Several people have contacted me asking whether the Pfizer or Moderna COVID-19 vaccine would be best for their child under the age of five. There are several issues here, but no perfect answer.
The very good news is that both these vaccines have almost no toxicity in this age group. Even rare concerns like myocarditis that have been seen in adolescent individuals were not observed in these young people. Therefore, safety is not a concern that differentiates the vaccines.
Efficacy in this age group is significant when looking at acute protection from infection. Much as they do for older people, the vaccines prevent children from being infected for a short period of time, probably about six months. The long-term efficacy is not clear, but the important thing to remember is that most children in this age group do not get significantly ill from COVID-19. On the other hand, the vaccine will prevent them from infecting those around them (especially in their families) and also may prevent them from becoming more significantly ill if they get COVID for the first time as they become teenagers.
I lean towards the Moderna vaccine simply because it is two shots rather than the three needed with Pfizer. Vaccination is traumatic in young children and avoiding that third shot is a significant benefit.
A more difficult issue is trying to make sense of “long COVID.” Individuals have asked me if there are treatments or preventions for long COVID other than being vaccinated. Unfortunately for those that don’t want the COVID-19 vaccine, the mRNA vaccines are one of the few things that has been associated with marked decreases in long COVID. Most other issues about long COVID are still open to speculation.
I wish I could be more definitive for those of you having long term symptoms after a COVID-19 infection. Unfortunately, there is very little definitive information on this problem. Rates of long COVID vary tremendously in the literature, and the symptoms seem equally variable. While recent articles suggest long COVID is more of a problem for women than men, no reason has been defined for this difference. Long COVID seems less common with Omicron, which is good news.
A recent study conducted by the National Institutes of Health failed to find any definitive abnormality in individuals with long COVID other than increased anxiety. In contrast, other studies have suggested long term symptoms occur in almost 20% of people who get infected. Clearly, the actual outcome is somewhere in the middle. Another study has suggested that diabetes, mononucleosis virus (EB virus), or autoantibodies predispose to chronic COVID symptoms. None of this data has been validated consistently.
While most individuals with long COVID have very mild symptoms, others are having more prominent difficulty with thinking and concentration. There is also data suggesting that receiving a COVID-19 vaccine may have therapeutic value once individuals develop long term symptoms. Unfortunately, this is controversial.
If there is any good news, it is that there are almost no reports of death from long COVID. If, however, you are having long-term symptoms, please contact your physician. There may be very specific and individualized approaches to help with your illness.
Pandemic Pondering 
Dr. Baker, As you point out, the data on long covid is highly variable, which is typical of self-reporting data, and especially in the midst of an event where there is a lot of public attention and discussion of potential symptoms, i.e., many people will assume that anything they ‘feel’ is different is due to covid. Furthermore, if a medical person provides them with a list of symptoms to check off, they will likely identify something on the list that matches their symptoms. This is not to say that some people will have long-lasting, and even disabling medical issues resulting from their covid infection, but my suspicion is that clinically verified long covid will be exceedingly rare.
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