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For Toddlers, Pandemic Shapes Development During Formative Years

Lucretia Wilks, who runs a small day care out of her home in north St. Louis County, is used to watching young children embrace, hold hands and play together in close quarters.

But the covid-19 pandemic made such normal toddler behavior potentially unsafe.

“It’s weird that they now live in a time where they’re expected to not hug and touch,” said Wilks, founder of Their Future’s Bright Child Development Center, which cares for about a dozen children ranging from infants to 7 years old. “They’re making bonds, friendships, and that’s how they show affection.”

Day care and other child care providers said they are relieved to see covid cases drop as vaccines roll out across the United States. But even as the nation reopens, mental health and child development experts wonder about what, if any, long-term mental health and development consequences young children may face.

In the short term, medical and child development experts said the pandemic has harmed even young children’s mental health and caused them to miss important parts of typical social and emotional development. Besides not being able to get as close to other people as usual, many young children have seen their routines interrupted or experienced family stress when parents have lost jobs or gotten sick. The pandemic and its economic fallout have also forced many families to change caregiving arrangements.

“Coronavirus is impacting children and families in many ways mentally. The biggest and most obvious way is in the children’s structure and routine,” said Dr. Mini Tandon, an associate professor of psychiatry at the Washington University School of Medicine in St. Louis. “Young kids thrive in structure and routine, so when you disrupt that, things go awry pretty quickly in their day-to-day lives.”

Tandon, who has spoken frequently with parents and caregivers since the pandemic began, said she and her peers have seen more severe anxiety and high levels of stress in young children than in the past.

Child behavior experts pointed to a number of problems exacerbated by the pandemic in a National Center on Early Childhood Health and Wellness webinar last year, including separation anxiety and clinginess, sleep issues and challenges learning new information. Children have also shown regressive behaviors — wetting the bed even though they’ve been potty-trained, for example.

For young children, changes in caregiving arrangements can be a huge source of stress. And the financial strain of the pandemic forced many families to rethink how they cared for their youngest children.

The average monthly child care cost in Missouri, for example, is $584 for 4-year-olds and $837 for infants, according to Procare Solutions, which works with over 30,000 programs for children. That has been too high for some parents who lost their jobs in the pandemic. President Joe Biden’s covid relief plan signed into law in March gives monthly payments of up to $300 per child this year and his latest proposal would help reduce child care costs and increase access to preschool, if approved.

But in the many months when day care has been out of reach, some parents have had to rearrange their work schedules to care for infants or toddlers while also helping school-age children with virtual learning. Others have relied on grandparents for help, although that option was potentially dangerous before vaccines were available. Keeping children apart from grandparents has been tough for both kids and seniors.

Even when parents could afford day care, fear of getting or spreading covid affected their choices about whether and when to send them. And some facilities closed temporarily during the pandemic.

Aimee Witzl, 34, of St. Louis, an accountant and new mom, said she and her husband were hesitant to send their daughter, Riley Witzl, to day care early in the pandemic. Riley was born prematurely in November 2019 and had to spend nine weeks in the neonatal intensive care unit before coming home. So, the couple waited until August to send her to day care part time, then until January to send her full time.

“We were already high-risk,” Witzl said. “Then covid happened, so we kept her home even longer than planned.”

Fortunately, she said, no one in her family has contracted the virus.

In March 2020, the Early Childhood Development Action Network, a global collection of agencies and institutions promoting child health and safety, put out a “call to action” shared by the World Health Organization saying they were concerned about the pandemic putting “children at great risk of not reaching their full potential” because the early years are a “critical window of rapid brain development that lays the foundation for health, wellbeing and productivity throughout life.”

Tandon, the Washington University psychiatrist, said she’s especially worried about young children who may have been isolated in unsafe homes where they were mistreated. Maltreatment is more likely to go unnoticed, she said, when children are outside of the day cares and schools where adults are required to report child abuse and neglect.

But Tandon said the stresses of the pandemic can affect the mental health of any child, which motivated her to write a children’s book about a girl dealing with anxiety during the pandemic.

Now, though covid vaccinations still remain months away for the youngest children, a shift is occurring that may cause a new round of disruptions for them. Nancy Rotter, a child psychologist and assistant professor at Harvard University, said young children may be experiencing separation anxiety as they fully transition back into their schools and day cares after being at home with their parents.

To help kids heal, the Centers for Disease Control and Prevention suggests families make sure kids stay connected to relatives and friends. The agency also advises that parents do their best to recognize and address fear and stress in themselves and their kids and seek professional help if needed. CDC experts suggest parents talk about emotions and provide opportunities for children to express their fears in a safe place.

Yet as children and toddlers return to a new normal, it may not be as strange to them as it is for adults. Though the pandemic has presented stressors, Rotter said, children can be very resilient.

“Supportive caregivers and supportive emotional environments help with resilience in the child,” she said. “Resilience is not just what’s in the child, but what’s within the child’s environment. It’s the home, religious community, school and day care environment that aid in the child’s development and how they cope with changes.”

And the pandemic may leave behind one benefit for children: the emphasis on washing hands. Child care experts said good hygiene habits are an important life lesson that will likely last beyond this health crisis.

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


Get A Free Six Pack of Beer With Your Proof of Vaccine!

There are enormous disparities in the COVID vaccination rate – from state to state, county to county, and community to community. Why is it that when the vaccine is so readily available in this country, so much so that President Biden has promised to send a whole lot (5 million doses) overseas, that states and cities are resorting to lotteries and wild incentives to “sell” the COVID vaccine to their constituents?

President Biden has set a target to have 70% of adults vaccinated with at least one dose by July 4th.  But as we near that date, it is becoming increasingly evident that goal might not be achievable.  To date, 62.8% of American adults have already received at least one dose of the vaccine but the vaccine intake rates have dropped precipitously in the past few weeks, especially in rural America.  That leaves many of those communities grappling with an imperfect pandemic endgame.

Its an Access Issue

Who has got vaccinated and who has not?  It seems easy and almost lazy to just assume that anyone who has not been vaccinated is just an anti-vaxxer because of mistrust, political leanings or mis-information. Some people are busy with multiple jobs, or they procrastinate, or they’re worried about side effects. But that does not tell the whole story.

“According to a new U.S. census estimate, some 30 million American adults who are open to getting a coronavirus vaccine have not managed to actually do so.”  It’s an access issue and an accountability one as well for the government, says Amy Harmon, a national correspondent for The New York Times at the USC Center for Health Journalism webinar titled “The Vaccine Tipping Point”. 

Their numbers are larger than those who have been labeled hesitant — “the 28 million who said they would probably or definitely not get vaccinated, and the 16 million who said they were unsure.”

 To the 30 million Americans who want to get vaccinated but have not, due a myriad reasons – access is key.  My gardener Joel is emblematic of many such cases.  I live in Santa Clara county in California where 79% of residents aged 12 and over have had at least one dose of the vaccine.  But Joel only got his first dose this week.  When I asked him why, he said that he was busy working from 8 to 7, 6 days a week and receiving physical therapy when he could, for a recent auto accident.  He just couldn’t make the time to get vaccinated.

This is true for many of the 30 million Americans captured in the Census data.  They are just busy with multiple jobs, and if the vaccine center is not on their way to work and back, it may not get prioritized.

This scenario is exacerbated if you live in a rural part of the country according to Katheryn Houghton who serves as Montana correspondent for Kaiser Health News.  Travel is a real issue in rural America where public transportation is not available.  Folks need a car, gas money and time off from work in order to get to a vaccination site.   Also, smaller health departments mean less staff to get the information out and take care of their community. 

Don’t tell me what to do

“Getting the Pfizer vaccine is a tricky business in rural America not just because of the cold storage issues, but the amount of doses the Pfizer vaccine comes in.  The minimum amounts can be bigger than the communities that are trying to get vaccinated.”   This makes it trickier to reach younger populations as well because Pfizer is the only one vaccine that is approved for that age group.  Houghton says “there are a lot of complications overlapping with distrust of government or distrust of a health system that has been unfair to them in the past”.  A “don’t tell me what to do” attitude does not help either.  

“Covid vaccine was the next step of the kind of the tension that this community has felt over the last year.  This is a place where even the county board of health was a split vote on whether to pass mask mandates, where they did not even limit crowd sizes during the county’s largest covid outbreaks,” says Houghton.

The CDC tracks the Social Vulnerability Index – which refers to resilience, or the ability to “bounce back” when confronted by external stresses on human health, natural or human-caused disasters or disease outbreaks. As expected, communities with the highest Social Vulnerabilities have the lowest vaccination rates.  Historically, these are communities of color, and vaccine hesitancy in these communities are sensitive to different kinds of interventions due to historical reasons of distrusting the medical establishment.

Will free beer, donuts, and cash work?

To increase the access to all Americans who want the vaccine but have not been able to, the Biden administration has unleashed a slew of strategies declaring June a “national month of action” including partnering with childcare providers, pharmacies, universities, and radio stations.   

To help meet the national goal by the 4th of July –  government leaders, corporations and others are also pushing to keep the momentum going with giveaways for free cash, donuts, beer, guns, fries, hotdogs, sporting tickets, scholarships and even millions of dollars in lotteries. Will it work? Will it be the tipping point to move Americans who are reluctant or hesitant?  Behavioral scientists are waiting to find out.  

Early in the vaccine deployment cycle, behavioral scientists and public health officials were skeptical if incentives would work.  Dr. Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania School of Nursing, was afraid that “If you have to pay me, it must not be a very good or safe vaccine” was the thought going through the minds of Americans who were hesitant, especially those afraid of side effects.  They were also concerned that it was financially inefficient to pay everyone to get a vaccine.  The government has to do a better job “meeting people where they are – both attitudenly and physically,” she adds.

Public health officials in rural Montana on the other hand did not want to offer incentives because they did not want it to look like propaganda and to be accused of trying to manipulate people. They were concerned that it might trigger more of a backlash.

But in the last few weeks, there has been an explosion of incentives with Ohio and California leading the charge with million dollar sweepstakes.  California’s “Vax for the Win” drive is a contest open to everyone over age 12 who has had at least one dose of the vaccine and on June 15, the state will announce 10 winners of $1.5 million cash prizes.

But Dr. Buttenheim says that Philadelphia is trying a different strategy called “Philly Vax,” using what scientists call “anticipated regret” to nudge more folks towards vaccination.  In this regret aversion lottery – you can get your name pulled out of a hat even if you are not vaccinated but you have to be vaccinated to win.  Scientific studies show that “anticipated regret” is very motivating. The results will be telling when comparing Philadelphia with other cities and states where only the vaccinated are eligible to participate.

So, why does the lottery work better than a beer for everyone?  The “small chance of a big prize versus the fixed payment for everybody of an equal expected value” is more motivating, says  Dr. Buttenheim. As states like Ohio have found out, you can do a lot more with a lot less money with a lottery based incentive.  The amount of publicity that was garnered by announcing the lottery was worth a whole lot more than the cost of paying out the lottery.  

It’s a win-win if the vaccination numbers increase.

The question is, as the next vaccine or a booster for the current COVID vaccine rolls out, will people only respond to prizes and incentives? That is a real danger of motivation crowdout, says Dr. Buttenheim, that when we provide people an incentive for something, it could reduce their intrinsic motivation to participate in the future.

Only the future will tell. 

Anjana Nagarajan-Butaney is a producer at DesiCollective. A Bay Area resident with experience in educational non-profits, community building, networking, and content development and was Community Director for an online platform, Anjana is interested in how to strengthen communities by building connections to politics, science & technology, gender equality and public education.

Edited by Meera Kymal, contributing editor at India Currents

Image: https://twitter.com/CraneBrewing/status/1381642980256317443


Racism is a Public Health Crisis Say CA Lawmakers

After the killing last year of George Floyd, a Black man, by a white Minneapolis police officer, Wisconsin Gov. Tony Evers declared racism a public health crisis. The governors of Michigan and Nevada quickly followed, as have legislative bodies in Minnesota, Virginia and Washington, D.C.

Yet California Gov. Gavin Newsom, who governs one of the most racially and ethnically diverse populations in the U.S., has not.

State Democratic lawmakers are not waiting for Newsom to make a declaration and are pressuring the first-term Democrat to dedicate $100 million per year from the state budget, beginning July 1, to fund new health equity programs and social justice experiments that might help break down systemic racism. Possibilities for the funding include transforming parking lots in low-income neighborhoods into green spaces and giving community clinics money to distribute fresh fruit and vegetables to their patients.

Lawmakers say covid’s disproportionate impact on California’s Black and Latino residents, who experienced higher rates of sickness and death, makes their request even more pressing.

“Covid uncovered the disparities of the segregated California of the past that still has an effect today, and that we can correct if we focus on equity,” said Assembly member Mike Gipson (D-Carson), who is spearheading the funding push. “We need to build a healthier society that works for everyone.”

Lawmakers are lobbying for the money in their negotiations with the governor over the 2021-22 state budget. The legislature must pass a budget bill by June 15 for the fiscal year beginning July 1. Once Newsom receives the bill, he has 12 days to sign it into law.

The $100 million proposal to address the health effects of racism is part of the Democratic-controlled legislature’s broader public health agenda that includes a request for $235 million annually to help rebuild gutted local public health departments, $15 million per year for transgender health care and $10 million to establish an independent “Office of Racial Equity,” which would attempt to identify and address racism in state spending and policies.

Health care advocacy groups say the investments are critical to address inequality in society and the health care system that has contributed not only to higher rates of covid within disadvantaged communities, but also chronic diseases like diabetes and heart disease.

“Those who got sick and lost jobs were mostly communities of color, so seeing no new investment from the governor to really tackle racial equity is unconscionable,” said Ronald Coleman, managing director of policy for the California Pan-Ethnic Health Network, which sent Newsom a letter last July asking him to declare racism a public health crisis.

Newsom hasn’t committed to supporting the funding but said he’d be “very mindful” in negotiations with lawmakers. One proposal Newsom and state lawmakers agree on is funding for a chief equity officer to address racial disparities within state government.

Newsom pointed to other budget proposals he has made, including $600 economic stimulus payments to households earning less than $75,000, rent and utility bill assistance, and an expansion of the state’s Medicaid program for low-income residents, called Medi-Cal, to unauthorized immigrants age 60 and older.

Dr. Georges Benjamin, executive director of the American Public Health Association, said George Floyd’s killing in May 2020 motivated state and local lawmakers to look at racism through the lens of public health — which could have helped save lives during the covid pandemic. “We’re at a tipping point,” Benjamin said. “It’s important to first acknowledge that racism is real, but then it requires you to do something about it. We’re now seeing other states beginning to put money and resources behind the words.”

Some cities and counties in California have declared racism a public health crisis, including Los Angeles and San Bernardino County. But those declarations would be more meaningful backed by an infusion of state resources, health care advocates say.

“We need to be willing to put dollars into innovative approaches to addressing racism in the same way we invest in stem cells, and we need to be willing to accept that some of the things we try will work and some won’t,” said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network.

Should Newsom sign off on the funding, grants would be available to health clinics, Native American tribes and community-based organizations to develop programs aimed at combating racism and health disparities.

The Community Coalition in South Los Angeles, a nonprofit that originally set out decades ago to address the crack epidemic, expressed interest in applying.

“There are so many vacant lots in South Los Angeles that could be turned into mini-parks. That helps not only with physical health but mental health,” said Marsha Mitchell, the organization’s communications director. “We have very few grocery stores, and if you live in Compton or South Los Angeles, your life expectancy is almost seven years lower than if you lived in Santa Monica, Beverly Hills or Malibu.”

Directing more resources to address racism could backfire, in part because voters, including some Democrats, have displayed skepticism over some of the liberal and expensive policies sought by Democrats who control Sacramento, said Mike Madrid, a Sacramento-based Republican political consultant who has also worked for Democrats.

He pointed to Proposition 16, the November 2020 ballot initiative that would have repealed California’s 1996 law banning affirmative action, which was defeated 57% to 43%.

“Racism is very much a public health problem — just look at the chronic diseases and lower life expectancies of Black and brown people, and most people believe that racism is systemic in our governance,” Madrid said. “But voters are becoming more discerning about how racism is being used by politicians to advance an agenda.”

Focusing too heavily on racism could prompt a backlash, he said, “whereas if you focused on poverty and inequality, that would solve many of the racial problems.”

But state Sen. Richard Pan (D-Sacramento), who is leading the drive to establish an Office of Racial Equity, said funding and state leadership focused intensely on structural racism are essential to ending it. Should the office not be funded in the budget, Pan said he’d press forward with a bill.

The office would work with the state’s new chief equity officer to examine the California government, including state hiring practices, proposed legislation and budget spending decisions, for evidence of racism or inequality.

It’s a priority for the legislature’s Asian & Pacific Islander Legislative Caucus, given the rise in hate crimes perpetrated against people of Asian descent, Pan said.

“We need to invest more in prevention,” Pan said. “The state needs to step up and support communities of color.”

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


End the Pink Tax on Moms & Babies

Amid a pandemic that has pushed millions of mothers out of the workplace, caused fertility rates to plunge and heightened the risk of death for pregnant women, California Gov. Gavin Newsom and Democratic lawmakers are seeking a slate of health proposals for low-income families and children.

Newsom, a self-described feminist and the father of four young children, has long advocated family-friendly health and economic policies. Flush with a projected budget surplus of $75.7 billion, state politicians have come up with myriad legislative and budget proposals to make poorer families healthier and wealthier.

They include ending sales taxes on menstrual products and diapers; adding benefits such as doulas and early childhood trauma screenings to Medi-Cal, the state’s Medicaid program; allowing pregnant women to retain Medi-Cal coverage for a year after giving birth; and a pilot program to provide a universal basic income to low-income new parents.

“COVID-19 laid inequity bare for all to see,” Assembly member Wendy Carrillo (D-Los Angeles) said in a written statement. She is the co-author of Senate Bill 65, led by Sen. Nancy Skinner (D-Berkeley), which would pour hundreds of millions of dollars into family and health care programs annually, focusing on minority groups that Carrillo said were “pushed out of the social safety net by the prior White House.”

Newsom and the Democratic-controlled legislature are unified on major health care and social safety-net expansions, which would direct billions in health benefits and cash assistance to the state’s most vulnerable residents and low-income parents. Legislative Democrats for years have pushed a progressive agenda to help struggling parents and families, featuring proposals like those to permanently end taxes on menstrual products and diapers — expected to cost the state millions.

“We don’t need to balance the budget on half of the population that has a uterus,” said Assembly member Cristina Garcia (D-Bell Gardens), who has for years sought an endto the “pink tax” on diapers and menstrual products.

Skinner, chair of the Senate budget committee, is among the powerful lawmakers who’ve put forward legislation to make childbirth safer and parenthood more affordable. Her bill, which cleared the Senate and was up for consideration this week in the state Assembly, has several features that would dramatically expand maternal health care (transgender men also get pregnant and give birth).

Before the pandemic, Medi-Cal covered mothers only up to 60 days after their pregnancies ended unless their income fell below a certain line or they had a mental health diagnosis. Skinner’s bill, part of a broader national push to improve birth outcomes, would expand full Medi-Cal coverage to 12 months after the end of a pregnancy. Other parts of the bill would intensify state reporting and reviews of fetal and pregnancy-related deaths and severe maternal morbidity, expand housing benefits for families that have a pregnant member, and increase training programs for midwives.

Newsom’s $268 billion budget blueprint includes about $200 million a year to fully implement the expansion of Medi-Cal coverage for new mothers, with matching dollars from the federal government until those funds expire in 2027. If the expansion were not renewed, the state would revert to previous Medi-Cal qualifications.

Medi-Cal covered 45% of all births in California in 2017, the last year for which data could be found.

“Not all postpartum issues end at 60 days, and when patients lose insurance, we can’t address them in the usual way,” said Dr. Yen Truong, an OB-GYN who works with the American College of Obstetricians and Gynecologists on legislative issues in California.

About half of pregnancy-related deaths occur during the pregnancy or on the day of delivery, but about 12% take place between seven weeks and a year after giving birth, according to the Centers for Disease Control and Prevention.

The U.S. had 17.4 early maternal deaths per 100,000 live births in 2018, according to the most recent CDC data with state figures. California’s rate, 11.7 per 100,000, was among the lowest in the nation, but the state collects data on maternal deaths in a way that could result in underestimates.

California’s overall numbers also obscure stark racial disparities. Statewide, Black infants averaged 7.8 deaths per 1,000 live births, compared with an average of three deaths among white babies. Data from 2013 from Los Angeles County showed Black women had pregnancy-related deaths at rates more than four times as high as the overall rate in the state’s largest county.

“Given our state’s wealth and medical advancements, this is unacceptable,” Skinner, vice chair of the Legislative Women’s Caucus, said in a news release.

Democrats also appear unified on another aspect of Skinner’s bill: a pilot program to test a universal basic income program for struggling families. The bill would give $1,000 a month to low-income expectant and new parents with kids under 2 years old in counties that decide to participate. Newsom has also proposed $35 million over five years for pilot programs for universal basic income.

These issues could play well, especially among women, and improve Newsom’s standing going into a recall election later this year, said Rose Kapolczynski, a longtime campaign consultant to former U.S. Sen. Barbara Boxer who has worked on reproductive health care issues in Sacramento.

Indefinitely rescinding sales taxes on diapers and menstrual products — the taxes have been temporarily lifted since early last year — is a particular no-brainer because of its bipartisan appeal, she said.

“It’s hard for Republicans to attack something that is a tax cut, and sales taxes are regressive, so progressives would like it,” Kapolczynski said.

As for Medi-Cal expansions, Kapolczynski said that even though it wouldn’t affect most Californians, the pandemic has made health care even more important to voters. “The budget surplus is allowing many things that were called impossible to be possible, and that includes health care bills,” she said.

Investing in California’s young families could help close the racial gap in maternal and infant mortality, said Nourbese Flint, executive director of the Black Women for Wellness Action Project, which endorsed Skinner’s bill.

Flint is especially excited about the possibility of covering doulas through Medi-Cal. Doulas, trained as emotional and physical supports for women in pregnancy and postpartum, have been linked to lower odds of cesarean births and greater satisfaction with the birth experience. If doulas saved Medi-Cal money by reducing cesarean births, that could enable the state to renegotiate payments for labor and delivery, according to an analysis by the independent California Health Benefits Review Program. Under Newsom’s proposed budget, Medi-Cal coverage of doulas would cost about $4.4 million a year.

California’s would become the first Medicaid program to include “full spectrum” doula coverage, meaning it would include care for women who have abortions, miscarriages and stillbirths, said Amy Chen, a senior attorney at the National Health Law Program.

“California has always led the country and been a little bit in front of where our federal government is when it comes to covering folks,” Flint said.

California Healthline correspondent Angela Hart contributed to this report.

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


Did It Feel Like A Truck Hit You After Your Covid Vaccination?

If you think vaccination is an ordeal now, consider the 18th-century version. After having pus from a smallpox boil scratched into your arm, you would be subject to three weeks of fever, sweats, chills, bleeding and purging with dangerous medicines, accompanied by hymns, prayers and hell-fire sermons by dour preachers.

That was smallpox vaccination, back then. The process generally worked and was preferred to enduring “natural” smallpox, which killed around a third of those who got it. Patients were often grateful for trial-by-immunization — once it was over, anyway.

“Thus through the Mercy of God, I have been preserved through the Distemper of the Small Pox,” wrote one Peter Thatcher in 1764, after undergoing the process in a Boston inoculation hospital. “Many and heinous have been my sins, but I hope they will be washed away.”

Today, Americans are once again surprisingly willing, even eager, to suffer a little for the reward of immunity from a virus that has turned the world upside down.

Roughly half of those vaccinated with the Moderna or Pfizer-BioNTech vaccines, and in particular women, experience unpleasantness, from hot, sore arms to chills, headache, fever and exhaustion. Sometimes they boast about the symptoms. They often welcome them.

Suspicion about what was in the shots grew in the mind of Patricia Mandatori, an Argentine immigrant in Los Angeles, when she hardly felt the needle going in after her first dose of the Moderna vaccine at a March appointment.

A day later, though, with satisfaction, she “felt like a truck hit me,” Mandatori said. “When I started to feel rotten I said, ‘Yay, I got the vaccination.’ I was happy. I felt relieved.”

While the symptoms show your immune system is responding to the vaccine in a way that will protect against disease, evidence from clinical trials showed that people with few or no symptoms were also protected. Don’t feel bad if you don’t feel bad, the experts say.

“This is the first vaccine in history where anyone has ever complained about not having symptoms,” said immunologist Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

To be sure, there is some evidence of stronger immune response in younger people — and in those who get sick when vaccinated. A small study at the University of Pennsylvania showed that people who reported systemic side effects such as fever, chills and headache may have had somewhat higher levels of antibodies. The large trial for Pfizer’s vaccine showed the same trend in younger patients.

But that doesn’t mean people who don’t react to the vaccine severely are less protected, said Dr. Joanna Schaenman, an expert on infectious diseases and the immunology of aging at the David Geffen School of Medicine at UCLA. While the symptoms of illness are undoubtedly part of the immune response, the immune response that counts is protection, she said. “That is preserved across age groups and likely to be independent of whether you had local or systemic side effects or not.”

The immune system responses that produce post-vaccination symptoms are thought to be triggered by proteins called toll-like receptors, which reside on certain immune cells. These receptors are less functional in older people, who are also likely to have chronic, low-grade activation of their immune systems that paradoxically mutes the more rapid response to a vaccine.

But other parts of their immune systems are responding more gradually to the vaccine by creating the specific types of cells needed to protect against the coronavirus. These are the so-called memory B cells, which make antibodies to attack the virus, and “killer T cells” that track and destroy virus-infected cells.

Many other vaccines, including those that prevent hepatitis B and bacterial pneumonia, are highly effective while having relatively mild side effect profiles, Schaenman noted.

Whether you have a strong reaction to the vaccine “is an interesting but, in a sense, not vital question,” said Dr. William Schaffner, a professor of infectious disease at Vanderbilt University Medical Center. The bottom line, he said: “Don’t worry about it.”

There was a time when doctors prescribed cod-liver oil and people thought medicine had to taste bad to be effective. People who get sick after covid vaccination “feel like we’ve had a tiny bit of suffering, we’ve girded our loins against the real thing,” said Schaenman (who had a slight fever). “When people don’t have the side effects, they feel they’ve been robbed” of the experience.

Still, side effects can be a hopeful sign, especially when they end, says McCarty Memorial Christian Church leader Eddie Anderson, who has led efforts to vaccinate Black churchgoers in Los Angeles. He helps them through the rocky period by reminding them of the joyful reunions with children and grandchildren that will be possible post-vaccination.

“I’m a Christian pastor,’’ he said. “I tell them, ‘If you make it through the pain and discomfort, healing is on the other side. You can be fully human again.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

image credit: getty images at KHN

In Santa Clara County, Nearly 67% Of Residents 16 + Have Had A Vaccine Shot

The Number of Californians With at Least One Covid Vaccine Dose Continues to Rise.

More than 75% of California’s seniors have had at least one dose, which makes epidemiologists hopeful that other age groups will follow suit

Demand for covid vaccines is slowing across most of California, but as traffic at vaccination sites eases, the vaccination rates across the state are showing wide disparities.

In Santa Clara County, home to Silicon Valley, nearly 67% of residents 16 and older have had at least one dose as of Wednesday, compared with about 43% in San Bernardino County, east of Los Angeles. Statewide, about 58% of eligible residents have received at least one dose.

The differences reflect regional trends in vaccine hesitancy and resistance that researchers have been tracking for months, said Dean Bonner, associate survey director at the Public Policy Institute of California, a nonpartisan think tank.

In a PPIC survey released Wednesday, only 5% of respondents in the San Francisco Bay Area and 6% of those in Los Angeles said they wouldn’t be getting vaccinated. But that share is 19% in the Inland Empire and 20% in the Central Valley.

“More urban areas might be hitting a wall, but their number of shots given is higher,” said Bonner. “The rural areas might be hitting a wall maybe even before, but their shots given isn’t quite as high.”

Infectious disease experts estimate that anywhere from 50% to 85% of the populationwould need to get vaccinated to put a damper on the spread of the virus. But overall state numbers may mask pockets of unvaccinated Californians, concentrated inland, that will prevent these regions from achieving “herd immunity,” the point at which the unvaccinated are protected by the vaccinated. Epidemiologists worry that the virus may continue to circulate in these communities, threatening everyone.

The regional differences could be attributed, at least in part, to political opposition to the vaccine, said Bonner, as about 22% of Republicans and 17% of independents in the survey said they wouldn’t be getting the vaccine, compared with 3% of Democrats.

But officials and epidemiologists see some encouraging signs that the state has yet to hit a wall of vaccine refusal. “As a strongly blue state, one would expect that California is less likely than red states to hit a relatively low ceiling of vaccination, assuming that the access is good and the messaging is strong,” said Dr. Robert Wachter, chair of the department of medicine at the University of California-San Francisco School of Medicine.

As of Wednesday, 77% of seniors in California, and 68% of those ages 50 to 64, had received at least one dose of covid vaccine, according to a KHN analysis. These large percentages reflect the early vaccine eligibility of these age groups and are a hopeful sign considering how difficult it was to get a shot in the beginning of the year, said Rebecca Fielding-Miller, an assistant professor at the University of California-San Diego specializing in infectious diseases and public health.

“I’m very hopeful that addressing access would pick up at least another 10-15% before we need to really start addressing myths and hesitancy issues,” she said.

The state could see a new jump in vaccinations as workplaces, schools and event organizers begin to require the shots, Wachter said. For example, the University of California and California State University systems announced April 22 that their 1 million-plus students and staff members will be required to get vaccinated against covid once the shots are formally licensed by the Food and Drug Administration, likely to occur this summer.

Still, the red-blue political distinction on vaccination is meaningful within California as well as nationally. Despite depressed vaccine demand across the board, counties that lean conservative have lower rates of vaccinations.

In true-blue Los Angeles, 4.5 million first covid vaccine doses have been administered, meaning that about 55% of eligible Angelenos have gotten at least one shot.

But first-dose appointments at county-run sites were down at least 50% last week, said public health director Barbara Ferrer on Thursday. The county has opened several sites where people can walk in and get vaccinated without an appointment, but these walk-ins don’t make up for all of the unfilled spots.

Last week probably marked the first time the county did not administer 95% of the doses distributed to it, she said.

In San Diego and Orange counties, meanwhile, vaccination appointments are going unfilled or taking days to get booked up.

About 20% of appointments in Orange County started going unclaimed on April 25 and the slack has persisted, said Dr. Regina Chinsio-Kwong, deputy health officer.

However, based on survey data from last winter indicating that about 58% of Orange County residents plan to get vaccinated against the coronavirus, the county is still expecting more residents to seek out appointments. As of Sunday, about 49% of residents had received at least one dose.

In San Diego, officials expect all appointments to be filled despite the slowdown, said county spokesperson Michael Workman. About 54% of eligible residents had received at least one dose as of Wednesday.

In San Bernardino, the slowdown started in late March, said county spokesperson David Wert. Only 42% of county residents had gotten at least one dose as of Monday.

Across the state, officials are unclear on the extent to which hesitancy or lack of access to a vaccine are responsible for the slowdown.

Campaigns to educate, convince and reach out to people have started to pick up throughout the country, including targeted messaging for conservatives. Ten GOP doctors in Congress recently issued an ad urging their constituents to get vaccinated.

Santa Clara is shifting most county-run sites to enable walk-ins and expanding evening and weekend hours to make it easier for working people to get a shot. San Diego and San Bernardino are also allowing walk-ins.

Other counties are returning unused doses to the state to be redistributed, a bounty from which Los Angeles County has benefited, according to Barbara Ferrer, director of the county public health department. Representatives from Blue Shield and the California Department of Public Health would not say which counties are sending doses back.

California’s good pandemic news, which has enabled counties to reopen many businesses, is one of the challenges to getting less-than-enthusiastic people in for their shots right now, said Wachter of UCSF.

As of Thursday, California has one of the lowest case rates in the U.S. at 31.3 cases per 100,000 and a covid-test positivity rate of 1.3%.

“My hope is that a strong communication campaign, perhaps coupled with some degree of vaccine requirements, will get some people to jump off the fence,” Wachter said.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Image: County of Santa Clara Public Health Department

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