...if COVID affects kids? (with Dr. Priya Soni)

Ever Wonder? / November 10, 2021
Dr. Priya Soni, MD
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Dr. Priya Soni

Since the early days of the pandemic, there’s been a lot of confusing, and sometimes conflicting, information about COVID-19 and children. On the one hand, we know that disease risk is linked to age, with older adults getting sick and dying at disproportionately higher rates than younger people. But on the other, COVID-19 has now become one of the top ten leading causes of death among children'. With the recent approval of COVID vaccines for children ages 5 to 11, understanding the real risk COVID poses to this age group is more important than ever. 

Do you ever wonder if COVID affects kids? 

Dr. Priya Soni (@PriyaSoniMD) is a pediatric infectious disease specialist and assistant professor in pediatric infectious diseases at Cedars-Sinai. Since the beginning of the pandemic, she’s been following the science about COVID-19 and kids and treating patients in the clinic. She walked us through what we currently know about how COVID-19 affects children, and what the data says about the new vaccine for 5 to 11-year-olds.  

If you have questions about vaccines for your kid, talking to their pediatrician is a great place to start. 

Have a question you've been wondering about? Send an email or voice recording to the podcast team to tell us what you'd like to hear in future episodes. 

Subscribe to our show on Apple PodcastsSpotify, or Google Podcasts. To see a full list of episodes, visit our show’s webpage


Perry Roth-Johnson (00:06):

Hello! This is Ever Wonder? from the California Science Center. I'm Perry Roth-Johnson. Since the early days of the pandemic, there's been a lot of confusing and sometimes conflicting information about COVID-19 and children. On the one hand, we know that disease risk is linked to age with older adults getting sick and dying at disproportionately higher rates than younger people. But on the other, COVID-19 has now become one of the top ten leading causes of death among children. With the recent approval of COVID vaccines for children, ages 5 to 11, understanding of the real risk COVID poses to this age group is more important than ever. So, do you ever wonder if COVID affects kids?

Perry Roth-Johnson (00:46):

Dr. Priya Soni is a pediatric infectious disease specialist and an assistant professor in pediatric infectious diseases at Cedars-Sinai. Since the beginning of the pandemic, she's been following the science about COVID-19 and kids and treating patients in the clinic. She walked us through what we currently know about how COVID-19 affects children and what the data says about the new vaccine for 5 to 11 year olds. And just a note for our listeners: if you have questions about vaccines for your kid, talking to their pediatrician is a great place to start. Okay, here's Dr. Priya Soni. Take a listen. Dr. Priya Soni, you are a pediatric infectious disease specialist and an assistant professor in pediatric infectious diseases at Cedars-Sinai. Priya, welcome to the show!

Priya Soni (01:31):

Thank you so much Perry. Glad to be here.

Perry Roth-Johnson (01:34):

So Priya, I'm thrilled to talk to an expert like you about vaccines for kids. Um, it's really timely just a few days ago. The FDA cleared Pfizer's COVID vaccine for kids ages 5 to 11, but before we get into the vaccines and some of the questions people might have about vaccinating kids, I just want to start with some basics about your expertise. Can you tell us what it means to specialize in pediatric infectious disease? Just for context, like our listeners may be familiar with pediatricians, you know, doctors who specialize in treating children or with experts who study infectious diseases, but when you mash those two together, how does specializing in pediatric infectious disease compared to those things people might be more familiar with?

Priya Soni (02:16):

So pediatric infectious diseases is a subspecialty of pediatrics. And what it basically means, uh, the short answer is that after medical school, four years, you do finish your three years of pediatric residency, but then further specialize in all types of infections in children. And so that can range from different viruses, bacteria, fungal infections, you name it, um, from birth till about 18 years of life. And we pretty much see it all it's, you know, kids as, as you all know, they are getting into all sorts of things. And we're well equipped to, to kind of guide parents through a simple infections, but also, um, more serious ones, um, in kids that are immunocompromised or, um, have other complications and underlying medical history. So it's a really, really fun field. So you gotta keep up to date with all of the information that's out there. Um, but also, um, know that you're kind of the end of the line when people come to you with their problems. Tell

Perry Roth-Johnson (03:26):

Me more about that. What, why you say you're that you're the end of the line?

Priya Soni (03:29):

Well, I think, you know, pediatricians, general pediatricians, um, we, you know, parents really rely on them to get them through the day-to-day of things that come up, ear infections, sinus infections, pneumonias, um, things that are pretty common. Um, but then, you know, there's always caveats and complications and unique infections that they might not be as familiar with. And so we, um, you know, are able to help them to guide them through the, both the families, the children and the pediatricians, uh, through some of those, uh, complications and, uh, unique scenarios.

Perry Roth-Johnson (04:10):

And how has your work changed and shifted in response to the COVID-19 pandemic? It must've like felt like your world's kind of turned upside down in a way.

Priya Soni (04:19):

Yeah, absolutely. You know, coming out of training and, um, starting out as a young attending, I had an idea of, okay, I'm going to be studying this and working on research in this particular field. Um, but when the pandemic happened, it really made me shift, um, all of my focus to understanding, um, and helping drive the response here at the hospital, as well as kind of being a leader for, um, our pediatric department in, in understanding how this is going to impact children, um, revamping policies and, um, kind of getting your feet wet with, um, the epidemiology behind all of this. So it was very much, you know, as they say, uh, building the ship as you're riding it. And, um, it has still been that to this day. So every day is, is, is, is something new, you know, and I think, um, you get satisfaction out of helping your patients and, um, knowing that you helped a family and a child kind of through an infection at a certain part of their life, but then part of it too is asking these bigger questions. What did we know about the certain virus or bacteria at this part in history and what can I do to better understand the pathogenesis to help the future, um, and to impact more people in the future. And so, you know, now that the pandemic has happened and we're all in this, um, there's so many more questions, you know, surprisingly think there'd be less, less questions, but I think there's even more questions at this stage in the pandemic than, than earlier on, um, and how it will play out.

Perry Roth-Johnson (06:08):

So let's get into some of those questions, cause there's a lot of confusing info out there about COVID-19 and children. On the one hand, some people seem to downplay the risks that COVID-19 poses for children or others, uh, would point out that children around the world have died from the disease. So let's try to clear some of that up.

Priya Soni (06:26):

Absolutely. And I think, you know, we have heard so much from so many different sources about gosh, you know, and it's not wrong and it's not minimizing to say that children have been slightly less impacted than adults, especially older adults with, um, other factors going on. Um, but I will say, you know, children have been very effected by this pandemic, um, and in looking through kind of the last year, year and a half or so, um, COVID-19 has as, you know, come up to one of the top 10 reasons for death in children. And so that's, that's huge, you know, that was never an issue before and now nearly 700 kids have died of this infection. Um, and so it's huge. Um, and especially in this group that we're going to be talking about soon, the 5 through 11 year olds, about a 196, 5 through 11 year olds have past of COVID-19, um, related issues. So, you know, I think if you look at the hospitalizations and kids, uh, that kind of a thing, especially, especially with the Delta surge that we recently experienced, um, we found that what was happening earlier, where the kids weren't as effected, not the case now, um, they, they are being hospitalized and they are getting super sick, especially those with certain underlying conditions. So that was a huge shift in our kind of looking at this question and risk and kids. And the other thing is you, you look at our influenza season, you know, before the pandemic, we had influenza seasonal influenza, big deal in kids. But if you look at the overall deaths in kids, they were in the hundreds, um, compared to now over 600, almost 700 kids that have died of COVID-19.

Perry Roth-Johnson (08:24):

Oh, I see. It's like almost an order of magnitude worse than for COVID versus influenza ni kids.

Priya Soni (08:29):

Absolutely. And then, you know, not to mention, um, some of the things that are even, you know, murkier here, like some of the questions that we have, some of these kids are having, um, long haul COVID symptoms. Um, some of these kids are contracting what is called M.I.S.C. um, the multi-system inflammatory syndrome in children. Um, so there's a lot of different ways that this infection is affecting kids.

Perry Roth-Johnson (08:58):

Despite all of this. And you alluded to this earlier, it's true that we're seeing much lower COVID-19 case rates among kids than among older adults. Uh, can you talk a little about, about some of the reasons why you might think kids are less susceptible to severe COVID-19 than adults?

Priya Soni (09:17):

Yeah. So remember how I was saying though, in the beginning of the pandemic kids, weren't really getting sick. Um, now if you look at September, October data, nearly 20 to 25% of all new COVID cases are coming from children. And I think the virus is just kind of running out of, um, places to go and multiply, right. Um, a new hosts that have never seen this virus. So, yeah. So I will clarify that, you know, they are getting more infected now than the older population that most of them have, um, thankfully been vaccinated. So yeah, so the kids are, um, getting infected more, but there are a host of factors that we have started to look at and to kind of think about in kids that might be impacting why they don't get overall as severe infection as older adults. So one of them may be, um, that, you know, they're not expressing this ACE-2 receptor, we've heard a lot about the ACE-2 receptor.

Perry Roth-Johnson (10:23):

Oh, is that the, uh, the spike protein that I've been hearing a lot about that's on the outside of COVID, so that spike from COVID attaches to this ACE-2 receptor on your cell to get inside.

Priya Soni (10:33):

Exactly, yeah. So the spike protein attaches to our human ACE-2 receptors, um, and then allows the virus to get inside. Um, and for whatever reason, um, kids on they're younger, they may not be expressing as many cells with these receptors to allow viral entry. Um, they, they tend to have less of it in their upper respiratory tract and especially in their lungs. So, um, it's a really interesting thing that we noticed. Um, another thing is, you know, kids in general, like they are, uh, exploring the world and getting into all sorts of things and, um, really have given their immune system role challenges back to back through getting through colds and that kind of a thing. So, um, and especially through their childhood vaccination schedules, every time they get a vaccine, you're kind of, um, putting your immune system through a little bit of a stress, but then allowing it to build these antibodies in a protective way. And so kids may inherently just have less symptoms and less severe disease because they've already been putting themselves through these immune challenges, so to speak, um, in childhood, less, less seen in adults. I mean, adults, you know, our immune systems are very, very different than these kids who are constantly facing pathogens and handling them. Um, so that could be a potential reason why. Um, so it's really, really interesting. I, you know, I'm, I'm very, um, curious to understand the immune system of these kids a little bit more as we kind of get through this.

Perry Roth-Johnson (12:18):

Yeah, yeah. Uh, it's, it's so interesting because what I'm hearing you describe as like there's certain fundamental things that are different about a kid's immune system than an adults, but layered on top of that, which might be causing some of the murkiness or confusion is that the virus has changed over time. You know, the one we had at the beginning of the pandemic didn't have this Delta variant widely spread like it is today. Plus people have just been getting vaccinated like adults, you know? And so then there's just fewer places for the virus to go. And so it's, it's, it's getting to kids bottom line though, should parents be worried about their child getting COVID-19 now?

Priya Soni (12:58):

I think as parents, you should be concerned about your child getting COVID infection and potentially leading to severe disease, um, and also potentially causing these long-term effects and or M.I.S.C. Um, so for those three reasons, you know, that alone should really be something that parents should think about when they start making these decisions for their kids in the coming future. So yeah, the calculation really, really straight forward to me, this virus still continues to be a global threat, um, and our children, um, you know, who are interacting with their classmates now, their friends, their relatives, um, we, we know and, and have seen what COVID can do if we don't really control it spread. So, um, having children vaccinated is the next obvious logical step. And you'll ask any pediatrician that I'm, I'm sure they'll agree.

Perry Roth-Johnson (14:01):

That's a great segue because now we can dig into the recent news that the FDA vaccines advisory committee met on October 26th. And based on that committee is thorough review. The FDA authorized the emergency use of Pfizer's vaccines, uh, for kids 5 to 11 on October 29th. So the Pfizer vaccine, uh, has already been fully approved by the FDA for use in adults, uh, age 16 and up our kids ages 5 to 11, getting the same vaccine that's been approved for adults or something, a little different, uh, walk our listeners through that.

Priya Soni (14:36):

This is really exciting news, um, last week. And I think it's been what a lot of us have been waiting for. And so I will, by saying this vaccine in general has been studied more than any other vaccine in human history, just because of the sheer amount of people who have already received it over 3.8 billion people who have gotten this vaccine, et cetera. So, I mean, if you think about that and now move to how it's been studied in kids, you know, um, it kind of helps to digest it all. So looking at the data last week was really exciting. Um, because overall we were able to see that Pfizer, um, studied this vaccine and gave it in a third of the dose as what we would receive as an adult. So if you got the Pfizer vaccine as an adult, you received 30 micrograms of the MRNA, um, at two doses and in kids from 5 through 11, it will be 10 micrograms. So it would be 10 microgram dose each time, um, spaced three weeks apart. So in order to get that dose, right, you know, that Goldilocks dose for kids in this age group, um, they relied on a lot of, uh, preclinical data phase one data, um, to kind of make sure that we were giving a dose that was going to elicit an immune response that was positive in kids, but not too much to create all these side effects that we're really trying to avoid. And, um, you know, just making sure that, um, that it was, it was an appropriate enough dose to, to get to where we wanted to. And that's the same process that takes place for all vaccines and kids, parents should understand that, you know, it's not that kids are just tiny humans, their immune systems they're evolving every day. Um, and they can handle smaller doses of vaccines and produce a more robust immune response than adults can sometimes. So just to talk about the trial a little bit, the kids 5 through 11, they were studied, uh, in placed pretty much in two groups, you know, the vaccine arm and the control arm, where they were just received a placebo, um, and the way that they actually did the study, um, because we're in a pandemic and we're studying kids and we need to know, um, how effective is this vaccine? They would normally randomize one-to-one. Um, but they did two to one. So they put, uh, just as many kids in the vaccine arm, as they did in the placebo. So overall we're looking at about 3109, uh, participants over 3000 participants and children that were included in this trial, um, and received the vaccine.

Perry Roth-Johnson (17:33):

That's a lot of kids.

Priya Soni (17:33):

That's a lot of kids.

Perry Roth-Johnson (17:35):

Let's talk about the safety data for the Pfizer, uh, uh, kid vaccine. Like what does the data say about safety in children?

Priya Soni (17:42):

That's one of the top questions on many parents' minds right now. What did the study show with regard to safety? And so, um, first before we get into it, I think, um, I also wanted to mention that the study group included about 20% of kids who had comorbidities or other conditions. A lot of times we think about vaccine trials as just including healthy kids and all this one included about 20% of subjects who had different issues like obesity, kids with asthma, neurological disorders, congenital heart disease. So, um, that I really wanted to mention, but the safety data looked really good. Um, of course you're going to have the most common sort of, um, side effects, like some pain around the injection site. Um, maybe a little bit of swelling, um, and that kind of a thing. But, um, these kids tolerated it really, really well. The number one thing that was noted was, um, this lymphadenopathy or lymph node swelling sometimes, um, and that can occur in the neck region. Um, but not a hundred percent. It's just, it was more associated with, um, this vaccine in this age group. Um, but self resolved, wasn't an issue. Um, but most importantly, none of the participants experienced any allergic reactions or anaphylaxis. Um, none of the kids had any, um, heart swelling or that myocarditis, um, issue pericarditis and, and none of the, none of the kids, um, of course died of this vaccine. So those are the main things to take away.

Perry Roth-Johnson (19:27):

So, I just want to make sure I heard this right, cause I didn't know this word. So I was preparing for this interview myocarditis, which is of some concern lately that they didn't find any cases of that in this clinical trial with the kids.

Priya Soni (19:42):

Absolutely none. And, um, that was a really good thing, but not surprising to us who are in infectious diseases because myocarditis as a whole, um, happens very, very rarely because of these vaccines and, um, in the 5 through 11 year old age group, you know, overall the rates of myocarditis not even related to vaccines is so low part of our due diligence with this FDA, CDC, they're going to be continually monitoring children that that start receiving this vaccine to look for those signals that may be picked up in a larger group if we give it to more kids, but of course, balancing the pros and cons at this point, it's, it's very much, um, exciting news to see the safety and efficacy data and, and, and know that, you know, everything went pretty smoothly.

Perry Roth-Johnson (20:39):

Yeah. Yeah. Well, let's talk about, you know, some of those pros on the efficacy side, now that we talked about safety, what does the data show overall about how well the vaccine works, protect kids against COVID.

Priya Soni (20:49):

They looked at, um, the efficacy in these participants, um, around seven days after the second dose. And when they followed these kids out in the placebo group, about 16 kids ended up developing COVID-19. Um, however, in the vaccine arm, um, which included about 1300 kids, there were only three that developed COVID. And so that translates into an efficacy of nearly 91%, which is huge. I mean, you don't see, uh, such great efficacy in terms of that, uh, type of endpoint often. So that was really reassuring and very similar to the vaccine trials and the 12 through 15 year old group as well. So, um, it's a very effective vaccine

Perry Roth-Johnson (21:40):

Bottom line. What's your message to parents who are thinking about whether or not to vaccinate their child against COVID-19, you know, now that you've had a chance to review and digest this data.

Priya Soni (21:51):

Yeah. You know, I think parents should understand that this is a threat that's really not going away. Um, and we know that it's a threat that's going to constantly continue to evolve until we put an end to it on a global level. Um, and I completely appreciate, uh, uh, parents, um, pause and hesitation with giving your child a vaccine. However, in looking through the data and understanding the risks, um, that children can, you know, have to experience and then, you know, potentially live with, um, because of this virus, it's, it's a really clear yes, for me that I would fully support, um, a parent, uh, giving their child this vaccine. One of the people I look up to in vaccine research and infectious diseases had, uh, paraphrase something really nicely. It's never one, you know, everything, you're never gonna know everything about a particular topic or, um, a vaccine, but it's when you know enough and looking through the data, we know enough, um, to support its use in children. And we're going to continue to look and make sure that it's working well without causing any side effects and in children as we continue onwards. So parents should be reassured by that the systems that we have in place are sound, um, and scientific. And if you ask any, you know, physician, um, we're all very excited to be able to offer this to kids. In fact, I'm kind of disappointed that we send our kids back to school without giving them this vaccine. So I'm very happy to be where we are now.

Perry Roth-Johnson (23:35):

Yeah, for our listeners who can't see you because this is audio, but you're, you're basically like grinning ear to ear. I feel like you're talking about this. Um, and I love that notion too, of you can't know everything about a subject or a vaccine, but you can know enough at some point, but for the sticklers out there who might ask, how do we know we aren't missing something in these trials? For example, what about so-called long-term effects? Is it possible for a vaccine to have an unintended side effect years later?

Priya Soni (24:06):

For those folks, I would say that if you understand how the MRNA technology works, you, you know, and I'll remind the audience that, you know, MRNA, uh, is new maybe for most of us, but, uh, the science scientists I've been working on, I have been working on it for decades for various other infections. And that kind of a thing we've only now been forced to kind of use it, um, in COVID-19, but, um, MRNA degrades really rapidly, um, and tissue, it elicits the immune response that you want without lingering around in your body or integrating in any way it's, it's doing what we need it to do. Um, and then it's kind of going away. So there is no concern that there would be, um, these long-term effects from the vaccine. That's just not how the science works. So I think I would, I would say that, and then also remind them that we have been giving vaccines to kids, you know, for so long, you know, throughout history. And because we haven't had to deal with a measles outbreak in some time, or, you know, had kids that polio, um, because of these vaccines that we're giving to kids on a daily basis, I think we need to trust and lean into the science at this moment. Um, and if you still have questions, you know, I always always say, use your pediatrician as your soundboard and come to them with some of your concerns. And hopefully they can have an open and honest conversation with you, um, about them.

Perry Roth-Johnson (25:46):

Uh, as we start to wrap up Priya, any final thoughts, is there anything else you want people to know?

Priya Soni (25:52):

One thing about COVID is that in getting our kids vaccinated, it's not just what we're going to do to protect them, you know, um, it's also the next logical step forward in protecting our society and protecting others around us. And then lastly, we know that once kids start to get vaccinated, this is going to have some huge implications on, um, school and disruptions in school changes in quarantine policies for vaccinated children. Um, and I, I urge parents to consider and think about that as well, because, um, you know, those that are vaccinated are not only going to be protecting themselves and others, um, in school settings, but, uh, they'll probably be less, uh, privy to all of these disruptions and, um, quarantines, um, that, that many of these kids have had to experience since restarting school. So I think that's an important consideration. Um, I also, uh, know that the holidays are coming up right? And many parents are very eager to have their kids, uh, visit grandparents and family around the country. Um, you know, and getting your child vaccinated before all that, uh, starts up is a really, really important thing. Especially if they're going to be around an older grandparent or another family member that's immunocompromised. Um, and we do know that these kids are able to pass it from each other, but also to us as adults. So I think that's an important consideration to think about as you make these decisions. And I think lastly, I really liked the analogy of thinking about this vaccine and kids as you would a seatbelt, right? Everyone knows seatbelts are safe and seatbelts are needed. And when you put your child in the car, you're putting on their seatbelt, getting a COVID-19 vaccine for your child is like wearing a seatbelt. Um, you know, you, most of the time are taking them from point a to point B and the seatbelts on, and you don't even need it, but on the off chance you get into a situation car accident, you know, you want to have that protection there. And so I urge parents to think about it like that. I love that analogy. I think it really drives home the importance, um, in this age group,

Perry Roth-Johnson (28:20):

Beautiful, simple analogy. Dr. Priya Soni, thank you so much for spending some time with us, uh, to unpack what's behind the, the clinical trials, the kid vaccines. And, uh, thank you for all you've been doing to keep us all safe. Thanks for coming on the show.

Priya Soni (28:34):

Thank you so much for having me.

Perry Roth-Johnson (28:36):

That's our show, and thanks for listening! Until next time, keep wondering. Ever Wonder? from the California Science Center is produced by me, Perry Roth-Johnson, along with Devin Waller and Jennifer Aguirre. Liz Roth-Johnson is our editor. Theme music provided by Michael Nickolas and Pond5. We'll drop new episodes every other Wednesday. If you're a fan of the show, be sure to subscribe and leave us a rating or review on Apple Podcasts. It really helps other people discover our show. Have a question you've been wondering about? Send an email or voice recording to [email protected] to tell us what you'd like to hear in future episodes.