Published on in CHOP News
Children’s Hospital of Philadelphia (CHOP) physicians Lori Handy, MD, MSCE, and Marleny Franco, MD, know a lot about COVID-19. As the Medical Director of Infection Prevention and Control, Dr. Handy has helped put in place safety measures to keep CHOP patients, families and staff safe throughout the COVID-19 pandemic. In Dr. Franco’s work as an attending physician in CHOP’s Emergency Department (ED), she’s seen firsthand the worst part of the pandemic: children sick and hospitalized with severe COVID-19 disease.
As moms of children under 5 years old, these women also know what it’s like to pack an extra mask in the diaper bag and to work from home with a little one underfoot. Like parents across the country, Drs. Handy and Franco have navigated two years of isolation, quarantine, restrictive return-to-school protocol and minimal visits with family and friends. Now, with global attention on the COVID-19 vaccine for children under 5, these busy supermoms sat down for a brief conversation about the pandemic, vaccination and masking. Read on to find out why they plan to vaccinate their kids and why they think you should, too.
A quick look:
Marleny: Families with young children like mine have been so limited in what we can do socially; it’s left us feeling a little trapped. My daughter (4) is really good about wearing her mask, so I’m much more willing to take her places, like the Please Touch Museum, and let her participate in extracurricular activities like dance. But my son (1) can’t wear a mask. That means my husband and I have to separate on the weekends: one person does something fun with our daughter and the other stays home with the baby. We haven’t been able to do the same things with my son that we did when my daughter was an infant, such as mommy-and-me music class. I see the vaccine as giving my family some freedom. Of course, we won’t throw caution to the wind, but vaccination will mean we’ll be able to take more calculated risks around which activities our kids will be able to do.
Lori: Over the last few months, as vaccination rates have increased, I haven’t worried about severe disease or death in my household. I’ve been more worried about the practical implications of the disease. School protocol could mean having to be isolated for weeks or up to a month, which would be very stressful. Having fully vaccinated children makes parenting a lot easier. I would restrict their activities less if I knew that a COVID-19 exposure wouldn’t cost them time at school or other experiences.
Q: If children younger than 5 years are less likely to develop severe COVID-19 illness, why is it still important to vaccinate them?
Lori: “Less likely” is not the same as “not at all.” I often remind families that most vaccines, including the chicken pox vaccine or the pneumococcal vaccine, are all to prevent rare, serious consequences of disease. Preventing these severe outcomes is the main goal of all vaccines. Getting our kids vaccinated leaves hospitalization for treating those diseases that we can’t prevent.
Marleny: The media has really focused on the mortality rate of COVID-19 in children, and while it is low, it’s not zero. Even healthy kids with no past medical history can and do get sick and can pass disease to more vulnerable members of society. I’ve also seen children in the ED with symptoms of long COVID-19 and kids with MIS-C who end up in the ICU. If a vaccine can prevent that, why take the chance?
Lori: Vaccines are held to the highest safety standards, and the COVID-19 vaccine trials have had the same level of safety rigor as that of any other vaccine. The trials are placebo-controlled, meaning one group receives the vaccine and the other group receives a placebo (inactive drug). Children are studied daily after receiving the vaccine, then weekly, monthly and will continue to be studied for up to 1 to 2 years.
It's also important to know that most adverse effects of the vaccine are noted within six weeks of vaccination. Because the mRNA vaccine is quickly broken down by the body, we don’t anticipate any adverse effects down the road if they haven’t been noted within the first six weeks. As we follow data on these vaccines, I am most looking at their ability to prevent severe diseases, such as hospitalization or death. It’s OK for children to get vaccinated and still get a mild illness, similar to the common cold. If COVID-19 vaccines can keep children from having to come into the hospital and reduce the likelihood of MIS-C, that is a win for kids.
Q: As pediatricians, what are the most common concerns you hear from parents who are hesitant to vaccinate their children?
Marleny: When I ask families why their kids aren’t vaccinated, they usually say they’re not comfortable. I get the sense people feel uneasy and think there’s not enough data or information about long-term side effects. Many parents get vaccinated themselves but aren’t comfortable taking that risk for their children.
Lori: I’ve heard, “I just don’t know what adverse effect this could have down the line, and I don’t want to be responsible for my child having fertility issues in the future.”
Marleny: I’ve definitely heard the rumors about fertility from parents and even my own family members. I emphasize there’s no data to back that up, and also share that I received the COVID-19 vaccine when I was pregnant with my son. To be honest, I was hesitant, because pregnant people are often not included in clinical trials. There were women who became pregnant during the trial and had no adverse effects, but that’s a smaller number. I had to talk to people I trust, including a friend in maternal fetal medicine. We reviewed the physiology and weighed the risks and benefits. Because pregnant women with COVID-19 have an increased risk of poor outcomes, and women of color already have an increased risk of poor outcomes from pregnancy, it became clear to me that I needed to get vaccinated. When people talk to me about fertility concerns, this is the story I tell them. We also now know that the vaccine confers immunity to the fetus.
Lori: I think parents need to recognize that the choice not to vaccinate their children is a choice to put their children at risk of severe COVID-19. Because the vaccine is so well-studied, the risk of an adverse effect is small compared to the risk of severe disease, which includes hospitalization and even death. Based on how the COVID-19 vaccine was made, we don’t anticipate any long-term effects, but we already know that COVID-19 does have long-term consequences. With the transmissibility of the virus, it will become harder and harder to avoid infection.
Marleny: I do think we also have to acknowledge the history of mistrust of the medical establishment by people of color, given the exploitation of black and brown bodies by the medical community. That is likely part of some parents’ hesitance to get vaccinated and vaccinate their children. I’ve tried to lead by example and share my vaccination status for that reason, but we’re going to have to partner with leaders in the community to get that message out. Look at Ala Sanford, who brought COVID-19 testing and vaccination to black and brown communities in Philadelphia. She hired a team of people from the medical establishment who also looked like the community they were trying to serve, and she was hugely successful. When the COVID-19 vaccine is approved for children under 5, I think it’s going to be pivotal to partner with people in the community doing this type of work.
Q: Without an approved vaccine for children under 5, how have your families navigated changing guidelines around masking?
Lori: We’ve made our decisions based on community prevalence: when disease prevalence is low and community immunity is high, we feel safe to interact in more crowded settings. We’ve gone to restaurants at off-peak hours; we’ve visited Legoland wearing masks. We know our children need experiences with all parts of society for normal development. There are ways to mitigate risk until our youngest children can be vaccinated.
Marleny: For me, it depends on whether or not we’re in a surge. During Omicron, I was seeing people come into the ED with COVID-19 symptoms, but we were also seeing many positive tests for people coming to the hospital for non-COVID-related things. That made me very uncomfortable, and my family decided to lockdown. During that time, we weren’t doing any indoor activities with my daughter outside of our home. Now, she’s still wearing a mask in daycare, as are her teachers.
Q: What is your response to parents who may feel mask mandates are lifting too soon?
Marleny: Personally, I worry about the mask mandates being lifted. I think there is nuance that is being missed. We can enjoy more freedom, but I think we still need to be judicious in crowded spaces. The situation is better now; the chances of sitting next to someone who doesn’t have immunity to COVID-19 (either through vaccine or infection) is really low. But things may change, and we may need to increase restrictions again.
Lori: While we are still in a worldwide pandemic, we do have the opportunity to assess what’s going on locally in terms of community prevalence, and we can make different choices without dismissing that there are still many humans who are experiencing pain and suffering. Parents of young children have been preconditioned for two years to believe they must mask their children and stay home to be safe, but we forget that was to reduce community transmission. Those were sacrifices we had to put on our kids for the greater good. With lower community prevalence and increased vaccination, we don’t have to do that right now. We can always bring back masks, but in this moment, a mask-optional approach is giving some children experiences that they need.
Q: What are you most looking forward to once your children are vaccinated?
Marleny: Indoor playdates! The winter has been so difficult for families with young children. When it’s cold and dreary, we’re not able to play outside very much and it’s isolating. I really miss visiting my adult friends while our kids play. Lori and I are good friends, and so are our girls. They haven’t been able to see each other very much, and they’ve been asking when they can have a sleepover. I think that’s going to be able to happen soon.
Lori: Marleny said it! Our girls are only 4 years old; half of their lifetime has been spent in the pandemic, and their relationship has been sustained through outdoor playdates and FaceTime! During surges, we have lived by the motto: “There is no bad weather, only bad clothes,” and have found desperately creative ways to socialize in cold weather. We are really eager for our kids to socialize without COVID-19 hanging over us. Once they’re vaccinated, an incidental exposure won’t mean quarantine, so they’ll get to continue going to school.
To determine community prevalence in your area, use the Centers for Disease Control and Prevention (CDC) guide here.