Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole and today, we're talking about pediatrics and COVID-19 and the Delta variant. Joining me is Dr. Brent Reifsteck, he's the Medical Director for Children's Service Line at the Carle Foundation Hospital. Dr. Reifsteck, I'm so glad to have you with us today.

Many people, you know, we're hearing so many different variations and things about this. So, tell us a little bit about the Delta variant of concern and the recent increase in pediatric respiratory illnesses, including COVID, RSV, what you think the reasons are, why this is so important.

Brent Reifsteck, MD (Guest): Well first, thank you very much for the opportunity to talk to you guys today. I really appreciate it. So, Delta variant is concerning. We're really glad that they moved from their old nomenclature to starting to use Greek letters because it's way better than trying to figure out what b.one.one.seven, what that means.

Cause that's how they name viruses. So, Delta is just one in a string of variants and variants occur whenever a virus mutates and each mutation has its own set of characteristics. So, the concern is when a virus is allowed to mutate and become a variant, then what's the next variant going to look like? And there are different categories of variants. There's variants of interest. Variants of concern and variants of high consequence. We have no variants of high consequence right now, which is good because to be classified as that, a variant has to be basically unmanageable, untreatable, not able to be contained.

While, variants of concern are ones that have specific characteristics that make them more worrisome, but they're still able to be controlled by what we have available, namely, the vaccine. So, the Delta variant can spread much easier than the other variants, which makes it really worrisome because it can get up there and just spread like wildfire. But we do know that the vaccine still protects people, even if they catch it, from ending up in the hospital, ending up in the ICU and severe illness. The vaccine protects much more than not having the vaccine. So, even though the variant, the Delta variant is more virulent in the body, more worrisome in the body and it spreads easier; it's still able to be controlled by the vaccine, which is good. So, that's a positive thing. The negative thing is we have a whole swath of the population that's not vaccinated, which means that the Delta variant can spread through them a lot easier. And then once that's inside of people, then it has that opportunity to mutate.

Host: So, tell us a little bit about the difference from other variants in terms of infectivity. You know, when COVID began, we were all wiping down our groceries and everything was so concerning about surfaces, but we're learning a little bit more about that now aren't we?

Dr. Reifsteck: As we learn more about the virus itself, but also the variants, we learn how it spreads and why it spreads and the things that we need to do to help mitigate it. And the biggest change of Delta compared to others is that it spreads more easily, but we also know, like you were talking about wiping down groceries and stuff like that; that it's largely respiratory. It's largely spread through respiratory droplets in the air. And so the more important thing to be concerned about is spending time close together, unmasked or the amount of time you spend within six feet of other people. And that's why all of the things that we talked about in the very beginning, like masking, hand-washing and physically distancing, all of those things are still the most important things along with vaccines, which we didn't have in the beginning. When we look at the published data relative to the wild type. When we talk about how transmissible it is, it's about double, two times as transmissible. And 85% more likely to put you in the hospital. And some estimates are at just 50% more deadly, some up to 230% more deadly than the wild type virus.

So the worries about the Delta vaccine or sorry, Delta variant is that it's not just more communicable, it's more likely to put you in the hospital and more likely to kill you. And that's across multiple studies that are published.

Host: And one of the biggest differences, horrifying and scary for parents is that we're seeing it in children. Right? We're seeing it. We didn't used to see that before. So, tell us a little bit Doctor about the vaccine, who is it approved for as of now, and then we're hearing that it could even go, maybe Pfizer could go as low as five years old, but tell us a little bit about what's going on right now with our children, this variant and the vaccines.

Dr. Reifsteck: Well, I'm super glad that you asked this question because this is really exciting just in the last week. So, right now we have three vaccines approved in the United States. As young as 12. Which is great. So 12 and up can get vaccinated. Now there's only one vaccine product, the Pfizer vaccine that's approved for down to age 12.

But the biggest reason we're seeing children come into the hospital with respiratory illness right now and COVID is because they are a huge swath of the population that's not vaccinated or under vaccinated. So, they're just easy targets for infection. Plus what just happened in our society in the fall early, late summer, early fall.

Well, our kids went back to school and there's a large push for all of our kids to be in-person in school and that's supported by almost everybody, but we have to do it safely if we're going to do it. So, when we started to see that influx of RSV kids, which we did not see over the winter, when we expect it, we started to see those kids come in mid May to late May.

And what happened in our society at that time? Well, that's right after mask mandates were relaxed by the federal government. So, suddenly people are wearing masks less because they're vaccinated and then, well, our hospitals filled up with RSV babies and children. So, we know just based on that, that masks work, they do their job and the new news that we have just in the last week, which is really exciting is that Pfizer is in the next, you know, seven days or so, going to release, officially release and publish the data that they have from their clinical trials for their vaccine product down to age five. So, once that's released, the FDA and the American Council on Immunization Practices will start to review that data. And if we use the 12 to 16 year old group that data, when it was published and then got emergency use authorization, if we use that timeline, we should expect the Pfizer vaccine to have emergency use authorization for children as young as five before Halloween. So, that's exciting news because then that chunk of, that school age chunk of the population can get vaccinated. And then our job in the meantime, is to teach parents and families and teachers and the general population, how safe this vaccine is and how effective it is because the data that we're seeing in the preliminary results is that even though the dose for this age group, the five to 11 year olds, the dose is about a third of the adult dose, their immune response is just as robust, which is not surprising. Kids have brand, their immune systems are brand new.

So, their response is robust. And the side effects are actually less. And my theory there is that kids just kind of do their thing. They play, whereas us as adults, if our arm hurts or we get a headache, we kind of are babies about it and will complain about it. Whereas kids, you just give them something to do. And they go, they forget about their headache. They forget about their sore arms. So, we know that the vaccine product is safe for them and we know it's effective. And you know, if we have to try to convince the general population, we just crossed the 6 billion mark, as far as worldwide vaccines given. So, 6 billion doses have been given of various vaccine products worldwide with about 3.4 billion people being vaccinated and that's a pretty big group to use as a clinical trial and the safety profiles remain very favorable.

Host: Well, as far as the sore arm that Tic-Tok arm swing worked for me. So I don't know, you know, I didn't, I was lucky I didn't have any side effects. However, I know, you know, people were concerned about that. Now, as far as our kids, when these vaccines do become available, Doctor, do you feel that they should or will? And this is just your opinion, be available at our pediatric offices. I mean, we love our pediatricians. So, you guys are the ones helping us raise our children and raise them safely in this medical home. Whereas when we were adults taking this vaccine, we could go to our pharmacy and get it. How do you see this rolling out?

Dr. Reifsteck: Thank you so much for that question. I am clearly biased, so I'm going to have a very biased answer for you, but we had this conversation once the Pfizer vaccine was approved down to age 12, because at that point we were vaccinating in mass areas. We were, taking over abandoned storefronts and turning them into vaccine clinics and just assembly line style, getting people through. That is not the type of environment that I would prefer my pediatric patients to get vaccinated through. So, you're absolutely right. I believe that, you know, our pediatricians should be driving that ship and should be the place where you go get that trusted medical care for your children.

Now we have a great group of family practice docs here that are amazing with kids too. And you know, your primary care office in general, I think, is going to be able to handle most of these vaccinations. That doesn't mean that some places will do mass vaccinations and that's totally fine if you do it the right way. But I do think the voice of reassurance and encouragement is going to largely come from our pediatricians. And you're right. That's the trusted authority.

Host: Well, it certainly is. And now there's another thing as kids are going back to school, Doctor is this mask situation. And I don't know why it's become political when this is you don't want to politicize public health and a public health crisis, but our kids are back in school and we've seen this uptick in RSV and other illnesses. Can you please reiterate why masks are important in schools and everywhere right now, even if the adults in the family and the older kids in the family have been vaccinated, why it's still important that we can wear our masks while this is still going on?

Dr. Reifsteck: Sure. Yeah. And you know, I think it's become political because it's something that people don't want to do. Let's be honest, wearing a mask all day or in places where you're not used to wearing it. It's not very much fun. And I totally agree with that. I don't like wearing a mask all day at work, but I know that it's the right thing to do.

And I literally do wear a mask all day if I'm out on the pediatric ward, because I know it's protecting people. And I don't want my staff to have to wear a mask if I'm not right there wearing a mask with them. So, that's my message that I would send to parents. You know, you might have your vaccine, but your ten-year-old can't and taking them out into public, where you're not wearing a mask, but they have to, is no fun.

And to kind of build upon that, there's a lot of folks that say my kid won't wear a mask or you can't keep a mask on my kid all day at school. And I just actually did a talk with some retired teachers, and one of them asked that question, you know, what do I say to a parent who says, you can't put a mask on my kid all day?

My response is okay teachers you've had bad kids and good kids throughout your careers. But have you ever had a kid that you couldn't get to do the thing you're asking them to do? And they all laughed because if there's one person that can get your kid to do what they're supposed to do it's a teacher. Teachers are absolutely amazing human beings and they can do just about anything with our kids.

If you put your kids in the right mindset and you coach them through the fact that this is the right thing to do. It's protecting your friends and you should listen to your teacher, they know best. That's going to set your teachers up for success and by extension, your kids. So, the bottom line with masks we've got good data that tells us that they work.

I have real world data to tell me that they work because of the RSV situation I referred to before, where we had an influx of RSV after the mask mandates were relaxed. So, you know, we have good data to tell us that plus we had a good study released and it's been about three weeks ago now that tells us specifically in this pandemic, that masks are an effective way.

And then are all kinds of bad videos that are out there that tell you that masks will do bad things to you. And none of those are backed up by any sort of scientific data. And so masks definitely work and they're the right thing to do. And the best way to help us to get through to the other side of this, is to coach your kids to make it normal. And that will help out the teachers a lot.

Host: Well, I mean, surgeons have been wearing masks for hundreds of years. And I have trouble understanding why people don't accept that they don't work and yeah, they're not comfortable, but they do cover up a multitude of sins. I'm 57. I don't mind wearing them. My eyes nice. As we wrap up, Doctor, please offer your best advice for providers in counseling their patients, if they have parents that are nervous at the thought of getting their child vaccinated, and all of these things we've discussed here today, give them some talking points, give them your best advice in how you would like them to counsel their patients on the importance of these recommendations.

Dr. Reifsteck: For providers, I think it's important to grab two or three pieces of data, two or three important studies that have been published that address exactly what concerns are out there and be able to thoughtfully and kindly present them to families. One good place that I go to is the actual meeting materials for the American Council of Immunization Practices.

It's right there on the CDC website. They publish their slides after every meeting. And I go there a lot to get their like risk benefit analyses. Specifically a good example is myocarditis and teenage boys. There's good data that tells us that the incidence of myocarditis and pericarditis after vaccination, specifically the second dose of Pfizer and Moderna. They have a higher incidence of myocarditis and pericarditis, but when they run the risk benefit analysis and look at that same condition after COVID infection and compare it to vaccinated folks, the risks are still so much lower than the benefits of getting the vaccination. And when you look at it that way and you're able to present it in a way where you say, gosh, I hear that concern. I totally understand where you're coming from. And I know that, that data is out there. So, let me show you what we have found when we look at the data in a broader way, let me show you and give you some reassurance. Doing that in a kind and understanding way where you validate their concerns before you give them the opposing data, is really an important approach and having a few data points where you can present them with the correct information in the office is going to go a long way. It's going to help convince them.

Host: 100% agree. Great information, Doctor, thank you so much for joining us today. That concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle's sponsored educational activities, please visit our website at carleconnect.com for more information, and to get connected with one of our providers. Thanks so much for listening. I'm Melanie Cole.