Did You Know?
Mutation vs Variant
Mutation: A mutation refers to a single change in a virus’s genome (genetic code). Mutations happen frequently, but only sometimes change the characteristics of the virus.
Variant: A variant is a viral genome (genetic code) that may contain one or more mutations. In some cases, a group of variants with similar genetic changes, called a lineage, may be identified as a Variant of Concern (VOC) or a Variant of Interest (VOI).
Do mutations and variants matter? It depends. If they change the way the virus transmits, for example if a virus spread by droplet changes to one that remains airborne for long periods of time, or if the changes result in better immune system evasion, then they matter. But for the most part viruses mutate constantly and they do not change the infectious pattern.
Infection versus disease versus severe disease.
The medical community sometimes seems obsessed with pointing out that the vaccine doesn’t prevent infection it prevents severe disease. What is the difference and why does it matter?
Asking a vaccine to prevent against infection, meaning the virus can’t enter the body or enter cells, is a pretty tall order given how the immune system responds to invading organisms. It takes a little bit of time for the immune system to respond and attack a virus before it enters cells (antibodies do this) or to train killer T-cells to attack infected cells. The vaccine gives the body a heads up and starts this process ahead of time. So while “infection” might still happen the immune system is ready to mobilize quickly and shut down the virus. Without the vaccine training in place, the body takes longer giving the virus more time to replicate (reproduce) and damage more cells. This can lead to “disease” or “severe disease” which leads to hospitalization in some cases.
A simpler way to put it is infection is when the virus enters your cells. Disease is when you show signs and symptoms of that infection. Symptoms such as fever and inflammation are results of the immune system attacking the invading virus. Sometimes this response can get out of control and a child might experience Multi-system Inflammatory Syndrome (MIS-C). See below for more information.
What about medications?
Antivirals either make it harder for the virus to get into a cell or they prevent the virus from reproducing once they are inside of your cells. Antivirals, and other treatments such as monoclonals, are still being developed.
COVID and Mental Health in children
There is still much to learn about the mental health effects of COVID on children. It is fairly easy to assume that the social and mental health impacts of social distancing and pandemic restrictions would have on children.
For most children being isolated from friends, school and extended family is not conducive to social and mental well-being. There are of course exceptions to every rule, but to say children, especially adolescents, have not fared well during the pandemic would be an understatement. New research is beginning to shed light on how a COVID infection may cause neurological damage that impacts children and adult mental health.
Multi-systemic Inflammatory Syndrome (MIS-C)
MIS-C is a rare but serious complication of a COVID infection. In the simplest terms it is an immune response against your own blood vessels causing organs (heart, kidneys, brain, skin, eyes, intestinal system) in the body to become inflamed. What actually causes MIS-C to occur is unknown but children with MIS also have blood tests indicating an infection by the virus that causes COVID-19.
The most commonly affected age group is school aged children, specifically 8-9 year old’s. Infants and older children can also develop MIS-C although less commonly.
The symptoms of MIS-C, high fever, fatigue, stomach pain, rash, red eyes, diarrhea, dizziness, commonly show up about 4 weeks (anywhere from 2-6 weeks) after a COVID infection. During this time there is no virus shedding. May occur after a mild or severe infection.
Kids showing symptoms of MIS should be seen by a doctor promptly to avoid long term damage to organs. The condition is treatable and full recovery occurs in most children.
It is too early to make definitive statements regarding vaccine protection against MIS-C but early indicators and study do show that most of the children who develop this particular complication of COVID are unvaccinated.
Can children get long COVID?
Long Covid, or post-acute sequelae of SARS CoV-2 infection, refers to a condition in people who experience 4 or more weeks of ongoing problems or symptoms following a COVID infection. For some people these conditions may last 9 months or longer. It is still unknown how the coronavirus can impair the heart, lungs, skin, kidneys and brain, but it does. The symptoms are not all physical. Mental health is also affected in many children and adolescents who may experience anxiety or depression or what is becoming known as COVID Brain Fog.
Long COVID can be especially hard for parents as well. There is not much known about why it happens, why it only occurs in some children and adults or how to cure it.
The best way to prevent the suffering of long COVID is to prevent COVID. Preventing COVID is done through vaccines.
What about myocarditis associated with the vaccine?
Simply put, myocarditis is an inflammation of the heart muscle. You may have never heard of this condition until recently but it is diagnosed in thousands of people every year. The most commonly affected population is young adult males often otherwise young and healthy. Several different viral infections cause myocarditis including flu, colds and COVID.
Symptoms can range from mild to severe, with severe cases requiring hospitalization and sometimes resulting in permanent damage to the heart. The symptoms of myocarditis might be the same as the illness that brought it on such as fever, shortness of breath and chest pain. Most cases resolve on their own.
Myocarditis is an excellent example of comparing risk of vaccine side effects versus risk for possibility of a complication of a disease. CDC has identified myocarditis as a rare, but real, side effect of the mRNA vaccine, specifically in young adult males. About 4-7 out of 100,000 vaccinated kids. Exactly why this happens is not clear but most likely related to a hyper immune response. Current observations suggest that myocarditis after a vaccination tends to be mild and resolves quickly.
It’s difficult to compare numbers in these situations but people who are infected with COVID are much more (17 x more) likely to have myocarditis than someone who is not. If you took the group of 100,00 from above where 4-7 have risk of vaccine side effect and didn’t vaccinate them about 5,500 would become infected with COVID in a 3 month time-frame. Of those 5,500, about 50 would end up hospitalized due to serious disease. (Example taken from CHOP: Myocarditis Get the Facts)
Choosing to not vaccinate your child is not how you prevent myocarditis.
Bringing It Home
COVID will impact our lives and the lives of our children for years to come. It has reminded us we are not invincible, but we are clever and courageous. It has shown us where our society has weakness, where our public health systems need to be strengthened and how quickly facts can be lost in the conversation. What has held up under all this uncertainty and confusion is that the scientific process of asking questions, collecting data, examining that data, and drawing conclusions. And when new data is available going back through the process. We’ve also seen up close, and personally to many, that vaccines work. Vaccines save lives.