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Pima County readying COVID-19 shots for kids ages 5-11

Pfizer vaccine cleared for younger children by FDA

As the promise of COVID-19 shots for kids aged 5-11 cleared another hurdle this week, Pima County officials are preparing to start vaccinations by next week, which will eventually inoculate 88,000 children here.

On Friday, the FDA authorized the Pfizer-BioNTech vaccine for children 5-11 in a watershed moment, authorizing the smaller doses for children and clearing the way for increased vaccinations as the United States strains to gain some form of "herd immunity" by getting enough people vaccinated against the deadly virus.

In a clinical trial, the vaccine was found to be 91 percent effective at preventing COVID-19, and regulators have said that rare cases of cardiac side effects among boys are mild and treatable. The hurdle is the CDC's Advisory Committee on Immunization Practices, which will review the vaccine for kids 5-11 on November 2.

As the process has moved forward, Pima County officials outlined a plan to begin vaccinating children within days, beginning with an initial allocation of 11,400 pediatric doses that will be sent to 15 health-care providers.

Pima County’s chief medical officer, Dr. Francisco Garcia, said on Friday that those doses will be pre-positioned in county vaccination sites so that county can be ready to deliver them when the CDC makes their recommendation for the age group to be vaccinated.

State officials have said that they expect 224,700 doses to begin vaccinations, and Pima County officials have said they expect to distribute 22,000 doses in November, with more doses coming over the next four months.

The county said they will not set up the large-scale 24-7 distribution sites that marked the early days of the vaccination effort at the beginning of this year, but will instead rely on its own health-care centers—including El Rio—on sites managed by United Health Care, as well as commercial pharmacies. The county will also work with schools in some cases to set up community vaccination locations especially in areas that are more socially vulnerable than others, said Crystal Rambaud, who manages the Vaccine Preventable Disease Program for the county Health Department.

Rambaud said that she didn't "anticipate" supply issues, and that there are preparations in place to ensure that the county can "wind up" and begin vaccinating kids appropriately. She said that the county had learned some lessons from the vaccinations of kids 12 and over.

"This jump will be easier for us, because we've ironed out some of the issues around the earlier group," Rambaud said.

Pfizer's vaccine for children 5-11 is one-third the dosage given to children 12 and older—10 micrograms of mRNA compared to 30 micrograms. Young children will get the vaccination under the same protocol, getting two doses of the vaccine scheduled three weeks apart.

Officials said that the dose for children will come in vials marked by an orange cap and an orange label, distinguishing it from the vaccine for adults and teens that comes in vials with purple markings.

Lee Savio Beers, president of the American Academy of Pediatrics, praised the FDA's approval.

"More than 6 million children have been infected with this virus since the beginning of the pandemic, and children have suffered in numerous other ways. This includes disruptions to their education, harms to their mental and emotional health, and greatly diminished access to critical medical services," he said.

"Authorization of the vaccine for younger children is an important step in keeping them healthy and providing their families with peace of mind. The vaccine will make it safe for children to visit friends and family members, celebrate holiday gatherings, and to resume the normal childhood activities that they’ve missed during the pandemic," he said. "Pediatricians are standing by to talk with families about the vaccine and to administer the vaccine to children as soon as possible.”

Since July 20, when school calendars began, there have been 3,513 school-reported COVID-19 cases, Pima County officials said. Garcia told reporters Friday that 87 percent of those cases were students and that 47 percent of the total cases have been children between the age of 5 and 11. Kids between aged 12-19 are 39 percent of the total cases. 

Cases have been reported out of 281 different schools, 105 of which have had an outbreak, using the CDC definition of having two linked cases of students who are not from the same household. This has resulted in 62 classroom closures, Garcia said.

“This is a good news story because, for a lot of other jurisdictions, the rate of classroom and school closures is much more elevated,” he said. “When you look at the size of our community and when you look at the number of classroom closures we’ve had, they have been very modest compared to similarly sized counties.”

School-related cases peaked in August and started to taper off shortly after, Garcia said. He noted how important it is to see that most of those cases have been from this the age group younger than 12.

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“This is really critical because up until hopefully next week sometime this 0-to-11 group is completely unprotected,” he said. “This has really been a source of anxiety on my part.”

According to data from Tucson Unified School District, there were 17 cases of COVID-19 among students reported to the district on Oct. 27, and 4 adult cases. Other districts have reported COVID-19 cases, but remarkably, the Vail School District, which began enduring cases after school opened in July, has removed its webpage showing the district's COVID-19 plan and general information.

In a memo, Chief Deputy County Administrator Jan Lesher outlined how the county had been effective in vaccinating a significant number of adults, as well as kids 12-18 through the state-run distribution sites, a series of pop-up sites, as well as through county health centers, and private pharmacies.

Overall, around 1.3 million doses of the COVID-19 vaccine have been distributed in Pima County, including doses provided by the large-scale point-of-distribution at the University of Arizona, as well as community health centers like El Rio, which distributed more than 36,200 doses alone. "Despite areas of substantial social vulnerability, Pima County continues to have higher vaccination coverage rates compared to the rest of the state and the nation," Lesher wrote.

Around 78.2 percent of Pima County's eligible residents have received at least one dose of the vaccine, and around 68.7 percent have been fully-vaccinated. However, the overall rate of vaccinations is just 63.8 percent, according to data from the Arizona Department of Health Services.

Statewide nearly 8.2 million doses have been distributed, and 69.5 percent of those eligible have been vaccinated, according to data from the Arizona Department of Health Services. However, this rate variously widely among the counties. Mohave County's rate is just 43.4 percent of those eligible; meanwhile Santa Cruz County has effectively vaccinated everyone in the county, and has pushed to vaccinate people in neighboring Sonora, Mexico driving the county's effective vaccination rate to 104 percent.

Maricopa County, the state's most populous county has a vaccination rate of 67 percent of those eligible.

The county expects to distribute around 22,000 doses in November, covering around 25 percent of kids in the age group in the county. In December, that allocation will accelerate to 35,000 doses. By the end of February 2022, the county expects to distribute 102,000 doses, covering 60 percent of kids in the county with at least one dose, and possibly fully-vaccinating nearly 50 percent of the age group.

Don Harrington, the interim of ADHS, said his agency and county health departments have "worked extensively to ensure capacity in Arizona for pediatric COVID-19 vaccination."

"This includes recruiting additional pediatric providers to be vaccinators, working with schools and local healthcare providers to identify easily accessible locations for vaccinations, engaging our health equity partners to ensure plans consider access and vaccination capacity for under-served communities, and developing communication materials for healthcare providers and the public," he said. Harrington said that the first doses of the Pfizer vaccine for ages 5-11 will be allocated to states based on population by CDC.

He added that 900 providers will be able to administer the vaccinations in the coming weeks.

"Because of that, ADHS will need to allocate set amounts of vaccine to local jurisdictions based on their pediatric population, which in turn will allocate to providers that can vaccinate the age 5-11 population in their areas," he said. "We have been told to expect an initial allocation of 224,700 pediatric doses and expect many more doses to begin arriving soon after the CDC issues its recommendation."

Based on an estimate from the Kaiser Family Foundation, the county believes that around one-third of parents "will vaccinate their children aged 5-11 as soon as the vaccine becomes available."

"Of these, most will get a second dose," county officials said. "If uptake trends for children aged 5-11 match the experience in Pima County for adolescents aged 12-17, around 60 percent of the newly eligible population will seek vaccination after several months."

In some cases, the county will use mobile efforts, and the county will look at coverage to determine how vaccinations are distributed, said Rambaud. With this information, the county can "tailor" efforts to seek vaccination equity, using a $9.5 million grant from the federal government to reach that goal. "We're hiring teams, and we have a vision where we can pair nurses with health-care navigators to get teams out by district and into the field to try to get to those people who can't get to the standard sites, and can't get to pharmacies," Rambaud said. "It's going to be more a focus over the next few years," she added.

The county estimated that around 5,000 kids will get vaccinated in Marana, around 2,940 will get vaccinated in Oro Valley, and in Sahuarita, around 3,651 kids will be vaccinated. The county estimated that in Tucson, 47,200 kids will be vaccinated, and in the rest of Pima County, around 28,600 kids will be vaccinated. All told, around 88,040 will be vaccinated.

There are around 645,000 children aged 5 to 11 in Arizona, said Steve Elliot, a spokesman for ADHS.

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As county officials noted, as of October 2021, there have been nearly two million COVID-19 cases in children aged 5-11 since the pandemic began—at least 6 million cases in children up to 18. And, among children 5-11, there were over 8,000 hospitalizations, and over a hundred deaths nationwide.

Moreover, Arizona "bears some of the highest cumulative pediatric COVID-19 cases and hospitalizations in the country," Lesher noted. 

They also noted that "despite early suggestions" that children may have a lower infection rate, new studies show that COVID-19 infection and illnesses in children are "comparable" to adult rates. "Transmission studies have shown that children may infect others in schools, camps, sports events, their households, and the general population," county officials wrote.

Nonetheless,  the county  has also begun to consider how to deal with vaccine hesitancy, noting that parents have previously had a "greater vaccine hesitancy than non-parents."

"Most likely people will go in pretty vaccine confident," said Rambaud said, but some parents will be "on the fence." And, she said that here, trusted sources, including health-care clinics and pediatricians can help counsel people and act as a "trusted source."

"As people go to pediatric appointments, doctors can help answer questions, and do it in a convenient way," she said. "Pediatricians are very informed about vaccinations, and they're big part of vaccination practices," she said. She hopes that pediatricians can provide "strong, effective recommendations," however, she "how that translates into uptake in coverage, we don't know"

"Younger kids are perceived as vulnerable and precious," Rambaud said. "Some times that works to our advantage, and some times it doesn't if there's a sense that the vaccine is unsafe.

"But, this vaccine is safe," she said.

As Harrington put it, "Nearly all Arizona children ages 5 to 11 are vaccinated against measles, diphtheria, whooping cough, rubella, mumps, polio, and other diseases that have been eliminated or all but eliminated thanks to modern medicine. "

"This is a lot of information, but the goal is simple: Kids already benefit from all kinds of safe and effective vaccines, and adding COVID-19 vaccination to the mix helps keep children, their families, their friends, and their communities safe," he said.

While serious illnesses rare, long-term consequences 'poorly understood'

While children are generally less-likely to be seriously ill, or even die from COVID-19, health officials believe that vaccinations are still necessary, especially for children 5-11. Around 1.9 million children 5 to 11 have tested positive for COVID-19, and more than 8,400 have been hospitalized nationwide, since the pandemic began last year.

As AzDHS's director put it, while severe illness, hospitalization, and death "are indeed rare among children," but there are cases in which otherwise healthy kids get "extremely sick." Harrington said that in Arizona, 40 people under 20 have died from the novel coronavirus, and nearly 3,000 have been hospitalized.

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Additionally, in rare cases some children with COVID-19 have developed a potentially deadly condition known as Multi-system Inflammatory Syndrome, or MIS-C, Harrington said.

Moreover, health-care officials are still trying to understand how COVID-19 affects children, not only during an infection, but also in the days and years afterward. Some children have experienced a condition known as "Long COVID," which includes shortness of breath, chest pain, disgestive disorders, as well as memory loss and difficulty concentrating.

One study from Israel showed that around 11 percent of roughly 13,000 children who have COVID-19 experienced some form of "Long COVID" and 1.85 percent to 4.6 percent had symptoms after six months. This matches with a study from the National Institutes of Health, which found that 11 to 15 percent of kids with COVID. As Dr. Francis Collins, director of the NIH told Congress during an April hearing, kids infected with the disease can "end up with this long-term consequence, which can be pretty devastating in terms of things like school performance."

As county officials put it, the impact of pediatric infections, especially by new variants like the Delta variant, remain "poorly understood."

"Though children with COVID-19 have lower hospitalization and ICU admission rates than adults, some children can face lasting health consequences of COVID-19 infection," county officials wrote. They noted that a common side effect—the loss of smell and taste—could "negatively impact the brain development of children." And, they noted that one study found as many as 22 percent of kids with COVID-19 or MIS-C had "documented neurological involvement," and 12 percent developed "life-threatening neurological conditions." 

Even kids who are entirely asymptomatic reported symptoms including insomnia, respiratory symptoms, nasal congestion, fatigue, muscle and joint pain, and difficulty concentrating. "These symptoms can last six to eight months after clinical diagnosis of COVID-19," the county said.

Earlier this week, the CDC released a report, outlining the safety of vaccinations. In a study of 11 million people—including 6.4 million who received the COVID-19 vaccine and 4.6 million who did not—over six months beginning in December 2020, the CDC found no increased health risks for those who received the COVID-19 vaccine. This did not change when looking at age, gender, race, ethnicity, or the type of vaccine received, the CDC said.

As Harrington wrote, "In fact, vaccinated individuals were slightly less likely to die for reasons other than COVID-19, possibly because vaccinated individuals tend to be healthier than individuals who aren’t vaccinated."

"The pandemic appears to have plateaued in Pima County," wrote Lesher. "The Health Department continues to invest heavily in vaccination and testing as its primary strategies to mitigate the COVID-19 infection in this community."

"Vigilance is still indicated during this time, even as we begin to fatigue of the important mitigation measures that we must continue to practice: mask use in public indoor spaces, avoiding work or school when sick, and maintaining physical distance from those outside our household," she wrote.

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A vaccination ready for doctors and other healthcare providers during a clinic in December 2020.

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