Vaccine Trials in Children- Thoughts from Parents?

    I woke up to the news that very young children are now being invited to participate in COVID-19 vaccine trials. Given that kids interact with other another and with their families, including grandparents, a lot, they are good targets for vaccines given their ability to spread the virus. Similar to the way the vaccines are currently scheduled, for Pfizer’s trial, all the kids will get their second dose 21 days after the first, and for Moderna, all kids will get it 28 days later. I read multiple articles all over the internet about Dr. Zinaida Good, a research fellow at the Stanford cancer center, who has signed both of her young children (7 months old and 3 years old) up to receive the vaccine as a part of Stanford Hospital’s Pfizer trial. Apparently, neither child felt severe side effects besides sore arms and fatigue, which the rest of us have also experienced with our vaccines. Another doctor, Dr. Angelica Lacour, also enrolled her 3-year-old daughter in the vaccine trial, stating that the reason she did so was for the safety of all children who are not currently eligible for vaccine based protection, not just her own children. 

In thinking about this news, I wondered if I as a parent would enroll my children in a vaccine trial. At this stage in my life, and especially as a product of having been in the Humans and Viruses classes, I understand how important it is to combat viruses that kill millions of people each year. Especially in a situation like this where we are embroiled in a pandemic that has taken so many lives, I think it’s important to be brave and sign up for vaccine trials if you have the ability in order to save potentially generations of humanity. With that being said, perhaps my perspective would change if I actually had kids and actually were presented with the opportunity to enroll my children in a vaccine trial. Then, I think my brain might be telling me one thing and my heart might be telling me something else. I am curious to know if there are any parents reading this blog post (including Dr. Siegel!), would you sign your children up for a vaccine trial during a pandemic? Why or why not? It’s impossible for me to know as a 23 year old without children, as I can only really think in the abstract…

-Komal Kumar, 4/27/21

India's SARS-CoV-2 Variant

    I wanted to write another post about India’s COVID-19 surge, but more specifically about the variant that is causing the surge to occur. The variant that is currently dominating the country is the B.1.617 version of COVID-19, which has multiple sequence changes from the older SARS-CoV-2 virus. This variant was first identified in Maharashtra (a state in India) back in October of 2020. Two of the main mutations are in the spike proteins of the virus, at the locations E484Q and L452R, however, there are a total of 13-17 mutations from the original virus. 

The mutations are interesting to look into- while there are about 13-17 mutations estimated in total, there are three main mutations in the spike proteins that are of the most interest. One of them is E484Q, which allows the virus to bind more tightly to the human ACE2 receptor. One of them is L452R, which confers a weaker recognition capability of the host immune system and similar to the E484Q mutation, allows for a stronger binding to the ACE2 receptor. Finally, the P681R mutation that may boost cell-level infectivity of the virus by allowing for easier conversion of the S precursor protein to the active S1/S2 configuration. However, all of these mutations are still under review and being actively researched, but these are the preliminary findings I was able to locate. 

At this point, the variant is being found in many countries outside of India- the U.K., the U.S., and more- in fact, 18 countries in total and on every continent besides Africa. I wonder what this means in terms of our journey to eradicate COVID-19. Luckily, cases in the U.S. have fallen as a result of widespread vaccination, but given that the vaccines may not be effective at protecting against the Indian variant, will we experience yet another surge in COVID cases as variants begin to circulate the globe? Can new vaccines or boosters be developed that protect against variant forms of COVID-19? Perhaps our fight against COVID-19 is not close to over, perhaps it’s far from over…

-Komal Kumar, 4/25/21

Kumbh Mela & India's COVID Crisis

    Looking at the COVID-19 surge in India has been scary, and I (as have many others) have been wondering about the factors that are playing into this surge. One factor that may have played a large role in the spread of COVID is a festival that I just learned about today known as the Kumbh Mela (“koombh mayla”). It happens once every 12 years, and consists mainly of a pilgrimage where some of the world’s most devout Hindus travel to the River Ganges in the months of January through April in order to bathe in the holy waters for religious reasons. The festival typically occurs in a city called Haridwar, and it is estimated that this year over 9 million people have travelled to Haridwar to complete the Kumbh Mela since January. Most of these 9 million people (around 6 million of them) have actually come this month in April, which coincides almost perfectly with when the surge of COVID-19 cases in India began. As a Hindu myself, I was surprised to learn about this festival since I had no idea that it existed. Better yet, I was surprised that over 9 million people could be travelling to one location during a global pandemic. 

Apparently, the main priestly body behind the Kumbh Mela (called Ganga Sabha) has been encouraging people not to go on the pilgrimage this year. Pradeep Jha, the head of the organization, told his followers that they should not gather for the Kumbh Mela this year and should instead celebrate in a measured and safe manner until COVID-19 comes to an end. This did not stop people from going, however, since the state government of the region did not put any sort of cap on gatherings or put a ban on the Kumbh Mela from happening. I find this to be pretty sad, especially seeing that one of the local religious chiefs stated “Death is certain one day for everyone, but we must follow our traditions.” The things people will do for the sake of religion or tradition, no matter how harmful, will always baffle me. 

-Komal Kumar, 4/22/21

Johnson & Johnson Rollout Halt

    I remember having a small argument with my mother (an internal medicine doc) a week ago when I signed up for my vaccine appointment. Since Stanford only had me schedule one appointment, my mom thought this meant that I was getting the single-dose Johnson & Johnson vaccine. She told me, “whatever you do, don’t get that one- please try to ask for a different vaccine if possible or back out and sign up for a different appointment later.” I told my mom at the time that this was ridiculous, that beggars can’t be choosers, that who was to say that the second time around I wouldn’t get Johnson & Johnson as well. Her concerns primarily surrounded efficacy at the time.  

Ironically, I learned today that the Johnson & Johnson vaccine rollout has been paused due to concerns that the vaccine may be causing a rare blood-clotting disorder. This clotting happened in six recipients of the vaccine, who all developed the clotting within a few weeks of receiving the vaccination. However, something about this number should strike you- out of the seven million people in the US that have received this vaccine so far, only 6 people in total have developed this clotting disorder. The risk of getting a blood clot from birth control pills is so much higher- around 6 women in every 10,000 taking oral birth control pills will develop a blood clot! I find this to be funny because half of the women I know are on oral birth control, including myself, and such a huge alarm is being raised at the prospect of 6 women out of 7 million people getting blood clots from the vaccine. The decision to pause J&J rollout concerns me, given that so many people are already vaccine hesitant and refuse to take the vaccine because of concerns that vaccines cause diseases or uncurable side effects. This blood clotting issue is so rare, and the response to pause the vaccine I fear will only further fuel vaccine hesitancy among people that are already skeptical of vaccines, prompting even fewer Americans to get vaccinated than we are already seeing. 

Apparently, the next step is for the FDA and CDC to “jointly examine possible links between the vaccine and the disorder and determine whether the F.D.A. should continue to allow emergency use of the vaccine for all adults or modify the authorization, possibly by limiting the vaccine to certain population groups. An emergency meeting of the C.D.C.’s outside vaccine advisory committee has been scheduled for Wednesday.” A link to the article I read is here: https://www.nytimes.com/2021/04/13/us/politics/johnson-johnson-vaccine-blood-clots-fda-cdc.html

-Komal Kumar, 4/13/21

The Decrease in Influenza Cases- A Silver Lining

    I got my flu shot this past season but couldn’t help but wonder if I even really needed it. At the time, I remember there being all this buzz about a double whammy COVID-19 plus Flu season mega-pandemic going around, but so far I haven’t really seen or heard any news regarding this year’s Flu season as we normally do. Perhaps this is because COVID-19 news generally overshadows everything these days, or perhaps this is because the Flu is far less severe this year than it has been in previous years. In order to find out, I decided to do some research into this year’s Flu.

Apparently, there’s been a 98% decrease in Flu cases this past season, where between October 1st and January 30th, only 155 people in the US were hospitalized with the Flu whereas around 8,500 people were hospitalized during the 2019-2020 Flu season during the same months. One relatively obvious thing is that since the Flu is transmitted via droplets the same way that COVID-19 is, any measures taken to prevent against COVID-19 would also be efficacious in reducing the incidence of Flu cases. Mask-wearing, physical distancing, limiting gatherings, hand washing, and more has largely decreased Flu cases, prompting me to wonder why we didn’t implement more Flu prevention measures in the past (perhaps because the Flu is just not nearly as bad as COVID-19). Another reason for the drop is the closure of schools and offices- these spaces are typically where large gatherings occur on a daily basis, and so the shutting of these venues also meant that the Flu could not hop from person to person. 

This then begs the question- if Flu cases are going down, shouldn’t COVID-19 cases also be going down? This could be because first of all, COVID-19 is far more contagious than the Flu and has a much longer incubation period. A longer incubation period means people may be spreading the virus for a while before they feel symptoms, whereas for the Flu people would be isolating themselves almost right away. However, this difference is also partially because human beings have had years to build up partial immunity to Influenza, whereas virtually no one on earth had antibodies and immunity to COVID-19 prior to the pandemic. I’m glad that the “twindemic” fears that many people had did not end up coming true and that the decline in Flu cases this year remains one victory we can all celebrate (safely, from our own homes)!

-Komal Kumar, 3/27/21

The Ethics of Vaccine Attainment- Thinking Out Loud

    I wanted to write a post about the ethics of vaccine distribution since it’s been on my mind a lot lately and I’ve had several informative conversations with people surrounding this topic. I’ll first present a few anecdotes. I had a friend tell me a few weeks ago that they could send me a “link” that would help me qualify for the vaccine at a certain facility in the East Bay, where I could go and no questions would be asked and I could get the vaccine. I did not use this link, since I believed it would be better and more ethical to wait my turn and not deprive others of the vaccine who need it more than I do. While this friend of mine was more of an acquaintance, one of my best friends told me just a few days ago that she qualified for the vaccine because she found some random loophole where having an “underweight” status as a child meant that even as a healthy adult she could now get the vaccine. This bothered me more, since she is completely healthy and young and could have easily waited until the vaccine became available to her as for all others. 

I have several thoughts about this. First, perhaps I am just more upset at stories of people finding loopholes or forging information because I am not vaccinated and have been patiently waiting my turn to get the vaccine. I also am upset because I know that there are people FAR more at risk than these friends of mine, who are possibly having difficulties booking their dose appointments because people are taking their vaccine slots. However, I had a conversation with a friend who works at a healthcare clinic serving unhoused people in SF about the vaccine tiers, and it was her opinion that the order of who is eligible for the vaccine is somewhat arbitrary and leaves out a lot of vulnerable people, so those that are not following the rules of distribution aren’t necessarily committing the biggest crime ever by trying to get ahead. While I somewhat see her point that there is no perfect order to who can get vaccinated in a society, I still do believe that whatever order has been prescribed has been prescribed for a reason and healthy, young people should not be trying to find loopholes or fake information in order to get the vaccine early when there is a clear shortage of doses for those most at risk. I do applaud these people for being diligent about getting the vaccine and trying to protect themselves/their loved ones, but I suppose I have mixed opinions about the way in which many people are being opportunistic these days. If COVID-19 has revealed anything about human nature, it’s how selfish people can be and I see vaccine distribution and attainment as a minor example of this. My thoughts fluctuate, however…

-Komal Kumar, 3/22/21

MMR Vaccine Offers COVID-19 Defense?

        An interesting pool of evidence has suggested that live attenuated vaccines completely unrelated to COVID-19 could serve as a protective measure against the infection. The first indication of this was the MMR vaccine, where out of 1000 sailors aboard the U.S.S Roosevelt ship that tested positive for COVID-19, only one sailor was hospitalized. It is theorized that this is a result of the fact that all US Navy recruits are given MMR vaccines- thus, it is possible that the MMR vaccine has a protective effect against COVID-19 and could result in less hospitalizations from the virus. Whereas typically COVID-19 in those aged 20-44 years old usually results in a hospitalization rate of 14-21% (according to the CDC), the hospitalization rate among these sailors was far lower which is impressive. 

    A study was done to look into this, where researchers took the blood of recovered COVID-19 patients and looked for MMR titer levels. They measured titers from both MMR vaccinated individuals and those that had MMR antibodies from sources other than the vaccine- ultimately, it was found that those with high titers specific to the mumps virus from the vaccine (134-300 AU) were functionally immune or asymptomatic for COVID-19. On the other hand, all those who had been hospitalized with COVID-19 and required oxygen in the hospital had mumps titers that were very low (below 32 AU). Overall, the results of this study showed that there is a significant inverse correlation between mumps titers from the MMR vaccine and the severity of a COVID-19 infection, indicating a promising protective effect of unrelated vaccines against COVID-19. I wonder if there are other vaccines as well that might serve this same protective effect, and I wonder why those aren’t being researched more. Perhaps it’s because we already have vaccines against COVID-19 developed and being rapidly distributed, but what if we weren’t at this stage yet? Would we be researching the efficacy of currently existing vaccines against COVID-19 in that case? Here is a link to the study that discussed the MMR titers: https://mbio.asm.org/content/11/6/e02628-20

-Komal Kumar, 3/16/21