Transition Lenses

As implied by the title, today’s theme involves transitions.  On the list of topics to be covered are the transition of our Covid-19 saga into the endemic phase, the availability of Covid-19 vaccines for nearly all age groups, societal devolution, and some changes here at Peds First.  And of course, while at it today, will pair everything with some acoustic entertainment to feed your head.

Had a longer playlist than typical, so starting you off with a pair of mellow instrumental pieces.  Nice deep cuts from The Beastie Boys off Ill Communication and Frank Zappa off Hot Rats.  

Welcome Covid-19 to Your Endemic Phase

Now that Covid-19 has had the opportunity to infect nearly everyone once, if not twice or thrice, in addition to a large percentage of the population availing themselves to one of the vaccine options, we have transitioned to the endemic phase of this viruses’ life cycle from the pandemic phase.

Hey Doc, English! Do you speak it?

Solo un poquito.  And maybe a bit more than a little.  But I digress…

The endemic phase of the Covid-19 life cycle is where we must adapt to deal with it as an ongoing nuisance.   It is not going to completely go away.  Not even with a ton of clapping using inverted Tinker Bell technique.  Don’t fret though, this is like influenza and a litany of other illnesses we have come to know and love and live with.  There will be some “good years” and some “bad years,” but barring seismic changes to the virus, we are not likely to re-experience the craziness of the last few years from this particular virus.  There will be another pandemic eventually.  It could be another coronavirus.  It is not likely going to be Monkeypox for those at home wondering.

*Last comment inspired by my little friend who stopped by the house to ask if he could get vaccinated against Monkeypox (in as sarcastic a manner as possible – much appreciated).

So, if we are stuck with it, what do we do?

There is no foolproof plan here, but there are some obvious considerations.  We have vaccines and we have some medications that can help those that contract the illness despite.  Continued research into vaccination may yield one that is longer lasting.  We may develop better treatments.  For now though, at minimum, the high-risk folks should plan on getting multiple boosters.  This is a far better circumstance compared with where we were in March of 2020.

Did you just say multiple boosters?

Yes I did.  The current vaccines appear to prevent from serious infections very well for at least six months duration.  So it is possible that if you are 80 years old, you may very much elect to get a booster that frequently if ultimately permissible and/or recommended.  To date, I cannot understand why this bothers so many folks.  We put food in our bodies every day to maintain ourselves.  We take medications in many cases daily for the same.  Yes, this one comes with a needle.  So does insulin.  Better than having a breathing tube inserted to be on a ventilator.

The issue is a bit tougher as we migrate to the younger folks in society, especially children and low risk individuals.  I can very much understand the reluctance to get a twice a year or even once a year booster for a low risk illness.  I can even understand the reluctance to vaccinate at all in the lowest risk categories such as infants.  More on our little friends in a subsequent section.

So, how do you decide?  Partly by continuing to collect data, keep an open mind, and make the best decision you can with the information at hand at the time.

What about the masks?

At the current time, I feel for most settings, the requirement for such is unwarranted.  That does not mean you cannot choose to wear one in areas of concern for exposure.  And that choice should not lead to derision from your fellow human peer group.  It also does not mean a private business cannot require what they want from their employees or customers.  Don’t like it? Work somewhere else or patronize another business.  Health care and a few other industries need to further evaluate what is truly helping and what is window dressing.  Until then, while I do not enjoy wearing a mask all day at work, I can accept that fate for now in the absence of enough information to know it is not affecting my ability to harm others at work.   I make decisions with my life based on my risk tolerance, and that will include four concerts next week sans mask.  It is not for me to make that decision for the client who comes to a health care facility.

David Bowie, Changes.  Live from the Hammersmith Odeon (1973).

Covid-19 Vaccines for the Youngins

As of this weekend, the CDC has officially recommended the Covid-19 vaccine for all ages greater than six months.  Furthermore, there are now options available as to which of the mRNA vaccines may be offered to all ages, as both the Pfizer and Moderna vaccines were approved for such use.

Are they safe?

It depends on what degree of safety you expect from the vaccine.   The issue with both the Pfizer and Moderna trials is similar to that of the trials that preceded them for older children.  Specifically, they did not test the vaccine in a large numbers of them.  In the Moderna trial, approximately 4,700 children under the age of 5 years were administered the vaccine with fairly typical vaccine related side effects noted.  These included local reactions (redness/swelling/pain), fevers, swollen lymph nodes, fatigue, headache, muscle aches, and nausea/vomiting.  The Pfizer trial, 2,970 children under the age of 5 years were administered the vaccine, again with the same typical vaccine side effects noted.

Trials of the magnitude conducted are adequate for common side effects.  They are not designed to detect the 1:2,500 variety or rarer.   Is it likely that something catastrophic is going to manifest from the vaccine in 1:3,000 infant vaccine recipients?  No.  Is there actual data to support that statement?  No.

Do they work?

It depends on what degree of protection you expect from the vaccine.  Are you seeking protection from any infection?  Getting hospitalized?  Death?

Both clinical trials were approved based on their data demonstrating antibody responses similar to older individuals who had received the vaccine in prior trials.  This is a proxy for protection.  The Pfizer trial was too small to assess whether there was any protection from contracting Covid-19 despite vaccination or any specific outcomes if contracted.  The Moderna trial results for the 6 month to 2 year age group demonstrated 50.6% effectiveness at preventing infection with Covid-19.  The vaccine was effective in preventing Covid-19 in 36.8% between the ages of 2 and 5 years.  Again, the trial was too small to ascertain protection from the more serious endpoints (hospitalization/death).  It was worth noting that the Moderna trial was too small to assess protection in the 6 to 11 year old range.  It was 93.3% effective in the 12 to 17 year age range.

While addressed in more detail in a prior blog, it is very difficult to conduct a study in children to demonstrate protection from more serious Covid-19 infections.  The reason is that they are very uncommon in children.  As of June 2, 2022, the CDC had reported 1,086 deaths in children since January 2020 from Covid-19.  Yes, you read that correctly, in 2 1/2 years there have been 1,086 fatal outcomes.  Compare that with the 1,004,150 deaths in folks older than 17 years during the same time period.  Just as an added kicker….299 of the 1,086 fatal outcomes were in infants under 1 year of age.  It does not break their age down by month, but it is safe to assume that nearly 1/5 of the fatal outcomes are in infants that cannot even be vaccinated.

So, what should I do Doc?

What should you do? I cannot give you a strong argument to run out and vaccinate every youngin.  Do they have some risk if they get Covid-19?  Yes.  They also have risk on a daily basis from a very long list of Darwinian challenges they undertake.  In 2020 alone, 4,300 kids were shot dead.  As in the bullet variety of shot, not vaccine*.  Also in 2020, 3,900 died in car crashes, and another 1000 by overdose. Just keeping it real.

Do I genuinely think you will harm them if you vaccinate them?  No, I don’t.  But again, the safety data is limited at this time.  Some solace can be taken from the fact that it has been safe in other ages.  Alas, little kids are not the same as adults.  You can see that quickly in the limited effectiveness data published.

So ultimately you will need to take a good look at your personal risks, tolerance for taking on risks, and expectations for benefits in deciding.  Do you live with great-grandparents?  Does Dad have diabetes and early heart disease?  Does Mom have lupus and on immune suppressants?  Is there a sibling with cancer on chemotherapy?  There are reasons folks take on risk.  This is why I am appreciative that the vaccine is available if you want it.  In a couple of months, more data will be available to further refine your decision making.

* also not the Bulleit variety of shot, which is quite tasty

A Couple More Things About Covid-19 Vaccines

Boosters in children

Booster vaccines are now recommended for children as well by the CDC.  Are they necessary?  If your goal was to protect them with the vaccine and your reasons for doing so have not changed, it is a very reasonable thing to do.  There have been no additional safety concerns noted with the boosters.  Timing of the booster may, however, be a consideration.  The fact that they are suggesting a booster six months after the initial doses is because that is about how long benefit of vaccination has been noted.  This age group is not approved for 4th doses.  Unless you are traveling, it may be worth waiting until September for the booster, that way you can attempt to maximize the benefit during the classic coronavirus season that starts in October.  There is a low likelihood that a fourth dose will be permitted in time to address this concern.

Quick word to parents and adults in general

While we obviously focus on the pediatric population, we do care about those who raise them as well.  If you have not received any Covid-19 vaccine, I would very strongly consider such, even if just the primary series.  I would also strongly consider the first booster.  If you are 28 years old, you are likely a low-risk individual.  You are not at no risk.  We have seen plenty of poor outcomes among the parents in the practice.  Please don’t gamble.  You cannot chase your kids around with an oxygen tank.  Some folks have serious fatigue that makes getting mono look like taking amphetamines.  We have seen parents with all varieties of neurologic oddities due to Covid-19.  The vaccine is safe.  Don’t gamble.  Your kids want you around, intact, and ready to play.

Live Hendrix with Buddy Miles.  Gotta love the Band of Gypsys. 

Societal Devolution

I know.  This section is kinda random.  Just sad to watch this country rip itself apart without any ability for proper discourse, negotiation, and ability to make decisions together for the benefit of all.  Not what I remember growing up.  And why a nice mountain home is looking better by the day.  Definitely not looking to be coastal.  If they don’t cure the global warming issue, it would be like living in Atlantis.

Guns and Mental Health

The current conversations regarding gun control in this country in the wake of continued mass shooting events have taken on the same form as every other discussion in politics.  Polarized.  Some feel the answer is to just get rid of guns or at least some varieties.  Others feel that all we need to do is address those that have mental health issues leading them to use guns inappropriately.  Our leaders again cannot get out their own way.  Is there not some place where both approaches can be implemented?

I have many friends that hunt.  For that I am grateful.  Keeps my freezer full of venison, duck, and the occasional moose or something more exotic.  Every one of my friends who hunts is fanatical about how they store their guns.  Clean their guns.  They all deeply respect the game the hunt.  They aim for quick and painless kills with a single shot.  They are not using machine guns to mow down a deer.

So, if you are one of those that really wants a rapid fire, large clip assault rifle, perhaps you really need to have a background check.  And heaven forbid you have to demonstrate proper care.  Or run the risk of having it taken away if you become demented or identified as high risk because you starting spouting on Facebook that you feel all folks with last names rhyming with “muppet” need to be eliminated.

Realistically, we are not getting rid of guns in this country entirely, and there are benefits to an armed population.  Some may be for dinner tonight. But some diligence is quite possible.

Mental health is a major contributor to the problems we face with firearms.  Some folks really should not have them.  Psychotic illnesses, severe depression, people with violent history.  But aside from the firearm issue, we are not dealing well with these issues as a society.  These people need help and it needs to be addressed.  There is a lack of funding for such.  Even among those insured.  Here is an example that should appall you.  Our office has several providers who have undertaken additional training to assist those with mental health issues because there are massive wait lists with psychiatrists to assist them.  Often these lists are months long, and that is if there is even one local, and covered, by a given insurance company.  Brace yourself……despite lack of alternative, there are an increasing number of major insurance companies that will not cover mental health services if we provide them to you.   So perhaps our leaders will get their thinking caps on to help with this problem as it is rapidly escalating.

Child Pawns

Society needs to cut the crap with the “what about the children” thing as it pertains to Covid-19.  They are not the target nor the problem.  The constant fear mongering in schools and media is deplorable at this point.

There again is a major push to vaccinate the youngest.  The lowest risk of all.  With a vaccine that appears to protect them less than half the time from getting Covid-19, and for which there is no data on preventing severe disease.  Again, there is next to no severe disease to prevent them from.  The unstated goal is likely to protect adults that are not interested in protecting themselves.  The vaccines work great for adults.  And yes, they may need boosters.  Whoopee. You cannot possibly think it is ok to propose mandating low-risk individuals every six months to protect an adult who refuses even one dose.   Calling out the colleges on this one.  Bastions of education?  Grrrrr.


Here is the most random one for you today.  What is going on with sports gambling in this country?  I cannot watch a sporting event without commentary on all sorts of betting propositions and advertisements for sites for gambling.  Can you not see how this is going to end poorly?

More indecision from me today, so you get a bonus track.  Steely Dan and some Stills & Nash for you. 

Peds First Transitions

A Show of Appreciation and a Warm Welcome

I want to offer thanks on behalf of the staff of Peds First and myself (and I guarantee thousands of families) to Stacey LaCarrubba for being everything one could ask for in an office manager, coworker, and friend.  While she has chosen to move on from her position as office manager for Peds First, she will continue to assist in a consulting role as she pursues other ventures, including serving the community as a child birth educator and LIDA certified birth doula.  Should you choose to avail yourself of her services, please email her at

I wish at this time to introduce Vilma Bonilla, who has assumed the title of office manager.  Like her predecessor, Vilma is among the warmest, kindest individuals you will meet.  She wants nothing more than to ensure that everyone receives the best experience they can when they interact with our office.

Passing the Torch

One more transition for you today.  As of the end of June, I will be stepping away from my duties as managing partner for Peds First.  Don’t fret, I am not retiring from clinical practice.  If anything, I will have slightly more hours available for assisting patients.  Dr. Iype will be assuming most of those duties, at least initially.  We have been preparing together for quite some time now, and as I am not going anywhere soon, I will continue to serve as his consiglieri as needed to ensure a smooth transition for all.

Live Cat Stevens (1971).

Parting Thoughts

This will likely be the last blog until mid-July, as I will be taking a couple of weeks off in the beginning of July.  Will as always keep you updated as more data and information are available.  Hope y’all enjoy the beginning of your summer!

Post authored by Jason Halegoua PhD, MD, MBA, FAAP.  Jason is the founder of Peds First Pediatrics in 2009, and has been a practicing general pediatrician since completing residency at Schneider Children’s Hospital in 2004.  In addition to earning his medical degree from the Medical College of Pennsylvania, Jason earned a PhD in Molecular Pathobiology for his work contributing to the understanding of the genetic regulation of immune responses to murine leukemia viruses from Hahnemann University in Philadelphia and an MBA in Finance from Hofstra University.