Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 828 days since the first documented human case of COVID-19. In 828, human occupation of Pueblo Bonito, a site in Chaco Canyon (today in New Mexico), began. Pueblo Bonito is a key archaeological site in our understanding of the history of the southwest and the indigenous people who lived there long before there was ever a United States.
Today we will discuss Moderna’s pediatric vaccine results. The paid-only “Other Viruses” section will discuss how mitochondria are essential to the antiviral immune response.
See you next week and have a great weekend!
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Now, let’s talk COVID.
Moderna announces trial data for pediatric vaccine
Yesterday, Moderna announced data from a trial of a pediatric (6 month of age to 6 years) formulation of its vaccine: https://investors.modernatx.com/news/news-details/2022/Moderna-Announces-its-COVID-19-Vaccine-Phase-23-Study-in-Children-6-Months-to-Under-6-Years-Has-Successfully-Met-Its-Primary-Endpoint/default.aspx
Here are the key results:
The study met its primary endpoint of high neutralizing antibody titers—but details at this time are sparse
Efficacy against symptomatic disease in an omicron variant-rich environment was similar to known efficacy of two vaccine doses against omicron variant-mediated symptomatic disease in adults (43% in this study)
Safety was excellent, with almost all events being mild or moderate in severity; there was no myocarditis observed in the study, either
Obviously, a press release is not a paper and this doesn’t tell us the whole story, but what we do know from this is that Moderna feels strongly enough to be preparing submissions for approval in both the 6 to 12 years age groups (based on previous data) and in the 6 month to 6 years age group.
However, this is the most unambiguously good data we have seen yet for a vaccine in children.
We are going to see some pushback, I expect, from certain corners. There are those who will emphasize that COVID-19 rarely causes serious outcomes in children, and those who will try to say that even the apparently small risks are not worth the potential adverse effects.
I think these sorts of points are inherently presumptuous. Firstly, no matter how rare death from COVID-19 is in children, it is irreversible. If my own child were to die of COVID-19 because I didn’t get her vaccinated, it would destroy me. There is no other way to put it. Furthermore, we do not fully understand the long-term effects of COVID-19. At all. We do know that it can cause impairment of lung function in children, we know it can cause long-term serious effects like MIS-C, and we know that there are adults still struggling with the effects of Long COVID years after having it. Furthermore, a vaccination in childhood builds a foundation of immunity that prepares a child for a lifetime of exposure to whatever SARS-CoV-2 variants or descendants may be coming down the road. Children do eventually become adults, which will lead to elevated risk of serious disease, and I think it is best to arm people with defenses against this virus as early as they can be armed.
I want to see the full data package, of course, but presuming that the data are as strong as they sound this is a huge advance. Parents who have been sequestering their youngest children at home, or otherwise living in a state of extreme restriction due to the virus, will finally have a protective measure that they can count on.
Part of science is identifying and correcting errors. If you find a mistake, please tell me about it.
Though I can’t correct the emailed version after it has been sent, I do update the online post of the newsletter every time a mistake is brought to my attention.
No corrections since last issue.
What am I doing to cope with the pandemic? This:
Sleep training
Speaking of children, my wife and I have been sleep training our daughter using a method called Stay-and-Support, as detailed in a book we received from friends in the UK entitled The Baby Sleep Solution. Sleep is a very precious thing, and we’re not really born knowing how to get ourselves into it. Especially as the brain develops, sleep can become more elusive for a baby, and thus for its parents. Sleep training tries to control the process of learning to fall asleep and stay asleep. The classic method is to let the baby cry it out. This is hard on a parent, and also, when you live in a small apartment as I do, pretty loud.
The “stay and support” method, I thought, would allow us to calm our child down. Mostly it consisted of just being in the same room with her and ineffectually trying to calm her down, though. There were tears. Also, the baby cried.
The hardest part was not simply feeding her when she woke up in the middle of the night. This involved losing a lot of sleep for us as she worked to put herself back into dreamland. It’s really tough, at 3 AM, to stare down an hour of wakefulness with a screaming child and know that 10 minutes of feeding would solve the problem—but it would only treat a symptom, not the cause. We persevered, though, and now our daughter is not waking up in the middle of the night as much anymore (about once a night, later on in the night, I understand to be pretty common even after some sleep training).
Despite the difficult times here, or more accurately because of them, just last night, she fell asleep in 10 minutes without complaining at all. This whole thing took a few days and seems to have gotten us to a pretty good place. The investment of a few sleepless hours will, we expect, pay off in more consistent full nights’ sleeps for us all.
Reader Joe C asked:
If people who are protected against one subvariant are also well-protected against others, why would there ever be a surge in a place that already had an Omicron surge (like Europe)? Is it just changes in behavior/regulations combined with immunity fading from vaccines & boosters, and nothing to do with the difference between subvariants at all?
My answer:
Good question. I cannot give you a precise answer, but I do think it is related to overall immunity and the size of the susceptible population. European countries have, generally, had better control of the pandemic than American communities, which means they may still have a larger percentage of people who have not had experience with the virus. Alternatively, this could be an effect of waning of vaccine-mediated immunity and boosters, but in the US, vaccine uptake and booster uptake is so much worse than in Europe.
What I feel confident saying is that clearly Europe has a BA.2-susceptible population and the virus is spreading through it. The US so far does not appear to have as large a susceptible population. While I've speculated as to why, the answer is that I don't really know much beyond what we can see in the data.
I think we have reached a level of experience with this virus where we are realizing the limitations of what we've learned about it so far. I am afraid that we are probably going to understand the difference between the US and Europe in this particular moment *after* that information is at its most useful.
In my last piece I tried to provide some general principles that offer a way to think about your local and personal situation as best as we currently can--evaluate the number of susceptible people that may be around you against your personal vulnerability, and calibrate your protective measures to that. For now this is the best we can do.
You might have some questions or comments! Join the conversation, and what you say will impact what I talk about in the next issue. You can also email me if you have a comment that you don’t want to share with the whole group, or if you are unable to comment due to a paywall.
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For those who won’t be continuing beyond that into the rest of the paywalled section below—as well as everyone who will—please know that I deeply appreciate having you as readers, and I’m very glad we’re on this journey together.
Always,
JS
Mitochondria in antiviral immunity
If you’ve taken a biology course, you might have heard that “mitochondria are the powerhouse of the cell.” You might also have heard this if you’ve seen people online making fun of biology courses.
It turns out they’re much more than that—and they’re central to antiviral immunity.