healthcare Archives - Monterey Bay Parent

What you need to know about the Coronavirus Vaccine

By Monterey Bay Staff | January 6, 2021

It’s a time to celebrate: the end of the Covid-19 pandemic may be within sight.

Vaccines are on their way to thousands of locations in the United States. In California, 327,00 doses of the Pfizer vaccine were received in mid-December (when this article was written). Of those, 3,000 were bound for Monterey County. 627,000 doses of the Moderna vaccine, the second one cleared for emergency use, are also on their way to the state, and allocations of this vaccine will be distributed to Monterey County. Officials said they hope to provide 2.6 million doses to California residents before the end of the year. Since each of the currently available vaccines requires two doses, more will be needed to cover all 2.4 million health care workers in the state.

What Vaccines Have Been Approved by the Food and Drug Administration?

As of this writing, two vaccines have been cleared for emergency use by the FDA, the Pfizer and the Moderna vaccines. The Pfizer vaccine has a 95 percent efficacy rate, the Moderna vaccine has a 94.1 efficacy rate, and the latter has shown an all-important additional ability to prevent serious disease, which could reduce hospitalizations. Several other vaccines are in clinical testing. It should be remembered that all but one of the vaccines in Phase 3 testing, the last phase before they can be released to the public, require two-stage dosing separated by three weeks in order to be maximally effective. It is not uncommon for vaccines where full immunity is expected only after the second dose. This means that between doses, masking, social distancing, and avoiding crowds are still required to ensure that the virus is not transmitted, and will still be required until herd immunity (see section below) is achieved.

Of the two vaccines now available for distribution, the Pfizer vaccine requires extremely low temperatures for safe shipping and storage. The County Health Department and the major hospitals and laboratories in Monterey County have all been provided freezers that can maintain the appropriate temperature. The Moderna vaccine does not require low-temperature refrigeration which makes it especially valuable for rural areas, community health centers, and doctors’ offices that do not have the special freezers required.

The duration of immunity is not yet known. Rigorous investigation and follow up will be required to answer this question after a sufficient number of vaccinations has been performed.

How Do The New Vaccines Work?

In only the last few years, a major breakthrough in vaccine development has been achieved that has made the rapid development of the Covid-19 vaccine possible. The polio vaccine, for example, took twenty-three years to develop, during which time parents were constantly threatened by the prospect of their children contracting this paralyzing disease. The vaccine, like many today, worked by introducing dead or weakened viruses to teach the immune system to recognize and wipe out the viral passenger. The new technology, called “mRNA”, for messenger RNA, works via a totally different route. Rather than a tiny bit of actual virus being introduced into the body to teach the immune system to recognize and wipe out the viral passenger, both the Pfizer and the Moderna vaccines deliver a strip of non-viral genetic material to a person’s cells. Once inside the cells, the messenger RNA builds replicas of the spike protein that studs the outside of the coronavirus. The immune system learns to recognize and block the spike. When the individual encounters the virus, the body releases cells, called T cells, which eliminate the infected cells. Then antibodies block the virus from infecting healthy cells.

What are the Side Effects?

As with most vaccines, side effects can be expected, such as soreness at the injection site and flu-like symptoms–muscle aches, fatigue–that last for a day or two. A very small number of people have strong allergic reactions to almost any vaccine, and they need to alert their medical professionals in advance about these reactions so they can be under close observation following vaccine delivery. However, in the opinion of public health experts, even in this small population, the risk-benefit ratio is favorable. Allergic reactions can be treated, and Covid-19 remains a far more dangerous predator.

Who Will Receive the Vaccines First?

The first recipients will be frontline healthcare workers who care for Covid-19 patients in ICUs or hospital Covid units, and those who come in close contact with Covid patients, such as hospital housekeepers. They will be followed by healthcare personnel and residents of long-term care facilities. They will likely be followed by people over the age of 65 and those with underlying conditions that compromise their immune systems. This priority list will be established by the CDC and the California Department of Public Health. At this time vaccinations are not to be provided to children below the age of 16. The first clinical studies in adolescents are just getting underway.

Multiple sources of information are being established for residents to keep up to date on who is being vaccinated at any particular time: Monterey County’s Health Department website offers a page on the vaccine, local hospitals also have web-based information, and the CDC makes recommendations based on input from its Advisory Committee on Immunization Practices on their web page (see Resources sidebar).

What are the Major Hurdles to Widespread Vaccination?

Although the percentage of people who have told interviewers that they will agree to be vaccinated has recently risen considerably, there are still obstacles. African-Americans and Latinos, for example, have long been particularly suspicious of vaccinations. However, in the Moderna testing, it is worth noting that a fifth of the participants were Hispanic and 10 percent were African-American, two groups that have been especially hard hit by the virus. The government recognizes that special messaging is necessary to persuade them that the vaccine is both safe and effective for them. Vaccines have long been regarded as essential tools in crushing infectious diseases such as measles, polio, diphtheria, smallpox, and other highly contagious diseases. People who are against vaccinations of any sort are difficult to persuade but, like everyone else, are subject to contracting this deadly virus.

The goal of widespread vaccination is what is known as “herd immunity.” This occurs when at least 70 percent of the population is vaccinated and thus becomes immune to a disease, making the spread of the virus from person-to-person unlikely. In that way, the entire community becomes protected, not just those who are immune. Anthony Fauci, our leading virologist, predicts that herd immunity could occur by mid 2021 if people receive Covid-19 vaccines in large numbers.

How Much Will the Vaccine Cost?

Cost will not be an obstacle to getting vaccinated against Covid-19. Doses have been purchased with U.S. taxpayer dollars, although some vaccination providers may be able to charge small administrative fees. The providers can get this fee reimbursed by public or private insurance, or for uninsured patients, by the Health Resources and Service Administration’s Provider Relief Fund.

In Summary

• Two vaccines are now cleared for emergency use by the FDA and are available first to frontline healthcare workers and those who come in close contact with Covid-19 patients. The next likely recipients will be residents and staff of nursing care facilities, assisted living facilities, and similar settings.

• Both vaccines have been thoroughly vetted for safety and efficacy by the U.S. Food and Drug Administration (FDA)

• California is receiving allocations of dosages of these vaccines; Monterey County is receiving its own allocations according to a schedule established by the state.

• Neither vaccine is approved for children under the age of 16, but both companies are running trials on children as young as 12, and have plans to start studying even younger children.

Susan Meister is a journalist, columnist, and community activist living in Pebble Beach. Susan’s writing was recognized with the 2020 Bronze Award for service writing from the Parenting Media Association.

Set the Stage for a Positive Dental Visit for Your Child

By Monterey Bay Staff | January 27, 2020

Children’s visits to the dentist are typically a positive experience for both parents and kids alike. Still, between 9 and 15% of American adults fear going to the dentist, according to Cleveland Clinic. When parents are anxious about the dentist, that nervousness can instill fear and anxiety in their child, too.

Adults and kids may fear going to the dentist for several reasons. Cleveland Clinic explains that perhaps the adult or child had a negative experience at the dentist or has heard horror stories that exaggerate their fears. Fear of pain is the most common cause of anxiety. While some people also worry about the effectiveness or side effects of anesthesia or have a fear of needles.

A negative experience at the dentist as a child can result in continued anxiety over routine dental care into adulthood. So, learn how to prepare for your child’s first and subsequent visits to the dentist to ensure a positive, successful experience. This will help pave the road to a lifelong devotion to receiving routine dental care on a consistent basis as your child grows.

Your child and the dentist – building a positive relationship early on

The earlier your child begins going to the dentist, the better. The American Academy of Pediatric Dentistry recommends a first visit should be by the time your child turns one or within 6 months of when the first tooth erupts. At this stage, your child’s visit will be quick, simple, and pain-free. Providing your child with early positive experiences will help your child develop trust in the dentist.

Depending on your child’s age and the dental office policies, many dentists will ask you to remain in the lobby during your child’s checkup. Typically, this is recommended for children over the age of 3. There’s a good reason for this. Separating a child from parents usually results in fuller cooperation from children. This can go a long way toward a more positive experience for your child.

When your child is placed in the care of the dental staff, they’ll try to make your child’s first experience fun and informative. The dentist will explain and demonstrate routine procedures to your child and then perform those procedures. Your child quickly learns the dentist is someone to trust.

Down the road, if your child needs non-routine dental work, the dentist will work with your child in a similar fashion to help alleviate fears.

If you’re still concerned with sending your child in alone, call and ask to speak with the dentist or hygienist. Avoid causing your child alarm, and make the call in private so your child doesn’t pick up on your anxiety. Explain your specific concerns so the dentist can address and alleviate your worries.

Approaching scared or uncooperative children

For a variety of reasons, some children become fearful or uncooperative during a visit to the dentist. If your child arrives unprepared or senses your anxiety, your child may develop undue worry. A previous experience could also cause stress. Children who are ill or have a physical or mental disability, a behavioral disorder, or developmental delay may also be challenging to treat. Whatever the reason, the way your dentist handles your child’s fears and behavior is vital to your child’s emotional well being and ability to cope with future visits.

The American Academy of Pediatric Dentistry has developed guidelines for behavior management that dentists should follow. Your dentist should use the communication techniques learned in dental school, including positive reinforcement, distraction, voice control, non-verbal communication, and the tell-show-do approach.

These techniques all help reassure patients and gain their trust. In most cases, these approaches are sufficient, leading to visits that end on a positive note. If a practitioner lacks the expertise for handling a situation, your child should be referred to a dentist with the appropriate skills.

Prevent an experience that heightens your child’s fears by being proactive

Contact your state’s board of dentistry when choosing a practitioner to make sure no disciplinary actions have been taken.

Inform your dentist of any medical, behavior, or other conditions that might affect your child’s visit. That way the dentist can communicate with the child accordingly.

Pediatric dentists have specialized training for dealing with situations that can arise with children. If you suspect your child may have difficulty with dental visits, seek a pediatric dentist.

Six tips to get your child off on the right track

1. Tell your child about the benefits of going to the dentist to help keep their teeth strong and healthy and so they’ll have a nice smile.

2. Read to your child before their first visit to the dentist. Try one of the following: Why We Go to the Dentist by Rosalyn Clark; The Berenstain Bears Visit the Dentist by Stan Berenstain and Jan Berenstain; Celebrate! Going to the Dentist by Sophia Day; Dentist Trip (Peppa Pig) by Scholastic; Curious George Visits the Dentist by H.A. Rey

Also, express positive feelings about your own dental experiences. Don’t discuss non-routine procedures such as fillings. Explain to your child the basic procedures your child will undergo. For example, the dentist will count your child’s teeth and look at them with a tiny mirror. Avoid frightening terminology.

As your child grows, if you have concern over a possible cavity, don’t give your child too much information. This can result in undue anxiety. Your dentist should have the experience and expertise to talk to your child about such procedures in a manner that alleviates any anxiety your child might experience.

If your child is anxious, don’t try to soothe your child by lying about a procedure or possible pain. Instead, try to alleviate fears that may be out of proportion to the situation.

Finally, offer coping strategies to your child. Have your child practice taking long deep breaths. If you know you’ll be attending your child throughout the procedure (speak to your dentist first to confirm this), you can offer your hand to squeeze.

KIMBERLY BLAKER is a freelance parenting and lifestyle writer. She also writes content and blog posts for businesses. Find her at kimberlyblaker.com

Hurry Up Healthcare: Emergency Room or Urgent Care?

By Monterey Bay Staff | January 28, 2018

Sooner or later, all parents face an unexpected medical meltdown: The baby spikes a scorching fever in the wee hours. The preschooler swallows something suspicious. The middle-schooler wrenches an ankle at basketball practice. When faced with a medical emergency—or a situation that could become one—what’s a parent to do? Head straight for the chaotic, costly hospital emergency room? Or a local urgent care center?

Don’t load your sick kiddo into the car just yet. The best first move is to contact your child’s pediatrician, says Ernest Leva, M.D., director of the Pediatric Emergency Department at The Bristol Myers Squibb Children’s Hospital in New Brunswick, New Jersey. With knowledge of your child’s medical history and any existing conditions, your child’s pediatrician is best equipped to steer you toward the appropriate critical-care option, says Leva. And whatever treatment course you take, notifying your pediatrician allows the doctor to update your child’s medical chart and follow up as needed.

When it comes to choosing a site for quick emergency care, Leva prefers pediatric emergency departments over urgent care centers. While urgent care centers can provide fast care for minor injuries, Leva says that choosing an urgent care center first can slow down access to critical treatments. “Often, patients end up being transferred to an emergency department anyway,” he notes.

If a child needs a CAT scan, IV hydration, care for a broken bone, or surgery of any kind (for example, when a child aspirates or ingests a foreign body that must be removed surgically), the child is much better off in a hospital setting, where the required procedure can be performed quickly, says Leslie Mihalov, M.D., chief of Emergency Medicine at Nationwide Children’s Hospital. The Centers for Disease Control report that over 98 percent of emergency department patients can be treated on-site without being transferred to another facility. (And concerns over long wait times are often unfounded: over 20 percent of ER patients are seen within 15 minutes.)

When might parents want to consider an urgent care center instead of an emergency room? Urgent care centers can be a quick alternative to a regular doctor’s office visit, where patients can be treated for minor cuts, obtain prescriptions, and get basic labwork and X-rays. Another factor is cost: according to insurance provider Blue Cross Blue Shield, the average emergency room visit has a pre-insurance price tag of $1,045, while urgent care treatment comes in at just $130.

But before you write off the ER as too spendy, consider this: if your child needs to be transferred to an ER after visiting urgent care, as many do, you’ll end up footing the bill for both. Most insurance plans cover emergency room care, and federal law requires that emergency rooms treat all patients, regardless of insurance status or ability to pay.

The bottom line: “Any time a parent perceives a life-threatening condition, they should call 911 and take the patient to the emergency room,” says Leva. Conditions requiring a swift ER visit include significant injuries or deformities to limbs; difficulty breathing; ingestion of a foreign body; head injury or concussion; significant trauma or bleeding; sudden severe pain; severe allergic reactions; and dizziness, disorientation, or sudden changes in mental functioning.

Questions about fevers, vomiting, diarrhea, and flu-like symptoms should be fielded by a child’s pediatrician, says Leva, while concerns about possible poisoning warrant a call to the local Poison Control Center. Those experts will advise you on whether your child needs to head straight to the ER or not. And you can breathe a bit easier, knowing you’ve done the right thing.

Malia Jacobson is a nationally published health journalist and mom. She blogs about sleep and family health at www.thewellrestedfamily.com.