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November 2021

We know that you have been bombarded with information about COVID-19, and we are sure that you have a lot of questions.  We have attempted to answer some of your most frequently asked questions below.

It’s understandable that some parents want more information before getting their young children vaccinated against COVID-19, so this month’s
feature article aims to address three factors to assist parents’ decision-making.
Number 1: Safety of the vaccine
First and foremost, parents want to know that the COVID-19 vaccine is safe before they give it to their children. In particular, three areas of
concern have emerged. One is based on data; the other two are based on word-of-mouth concerns. All three generate legitimate fear that leaves
parents wondering about the risk for their child. So, let’s take a look:
Myocarditis — Myocarditis is inflammation of the heart. It has been found to be a rare side effect associated with receipt of the COVID-19 mRNA
vaccine. Myocarditis following vaccination most often occurs in the four-day period after receipt of the second dose of the vaccine, occurs more
often in males, and usually resolves completely without specific treatment. Because the dose for 5- to 11-year-old children is lower, the hope is that
fewer children will experience this side effect, which results from a strong immune response to the vaccine. Scientists tested a few doses to find the
lowest one that would still offer sufficient immunity in anticipation that the lower dose would also cause fewer side effects. The clinical trials did
not show myocarditis to be a problem; however, the study was too small to pick up a rare side effect.
This situation may cause some parents to consider taking a “wait and see” approach, delaying their own child’s vaccination until more doses have
been administered. However, what many parents don’t realize is that in teens and young adults — the group with the highest occurrence of this
side effect — the risk of developing myocarditis is greater following natural infection:
• Of 100,000 males between 16 and 29 years of age, about 5 would develop myocarditis after vaccination and about 59 would develop
myocarditis after infection.
• If we consider 100,000 females between these ages, 1 would develop myocarditis after vaccination and about 39 would develop myocarditis
after infection.
As such, the risk of experiencing myocarditis is greater in an unvaccinated person than a vaccinated person. Said another way,
opting to delay or forgo vaccination to avoid myocarditis is opting to take the risk of developing COVID-19 infection, which could put the child at
greater risk of experiencing myocarditis.
Fertility — Much discussion has centered on whether COVID-19 vaccines affect fertility. After millions of vaccinations, no evidence for this exists.
In males, concerns have related to an observation that sperm count temporarily decreases during COVID-19 infection; however, the same does not
appear to occur following vaccination, nor would it be expected to as the vaccines are processed near the site of injection and cause a significantly
lower “assault” on the immune system compared with infection.
In females, concerns have centered on two areas. First, reports of changes to menstruation following vaccination of oneself or someone around the
vaccinated individual have caused some to question whether these vaccines affect fertility. Given that millions of women have been vaccinated or
infected and changes to fertility have not been realized (i.e., the birth rate has remained unchanged), it is unlikely that even if short-term changes
to the menstrual cycle were found to occur, they would translate into long-term alterations to fertility. However, because of these reports, the
National Institutes of Health (NIH) is studying menstruation following vaccination. These data will need to be analyzed carefully since changes to
the menstrual cycle can occur due to a variety of reasons, including undiagnosed infections, fluctuations in hormone levels, or stress.
The second concern related to females and fertility involves a protein found in the placenta, called syncytin-1. A paper published prior to approval
of any COVID-19 vaccines suggested that the SARS-CoV-2 spike protein is similar to syncytin-1. This conclusion was based on a theoretical, or
computer-based, study that compared the genes for these two proteins. However, two points provide important context:
• While the computer-based method used for this paper is important for generating hypotheses, it cannot reveal what would happen in people.
Proteins are made of amino acids. Only 20 amino acids exist, so two proteins with a short section of similarity between these building blocks
is common. However, these similar sections do not necessarily mean that antibodies to one will recognize the other. As such, a hypothesis
based on this type of study would require experimental support, perhaps first at a lab bench, but ultimately in people, often referred to as
clinical data.
• We now have abundant clinical data that do not support this hypothesis. If the spike protein was in fact an issue, we would be seeing increased

numbers of miscarriages as women who were infected with the virus become pregnant. Since antibodies from infection do not lead to fertility-
related issues, antibodies from vaccination would not be likely to either, and this is supported by the fact that millions of vaccinated women

have given birth or become pregnant since being vaccinated.
As it relates to younger children, if these vaccines are not affecting fertility for men and women during their childbearing
years, they would not be expected to affect younger children either.
Other long-term effects — Fears associated with the potential for long-term effects are difficult to overcome because they are the equivalent of
the “fear of the unknown.” However, the easiest way to think about the potential for long-term side effects following receipt of these vaccines is by
realizing that their components are only in the body for a few weeks at most. The only thing that remains thereafter is the immunologic memory
generated by vaccination. Simply put, something that is not there cannot cause an issue. Additional details about this topic were
described in the February 2021 issue of this newsletter.



Considerations for COVID-19 vaccination of 5- to 11-year-old

What should I do if I think my child may have COVID-19?

Please CALL OUR OFFICE if your child has been exposed to someone with known or suspected COVID-19.  DO NOT COME TO THE OFFICE WITHOUT FIRST DISCUSSING YOUR CONCERN WITH A STAFF MEMBER.  Part of our job is to try and minimize the extent of spread by this virus, and we need your help to accomplish that.  Depending on the specific details, we can help determine the best next steps for you and your child. 


What is COVID-19?

This is a new strain of coronavirus that is currently circulating internationally.  Coronaviruses have been around for a long time and almost all of us have had one at one time in our lives.  Most of us have had several of them.  Generally these viruses cause symptoms consistent with the common cold.  These symptoms may include fever, stuffy/runny nose, cough, headache, sore throat, and body aches.


Why is this strain different?

Mostly because it is new – our immune systems have never encountered this specific strain and therefore are not as prepared to combat it.  There are still a lot of unknowns about this virus and we are learning more about it every day.  We know that in older people it is more prone to cause serious complications including pneumonia and respiratory distress.  We also know that in children it generally causes only mild illness.


Why is the mortality rate so high?

The actual mortality rate is unknown, as we do not know the total number of infections, many of which may be mild.  It is likely to have a similar mortality rate as Influenza.  For example in South Korea where there is more widespread testing for this virus, the estimated mortality rate is approximately 0.7%.  Just to offer some perspective – there have been 136 children who died from influenza so far this season in the US, and zero children who have died from COVID-19.


Can you test for COVID-19?

Yes there are a limited number of tests available through the CDC and through local public health departments.  We currently have a rapid test that can be done in the office and a send out PCR test that can be done in the office and sent to the lab.  

Is there a treatment for COVID-19?

Because it is a virus there is no antibiotic to treat COVID-19.  The immune system will fight it off, and most children will recover completely within a week.  You can treat your child’s symptoms with pain and fever reducers such as accetominophen or Ibuprofen (over 6 months old), rest, fluids, and nasal saline/suction.  You always want to monitor your child for dehydration, difficulty breathing, or fever that does not respond appropriately to medications.



The main way it is spread is by respiratory droplets.  Usually one would need to be within 6 feet of an infected person for 15-20 minutes to risk infection.


How can I avoid COVID-19?

The best approach is good hand washing throughout the day, especially prior to eating.  It’s always helpful to remind your child not to pick her nose and to sneeze/cough into his elbow.  Of course we all know that kids tend to be little germ magnets, so just do the best you can.


Where can I get more information:

There is a lot of information out there – in general reputable resources include the CDC, the AAP (including their Healthy Children website), and the local health departments.  Please call us if you have any additional questions or concerns.