Question about at home testing kits: are they all reliable at detecting Omicron? I've read that sme of them are not, especially those that detect a single protein. Asking specifically about the iHealth test, which says it detects the N proteins.
Good question. In principle the N protein should be still detectable as it has few changes in Omicron. However, I can't really speak for individual tests. I do know that Abbott Labs has put out a statement that BinaxNOW is not affected by Omicron and can still detect it; BinaxNOW is an N protein test as well.
I would check with the company that manufactures your test, at least until FDA provides overriding clarification.
At a population level, a bigger problem perhaps than disease severity in kids (though, as you rightly point out, that problem shouldn't be dismissed) is that a huge volume of pediatric COVID admissions will greatly reduce hospitals' ability to treat any number of other childhood ailments, and at the worst possible time of year.
100% agree. Especially since pediatric hospital care is often more specialized, and thus has different capacity limitations than the generalized adult units. Likely some adult beds could be repurposed for children, but it wouldn't be ideal. I used to work in a city where a local pediatric practice used ads of a very young child dressed in clearly an adult-sized business suit, with the slogan "because kids aren't just little adults," and I'm very much thinking of that in this moment.
The difficulty here is that the FDA hasn't even cleared use of Moderna in adolescents, despite results from that trial having been submitted last June. The holdup apparently has to do with the somewhat higher risk of myocarditis with the Moderna vaccine compared to the Pfizer one.
So, we could well have a situation where Moderna's vaccine is (unlike Pfizer's) shown to elicit an adequate immune response in kids under 5, but is nevertheless never approved due to the FDA's hesitance to make the vaccine available to an older age group.
I'd like to understand more about the pediatric situation. Putting it bluntly: do parents need to worry or not? Should we not be sending our kids to school, especially unvaccinated ones? It is extremely frustrating that the CDC is seemingly ignoring young children and their parents, so I have trouble knowing what actions to take and decisions to make.
Separately, are throat swabs necessary now? Here's one of a few sources reporting this.
As a parent of a young child who cannot be vaccinated, I very much relate to your situation. The vacuum of guidance--and to a lesser extent of evidence to serve as a foundation for that guidance--is very concerning to me. I try to comment on pediatric developments as often as I can, but frequently I find that there is not much I can say.
Right now, the average parent of a young unvaccinated child probably doesn't need to worry, but the problem with the word "average" is that I've never met an average person. Much to my own frustration, I've opted for keeping our child relatively isolated, and she sees people outside our household only on the rare occasion that family or friends visit. With her being 3 months old the decision to do that is easier for me than for parents of older children, but I still don't love it. I worry about what choices we will need to make when she gets older.
My clearest position on children who cannot be vaccinated right now is that I would only expose them to others if the child(ren) is/are either old enough to use a high-filtration mask, or you are confident in the vaccination and COVID-19 infection status of whoever they are being exposed to. High-filtration masks for children are easier to find than most people may realize; I would use Project N95 to identify child-appropriate high filtration masks. They have a dedicated section: https://shop.projectn95.org/masks/child-masks
It's notable that none of those masks are intended for use by children younger than 4 years, but probably children ages 2 and up should be masked. If you cannot find a high-filter mask for a child 2-4, or they simply won't wear it (I'm trying hard not too live too much in a fantasy land about what kids are willing to do), then a surgical mask is an inferior, but still somewhat protective, alternative.
This isn't something I have personally had to navigate because at this point my own child is not sufficiently developed for a face covering to be safe for her, and I don't look forward to having to deal with it when she gets there.
I'm sorry that I don't have much to say beyond this. The dearth of information from public health authorities affects me as much here as it does you.
Speaking of a dearth of information, I'm afraid I don't have a specific comment on the throat swab procedure. I have heard only anecdotal information about it, and while I cannot specifically see why it would be a bad idea, it's also not an instruction in the label of any of the at-home tests. I'm reluctant to advocate for something outside the label of a diagnostic without clear data supporting it.
A co-worker of mine mentioned that she couldn't find child-size masks for her kid, so I looked at the Project N95 page you linked. All but one mask are sold out. Almost every source is now out of high-efficiency filter masks for children, I assume because with omicron, we're seeing many more pediatric cases.
I think there are both scientific and ethical questions here, and no clear right answers to either.
The frequency of disease requiring hospitalization -- which in children can be due either to COVID-19 or to MIS-C -- is lower in children than in adults, but not so low as to be trivial. When authorizing pediatric COVID vaccines, the CDC gave an incidence of well over one in 200. And hospitalization *now*, when -- unlike in previous waves -- there are already many pediatric COVID admissions, may set the stage for worse outcomes. There's also the risk of long COVID, which is understand even less well in children than it is in adults. And there's the danger of children transmitting COVID to their parents. That last one is sometimes portrayed as a selfish consideration, but I don't think it is -- at least, not entirely. Losing a caregiver is a big deal!
On the other hand, being unable to attend school has a clear negative impact on kids, too. Indeed, in some particularly deprived communities, schools provide kids with a degree of security not available to them elsewhere.
And, of course, many parents simply don't have a lot of choice in the matter. If you have to go to work in person, you obviously have to put your kids in someone else's care while you're there. And the potential negative consequences of job loss to both parents and children would in most cases far outweigh those of SARS-Cov-2 exposure.
So, as Paul Offit has put it in a somewhat different context: there are no risk-free options, just different risks. Which ones make sense to take will vary based on individual circumstances.
I share your frustration with the CDC, though. Just today, Jeff Zients said, "We know how to keep our kids safe in school." Even assuming that pre-Omicron mitigation measures will still prove sufficient, the reality is that we have overcrowded schools without mask mandates or adequate ventilation; without consistent access to testing; and without vaccinated students, teachers, and staff. The existence of tenable theoretical model of COVID-safe schools does not render safe any actually-existing school.
Question about at home testing kits: are they all reliable at detecting Omicron? I've read that sme of them are not, especially those that detect a single protein. Asking specifically about the iHealth test, which says it detects the N proteins.
Good question. In principle the N protein should be still detectable as it has few changes in Omicron. However, I can't really speak for individual tests. I do know that Abbott Labs has put out a statement that BinaxNOW is not affected by Omicron and can still detect it; BinaxNOW is an N protein test as well.
I would check with the company that manufactures your test, at least until FDA provides overriding clarification.
Thank you.
At a population level, a bigger problem perhaps than disease severity in kids (though, as you rightly point out, that problem shouldn't be dismissed) is that a huge volume of pediatric COVID admissions will greatly reduce hospitals' ability to treat any number of other childhood ailments, and at the worst possible time of year.
100% agree. Especially since pediatric hospital care is often more specialized, and thus has different capacity limitations than the generalized adult units. Likely some adult beds could be repurposed for children, but it wouldn't be ideal. I used to work in a city where a local pediatric practice used ads of a very young child dressed in clearly an adult-sized business suit, with the slogan "because kids aren't just little adults," and I'm very much thinking of that in this moment.
It looks like we might have results for Moderna's trial in ages 2-6 by the end of the month: https://www.wsaw.com/2021/12/30/moderna-vaccine-trial-young-children-nears-finish-line/
The difficulty here is that the FDA hasn't even cleared use of Moderna in adolescents, despite results from that trial having been submitted last June. The holdup apparently has to do with the somewhat higher risk of myocarditis with the Moderna vaccine compared to the Pfizer one.
So, we could well have a situation where Moderna's vaccine is (unlike Pfizer's) shown to elicit an adequate immune response in kids under 5, but is nevertheless never approved due to the FDA's hesitance to make the vaccine available to an older age group.
I'd like to understand more about the pediatric situation. Putting it bluntly: do parents need to worry or not? Should we not be sending our kids to school, especially unvaccinated ones? It is extremely frustrating that the CDC is seemingly ignoring young children and their parents, so I have trouble knowing what actions to take and decisions to make.
Separately, are throat swabs necessary now? Here's one of a few sources reporting this.
https://www.nbcchicago.com/news/local/omicron-symptoms-with-sore-throats-common-should-you-also-swab-your-throat-to-test/2720958/
I've heard reliable anecdotes that Israel was swabbing nostrils and throat at the airport a few months ago already.
As a parent of a young child who cannot be vaccinated, I very much relate to your situation. The vacuum of guidance--and to a lesser extent of evidence to serve as a foundation for that guidance--is very concerning to me. I try to comment on pediatric developments as often as I can, but frequently I find that there is not much I can say.
Right now, the average parent of a young unvaccinated child probably doesn't need to worry, but the problem with the word "average" is that I've never met an average person. Much to my own frustration, I've opted for keeping our child relatively isolated, and she sees people outside our household only on the rare occasion that family or friends visit. With her being 3 months old the decision to do that is easier for me than for parents of older children, but I still don't love it. I worry about what choices we will need to make when she gets older.
My clearest position on children who cannot be vaccinated right now is that I would only expose them to others if the child(ren) is/are either old enough to use a high-filtration mask, or you are confident in the vaccination and COVID-19 infection status of whoever they are being exposed to. High-filtration masks for children are easier to find than most people may realize; I would use Project N95 to identify child-appropriate high filtration masks. They have a dedicated section: https://shop.projectn95.org/masks/child-masks
It's notable that none of those masks are intended for use by children younger than 4 years, but probably children ages 2 and up should be masked. If you cannot find a high-filter mask for a child 2-4, or they simply won't wear it (I'm trying hard not too live too much in a fantasy land about what kids are willing to do), then a surgical mask is an inferior, but still somewhat protective, alternative.
This isn't something I have personally had to navigate because at this point my own child is not sufficiently developed for a face covering to be safe for her, and I don't look forward to having to deal with it when she gets there.
I'm sorry that I don't have much to say beyond this. The dearth of information from public health authorities affects me as much here as it does you.
Speaking of a dearth of information, I'm afraid I don't have a specific comment on the throat swab procedure. I have heard only anecdotal information about it, and while I cannot specifically see why it would be a bad idea, it's also not an instruction in the label of any of the at-home tests. I'm reluctant to advocate for something outside the label of a diagnostic without clear data supporting it.
I hope this is at least somewhat helpful.
A co-worker of mine mentioned that she couldn't find child-size masks for her kid, so I looked at the Project N95 page you linked. All but one mask are sold out. Almost every source is now out of high-efficiency filter masks for children, I assume because with omicron, we're seeing many more pediatric cases.
Kollecte is also mostly sold out, but several models do still exist: https://kollecteusa.com/collections/kids
I think there are both scientific and ethical questions here, and no clear right answers to either.
The frequency of disease requiring hospitalization -- which in children can be due either to COVID-19 or to MIS-C -- is lower in children than in adults, but not so low as to be trivial. When authorizing pediatric COVID vaccines, the CDC gave an incidence of well over one in 200. And hospitalization *now*, when -- unlike in previous waves -- there are already many pediatric COVID admissions, may set the stage for worse outcomes. There's also the risk of long COVID, which is understand even less well in children than it is in adults. And there's the danger of children transmitting COVID to their parents. That last one is sometimes portrayed as a selfish consideration, but I don't think it is -- at least, not entirely. Losing a caregiver is a big deal!
On the other hand, being unable to attend school has a clear negative impact on kids, too. Indeed, in some particularly deprived communities, schools provide kids with a degree of security not available to them elsewhere.
And, of course, many parents simply don't have a lot of choice in the matter. If you have to go to work in person, you obviously have to put your kids in someone else's care while you're there. And the potential negative consequences of job loss to both parents and children would in most cases far outweigh those of SARS-Cov-2 exposure.
So, as Paul Offit has put it in a somewhat different context: there are no risk-free options, just different risks. Which ones make sense to take will vary based on individual circumstances.
I share your frustration with the CDC, though. Just today, Jeff Zients said, "We know how to keep our kids safe in school." Even assuming that pre-Omicron mitigation measures will still prove sufficient, the reality is that we have overcrowded schools without mask mandates or adequate ventilation; without consistent access to testing; and without vaccinated students, teachers, and staff. The existence of tenable theoretical model of COVID-safe schools does not render safe any actually-existing school.