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Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And today, we're talking about pediatric COVID concerns. We're talking about Omicron virus and our kiddos.

Joining me is Dr. Karen Acker. She's an Assistant Professor of Clinical Pediatrics at Weill Cornell Medical College Cornell University, and an assistant attending pediatrician at New York Presbyterian Hospital Weill Cornell Medical Center. Dr. Acker, I'm so glad to have you with us. So many parents have so many questions. So as we get into this topic, have you seen a general uptick in respiratory illness? Not only Omicron, but we've heard of RSV, and then there's flu going around. Tell us what you've been seeing.

Dr Karen Acker: So thank you so much for having me, Melanie. We've had a lot of changes since the pandemic has started. But yes, I do agree that over the last six to eight months, we started to see an increase in respiratory diseases as we saw increased circulation of respiratory viruses that kind of went away for a while during the first year of the pandemic and have come back, so particularly with RSV and along with another virus we call rhinovirus/enterovirus, that's the cause of the common cold. Both of those viruses were causing a lot of respiratory disease in the fall. Now with the Omicron surge, we did see many cases of Omicron in the community as we know. It's almost unprecedented how many infections it's been causing locally and in the US, and so we saw increased cases in kids.

Yet when you talk about respiratory diseases, I do have to differentiate a little bit. Earlier in the pandemic, our main concern with COVID was pneumonia due to COVID, so lower respiratory disease. COVID can also cause upper respiratory disease, runny nose, cough, sore throat. And what we're seeing with Omicron is that it seems to be more upper respiratory disease, so less that pneumonia in more severe cases with trouble breathing. And so that's definitely a shift we've been seeing with this new variant.

Melanie Cole (Host): Well, thank you for clarifying that. I'd like you to expand a little bit. So as you're telling us about Omicron and you'd mentioned that we are seeing more kids with it than we saw with the original COVID, was a lot of elderly, but how do we tell the differences? There's so many things going around and, you know, now, as you say, it's getting more common. As a pediatrician, how are you telling the difference between rhinovirus and RSV and Omicron? And are there some similarities, some differences? How is a parent to know?

Dr Karen Acker: It's very hard to differentiate. It's hard for a parent to know, it's hard for a physician to know. These viruses will cause very similar symptoms with the runny nose, cough, sore throat in kids. They can also get fever, not feeling well, even vomiting. So it's very difficult to differentiate without a test.

With COVID in general, I can't say it for Omicron, but one of the specific findings we saw with COVID infections was loss of your sense of smell or taste. We saw this in adults as a very specific symptom of a COVID infection, meaning that not everyone with a COVID infection has it. But if you had that, we were more concerned that you would have COVID versus another virus. But overall, it's tough to differentiate these viruses in children.

Melanie Cole (Host): So speak about testing then. Is it important that we know? Because now people are getting tests at their local pharmacies and, you know, hopefully we're getting sent these at-home tests. Can you speak about the importance? Are we still testing? Is it important to do this?

Dr Karen Acker: Yes. I think it is still very important to test, particularly when we have so much COVID and Omicron circulating in the community and we have these other viruses. So we know that Omicron is very transmissible. It's very contagious between people. So if you know you're positive for COVID virus based on our tests, then you should stay home and isolate according to your local department of health recommendations.

Additionally, I find it very important to know if you have influenza, because we, in some cases, do have treatments for certain patients that may be at higher risk for severe disease. Yet if you are symptomatic and you were able to stay home, but unable to get tested, that's okay as well. Because if you're staying home, you're at least decreasing the risk that you'll transmit whatever virus you have to someone else.

Melanie Cole (Host): I think that's a really important message that you just said, is about the staying home if you're sick. If you have symptoms of any of these things, it's really important to do that to protect the community around us. Now, can you tell us a little bit about boosters? And I know that the normal vaccines have been approved for five years and up, but boosters, not yet, right?

Dr Karen Acker: Yes, not yet for five to eleven years. But if you have a child that's five to eleven years old, who is immunosuppressed, meaning their immune system, for some reason, either due to medications or an underlying medical condition, their immune system doesn't work as well as it does normally. And in those cases, you may not develop a robust enough immune response to the vaccine. So for those patients, they can get a third dose. We just don't refer to that as the booster.

Melanie Cole (Host): Thank you for clarifying that. Now, I know that there's a lot of discussion about the vaccines, but you're a pediatrician and the AAP is recommending these, but some parents have concerns about pediatric myocarditis. Can you tell us a little bit about that, what it is, and if there is any relation, if this is a myth? Tell us a little bit about this.

Dr Karen Acker: So myocarditis is something we've known about way before this vaccine. And what it is, is inflammation of the heart muscle. And we see that with viral infections And, generally, it can be quite severe when it's caused by a viral infection. And what's happening is that for some reason, that virus decides to target the heart, and cause an inflammatory response in the heart. And of course, you know, your heart is a very important organ. So if it's inflamed, it may not work as well and may not pump blood as well. And while it's a severe condition in the setting of a virus, that's not the case with the cases we were seeing in association with the vaccine.

So we did see, very rarely, some cases of myocarditis particularly in young adolescent males after the second dose of the vaccine, yet what's interesting is that these cases were mild and not like the myocarditis we see with viral illnesses. We diagnosed it based on certain lab tests. They had mild symptoms and they improved with supportive care, even just with the medication, ibuprofen. That's very different than the myocarditis we see, and when I say viruses, that includes COVID.

And so, why I have so much trust in our vaccine recommendations and monitoring for side effects, is that as soon as we knew about this result immediately, the American College of Immunization Practices convened with the CDC to review these cases. And interestingly, what they found was that your risk of getting myocarditis with COVID infection was much, much higher than your risk of getting myocarditis from the vaccine. And so when you're having a lot of COVID circulate in the community, the benefits of vaccine highly outweighs the potential risks.

Melanie Cole (Host): One hundred percent. They definitely do. Now, a lot of parents are concerned about the school situation. So tell us a little bit about what we can do to hopefully -- I mean, our kids just get all kinds of things all the time, but masks really help. I'd like you to speak about that and about what we should be teaching our kids because, you know, the mask thing seems to be harder for adults than it is for kids. They just wear them and they don't really care. But tell us about returning to school, because a lot of the schools are going back in person now.

Dr Karen Acker: Yes. And I agree with you when it comes to the masks. A lot of what we have to advise for our children is harder on us as parents than on the kids. Kids are very adaptable, yet they certainly have been affected greatly by this pandemic even if they're not the ones getting infected as often. So they're getting affected because we know with school closures, it's affected their routine. We know that mental health issues such as anxiety and depression have been on the rise in kids since the pandemic. So I think it's really important to get our kids back to school in person. But we also want to keep them safe from infection. And we know from many studies that schools that have implemented mask protocols decrease the risk of getting COVID in school. And so while we have high rates of transmission in the community, I think it is important to keep our kids masked, really so that they continue to go to school. Because even if schools are open, if there are continued outbreaks in the schools, they're shutting down classrooms and then ultimately kids are having to stay home. So I think this is a continued sacrifice that we have to make, where we have kids continue to wear masks so that we can continue to send them to school. But at the same time, I think we can look forward to in the future that hopefully they won't have to wear masks continually. So I tried to think of this as a short term measure that we do when we need to, when we still have a lot of COVID circulating.

Melanie Cole (Host): Well, and as you say, if we're really intent on getting these kids back into the classroom, sometimes there are just certain things that can help to keep them safe. Speak about some of the other things that you would like parents to make sure that their kids do, whether it's hand-washing when they get home, getting decent night's sleep, you know, all of these things go into helping our immune system, yes?

Dr Karen Acker: Yes, I think our immune system and just our general health relies on so many factors. And sleep and good sleep hygiene in kids is really important for their ability to fight infections and for their mental health. Hand hygiene, I always encourage. It prevents multiple infections just by doing good hand hygiene with Purell or washing with soap, particularly before you eat or before you touch your face. So just implementing that with your kids regularly. But really the main measure that's going to keep them safe at least from infections is vaccination. And I know it's been tough because we're still waiting on our younger kids to be eligible to get vaccinated, but they're still protected if their family members are vaccinated, if their teachers are vaccinated. And, once they are eligible, I'm a big proponent of recommending vaccination as soon as kids are eligible. And I think the sooner we have those measures in place, we'll be able to send our kids to school safely and then hopefully get to remove some of the things that we don't want as much like the masks, but we really can't do that until we've controlled this pandemic and vaccines are the way to do it.

Melanie Cole (Host): I agree with you. And Dr. Acker, very informative, can you wrap it up for us with your best advice for parents that are concerned about Omicron, but want our kids back in school? And we're seeing all these other viruses kind of come around at the same time. Just on your best advice as a pediatrician, and we sure love our pediatricians, on what you want families to do to just protect each other and the community.

Dr Karen Acker: Well, I can never emphasize vaccination more. I know I already have, but I think that we're thinking about our kids' safety but also thinking about our kids' lives. And I think the sooner that we can get them to a normal routine and back to schools and back to where we don't have to feel fearful of these infections circulating, like that's our job as parents and pediatricians, but not the jobs of the kids. So as soon as we can get them to a normal routine, the better. And with vaccination and the other measures that we discussed, I think we can do that.

Melanie Cole (Host): I think so too. And thank you again for joining us. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids' Health Cast on Apple Podcasts, Spotify and Google Podcasts. For more health tips, you can visit weillcornell.org and search podcasts. And don't forget to check out our Back To Health. I'm Melanie Cole.

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