COVID vaccines now recommended by CDC for ages 12 & up

 Today's announcement from the LACDPH:

Starting tomorrow, Los Angeles County vaccination providers may begin offering the Pfizer vaccine for 12 to 15-year-olds at vaccination sites that offer the Pfizer vaccine. All eight county run sites will be open tomorrow and able to vaccinate children 12-17; teens should be accompanied by a parent, guardian or responsible adult, and present a photo ID and verification of age.  For a full list of sites across the county offering Pfizer vaccines, please visit http://bit.ly/PfizerSites . To schedule an appointment, visit www.VaccinateLACounty.com beginning this evening; walk-ins are welcome at all 8 county-run sites.  Parents or teens with questions about the vaccine should contact their healthcare provider or visit the Public Health website for more information on vaccine safety and efficacy.

From the American Academy of Pediatrics:

Safety

Pfizer and CDC officials reviewed data on safety and efficacy of the vaccine during Wednesday’s ACIP meeting. Pfizer and BioNTech conducted trials in more than 2,000 adolescents ages 12-15 with half randomized to receive the vaccine and half to receive a placebo.

The most common side effects in adolescents were pain at the injection site, fatigue, headache, chills, muscle pain, fever and joint pain, consistent with trials in older teens and adults.

About 6% of vaccine recipients experienced an adverse event, including seven cases of swollen lymph nodes. There were five serious adverse events in the vaccine group (0.4%) including one person with abdominal pain, constipation and neuralgia and others with depression, anxiety and suicidal ideation. None of the serious events were determined to be related to the vaccine and no deaths were reported. There also were no reports of blood clots, serious allergic reactions or Bell’s palsy.

Efficacy

Vaccine efficacy for this age group was 100%. Among just over 1,000 vaccine recipients, there were no cases of COVID-19, while 16 were reported among more than 970 placebo recipients. An immunogenicity analysis in 190 participants also showed their response was even better than the response for those ages 16-25 years.

I do recommend vaccinating kids 12-17. I think this Washington Post piece summarized the data well:

https://www.washingtonpost.com/opinions/2021/03/24/case-vaccinating-children-covid-19/

I am sorry that I am unable to offer the vaccine in my office yet.  Pfizer's vaccine requires a special, ultra-cold freezer and also only comes in shipments of 1200 doses.  Both of these are expected to change in the coming months. My website will be updated with all news. 

Stop the ice for sore muscles?

It is important to me that the advice we give as doctors is based on evidence, but sometimes when we don't have that, we rely on tradition.  I am glad when "the way we've always done it" is given a fresh look.  In this article, the author discusses new studies that suggest that the common practice of applying ice after muscle injuries may do more harm than good...

No ice for sore muscles?

Is coronavirus still a big deal? YES.

Just because we are tired of this doesn't mean it is going away. The virus doesn't care how we feel about it.

I continue to get calls EVERY DAY from families in my practice who have been exposed to or caught coronavirus.  Some family members have become seriously ill,  fortunately none of them children.  As studies have shown, symptoms in kids range from nothing at all to mild congestion and runny nose, or low-grade fever, to high fevers, coughing, vomiting, and loss of taste or smell.  So potentially any sign of illness could be coronavirus.  Please continue to wear masks and socially distance to prevent spread and stay home for 10 days if your child has any sign of illness.  1500 people died from the flu in L.A. County in all of 2019, but 5381 people have died from COVID in L.A. County as of today, only 6 months after it started. See publichealth.lacounty.gov/media/Coronavirus/data/index.htm

Back-to-school time

Because kids themselves (and people under 40 with no risk factors) are at low risk of serious illness (death rate about 0.1%), many kids may be able to return to school under careful protocols.  Each family has to consider their individual situation and risk to family members, however.  Every exposure to another person increases risk and many families have made the decision to keep their kids at home.  For those who are sending their kids to school and daycare I am concerned about exposure to grandparents, whose risk is much higher.  The risk  in people over 60 was 10% and over 75 20-30%.  Fatalities currently are going down in Los Angeles, but this is partially because there are fewer cases among the elderly, where nursing homes were hit hard at the beginning, and more among younger people, who are more likely to have mild cases. 

For more information here is a SUPER HELPFUL website!

explaincovid.org

Stay safe!

Updates from our office!

It is very quiet now in the office so we can open up to more well visits.  We are now seeing 0-4 year olds and 11 year olds for checkups. In addition, any child who is overdue for a vaccine may have a nurse-only visit at any time. Please call for an appointment. 

For everyone's safety:

We have only one patient in the office at a time.

Morning and early afternoons are reserved for well visits only.

Only one parent may attend and no siblings.

There is no check-in; you can go straight to your room upon arrival.

Only the minimum in-office is done: Maggie does the measurements and screenings and Dr. Schramm's exam, then shots.

In the afternoon a separate 15-minute video chat from home with Dr. Schramm gives you plenty of time for discussion and questions.  You can download the sprucecare app on your phone from the top of my website.

We all wear masks and we ask that you and your child do too (if they are 2 or older.) Dr. Schramm is in full PPE + n95 for every visit, but kids don't seem to mind.

We thoroughly clean & sanitize after every patient. Donations of Lysol or other EPA-registered disinfectants are gratefully accepted.

If it stays quiet, we should be able to add other ages.  

Hope to see you soon!

Stay well everyone!

We are open every day 9-5 and you can call me anytime!

We have strictly limited in-office visits so that those that need to come can be safe.

In the office, we are seeing the following:
   
MORNINGS

     - well infants and toddlers for checkups and vaccines

     - well kids of any age who are due for vaccines (vaccine visit only)

AFTERNOON

     - sick kids via telemedicine

     - not "sick" but having a problem, via telemedicine (ADHD, injury, developmental issues etc.)

     - sick kids in the office in the rare cases that telemedicine is not appropriate

COVID-19 recommendations and office changes

     As more cases of community spread have been reported in Los Angeles, it has become clear that it is time to not only be vigilant about hygiene (using hand sanitizer, soap and not touching our faces) but also to practice social distancing.  This means staying home as much as possible and avoiding unnecessary contact with others.  Please do this if you or your child shows any sign of illness, but even if not.

     Kids appear to be at low risk for serious illness, fortunately, but are frequently carriers of illness to friends and family members, as we all know.  For this reason, I recommend that as much as possible kids are kept away from older family members (over 60) who are at higher risk for serious illness.  Even kids who appear perfectly healthy can be less than 24 hours from developing fever or cough (and thus contagious during this asymptomatic time).

     If we can "flatten the curve" so that the virus spreads more slowly, then we can avoid overwhelming hospitals.  Here's a great explanation:
https://www.wired.com/story/whats-social-distancing-flattening-curve-covid-19-questions/

     If your child is sick, I am always available to talk.

Here are some FAQs:
1 - Well visits
     We are sanitizing frequently in the office and moving all well visits to the morning so babies can stay up to date on their shots and checkups as safely as possible.  We are also asking for well visits 2 yrs and up to be temporarily deferred.  Sick visits are being moved to the afternoon. Please keep in mind that patients will be asked to stay in the rooms, so try to avoid bringing siblings.

2 - Mild runny nose/cough, no fever or low fever (under 102)
     Ideally, I would love to test everyone for COVID-19, but we have very few test kits.  I am looking forward to wider availability of testing, either in our office or drive-through. As of today, we are being asked to limit testing to those who have fever, cough AND a known contact with COVID-19 or recent travel from Italy, Iran or China.  For now, children with mild respiratory illnesses should stay home and avoid contact with others until they are completely well. They may also be brought to the office if you are concerned and would like them to be seen.

3 - Moderate respiratory illness (fever over 102 or lasting >72 hours, fever that started after 3 days of a cold, cough more than every 10 minutes, labored breathing that is relieved by asthma medicine)
     Should come in & be seen in the office or at urgent care.

4 - Severe respiratory illness (labored breathing, decreased drinking so not urinating at least every 8 hours, lethargy even after ibuprofen)
     Call me but may need to be seen in ER.

Coronavirus recommendations

The Los Angeles County Dept. of Public Health website is the best way to stay informed!
Here is a wonderful, detailed guide to what you can do to protect yourself: http://www.publichealth.lacounty.gov/media/Coronavirus/GuidanceParentsEnglish.pdf
You can also subscribe to their twitter feed for updates!