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Shot in the Arm

Following updated guidance from the Centers for Disease Control and Prevention (CDC), the Baker-Polito administration has outlined how families in Massachusetts can access Pfizer COVID-19 pediatric vaccines for children ages 5 to 11.

Children will be able to receive the Pfizer pediatric COVID-19 vaccine from more than 500 locations, including retail pharmacies, primary-care practices, regional collaboratives, local boards of health, community health centers, hospital systems, state-supported vaccination sites, and mobile clinics. Some appointments are available now for booking, with additional locations and appointments expected to come online in the coming days.

“Pediatricians and parents should be very excited about the approval of the COVID-19 vaccine for children ages 5 to 11,” said Dr. John O’Reilly, chief of General Pediatrics at Baystate Children’s Hospital. “Some parents may be reluctant to have their children in this age group vaccinated, but if a day of soreness can get your child safely back to playing with friends and visiting relatives, then the benefits clearly outweigh the discomfort.”

As a pediatrician, O’Reilly said he had been hoping for this approval for months.

“Some parents may be reluctant to have their children in this age group vaccinated, but if a day of soreness can get your child safely back to playing with friends and visiting relatives, then the benefits clearly outweigh the discomfort.”

“I was very glad that the FDA took the time to be sure that the vaccine was safe and effective for children in this age group before it was approved,” he added. “Clinical trials of over 3,000 children who received the vaccine found it produced protective levels of antibodies with only mild reactions to the shot, such as pain at the injection site, fatigue, and headache.”

He understands that some parents might have safety concerns, but noted that much misinformation has been spread about the development of the mRNA vaccines, especially considering how fast the COVID vaccines were rolled out. The truth, he noted, is that scientists have been working on the development of mRNA vaccines for decades. The basic scientific advances in gene sequencing and gene modeling allowed companies to quickly adapt mRNA technology to the COVID-19 virus.

“Vaccine development is very expensive, and companies developing other vaccines would be slower in developing them because of the cost,” he explained. “Operation Warp Speed gave companies billions of dollars in support and guaranteed purchases, allowing companies to use those funds to quickly ramp up clinical trials and manufacturing. The trials themselves followed the highest standards of research, and the FDA has reviewed all of the trial data to be sure that the COVID- 19 vaccines are safe and effective.”

O’Reilly noted that children infected with COVID-19 tend to experience mild symptoms, but for some, it can be more serious. Since the pandemic began, about 1.9 million children ages 5 to 11 have been infected, about 9% of all U.S. cases. More than 8,300 in this age group have been hospitalized, with about one-third requiring ICU care, and 94 have died, according to federal data. Children ages 5 to 11 who are black, Native American, or Hispanic are three times more likely to be hospitalized with COVID than white children.

Also, several thousand children infected with the virus have developed severe cases of inflammation throughout their bodies known as multi-system inflammatory syndrome, while others are reporting long COVID symptoms similar to adults, such as headache, cough, fatigue, and more.

“Parents who vaccinate their children not only protect them, but they also protect everyone their children come in contact with,” O’Reilly said. “In school, it protects vulnerable classmates and adult staff whose medical conditions put them at risk for severe COVID-19. It also protects family members and makes visiting at-risk family members at the holidays safer for everyone. Vaccinating our kids also helps to protect our communities. The higher our community immunization rates, the lower the risk of COVID-19 rapidly spreading through our at-risk community members.”

Parents who prefer to have their child vaccinated by their primary-care provider should call their provider’s office directly. Others may visit the VaxFinder tool at vaxfinder.mass.gov for a full list of hundreds of available locations. Residents will be able to narrow results to search for locations that are offering the Pfizer pediatric COVID-19 vaccine, with some appointments available now for booking. Additional appointments will be available online in the coming days. Many locations will be booking appointments out weeks in advance.

“Parents who vaccinate their children not only protect them, but they also protect everyone their children come in contact with.”

For individuals who are unable to use VaxFinder, or have difficulty accessing the internet, the COVID-19 Vaccine Resource Line (Monday through Friday from 8:30 a.m. to 6 p.m., Saturday and Sunday from 9 a.m. to 2 p.m.) is available by calling 211. The COVID-19 Vaccine Resource Line is available in English and Spanish and has translators available in approximately 100 additional languages.

All state-supported vaccination clinics will offer low-sensory vaccinations for children with disabilities.

Additionally, the administration has partnered with several non-traditional, youth-friendly locations for pediatric vaccination clinics, including the Discovery Museum in Acton, the Museum of Science in Boston, the Springfield Museums, and the EcoTarium in Worcester. Appointments for these clinics are available now on the VaxFinder tool. Visit www.mass.gov/covidvaccinekids for more information.

While infection rates have been trending down from an early-fall spike, the Massachusetts Department of Public Health reported 1,586 new, confirmed COVID cases in the state on Nov. 4, bringing the total since the start of the pandemic to more than 800,000. Health officials said the total number of confirmed cases in the state, as of that date, was 801,567.

The DPH also reported 23 additional COVID deaths in the state, bringing the total number of confirmed deaths since the start of the pandemic to 18,671. As of Nov. 4, there were 509 people hospitalized for a coronavirus-related illness, including 147 in intensive care.

State health officials say getting vaccinated remains the most important thing individuals can do to protect themselves, their families, and their community. Individuals do not need an ID or health insurance to access a vaccine and do not need to show a vaccine card when getting a vaccine.

Massachusetts leads the nation in vaccine administration, including adolescent vaccination, with more than 80% of youth ages 12-17 having received at least one dose. More than 4.7 million individuals in the Bay State are fully vaccinated, with more than 92% of all adults having at least one dose.

“I can’t emphasize enough how important it is for parents to make the right decision to vaccinate their children,” O’Reilly said. “It can be life-saving for your child and further protect those in your household as well as the community from this terrible disease that spares no one. I am looking forward to a holiday season when kids are fully vaccinated and we can all gather with friends and family to celebrate being together without fear of COVID.” u

Business of Aging

Shot in the Arm

As COVID-19 vaccines begin to roll off production lines, many questions remain — about how quickly they’ll reach the general public, about long-term efficacy and safety, about how many Americans will actually want one.

But on one issue, there is no doubt, Dr. Andrew Artenstein said.

“This is a spectacular achievement just to get where we’ve gotten so far, and I think we should appreciate that,” the chief physician executive and chief academic officer at Baystate Health told BusinessWest. “It’s been a whirlwind, and I mean that in a good way.”

Everyone in healthcare understands the upside — the dramatic promise — of a vaccine as the COVID-19 pandemic enters its 10th month.

“A vaccine is a major component of getting on the other side of this,” Artenstein added. “It’s not the only component, but it’s an important and necessary piece of shortening the duration of this pandemic and possibly preventing future waves.”

With Pfizer gaining emergency-use authorization from the U.S. Department of Health and Human Services to begin distributing its vaccine — and Moderna expected to do the same — the Baker-Polito administration announced allocation and distribution plans for the first round of vaccine shipments to Massachusetts, expected to begin around Dec. 15. The state’s first shipment of 59,475 doses of the Pfizer vaccine was ordered from the federal government and will be delivered directly to 21 hospitals across eight counties, as well as to the Department of Public Health immunization lab.

Doses will then be redistributed for access to 74 hospitals across all 14 counties for frontline medical workers. Another 40,000 doses of the Pfizer vaccine will be allocated to the Federal Pharmacy Program to begin vaccinating staff and residents of skilled-nursing facilities and assisted-living residences in Massachusetts.

In all, Massachusetts is expecting 300,000 doses of vaccines from both Pfizer and Moderna to be delivered by the end of December. Both vaccines require two doses administered three to four weeks apart. While all delivery dates and quantities are subject to change due to ongoing federal approval and allocation, state leaders expect to receive and distribute more than 2 million doses to priority population groups by the end of March.

Dr. Andrew Artenstein

Dr. Andrew Artenstein says the public should not let down their guard when it comes to masking and social distancing while they wait for the vaccine.

“It does make perfect sense,” Artenstein said of the prioritization plans, which reflect judgments on the federal level and ensure delivery to groups like healthcare workers, first responders, the elderly, and people with co-morbidities before the rest of the public. In the case of seniors, for example, “it’s not that they’re more likely to get the virus, necessarily, but they’re more likely to die if they get infected. They do worse.”

Meanwhile, he added, healthcare workers have a greater risk of coronavirus exposure than most other people.

“We’ve been inundated — inundated — with calls from other groups that they want the vaccine,” he said, placing heavy emphasis on that word. “But the truth is, it isn’t available for the general population now, and it may be several months before it is.”

Artenstein, an infectious-disease expert who founded and directed the Center for Biodefense and Emerging Pathogens at Brown University for more than a decade before arriving at Baystate, has been one of the public faces locally of the fight against COVID-19, and he was careful to temper optimism about a vaccine with a reality check on the timeline — and what people need to do in the meantime.

“A vaccine may eventually be the answer, but it’s only going to be part of the solution for the next six to 12 months, assuming we continue to get vaccines that are safe and effective. It’s going to take a while — even if all goes well — before we get enough immunity in the population to really put an end to this thing.

“In the meantime,” he went on, “we would benefit greatly by continuing to push the classic ways to interrupt transmission: masks, distancing, avoiding gatherings. All those things will continue to help us because, even after we start vaccinating parts of the population, it will take the better part of the year to roll it out to everyone, and we need to continue to interrupt transmission.”

Jessica Collins, executive director of the Public Health Institute of Western Massachusetts, agreed, even though it can be a challenge getting through to people suffering from ‘pandemic fatigue,’ who feel isolated and weary of all the changes in their lives over the past year.

“I’m sorry people are tired,” she said. “But the basic messaging isn’t hard — wear a mask, wash your hands, and don’t be inside spaces with a mask off with people you don’t know. I do think the holidays have created a tremendous sense of urgency to remind people again, especially with students leaving schools and coming back to their homes.”

Hopefully, health leaders say, vaccines will put a definitive end to the crisis. But that day is still far off, Collins added. “People need to wait it out.”

 

Making a List, Checking It Twice

In announcing the Commonwealth’s vaccine-distribution plans, Gov. Charlie Baker noted that Massachusetts goes further than national recommendations by prioritizing all workers in the healthcare environment, not only providers, but also food-service, maintenance, and other facility workers. Similarly, home health workers, including personal-care attendants, are prioritized on the list, recognizing their important role providing services to vulnerable individuals and the fact that they often reside in communities highly affected by COVID-19.

Jessica Collins

Jessica Collins

“Messaging is critical, and the messengers are critical. Hopefully, we’ll have good results, and more people will be willing to take it.”

Phase one of vaccine distribution — which, as noted, includes healthcare-facility workers; police, fire, and ambulance workers; congregate-care settings, including not only senior-living facilities, but shelters and jails; and home-based healthcare workers — is expected to last into February. Phase two, expected to run from February to April, will prioritize individuals with co-morbidities that put them at higher risk for COVID-19 complications; all adults over age 65; as well as workers in the fields of early education, K-12 education, transit, grocery, utility, food and agriculture, sanitation, public works, and public health.

Phase three, expected to follow in April or May, will see the vaccine more widely available to the general public.

Baker’s announcement noted that vaccines go through extensive testing, more than any pharmaceuticals, including extensive testing in clinical trials. The U.S. Food and Drug Administration, which approves the vaccine, and the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which will make its recommendation for use, must ensure any vaccine is both safe and effective for the public before approval and distribution.

All this is necessary for emergency-use authorization of the Pfizer and Moderna vaccines, Artenstein said, but the testing process is far from over, and long-term effects won’t be known until, well, the long term.

The emergency-use ruling “is not licensure, but allows the immediate use of the vaccine pending more information that leads to licensure down the road — because we’re in a pandemic,” he noted, adding that he’s optimistic about further testing, as trials so far have shown about 95% effectiveness across all age groups, with no serious adverse effects.

“The data I’ve seen is pretty impressive for efficacy and safety of the vaccine. And there were around 40,000 people in the trial, so that’s a good sample,” he said — enough to start delivering some immunity to high-risk populations now.

The question, especially as distribution widens in the spring, is how many Americans will actually take the vaccine. Collins said the Public Health Institute has conducted preliminary outreach and found some skepticism and mistrust of the government when it comes to vaccine advice, especially in communities of color.

“In order to counteract that, we have been trying to find and lift up messengers in the community who are trusted people, whether faith-based leaders or other trusted messengers, to counteract skepticism and fear about getting vaccines, whether the flu vaccine or the COVID-19 vaccine,” Collins told BusinessWest, adding that the institute held a virtual town-hall event two days before Thanksgiving and asked 10 such messengers to share their wisdom on prevention measures.

Artenstein breaks down vaccine attitudes into three distinct groups of people — two of which are those champing at the bit for a vaccine, and a small but robust community of anti-vaxxers who express skepticism at vaccines in general.

“Then there’s a whole middle group who could be convinced to get the vaccine, but they’re concerned about safety and effectiveness,” he explained. “It’s a risk-benefit calculation, and based on what I know about vaccines, the risk seems low, and the risk of COVID seems pretty high, especially right now, with such high rates in the community.

Hampden County, in fact, currently ranks third among Massachusetts counties for transmission rate, with more than 50 positive cases per 100,000 residents.

Typically, around 70% of people in a community — or a nation — need to be exposed, either through natural infection or a vaccine, to reach the desired herd immunity, he added. “In the U.S., that’s a big number. But the risk-benefit calculation is obvious. You’d like, over time, to have enough people willing to get the vaccine to help the general population.”

 

Anticipation and Reality

While surveys currently suggest about 60% of Americans are willing to take a COVID-19 vaccine, that number could rise higher if early results from the priority groups demonstrate both effectiveness and safety.

“The U.K. is going first, and then U.S. healthcare workers have to go — which is obviously the right thing to do — then people over 65,” Collins noted. “It’s not like the general public is being made guinea pigs. We will actually be able to see a lot of people getting the vaccine, and the companies will see the reactions.

“So, messaging is critical, and the messengers are critical,” she added. “Hopefully, we’ll have good results, and more people will be willing to take it.”

Artenstein agreed, adding that, for the group of Americans ready to line up right now, the wait may be longer than they realize, but that’s OK.

“We’re a little over our skis on this,” he said. “There’s a lot of excitement and anticipation, but it’s going to come out as more of a slow roll; there’s a manufacturing process, an approval process, and a safety process. There won’t be 300 million doses available tomorrow, and that’s hard for some folks.

“There’s going to be a lot of interest, questions, and anxiety, and rightly so,” he added. “We’re living in a very different time, and people want to move very fast. But we have to make sure we do things in the safest possible way.”

 

Joseph Bednar can be reached at [email protected]

 

Opinion

Opinion

By Dr. Armando Paez

While experts cannot predict the severity of one flu season from another, this upcoming season will be unprecedented and can pose a severe threat due to the ongoing COVID-19 pandemic.

The very protection advice we have been stressing for COVID-19 — wearing a mask, frequent hand washing, social distancing — is what is going to protect many people from the flu this year. But the best protection of all is to get your flu shot each year.

Flu season usually begins in the fall around October, but doesn’t peak until December through February. It can sometimes last until May. Because there could be a possible second wave of COVID-19 coinciding with the flu, getting your flu shot this year is more important than ever before.

For the 2020-21 season, the flu vaccines were updated to better match viruses expected to be circulating in the U.S.

Already in advance of the onset of the 2020-21 flu season, the CDC is reminding people to get vaccinated sooner than later, with October being a good time to get vaccinated. It’s important to realize it can take up to two weeks for the vaccine to build up antibodies to protect you from the flu.

Once again, the CDC recommends all people be vaccinated against the flu, especially pregnant women and people with chronic health conditions. For the 2020-21 season, the flu vaccines were updated to better match viruses expected to be circulating in the U.S. The CDC has stated that providers may administer any licensed, age-appropriate flu vaccine with no preference for any one vaccine over another, including the shot or nasal spray.

People who should not get the flu vaccine include children younger than 6 months and those with severe, life-threatening allergies to flu vaccine and any of its ingredients.

In addition to the elderly, vaccination is particularly important for younger children who are also at high risk for serious flu complications, as well as those with heart disease, and pregnant women. The most important complication that can affect both high-risk adults and children is pneumonia. The flu can also aggravate and worsen chronic conditions such as heart disease, diabetes, and asthma.

Also, if you have a weakened immune system after contracting COVID-19, it can leave you at risk for getting a more severe case of the flu, or vice versa.

I’m always asked by those skeptical about getting vaccinated, “can the flu shot give you the flu?” The answer is no. This year, I’m also being asked, “can the flu shot protect you from COVID-19?” Unfortunately, the answer is also no, but we’re hopeful for a vaccine against COVID-19 early next year or sooner.

While the flu vaccine is not 100% effective, the CDC noted that recent studies show that flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine.

Remember, it’s never too late to get your flu shot, preferably before flu viruses begin spreading in the community around the end of October.

Dr. Armando Paez is chief of Infectious Diseases at Baystate Medical Center.

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