talk to your doctor. For right now, the Centers for Disease Control and Prevention are only suggesting booster shots for immunocompromised people who received the Moderna or Pfizer vaccine.
4. There’s a lot we don’t know. Data doesn’t exist yet to explain for example if J&J recipients contract or spread the virus more easily than those who got the Moderna or Pfizer vaccines. How long protection lasts is not clear. These questions and more are why Prickett advises maintaining precautions such as masking and social distancing.
5. More information is coming. An Aug. 18 statement from CDC Director Rochelle Walensky and other officials said they expected more data on J&J in coming weeks and pledged to “keep the public informed with a timely plan for J&J booster shots as well.” J&J data collection is different from the Moderna and Pfizer for multiple reasons; the rollout began later, and the shot uses different technology.
— Alison Bowen and Lisa Schencker
Should parents get a COVID-19 shot for their 11-year-old?
Frank Belmonte, chief medical officer at Advocate Children’s Hospital says this is not recommended. He pointed to an American Academy of Pediatrics statement regarding this issue.
Both the AAP and the Food and Drug Administration advise against administering the vaccine to children under 12; clinical trials for children 11 and younger are underway.
“We need to see the data from those studies before we give this vaccine to younger children,” AAP president Lee Savio Beers said in a statement.
Although it’s unclear what the consequences could be for vaccinating children under 12, and pharmacists may not ask parents for proof of age, administering the correct dosage is key. The dose for an adult vaccine is much higher than those being tested in children below age 12.
The AAP has urged the FDA repeatedly to authorize a vaccine for children. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said the FDA will move quickly to review data from trials on children ages 5 to 11 when it is expected to be submitted by Pfizer this fall.
Yvonne Maldonado, chair of the AAP’s Committee on Infectious Diseases, urged parents and physicians to wait. “I know parents are anxious to protect their children, but we want to make sure children have the full benefit of ongoing clinical trials.”
— Alison Bowen
Does the AAP recommend a specific flu vaccine for children?
AAP recommends that all children aged 12 years and older receive the COVID-19 vaccine now approved for children 12 years to 17 years old and adults. AAP also recommends all children age 6 months and older be vaccinated annually with influenza vaccine. While the AAP has no preference for a specific type of flu vaccine, depending on the child’s age and health, they may receive either the inactivated influenza vaccine (IIV), given by intramuscular injection, or attenuated influenza vaccine (LAIV), which is a nasal spray.
The American Academy of Pediatrics recommends that all healthy children 6 months and older are vaccinated for influenza this fall as the best protection against the flu, especially now that many children have returned to in-classroom learning.
According to Dr. Flor Munoz, with the AAP Committee on Infectious Diseases, “During the COVID-19 pandemic, it’s important to remember that influenza is also a highly contagious respiratory virus that can cause severe illness and even death in children. The flu vaccine is safe, effective, and can be given alongside other routine immunizations and the COVID-19 vaccine.”
Can children who get the influenza vaccine still get the flu?
If children do get sick with the flu, those who have been vaccinated are less likely to have severe illness or be hospitalized. In prior years, about 80% of children who died of influenza had not been vaccinated, according to research. Similarly, about half of the deaths from influenza occur in children who are otherwise healthy, with no underlying medical conditions. In 2017-18, there were 188 pediatric deaths reported to the Centers for Disease Control and Prevention. During the 2018-19 flu season, 144 children died from influenza, while 199 deaths occurred in the 2019-2020 season.
The AAP recommends that children with acute, moderate or severe COVID-19 should not receive the influenza vaccine until they have recovered. Children with mild illness may be vaccinated. Pregnant women should receive an inactivated influenza vaccine at any time during pregnancy to protect themselves and their infants. And women in the postpartum period who did not receive vaccination during pregnancy should receive influenza vaccine before discharge from the hospital. In addition, the AAP says Influenza vaccination during breastfeeding is safe for mothers and their infants.
What kind of flu season can we expect for kids back in school?
With school back in person, public health experts are concerned about a resurgence of flu activity this winter. “This year it will be especially important to keep our children healthy, as we’ve seen hospital beds and emergency services fill beyond capacity in communities where transmission of SARS-CoV-2 and other respiratory viruses remains high,” Dr. Munoz said. “This means catching up on all immunizations, including the flu vaccine, and making sure children wash hands frequently, wear masks in school and during indoor group activities, and maintain physical distance from others.”
— Karen Ann Cullotta
The Food and Drug Administration approved the Pfizer vaccine. What does that mean?
The U.S. becomes the first country to fully approve the shot, according to Pfizer. The news comes on the heels of a Chicago and Cook County-issued mask mandate (everyone over the age of 2 will have to be masked in indoor public spaces, regardless of whether they’re vaccinated). On Aug. 20, Illinois marked its highest one-day total in COVID-19 cases since late January, with a reported 4,904 new confirmed and probable coronavirus cases.
“The FDA’s full approval of the Pfizer-BioNTech COVID-19 vaccine marks a pivotal milestone in the nation’s quest to control the effects of this pandemic,” said Dr. Barbara Alexander, president of Infectious Diseases Society of America.
Dr. Emily Landon, chief health care epidemiologist at the University of Chicago, said the approval is exciting for two reasons:
“A lot of people don’t realize when most medications that we use when they’re approved by the FDA, doctors can use them however they see fit,” she said. “So, a new study comes out saying that you can use aspirin for a new condition. The next day, I can give people aspirin, I can say, ‘Take aspirin for this condition it’s going to help.’ But when you have an emergency use authorization, the FDA only allows you to use it for the specific things that they gave you authorization to use it for, because that’s all they studied at that time.
“Now that we have a full FDA approval, we can use that drug whenever there’s new evidence that tells us a way to use that vaccine that’s better or safer or if there’s a patient that we really think would benefit — say a transplant patient that got three doses and still doesn’t have any antibodies — we can use it now to give them a fourth dose. We don’t need to stick to just the recommendations that they make.
“There’s no rule right now about what to do for an immunocompromised person who got Johnson & Johnson — we know that they need an additional dose in order to be better protected. We know that they’re at too high of a risk, but there aren’t really enough studies for the FDA to approve that. But on an individual basis, if I was seeing a patient in my clinic and the patient and I together felt like the risk of getting another dose of messenger RNA vaccine or Pfizer was low compared to the risk of getting COVID, we should just do it now. And that’s a big difference.
“The second reason why FDA full approval is really great is because while health professionals really understand that that’s really not needed to prove that something is safe, it may make some people feel more comfortable to get the vaccine. It’s a bar that some people said, ‘Well, I’ll get it when this happens,’ and it’s happened. Now, I think that should really help people have confidence, and I really hope that people who told themselves when they had the full approval, that’s when they’ll feel comfortable. This is your chance; you’ve got it now. Don’t let any other doubts creep into your mind. Trust in the science, go get your vaccine.”
More than 200 million Pfizer doses already have been administered in the U.S. since emergency use began in December. Just over half of the U.S. population is fully vaccinated with one Pfizer, Moderna or Johnson & Johnson.
Moderna has also applied to the FDA for full approval of its vaccine. J&J said it hopes to do so later this year.
— Darcel Rockett and The Associated Press
U.S. health officials recommend booster shots for some. What’s the difference between boosters and third doses?
Booster shots for COVID-19 were being discussed early this summer, now U.S. health officials recommended a third shot for some people with weakened immune systems, such as cancer patients and organ transplant recipients.
The Biden administration announced that COVID-19 booster shots will be available by mid-September for those eight months into being fully vaccinated with the Pfizer or Moderna vaccine. The plan, as outlined by the Centers for Disease Control and Prevention and other health agencies, is subject to a Food and Drug Administration evaluation of the safety and effectiveness of a booster and a review by a CDC advisory panel. Special clinics to provide a third COVID-19 shot to immunocompromised individuals are up and running in Oak Park, with over a dozen already dispensed.
Dr. Emily Landon, chief health care epidemiologist at the University of Chicago, clarified some questions about the booster/third dose of the COVID-19 vaccine.
Is there a difference between booster shots and third dose vaccinations?
Yes. A booster is given to people who got a full course of a vaccine and developed a good response. For some vaccines, antibodies and other aspects of a person’s initially strong immune response start to decrease (or wane) over time. When that happens, people are offered booster doses to pump their immune response back to previous levels.
Third/additional doses of COVID-19 vaccines are for people who received the complete series of vaccines but then their immune systems didn’t have a good enough response. Evidence shows these are generally people whose immune systems are weaker. That’s why the FDA and CDC are recommending an additional dose for immunocompromised individuals.
Who is considered immunocompromised?
People who have had or are receiving:
- Organ transplants
- Stem cell transplants within the past two years
- Active cancer treatment for tumors or blood cancer and are undergoing chemotherapy
- Severe primary immunodeficiency
- Advanced or untreated HIV
- Active treatment with high-dose corticosteroids or other drugs that may suppress immune response.
You are not eligible for a third dose of the vaccine at this time if you are healthy, do not have one of these conditions, or do not take certain immunosuppressive medications. If you aren’t sure whether your condition counts, contact your doctor. Other people will be able to get booster shots as early as fall 2021.
If I am immunocompromised, will I be fully protected after I get my third dose?
No. If you are immunocompromised, a third dose is supposed to provide better protection from COVID-19, but it may not provide you with the same level of immunity as healthy people. In studies, most participants who had any immune response to the first two doses did better after a third dose, but some people didn’t.
Does my booster vaccine need to be the same brand as my initial vaccine?
If possible, yes. The CDC recommends booster doses match the original mRNA vaccines people received earlier. If you absolutely cannot find a matching dose of vaccine, it would be OK to get the other one. There is not enough data yet to know whether immunocompromised people who got the Johnson & Johnson vaccine need another dose, but scientists expect to know more soon.
— Darcel Rockett, Associated Press
When is it a HIPAA violation to disclose proof of vaccination?
This may be something many misunderstand. According to Andy Reeder, associate vice president and privacy officer at Rush University Medical Center, people may confuse HIPAA with an individual’s desire to assert personal privacy. HIPAA constrains what health care staff can or cannot disclose about someone in their care, but does not typically apply, he explained, in the case of private individuals or businesses requesting information in the interest of public health. For example, asking someone’s vaccine status is not a HIPAA violation. But a doctor sharing a patient’s vaccination status without the patient’s permission is a violation.
— Alison Bowen
What is the risk for breakthrough infections?
According to Dr. Robert Murphy, executive director of the Institute for Global Health at Northwestern University Feinberg School of Medicine, “The vaccine is about 90% effective against the delta variant, so 1 person in 10 who gets vaccinated and is exposed to SARS-CoV-2 will have a breakthrough infection.”
“Anybody is at risk for it, not just the immune-compromised,” Murphy said. “It’s athletes. It’s totally healthy people. Certainly, the immune-compromised are at a higher risk because they can’t mount a strong enough immunologic response to the vaccine. Older people may also have a weaker response to the vaccine.”
Still, Murphy has some encouraging news for those who are fully vaccinated.
“The end game is most people who get breakthrough infections either have very mild symptoms or no symptoms. They rarely end up in the hospital, and they don’t die,” Murphy said, adding: “The big question is how infectious are they? That’s what we are trying to find out.”
Murphy is among a group of doctors at Northwestern and other universities who are investigating the infectiousness of vaccinated students who got COVID-19, with the results of their study expected in the coming months.
Is the delta variant causing more breakthrough infections?
Mercedes Carnethon, vice chair of preventive medicine at Feinberg, said doctors are seeing breakthrough infections, adding that “while we know that no vaccine is 100% effective, it feels frightening.
Experts remain unsure why the “rate of infections — both new and breakthrough — appear to be picking up,” she said.
“One concern is the delta variant is evading the vaccines. Another concern is any virus that causes a high viral load would break through vaccine protection — and there is evidence that the delta variant does cause higher viral loads earlier in the course of infection,” Carnethon said.
“We will never get away from these concerns because the virus will continue to mutate itself into new variants so long as it circulates in the population, and the biggest space it has to circulate is among the unvaccinated,” she said.
Should vaccinated people wear masks?
Even prior to Illinois Gov. J.B. Pritzker’s mask mandate for Illinois schools in early August, Dr. Benjamin Singer, assistant professor of medicine in pulmonary and critical care at Feinberg, said, “vaccinated people may still choose to wear masks if they or someone in their household contact is at particularly high risk.”
“In places with low vaccination rates and high community transmission, I think it makes clear sense to add back masking when you are indoors as an additional layer of protection from a more contagious variant,” Singer said.
Should your behavior change if you are an older adult?
“All vulnerable individuals, either due to age or pre-existing conditions, should take precautions because if they are infected or re-infected it may not be a mild illness,” Carnethon said. “The highest rates of mortality consistently have been older adults, which is traditionally defined as 65 and older.”
“However, the risks for severe illness go up with each decade of life, and there is no age cutoff where the risk of illness is significantly lower,” she said. “There are 40-year-olds with the health profiles that we know are associated with severe illness—obesity, diabetes, uncontrolled hypertension, cancer or preexisting heart disease. Those individuals, regardless of their age, are just as vulnerable as older adults and should also take precautions.”
— Karen Ann Cullotta
It’s now being recommended that pregnant individuals be vaccinated against COVID-19. What changed?
The move is a turnabout from earlier in the year, when data was not there pertaining to pregnant women, vaccinations and clinical trials.
Northwestern Medicine’s Chief of Obstetrics Dr. Emily Miller, a member of the Society for Maternal-Fetal Medicine’s COVID-19 Task Force, helped write the new language from “should not be excluded” to “recommend vaccination.” Miller said that the change is in light of coronavirus cases rising.
“The original data that showed us that the vaccines were safe and effective excluded pregnant people,” Miller said. “So, the national organizations had to temper their recommendation since they had no data on pregnancy — the recommendation was to individualize that decision making based on that person’s risk as far as SARS-COV2 acquisition. We would individualize and not withhold the vaccine, but we didn’t feel like we could initially recommend it just because we had no data. Now we have data that the vaccine works in pregnant people, reduces their risk of COVID-19, and we don’t see any signals that there’s an increased risk of adverse pregnancy outcomes. And so now that we have these data we can say the benefits of the vaccine outweigh the risks.”
Pregnant individuals who have decided to wait until after delivery to be vaccinated may be inadvertently exposing themselves to an increased risk of severe illness or death. Those who have recently delivered and were not vaccinated during pregnancy are also strongly encouraged to get vaccinated as soon as possible.
Miller hopes the recommendation from the professional societies emphasize how important vaccinations are and will help sway some people who have yet to be vaccinated. According to the Centers for Disease Control and Prevention, almost 140,000 pregnant people have been vaccinated.
“I know that it’s stressful, and people want to be safe but I think we have to recognize that it’s not safe to be unvaccinated in a pandemic,” she said. “I think people are forgetting that not getting the vaccine means you’re at risk of infection. Particularly now when we’re entering what is it? Our fourth or 2000th wave?”
Dr. Carmen Adams, obstetrician and gynecologist at Cook County Health, received her first COVID-19 vaccine shot when 37 weeks pregnant. She received her second shot about two weeks before she gave birth to her first child. She said the science behind the vaccines led her to her lightbulb moment to take the vaccine.
“The only vaccines that we don’t give to pregnant women are live vaccines and knowing that made it safe,” Adams said. “I did not want to have a COVID infection close to delivery, with delivery (I was still seeing patients in the hospital basically until I delivered) and I didn’t want to take a chance getting an infection and getting severely sick or having to be separated or isolated from my baby after delivery.”
Adams feels better as a provider to say that practitioner societies are recommending taking the vaccine. And in turn, she thinks her patients will feel more comfortable receiving it.
“I like to tell my patients you should get it to protect yourself so that you don’t get sick, but I also think there’s really good data out there that’s showing that there’s antibodies created from pregnant women that go to the placenta and to the baby that are likely going to protect the baby for several months,” she said. “I like to emphasize that not only can we protect ourselves but likely protect our babies as well and I think that that is encouraging too.”
Chicago public health Commissioner Dr. Allison Arwady said in an Aug. 3 news conference that the delta variant is more contagious, but there’s no clear data that the variant is making people sicker or putting them in the hospital more than other variants.
“The thing that is extremely clear is that the vaccines are working really well,” she said. “And where people are fully vaccinated, I’ve not seen anything that has made me change my behavior at this point except putting my mask on inside while we get through this surge. All we can say is here is the data we have now, here’s the recommendation, and stay up with the science of it.”
With the new surge of COVID-19 infections, the Food and Drug Administration has accelerated its timetable to fully approve Pfizer-BioNTech’s coronavirus vaccine, aiming to complete the process by the start of next month, according to reports.
— Darcel Rockett
Can COVID-19 push someone into diabetes?
According to Dr. Sirimon Reutrakul, associate professor in the endocrinology, diabetes and metabolism division at UI College of Medicine, there are some suspicions in the medical community that there’s some association between diabetes and COVID-19. Research is going on to see if there is causation.
Reutrakul said she’s seen people come in with COVID-19 with new onset diabetes, though not many.
“I think this is why people are trying to do these studies,” Reutrakul said. “I don’t know if you could prevent yourself from getting diabetes if you’ve become infected with COVID-19 that’s a bit extreme. But I think some of the symptoms of COVID-19 and some symptoms of diabetes may overlap (fatigue and weight loss), so that’s one thing to think about.”
Until there’s something definitive, she said people should keep their eye on the science.
Her suggestion: “If you have a fever, sore throat, a runny nose, those are not symptoms of diabetes. If you have COVID-19 and have significant weight loss, drinking/urination a lot, those may be indicating that you might have something else on top of COVID,” so go get checked.
— Darcel Rockett
Illinois has a new mask mandate. Where does it apply?
Gov. J.B. Pritzker issued a new mask mandate for preschool through high school students and staff statewide, effective immediately. Universal masking also will be required in long-term care facilities statewide.
The requirement will apply to all indoor athletic activities in schools, Pritzker said. Masks won’t be required for outdoor sports and activities.
The move comes as a new school year approaches and a fourth coronavirus spike is occurring in the state. Chicago Public Schools, the state’s largest district, had already made the decision to require masks, but other districts have made them optional in the face of vocal opposition from some parents.
“Far too few school districts have chosen to follow the federal Centers for Disease Control and Prevention prescription for keeping students and staff safe,” Pritzker said in issuing the new requirement, which applies to public and private schools, and day care centers. “Given the CDC’s strong recommendation, I had hoped that a state mask requirement in schools wouldn’t be necessary, but it is.”
— Dan Petrella, Lisa Schencker, and Madeline Buckley
What do we need to know about the variants, like delta or lambda?
First, many called it simply the coronavirus, then COVID or COVID-19. Now, we are keeping track of descriptors like alpha, beta and gamma, the variants of COVID-19. The World Health Organization created this naming system to make them easier to publicly discuss.CQ
The Illinois Department of Public Health lists COVID-19 variants of concern. CQAs of their most recent data, updated July 26 , the original alpha still accounts for the majority of cases, with 6,973 of the total 10,886 cases. Next up is the gamma variant, with 2,641 cases, followed by 636 cases of the delta variant.
Viruses are constantly changing through mutation, which results in new variants, something scientists expect to monitor.
— Alison Bowen
Should we wear masks inside?
Previously, the CDC had eased mask guidelines, saying fully vaccinated people did not need to cover faces.
— Alison Bowen
How many minutes is considered exposure to someone with COVID-19?
But given that researchers are concerned the delta variant might be more transmissible, Dr. Stephen Schrantz, an infectious disease pediatrician at University of Chicago Medicine, said delta’s increased contagiousness “should give the CDC some reason to re-examine its definition of ‘an exposure.’” He added, “I will not be surprised if the CDC does amend its recommendations regarding the duration of contact as more data accumulates.”
— Alison Bowen
Suffering from lingering COVID-19 symptoms after dealing with coronavirus? Illinois looking to help long haulers.
Long COVID-19 is a range of symptoms that can last weeks or months after first being infected with COVID-19 or can appear weeks after infection, according to the Centers for Disease Control and Prevention. Symptoms of long COVID-19 vary greatly — some of the most common symptoms include fatigue, difficulty breathing, difficulty concentrating, body or muscle aches, problems with taste or smell, trouble sleeping, feeling anxious or depressed, dizziness and weakness — and the risk of becoming a long-hauler increases with the severity of illness after infection.
It can happen to anyone who has had COVID-19.
Estimates suggest 10% to 30% of people who get COVID-19 will develop long COVID-19, according to Dr. Jerry Krishnan, University of Illinois Chicago associate vice chancellor for population health sciences and professor of medicine and public health.
“The CDC estimates that about 33 million Americans tested positive for COVID-19, which means 3 to 10 million Americans likely have or have had long COVID,” Krishnan said.
National and local initiatives are being formed to understand and treat patients with the condition.
UIC has been selected to lead an Illinois-based team for the U.S. RECOVER consortium. Krishnan is a part of the team spearheading the efforts to bring health centers, community-based organizations and faith-based organizations in Chicago, Peoria, Rockford and Urbana together to form a network of state resources for a directory that can be available to people with long COVID-19.
There is no test for long COVID-19, Krishnan said. Serology tests used to look for antibodies in the blood are the best gauge for diagnosis, he said. Finding a doctor who knows about testing and best practices from current data is necessary to prevent confusion with other health conditions, he said.
“We’re going to have to rethink where to care for these individuals,” Krishnan said. “The other piece is we got to be careful because we don’t know yet what to do for these individuals.”
— Darcel Rockett
Will extended mask-wearing affect our susceptibility to germs?
“By adulthood, we have come into contact with many types of viruses and bacteria,” she said. “Our immune system has created memory to these pathogens, so that when we come into contact with them we can make antibodies to fight off the disease.”
Vaccines are important for novel pathogens, like COVID-19, she noted.
— Alison Bowen