Dr. Randall G. Fisher

Yes, it is safe to have a flu shot while pregnant. Dr. Randall Fisher

Yes, it appears that the vaccine is safe during pregnancy. The infection, however, is not. Pregnant women have a tendency to end up sicker than non-pregnant women when they contract the virus, because pregnancy is, in itself, a mild form of immune suppression.


Randall Fisher, M.D.
Medical Director
Division of Infectious Diseases
Eastern Virginia Medical School
Norfolk, VA

There is no need for a CT scan unless you are very sick and already in the hospital, in which case your doctor would order it for you. So, in short, if you are at home and are not sick enough to be hospitalized, you definitely don't need to have a CT scan.

Randall Fisher, M.D.

PCR tests are the most reliable. Rapid antigen testing is not very good, although if you have compatible symptoms and the test is positive, it is probably real. The home rapid antigen tests are often falsely negative, though, which means they might tell you that you don't have when you really do. So, if you really want to know, you need to get a PCR test.

Randall Fisher, MD

Yes, a 7-year-old can get the Pfizer Covid vaccine. It was granted an EUA by the FDA in late October of 2021.

Randall Fisher, M.D.

If you had your primary series of vaccinations less than 6 months ago, there is no need for a booster, unless you have some kind of high-risk condition.


Randall Fisher, M.D.

The time it takes to get back to full strength following Covid varies considerably. Some people, as you know, never even develop symptoms. Others are sick for a few days or a week or so and then feel fine. Still others, like yourself, don’t feel quite right for a much longer period of time. There are people who experience what is now known as “long Covid”: some of these people don’t feel quite right or have lingering symptoms that can last for months on end.

So it is impossible to give you an answer as to how long it will take YOU to get better; there is just too much variability. I can tell you that if you stay positive and try to get good nutrition and good sleep, it will hasten your recovery.

Good luck. I hope you feel better soon.


Randall

Pregnancy is a form of mild immune suppression, because the mother cannot allow her immune system to reject the fetus. Therefore, many infections are higher risk for pregnant women. Among the most commonly known and well documented are influenza and chickenpox, both of which can cause severe disease and even death in pregnant women who are otherwise completely healthy. Covid-19 also appears to be more serious, generally speaking, in pregnant women versus non-pregnant same-age comparisons. Sadly, occasionally Covid-19 in pregnancy proves to be fatal. I would strongly recommend looking into vaccination if you haven’t already been vaccinated.

Randall Fisher, M.D.

For any type of infection, not just Covid, you only need to take your child to the hospital if she is sick enough to need the hospital and/or emergency care. There is no reason to take your child to the hospital if she is only mildly ill. So, if she is able to eat or at least drink, is not dehydrated, is not having difficulty breathing, and is not appearing quite ill to you, you do not need to take her to the hospital.

Randall Fisher, M.D.

I’m not sure what the last part of your question means, but most 15-month-old children, since they cannot provide for themselves, live with at least one adult, who provides care. In the event that that adult (or two adults, as the case may be) contracts Covid, the toddler doesn’t have much of a choice but to remain in that home. The parents (or caregivers) should take all precautions to protect the child from spread (frequent hand washing, masking even in their own home, etc.), but a toddler must be provided for.

Maybe the last sentence is you are wondering whether a 15-month-old who was hospitalized for some reason should be discharged to the care of providers who are sick with Covid? That’s a tougher question, but generally speaking, hospitals can’t continue to provide care to patients who are recovered because insurance companies will not continue to pay and because the beds are needed for children who are sicker and need inpatient care. In that situation, if there were grandparents who were not sick who could care for the child, that might be ideal, but if no other caregiver exists, I don’t know that the doctor/hospital would have any other choice than to discharge the toddler to his/her own caregivers. Sometimes there is no perfect situation and we just have to make the best of things.

Randall Fisher, M.D.

For most children, the disease itself isn’t too bad; kind of like a really bad cold for some, like a normal cold for others, and even perhaps not as bad as a typical common cold for others. However, there are two problems that can be seen; one of them is fairly common in adults and the other one is almost unheard of.

The first problem is what has been termed “long Covid.” Although it is true that this is much more commonly seen in adults, it has certainly been reported in children. In “long Covid” patients remain ill for a long period of time, sometimes months on end. Acute respiratory symptoms generally get better after a couple of weeks, but tiredness, lack of energy, brain fog, muscle aches, and chest pains, as well as loss of the sense of taste and smell can sometimes go on seemingly indefinitely.

The second problem is a problem that has been termed “MIS-C,” which stands for Multisystem Inflammatory Syndrome of Children. This is a condition that occurs a few weeks after uncomplicated Covid. It is marked by high fever and a host of other symptoms that look a lot like Kawasaki Disease; namely, conjunctivitis, redness of the oral mucosa, peeling of the lips, rash, swelling of the hands and feet, etc. Inflammatory markers are really high, including BNP, which is an enzyme that is usually elevated in heart conditions. MIS-C can be serious. At our hospital, we have had about 25 patients admitted with MIS-C since the pandemic began, and about half of them have been sick enough to be in our Intensive Care unit.

Obviously, both of these are uncommon or rare outcomes. So the answer to your question is that the vast majority of the time, children under the age of 12 do very well with Covid and get better rather quickly, with no apparent long-term adverse consequences. But occasionally, there are significant problems.

Randall Fisher, M.D.

You should take her to your primary care doctor for an evaluation. Maybe she now has reactive airways disease induced by the infection (similar to asthma). Maybe she could benefit from a bronchodilator or an inhaled steroid. I am assuming that the cough has persisted for weeks with this answer. If it has been less than three weeks, I would wait to see what will happen. If it has been a month or longer, take her to be seen.

Randall Fisher, M.D.

Yes, it is safe. It has been tested all the way down to 6 months of age. Flu vaccine doesn’t contain any live virus. It is tolerated very well by children. If he is only 7 and has never had a flu vaccine before, your provider will want to give him two shots one month apart. Going forward, each year he would only need a single shot. We do a “prime-boost” strategy in young children to get a more protective response. He will do fine. The other thing to do to keep your son from getting the flu is to get everyone who lives in the home with him vaccinated, too.

Randall Fisher, M.D.

The short answer is yes. There are receptors for the virus in the lining of the GI tract. Diarrhea is certainly not the most common symptom, but it has been widely reported in patients on all continents.

Randall Fisher, M.D.

First of all, if you have been living with your wife, and both of you have been following guidelines, there is no reason at all to not kiss her. You should have been kissing her all along! Secondly, you should NOT cancel a vaccine appointment because of this. You should go get vaccinated. Now I will answer your three questions in order:

1) No, you will not get Covid from kissing your wife. It is IMPOSSIBLE to get Covid from the vaccine, as it does not contain live viruses. There is no such thing as a “combination of the vaccine and kissing.” Maybe you are worried that the vaccine will somehow weaken your immune system or something? It will not.

2) The vaccine will likely protect you from getting Covid, yes. It is well over 90% protective. No vaccine is perfect, but these vaccines are about as good as vaccines get.

3) As far as we know, the virus does not “lay dormant” and then reactivate; there are some viruses that do that, but coronaviruses do not. So, no, you will not get Covid from a dormant virus.

I hope this helped.

Randall Fisher, M.D.

There are no trials of medications for children with Covid. There are also no outpatient treatments that are active against the virus that causes Covid. Symptomatic treatment for symptoms such as fever, cough, sore throat, etc., can be done just as you would with common cold. It is probably not a bad idea to make sure that your child takes a multivitamin supplement. Thankfully, most children that age do very well with Covid unless they have preexisting conditions such as sickle cell anemia, diabetes, or immune suppression. Take your child for medical care if he/she gets much sicker, has difficulty breathing, or if you are otherwise concerned.

Randall Fisher, M.D.

If the vaccine is ever going to be given to children, it has to be tested. Part of the reason for that testing is safety, and the other part is to see whether the vaccine will produce a good immune response. The dosing of the mRNA in the vaccine will likely have to be different from what is being used in adults, and the company will probably test a range of doses, trying to find out what is the smallest dose that produces a good immune response. Smaller doses should lead to fewer side effects. Children enrolled in the trials will be randomized to getting vaccine at a particular dose or to getting a placebo (salt-water shot). So, some of the children in the trial don’t have any possibility of side effects because they won’t actually be receiving the vaccine. I believe that the vaccine will be safe in children, but until the study is completed, we won’t know for sure. The fact that the vaccine has been given to over a hundred million adults is reassuring.

Randall Fisher, M.D.

Covid vaccines are currently in clinical trials for children between the ages of 12 and 18. The length of time it will take to complete these trials and get approval from the FDA depends on a number of factors, most importantly how quickly they are able to get enough children enrolled. I expect enrollment to move quickly. If the trial goes well, Emergency Use Authorization from the FDA should be not much more than a formality that might be over in a day. Another issue is that there is a great push to get all the high-risk people vaccinated first, and teenagers obviously don't fall into that category. So, even after the vaccine is approved, it likely won't be given until all the available and willing high-risk people have been vaccinated. I don't have a crystal ball, so I can't say for sure, but it wouldn't surprise me if it were available by the late summer/early fall (but don't quote me!).

Randall Fisher, M.D.

No one outside the company itself really knows the answer to your question. Drugs and vaccines are almost always tested in adults first and then tested in teenagers, then later in younger children. The companies that make the vaccines are studying their safety and efficacy in children now; when they have results, they will present them to the FDA and attempt to get an EUA (“Emergency Use Authorization”) for the vaccines in children. As soon as they get that authorization, they will begin to vaccinate children. Since nobody except the companies themselves know exactly how far along they are in the studies, nobody can tell you exactly when they will be approved for children. If I had to guess, I’d say maybe in late summer of this year, but it could be a little earlier or perhaps even a little later.

Randall Fisher, M.D.

In general, flu vaccines are slightly more effective for children than they are for adults; vaccine efficacy wanes even more in the elderly. Vaccine efficacy of flu vaccines depends, to a great extent, upon how well the vaccine strain matches the actually circulating strain. The virus that causes the flu is constantly evolving. We have to predict what strain will arrive on our shores by looking at the viruses that are circulating earlier in the Far East. It takes a while to manufacture the vaccine, so sometimes by the time the virus actually arrives on our hemisphere, it has mutated slightly away from the vaccine protection. Some years, on the other hand, the match is very good; in those years the flu vaccine works better.

Please remember that the flu vaccine only protects against influenza viruses. It cannot and does not prevent infection with common cold viruses, of which there are literally hundreds. Sometimes people think that they got the flu despite the vaccine when they really just got one of the other common cold viruses. Also, flu vaccine does not protect against the viruses that cause vomiting and diarrhea, so, if you end up with one of those, it does not mean the flu vaccine failed.

Randall Fisher, M.D.