Weitzman ECHO on COVID-19 - November 3rd 2021

1. Continuing Education Credits
In support of improving patient care, Community
Health Center, Inc. / Weitzman Institute is jointly
accredited by the Accreditation Council for
Continuing Medical Education (ACCME), the
Accreditation Council for Pharmacy Education
(ACPE), and the American Nurses Credentialing
Center (ANCC), to provide continuing education for
the healthcare team.
A comprehensive certificate will be sent after the
end of the series, December 2021.

2. Disclosures & Disclaimers
With respect to the following presentation, there has been no relevant (direct or indirect)
financial relationship between the faculty listed above or other activity planners (or spouse/partner)
and any for-profit company in the past 12 months which would be considered a conflict of interest.
The views expressed in this presentation are those of the faculty and may not reflect official
policy of Community Health Center, Inc. and its Weitzman Institute.
We are obligated to disclose any products which are off-label, unlabeled, experimental, and/or
under investigation (not FDA approved) and any limitations on the information that are presented,
such as data that are preliminary or that represent ongoing research, interim analyses, and/or
unsupported opinion.
This project is supported by the Health Resources and Services Administration (HRSA) of the
U.S. Department of Health and Human Services (HHS) as part of an award totaling $137,500 with 0%
financed with non-governmental sources. The contents are those of the author(s) and do not
necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S.
Government. For more information, please visit HRSA.gov.

3. At the Weitzman Institute, we
value a culture of equity,
inclusiveness, diversity, and mutually
respectful dialogue. We want to
ensure that all feel welcome. If there
is anything said in our program that
makes you feel uncomfortable,
please let us know.

4. 3 Nov 2021

5. 46,091,924 cases on 10/18/21 with 747,033 deaths
https://coronavirus.jhu.edu/us-map
COVID-19 in the United States: TOTAL

6. COVID-19 Hot Spots
https://www.nytimes.com/interactive/2021/us/covid-cases.html

7. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
New Reported Cases – United States

8. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

9. Delta Variant – “like COVID on steroids”
https://www.axios.com/variants-tracker/

10. ‘Bully in the Playground’

11. Pediatric COVID Vaccinations
• Pfizer vaccine approvals:
– FDA authorized use for ages 5 through 11 years
– Advisory Committee on Immunization
Practices met on November 2…
• Moderna for younger ages:
– On hold

12. Pediatric COVID Vaccination
• Vaccination program for children aged 5 to 11 will
start “running at full strength”
– Second week of November, per the White House
• There are 28 million children aged 5 to 11
– Surveys indicate only ~1 in 3 parents will have kids
vaccinated immediately
– “We have more than enough vaccine for every
child 5 to 11.”
– Jeffrey D. Zients, the Pandemic Response Coordinator

13. COVID-19 Vaccinations Across the Nation
https://covid.cdc.gov/covid-data-tracker/#vaccinations

14. COVID-19 Boosters Across the Nation
https://covid.cdc.gov/covid-data-tracker/#vaccinations

15. Percent Fully Vaccinated by State for Total Population
https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-fully-percent-total

16. Trusted Resources
• Johns Hopkins
https://coronavirus.jhu.edu/map.html
• CDC
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• WHO
https://www.who.int/emergencies/diseases/novel-coronavirus-
2019
• Others
https://www.nytimes.com/interactive/2021/us/covid-cases.html
https://www.thelancet.com/coronavirus
https://covidactnow.org/

17. Where are we now?
Kids don’t catch COVID-19.” Really?!
• Infection
– 1.9 million 5-11
year olds have
been infected
– 10.6% of cases
(they make up
8.7% of the
population)

19. “Kids don’t get that sick from COVID.”
• Hospitalizations
– >8300 COVID-19
hospitalizations of 5-
11 year olds
• Over 30%, NO
underlying condition
• Starting in August, 5-
11 had their highest
rate since the
beginning of the
pandemic
• Once hospitalized,
1/3 of kids ended up
in the ICU

20. Health Inequity

21. Where did the flu go?

22. “COVID is just a bad cold like the flu.”

23. Risk Factors

24. Mortality

25. COVID Now in Top Ten

26. What about MIS-C?

27. In for the Long Haul . . .
• Most common symptoms: fatigue, headache, insomnia,
trouble concentrating, muscle and joint pain, and cough
• Post-COVID conditions do occur in children
– Less common in children than in adults
– 7-8% of children with COVID-19 reported continued symptoms >12 weeks
– Can appear even after mild infections
• Can have significant impact on quality of life
– Limitations on physical activity
– Feeling distressed about symptoms
– Mental health challenges
– Decreased school attendance/participation

28. Kids Have Cooties,
and Teachers, too!

29. Mask On!
And get your shot, too!

30. Pediatric COVID Vaccine

31. Show me the Data!
• 2,268 trial participants
(including 1,518 vaccine
recipients)
• A “safety expansion”
group of an additional
2,379 participants
(1,500 vaccine
recipients)

32. Does it work?
• Immunobridging
– Comparable antibody levels to older age group
• 90.7% efficacy
– 3 cases in vaccine group, 16 in placebo
• Worked well against delta variant
– Tested during high delta incidence
– Vaccinated sera effectively neutralized delta

33. Is it safe?
• Most common adverse events
– Fatigue (39%)
– Headache (28%)
– Muscle pain (12%)

34. Safety
• Two other adverse events linked to the vaccine:
– Lymphadenopathy: 13 vaccine participants vs. 1 placebo
participant
– Hypersensitivity rash
• 5 severe adverse events. None were linked to the vaccine:
– Ingestion of a penny (1 person in the vaccine group)
– Fractures (2 people in the vaccine group and 1 in the
placebo)
– Infective arthritis (one person in vaccine group)
• No cases of myocarditis, anaphylaxis or deaths

35. Context

36. Context

37. Benefits Not Trivial

38. More than Just Less COVID

39. Myocarditis “Flavors”

40. Myocarditis Deaths

41. Myocarditis Recovery

42. Myocarditis After Vaccine

43. Vaccine After COVID
• Prior infection confers variable immunity
which wanes over time
– 2-5x higher risk of reinfection compared to
vaccine
• Significant boost in antibody levels
• Safe

44. Vaccine Hesitancy

45. What do parents think?

46. What are their top concerns?

47. Which specific side effects?

48. Vaccine Hesitancy

50. Health Equity

51. Disparities

52. Disparities

55. In Children 5 years and Older

56. Transportation
• Shipped on dry ice in thermal container
• Use insulated gloves!
• Note data logger
– “Stop delivery” button, press for 5 seconds
• Can transfer to ultra-cold freezer or fridge
• Temps must be monitored by a data logger
• Ancillary kit = diluent, needles, vaccine cards

57. Storage and Handling
• Ultra-cold freezer (-76F to -130F)
– > 6mo, until expired
• Pediatric vaccine cannot be stored in freezer
– Adult freezer up to 2 weeks
• Medical grade refrigerator (36F-46F)
– Pediatric – 10 weeks
– Adult – 1 month
• Protect from light, transport at 36-46F

58. Administration and Labeling
• Both vaccines require dilution; see ancillary kit
• Allow to warm to room temperature (~20 min) before diluted
• Do not shake! Rock back and forth gently before and after
dilution
• Pediatric vials: 1.3mL diluent. Adult vials: 1.8mL diluent
• Pediatric dose: 0.2mL = 10mcg. Adult dose: 0.3mL = 30mcg
• Once vial pierced, good for 6 hours for adult, 12 hours for
pediatric
• Pediatric vial = 10 doses. Adult vial = 6 doses
• May not refreeze

60. Administration and Labeling
• Safety of concern when dealing with multiple types
of vaccines!
• Pediatric vaccine = orange cap, Adult vaccine =
purple cap
• Consider separate areas of vaccine preparation
– Amount of diluent different for each vaccine
• Label drawn up syringes to identify which vaccine it is
• Once vial pierced, draw up all doses from vial and
label
– Best practice is to not leave partially filled vials
– Consider separate areas for different vaccines

61. Post-Vaccine Observation Period
• 15 minute post-vaccine monitoring period
• Logistical considerations
– Volume/demand
– Vaccinators
– Spacing
– Other support staffing (greeters, registrars, etc.)
• Response (“code”) team considerations

62. Resources
• https://www.cdc.gov/vaccines/covid-19/health-departments/addressing-
vaccine-misinformation.html
• https://www.chop.edu/centers-programs/vaccine-education-
center/making-vaccines/prevent-covid
• https://www.fda.gov/news-events/press-announcements/fda-authorizes-
pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-
years-age
• https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e2.htm
• ACIP November 2-3, 2021 Presentation Slides | Immunization Practices |
CDC

63. Additional Resources
• AAP-AACAP-CHA Declaration of a National Emergency in Child
and Adolescent Mental Health
• Pediatricians, Child and Adolescent Psychiatrists and
Children’s Hospitals Declare National Emergency in Children's
Mental Health