Medical Discussion of Coronavirus

[FIREshrink]

I'd have to lie to do that, because they typically want some data including insurance to bill. I know it's not required but since I have insurance I'm asked to provide it. Plus, the question of dose.

Say you had a 12 year old who weighs 75 pounds, would you give full dose or 1/3 or 1/2?

Would any docs here authorize the lower dose for a 12+ patient who is small? Is this done with other vaccines (ie, do some parents ask for smaller doses for their kids for influenza or any other common vaccines)?

[CordMcNally]

We will be overseas by then and having even one shot will considerably simplify our lives

Upper class problems...

But to answer your question, no, I wouldn't lie. Your mileage may vary, though.

[Sampter]

That would go into the white lie category for me.

I would give full Pfizer dose for almost 12 yo which is already 1/4 mRNA dose of the Moderna vaccine.

I would never give a smaller dose of other vaccines if parents request. Accept the vaccine or don't.

[FIREshrink]

That would go into the white lie category for me.

I would give full Pfizer dose for almost 12 yo which is already 1/4 mRNA dose of the Moderna vaccine.

I would never give a smaller dose of other vaccines if parents request. Accept the vaccine or don't.

Why is the 5-11 dose 1/3 the adult dose, ie once 5-11 gets EUA, an 11.364 year old gets X dose, then the next day he would get 3X dose. All of this regardless of weight. Furthermore in the original Pfizer data there was evidence the obese had less robust immunogenicity than non obese, suggesting there should be some weight adjustment. And the data for 12-15 showed they had an antibody level 75% higher than 16-25, again suggesting dosing should vary more based on weight.

My son is just about 25%ile, so not super tiny, but his weight is close to an average 11 year old. Hence my question.

[Tim]

This is no different than prescribing any medication off label IMO which happens all the time in America, especially drugs in pediatrics. The only considerations are that the Pfizer vaccine is not fully FDA approved and also paid for by the federal government.

You can bypass a doctor and just get vaccinated at a pharmacy or even a health fair.....no one will care.

I don't think this question is really medical or legal. I think it is more about the child. One will need to "instruct" specifically to lie about the DOB on the form. For all the emotional debates about setting policy for 320m and one death is too many and the outrage about the unvaccinated and anti vaxers, this is simply about intentionally lying and "it is ok in order to get what you want."

12 yr old +/- 7 days could have been the guideline as well. But it is not. "So close" and personal needs/desires happen all the time. How do you want to raise your child?
This won't be the only time, it is not an isolated judgement call. Just saying, how you raise your kid.

[G]

We will be overseas by then and having even one shot will considerably simplify our lives

I am probably just under-caffeinated, but travelling internationally during a pandemic with an unvaccinated child seems discordant with the tenor of some of your other posts.

Nobody weighed my kid. Heck, at the rodeo site, you don't even get out of the car.

However: I would not lie about age. I would not vaccinate at age 11 plus 362 days, nor would I search for a doctor/nurse/pharmacist willing to do that.

If a [knowledgeable] doctor asked me to go off-label for an EUA just to simplify their life, that would forever taint my opinion of them. And I don't know about your kid, but ages matter and mine knew that she had to be 12 to get it..."let's fudge the truth, just this one time"...not a lesson I want to give.

[Sampter]

What if a household member was immunosuppressed (parents, grandparents, siblings)? Would it be more palatable to lie about the age/prescribe off label at that point to protect the family? Especially if you want the 11 yo to go to in person school, activities, etc? You can bet that this question is already being raised and will continue to be an issue moving forward, especially once the Pfizer vaccine is fully FDA approved for adults.

I agree with weight vs age based dosing would have been better.

Again, medicines are used ALL THE TIME off-label in children and adults.

[CordMcNally]

What if a household member was immunosuppressed (parents, grandparents, siblings)? Would it be more palatable to lie about the age/prescribe off label at that point to protect the family? Especially if you want the 11 yo to go to in person school, activities, etc? You can bet that this question is already being raised and will continue to be an issue moving forward, especially once the Pfizer vaccine is fully FDA approved for adults.

I agree with weight vs age based dosing would have been better.

Again, medicines are used ALL THE TIME off-label in children and adults.

Instead of making up various scenarios, how come we don't just look at the scenario FIREshrink gave us? They want to lie about their child's age because they are going on an international trip and it would inconvenience them otherwise. Just to entertain your scenario where would you put the cut off? First you start saying it's ok for those 11 years 363 days to get vaccinated and then someone wants their child who is 11 years 360 days to get vaccinated and then someone wants their child who is 11 years 350 days to get vaccinated and on and on.

I don't think anyone is arguing that medicines aren't used off-label all the time. Do these off-label uses require a parent and/or physician to lie in order to use them? I'm not aware of any that do.

[billy]

What if a household member was immunosuppressed (parents, grandparents, siblings)? Would it be more palatable to lie about the age/prescribe off label at that point to protect the family? Especially if you want the 11 yo to go to in person school, activities, etc? You can bet that this question is already being raised and will continue to be an issue moving forward, especially once the Pfizer vaccine is fully FDA approved for adults.

I agree with weight vs age based dosing would have been better.

Again, medicines are used ALL THE TIME off-label in children and adults.

I am very pro vaccine, but I have to disagree here. The immunosuppressed should get vaccinated, and I would argue for them to get a booster off-label over vaccinating the healthy young child off label. Then the child/siblings have to weigh the risk /benefit of school activities hanging out with grandpa indoors etc, just like many of us had to over the past year and a half. I spent basically a full year living in a different part of my apartment than my very immunocompromised wife, and masking in the common areas; it truly sucked but it was what we had to do.
And in the future, when that same child lies about something else to get their way, you kinda helped them get comfortable doing it. I'm not saying this would be the trigger to get the kid to lie and steal, but its another step in forming their judgement and moral values. The initial question was about lying in order to get to go on a trip without being inconvenienced, not about protecting sick family members.

[Kamban]

We will be overseas by then and having even one shot will considerably simplify our lives

I love travel as much as the next person here but would not take an unvaccinated 12 year old overseas. The risks outweigh any benefits, unless that trip is for emergencies.

I would wait for at least 4 weeks post vaccination to have the max immunity built up before any travel.

[Sampter]

I agree a slippery slope for a vacation....although could argue on the pro vaccine side to prevent contracting and potentially spreading Covid. Doesn't mean I would do it, but in certain situations I don't think it would be wrong to do.

Once fully FDA approved, this will be much more common and like any off label use of drugs, it will be at the individual physicians discretion on how old the child, dose, etc. Assuming the parent is pushing for it, and the physician agrees. At that point, won't need to lie about the age.

[Tim]

I love travel as much as the next person here but would not take an unvaccinated 12 year old overseas. The risks outweigh any benefits, unless that trip is for emergencies.

I would wait for at least 4 weeks post vaccination to have the max immunity built up before any travel.

Throw in the WHO:
https://finance.yahoo.com/news/asks-...hssrp_catchall
No boosters for ANYONE, sacrifice is needed. Certainly they would not approve of a wealthy physician using a vaccine 2 days early. They actual prefer to take vaccines and have you pay for it. Makes all the sense in the world order.

[FIREshrink]

To be clear, I know I could lie; I’m not going to. Hence my posts.

I’m curious, what is the ‘tenor’ of my posts? People read an awful lot about others based on very little information. I’ve never been particularly concerned about kids and the virus, my kids have been participating in outdoor sports for 8 months with no masks. I think delta is more concerning, but the risks to otherwise healthy kids remain extraordinarily low. We also have no high risk individuals in our daily life (no elderly, no immunocompromised) and the rest of us are vaccinated. The country we are visiting will have a higher vaccination rate than the US by the time we go. By most (not all) accounts, airplane flying is safe.

The trip was planned a long, long time ago (10 months ago). There are family reasons for going. At the time I expected the virus would be pretty subdued and until delta, this was true. I also thought there was a good chance vaccine would be available for 5–11 by then.

If the virus is raging we likely won’t go regardless of anyone’s vaccination status. But if it’s quieted down - as it has in UK for example - we need to try. Based on what Fauci said yesterday it’s even possible we’ll get an EUA just days before our trip in which case son will be first in line. The country we are going to has placed strict limits on activities for the unvaccinated, including kids 12 and up, which makes for an extremely awkward trip for us (he will be 11 when we leave the states, but 12 when we land - so can’t vaccinate here, will be unvaccinated but ‘verboten’ when we land). Can’t receive vaccine in country in question, already checked (again, unless I lie).

In psychiatry we don’t have any drugs that are only approved for certain age groups, and we don’t do vaccines, so I’m not familiar with the legalities or ethics of the scenarios I posted. Of course we prescribe meds off label all the time. That’s about 80-90% of my practice, since I see very sick hospitalized patients and patients who have failed all the usual treatments (like many psychiatrists). So I’m super comfortable with that concept.

regarding the vaccine specifically, if we get a 5-11 EUA before the trip then problem is solved. If not, I will ask his pediatrician but in no way demand it. I think like sampter said, an argument can be made that we’re talking about 36 hours early, and the benefits (preventing spread or contagion) outweigh the risks. But it’s not for me to decide.

We’ll be stopping over for a few hours in another country at which point he will be 12, I even thought about getting him jabbed there if they have something in the airport, but right now I cannot see that they do.

[Rando]

Will the vaccine be effective if he gets it a couple days early - almost certainly. The issue will be if you run into a bureaucracy and they see he was given the shot a couple days early it will be outside their guidelines and they will possibly not accept it. I've run into this problem in peds where the school reviews the shot record and sees a vaccine was given a day early 4 years ago, then wants them to repeat the vaccine. Dumb but it happens.

So if you are getting it for peace of mind and can find a way to get it I say go for it, if you are getting it to satisfy some foreign governmental guideline you might run into trouble. Good luck and I hope you have a great trip.

[billy]

Does the country you are traveling to count one jab as vaccinated and allowed to participate in things, or do you need to be fully vaccinated? it still doesn't change my answer, but you may be out of luck either way. And while it does suck to not be able to participate in things, how is it any different from us telling the general public the same? I do feel for you and your situation, but you could theoretically also fly out two days later- yes it will cost more but then it gets the job done without white lies all around. Is the date more important (wedding funeral) or being excluded once you are there from certain activities?