When It Comes to Our Collective Health, Pardon the Expression, but WTF Is Going On?
From Monkeypox, to a hepatitis outbreak, to high alerts for COVID-19, to child vaccination updates, Dr. Jeremy Faust is here to keep us in the loop...
When it comes to our collective health, pardon the expression, but WTF is going on?
In many parts of the country, we’re on high alert for COVID again.
Monkeypox is on the rise.
And, if that’s not enough, there was a mysterious hepatitis outbreak among children that’s causing concern.
Seriously, WTF.
As always, I like to turn to Dr. Jeremy Faust for answers.
Photo courtesy of Dr. Jeremy Faust
Top ER doctor, fellow Bulletin writer and my go-to medical expert.
We begin by talking about the hepatitis outbreak that is confounding doctors everywhere.
WHAT’S CAUSING THE HEPATITIS OUTBREAK AMONG CHILDREN?
ALINA CHO: I want to ask you about the news that came out not too long ago about this surge in hepatitis cases [among children] in Texas.
Source: The Guardian
What is going on? Does anybody know?
DR. JEREMY FAUST: No, we have no idea. It’s still rare, reassuringly, but it's concerning when you see stories of young children getting liver transplants. The kids who survive, they're immune suppressed for life. So, yeah, you can save their life with a liver transplant, but this is a life-changing thing. And there have been some deaths.
ALINA CHO: I guess the question is, do we know why this is happening?
DR. JEREMY FAUST: There are competing hypotheses. The first study that came out in the CDC points the finger at a variant of adenovirus, adenovirus 41.
Source: Fortune
That seems possible, but it doesn't seem like it's the whole story, because adenovirus 41 doesn't really cause serious disease.
ALINA CHO: Listen, some people want to make it somehow COVID-related or vaccine-related.
DR. JEREMY FAUST: Yeah, so let me address that. I think that adenovirus 41 could be a piece of the puzzle, but I don't think anyone's satisfied that that's the whole story. Then the question is, is it COVID-related?
ALINA CHO: Exactly.
DR. JEREMY FAUST: The kids who've had the hepatitis didn't have COVID at the time, for the most part, so we don't think it's an active infection issue.
ALINA CHO: So...
DR. JEREMY FAUST: There's a hypothesis that the combination of a prior COVID infection, and then what would normally be a benign illness like adenovirus 41, is the one-two punch that knocks the kid down. That's the current most interesting theory that I've seen.
ALINA CHO: Could it be vaccine-related?
DR. JEREMY FAUST: The vaccine question is really important because, first of all, this is happening in very, very young children, children who are too young to have been vaccinated against COVID. It can't be the COVID vaccine. But then people try to say, “Well, what about the moms? Did they get vaccinated?” And that doesn't work either because the kids are too old, for the most part, for that.
ALINA CHO: Can you explain why there were a cluster of cases in one spot?
DR. JEREMY FAUST: I have no idea. It’s a mystery unfolding before our eyes. Someone's going to unlock this, and it's going be very interesting. I don't have the answer.
ONE MILLION U.S. COVID DEATHS… WHAT NOW?
ALINA CHO: We reached an unthinkable milestone recently — one million deaths in the United States from COVID.
Source: The NYT
The interesting stat that I found beyond that staggering number was that 429,000 of those deaths happened after we had access to the vaccine. What does that say to you?
DR. JEREMY FAUST: I think the reason we've had so many deaths after the vaccine came out is, one, not enough people are vaccinated, and two, not enough people who need to be boosted are boosted, and three, the strains that are circulating are so contagious, that we just had many, many more infections in 2021 than we did in 2020.
WHAT ABOUT THE UPDATED VACCINE THAT TARGETS VARIANTS?
DR. JEREMY FAUST: [More than] half the deaths were pre-vaccine, but since the vaccine came on, we have unfortunately also had Delta and Omicron, so the vaccine had to face down a more contagious foe. The vaccines are still performing quite well in terms of preventing death, but you need a third dose if you're older, or a fourth dose. We need 100% booster rates among people over the age of 50 or 60.
ALINA CHO: What about this updated Moderna vaccine that targets the variants. They say it could be out as early as next month.
Source: Medical News Today
At that point, would you get a fourth shot?
DR. JEREMY FAUST: Yeah, I might. The interest in variant-specific vaccines and boosters makes a lot of sense. We're lucky that the original vaccines perform so well against all these variants in terms of severe disease and hospitalization and death, but we know that they aren't performing as well in terms of infection. If you're going to get another dose, you might as well get the one that targets variants and get the maximum impact out of it.
WHAT’S THE LATEST ON VACCINES AND KIDS?
ALINA CHO: Where are we with the kids right now? For kids five to 11, they're now recommending a booster.
Source: FDA
And then, there’s the under-fives. Bottom-line it for me.
DR. JEREMY FAUST: Bottom line, for kids under five, I expect that we'll have a vaccine on the market in June.
ALINA CHO: Moderna?
DR. JEREMY FAUST: Moderna for sure — and [now] Pfizer.
Source: Yahoo Finance
ALINA CHO: So, for kids five to 11, the recommendation now is that they get boosted?
DR. JEREMY FAUST: I actually think that for [kids] five to 11, it might make more sense [to get boosted] than [it does for kids who are] 12-plus. I think we've talked about this – 12-plus got the adult dose.
ALINA CHO: Right.
DR. JEREMY FAUST: I think they have a great protection. Five to 11 actually got...
ALINA CHO: … one-third [the adult dose], right?
DR. JEREMY FAUST: Yeah. So, their response might be similar to the response that seniors have, which is that a third dose doesn't just protect you a little bit longer. It actually adds protection.
WHAT CAN WE EXPECT FROM A FALL/WINTER SURGE?
ALINA CHO: What about this whole notion of, “Let's all prepare for another surge in the fall and winter.”
Source: The Washington Post
What can we expect?
DR. JEREMY FAUST: There's a couple of possibilities that I think we should all consider and lay out. One is that the amount of immunity in the community via vaccines and infection is high enough that these cases no longer mean what they used to mean in terms of bad outcomes. That thing that we talked about for so long, herd immunity, or what I call herd safety, maybe that's what will happen. We can have tons and tons of infections, but the implications aren't particularly special anymore.
ALINA CHO: That would the best-case scenario, I suppose.
DR. JEREMY FAUST: The other possibility is that the next wave or the fall wave is somewhere in between, right? So, it's not 2020, it's not Delta or Omicron, but it's not just what’s going around, you know, like, “Oh, there's a cold going around.” It’s something in between. And then, the worst-case scenario is that there's a bad variant or the vaccines are waning more, which we really haven't seen in terms of severe disease. [If that happens], we [might] all need those extra doses. I am a person who thinks that there's a seasonality to this.
ALINA CHO: Yeah. I know.
DR. JEREMY FAUST: Coronaviruses are seasonal. The question is, what does the seasonality mean?
ALINA CHO: And what does it look like?
DR. JEREMY FAUST: I'm cautiously optimistic that it might be more and more like a nuisance and less and less like a crisis.
ALINA CHO: I mean, that's our hope, right?
DR. JEREMY FAUST: With this much immunity, and this much vaccination. We are in absolutely new terrain, and therefore, I say prepare for the worst, but hope for the best.