'They Don't Want This To Happen To Other Children, Other Families In Iowa' — Pediatricians Discuss Kids, COVID-19 And Vaccines

Between school, childcare, sports, family and everything else — every child in this country has been affected by the COVID-19 pandemic.

When it comes to the virus itself, we've learned a lot in the past year about how it affects kids and passes between children and others, and we're learning more all the time.

After the Pfizer vaccine receivedemergency use authorization for kids 12-15, two pediatricians joinedTalk of Iowa to discuss COVID-19, kids and vaccination. Dr. Joel Waddell is a pediatric infectious disease specialist at Unity Point Health in Des Moines, and Dr. William Ching is a pediatric hospitalist at Unity Point Health, St. Luke’s Hospital in Cedar Rapids. They have treated some of Iowa's youngest COVID-19 patients.

Asschools make plans to reopen and the delta variant surgesacross the country, we thought it was a good time to revisit this conversation.

This interview has been edited for length and clarity.

Charity Nebbe: “I want to start with some of the basics. As I mentioned earlier, early on in the pandemic, it became very clear that children were not in the highest risk categories. And early in the pandemic, children really weren't even getting tested for COVID. Tests were scarce. And testing children was not a priority. So Dr. Ching, why don't you start us off, but now we know a whole lot more about COVID-19 and kids, let's start with the basics. What do we know?”

William Ching: “What we know about COVID and children is that for most kids, it remains a fairly benign infection. That being said, there are populations that are more vulnerable to developing severe COVID. And as time goes on, we're getting more clarity on which populations of our children are at risk and how COVID affects them. And also, which children are at higher risk of COVID-related conditions such asmulti-system inflammatory disease in children (MIS-C).”

Nebbe: “Well, and multi-system inflammatory disease, that's something that we'd started seeing fairly early on in the pandemic, it seemed very mysterious and terrifying at first and still is very frightening. What is it?”

Ching: “So it's a syndrome that was originally believed — it's a system of inflammation in different organ systems that initially was thought to be similar to an illness known as Kawasaki disease. But since then, as we see more of it, we've been able to pick apart differences between different types and different presentations of it. And we've been able to have more information on how best to treat it. Dr. Waddell would be a great person to take this from there.”

Nebbe: “Alright, Dr. Waddell?”

Joel Waddell: “Yes, like Dr. Ching said, it's a very serious illness. It usually happens a couple of weeks, two to four weeks, after an initial COVID infection. So a lot of kids we see have asymptomatic disease, and go on, go on to develop multi-system inflammatory syndrome. And so essentially, what happens is, the way I like to think about it is the child's immune system responds to the virus and then just kind of never calms down, and then continues to cause inflammation in all the organ systems. And so we have to combat that inflammation. Children are often admitted to the ICU. And one of the most worrying signs is they will require medications like epinephrine or better known as adrenaline, to keep their blood pressures up, and so we have to aggressively treat this inflammation. And so to treat it, we use multiple different anti-inflammatory therapeutics, kind of simultaneously. One is called IVIg, which is — it's just a lot of antibodies that people have donated, not antibodies to anything in particular, just kind of your common cold viruses. And then we give that to the child. We also give them systemic steroids. And, at times, with severe MIS-C, we have to give them even further anti-inflammatory medications.”

Nebbe: “With children that you've treated, once the crisis is over, what does recovery look like?”

Waddell: “It's pretty remarkable. What I love about my field is these children are quite sick, sometimes requiring multiple medications to keep their blood pressure up simultaneously. They usually are in the hospital for a week or so, often in the ICU, and then when they go home, for the first week or two, they're quite fatigued. And then by the time I see them about a month and a half after their hospital discharge, most of them are back to where they were before. They're back to their normal. However, some of the children who suffer from MIS-C still, as of today, have ongoing symptoms and complications from MIS-C, the most common being, essentially heart failure, where their heart doesn't squeeze or pump blood as much as it's supposed to. And they require medications to help their heart pump appropriately. And we don't know how long that's going to last, because this is a new syndrome that was only first described in April of last year. And so they have to follow with heart doctors and get multiple follow-up imaging studies and stress tests to see when and if the hearts are going to go back to normal.”

Nebbe: “So lots and lots of questions. Can you give me an idea of how many patients you have treated for this multi inflammatory system disease?”

Waddell: “Yeah, I don't know the exact number, but probably around 15 or 16, here in Des Moines. But those children don't just come from Des Moines, they come from all of Central Iowa. And then talking to my counterparts at the University of Iowa, they probably have similar numbers — 15 to 20 in the past year.”

Nebbe: “And are these kids of all different ages?”

Waddell: “That's a good question. And kind of like Dr. Ching was alluding to. It's a little different than Kawasaki's disease. Kawasaki disease, we usually see it in, in preschool-aged kids or maybe young elementary age. But MIS-C often is teenagers, so the individuals who are now eligible to receive the vaccine, and maybe middle school-aged kids. So your infants, young preschoolers, MIS-C is not very common in that age group.”

Nebbe: “And we do know thatthree children in Iowa have died of COVID-19in the past year, all under the age of five. Obviously, that's a low number, but it's — you don't want to lose any children at all. Dr. Waddell, if you were talking to parents right now about the risks of COVID-19 for their children, we do know that a lot of kids if they get it, kind of have the sniffles or a mild cold, and then things return to normal. What do you tell people? Or what would you tell people about the risk of this virus and young people right now?”

Waddell: “You're right, that the majority of children who get COVID-19 are either asymptomatic, meaning they have zero symptoms at all, or they have mild disease. They get fever, cough, it goes away. But children do get sick, and children can get severely sick from COVID-19. I have seen many of those cases, not just MIS-C, but acute COVID, when children have been very sick and hospitalized, including hospitalized in the ICU. It's not a fun thing to experience. And it's hard to watch parents care for their kids in the ICU with acute COVID.”

Nebbe: “Dr. Ching, anything you wanted to add to that?”

Ching: “Yes, people sometimes talk about COVID as being no worse than the flu. The issue is that the severity of COVID in children is still much higher than that for influenza. The hospitalization rates for children is many times that for influenza. And the second part of it is that children who are hospitalized for COVID have a much higher risk of needing significant support for conditions, such as respiratory failure, or shock or other components that are part of acute COVID. And many of these symptoms are — approach similarity with what we see in the adult population. So COVID and children, especially in teenagers and other children who have vulnerabilities to severe illness, such as prematurity, immunodeficiency, children with cancer — COVID can remain a significant threat to their health, and it's not something that you can easily write it off. I've seen, as Dr. Waddell has seen, I've seen quite severe cases of COVID in children that have required ICU care. And it's not a good experience for the family, and I would wish to prevent that if possible.”

Nebbe: “Sometimes I wonder if this disease had come along and had only affected kids at the rate that it affects kids now, but with without the horrors of what it was doing to our older populations, I mean, Dr. Ching, how do you think people would respond if there was this new virus and it affected kids in this way, without all of those other things that were going on?”

Ching: “I think, in part, our approach might be a little different and the same because the measures needed to slow this down would be similar. I don't think the horrors of a pandemic, necessarily, discriminate by age, but certainly the trauma that we feel as a community, as a population, would be a bit different. I think that we all love our kids, and we would do whatever is necessary to save our kids just as we would our relatives, our family, our community members. It would be, I agree with you, it would be different. But it would be challenging in another way.”

Nebbe: “(Dr. Waddell) I would love to hear your feelings about that as well. Of course, I mean, this pandemic has been so big, with so many different elements going on, do you think that we have given too little attention to COVID-19 in young people?”

Waddell: “I think that's a good question. Kind of like you mentioned earlier, initially, during the pandemic, we realized that our older individuals were higher risk, and so appropriately focused most of the attention on the high-risk categories. Now the question of 'have we paid too little attention to COVID in children?' I don't think so. I think that groups like the American Academy of Pediatrics, AAP, have taken a large lead role in paying attention to COVID in children. The one thing I would say is the AAP, and their research infrastructure is not gigantic. And so, there has not been a ton of research from larger research institutes, like the NIH, in children. So that's maybe one area where we necessarily haven't been able to pay as much attention to kids. But overall, I think that the AAP has done a great job at keeping us all updated and informed on COVID and kids.”

Nebbe: “All right, well, how about the public, though? Of course, there's a very different world between medical professionals and what the public hears. And for a long time, it feels like we were hearing from our politicians from our leaders, this message of 'COVID doesn't affect kids,' 'COVID doesn't pass between children.' I mean, that there was a lot of work that went into kind of perpetuating what, I think, is pretty clearly a myth. What do you think about that?”

Waddell: “I think you're onto something there. Yes. I mean, when the pandemic first hit, that was kind of the messaging that we received from, kind of, the top down was that COVID doesn't affect kids, and we now know that that's just not the case. We know that kids can get severely impacted by the virus. And, on top of that, they are severely affected by the pandemic itself. And so I would tend to agree with your assessment there.”

Nebbe: “Dr. Ching, did you want to add anything to that?”

Ching: “Sure. I think a large portion of that myth, as Dr. Woodall aptly put it, comes from priorities, right? We make a diagnosis of COVID based on a confirmed test. So most of the people who are being tested were people who were sick. And during the initial stages of the pandemic, that was limited mostly to the adult population, whereas in most children, if a child comes down with sniffles and doesn't feel well — is it mono? Is it a cold? Is it something that they brought back from school? And rarely would a child get tested, if a test were even available. The second part of this, as also Dr. Waddell talked about, is that research in children's health is drastically underfunded compared to other parts of medicine. So in terms of medication, trials and approvals, as is the case with vaccines, we're last in line. We're the last people who participate in clinical trials if we even do. Recent changes in legislation, pushing for involvement of the pediatric population in clinical trials, have worked towards addressing that disparity. But that remains very much a problem. Especially as time goes on, as this pandemic changes, evolves and persists, it's going to be super important to collect information on how children are affected, not just by acute COVID, but by post-COVID syndromes. We don't know what they are, and also what the effects on their well-being and mental health are. And I think we haven't paid enough attention to that yet.”

Nebbe: “There have been a few stories in various media publications about kids who have gotten very sick from COVID over the past year. For this program, we weren't able to convince a parent to join us, and my sense is that a lot of parents are really uncomfortable talking about their kids' experiences with COVID. So I have anecdotal stories that I've picked up from people who know people. For example, I know about a 13-year-old girl in rural Iowa who had COVID in January. A couple of months later, her heart rate started spiking, and doctors don't know for sure that that's from COVID-19. But she's now on heart medication. And we have, you know, not only seeing these stories about the multi-organ inflammatory syndrome, but we've also seen, in particular, teenagers getting severe COVID with the symptoms that adults get. And it feels like a lot of parents don't want to talk about this. And you know, I can only speculate why. I'm sure that we all carry around a lot of parent guilt. So there's that worry and worry about blame, and worry about any kind of stigma that their children might carry. Dr. Ching, of course, working with children and working in a hospital as you do, you've seen these cases firsthand. So you have a much stronger understanding of what's going on here. So in addition to some of the messaging that we've had, it feels like COVID is kind of invisible among children to the public. Do you feel that's true?”

Ching: “I think the myth that it doesn't affect children has colored a lot of that. And also the second part of it is that with COVID, the challenge for us as physicians is our toolbox for handling it is not, is not so much optimized. But let's just say refined to address it. Well, because this is a new syndrome, especially in children, and our fortunate experience is that children who that is the rarity of severe COVID in certain populations of children, specifically early school age. However, as the physician treating a child and a family who has severe COVID, it's a day-by-day experience. It's a marathon because each day is different. Each day there are changes. And we, as a team, involving the entire healthcare team, as well as family and the child, talk through our options, what we know, what we don't know, and how do we go forward, and what to expect if, if we can give that advice in the next hours or days. And that's nerve-racking. And, the causes of ICU syndrome or ICU syndrome in families, it's a very traumatic experience, and I have absolutely the utmost regard for families who've been through this and understand a reluctance to talk about it, because it's still relatively fresh.”

Nebbe: “Dr. Waddell, did you want to add anything to that?”

Waddell: “I would agree with Dr. Chang. I mean, it's a very complex, emotional process to go through when your child has severe COVID or MIS-C. One thing I've noted though is children who have MIS-C and are hospitalized, I see them all in my clinic for follow-up after they're discharged. And, almost uniformly — I can't even I can't think of a patient or family off the top of my head who hasn't said 'how can we help?' Meaning they've all wanted to be involved or referred to research studies on children who've had MIS-C, because they don't want this to happen to other children, other families in Iowa. And I know of a couple who have gone on to their social media accounts or a couple of local news stations and have said 'you got to take this thing seriously in children.' And so it's, I think, for some families, understandably, they don't want to talk about this significantly, but others want to scream from a rooftop: 'Hey, you have to take this thing seriously for your children.'”

Nebbe: “Well, I also wonder about the mild cases, as well. I've had several people tell me, in confidence, in strict confidence, 'you can't tell anyone,' 'you can't tell your kids that my kid had COVID' or tested positive for COVID. It does feel like there is a stigma or a shame, or just a fear, about being open about this virus. Dr. Ching when you talk with parents, when they want to talk to you about kids and COVID, and they haven't had this personal experience, what kind of questions are you getting from parents right now?”

Ching: “So the questions I get stem from what they hear. It's questions such as, 'is this really that serious?' Or 'is this quarantine for real? Does it help?' Or 'is physical distancing useful?' 'Are masks helpful?' 'When will there be a vaccine?' These are the questions that we — there are questions that we get about many other infectious diseases, but tinged with a certain element of 'this is new, we haven't experienced this before. The closest thing we've come to this is the flu. What's the difference? And why should we worry about this?' That was in the beginning of the pandemic. And the questions have evolved over time, as we've seen different parts of the world affected differently by the pandemic. But many of those questions, especially with regards to the knowledgeability, for vaccines, are popping up again. And they're good questions.”

Nebbe: “So are they easier to answer for you now than they were at the beginning of the pandemic?”

Ching: “I think so. Yes. Because we have more information on how people have done with COVID infections, we've been able to answer questions better with evidence and data. For example, one of the questions that has been asked about COVID vaccination is its effect on women. And now we have a lot more data from different countries that tells us about this potentially severe impact that COVID has on pregnant women, and also safety information on vaccines that have been given to women, who subsequently have a child. So armed with that new information, we can more confidently answer those questions.”

Nebbe: “Yeah, well, and that is one of the questions that you see coming up quite a bit with people who are nervous about vaccination. And we will dive into this more deeply. But just since you referenced it, if people haven't heard these, there are people who areconcerned that the vaccine might affect fertility. We've heard quite a bit of anecdotal evidence that sometimes women will experience a heavier period after receiving a vaccination. But we also know that COVID itself is associated with a higher risk for pre-term birth. And Dr. Ching, you're saying we're not really seeing that there is a risk to fertility with this vaccination?”

Ching: “So with the evidence that we have so far, and this is including millions and millions of doses given in study populations out there — certainly in the clinical trials of women who received the vaccine, there were no changes. There wasno increase in pregnancy outcomes or bad outcomes or complications compared to the placebo group. So that is a great piece of information.”

Nebbe: “And before we dive into the vaccines a little more heavily here, you mentioned all these questions that you're getting from parents. But let's answer a couple of those questions. Dr. Ching, I mean, when they asked, 'Do masks really work, does distancing really work? Do these quarantines work?' What are we seeing from school districts that are following those policies?”

Ching: “What we've seen out there is that, yes, so many of these measures come from studies that were done looking at, for example, the mask. A lot of the mask data comes from studies where certain particles were pushed through masks of different kinds. So those are lab studies. But we also have seen since then epidemiological studies, not just on a small scale, where people in certain enclosed spaces had experienced a cluster of infections. And they subsequently determined that the people who got the infection were all in line of ventilation, of a stream of air, that was being pushed through from the ventilation system. We're also seeing that people who are outside have a much lower risk, that the risk of infection decreases as physical distance increases. So we have progressively better and better evidence confirming that the measures that we have been recommending, such as masking, physical distancing, limitations of numbers of people in an enclosed space, improvement of ventilation, that these work, not just in the lab, but also in the real world. One great example that we've seen is a gym that installed a new ventilation system, and they've, as far as I know, as of now, have had zero cases that have been traced. So their machines are appropriately distanced. Everyone wears a mask. The facility is well ventilated, including to the outside, and they've done fantastically well. There are ways we can make this work and we have good data that shows that they work.”

Nebbe: “We're going to be focusing on vaccination, obviously, that is on so many parents' minds right now, now that the Pfizer vaccine has been authorized to use in children between the ages of 12 and 15. Dr. Waddell, obviously, parents are responding to this in different ways, just as people have responded to the vaccines for adults in different ways. Tell me what your response has been to the news that the vaccine was approved for kids 12 and up.”

Waddell: “My personal, I have been — joy, honestly, is the first word that comes to mind. Like Dr. Ching was talking about earlier, oftentimes clinical research in children lags years behind the research in adults. And so the fact that we have now very, kind of early into this pandemic, a vaccine that is safe, that is effective for children is amazing and quite exciting.”

Nebbe: “And how do you think this changes, obviously, it changes life for families. Specifically, I have a 13-year-old and a 15-year-old, and I'm also very excited to get my kids vaccinated. It feels like now is when our family will really start reaping the benefits of vaccination, at least, it will allow us to do things that we haven't been able to do, although we're incredibly grateful that we've been able to spend time with grandparents already because of their vaccines, and because of the vaccination my husband and I have received. But how do you think this changes life for families that choose to get their teens vaccinated?”

Waddell: “So you hit on some key points there. So it does a few things. So first is, and most importantly, is it protects your child from the potential of developing severe disease from COVID. But then, more immediate effects would be, it's going to make — I should back up, we have asked a lot of this generation of children: We have asked them to not see their peers. We have asked them to do Zoom classrooms. We have asked them not to see their grandparents. We have asked a lot of them. And so this vaccine will allow them to go to the grandparents, would allow them to stay overnight at their friend's house and, in the summer, allow them to go to the camps — summer camps, baseball camps, etc. SoI think that there is an immediate benefit of giving this vaccine. I think it's going to loosen things up a little bit in terms of what activities are safe.

Nebbe: “Well, and Dr. Ching, how does this affect herd immunity? Of course, this is largely theoretical, as of yet, but looking ahead, how do you think this could impact the pandemic?”

Ching: “I think this is huge because for quite a few infectious diseases, such as those that we see during the winter or other ones that are seasonal, children are a very big reservoir for the virus. So basically, the infection goes to children. Children pass on amongst themselves. Frequently, the children don't necessarily get super sick, but then they can pass them back to other populations. So having the ability to vaccinate children — and, let's note that the efficacy of this vaccine in the trial is amazing. Of the children who received the vaccine, zero developed COVID. Zero. And for the safety of the vaccine, there were no serious events that were related to the vaccine. There were no clots, no serious allergic reactions, no Bell's palsy, nothing that had been feared, that could have come up when we were looking at expanding the eligible population for the vaccine. I mean, this is incredible. And the ability, just like Dr. Waddell said, to return to normal activities is the biggest thing. I mean I'm a molecular biologist by training, and this technology is a dream. The ability to generate a vaccine that targets the virus so specifically, with such purity of its materials is unprecedented. And the ability for our kids to get together again, to run around, to sleep over, to go to camp, to go to a theme park, without needing to distance, without having to quarantine for 14 days. These things are game-changers that will do so much to restore normalcy for our children and our families.”

Nebbe: “We have some parents who have questions and also want to share their experiences. Richard is on the line in Dubuque, I think, with one of the most common questions. Hello, Richard, what is your question for our doctors?”

Richard: “I'm really curious on how they can claim the safety and the effectiveness of a so-called vaccine that hasn't been out for very long?”

Nebbe: “Okay, let's not call it a 'so-called vaccine' because it is a vaccine. But, Dr. Ching, I know that is a question that a lot of parents have. It was developed very quickly and tested very quickly. And I will just throw in here that one of the reasons that it was able to be tested so very quickly is because of the prevalence of this virus. If the virus had been less prevalent, it would have taken longer, but there's been a whole lot of COVID around. But Dr. Ching, respond to Richard's question.”

Ching: “So the safety questions look at different types of events. And the concern is, 'was this developed too fast?' Was the testing done too quickly?' And the answer to that is that most side effects or adverse events will happen within the first 60 to 90 days of administration of the vaccine. This has been the case with pretty much every vaccine that we give to children and adults, as far as I know. So the fact that we haven't seen this, in our trials so far, is very, very encouraging. And we continue to perform surveillance. So, anyone who gets a vaccine, the CDC maintains a database through V-safe and tracks all of this. The recent concern about a rare blood clot, with the administration of the Johnson & Johnson vaccine was caught by this surveillance mechanism, which tells you that it works. And that we haven't seen this is very, very encouraging. Is it 100 percent? We can't say that. That's impossible. But I'm very, I am very hopeful and reasonably confident that as time goes on, this safety track record will be borne out. And if there is a problem, if there is an issue, we will catch it and address it. But out of the adolescents who have received the Pfizer vaccine in this trial, that we haven't seen anything serious is, is very encouraging.”

Nebbe: “With the vaccine, I know a lot of people have done quite a bit of research trying to understand what mRNA vaccines are. And we are talking specifically at this point about thePfizer vaccine. You mentioned the Johnson & Johnson vaccine, but that has not been approved for anyone under the age of 18 at this point, so that's not really in play at this moment. But when you look at the Pfizer vaccine, Dr. Ching, help us understand. You talked about really, how miraculous and clean this vaccine is. Explain what that means.”

Ching: “Sure. So, typically, with other types of vaccines, there are many different kinds. So the idea behind, the technology behind the vaccine is that the vaccine causes a certain antigen to be presented to the body so that the body recognizes it as foreign and develops an immune reaction to it. And then, subsequently, when presented with the real thing, it's already been primed, because typically an immune reaction can take weeks to fully ramp up. So this is, kind of the, shall we say like a practice run for the body's immune system. So the way an mRNA vaccine works is that mRNA is messenger RNA, it is a sequence that, in the routine operation of the body, is what the body makes from DNA. And then is translated to protein. So the normal progression is DNA into mRNA into protein, and then the protein does its thing with the vaccine. It's a specially designed mRNA that will cause, that encodes for a spike protein, and the spike protein is one of the main antigens in the SARS-CoV-2. So, with this, there is only one protein that the vaccine tells the cells that where it's injected to make and present for an immune response. The other components are several different lipids that make a little bubble around the mRNA so that it can be transported and appropriately taken up by the body. So it basically means that instead of a mix of different antigens, there is only one that is presented.”

Nebbe: “Let's go back to the phones. Jodi is on the line in Ames with a question. Hi, Jodi, what is your question?”

Jodi: “I'm trying to encourage my grandson a little more to get the vaccine. I am in my mid-50s. I have a couple of immune deficiency diseases. I have a rare blood clotting disorder that is genetic. And I got the vaccine because of what COVID could do to me. And also, I don't want to be the spreader of it. My grandson is 13. He has a couple of pre-existing conditions, and I would highly encourage him, I am encouraging him to get the vaccine, but he has a lot of reservations. And I'm trying to teach him, also, to make his own rational decisions. You know, he's 13. He thinks he wants to be a dad someday, and so he has these — he's heard from other people that it could cause some kind of reproductive issues. And also he, you know, it hasn't been approved by the FDA, so he doesn't want to be a 'guinea pig.' So, I don't know. I guess that's just ... I don't know how to encourage him that it's safe. You know, I also am a lab technician. So I have a little bit of understanding of this mRNA stuff.”

Nebbe: “Well, that's a great question, Jodi. It sounds like you're doing a good job, answering questions. Dr. Waddell, what would you say to Jodi? Yeah.”

Waddell: “When it comes to the safety of these vaccines, it should be noted a couple of high points. Number one, the Pfizer vaccine has gone through the same safety trials and the same safety stop points that every other vaccine has gone through. It seems like it's gone through quicker. I mean, it has gone through quicker, but it doesn't mean any safety shortcuts were taken. Usually, when you have a vaccine development, you go through a phase one trial. You invest millions of dollars, and you don't start phase two until months or years after phase one is completed. You don't start phase three until phase two is completed. And here, the federal government, in addition to private companies, invested billions of dollars in every phase of the trial simultaneously, so there was no lag period, like we're waiting to distribute. And so it would not go through the FDA and the CDC, they would not approve these vaccines for children if it was not safe. And so it is safe for children. And the other common question I get, and kind of alluding to the previous caller: How do we know there's not going to be long-term side effects? There has never, in the history of vaccine development, there has never been a vaccine developed where a long-term side effect was only seen years or decades later. It has never occurred. And so the fact that we've already seen that it's safe in children and adults means there's no scientific reason or historical reason to think there's going to be long-term side effects we have not reached. And, more practically speaking, to a 13-year-old, doing this vaccine is going to let you do the things you'd like to do. I mean, it's going to let you get out and meet with your friends and continue going to classes.”

Nebbe: “It also sounds like an opportunity maybe to talk to a family doctor and get those questions answered by somebody they know and trust. Dr. Waddell, does that make sense to you?”

Waddell: “That makes 100 percent sense. I think our family doctors and pediatricians, they're kind of the boots on the ground. Like you said, you already have a relationship with that provider. Call them, talk to them. That's what they want you to do. They're begging you to call.”

Nebbe: “Alright, and Deb is on the line in Wilton, and Deb your child just got vaccinated this morning?”

Deb: “Yes it's been, took a long wait for this. Our whole family has been vaccinated since January because we're essential workers and health care workers. But my 15-year-old daughter with severe asthma, it's been so hard waiting. So as soon as I heard that it was going to be approved this week. I started calling to make an appointment, trying to get an appointment, and explaining to the pharmacists 'Yeah, I know she's not approved yet, but she'll be approved by Wednesday.' And so we almost didn't make it today though, because she got a fever a couple days ago, and we had to get COVID testing for her, but she was cleared. And now we're back. We got that first vaccine in the arm and just can't tell you how excited I am about that.”

Nebbe: “Oh, Deb, that's fantastic. I know there are a lot of kids excited to get a shot for the first time in their lives.”

Deb: “Yes , it's like ... we can start breathing again. We don't have to fear that something horrible is gonna happen to her if she gets COVID.”

Nebbe: “Well, Deb, thank you so much for your call and congratulations. I'm glad you were able to get in. Dr. Ching and Dr. Waddell, thank you both so much for being here. And this does feel, Dr. Ching like a really exciting moment.”

Ching: “I'm so thrilled that we're seeing the light at the end of the tunnel. And our ability to protect our children and our families, we feel so relieved and also hopeful that we will get back to normalcy with this, with vaccination.”

Ching and Waddell made their comments on a May episode of Talk of Iowa.