Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.
When will there be a vaccine for children?
As I read the CDC’s new playbook for how to roll out a COVID-19 vaccine, one thing is missing from the plan: how we will vaccinate children. The plan, understandably prioritizes seniors, health care workers, people with medical vulnerabilities, people in jails, homeless shelters and other at-risk populations. The first priority group also includes daycare workers and school teachers, but does not mention the students, except for college students.
There are reasons for this.
First, young people are not immune to COVID-19 but generally are not as likely to become sick from it, even if they are infected. Of course they can, and do, spread the virus to adults. But there is another reason that children may not be vaccinated until late next year at the earliest. All of the leading vaccine trials right now involve adults, not children. So when we get a successful vaccine, possibly later this year, it will be a vaccine that has only been used on adults and will not have been prove “safe and effective” for children.
“Right now I’m pretty worried that we won’t have a vaccine available for kids by the start of next school year,” said Dr. Evan Anderson, a pediatrician at Children’s Healthcare of Atlanta and a professor at the Emory University School of Medicine.
Anderson had a lot more to say in an essay published in the journal Clinical Infectious Diseases. He said the nation’s vaccine trials for children are “stuck in neutral” and that they should be moving forward alongside adult vaccines, not waiting for the adult vaccine to be approved before perfecting a vaccine for young people. He writes:
The risk of serious COVID19 in children (both hospitalizations and MIS-C) occurs with disproportionately higher rates in both Hispanics and Blacks as compared to Whites [8-10]. A pediatric COVID-19 vaccine could dramatically reduce hospitalization and racial disparities from COVID-19. Children in the US are dying of COVID-19-related complications; in the first 5 months of the pandemic, 103 children have died in the US from COVID-19 through September 9, 2020.
Anderson makes the important point that if children keep getting infected, even if they do not show symptoms, then the virus will continue to spread even with an adult vaccine:
Without a COVID-19 vaccine, children will likely serve as a reservoir, which would undermine efforts to end the pandemic. Until all children can more safely return to school and parents can return to fulltime work, it is difficult to imagine that the economy can completely recover.
But what about safety? Can you imagine allowing your child to take a shot that is not known to be safe and effective? Anderson says given the known safety of the adult vaccines that have cleared Phase 2 trials, the drug companies could begin testing on older kids first.
Pediatric clinical trials of leading vaccine candidates can safely be initiated now. To establish safety, trials should start with adolescents and older children before expanding to younger children. The strategy of age de-escalating trials to bridge vaccines from adult studies to children is one that has been commonly used in the past to ensure early identification of safety signals while minimizing risks, establishing dosing, and evaluating immune responses. Similar to adult studies, it will take time
Phase 3 drug trials help pharma companies figure out what doses are most effective for which populations. For some drugs, the dose for children is lower, but for others, like those fighting pertussis, the childhood dose is greater than the adult dose. And in the past, such drug trials have had years to figure out those doses.
Fox News reports that some of the front-running drug trials are starting to expand their tests with children in mind:
Moderna and Astra Zeneca (though the latter is on pause in the U.S. for a safety matter) enrolled people aged 18 and older, while a recent proposed trial expansion by Pfizer and BioNTech looks to include those as young as 16.
Jeff Richardson, speaking on behalf of Inovio Pharmaceuticals, told Fox News that “in general, industry practice is to begin clinical trials for most infections/diseases with adults and enroll younger subjects in later trials.”
Dr. Anna P. Durbin, professor of international health in the Johns Hopkins Bloomberg School of Public Health with a joint appointment in the School of Medicine, said “the safety and efficacy of the vaccine needs to be determined in those at highest risk of COVID-19 disease first because they will be receiving the vaccine first. Children will not likely be included in the first, highest priority of vaccine recipients.”
Meanwhile, a Moderna spokesperson told Fox News of plans to initiate pediatric vaccination trials for COVID-19 by the end of the year.
Still to be seen is whether schools will eventually require children to have been vaccinated against COVID-19, as they require other vaccinations.
Can COVID-19 make you lose your hair?
The Indiana University School of Medicine surveyed 1,500 COVID survivors that they call “long-haulers” — people who have lingering symptoms for months after initially getting sick. Long-haulers report many symptoms that are not listed on the CDC’s official list. And 423 of the 1,567 long-haulers reported hair loss. Some experts are suggesting the hair loss may be more closely connected to the stress of being infected than to the virus itself.
Among the other symptoms long-haulers citied in addition to hair-loss were night sweats, memory problems, blurry vision and pain in the hands and feet.
Where are the students?
Schools are finding it really difficult to track student attendance when classes are held remotely. FutureEd reported:
Tracking attendance can be complicated by family circumstances: New Jersey’s guidance notes that, depending on parents’ work schedules, some students will have to do their learning in the evening. Such students should be counted as present if they turn in assignments.
Attendance can also be complicated by hybrid models, in which students are on campus some days and learn remotely other days. Ohio’s guidance specifies that a student can’t make up an in-person absence by logging in remotely. Ohio also calls on schools to record attendance and participation by hours and assign hourly values to projects students do at home. Completing a diorama, for instance, would be worth eight hours regardless of how long it takes the student to complete.
Around the country, teachers and school administrators are hoping that a patchwork of plans cobbled together over the summer will help address one of the most pressing challenges they face as millions of students start a new school year online: How to make sure they come to virtual class, and what balance to strike between punitive and forgiving policies if they don’t.
Attendance data from last spring, while limited, suggests that the problem loomed large in many districts after school buildings closed in mid-March. In one survey of 5,659 educators around the country, 34 percent of respondents said that no more than one in four students were attending their remote classes, and a majority said fewer than half their students were attending.
Columbus, Ohio, schools that already had high absenteeism rates are trying to figure out what happened to 1,500 students who never showed up in enrollment records this fall. And Chalkbeat says this is happening around the country, and is especially concerning because lots of the kids schools expected to be in class but are not include kindergarteners.
In Broward County, Florida, school officials noticed something worrying this month.
Schools were back in session, virtually. But a few weeks in, one group of students was missing in large numbers: kindergartners.
At Deerfield Beach Elementary, where 81% of students come from low-income families, there are 52 fewer kindergarten students than there were last fall. Twenty miles south, Harbordale Elementary, where 40% of students are from low-income families, was down 38.
“We were definitely concerned,” said John Sullivan, who oversees the district’s enrollment planning.
Some declines were projected, due to factors like lower birth rates. But this was something different. All told, the district’s traditional public schools are serving 2,000 fewer kindergarten students — a decline of around 14%.
School districts are seeing similar double-digit declines across the country, from Oakland, California to Philadelphia. Kindergarten enrollment is down 15% from last fall in Hawaii’s schools, according to state data. In Los Angeles, it’s down 14%. And in Gwinnett County, Georgia, where in-person classes have resumed, it’s down 10% since last fall, state and district figures show.
In Montgomery County, Maryland, the school system says it may allow students to take “mental health days” during the pandemic.
Trump to sign executive order for pre-existing conditions, but it may not matter
President Donald Trump is holding up an executive order that he says will forbid insurance companies from discriminating against people with pre-existing conditions as protection in case the Supreme Court rules that Obamacare is unconstitutional. He made the announcement at a rally in Charlotte, North Carolina, Thursday evening.
But like other of Trump’s executive orders, this one might not make any difference. University of Michigan law professor Nicholas Bagley tweeted that unless Trump is “exercising a power that’s been specifically delegated to him, an executive order directed at private parties has no more legal weight than a press release.”
In July, the president held up an executive order that he said would reduce prescription drug prices for millions of Americans. But he didn’t actually sign or file the order for months, and when he did, it became clear the order didn’t have the authority to prompt a drug pricing change.
Right after the November election, the Supreme Court will hear a case that could determine the future of the Affordable Health Care Act. One of the most popular parts of the act protects people with conditions that insurance companies would rather not cover.
The president said he wanted to work with Congress to stop “surprise billing,” which happens when patients are treated, often in emergency situations, by providers who are out of network but work in a hospital that is in network. He did not offer any legislation for Congress to consider, just a hope that everybody could work together.
Should copper surfaces replace stainless steel to fight germs?
A story in StatNews included an interesting story that said:
Even before the rise of Covid-19, hospitals have increasingly struggled to get health-care associated infections in check. There are 2 million such infections — and 90,000 related deaths — in U.S. hospitals every year.
As hospitals across the country hunt for ways to reduce the spread of pathogens to patients, a growing chorus of researchers is arguing that a simple swap might help: replace stainless steel surfaces with copper.
Copper’s ability to neutralize microbes is well-known. Researchers studying SARS-CoV-2, the disease that causes Covid-19, noted back in March that the virus lasts for several days on stainless steel — which most hospitals use for the majority of surfaces — but dies within hours of landing on copper.
What we do not know is whether it would make any difference to the spread of hospital infections.
Those plastic face shields may not help much
I post this with a little trepidation since it was not that long ago when health experts were saying that face masks didn’t help much, right before they told us we had to have them. But with that in mind, read this from The New York Times:
The shields, which have been marketed as an alternative to face masks to guard against the coronavirus, do almost nothing to stop the spread of microscopic airborne droplets that are increasingly understood to be a major vector for spreading the disease, according to a recent study by researchers at the Riken Center for Computational Science, a research institute based in Kobe, Japan.
Face shields may be useful for protecting the wearer from the droplets generated by others, but are almost completely ineffective at protecting others from the wearer’s own droplets, according to Makoto Tsubokura, a professor at Kobe University and the lead researcher on a team that is using Japan’s world-beating supercomputer to better understand how to defend against the coronavirus.
Holiday hiring mostly for online workers
It probably is no surprise that big retailers say they will hire more workers for the holiday season but the people will be fulfilling online orders. Target says it hopes to hire 130,000 seasonal workers this year, which is about the same as last year. But many of the workers will be delivering to curbside pickup buyers and working in warehouses rather than retail stores.
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Al Tompkins is senior faculty at Poynter. He can be reached at email@example.com or on Twitter, @atompkins.