March 2021 COVID Vaccine Questions Answered
Consulting with a pediatrician, a teacher who was vaccinated while pregnant, and an OB/GYN
Poppy Seed Health continues to keep our ear to the ground about the COVID-19 vaccine as it relates to pregnancy, postpartum and families. To learn more about how this information is evolving, we interviewed a pediatrician, a teacher who was vaccinated while pregnant and an OB/GYN to get their thoughts on COVID safety, best practices around the vaccine and mitigation strategies for pandemic-related anxiety.
Here are excerpts from their interviews:
Dr. Stacy Cary-Thompson, MD
Dr. Cary-Thompson is a board-certified pediatrician, and the founder of Cary Cares Parenting LLC, based in the D.C. metropolitan area. Cary Cares is a COVID-friendly, digital space that offers parents an extended village as they navigate their parenthood journey. Through Cary Cares, parents can have in-depth coaching conversations with a pediatrician about how best to support their children throughout their development.
Dr. Stacy, what are parents’ biggest concerns about whether they and their children should ‘opt in’ to receive the COVID-19 vaccine?
As a pediatrician, I am no stranger to vaccine hesitancy. I recognize that parents want to do what is best for their child, even those who ask questions, and in fact, I encourage questions! With other routine childhood vaccines, I view myself as a partner with parents in their decision-making, and the COVID-19 vaccine is no different in that regard. To that end, it is important to discuss the benefits of the vaccine and the possibility of adverse events.
One of parents’ biggest concerns is wondering whether it is safe for children to take COVID-19 vaccines because of the initial efficacy and safety studies that occurred in the adult population. While that is typical for vaccine development, for this disease it makes sense that the vaccine was first tested among adults since they are the group of people most heavily affected with hospitalizations, severe infection, and death.
Because children overall have not been as severely affected as adults, another big concern parents have is deciding whether or not their children should even opt-in to receive the vaccine when it is made available to children. Is it worth it? Well, there is a lot of "bad" between dead and alive, including serious health problems that might be permanent, from a battle with moderate, severe, critical COVID or even from those with "chronic COVID."
According to the American Academy of Pediatrics (AAP), more than 3 million children have been diagnosed with COVID-19, representing approximately 13% of all COVID cases. The AAP data also suggests that between 0.1% and 2.2% of all children diagnosed with COVID were hospitalized, and approximately 0.04% of child COVID cases were fatal. Though the numbers are less scary when compared to those of the adult population, the potential for cardiac injury has been a significant concern for children with COVID symptoms severe enough to require hospitalization. Whether cardiac injury, including myocarditis, also occurs with asymptomatic or mild COVID-19 infection is uncertain. But because children are meant to play, the implications are far-reaching.
Within the pediatric community, there is ongoing concern about COVID-19–associated cardiac pathology, especially among athletes, because myocarditis is an important cause of sudden cardiac death during exercise. There is clearly a lot that we don’t know about the long-term sequela [impact] of this disease.
In a similar vein, parents are also concerned about what is not yet known about the vaccine. The presence of a COVID-19 vaccine provides a societal hope that we will soon be able to emerge from this pandemic, but questions understandably remain about long-term side effects. We also don’t know how long protection lasts once a person is vaccinated, but we do know that experts are working to learn more about both natural immunity and vaccine-induced immunity.
As more and more people receive the vaccine, parental concern shifts to questions like, “Will the coronavirus vaccine need to be given annually like the flu shot” or “Once my kids and I are vaccinated, how do we navigate interactions between those who have opted not to receive the vaccine?” Many questions remain difficult to answer, but it is possible that over time, more doses will be needed to provide continued protection – similar to many vaccines we have been getting routinely for years.
We listened to an episode of the New York Times podcast The Daily, on kids and the COVID vaccine and learned the vaccine is still being tested on children and won’t be available until the fall at the earliest. What are you telling parents to reassure them about their kids getting the vaccine?
Persons under age 18 make up about 24% of the U.S. population. That’s almost one in four! So even if almost every adult gets vaccinated, that’s still a huge percentage of the population that will not have any protection. We want to keep kids and those around them safe.
In addition to restoring stability to the education system and parents’ work schedules, vaccinating children is essential to helping the country reach herd immunity and decrease the threat of new variants. Herd immunity occurs when enough people become immune to a disease to make its spread unlikely. As a result, the entire community is protected, even those who are not themselves immune. The two vaccines that have been authorized for emergency use in the United States so far—made by Pfizer-BioNTech and Moderna—are only recommended for people aged over 16 and 18 respectively, according to the CDC. Pfizer’s and Moderna’s adolescent trials have focused on evaluating participants’ immune response by measuring antibodies. Manufacturers need to prove vaccines are safe and effective in younger bodies, so they are in the process of starting age de-escalation trials. For instance, clinical trials will be conducted in people ages 16 to 12, then 12 to 9, then 9 to 6. Researchers still need to study how kids’ immune systems react and to confirm the optimal dosage. According to Dr. Anthony Fauci, though it may come too late for the first day of school, American high school students might be able to get vaccinated against COVID-19 by fall 2021. However, data on the safety and efficacy of vaccines for elementary school children likely won't be available until early 2022.
Once most adults have been vaccinated, do you think it’s safe for children to visit their extended families? We have heard from parents that not being able to see grandparents, aunts, uncles, and cousins has been tough on the whole family.
I agree. It has been VERY tough not seeing extended family! However, it is important to note that so far, the vaccines have only been proven to prevent disease and not transmission, which means it is not guaranteed yet that vaccinated individuals can’t spread the coronavirus even if they don’t get sick themselves. I caution against a feeling of invincibility. Once vaccinated, it is still important to continue using all the tools available to help stop this pandemic, as we learn more about how COVID-19 vaccines work in real-world conditions. My suggestion is to continue to do the following to protect against COVID-19: wear a mask over your nose and chin with the sides snuggly against your cheeks, stay at least 6-feet apart, avoid crowds, avoid poorly-ventilated spaces, and wash your hands thoroughly and often (or use hand sanitizer with at least 60% alcohol).
What is the best way for parents to coach their children through the new world we’re living in, as a result of the pandemic?
We often get overloaded with information that worries us more. While it is important to stay abreast of credible facts about COVID-19, it is equally important to take a break. Children and adults should feed their minds with small, joyful activities. Parents should also keep in mind that children and teens react, in part, on what they see from the adults around them. When parents can model calm, and can tolerate uncertainty, they exhibit important life skills and coping skills to their children. It is also incredibly supportive to acknowledge any difficult feelings the children may be having. While there are instances where I would encourage parents to play pretend with their kids, this isn’t one of them. Do not ignore your kids’ feelings. Validation is key!
Parents can also have age-appropriate conversations with their children about their own difficult feelings related to the pandemic. It lets children know that they are not alone in the challenges they experience in this “new world” we’re living in. (Dr. Stacy talks about this more here in this video.)
Keeping a routine is highly recommended because it provides structure and can mitigate stress. But it’s important for parents to be mindful that not all children and teens respond to stress in the same way. Some common changes to watch for include excessive crying or irritability in younger children, behavior regression, unhealthy eating or sleeping habits, poor school performance, difficulties with concentration and avoidance of activities enjoyed in the past.
However, everything listed here could also be indicative of something other than a stress response, so if you have concerns, it is worth discussing with your child’s physician or other healthcare practitioner.
Lastly, but certainly not least, encourage physical distancing but social connection. For instance, my family still does Sunday Supper every week. Instead of us all congregating at my in-laws’, we hop on Zoom for fellowship, so get creative! Technology affords us several ways to keep in touch with loved ones while staying safe.
Just because we can’t enjoy people in the same way doesn’t mean that we can’t enjoy them at all. Another option is to employ what I call “throwback methods” of connection. Because we are all tied to our devices so frequently, how refreshing would it be to receive a handwritten letter from someone?! I’m probably dating myself, but in grade school, I had a pen-pal. Even though we have other ways of communicating, encourage your kids to write a letter to someone they care about. It’s endearing, it’s personal, and it’s an opportunity to practice penmanship. Win-win!
In a similar vein, parents can encourage their children to write in the form of journaling, or poetry, or drawing. Though young, though little, though less experienced, children are very much people too, and can benefit from cathartic activities just like the rest of us. So nurture their existing talents or help them tap into something new.
If you’d like to schedule a session with Dr. Stacy or Cary Cares, enter “POPPY+CCP” for 20% off of any service. This coupon expires on April 15, 2021.
Emily Beard
Emily Beard is a teacher based in New York, who recently gave birth, is breastfeeding her child and has gotten the COVID vaccine.
Emily, tell us about your and your partner’s experience being pregnant in a pandemic. Did it impact how you two prepared at all? How different was a pandemic pregnancy compared to your others?
Being pregnant during a pandemic was very different from my first pregnancy. I carried our first daughter and she was born in 2015. That pregnancy felt social and was celebrated by friends and family. My 2020 pregnancy felt like I was in hiding. We left New York City in March to live with my family in the Midwest and I birthed our daughter there. It felt safer and being with family lessened the stress we felt about the unknown, but it also felt lonely and isolated. Despite that, giving birth away from the epicenter of the virus was the right decision at that time. I had a C-section and was able to receive hospital care for four days. If we’d stayed in NYC, they might have sent me home 24 hours after the birth. That would have been terrible for me.
When the COVID-19 vaccine became available to you, was it a struggle for you to decide whether or not to get it, while pregnant? Tell us about that decision process.
We measured the risk against contracting the virus, becoming sick, but still being responsible for work and the wellbeing of two young children. I didn’t hesitate, and am excited by the possibility of passing antibodies through breast milk. But I’d like to contextualize this a bit. My experience with the medical community has been primarily positive, and because of that I had a lot of trust in the vaccine.
Did you have any side effects that stood out in particular?
I was very tired after each shot! And the second shot gave me a fever and headache, but I managed it with Tylenol. My breastfeeding baby remains happy and healthy and seemed totally unaffected by the shots.
Would you recommend that other pregnant and lactating people get the vaccine?
Everyone has to do what’s right for them and their family. I can only speak from my own perspective. For me, this felt like a safe and important step in protecting my family against COVID.
How are you feeling about vaccinating your children when the vaccine is available for kids?
My wife and I are feeling very hopeful about our children getting vaccinated. We can see the impact that distanced and remote social interactions are having on our older daughter, and look forward to a return to normalcy. We see the vaccine as part of that process.
Dr. Michelle Aristizabal, M.D, FACOG
Dr. Aristizabal (or Dr. A, as she is called by many of her patients) is an OB/GYN and the owner of Wombkeepers, an OB/GYN practice operating from Montclair, NJ, and Scottsdale, Arizona, where she moved in 2020. She has personally delivered over 2,500 babies, and is the proud mother of two children.
Dr. A, what are your patients’ biggest concerns on receiving the COVID-19 vaccine while pregnant or lactating?
The most obvious concern my pregnant or breastfeeding patients have about receiving the COVID-19 vaccine is whether it could harm their baby in some way, which is very understandable. No one wants to inadvertently do something that hurts their baby. The second most common worry my patients are expressing is whether when they want to get the vaccine they will actually be able to receive it, as many vaccine sites are not allowing pregnant women to receive the vaccine because we do not yet have the data to support a strong universal recommendation from the CDC. I have talked to some patients who are even delaying pregnancy or stopping breastfeeding before they wanted to because they do not want to be denied the vaccine.
[Note: Both the American College of Obstetricians and Gynecologists (ACOG) and the CDC have said that pregnant and breastfeeding women should be able to get the COVID-19 vaccine, if they want it. In addition, the World Health Organization (WHO) initially advised women against getting the vaccine, but then the WHO reversed course and revised its recommendation, stating: “Based on what we know about this kind of vaccine, we don’t have any specific reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women.”]
What do you tell them to reassure them?
In terms of the first concern, I completely understand the fear of taking something new, that hasn’t yet been tested on pregnant patients, and not knowing whether or not it could cause harm. Hopefully, real reassurance will be coming soon. Pfizer has a vaccine trial specifically for pregnant women that is currently underway and the preliminary observational data on pregnant women who have already received this vaccine is good. Furthermore, given our understanding of how this vaccine is made and our experience treating pregnant patients with other similar vaccines, most physicians and scientists feel that it is very likely that this vaccine is safe for pregnant and breastfeeding women as well.
How has your opinion on pregnant and lactating people receiving the vaccine evolved, as research has come out in the past couple months?
I think, every day, we are getting more data that is suggesting pregnant women should receive the vaccine. We have a registry of over 30,000 pregnant and breastfeeding health care workers and IB patients who received the vaccine in December and January. In those patients, there was no observed increased risk of pregnancy complications such as preeclampsia, preterm birth, or congenital malformations and birth defects. We are also finding COVID antibodies in the blood of babies born to mothers who received the vaccine, as well as in the breast milk of mothers who received the vaccine. This means that by vaccinating pregnant and nursing mothers, we may also be able to prevent babies from contracting the virus, as we see with other vaccines such as the annual flu shot. This information has certainly made me feel even more strongly that mothers should be vaccinated, though it has always been my position that the biggest risk to mothers and their babies is contracting COVID and dying from it. I think it is extremely unlikely that any risk that could be associated with this vaccine is going to be higher than that very real risk right now.
What factors should pregnant and postpartum people take into consideration when weighing this decision?
I know making the decision to receive or not receive the COVID vaccine will be difficult for mothers no matter what. However, one important factor that may help mothers in their decision is an honest assessment of their risk of contracting the virus. If a mom has to leave the home to work or is living with or spending time with higher risk individuals or people who are not following proper masking and social distancing guidelines, then she should definitely consider being vaccinated. If a mom and her partner are able to mainly stay home and follow all masking and social distancing guidelines, then her risk may be low enough that she would rather wait until more safety data is available. Another factor that mothers should take into account is how far they are into their pregnancies. We know many patients have experienced side effects from the vaccine, such as fevers, nausea and vomiting, and general flu-like symptoms, which may be more problematic in the first trimester of pregnancy than later in pregnancy or in the postpartum period. I am personally advising my patients to wait until the second trimester for vaccination unless they are in a very high risk situation.
Do you have any advice for pregnant people currently going through a pandemic pregnancy?
The most important thing that pregnant mothers should do is minimize their risk of contracting the virus. The second most important thing, in my opinion, is to try to minimize the effects of the stress associated with the pandemic. We know that high levels of stress increase the risk of a number of pregnancy complications. Unfortunately, we can’t make this stress go away, but we can turn off the news and our social media accounts and decrease our daily exposure to it. We can try to make changes in our home life to lessen the stress from the increased demands of working from home, on-line school, and social isolation, such as family job charts and increased job sharing, relaxing our expectations of ourselves and others, and taking the time to connect with family and friends in whatever ways we can safely do so. We can incorporate mind-body activities that help mitigate the effects of stress on our body, such as simple deep breathing, meditation, or yoga, and make eating right and exercise a daily priority, even when it is the last thing we feel like doing. Finally, we should all look for ways to put more joy into our daily routines. Watch silly movies. Have a dance party in the living room. Spend time in nature. Focus on gratitude and tell the ones you love that you love them, often.
The CDC recently rolled out V-safe, a smartphone-based tool that uses texts and web surveys to provide health check-ins after people receive the COVID-19 vaccine. As part of this tool, there is also a COVID-19 Vaccine Pregnancy Registry, which collects health information from people who received the vaccine either in their periconceptional period (within 30 days before last menstrual period) or during pregnancy. This voluntary registry will help healthcare providers get critical information about vaccine performance and health outcomes for pregnant people.
While it is still unclear when children will become eligible for the COVID-19 vaccines, Pfizer and Moderna have completed enrollment for studies of children ages 12 and older, and are expected to release the data this summer.
For the latest guidelines on the COVID-19 vaccine, check the WHO guidelines, and ensure you’re subscribed to ‘The Push’ from Poppy Seed Health, our content hub which delivers inspirational stories, support tools and resources tailored specifically for women and birthing people, and is providing steady updates on COVID-19 vaccine development. You may also choose to bookmark our COVID-19 watch, which is updated weekly with the latest information pertaining to pregnancy and postpartum-related pandemic news.
Poppy Seed Health is a telehealth solution providing pregnant and postpartum people with 24/7 access to an advocate network of Doulas, Midwives, and Nurses. For access to this support network, or to join us as an advocate, visit poppyseedhealth.com today.