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Where vaccines for young children and the latest information about Long COVID

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Tanya Lewis: Hello and welcome to COVID, Coming soon as well Scientific American a series of podcasts.

Josh Fishman: This is your quick information about the COVID pandemic. We introduce you to the science behind the most pressing issues about the virus and the disease. We demystify the study and help you understand what it means.

Lewis: I’m Tanya Lewis.

Fishman: I’m Josh Fishman.

Lewis: And we Scientific Americansenior health editors. Today: vaccines for the little ones may already be almost here!

Fishman: And new evidence of long-term COVID-19 shows who gets sick most often and what the most common symptoms are.

It has been almost a year and a half since the COVID vaccine was approved for adults in the United States. But children under the age of five are still not eligible, even if testing on children began more than six months ago. Can this change?

Lewis: Maybe. I can understand why many parents are disappointed. For several months they were told that the vaccine was not far off. But there were some promising developments.

How’s that? Were the test results good?

Fishman: Just a couple of weeks ago, vaccine maker Moderna announced it was granting permission for the emergency use of its vaccine for children aged six months to six years. And Pfizer recently announced in a press release that its vaccine was 80 percent effective in preventing symptomatic COVID in children under five, although they have not yet released the data.

Does this bring us closer to getting the green light from the FDA?

Lewis: SciAm member Charlie Schmidt asked the experts about when to expect vaccines for the little ones, what causes delays and more. The FDA’s Vaccine Advisory Committee is scheduled to meet on June 8, 21 and 22 to discuss getting young children to participate in the competition.

Fishman: Charlie guessed what might happen at these meetings?

Lewis: He spoke with Arnold Montt, Acting Chairman of the Advisory Committee and Epidemiologist of the School of Public Health, University of Michigan. Monta said the FDA could issue an EUA to children within a day or two of those meetings, but cited “no guarantees.” One possibility is that the committee may recommend vaccine approval only to children who are at high risk or have a weakened immune system.

Fishman: Why not just allow it for all the kids?

Lewis: Well, the FDA has a very high bar for approving new vaccines or other biologics for children. Children already have a fairly low risk of serious outcomes from COVID, so companies need to show that their vaccines do not cause other problems.

Fishman: So far they have not seen any serious security issues, right?

Lewis: No, most of the side effects were mild and similar to those seen in older children or adults. mRNA vaccines can cause side effects such as fever, which can cause seizures in infants and young children. But Moderna and Pfizer were able to achieve strong immune responses even at fairly low doses, reducing these risks. And there have been no cases of myocarditis, inflammation of the heart, which is rare among adolescents, mostly boys.

FishmanA: So vaccines seem to be safe. That’s good. But how effective are they?

Lewis: This is a great question. Most of the initial data is actually derived from an analysis of the immune response to the vaccine – in other words, the level of so-called neutralizing antibodies produced in people who are given it. By comparing these levels with the levels observed in older children or adults who had good protection against COVID infection, you can extrapolate this protection to young children. This is known as immune bridges.

Fishman: So we look at parts of the immune system and how they behave. What about the effects of the real world? Have vaccines reduced the level of infection in children?

Lewis: In terms of actual efficacy data, Pfizer announced only data on approximately 1,700 children, showing a three-dose efficacy rate of 80.3 percent. Moderna reported low efficacy of 37 to 51 percent for the two-dose vaccine for children under six. Whether this will clear the FDA bar remains to be seen.

Fishman: Okay, interesting. This is a big gap in efficiency. Is the FDA waiting for Moderna’s data assessment until Pfizer data appears?

Lewis: This has been the subject of controversy. Politico reported that the agency postponed consideration of Moderna’s materials until Pfizer’s adopted it. But FDA Commissioner Robert Calif told Andy Slavita, former senior adviser to President Biden on the response to COVID, in his podcast “In the Bubble” that there is no quote “no reason for the FDA to wait” to review it. Pfizer expects to submit its data by the time the FDA advisory committee meets in June, so they can eventually review the data from both Pfizer and Moderna at the same time.

Fishman: And, like many concerned parents, we will keep a close eye on this.

Lewis: It is becoming clear that acute COVID is not the only consequence of the disease. Prolonged COVID, symptoms that linger – this is a real problem. Two new reports shed light on who gets it and what it looks like.

Fishman: There is still no strict definition of long-term COVID, Tanya. But it is estimated that 10 to 30 percent of infected people will have at least one symptom, a true disability problem that affects them at least a month after they are cured of the virus, and sometimes within six months. Often they have several symptoms.

Lewis: i saw new CDC report while one in five infected may develop prolonged COVID. What are the most common problems?

Fishman: According to a new study, people are more likely to suffer from severe fatigue, which exhausts you after you move from room to house. Then there are breathing problems, loss of smell, headaches, insomnia and memory problems. There are also difficulties with concentration that people often call “brain fog”.

This list is based on new research Annals of internal disease, and this is the first report from a long-term study conducted by the National Institutes of Health. All of these people were evaluated 6 weeks after positive tests for the virus.

Lewis: Are many of these people older because age seems to make people more vulnerable to COVID?

FishmanA: Old age isn’t really a big risk factor, Tanya. In fact, people aged 39-50 are most often diagnosed with the condition after COVID. This follows from a huge analysis of private health insurance claims conducted on more than 78,000 people, collected by a non-profit group called HEALTH CARMER.

Lewis: They found that women are more likely than men to have long-term problems, right? About 60 percent compared to about 40 percent?

Fishman: Yes, they did. Another important finding was that severe disease was not a risk factor. Three-quarters of these people were not hospitalized. So you can have an easy case and still suffer after a few months.

Lewis: One of the problems of long-term patients with COVID is that it is difficult to diagnose. Is there any new information in this regard?

Fishman: A study confirmed this difficulty. The NIH team put people into their study using blood tests, lung tests, heart tests and more, and they didn’t find many abnormalities.

This means that the condition is real, but the tests are not good enough. This is a warning to doctors not to fire patients, not to say “it’s in your head” or anything like that. Physicians need to work hard to find a cure because this population is growing as the pandemic continues and they need help.

Lewis: Now you know. Thank you for joining us. The editor of our show is Jeff DelVishio and Tulika Bose.

Fishman: Come back in two weeks to the next episode of COVID, Coming Soon! And check SciAm.com for updated and in-depth COVID news.

[The above text is a transcript of this podcast.]

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