On this episode of the Bespoke Parenting Hour, host Julie Gunlock talks to Dr. Lucy McBride about her viral Atlantic article that aimed to reassure parents about COVID and vaccines and why she takes a compassionate approach when discussing this tough issue with parents. Julie and Dr. McBride also discuss the Pfizer vaccine for 5- to 11-year-olds, natural immunity, the actual (and positive!) data on COVID and kids, and the ongoing debate about mask mandates in schools despite low rates of child infections. Tune in!
TRANSCRIPT
Julie Gunlock:
Hey everyone. I’m Julie Gunlock, host of the Bespoke Parenting Hour. For those new to the program, this podcast is focused on how parents should custom tailor their parenting style to fit what’s best for their families, themselves and, most importantly, their kids. Protecting children from danger is a fundamental instinct for moms and dads, and it’s the most basic role we play as parents. But life is not free of danger, sadly, and tolerating risk for our kids is just a part of the job, unless of course, you want to wrap them up in bubble wrap and lock them in the basement. That is something I’ve considered at times, but I hear doing that has a few downsides as well. So we parents constantly have to make decisions and do risk-benefit analysis to make sure those decisions are the correct ones. But that is really hard to do when it involves your own child, especially in the age of COVID.
So here to talk to me about this is Dr. Lucy McBride. She is a practicing internist in Washington, DC with two decades of experience. Dr. McBride is also a Bloomberg New Voices Fellow. I think I messed that up. Bloomberg New Voices Fellow. A healthcare educator, mental health advocate, and she calls herself, I love this, a healthcare disruptor. She’s working to increase awareness of the intersection of mental and physical health. Last month, Dr. McBride wrote an excellent article for The Atlantic called “Fear of COVID-19 in Kids Is Getting Ahead of the Data.” It really stuck with me, it rattled around in my head and I was thinking about it for weeks after it was published. So I’m just thrilled that Dr. McBride is here to talk to me about it today. Dr. McBride, huge thanks for coming on.
Dr. Lucy McBride:
Thanks so much for having me. I’m thrilled to be here.
Julie Gunlock:
So I want to get right to your article, but I want to make this comment. I think one of the first things that struck me about your piece was, it’s a very clear compassion for the fears that parents have about COVID because—I’m just bottom lining it here—you try to reassure these parents who are feeling afraid. But you don’t make them feel silly for feeling afraid, you don’t make them feel stupid for being worried. Right off the back, you tell this pretty hilarious story about your son asking to borrow the car keys and your own worries. And I chuckled when you said before he left the house, you reminded him to use the windshield wipers and the turn signals.
Dr. Lucy McBride:
Right.
Julie Gunlock:
Which I could just see. I have a 14-year-old, so I’m right before that stage. And I can see myself like, “Remember when you turn right, use the right turn signal.” So I could really relate-
Dr. Lucy McBride:
Yes.
Julie Gunlock:
… to that. And I thought it was a great way to open this essay that you wrote. So just before we get into the meat of the issues, why do you think compassion and relatability are important in your writing, when you’re communicating with parents?
Dr. Lucy McBride:
So the glue of any relationship, particularly the patient-doctor relationship is compassion and empathy. So I can’t make much headway counseling patients to change their behavior, or be safer with regards to their health, if I’m shaming, blaming, judging. Same thing with teenagers. My kids love to call me captain obvious when I recommend, “Turn the headlights on when it’s pitch black dark.” We all know that this is mom’s anxiety just unbridled. But they still hear me, they hear the concern, they hear the compassion, I hope. The same applies to patient care. So there’s no role for shaming and blaming patients. First of all, it doesn’t move the needle. Secondly, it doesn’t breed confidence or trust in anything I’m saying. And thirdly, it’s just not appropriate. So right now in the country, we are dealing with a whole lot of hot-button issues.
People are not only trying to make difficult decisions in their everyday lives, but they’re confronted with a deluge of mixed messages and stressful information. So what I’m trying to do in my public-facing role is cut through a lot of the shaming and blaming and false dichotomies. Because that’s what I do in my office every day, is help people, meet them where they are, understand their unique health issues, risk tolerances, preferences, which may be different from mine, may be different from my patient right before them. And to help guide them to a place where they can be healthy and well, for whatever that means to them.
Julie Gunlock:
Are you accepting new patients? You sound so nice, I want you to be my doctor. Okay, I’m kidding.
Dr. Lucy McBride:
You’re so nice. I would like… Yeah.
Julie Gunlock:
We can talk about that later, it’s a little off-topic there.
Dr. Lucy McBride:
And here’s the thing, like with anything, I don’t want to… So there’s this concept of radical acceptance. That we have to radically accept that there are harms everywhere, that life is not risk-free, that there are dangers of driving a car, getting into a pool, being in a sexual relationship, walking out your front door carries risk.
Julie Gunlock:
Exactly.
Dr. Lucy McBride:
So my job isn’t to sanitize the planet for my patients, but rather to arm people with the tools to manage the inevitable threats that we face every single day. The problem with COVID is that it has shined a light on the fact that we are walking risk factories.
Julie Gunlock:
We are. And what I see increasingly… It’s funny, I can tell I’m going off my script now, because I want to talk to you about 15 things you just said in that statement.
Dr. Lucy McBride:
I know.
Julie Gunlock:
But I do want to address one thing. I feel like this COVID response has increasingly become a zero risk response, where we’re looking for COVID zero. Where we’re putting all these measures in place that have never been in place for other infectious diseases. You get vaccinated for the measles, and the measles shot is not 100% effective. There are people who are still going to get the measles if they come in contact with it, even though they’re vaccinated. And yet we’re not having kids mask for that. I’m going a little too far off a tangent here, but my point is, I want to go back to that zero risk. Do you worry about that? About-
Dr. Lucy McBride:
I do.
Julie Gunlock:
And how do we pull that back? I think, for instance, you are a doctor with quite a microphone, publishing in the Atlantic, you can push back on that. But how can the medical community writ large and public health push back on that? Because I’m not sure that they are pushing back on that necessarily.
Dr. Lucy McBride:
Well, it’s interesting. The voices that are out there that are pushing back on the zero COVID public health posture, don’t get in my opinion as much air time as the voices that come from a place of very low-risk tolerance, vis-à-vis COVID. So let me be clear: COVID is a wretched beast. I’ve had patients die from COVID, I’ve had patients in the ICU from COVID-19, I have people with long COVID. I have patients who are immune-compromised, organ transplant recipients. I am not blasé about COVID whatsoever. My job, however, isn’t simply to protect people from COVID-19, it’s to protect them from all harms. Whether it’s RSV or diabetes, obesity, binge eating, trauma-related suffering, depression, anxiety. Indeed, we are layered complex organisms that are not just about one single body part or organism.
So you’re right. Before the appearance of vaccines in December 2020, it was more appropriate in my opinion, to be afraid. We had this tiger in the wild, on the loose, and we didn’t know who it was going to strike, we didn’t know when it would strike, it was invisible and ubiquitous. Once vaccines came on the scene, and once every American over the age of 16 was eligible for vaccines in April 2021, we started to cage the tiger. The vaccines are extraordinarily effective. They basically take your risk of death and severe disease way down, and turn the virus into its wimpy-er cousin, which is a cold or a mild flu. Three of my patients have breakthrough infections right now, but they’re not that sick. So the point is that it’s appropriate as we do in medicine and public health in general, to pivot the messaging to the public on how we’re going to move forward as we contain a virus like we are.
Now, this is a regional epidemic. So there are places in this country that are surging, but there are places where the virus is not surging and where people are vaccinated, and the risk of getting COVID is much less. So, I’m rambling too now, but let me just say that there are real harms of a hyper-focus on COVID risk reduction in the public space and also in our personal lives. That’s not to say we shouldn’t care about COVID, but it is to say that once we have vaccinated and we have taken the claws and the fangs away from the virus, we, as individuals can start to, and I hope we are, and I’m doing this with my patients, open our eyes to the other threats that are a part of our everyday life. Like social isolation, our relationship to food. These are the things that people are struggling with more than they are with COVID right now, once they’ve been vaccinated.
Julie Gunlock:
Well, this leads us a great lead into my other question about, this sort of zero risk and this continued measures. I myself have put off certain doctors’ appointments because I don’t want to go in, or I’m worried, or am I monitoring my own health? And I know for sure we have data on this that people have had to put off cancer treatments, or haven’t gone to the doctor so their cancer hasn’t been detected. You must worry about that as well, about how this will affect not only your current patients, but just in general people out there ignoring warning signs, or ignoring their regular checkups. Has that gotten worse, or are you seeing people starting to pay more attention to their health outside of COVID?
Dr. Lucy McBride:
I think people have put off their routine medical care, and I think people have really sidelined their everyday health in many ways, out of necessity. When people are trying to manage parenting, caregiving, working, managing chronic illness, caring for elderly parents and children, all of that takes a toll on a body. And as I say to patients all the time, you know, health is more than just the one day a year you see me, it’s the 364 days a year you’re not in my office. So putting off your colonoscopy and mammogram is not ideal, and many people have done that. And I have one patient who has breast cancer that would’ve been detected in 2020 had she gone for her mammogram, no shame, no blame on her at all, it just was situational.
But what I’m seeing much more commonly is people just sidelining their regular health habits. Like sleep, routine, exercise, eating-
Julie Gunlock:
Alcohol. Yeah.
Dr. Lucy McBride:
… alcohol intake, these mundane everyday habits that you have, have gone off the rails for many people. And that is health, too. Health isn’t just getting your mammogram or checking your cholesterol, it’s about, how do you feel in your body every day? What’s your relationship to food, alcohol, your spouse? There are plenty of marriages that are breaking up. There are plenty of marriages that are struggling. There are plenty of people who are having trouble at home domestically. These things are part of our health profile as well, and unfortunately are not being looked at like they should. I’m hopeful…
This is what I hope and COVID has really laid bare our vulnerabilities, medically, psychologically, societally. And it does provide, if you will, an opportunity to look at what it means to be healthy, from a societal standpoint and from an individual standpoint. And to me, it’s more than the absence of COVID-19. It’s about having tools and information and a non-judgmental guide hopefully, that’s not just someone on the internet, to help you be healthy mentally and physically, the best you can every day. Because again, when we hyper-focus on a single pathogen as we have for the last 18 months, somewhat out of… If you focus on a single pathogen like we have for the last 18 months, of course out of necessity, you run the risk of losing sight of the big picture. What is health?
Julie Gunlock:
Well, let’s expand that big picture a little bit more to… And it’s funny because I feel like this podcast originally was supposed to be, looking at… because the whole point is tailoring your parenting to what best fits you. So you have a lot of parenting experts out there saying, “This is how you do it.” And it’s not just parenting experts who seem to get that parenting comes in all different shapes and sizes, but it’s more the mommy blogger set, and a lot of entertainment figures will say, “Oh this is how you should do it. This is how you should feed your children.” And I always laugh at the Bento Box mommy, who makes those lunches in the morning, and I-
Dr. Lucy McBride:
I was never the Bento Box mom.
Julie Gunlock:
Oh. But I will tell you, the parodies are hilarious on the… So I thank God for the Bento Box mommy, because she birthed all these parodies on her, so. But I will say, originally I wanted this podcast to focus on, for instance, parenting while you’re dealing with illness. Divorced parents, how do they deal with the transfer of the kids or whatever. Or working moms versus stay-at-home moms or homeschoolers versus… But then COVID hit and it’s basically been a lot of COVID as you can imagine. And frankly, I was fine with that because that’s really what I wanted to talk about and I think a lot of people wanted to hear about, but I do.
And so I’m trying to get back to the original reason for having this podcast and talk about different forms of parenting and different styles. But I do think it’s… Since you’re such an authority on this stuff and you’ve written about COVID and I know you have a newsletter, which I want you to talk about as well. But your article, and going back to the Atlantic article that I mentioned—let me find the title here—“Fear of COVID-19 in Kids Is Getting Ahead of the Data,” I really can’t say firmly enough how you should Google that, find it on the Atlantic… I don’t think it’s behind a paywall; I read it again today. And read it, because it is thick with data and reassuring facts.
And Dr. McBride, I just want to take a moment to… you say, “Delta is not more lethal than prior variants, it is more contagious. But also good news, it doesn’t seem to target kids.” Similar to the other variants, it’s not like it has a laser eye for kids. You reminded people that of course, it’s going to look grim when it seems like suddenly more kids are getting infected, but you make the important point, “You got to remember, it’s because more adults are getting vaccinated, so it only leaves this pool.” You think of the pool of people left for this disease; it’s hopping around looking for a happy host. It’s of course going to have more kids because that can get sick, because more adults are getting vaccinated.
Because again, you’ve never said that it may not target kids, but kids can still get infected. You cite a report by the American Academy of Pediatrics. It shows that 0.9% of COVID-19 cases in children have resulted in hospitalizations. Again Dr. McBride, I have to say, you see that and you’re like, “Oh wow.” You can exhale and you say, “A slight increase since the spring, but well below the corresponding percentages of most last year.” And then you say, “0.1% of infections have resulted in death.” This is among children. So okay, I’m reading that and feeling great. And then I turn my news on or I send my kid off to school and, despite all this good news, there’s tons of panicked parents.
And many of those panicked parents are still agitating for almost daily testing in the schools, that’s at least happening in my community. And masks, constant mask-wearing by kids. Before we went on air, I had mentioned to you that I had interviewed Emily Oster, who has been very vocal on school openings and tends to agree with CDC on mask guidelines. And I know people are torn on that because I think in Emily’s view, it’s like, “Hey, anything to get the schools open.” But I’d like to get your opinion on the mask situation.
Dr. Lucy McBride:
Sure. So let’s start at the top with the data you cited in my article, which by the way is evolving. That article was written in-
Julie Gunlock:
August.
Dr. Lucy McBride:
… August. But still it’s true that the Delta variant has not been shown to be more lethal in children. It is infecting more children because kids are the ones who are not vaccinated. The kids account for a larger share because more adults are being vaccinated. You also read the headlines that are terrifying. So both things can be true. You can have a statistic that shows that on average children are relatively low risk for severe outcomes from COVID. And you can have kids tragically, horrifically dying in ICUs in our country. So we can hold a paradox, we can understand and we can empathize with those families, that there is death and destruction.
We can also understand that in general, our risk for our children is relatively low. And that is not to dismiss the very real lived experiences of families who are struggling with COVID-19 or, God forbid, have lost a child. So in general, we know that kids don’t get terribly sick from COVID-19, if they get it at all. But that’s cold comfort, of course, if you’ve lost a child. One of the things that I’m seeing is that… and I witness this all the time in my patients who are parents, particularly of young kids, age five to 11, is that the constant drumbeat of panic and fear-based messaging is causing people to have a lowered risk tolerance than they did pre-pandemic. When they would send their kids to school like you and I did, during flu season, during RSV season.
It is not to say that it’s okay, that kids are dying from RSV or the flu. It’s not to say that the flu and COVID and RSV are the same things, they’re not. What I’m saying is that the public space is filled with panic-inducing narratives, some of which is based in reality, of course, because there’s awful tragedies happening. But that is in my opinion, out of proportion to what the facts show and that trigger people’s anxiety. There’s already forest fire because of the situation we’re in. When we are feeling out of control and uncertain, and when there’s a ubiquitous threat to our children, the most precious animals on the planet, it’s normal to feel fearful. But the problem is that fear begets fear when the media, which of course I respect in many ways, of course, is stoking that fear. And I don’t think it’s malicious in every case, I really don’t. I don’t think that-
Julie Gunlock:
I think media is like a normal person in many cases, they don’t have a medical degree either. So they’re like me, they’re sort of aha.
Dr. Lucy McBride:
That’s right. So I don’t think it’s malicious. I don’t think necessarily people have mal-intent, but I do think, just like you read about plane crashes and you might get-
Julie Gunlock:
Yes, good analogy.
Dr. Lucy McBride:
… anxious about flying… We are watching this terrible situation play out, but we also need to realize what the facts are. And it’s really how I help my patients one at a time, is by bringing the facts into the room and understanding how to calibrate our worry, which you’re entitled to, of course, to your particular situation. Because we all are different. We all have different risk factors, we all have different vulnerabilities.
Julie Gunlock:
Well, it’s interesting that you use the airplane analogy. Because I remember we used to travel a lot when I was little and my dad would always say, “Julie, there’s only like…” My dad was Mr. Data nerd and he would always say, “Julie, there’s only 0.4 airplane crashes a year or something.” He’d say something, and I was never comforted by that, and to this day, I’m not comforted by that. Because you know what? You’re going to say… It’s just like that 0.1% of infections have resulted in death. You’re going to be like, “That’s going to be my kid and I’m going to be on that airplane.” You can always make it.
Dr. Lucy McBride:
You always make that… Yes. And one of the ways I help people and doctors hopefully help people manage this unbridled fear, which again is often rooted in reality, is by recognizing the things that in our environment, may be triggering that fear, uncertainty, the unknown, constant deluge of messages from people who may not have expertise in that particular area. And then so… I’m not being very eloquent because it’s the end of the day. But one of the ways we help people manage anxiety is by helping identify what the triggers are and naming the fact that we are in a very unique time where people feel uncertain and anxious. And so if you can name that and understand it…
Julie Gunlock:
But back to the mask issue, do you think it is this sort of… and I get the irrational fear, but also rooted in truth and rooted in fact. Look, I want to talk to you about your expertise in the medical field and I don’t want to make this a political conversation, but we know there have been political influences on this masking stuff. We do know this, there are emails-
Dr. Lucy McBride:
Oh, yeah. Masking… Yes.
Julie Gunlock:
Yes. So I’d like your opinion. No. What frustrates me is we talk about masking and masking, fine, get the schools open, but there are tremendous downsides to masking, including to special needs kids, which…
Dr. Lucy McBride:
Yes.
Julie Gunlock:
… we talk about the demographic that’s totally ignored in this country. And kids who might face abuse at home and homeless kids and LGBT kids, and other kids that are really struggling, who might not have good strong foundations at home, and again, the kids who really struggle educationally, special needs kids. And so I’m wondering about your position on masks in terms of… I get why parents might be wanting them, but what’s your opinion? Do you think that’s the right thing to do, to mask kids eight hours a day, especially teeny, little kids?
Dr. Lucy McBride:
So I think that masking, as you just said, has become a hot button and politicized issue. It’s become, on the one hand, this symbol of trying to control the uncontrollable. And then the other side, it’s become this symbol of, “Do not try to control me with something that doesn’t have scientific backing.” There’s nuance all around. We have some pretty good studies to show that masks, not surprisingly, if they’re good quality can reduce transmission, but of course, it depends entirely on the environment we’re in. So a mask might work and probably would, it makes intuitive sense, if you are in a room full of unvaccinated, COVID-positive coughing people. You’re going to get a better benefit out of that mask, than if you’re in a classroom where every person is vaccinated and there’s good ventilation and people have been careful.
So my point is that the efficacy of masks is on a broad continuum. The mistake we’re making in the public square is to think of masks as this magic wand that is going to make the risk go away, or think that there’s no role for it. We also need to balance the harms against the benefits, as you just said, for certain kids, particularly kids who are disabled, kids who have social anxiety and, for many kids, the harms of masks are real. I think, for most kids, even kids who say that, “I don’t mind masking,” I would imagine they’re… How do I say this? Even kids who are quote unquote pandemic proof and seem not to mind masking, I think I would imagine, and this is an assumption, would rather not think that the air they breathe is potentially dangerous. Now that’s hard to study because that is a hypothetical and a subjective concept. My point is that we cannot mask forever.
We need to understand that masks are one small intervention and certainly compared to vaccines, pale in comparison to the efficacy. And that at some point we need to have off ramps. And what would be really nice is for public health institutions and experts in the medical space, would be able to come together and articulate clear goal posts and endpoints. For example, if we got to a place where like in June, July 2021, where we had case rates in the 20 per 100,000 range, which is relatively low, could you then in a school that was mostly vaccinated, take masks away? I would argue, yes. You could make the argument to take masks off right now. Basically, it comes down to a societal risk tolerance and then a personal risk tolerance. And at some point we have to decide that risk is everywhere, we’re going to face risks whether we mask or not, which risk is worse?
Julie Gunlock:
Well, I think I also do, to be honest with you, I worry a little bit about the next generation of kids who… For instance, my 12-year-old. And I really can’t stand on Twitter when people go, “When my 12-year-old said, oh, why is that man so bad?” I’m not about to do one of those things. But my 12-year-old has asked, “Why do I have to wear a mask when I’m vaccinated?” And having that conversation with him, I’m like, “Well, because Governor Northam wants you to.” And essentially, that’s what I do. I say, “The Virginia governor has mandated, I have no other answer for you.” But I do wonder because… and I know you are, we’re obviously two very pro-vaccine people, but I wonder about, you have a child, they get a shot, they might have some chills and feel sick for two days and then after that, they still have to put a mask on, not a great lesson. Not a great lesson when you compare that to-
Dr. Lucy McBride:
That’s right. Well-
Julie Gunlock:
… you compare that to the ’50s where people were winding up to get their polio vaccines and other vaccines, and they went back to normal life. So I do wonder about that, how that’ll affect this generation of kids. Will they say, “What’s the point?”
Dr. Lucy McBride:
Yeah. What’s the point and also, we have these on ramps of all these restrictions, what about the off ramps? And I think we all had some emotional whiplash when the CDC went from saying, “Vaccinated people can unmask, back in May.” To then, vaccinated people need to mask again because of some data from this province town outbreak that turned out to be.
Julie Gunlock:
A really great party.
Dr. Lucy McBride:
… the environment that was the stress test for vaccines. And so, unfortunately, there’s been an erosion of trust in public health institutions, there’s been an erosion of trust in medical providers. And so, as I said in the very beginning, trust is the glue in any relationship, particularly in healthcare. And one of the ways we inspire trust in patients and the general public is by making clear what our goals are. Once you’ve been vaccinated, the chances of dying or go to the hospital from COVID-19 are very, very slim. And if you’re a child, if you’re a 12-year-old, your chance was already very low. And so once you’ve been vaccinated, it really, really goes down. And your chance of transmitting the virus, if you’re not sick.
So an asymptomatic person who’s been vaccinated, the chance that that person transmitting to another person… of course it can happen, it absolutely can happen, but it’s very unlikely. At some point, we need to decide, what is the societal risk we’re willing to take, say, within a school system or within a state of getting COVID, which is going to be a cold or mild flu in most children? And what are the benefits of unmasking? And, at some point, and I think we’re getting close, we will decide I hope, that masks have more harm than benefit.
Julie Gunlock:
This is a great way to segue into this new Pfizer vaccine that has come out, that Pfizer’s talking about, it’s been approved by the FDA for use for five to 11-year-olds. And so again, I think we have a situation where a parent’s really nervous, they go to the Atlantic, they read your article, which I know you’ve said, “Okay, there’s a little bit of updating to do,” but in general, that article, it holds up. And that it hasn’t changed in terms of the Delta variants. It’s very contagious, but it doesn’t target children, blah, blah, blah, blah, I don’t want to repeat everything I said earlier. But the point is, it’s just like masking. Now parents have to think about this new COVID vaccine and look, I talked to Dr. Paul Offit and I remember him saying, “Look, vaccine skepticism is okay. It’s okay to be skeptical.”
I keep coming back to that now because, look, let’s face it, people have been shamed for being vaccine skeptical with this new vaccine. So you can’t ask any questions or you’re shamed if you hesitate at all. And certainly that’s not true for true you, and not true for Dr. Paul Offit. He welcomes questions, he thinks you should be curious and do research. But so I worry about how parents are going to react. Look, I’m interested in this new vaccine, I think it’s great if it adds freedom to people’s lives. But I think you tell a person to give your five- to seven-year-old a vaccine, and they’re going to go right back to school with a mask, what is the point? So it’s the same question I’m asking you, I’m interested in your opinion on this new vaccine and your thoughts on it. And more practically, what should parents be asking their pediatricians about this new vaccine?
Dr. Lucy McBride:
So it’s a great question. Let me just be clear. The Pfizer vaccine is the same vaccine that has been administered to now billions of people across the globe. It’s a smaller dose that should be, I would imagine approved for emergency use by the FDA next month for children five to 11.
Julie Gunlock:
Thank you for correcting that I was wrong. I thought it’d already been approved, but yes. Okay.
Dr. Lucy McBride:
Pfizer has presented the data to the FDA and we’ve seen Pfizer’s press release, we have not seen approval by the FDA.
Julie Gunlock:
Okay.
Dr. Lucy McBride:
But assuming Pfizer isn’t making up their data, which I can’t imagine they are, but you never know. Assuming Pfizer is presenting their data appropriately… And again, this is a study of, I think it was 2200 kids. A third of them were given the placebo and the other two-thirds were given the actual shot, the safety profile looks great. They couldn’t do a study on efficacy because kids don’t get that sick from COVID. And so they didn’t get enough sickness to know that it worked for protecting people from disease in a robust way, because there were just not that many kids they studied. But the main thing we care about in vaccines for children, particularly for a virus that generally doesn’t cause severe outcomes is the safety profile.
And so far, it has cleared that hurdle, but in a small cohort of children. So I think you’re right. Questions about vaccines is not synonymous with anti-vax. In fact, I have been able to convince many of my adult patients to get vaccinated because they ask questions and I listened and I answered them. If I said, “Come on, you’ve got to be kidding me. That is anti-science ridiculousness, what’s your problem? Get vaccinated.” They would run for the Hills and not get it. Let’s just face it, the health of any relationship hinges on listening. So there’s just no role for telling a parent who has a question about a brand new vaccine, “What’s your problem. You anti-science monster.” That is just the ticket to nowhere. So moreover, the questions are really good.
That’s what a trial is for, is asking a question. This is science, asking a question of a vaccine, so it’s appropriate for the consumer to also ask a question. I think we’re in a trust desert in the United States. And so that’s only fanning the flames of mistrust. So we need to make sure that we are clear as medical professionals, and that we answer people’s questions appropriately. And the truth is, we’re not going to be able to answer all the questions. When you have a child who is, as you said, five years old, who’s generally healthy, who has no underlying health conditions that would put that child at higher risk for poor outcomes of COVID, I can understand why you would want to have a shared decision making conversation with your pediatrician about whether or not to vaccinate.
Two reasons. One, if your child is going to go back to the classroom masked, you might think, what’s the point? And two, we have to recognize that there are risks with everything we do. I am going to guess, and this is a guess, that the vaccine is going to be shown to be not only effective against disease, but also quite safe, particularly at these lower doses for kiddos. But I don’t know that it hasn’t been studied enough. As you said, in the outset, I am pro-vax, I will get vaccinated every day with a new vaccine, if I could. I shouldn’t say that. I am pro-vax, I am a believer in these vaccines. I get every vaccine that I’m eligible for. But I think it’s also fair to ask questions.
I think one of the things that we need to do better at is risk stratifying. So there are kids in ICUs, there are kids in hospitals right now with COVID-19, we need to know who are those kids? What put them at higher risk. We think we know it’s kids who have obesity, who have cardiac abnormalities, who have diabetes. And, by the way, saying that most of those kids who are in the hospital have underlying health conditions is not dismissing of kids with underlying health-
Julie Gunlock:
Of course.
Dr. Lucy McBride:
… it’s not dismissive of underlying health conditions, it’s just the facts. But we need to understand that, in medicine, there’s no one-size-fits-all recommendation for every person. So I would get my child vaccinated with the vaccine for children if, for example, he or she was at higher risk for poor outcomes. But I probably would get them vaccinated regardless; I just would want to see that data. And I’m just not envious of people who have to make that decision.
Julie Gunlock:
And I think it really is important for parents to, just like this podcast, Bespoke Parenting, make the decisions best for your child. If you have a child that suffers from diabetes or has heart problems or kidney problems, or suffers from some disease unrelated obviously to COVID, then this is something that might save their life. So again, you need to look at your child and look at their health and make that decision. Do you think, and this is purely you guessing, because there’s no indication so far, but I have seen, especially on Twitter and some medical people saying, “Get your seven-year-old this vaccine so they can go back to a normal life.” And I thought, “Wow.”
And I’ve seen other people say, “Play sports, or go to classroom field trips.” And I thought, “I wonder if this is going to be made mandatory.” Do you think that will happen? So far, there haven’t been any mandatory… you don’t have to get your 12-year-old a vaccine, you don’t have to get your teenager a vaccine to attend high school. But do you see this as being part of the vaccines?—at school, you have to turn in a vaccine sheet every year. Do you think this will be one of those mandatory vaccines that will be added?
Dr. Lucy McBride:
I don’t know. I think it’s going to be a hard sell on an emergency use authorization. I think it will be a hard sell. But I think as you said… So, I don’t know. It’s really a political question.
Julie Gunlock:
Yeah, it’s a tough question.
Dr. Lucy McBride:
It’s a tough question, I don’t know. I think the vaccine mandates have worked in many ways for adults, but I wish we hadn’t had to go there. But we also have a very heterogeneous population and we needed to get people vaccinated to be able to contain the virus, to be able to open up life. For kids, there’s a little bit of a different calculation because the risk for the average child is relatively low.
Julie Gunlock:
It’s very low. Yes, exactly. And that’s-
Dr. Lucy McBride:
And so, the question… So, the going back to normal is just an interesting question for kids, because it depends on where you live. It depends on your school, it depends on the child itself.
Julie Gunlock:
Their age. For some of them, this is normal, relative to their age.
Dr. Lucy McBride:
Right. So I guess what I’m saying is… what am I trying to say? I’m trying to say that… My gosh, my brain is just like.
Julie Gunlock:
Mash potatoes. I get it. And let me guide you. Well, I think that what you’re saying, it could, but there is complications. Unlike measles, which is a… it’ll affect anyone, it’s just promiscuous. Whereas this one, it doesn’t affect kids, and that is what the complication is going to be for parents. And look, let’s not forget, there were some complications, there were some heart issues with young kids. I think the FDA eventually ruled that it wasn’t significant enough numbers to stop vaccinating 12-year-olds, but still, parents think about that stuff and worry about that stuff. And again, as someone’s who’s like. Go on.
Dr. Lucy McBride:
Sorry, go ahead.
Julie Gunlock:
No.
Dr. Lucy McBride:
I was going to say there, so there is a real albeit tiny safety signal, this risk of myocarditis, which is inflammation of the heart in teenage boys and young adult boys. Now, the risk of COVID is probably bigger than the risk of the vaccine in teenage boys and young men. But we still need to understand that safety signal and ultimately risk stratify kids and maybe think about dosing for teenage kids. But that does get the attention of parents of kids who are younger than that, because we don’t know why myocarditis, even though it’s really rare and COVID itself causes myocarditis or can do, we don’t know why it affects boys more than girls. And so it’s appropriate for people to have questions. But the problem is that a lot of people don’t trust any medical expert, such that they are quote, doing their own research, and that involves a lot of Googling and misinformation.
So I don’t have a good answer for you on whether you should vaccinate your five- to 11-year-old child. If I had a five-year-old to 11-year-old child, I probably would because I believe in the vaccines. And I believe that staying in school and not having even a cold in the new landscape we live in, is going to be better for their ability to be in school for their social, emotional health and for their learning. And because I believe the risk of the vaccines is low. But I also would think twice maybe about getting dose two, or maybe I would want to space the second dose out more than three weeks, because just because that’s the cookbook doesn’t mean that has to be done that way. But this will ultimately be a shared decision-making between the pediatrician and parent.
Julie Gunlock:
And I think that’s key. My advice on this podcast is always, if you’re listening, if you’re getting your medical advice from me, you’re going to die. And so, you should consult an actual doctor, and hopefully, you have a regular pediatrician for your children because they know your children. And so I do think that’s good advice. And I do think it’s nice to hear a doctor agree that these are complex issues and not dismiss fears or skepticism or concerns. And I think that alone, at least… Look, I’m speaking here as a parent of kids that are kind of… I have an 11-year-old and I have 12 and I have 14, so I’m in that spot where it’s very worrying to me. And it’s nice to hear that, “Hey, look, these questions are good questions and these are things people are curious about.” So that alone helps.
Dr. Lucy McBride:
Ultimately medicine and our training is about critical thinking. It’s not about dismissing new research, it’s about inviting it and studying it and learning from it. So it would be very easy for me to say, “Look, the cookbook of Pfizer says, ‘Get your kid vaccinated three weeks apart, these two doses. Don’t worry about the reports of myocarditis. Just do it because that’s what we’re supposed to do so that you can get back in school, because ultimately that’s the way you should do it.'” And it would be easy for you to say, “Every American should be boosted after six months.” But there’s so much more nuance. That’s why my job, seeing patients one at a time is so much easier than messaging to a wider public, because ultimately we are as different as human beings, as stars are in the sky. That said, public health entities have to give broad recommendations.
They have to draw lines in the sand. But they also, in my opinion, have an obligation to be clear and transparent about the unknowns. People are dealing with so much unknown, so much uncertainty, we look to these institutions like never before. When before in your life did you look to the CDC for day-to-day advice. And I really don’t blame them. I respect Rochelle Walensky, I think she’s doing the best she can, given that this government agency was asked to take on much more responsibility than they were equipped to take on. And then the public is confused, anxious, getting mixed messages, and then misinformation is just rampant. So it’s not surprising that people are confused.
And I think this is where we need trusted guides more than ever. This is where I think primary care, which to me, I’m a little biased, is like the jewel in the crown of healthcare, where people can have this hub for problem-solving, needs to be elevated in healthcare reform, which is a different podcast for a different day.
Julie Gunlock:
Yeah, it’s a different show.
Dr. Lucy McBride:
So my point is that there’s no substitute for a dialogue about emerging evidence, marrying broad public health advice with your unique situation, your child, your living situation, your goals, your hopes, your fears, that’s health.
Julie Gunlock:
And that is Bespoke health that is making the right decisions for you and your family. And that is a perfect way to bring this to an end. I want you to know I have about 700 more questions, but I-
Dr. Lucy McBride:
I know, there’s so much more questions.
Julie Gunlock:
I know. And it’s been really fun talking to you mostly, that’s why I actually just want to keep picking your brain because it is really fun talking to you. And I want to say one thing as I’m closing out here. It has been shocking to me to learn, and I’m not going to bash the CDC, but it really is astonishing to me that you have people like yourself and Emily Oster… Emily Oster did a lot of work tracking the-
Dr. Lucy McBride:
A lot.
Julie Gunlock:
… outbreaks in schools. And a part of me is like, “Shouldn’t the CDC, shouldn’t education be doing that?” It’s just amazing to me. I think she’s doing it in her basement, and she has probably some people helping her.
Dr. Lucy McBride:
And she and I have done some live conversations on social media, where she is in her in-laws’ bathroom. One of the silver linings for me of the pandemic has been the ongoing conversations daily with this group of women doctors and public health epidemiology experts, who are basically citizen scientists, who are really, really digging into the data. And I’ve learned so much from them, I think we learn from each other. So it’s a tall order for the CDC to handle a little pandemic, but you’re right.
Julie Gunlock:
Well, look, it is. And I’m not, again, I’m putting my libertarian hat on here, they have lots of money. But look, I have sympathy for folks in public health and thanks to them. And the private innovation that went into the vaccine, I am just absolutely so grateful for the work that scientists and the medical profession has done to bring these great vaccines. But I do think it’s important that people realize there’s a lot of individuals out there like Dr. McBride, like Emily Oster, like you mentioned, this group of citizen scientists working on their own time, to help find solutions to these really difficult, knotty issues. And so I’m really grateful for all that you’ve done, and the reassurance that you’ve given so many parents. I know that a lot of people were talking… Just so know, a lot of people in my circles are talking about your Atlantic article, you really are making a huge difference. So thanks so much.
Dr. Lucy McBride:
Thank you so much for having me.
Julie Gunlock:
Well, we hope to have you on again soon. And honestly, it has been a fun conversation.
Dr. Lucy McBride:
I would love to. There’s so many other questions, there’s so many other, it just it scratches the surface, there’s so many things. And part of me wants to ask you, do you ever do writing for other people?
Julie Gunlock:
I do. It’s sort of like I’m freelance. So I write for a bunch of different publications. But before we sign off on this podcast, I do want to make sure that people know about your stuff. Everybody knows about my stuff.
Dr. Lucy McBride:
Oh yeah, please. Thank you.
Julie Gunlock:
I want you to give your Twitter handle, but also you have a newsletter. And then tell them anything else, where else you write.
Dr. Lucy McBride:
Okay. So my Twitter handle is… what is my Twitter handle?
Julie Gunlock:
I love it.
Dr. Lucy McBride:
I think my Twitter is @drlucymcbride.
Julie Gunlock:
I’ll confirm that while you’re talking.
Dr. Lucy McBride:
I am in a little love-hate relationship with Twitter as many people are.
Julie Gunlock:
Yes.
Dr. Lucy McBride:
After that Atlantic article came out, I got so much great feedback, but you also get really, really hostile messages. Because somehow trying to reassure people and provide empathy and compassion was confused by a lot of people as dismissive of people’s lived experience, which is exactly the opposite of what I’m trying to do. But anyway, so I’ve been writing a newsletter since March 2020, about COVID-19. And it’s basically trying to cut through the noise of all the news and to help people with real-time, fact-based information and guidance to manage mental and physical health in tandem. It is a little bit of dumb humor, it is a little bit of anecdote, it’s a little bit about me, but it’s also just trying to drill down into these bigger issues and help people frame complex decisions without me telling you what to do. Because ultimately, even if you’re my patient, I’m not telling you what to do, lecturing you, or looking down my nose, I’m helping you think through the issues, so you can make a healthy decision for yourself. And that’s what I’m trying to do in my newsletter, and it’s been super fun.
Julie Gunlock:
Well, listen, I’m going to confirm. You are at, @dr D-R-
Dr. Lucy McBride:
But my website is-
Julie Gunlock:
I’m doing your-
Dr. Lucy McBride:
Twitter?
Julie Gunlock:
… Twitter. Yeah. You’re @-
Dr. Lucy McBride:
My Twitter is @dr-
Julie Gunlock:
It’s @D-R Lucy, L-U-C-Y, McBride, M-C-B-R-I-D-E. So it’s DrLucyMcBride, one-
Dr. Lucy McBride:
Dr. Lucy McBride.
Julie Gunlock:
Yes. And.
Dr. Lucy McBride:
And then my website is where you can find my newsletter. It’s www.lucymcbride.com. You can see past newsletters, you can sign up to get the newsletter in your inbox, you can also read my Atlantic articles. I’ve written a couple of pieces for the Washington Post and CNN. And really it’s just volunteer passion for trying to cut through the noise. As you know, you don’t get paid for these things, it’s just for fun. I don’t want to say for fun because-
Julie Gunlock:
Well, look, I’m telling people on this podcast, and I know there are regular listeners, this is who you want to follow on Twitter. This is who you want to read. And look, I don’t agree with… I mentioned Emily a couple times. I don’t agree with everything Emily tweets about or says about, but she is so rational and so kind and so compassionate. So interested and curious, intellectually interested in talking about things. And she said on Twitter, just like you, “Oh God, Twitter, you can get beat up for something, I don’t like that.” And who does? But the point is, is that there’s just a wealth of information from these people who are not really attached to a federal agency and haven’t, this is the most important thing, made things political.
They are truly searching for the truth. And they’re doing this, really, because they’re interested in it. So I think those are great sources. And that’s part of what I see as my job as a non-expert, and a non-medical official and a non-scientist, but I like to share who has helped me as a parent make good decisions, and Lucy, you definitely have. And I’ve enjoyed this podcast so much. I do podcasting a lot and this is honestly one of my favorite conversations. Thanks so much for coming on.
Dr. Lucy McBride:
I’ve been delighted to be here. Thanks for having me.
Julie Gunlock:
Thanks, everyone, for being here, for another episode of the Bespoke Parenting Hour. If you enjoyed this episode or like the podcast in general, please leave a rating or a review on iTunes. This helps ensure that the podcast reaches as many listeners as possible. If you haven’t subscribed to the Bespoke Parenting Hour on iTunes, Spotify, Google Play, or wherever you get your podcast, please do so, so you won’t miss an episode. Don’t forget to share this episode and let your friends know that they can get Bespoke episodes on their favorite podcast app. From all of us here at the Independent Women’s Forum, thanks for listening.