Will This Novel Virus Revive Older Ones?

As I recently wrote here, and spoke about here, bans on elective surgery invoked by governors across the country in response to the COVID-19 pandemic have caused many people to suffer and even possibly face fatal consequences due to delays in necessary medical care. But there are other reasons why the public health emergency has the potential to generate secondary public health crises.

In some cases people are avoiding doctors’ offices and emergency rooms because they worry about handling the expense at a time they have seen their income, and perhaps their savings, vanish during the current economic shutdown. In other cases, people–particularly those with vulnerabilities–avoid medical care out of fear they might get exposed to the virus in the process.

Fear among vulnerable patients that they may contract and succumb to a COVID-19 infection is completely understandable. It is less understandable, however, when this fear makes parents forgo taking their children to the doctor’s office for routine vaccinations against diseases which are far more deadly and contagious, as the Wall Street Journal reported May 8. The timing of certain immunizations in children can be crucial. Forgoing or even just postponing them can have serious consequences.

Despite the fact that family practice and pediatrics offices have employed social distancing strategies to minimize the risk of COVID exposure to parents and their children if they come in for their scheduled vaccinations, the Journal reported:

The immunization rate for all recommended childhood vaccines declined about 40% in the U.S. from late February through mid‐​April, according to Physician’s Computer Co., a provider of electronic health‐​record systems. The data are based on vaccines administered by more than 1,000 pediatricians in 40 states who use PCC’s record system.

Concerns about a drop in the vaccination rate in association with the pandemic were also published by the Centers for Disease Control and Prevention. 

This is particularly unfortunate considering that children appear relatively spared by the COVID pandemic. According to the CDC, as of May 3 less than two percent of confirmed COVID-19 cases were among patients under age 18. The cases are almost always mild. The CDC report states, “In the U.S., as of April 2, 2020, there have been three deaths among children with laboratory‐​confirmed SARS‐​CoV‐​2 infection that have been reported to CDC, but the contribution of SARS‐​CoV‐​2 infection to the cause of death in these cases is unclear.” The fatality rate among adults under age 50 is likewise extremely low.

Meanwhile, diseases like measles and polio are much more deadly and contagious. Measles can lead to pneumonia, along with brain swelling and secondary permanent neurologic sequelae, such as vision and hearing loss and cognitive impairment. Measles can also be fatal. Complications of polio include paralysis. Parents must consider risks such as these when they fail to get their children vaccinated.

The World Health Organization reported 140,000 deaths from measles occurred globally in 2018, most under the age of five. Even polio virus, thought to be largely eradicated, is showing traces of a comeback, with worldwide reported cases increasing from 28 in 2018 to 163 in 2019.

It’s not only measles that poses a threat. Rotavirus, which can cause severe gastrointestinal illness in children is also a part of the standard vaccination package, as is immunization against Bordetella pertussis, the cause of “whooping cough.” Some vaccinations may protect against problems that can develop down the road. An example is the immunization for human papilloma virus (HPV), which can be a cause of cervical, anal, penile, and throat cancers in adults.

The Wall Street Journal article quoted one pediatrician as saying, “The numbers will tell you it’s guaranteed that some American kid today is going to die in 10 to 20 years of HPV as a result of Covid.”

It would be a great tragedy to see new pandemics, from pathogens previously believed to have been defeated, arise from the ashes of the current pandemic.

Public health experts should inform political leaders as well as the public about the dangers of COVID-19 and the best ways to avoid them. But policymakers and the public should also be told about trade‐​offs, as well as the relative risks faced by different demographic groups. Policies and personal decisions should be based on reason, not fear.