The Washington Post - USA (2021-11-23)

TUESDAY, NOVEMBER 23 , 2021. THE WASHINGTON POST EZ EE E3

HEALTH NEWS

“Is there reliable data on effec-
tiveness for the Russian vac-
cines?”
— Christopher in California
Russia surprised the world in
August 2020 when it became the
first country to register a corona-
virus vaccine. Peer-reviewed data
indicates the shots, which are
used in several dozen countries,
work well in preventing severe
illness. But questions linger
about the quality of the research,
and the vaccine has yet to receive
authorization from the World
Health Organization.
Known as Sputnik V, Russia’s
vaccine initially alarmed the in-
ternational community because
Russian officials authorized it be-
fore the results of Phase I and II
clinical trials were published.
Phase III trials, the gold standard
for drug testing, hadn’t even be-
gun when the shots started going
into arms. Officials also used the
Sputnik V Twitter account to cast
doubt on Western vaccines. This
didn’t inspire much confidence
from scientists and health lead-
ers. Many Russians were skepti-
cal, too.
A turning point came in Febru-
ary, when the results of a large
clinical trial were published in
the Lancet, a well-respected med-
ical journal. The study, which
involved nearly 20,000 partici-
pants, showed that Sputnik V was
about 91.6 percent effective at
preventing symptomatic illness.
That appeared to put in on par
with the Pfizer-BioNTech and
Moderna vaccines.
“The development of the Sput-
nik V vaccine has been criticized
for unseemly haste, corner cut-
ting, and an absence of transpar-
ency,” two independent scientists
from the London School of Hy-
giene and Tropical Medicine
wrote in a commentary in the
Lancet. “But the outcome report-
ed here is clear and the scientific
principle of vaccination is dem-
onstrated, which means another

vaccine can now join the fight to reduce the incidence of COVID- 19.” Encouraging findings, to be sure. But researchers have since voiced hesitations about the study design, and Sputnik V’s developers have faced criticism for not sharing the underlying data from the clinical trials. In September, a group of scientists flagged what it said were “ques- tionable” and potentially duplica- tive values in the trial data, and called on the study authors to provide a more detailed break- down. The WHO and European regulators say they, too, haven’t gotten all the data they’ve requested on Sputnik V. Reuters reported last month that the European Medi- cines Agency probably wouldn’t decide on whether to authorize the vaccine until at least the first quarter of 2022. Authorization from the WHO could also take months or even longer. A green light from the WHO is particular- ly important — without it, many Russians and others around the world who got Sputnik V won’t be able to travel to the United States, and the vaccine won’t qualify for the WHO’s Covax initiative to send doses to lower-income countries. “Unfortunately, Sputnik V’s de- fenders have yet to acknowledge that there might be any actual safety or efficacy issues with the drug, let alone provide data to satisfy the regulators that have flagged concerns. This stance un- dermines public faith in the vaccine at home and abroad,” Paul Stronski, a Russia expert at the nonpartisan Carnegie Endow- ment for International Peace, wrote last week. “Sputnik V clearly provides some protection against severe disease,” Stronski wrote, “but in- dependently verified data remain hard to come by.” — Derek Hawkins

Your questions about the coronavirus,

answered: How effective are Russian vaccines?

HEALTH SCAN

In the past 20 years, measles
vaccines have helped prevent an
estimated 31.7 million infections.
But despite progress toward elim-
inating the disease, the fight is far
from over.
That’s the message of a new
joint report from the World
Health Organization and the Cen-
ters for Disease Control and Pre-
vention that gauges the world’s
progress on the road to measles
eradication from 2000 to 2020.
Measles cases fell worldwide
between 2000 and 2016, with a
brief rise between 2017 and 2019.
But the number fell again in
2020, and the report says that in
the past two decades, incidence of
the disease has fallen a whopping
94 percent.
But decrease isn’t eradication,
and the pandemic has set back
progress toward a world without
measles. Routine immunizations
decreased worldwide, fewer
countries reported measles data
and, the researchers write, there
is an “immediate elevated
risk” for both measles transmis-
sion and outbreaks.
As the world heads into the
third year of the pandemic, ex-
perts are calling on countries to

close the immunity gap. Measles is almost entirely preventable through vaccines, the CDC says. “While reported measles cases dropped in 2020, evidence sug- gests we are likely seeing the calm before the storm as the risk of outbreaks continues to grow around the world,” said Kate O’Brien, director of WHO’s De- partment of Immunization, Vac- cines and Biologicals, in a news release. Since measles is so contagious, even a small number of cases can fuel outbreaks. The United States reached eradication — defined as no transmission for a year and a well-performing surveillance sys- tem — in 2000. But outbreaks can and do hap- pen, threatening the nation’s elimination status and jeopardiz- ing public health. As of Nov. 10, the CDC had documented 47 measles cases in the United States, up from 13 confirmed cases in 2020. — Erin Blakemore

CONTAGIOUS INFECTIOUS

Measles incidence is down, but pandemic has

slowed vaccination progress, researchers say

Progress Toward Regional Measles Elimination — Worldwide, 2000 -2020 CDC

BY KEVIN LORIA

M

any kids spent much of the 2020-2021 school year remote because of the pandemic. This year, although covid-19 is still a risk, many people are vaccinated and children are physically back in most schools. But as anyone who cares for a child knows, when kids are to- gether, they spread germs. That means that kids are coming down with a number of different bugs. Unfortunately, most symptoms, “mild or severe, from vomiting and diarrhea to congestion or runny nose, can be found in any cold, the flu and covid-19,” says Claire Boogaard, a pediatrician at Children’s National Hos- pital in D.C. Because it’s so hard to distinguish one virus from another in a home setting, “what we’re recom- mending is that anybody with these symptoms be tested for covid,” says Sean O’Leary, a pro- fessor of pediatrics at the Univer- sity of Colorado School of Medi- cine and an infectious-disease specialist at Children’s Hospital Colorado. Some schools even re- quire it. While you should never send a kid to school sick with anything contagious, it’s especially important to keep your child home until you know they don’t have covid-19. Anyone exposed should get a polymerase chain reaction test three to five days after expo- sure, says Syeda Amna Husain, a pediatrician based in New Jersey and spokesperson for the Ameri- can Academy of Pediatrics. In general, “it’s been a remark- able respiratory [virus] season,” O’Leary says. Last winter, with many people hunkered down at home, there was little circulation of respiratory viruses such as the flu and RSV (respiratory syncytial virus, which typically spreads in winter and can be dangerous for very young children and for older people). But last summer, there was a significant out-of- season RSV spike, along with infections from the delta variant of the coronavirus.

Traits of various bugs It’s important to reiterate that because covid-19 shares symptoms with a long list of other illnesses, anyone with symptoms should be tested to rule out covid-19. But there are some traits of various bugs that you can use to try to distinguish one virus from another. Pre-pandemic, many pediatricians would have said it’s not really important to know which pathogen a kid has, unless they are very sick, Boogaard says. Generally, home treatment for most circulating viruses is the

same: rest, hydration, and allevi- ating fever and discomfort. If it’s flu season and a pediatrician realizes early on that a kid has the flu, they could prescribe the antiviral Tamiflu, which may help people recover faster if giv- en early enough, Husain says. Here are some of the things you’ll typically see with respiratory viruses spreading right now: Covid-19: The one symptom that’s far more common with covid-19 than with other respiratory viruses is the loss of taste and smell, O’Leary says. Other viruses can affect these senses, but right now, most pediatricians will consider that symptom a pretty telltale sign of a covid- 19 case — and it may be the only one that shows up in kids that are otherwise asymptomatic. Generally, symptomatic covid- 19 cases come on gradually, over a period of a few days, but there may then be a sudden escalation of symptoms. Some other common symptoms include fever and cough. Gastrointestinal symptoms such as diarrhea, nausea and vomiting sometimes occur. Some kids may experience trouble breathing — a sign that should prompt a call to the pediatrician or in serious cases a trip to the ER. Symptoms can last for several weeks. Respiratory syncytial virus: RSV tends to start mild, but it can escalate suddenly. In pediatric cases, the biggest concerns are for kids under 6 months, or those under 2 years of age with lung or heart disease. (In older children, RSV infections usually cause a cold-like illness.) Fevers are common, as are coughs, sore throats, runny noses and sneezing. Pedia- tricians can generally identify an RSV cough from down the hall, O’Leary says — and can quickly diagnose the virus with a test if needed. Influenza: The flu can be severe for children, and it’s important to get flu shots now that flu season has started. Boogaard

says the flu is often characterized by its abrupt onset: Symptoms tend to appear much more quickly than with other respiratory diseases. Sore throats, fevers, fa- tigue, coughs, headaches and body aches are all common symptoms, and gastrointestinal symptoms also sometimes occur. Colds: Colds are caused by many different viruses, including other coronaviruses and rhinovi- ruses, Boogaard says. Because of this, time of onset and typical symptoms vary, she says. But symptoms typically peak after about three to five days. Most kids are better within seven to 10 days, although a cough may linger for a couple of weeks. Allergies: Allergies can cause a number of symptoms seen with respiratory viruses, including runny nose, congestion, sneezing and watery eyes. But if your child develops a fever, or is on allergy medication but develops new symptoms, they should be checked out, Boogaard says.

Treatment, emergency signs In most cases, kids can be treated at home for a respiratory virus, Husain says. Rest is essen- tial, and hydration is important, too. Let them drink what they want — warmer fluids such as soups may be helpful, she says. Saline drops can help with cough or congestion. It’s fine to give kids medication to reduce fever, such as children’s acetaminophen or ibuprofen, Husain says. But doctors don’t recommend any cough medi- cines for kids 6 and under, since these can cause changes in heart rate and pose a serious risk. It’s always a good idea to get in touch with your pediatrician when your child is sick, Husain says, so they can give you some guidance on red flags to look out for. Some emergency signs include the inability to get water down or stay hydrated. Young kids should have three to five wet diapers,

kids should be able to make tears, and their tongues should not look dry. If kids appear to be having trouble breathing, they should be seen by a pediatrician — or at the hospital if it’s clear they are struggling. Signs of breathing trouble include wheez- ing or seeing their ribs or chest working hard to get air in. If it’s hard to wake kids up, beyond normal tiredness, or to keep them awake, that lethargy is also an emergency sign, Boogaard says. If your child does test positive for the coronavirus that causes covid-19, you’ll want to provide the same supportive care at home. Doing so will be much easier if you are vaccinated, Boogaard says. As much as you can, try to isolate a sick person and to wear masks while inter- acting with them, she says.

Returning to school Many schools have policies in place that determine when kids can return after testing positive for the coronavirus or being exposed to the virus. Because of these policies, kids may also need a negative coronavirus test and a pediatrician’s note to return after having any symptoms. For other bugs, you should make sure kids have been fever- free for 24 hours without medication before taking them back to class. If they have been vomiting or having diarrhea, that should also be resolved before they return. A cough can last for two weeks after a cold, although it may last longer in kids with allergies or asthma. Kids can generally go back to school with that lingering cough — just get a note from their pediatrician if you need one. Getting your child vaccinated against the flu and covid-19 if they are eligible will make navi- gating this confusing time easier, says Boogaard, who is also the medical director of the Covid- 19 Vaccine Program at Children’s National Hospital. And if your child is not caught up on their other vaccinations such as those for measles because of the pandemic, it’s important to do that as soon as possible. “A lot of those diseases are more severe in kids than covid,” O’Leary says.

FROM CONSUMER REPORTS

Respiratory viruses vs. y our child

ISTOCK While you should never send a child to school sick with anything contagious, it’s especially important to keep your child home until covid-19 has been ruled out.

Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. CR has no financial relationship with advertisers in this publication. Read more at ConsumerReports.org.

7 to 9

years old

It’s not just teens but much younger kids
who are also using social media. About a
third of children ages 7 to 9 use social
media apps on phones or tablets,
according to a report from children’s
health researchers at the University of
Michigan. Based on data from a
nationally representative pool of 1,030 parents with at least one child
7 to 12 years old, the report notes an even higher social media
presence among slightly older children, with half of those ages 10 to 12
using these apps. The researchers found that most parents said they
do some sort of monitoring of their children’s social media
involvement (such as blocking certain sites, requiring parental
approval for new contacts or setting time limits for usage). But 1 in 6
parents were found to be using no parental controls. The main
reasons: they could not find the information needed to set up
controls, they said monitoring would be too time-consuming or
thought parental controls would be a waste of time because their kids
would simply find a loophole around them. Most parents recognized
the risks of social media use by young children with 60 to 70 percent
of them in the survey saying those risks include kids sharing
information that should be kept private, being exposed to
inappropriate content, getting exposed to online predators and not
being able to tell whether information they encounter online is true or
false. The researchers urged parents to help young children navigate
the social media world, but as one said: “Parents should also be
transparent that they plan to monitor their child’s profiles, posts and
interactions on social media until they’re older.”
— Linda Searing

THE BIG NUMBER

back into a lake, river or other natural source before being re- used — a step that helps make the idea of drinking treated sewage go down easier for some. Funding for more wastewater recycling projects is on the way. The bipartisan infrastructure bill passed by Congress has $1 billion for water reuse projects in the West, including the $3.4 billion project in Southern California. And tucked into the federal budget reconciliation package being debated is $125 million in grants for alternative water sources nationwide that could include reuse technologies. The Southern California project would be the nation’s largest

BY BRITTANY PETERSON AND SAM METZ

Around the United States, cities are increasingly warming to an idea that once induced gags: Sterilize wastewater from toilets, sinks and factories, and eventually pipe it back into homes and businesses as tap water. In the Los Angeles area, plans to recycle wastewater for drinking are moving along with little fanfare just two decades after similar efforts in the city sparked such a backlash they had to be abandoned. The practice, which must meet federal drinking water standards, has been adopted in several places around the country, including nearby Orange County. “We’ve had a sea change in terms of public attitudes toward wastewater recycling,” said David Nahai, the former general manager of the Los Angeles Depart- ment of Water and Power. The shifting attitudes around a concept once dismissively dubbed “toilet to tap” come as dry regions scramble for ways to increase water supplies as their populations boom and climate change intensifies droughts. Oth- er strategies gaining traction include collecting runoff from streams and roads after storms, and stripping seawater of salt and other minerals, a process that’s still relatively rare and expensive. Though there are still only about two dozen communities in the United States using some form of recycled water for drinking, that number is projected to more than double in the next 15 years, according to WateReuse, a group that helps cities adopt such conservation practices. In most places that do it, the sterilized water is usually mixed

wastewater recycling program, producing enough water to supply 500,000 homes, according to the Metropolitan Water District, which serves 19 million people in Los Angeles and surrounding counties. In Colorado, over two-dozen facilities already recycle water for non-drinking purposes, which is more affordable than cleaning it for drinking. But growing populations mean cities could need to pull additional supply from the Colorado River, which is already strained from overuse. At that point, it might make sense to start recycling for drinking purposes, as well, said Greg Fisher, head of demand planning for Denver Water. To warm residents to the idea, Colorado Springs Utilities is host- ing a mobile exhibit that shows how wastewater recycling works. On a cold, rainy afternoon, doz- ens of visitors showed up to learn about the carbon-based purifica- tion process and sample the results, which several noted tasted no different from their usual supply. The recycling process typically entails disinfecting wastewater with ozone gas or ultraviolet light to remove viruses and bacteria, then filtering it through mem- branes with microscopic pores to remove solids and trace contami- nants. Not all water can be recycled locally. Often, Western communities are required to send treated wastewater back to its source, so that it can eventually be used by other places that depend on that same body of water. “You have to put the water back into the river because it’s not yours,” said Patricia Sinicropi, executive director of WateReuse. As a result, much of the country already consumes water that

has been recycled to some degree, simply by living downstream from others. It’s why drinking water undergoes stringent steril- ization even when it’s pulled from a river or lake that looks clean. Encouraged by efforts in other cities, even places with stable water supplies are considering recycling their own wastewater. After a poll showed broad sup- port for the idea in Boise, Idaho, city officials began studying plans to recharge local ground- water with treated wastewater. “We need to be managing for the potential impacts of climate change,” said Haley Falconer, a senior manager in the city’s environmental division. The Southern California project, which still needs to undergo environmental review and final- ize its funding plan, would also lessen the region’s need to pipe in water from afar. In exchange for financing from water agencies in Nevada and Arizona, the area is ceding some of its share of the Colorado River. “We’re taking advantage of a water supply that’s right here in our backyard,” said Deven Upad- hyay, chief operating officer for the Metropolitan Water District. Officials emphasize the project uses technology that has been used safely elsewhere, including in Israel and Singapore. The reas- surances have become critical after a separate Los Angeles wastewater treatment plant, which uses a different process to purify water for irrigation and industrial purposes, flooded and spilled sewage into the ocean in July. “The last thing that any of us want is one of these projects that have a water quality hiccup that sets back public perception,” U padhyay said. — Associated Press

More cities look at recycled, drinkable wastewater

BRITTANY PETERSON/ASSOCIATED PRESS Two people drink wastewater that was sterilized at PureWater Colorado Mobile Demonstration in Colorado Springs last month.

“We need to be

managing for the

potential impacts of

climate change.” Haley Falconer, a senior manager in the city’s environmental division

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