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Omicron Update

Omicron Is Headed Our Way…

I hope that everyone has a Merry Christmas and a Happy New Year! It looks like the new Omicron COVID-19 variant will be hitting Florida hard within the next 30 days, so I just want everyone to be ready.

HOW OMICRON SEEMS TO BE DIFFERENT:

*Key Take-Aways:
1. Omicron is more contagious
2. A surge may come early January
3. Getting a booster vaccination is now more important

Omicron Is Already In 47 States

Omicron already accounts for 13% of COVID cases in the states of New York and New Jersey.

A Florida Surge Is Probably Coming Early January

This is according the largest hospital group in America, HCA. This means that cases will be on the rise during Christmas.

Two Times More Contagious Than The Delta Variant

You probably heard that Delta was much more contagious than the earlier COVID strains, well Omicron is even more contagious! Practically, this means that it will take less contact with a sick person to contract Omicron. Omicron will spread faster through our businesses, schools, and families.

A Shorter Incubation Period

The “incubation period” is the how long it takes someone to show symptoms after they catch the virus from someone. Delta was quicker than earlier variants, and Omicron is even faster. With Omicron, people are showing symptoms within 1 to 4 days. On the bright side, this means we won’t have to sit around waiting after exposures. But this also means that large populations of people will all be getting sick at the same time, which could be overwhelming for our healthcare system.

Possibly Less Severe Disease

The data out of South Africa (where Omicron seems to have started) suggests that Omicron may not cause as serious disease as earlier variants. But, South Africa’s population is younger, which could be the reason people are less sick than expected. There is also some research showing that Omicron divides very fast in the nose, but slower than previous variants in lungs (so less breathing problems). Let’s hope that this early information is all true and Omicron turns out to be less severe.

Vaccines Continue To Prevent Serious Illness

While our current vaccines are not as effective against Omicron, they still seem to be preventing hospitalizations and serious disease (but they may prevent transmission if with a booster dose).

Being “Fully Vaccinated” (2 Pfizer or Moderna shots or 1 J&J) Does Not Prevent Infection OR Transmission of Omicron

There are many documented cases of fully vaccinated people contracting Omicron and quickly infecting other people. But again, vaccines are still doing a good job at preventing serious disease. But, getting a booster shot can boost a person’s antibodies to the level that may prevent infection and transmission.

A Vaccine Booster Is Even More Important

A booster dose (a third dose of the Moderna or Pfizer mRNA vaccine) appears to increase antibody levels to the 80 to 90% effectiveness range for Omicron, possibly preventing infection and transmission. This has led several countries to recommend earlier booster dosing. The CDC currently recommends that a booster be given 6 months after the 2nd mRNA vaccine, but the UK (England) is now recommending adults receive a booster 2 months after the 2nd Moderna or 2nd Pfizer vaccine. Israel is now recommending a 4th dose. The CDC says that the booster dose can be from either vaccine (mixing and matching is okay for a booster dose).

The CDC currently recommends that immunocompromised individuals receive a 3rd Pfizer or Moderna vaccine 28 days after their 2nd shot. The CDC is calling this an “Additional Primary Shot”

For those whom initially received the Johnson & Johnson vaccine, the CDC is recommending a booster dose of Pfizer of Moderna two months after their J&J shot.

How To Be Prepared At Home

Dr. Sparks and I will always be available for our members, but you may want to order rapid home COVID test kits and a pulse oximeter to use at home–especially for parents, family, and friends. For members, we will have plenty of rapid tests available at the office and send-out 48 hours PCR tests.

Should We Change How We Are Living?

Every family has their own comfort levels, and we all need to be back in society interacting and socializing. I definitely recommend getting a booster shot ASAP and paying attention to the news. If Omicron surges, there is a good chance many businesses and schools will go back to mask wearing for a temporary period. If you or someone in your family is medically vulnerable, I would consider decreasing your social interaction during the surge.

I have been living life more freely, usually without a mask, but I am personally getting ready to go back to masking-up and being more careful with my social interactions. Also remember that masking is much better at preventing sick people from spreading COVID (because the sick person is wearing a mask), than preventing masked people from getting COVID from an unmasked sick person.

What About The Holidays?

There is a good chance that many of us will be getting together with people who have been exposed to Omicron. I would encourage family members to avoid gatherings if they have cold symptoms, such as fever, cough, sore throat or runny nose, and I would also encourage family members to get tested before gathering together for the holidays. Last, encourage eligible family members to get their booster shots.

Vaccines For Ages 6 Months Through 4 Years-Of-Age Are Delayed

For several weeks now, children ages 5-11 have been able to receive the Pfizer COVID-19 vaccine at a lower dose (1/3 the adult dose). With Omicron on the horizon, it is more important now than before for children of this age group to be vaccinated. While kids usually get less severe infection than adults, it does seem like with each strain kids are becoming more susceptible to COVID-19.

Pfizer released data on its vaccine trial for children ages 6 months to 4 years on Friday. They used 1/10th of the adult dose. There was a good immune response in children ages 6 months through 24 months after 2 doses, but not in children ages 2 to 4 years of age. It appears that Pfizer has decided to add a third dose to all ages, 6 months through 4 years of age, and not try to release the vaccine for any children under 5 until after this trial.

I have many families that were really hoping that the 6 month through 4 years-of-age vaccine would be released in January or February of 2022, but I am sad to say that it looks like mid-summer is more realistic, now that Pfizer is adding the third dose to all ages.

Still Accepting New Members

If you are interested in learning more about my concierge practice, Canopy Pediatrics, please text me at 850-701-9652 or email me at rhoman@canopypediatrics.com

Hopefully this wave will be shorter than previous waves, since Omicron spreads faster, but let’s also hope that we do not overwhelm our health system!

Dr. Russell Homan, MD

What is so bad about RSV?

One of the “strongest” cold viruses

RSV (Respiratory Syncytial Virus) is one of the worst “common cold” viruses in circulation. 1 in 20 children under 3 months-of-age who contract RSV will require hospitalization. It is also very dangerous for the elderly and immunocompromised. Symptoms can last up to a month and many children shed the virus for 2 to 3 weeks (it’s very contagious). People “catch” RSV by touching their eyes, mouth, or food that has been in contact with RSV secretions or mucous (yuck). So handwashing is very important!

The 2021 RSV Season is Late

Because of COVID, adults and children were staying separate and wearing masks this winter, so the 2021 RSV started late and is continuing later than normal. Usually, RSV season would be over by now.

RSV Goes to the Lungs

Most “common cold” viruses cause coughing because of a postnasal drip and inflammation of the throat. But RSV often moves down into the lungs, causing wheezing, trouble breathing, and possibly requiring oxygen.

How to Prevent RSV

Since there is not an RSV vaccine yet, the best way to prevent RSV is to limit possible exposure. During RSV season, make sure infants and toddlers are kept away from sick children and adults. Also, since it’s mainly spread through mucous or secretions, handwashing is very important! Daycares and preschools should send home infants and toddlers with cold symptoms, especially during an RSV outbreak.

How to Treat RSV

Since RSV is a virus, there is no medical treatment for RSV. But children with RSV can develop ear infections, bacterial pneumonia, or sinus infections. As with all “colds” follow-up with your child’s pediatrician if you are concerned about your child.

You Can Catch RSV Multiple Times

Theoretically, someone could catch RSV every winter! Thankfully, the infections is usually milder with each infection.

Medical Options For Allergy Symptoms

It’s that time of the year! Many of us are walking around like zombies: groggy, stuffy nose, headache, sore throat, and itchy eyes. There is a lot that can be done, and much with over-the-counter (OTC) medications. You don’t have to continue in a state of pollen zombiness. The following is what I recommend for my patients.

Most of people only know about sedating (ex. Benadryl) or non-sedating antihistamines (ex.’s Claritin, Zyrtec, or Allegra). “Sedating” means they cause sleepiness, and I think most people know that Benadryl can make you sleepy. But there are now many more options now, but we’ll start with the basics.

For Mild to Moderate Nasal Congestion, Sneezing, or Sore Throat:

Non-Sedating Antihistamines: I recommend always starting with a non-sedating antihistamine. They rarely make people sleepy, they work quickly, and they usually last all day. Examples are loratadine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra). Zyrtec is approved for children down to 6 months of age (but talk to your doctor first when giving it to a child less than 2 years of age).
Non-Sedating Antihistamines plus Nasal Decongestants: Two nasal decongestants, psuedoephedrine (Sudafed) and phenylephrine, can be combined with allergy medications. Pseudoephedrine works well, but it must be purchased at the pharmacy desk, because it can be abused as a stimulant or used in the production of methamphetamines. I recommend only using decongestants for short periods, such as 1 to 2 weeks at a time, and avoiding their use in the afternoon or at night, because they can cause trouble sleeping. There are many medical conditions in which decongestants should not be used, so if you have a medical condition (besides allergies) speak to your doctor before using one.
Sedating Antihistamines (i.e. Bendaryl): I would only recommend Benadryl (diphenhydramine) if you only have trouble with allergies at bedtime. Benadryl only lasts 6 hours and makes you sleepy.

If Antihistamines Do Not Work or for Moderate to Severe Nasal Congestion and Sore Throat

Nasal Steroid Sprays: For the majority of people, nasal steroid sprays are sufficient to manage symptoms. Examples are Flonase (fluticasone), Rhinocort (budesonide), or Nasocort (Triamcinolone). I recommend fluticasone as it is a “2nd generation” spray, so less than 1% of the medication enters your body (as opposed to 10 to 50% of the older sprays, like triamcinolone or budesonide). Flonase “Sensimist” is approved for children down to 2 years-of-age.
Cromolyn Nasal Sprays: Cromolyn nasal sprays are probably the safest allergy medicines available, it’s just that you need to use them 3 to 4 times per day. One brand is Nasalcrom. They don’t work as well as nasal steroid sprays, but they are so safe, I often suggest using them in infants (only try under the guidance of your pediatrician).

Prescription Options: If the oral antihistamines and/or Nasal Steroid Sprays do not work

Singulair (Montelukast): Many kids (and some adults) do not like having something sprayed up their noses. In these cases, I usually prescribe my patient Singulair. It’s approved for children down to 6 months-of-age. Sometimes Zyrtec (or Claritin) + Singulair is the perfect solution. Singulair also prevents wheezing in people with asthma.
Antihistamine Nasal Sprays: This is basically like spraying Benadryl right into your nose, and they work great for some people, especially people that have adverse effects from other medications.
Combination Steroid/Antihistamine Nasal Spray (Dymista): Some people (or children) find relief using both a nasal steroid spray AND an antihistamine nasal spray. There is even one spray, Dymista, that combines the two.

Eye Symptoms: Dry, Itchy, Red, Watery Eyes

Newer Antihistamine Drops: The drops work very and are safe, and all but one, “ketotifen” require a prescription. Ketotifen can be found under the brand name “Zaditor,” “Alaway,” or other names. Make sure you check for the active ingredient. It can burn a little when it goes it, but storing the bottle in the refrigerator can help.
Oral antihistamines: The the sedating (Benadryl) and non-sedating (like Zyrtec) also help with eye allergy symptoms.
Older Antihistamine + Anti-Red Eye Combinations: These don’t work as well as the newer antihistamine eye drops (like ketotifen), but are the most common drops that you will find in the store. These will be under the brand names Naphcon-A, Opcon-A, Visine-A. If you use these for more than 2 weeks, your eye will start to become red between doses.

Summary – For mild symptoms, start with Zyrtec (or similar). For moderate symptoms, start with a nasal steroid spray, like Flonase.

If you cannot get your allergies under control, I recommend contacting your doctor, because he or she can help you find the right mix of prescription and non-prescription medications to get you and your family outside enjoying the Tallahassee spring and summer.

The Race for 2021: COVID-19 vs the Vaccines

I think we are all incredibly happy to get 2020 behind us, and I hope that 2021 is a much better year. As far as COVID goes, we finally have vaccines and doctors are better at keeping COVID patients out of the ICU. But still, COVID will give 2021 a challenging start for a few reasons:

Challenges:

COVID-19 ER visits and hospitalizations in Tallahassee have surpassed the previous July peak, forcing our hospitals to open new COVID-19 wards.
A 50% more contagious COVID-19 strain is now circulating in the United States.
Vaccine distribution is progressing more slowly than expected.
About 25% of adults infected by COVID-19 still have symptoms 6 to 8 weeks later, many for months.

Positives:

Two COVID-19 vaccines have been licensed and distributed and many more are on the way.
Death and the need for ICU beds from COVID-19 is still an issue, but it is decreased from early 2020.

The End is Near, but We Need to Buckle Down

Then end is near, but I believe things will get worse before getting better. People are getting tired of social distancing, and we are now seeing an increase in COVID-19 cases from families getting together over Thanksgiving, Christmas, and New Year’s. And there is a new, more contagious viral strain circulating. We are also continuing to learn more about COVID-19 “long-haulers” who experience symptoms of Post-COVID-19 Syndrome for weeks (sometimes even months) after their initial infection.

If we can continue to be diligent with social distancing and limit unnecessary exposure to other people and families, many less people will contract COVID-19. As a society, we will be much better off once more of us are vaccinated.

Many of Us Must Continue Living with a Significant Amount of COVID Exposure

Still, most of us must continue living with a significant amount of COVID-19 exposure. I must continue to treat patients. Many people must work in-person. Some kids cannot succeed with distance learning and need to be in school. Some parents must send their kids to school or daycare so that they can work to put food on the table. But, we can all continue to be disciplined, and limit unnecessary exposures.

If vaccines are released to the public by this summer (as expected), we could have a very normal fall! Hang in there another 6 months! This definitely encourages me to be extra careful for the coming months.

Some Practical Social Distancing Reminders:

Eating with people: I see this all the time. If you sit down to eat with people, especially inside, then you have just exposed yourself and your family to everyone these people have exposed themselves to. If you really need to eat with someone, try to find a table outside, which is much safer (but not perfectly safe).
Exposure time: The amount of time you spend exposed to COVID-19 really matters. Quickly checking-out at a cash register or passing people in an isle is much different than working next to someone for an hour or two.
Masks are not perfect: Masks are helpful as they block COVID-19 droplets from directly reaching people, but COVID-19 virus particles also sneak around the sides of the mask (or through the mask material), float in the air, and then get breathed in by nearby people.

And remember, it just takes one exposure! I have heard many stories about families that had been very careful, but then let down their guard just once and got COVID. They may have gone to a wedding (where people were not masked), ate with a friend (who was not as careful as them), or spent extended face-to-face time with someone.

I Got The COVID-19 Vaccine!!

YESSSSSSSSSS! I am so glad this day is here! For me, getting a COVID-19 vaccine is like getting into college or getting a new car, it’s such a gamechanger! I am so thankful for TMH getting me in on day 1 in Tallahassee, Florida. And thank you to private industry for finding a solution to the COVID-19 Pandemic.

If you have any doubts about the safety of COVID-19 please read my previous blog posts. As a general pediatrician, I did a lot of reading, and the more I read, the more I wanted a COVID-19 vaccine. Yes, I may get a little soreness or a fever, but THIS IS PART OF THE VACCINE DESIGN. If the vaccine didn’t elicit any inflammation, then the body would not make antibodies against the COVID-19 spike protein.

Hopefully the general public will be vaccinated soon! I did not expect the vaccine to arrive until 2021!!!!!!!!

Give Me A Vaccine, So That I Can Avoid Post Covid-19 Syndrome

Blog 4 of the 4 Part Series: Why I Want a COVID-19 mRNA Vaccine (and why you should too).

This is the fourth of four blog posts where I share what I have learned as a Tallahassee pediatrician doing my own research, and why I am excited to receive a COVID-19 vaccine:

Sunday, December the 6th – How vaccines use our immune system to protect us against viruses, bacteria, and even cancer.
Last Wednesday – How mRNA and DNA vaccines are different than traditional vaccines.
Last Saturday – mRNA and DNA vaccine safety in animals and humans.
Today – Post Covid-19 Syndrome

For Young and Middle Age Adults, Post COVID-19 Syndrome May Cause More Suffering Than Acute Symptoms

Even though I turned 40 in 2020 (yes, I know I look 25…except for the hair), I am not as nervous about the immediate effects of COVID-19 (fever, trouble breathing, etc.), as I am about the chronic effects of COVID-19.

Very few people my age actually die from COVID-19, even though many will have flu-like symptoms for over a week or be hospitalized. But now, doctors and scientists are learning that some people will develop chronic COVID-19 symptoms for months, the most common symptom being fatigue, like having Mono, but worse. Others will suffer from shortness of breath, headaches, depression, brain fog, high blood pressure, cholesterol issue, or body aches. Some people alternate feeling fine for a week and then terrible for a week. This diverse group of chronic symptoms has been given the name, “Post COVID-19 Syndrome.”

It would suck to be sick for a few weeks, but it would be even worse to be tired and have body aches for months or years.

Post COVID-19 Syndrome May Be Caused by Damage to Small Blood Vessels

Doctors and scientists are not sure how COVID-19 causes these persistent symptoms, but they think it is from damage to small blood vessels throughout the body–in the heart, lungs, liver, and even the brain. COVID-19’s damage to small blood vessels can cause stroke and heart attacks in relatively young patients (even in patients younger than myself). As you can imagine, blood vessels are found throughout the body, so this may be why the symptoms are so diverse, ranging from depression to trouble breathing.

New Vaccine vs COVID-19 Infection

To me the answer is clear: I would rather take a new(ish) vaccine than get a COVID-19 infection (or a second COVID-19 infection). These new vaccines have already been given to thousands of people without serious side-effects, while we know that COVID-19 can cause death, make you very sick for weeks, and can have long-term side-effects for months and maybe years.

If you are skeptical about the Moderna and Pfizer/BioNTech vaccines, please read my previous posts. The more I learned about them, the more I wanted one!

mRNA and DNA Vaccines in Humans and Animals

Blog 3 of the 4 Part Series: Why I Want a COVID-19 mRNA Vaccine (and why you should too).

This is the third of four blog posts where I share what I have learned as a Tallahassee pediatrician doing my own research, and why I am excited to receive a COVID-19 vaccine:

Last Sunday – How vaccines use our immune system to protect us against viruses, bacteria, and even cancer.
Last Wednesday – How mRNA and DNA vaccines are different than traditional vaccines.
Today – mRNA and DNA vaccine safety in animals and humans.
This Wednesday December the 16^th – Post Covid-19 Syndrome

The History of mRNA and DNA Vaccines

Starting around 1990, scientists were first able to inject genetic material (mRNA or DNA) into animal muscle AMD get the muscle cells to produce a protein based on this genetic material. This laid the foundation for mRNA and DNA vaccines, which stimulate the muscle cells near the injection to produce the antigen for the vaccine. So far, the biggest challenge with DNA and mRNA vaccines has not been safety but getting them to work. Scientists have continued to tweak the antigen code and the adjuvant effect of the DNA and mRNA. They have also discovered better ways of getting the mRNA or DNA into the cells.

DNA and RNA Vaccines in Humans and Animals

Though the new COVID-19 mRNA and DNA vaccines will be the first fully licensed vaccines for humans, there have been DNA vaccines licensed for animals since 2002. This includes vaccines for fish, dogs, cats, horses, and chickens. None of these licensed vaccines for animals have had to be pulled from the market for safety or efficacy concerns.

mRNA and DNA Vaccines were already in Human Clinical Trials

Starting 10 years before the COVID-19 pandemic, mRNA vaccines had started entering human clinical trials. This includes vaccines against influenza, rabies, cancer, Mono, and Zika virus. In fact, Moderna had already completed a successful Phase 1 Clinical Trial for an mRNA influenza vaccine in 2017. Most of the mRNA vaccines in trials have been safe and effective, but just like traditional antigen plus adjuvant vaccines, some mRNA vaccines were not effective and some had too strong of an immune response. But after a decade of conducting mRNA vaccine trials on thousands of human lives, results have been so good and promising that research and interest has continued to grow.

COVID mRNA Vaccines are 90-95% Effective, in Studies of Over 50,000 People

I am so impressed with reports of 90 to 95% effectiveness. Yes, the Phase 3 Clinical Trials are just finishing, and we only have about 9 months of safety data in humans, but 95% efficacy is awesome! First, many vaccines and medications get to Phase 3 trials just to find out that they do not really work. Second, this is exceeding the CDC’s goal for 70% effectiveness (the seasonal flu vaccine is only 40 to 60% effective every year). 95% Efficacy means that if you give 100 people the COVID-19 mRNA vaccine, and then expose them all to COVID-19, only 5 out of the 100 would contract COVID-19!

COVID mRNA Vaccines have been Safe

So far, COVID mRNA vaccines have been safe. About 1/3^rd of people who received the Moderna or Pfizer/BioNTech mRNA vaccines had a reaction. Normally a little redness or swelling at the injection site or mild aches or fatigue. About 2% (2 out of every 100 shots) of study participants had a “grade 3” reaction, which means that the fever, body aches, fatigue, or swelling was severe enough to keep the person from doing his or her normal activities for a day or two. There were no life-threatening “grade 4” reactions in with either mRNA vaccine trial. This is similar to what people experience after a Tdap (tetanus-diptheria-whooping cough) booster vaccine.

What Other Adverse (aka Bad) Reactions were Scientists Worried About?

Some scientists were worried about too strong of an immune response from the adjuvant part of the mRNA. This could have led to high fevers, inflammation, damage of vital organs, or too much swelling at the injection site Thankfully, even though the mRNA immune response has been strong (which is good because it stimulates the body to build antibodies), it has not been dangerously strong. Again, the experience is similar to receiving a Tdap vaccine.

Second, scientists were worried about “Vaccine Enhanced Disease,” where the vaccine makes the real infection worse rather than protecting against the infection. There were some animal vaccine studies of the 2002 SARS Coronavirus (which is similar to COVID-19), in which the experimental vaccine made the SARS infection worse, so scientists were appropriately nervous about VED occurring with COVID-19 vaccination. Thankfully this has not happened. Even when vaccinated people get COVID-19, the COVID-19 infection has been less severe, instead of more severe. More great news!

Third, DNA and mRNA are genetic material. There is a theoretical concern that a DNA or mRNA vaccine could permanently insert foreign genetic material into our DNA, leading to health problems. In the decades of DNA and mRNA vaccine experimentation, this has never happened in animal or human studies (but it could make a good movie).

In conclusion, the COVID-19 mRNA vaccines appear to be very safe and very effective, despite the rapid development and challenges of making a new vaccine. Thankfully, mRNA and DNA vaccines had been in development for decades and were ready to be produced when the COVID-19 Pandemic hit.

I hope after reading this (long) blog, you are encouraged and excited about how our country can overcome this horrible illness. Post with any questions, and read my next blog covering Post Covid-19 Syndrome.

How mRNA and DNA Vaccines are New and Different

Blog 2 of the 4 Part Series: Why I Want a COVID-19 mRNA Vaccine (and why you should too).

This is the second of four blog posts where I share what I have learned as a pediatrician doing research, and why I am excited to receive a COVID-19 vaccine:

Last Sunday – How vaccines use our immune system to protect us against viruses, bacteria, and even cancer.
Today – How mRNA and DNA vaccines are different than traditional vaccines.
This Saturday – mRNA and DNA vaccine safety in animals and humans.
Wednesday December the 16^th – Post Covid-19 Syndrome

What is the Difference Between mRNA and DNA?

Our genetic code is stored in a DNA “double-stranded” spiraling helix, made-up of 4 different DeoxyriboNucleic Acids, corresponding to the A, T, G, or C of our genetic code. Think of DNA as our genetic code storage facility, and RNA (RiboNucleic Acid) as genetic copies that your body uses to make and do things. RNA copies that are used to build things are called “messenger RNA” or mRNA.

Why Use mRNA (or DNA) in Vaccines if all You Need is an Antigen and an Adjuvant?

In my first post, I explained how a vaccine basically has two parts: an “antigen” (for COVID-19, usually the “spike” protein) and an “adjuvant” to stimulate the immune system. Traditionally, vaccine companies make large quantities antigens and adjuvants and then package them into small vials for use. In fact, 5 of the 11 COVID-19 vaccines in clinical trials are being produced just like this. The problem is that takes a lot of time and money to design and build the manufacturing plants that safely and efficiently produce the antigen and adjuvant for a vaccine.

Alternatively, mRNA vaccines (and DNA vaccines) use our own human cells’ built-in protein making ability. The mRNA (or DNA) stimulates our own cells to make the antigen! So instead of having to manufacture a new adjuvant and antigen for every new vaccine, scientists can simply alter the mRNA (or DNA) code so that a different antigen is produced by the cell. And as an added bonus, RNA and DNA generally do not need added adjuvants, as they have built-in genetic code that triggers an immune response.

mRNA and DNA Vaccines Stimulate Cells to Make Antigens and Stimulate the Immune System to Make Antibodies.

In Summary, the mRNA in COVID-19 mRNA vaccines both stimulates human cells to make the COVID-19 spike protein AND stimulates the immune system to make antibodies against the COVID-19 spike protein. This saves both time and money, because scientists and engineers do not have to design and build manufacturing plants to produce large quantities of antigen and adjuvant. Instead, scientists can simply change the mRNA in a mostly ready-to-go system to rapidly manufacture a new vaccine.

In my next post this Saturday, I will review this history and safety of both human and animal mRNA and DNA vaccines. There will be a lot of good information! For example, did you know DNA vaccines have been licensed for use in animals since 2002?

Why I Want an mRNA COVID-19 Vaccine (and why you should too) – 4 Part Series

Blog 1 of 4 – How Vaccines Work

Like most of you, I have been encouraged by reports of 90% efficacy of both the Moderna and Pfizer/BioNTech mRNA vaccines. After all the human suffering from COVID-19, it would be great to end the pandemic with a human success story. Distribution of the vaccines could start next month in the U.S. and maybe next week in England.

And I will be the first in line to receive the vaccine! I was initially nervous about receiving and recommending a vaccine made with new technology against a new virus. But, I’ve done my research, and I really want to get one of these new vaccines.

This is the first of four blog posts where I share what I have learned, and why I am excited to receive a COVID-19 vaccine:

Today – How vaccines use our immune system to protect us against viruses, bacteria, and even cancer.
Wednesday – How mRNA and DNA vaccines are different than traditional vaccines.
This Saturday – mRNA and DNA vaccine safety in animals and humans.
Wednesday the 16^th – Post Covid-19 Syndrome

Part 1: How Vaccines Use Our Immune System to Protect Us Against Viruses, Bacteria, and Even Cancer

Our Immune System is Constantly Exposed to “Antigens”

Our body is constantly exposed to foreign material, which scientists call “antigens.” Every day, THOUSANDS of antigens make it into our body through the air we breathe and the food we eat. Our immune system is alwasy on the look-out for these foreign antigens, because some are dangerous (live viruses, bacteria, parasites, and cancer). Most of the time these antigens are harmless. They are quietly recognized and gobbled-up by our immune cells, not creating any noticeable immune response.

Our Immune System Makes Antibodies Against Dangerous Antigens

But sometimes an antigen will begin to damage cells in our body (like bacteria damaging your skin). The damaged cells send out alarm signals to the immune system. These alarm signals do many things, one of which is to activate the “humoral immune system,” which produces “antibodies” to this new, dangerous antigen. Antibodies are small proteins that float around in our blood (and the lining of our lungs and GI tract) that are custom made to stick to a specific antigen. If effective antibodies are produced to an antigen, the next time this dangerous antigen enters the body, these antibodies will quickly stick to the antigen and label it as dangerous This will trigger the immune system alarms, so that the antigen can be quickly destroyed before it damages too many cells (like it did the first time).

Vaccines Contain an Antigen, Designed to Make Antibodies

A vaccine basically puts a safe antigen into body, which stimulates the immune system to make effective antibodies against a dangerous disease (like COVID-19). It sounds simple, but there are many challenges to making an effective vaccine to a new virus. First, scientists had to decide which part of the virus to use as the antigen. Remember, the antibodies produced by the antigen would have to work against the real COVID-19 virus. Many experimental vaccines fail because they don’t create effective antibodies. And, you can’t just use the whole live virus as the antigen, or the virus will make people sick! Thankfully, scientists had already learned from previous Pandemic Coronaviruses that antibodies against the “spike” protein of the virus’s fatty cover seemed to work, and they already had experience making a spike protein antigen.

Scientists Must Use the Right Adjuvant to Stimulate the Immune System

But, if you inject someone with the spike protein alone, it probably won’t cause any damage (since it’s just one part of the virus), and it will just be gobbled-up by our immune system without producing any antibodies. So scientists must also include an “adjuvant” along with the spike antigen, that “tricks” the immune system into thinking that the spike antigen is dangerous and therefore the stimulating the immune system to turn on the alarms and make antibodies against the spike protein. Adjuvants are made of many compounds, including synthetic DNA resembling bacteria DNA, aluminum, and even proteins from the Chilean soapbark tree that the immune system thinks are dangerous bacterial proteins.

It Takes Time to Manufacture Safe Antigen and Adjuvant

So, at the most basic level, a vaccine is composed of both an antigen that can be used to make effective antibodies, and an adjuvant that stimulates the immune system to make antibodies. In fact, five of the eleven COVID-19 vaccines in stage 3 clinical trials are simply antigen-adjuvant vaccines. In my next blog, I’ll explain how mRNA and DNA are different (spoiler alert—they get our own cells to make the antigen).

Last Minute School Anxiety Tips

Leon County schools restart this Monday, and as a pediatrician in Tallahassee, I am hearing than many children (and parents) are feeling the grip of anxiety. With so many changes, such as masks and new drop-off rules, it is appropriate to feel some level of anxiety. Here are a few tips to cope with the new changes and the new school year:

1. Talk to your child about the changes

If you haven’t already, talk to your child about the changes. Younger children (like elementary school) will need these in more concrete terms, while older elementary, middle, and high school children may want to discuss topics more deeply. Sometimes this discussion is easier over a snack or a meal.

For example, you might say to your first grader, “School is starting tomorrow. You are going to get to see friends and your new teacher. School is going to be a little different this year. Teachers and kids will be wearing masks, and you will need to have your temperature checked every morning, but after a few days, the new changes will start to feel normal. What do you think about that?”

(It is sad for our kids that this will be the new normal for a time.)

For younger kids, give them the facts, and then wait and see how much more they want to know (if any).

2. Validate worries

It is totally appropriate to feel anxiety about this new school year as there are so many changes. If your child expresses worries about the new year, validate their concerns before telling them they will be okay.

To a first grader, you could say, “Jennifer, you are right. It is normal to feel sad that your best friend won’t be at school this year. But you know what? We will try to arrange playdates with her outside, AND remember all the new friends you made last year at school?”

3. Plan some special rewards

Looking forward to something special after school can help your child make it through the day. Consider rewarding your child for the first few days of school with a joint activity that includes one-on-one parent time. Examples are baking, doing a puzzle, playing chess, exercising, or going out for ice cream.

4. Practice anxiety-forming activities

If your child voices concerns about new procedures, such as getting his or her temperature checked or school drop-off, then practice these with your child. Practice should be just playing a make-believe or pretend game.

For example, if you child is nervous about getting her temperature checked everyday, explain to him or her how it will happen. Then ask your child who would they like to be, the adult or the child? Then act it out a few times, maybe even trading places. You can do the same for school drop-offs and walking into the classroom.

5. Contact your school’s guidance counselor and/or pediatrician

If you have spoken to your child and practiced everything, and the anxiety or fear is just overwhelming, then I recommend speaking to your school’s guidance counselor or pediatrician for more help. Most schools can make exemptions for children who are significantly affected by anxiety. For example, the school may be able to provide a consistent person for car drop-off. Sometimes it may help to have a note or a call from your child’s pediatrician.

In general, going back to school is going to be beneficial for so many kids. The lack of social interaction has been very hard on children and their families. But for many kids, Monday is going to be a tough day. Some kids will not make it out of the car, AND THAT IS OKAY, just make sure and contact your school’s counselor and/or your pediatrician.

Good luck everyone! Message me with questions or comments!