Reflections on National Preparedness Month and the Pandemic

Pregnant Persons, Parents, and Children on being Prepared during "Back to School" and an Autumn with the Delta Variant

Scott G. Hartman, Treasurer

Centering the USBC vision of thriving families and communities, the team at the USBC asked me to share a few thoughts about the pandemic during National Preparedness Month, and I'm hopeful that sharing some data and recommendations will be helpful. But first, I'd like to share some feelings about the situation, feelings that I am sure many of you are experiencing too.

I have a lot of anger and frustration about how the SARS-CoV-2 pandemic began and unfolded, the secrecy and incompetency and politicization that resulted in more than 600,000 preventable deaths. It has caused, and continues to cause, enormous harm globally. In the US, C-19 has highlighted the inequities embedded in our healthcare system, most strikingly leading to a 3-year decrease in life expectancy for Black American men from 2019-2021. This is not acceptable.

But, I also have hope. I am struck by the heroism of American first responders, nurses, lactation consultants, teachers, food service workers, environmental services staff, and countless others that have "risen to the occasion" and kept America running in the face of danger and uncertainty. I am inspired by the scientific creativity that utilized mRNA technology (previously studied for 10+ years) to rapidly develop novel vaccines that, while not 100% effective at preventing illness, are still amazingly powered to prevent hospitalization and death. And I am inspired by the USBC, with its prowess at creating a novel "COVID-19 Infant and Young Child Feeding Constellation" that, in 2020, rapidly created a story collector tool that ultimately sent data to the CDC and helped change the narrative around infant feeding in the pandemic.

To support our work in the lactation field, we need policies and systems that are supportive of all families in all communities. We have seen how the global pandemic and social unrest and upheaval have illuminated how we have a long way to go to achieve our vision. And yet, we do have some successes to celebrate. As we look further into fall 2021 and at the rise of the "Delta variant," I'd like to share some facts and then some recommendations.

C-19 Stats:  (from the AAP and ACOG)

• More than 300 children have died in the US of COVID-19 complications. (1)
• For the week of August 19, children made up 22.4% of weekly COVID cases. (1)
• Over 4.59 million childhood cases of COVID-19 have been documented. (1)
• Pregnant persons with COVID-19 experience higher rates of hospitalization than nonpregnant adults of similar ages. (2)
• Pregnant persons with COVID-19 may experience higher rates of miscarriage, preeclampsia, preterm birth, and stillbirth. (2)
• COVID-19 vaccines have demonstrated excellent safety profiles in pregnancy and lactation. (2)
• COVID-19 vaccines given in pregnancy or lactation pass some antibodies against COVID-19 on to the fetus or infant. (2)
• Approximately 113,000 of the COVID-19 hospitalizations in June and July of 2021 were preventable with vaccination. With the approximate cost of a coronavirus-related hospital admission being about $20,000, researchers estimated that these preventable COVID-19 hospitalizations cost the US health system $2.3 billion in just two months. (3)

Recommendations

As children, students, teachers, and administrators return to school, many feel anxious. But we still know that masking, physical distancing, sanitation, ventilation, and vaccination stand as our key weapons in the war against COVID-19's devastating effects on children's physical health and social well-being. The CDC School Guidance for 2021 recommends a "layered" approach, and this approach has been validated by both modeling studies (how the virus transmits via droplets and aerosols) as well as epidemiology studies (comparing rates of infection in schools or spaces that have used various approaches). The list of links below lists some of the key components of the layered approach. No one approach can effectively protect our children 100%, especially since some strategies such as masking and keeping children 3 feet apart can be challenging. But in combination, the layered approach offers excellent protection and should allow children to return to school safely. Access detailed information.
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Also, acknowledging that more than 90% of Americans live in counties or regions with high transmission of the delta variant, we must keep in mind that the layered approach applies to adults as well. We have an ethical and social responsibility to keep all members of our communities safe -- especially children and adults with compromised immune systems. While most "fully vaccinated" Americans who acquire a COVID-19 infection won't get particularly sick, they CAN transmit delta variant to others. Thus, masking in public indoor spaces is critical, even for fully vaccinated persons! Access recommendations for prevention of the delta variant transmission.

A Few Thoughts on Equity

In-person schools help to assure equitable access to food and education. The CDC and many other authorities emphasize the importance of a safe return to in-person learning for children of all ages. Transparent, culturally appropriate information on COVID-19, especially long-term impacts on children's mental and physical health must be disseminated. Many parents still think that COVID-19 is like a "cold," a self-limited illness in children. But just like adults, COVID-19 can exert long-term impacts on the heart and lungs, impairing the ability to play sports or engage in normal play or life activities. There is a lot we simply do not know yet.

Transparent, culturally appropriate information on COVID-19 vaccines must be distributed in multiple languages. The Navajo Nation has been highlighted by the medical community as a shining example of success in fighting the pandemic. Navajo leaders engaged their communities early on in promoting vaccination and have achieved vaccination rates well over 80% in the adult population. They now comprise the single "most vaccinated ethnic group" in the US. This is one of the success stories.

Lastly, the promotion of COVID-19 vaccination during pregnancy and lactation may help level the playing field in promoting optimal health for all Americans. We must assure a healthy start for all infants and children, and protection from this devastating illness comprises a critical piece of this! The following commonsense solutions can ensure that the vaccine is equitably distributed in communities across the country:

• Assure vaccine information in multiple languages
• Make vaccines available in primary care, community health centers, community settings
• Offer access to influenza, Tdap, and COVID vaccines during pregnancy, breastfeeding

As a doctor and as a human being, I am frustrated, and I am exhausted in this fight to save lives in a national and global pandemic. But, I still have hope, and the collaboration of my colleagues as part of the USBC continues to inspire me. I hope all of you will stay strong in this battle and know that the work you are doing makes a world of difference!

Prevention Strategies:

• Promoting vaccination
• Consistent and correct mask use
• Physical distancing
• Screening testing to promptly identify cases, clusters, and outbreaks
• Ventilation
• Handwashing and respiratory etiquette
• Staying home when sick and getting tested
• Contact tracing, in combination with isolation and quarantine
• Cleaning and disinfection

References:

1. https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report
2. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care
3. https://www.healthsystemtracker.org/brief/unvaccinated-covid-patients-cost-the-u-s-health-system-billions-of-dollars/ 
4. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html
5. https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html