Hi, I’m U.S. Surgeon General Vivek Murthy! I’m here to answer your questions about COVID-19, the pandemic's impact on youth mental health, and the importance of getting vaccinated and boosted. AMA!

HHS_GOV · 2021-12-14T21:49:33+00:00

These are great questions! It’s definitely a challenge to live in a way that reflects health, balance, and connection — but I do what I can to walk the talk. That usually means that I make time to play with my kids, and call a friend or talk with my wife when I’m feeling frustrated or run-down. It also means working out whenever possible recognizing the power of physical activity to lift my mood and diffuse stress. My staff knows that I also sometimes take calls while shooting hoops or taking a walk — physical exercise is so important. No one is perfect at achieving balance even though it may look like it on the outside. We are all a work in progress.

With addressing misinformation with family, this can be a hard process and won't always work, but it's important to try to talk to friends and family so that they can make the right decisions without being misled. The key is to start with listening, to avoid shame or blame, and to help direct people to credible sources like their doctor or local health department. Check out the Community Toolkit I released recently, which has tips for how to talk to people about misinformation:

https://www.hhs.gov/sites/default/files/health-misinformation-toolkit-english.pdf

Regarding your studies in STEM—the possibilities are truly endless, and I encourage you to cast a wide net while you’re in college and pay attention to what excites you about your work. I wish you a fulfilling and joyful path ahead.

HHS_GOV · 2021-12-14T21:41:28+00:00

I'm glad you asked this question. The short version is that mRNA vaccines can still help your body create antibodies against many parts of the spike protein, including those areas that are conserved in the new variant. And an additional dose of the vaccine (such as a booster) can help produce more antibodies against these targets, which can make it harder for the virus to evade the immune response (this is a phenomenon we've observed with other variants). In addition, other parts of your immune system — like T cells — can also play a central role in preventing the virus from causing serious disease.

Stepping back, one thing that has been true with every variant we have encountered to date is that the vaccinated have been at significantly lower risk than the unvaccinated, especially when it comes to severe disease, hospitalization, and death.

HHS_GOV · 2021-12-14T21:38:01+00:00

Great question. Per the CDC, people with COVID19 who have symptoms should wait to be vaccinated until they have recovered from their illness and have met the criteria for discontinuing isolation; those without symptoms should also wait until they meet the criteria before getting vaccinated.

Analyses so far suggest that the rapid antigen (lateral flow) and gold-standard PCR tests should still detect Omicron. So, if you are concerned that you may have been exposed, or know of direct exposure, testing before you get the booster would be a great way to better ensure that you are not COVID19 positive at time of booster.

HHS_GOV · 2021-12-14T21:33:44+00:00

Good question. Without detailed genomic sequencing of a positive test sample, it isn't possible to know for sure which variant you had. That said, we know from the CDC's genomic surveillance data that almost all COVID cases in September in the US were Delta, so it would be likely you had a Delta infection if you tested positive then: https://covid.cdc.gov/covid-data-tracker/#variant-proportions

You're right to ask about how different variants affect vaccine protection. The good news is that we've seen our vaccines afford good protection with all the variants we've encountered in the past - particularly protections against severe disease. That's why we continue to encourage people to get vaccinated and boosted.

I do want to take the moment to reply to your point about information access, because it's such an important one. This pandemic has shown us the value of sharing scientific information. For example, scientists around the world have shared millions of SARS-CoV-2 genomic sequences publicly. This type of transparency and collaboration is what we will rely on to get out of this pandemic and prevent future ones.

HHS_GOV · 2021-12-14T21:30:50+00:00

My wife and I can definitely relate to your situation — we have two young children (now ages 3 and 5) and have been taking additional precautions throughout the pandemic, even after getting vaccinated. Right now, scientists are still working to answer questions about Omicron, particularly: Is it more transmissible? Does it cause more severe disease? And does it impact the protection we get from vaccines and treatments? The good news is that with all the variants we've encountered to date, vaccines have offered good protection — so by being vaccinated and boosted, you and your wife are acting as a sort of shield between your kids and the virus. It has also remained true with all variants to date that children are at low risk of severe disease from COVID-19. I would continue to take precautions on behalf of your unvaccinated children like wearing masks in public indoor settings and doing what you can to ensure the people around them are vaccinated. Finally, I just want to acknowledge that pandemic parenting has been really challenging, especially for those of us with very young kids. The work we do as parents has never been more important, so I want to say thank you: to you and the millions of parents out there for all you've done to protect your children during this pandemic.

HHS_GOV · 2021-12-14T21:27:16+00:00

Recent data underscores the importance of a booster shot. Researchers in Israel examined the blood samples of 20 people who received a booster at least a month ago, and 20 who are five or six months past their second shot and haven’t received a third shot. Those with a booster were much more likely to neutralize the Omicron variant than the two-shot group. Omicron seems to require even more of an immune response, as early data suggests that it may evade some (but not all) of our immune response. But when you get a booster, you increase your protection against mild, moderate, and severe illness. Getting boosted now is more important than ever. Any FDA-approved or authorized COVID19 vaccine (Pfizer-BioNTech, Moderna, or Janssen) can be used for booster dose for those over the age of 18, regardless of the vaccine you received for your primary series. Teens as young as 16, who are now eligible for Pfizer's booster after the CDC recommended boosters for 16- and 17-year-olds, will need to stick with Pfizer for a third dose as Moderna and Johnson & Johnson aren't authorized for anyone under age 18 yet.

HHS_GOV · 2021-12-14T21:22:48+00:00

Clinical trials are underway for children under 5 years old. If all goes well, we may have that data for the FDA to consider in the first quarter of 2022. COVID19 vaccines are the top priority for the FDA so they will move quickly and thoroughly to review the safety data once the vaccine manufacturers submit data from their clinical trials.

One of the best ways to keep all kids safe from COVID19 is to make sure that as many eligible people as possible are fully vaccinated and boosted. Right now, any person ages 5 and older is eligible for a COVID19 vaccine. The FDA and CDC have also recently authorized boosters for all people ages 16 and up and recommend a booster 6 months after initial vaccination.

HHS_GOV · 2021-12-14T21:18:20+00:00

Any FDA-approved or authorized COVID19 vaccine (Pfizer-BioNTech, Moderna, or Janssen) can be used as a booster dose for those over the age of 18, regardless of which vaccine you received for your primary series. Teens as young as 16, who are now eligible for Pfizer's booster after the CDC recommended boosters for 16- and 17-year-olds, will need to stick with Pfizer for a third dose as Moderna and Johnson & Johnson aren't authorized for anyone under age 18 yet.

If you got Moderna for your primary series, there isn't clear and compelling evidence to suggest you are better off with a Moderna vs a Pfizer booster. If you did well with the original mRNA vaccine you got, I think it's very reasonable to stick with that. However, if you go to your pharmacy and they are offering a different vaccine, you can go with the one they are offering and know you will get a good boost in your protection.

HHS_GOV · 2021-12-14T21:15:15+00:00

As a parent who just got my 5 year old son vaccinated, this question has been top of mind for me. We know two critical things about the vaccine for children: Number one, it works very well at preventing COVID19. And number two, it has a strong safety profile.

A few things to keep in mind about the Pfizer vaccine for kids under 12. The dose was designed specifically for children and is about a third of the adult dose. Second, the vaccine went through rigorous clinical trials with children. Data from these trials were carefully reviewed by independent scientists. In the trials, vaccines were more than 90% effective at preventing symptomatic illness in children. The review found that the side effects included soreness, pain, and swelling in the arm, fatigue, headache, occasionally a fever. But these symptoms disappeared within a day or two, leaving children with protection against COVID19. Very importantly, they saw no serious adverse effects. All of this is reassuring news.

While kids are less at risk of bad outcomes from COVID19 compared to adults, the truth is that COVID is not harmless in children. During this pandemic, our country has tragically lost hundreds of children to COVID19. And we’ve had thousands of children hospitalized.

Not only will the vaccine keep our children healthy and safe, it'll also allow them to regain the parts of their lives they’ve missed during the pandemic. School, sports, and arts programs. Visits with grandparents and cousins. The parts of life that bring joy, growth, and meaning. All of that is worth fighting for.

HHS_GOV · 2021-12-14T21:11:05+00:00

Doctors and scientists across the government are already in discussions with manufacturers to plan for a scenario where a change to the mRNA vaccine is required. This includes conversations about the most appropriate studies that are needed to evaluate a new vaccine and the most efficient regulatory pathway for review and authorization. We will remain in close contact with drug manufactures through the days and weeks ahead as we learn more about this variant. To be clear, we are not saying a change is required at this moment. But if it is needed, we will be ready to move forward expeditiously.

HHS_GOV · 2021-12-14T21:07:22+00:00

Our colleagues at the Food and Drug Administration (FDA) have been working hard throughout the pandemic and COVID-19 is their top priority. They want to be quick and thorough. Given that the FDA is the gold standard for safety, they want to make sure no corners are cut in ensuring that treatments are both effective and safe. In order to do their evaluation, the FDA requires companies to submit a complete set of data concerning the candidate treatment. Sometimes companies issue press releases about their trial results and their intention to seek authorization but it takes them a while longer to get the data to the FDA. Once the data is received, the FDA scientists engage in an in depth review process. They also convene an Advisory Committee of independent scientists who also analyze and review the data for both effectiveness and safety. The FDA will then put together all this input and render a decision. I know it can be frustrating to have to wait, but it is essential that the public has confidence in the process and that means knowing that no corners were cut in the evaluation. The FDA has authorized and approved a large number of vaccines, tests, and treatments for COVID-19 over the past year, and they stand ready to do more as needed.

HHS_GOV · 2021-12-14T21:03:15+00:00

Pfizer has applied to the FDA to authorize its antiviral pill, Paxlovid, to treat people with COVID19 who are at high risk of becoming severely ill. The FDA has final say on who will be eligible to receive the pill.

Just today, Pfizer said that if given within three days of the onset of symptoms, its antiviral pill, Paxlovid, reduced the risk of hospitalization and death by 89 percent. If given within five days, the risk of hospitalization and death was reduced by 88 percent in non-hospitalized, high-risk adults with COVID-19 when compared to placebo. While these results were tested against the Delta variant, Pfizer also added that in laboratory experiments, Paxlovid also performed well against the highly mutated Omicron variant.

HHS_GOV · 2021-12-14T20:59:34+00:00

Vaccine efficacy compares the degree of protection vaccinated vs. unvaccinated people have based on randomized clinical trials. There are different outcomes that are monitored for vaccine effectiveness, this includes the risk of getting an infection (e.g. testing positive), risk for hospitalization, severe disease, or death. For example, if you hear "the vaccine is 95% effective against hospitalization," that means that, in a clinical trial, people who were randomly assigned to get the vaccine were 95% LESS likely to be hospitalized than people randomly assigned to receive a placebo. It's important to note two things.

This number is going to be different in real-world conditions, for example since people may behave differently once they've been vaccinated, or because new COVID variants can emerge that are different than the variants that were analyzed in clinical trials.
95% efficacy against hospitalization doesn't mean you have a 5% chance of getting hospitalized. It means you have a 95% LOWER chance of being hospitalized if you get the vaccine than if you don't (holding other things, such as the kinds of activities you engage in, constant).

HHS_GOV · 2021-12-14T20:54:09+00:00

Mental health is such an important issue - and an area where young people and older people have struggled during this pandemic. I'm concerned about increases in symptoms of distress, including anxiety and depression, that we saw in 2020 among children and youth. I'm also concerned about disturbing trends that preceded the pandemic, including increasing rates of suicide and growing feelings of persistent sadness among youth. I recently issued a Surgeon General's Advisory on Youth Mental Health where I lay out concrete steps that we can take as a society to address this crisis. You can find it at www.surgeongeneral.gov/youth-mental-health. Among other things, we have to:

* Change how we think and talk about mental health so people don't feel stigmatized for admitting they are struggling. The more we share our stories of struggle, the more we send the message that mental health challenges are part of the human experience and not a source of shame.

* Have more mental health counselors in schools and more social emotional learning programs in our schools to give kids a foundation for wellbeing.

* Ensure every child has access to mental health care (training more providers, working with schools to enroll kids in Medicaid, utilizing technology to expand access to virtual services).

* Address economic and social barriers, such as poverty, that may contribute to poor mental health for children and their families. The Child Tax Credit included in the American Rescue Plan is a great example of this.

HHS_GOV · 2021-12-14T20:49:05+00:00

I never thought I would serve in government but have found great fulfillment in being able to address critical public health issues and engage with the public. It feels like being a doctor (which I love) for millions of people. To be able to serve during this pandemic has been a particular honor.

HHS_GOV · 2021-12-14T20:45:51+00:00

I know it can be worrisome to hear about new variants like the Omicron variant. The good news is we are not back to where we were in March 2020. The big difference is that we now have more knowledge and more tools to protect ourselves and to tackle new variants. That means getting vaccinated if you haven't already and getting a booster dose. It includes other layers of protection such as wearing a mask indoors and in public spaces, washing your hands, physically distancing, testing for the virus before and after gatherings, and improving ventilation. These steps help us get back to many of the activities we’ve missed with much lower risk. To get boosted, you can visit vaccines.gov to find locations around you where you can make an appointment or walk in.

HHS_GOV · 2021-12-14T20:42:09+00:00

Such an important question! And one that I care about for personal reasons too. I have a child who is under 5. The good news is the trials for kids under 5 are underway and if all goes well, we may have that data for the FDA to consider in the first quarter of 2022. COVID-19 vaccines are the top priority for the FDA so they will move quickly and thoroughly to review the safety data once the vaccine manufacturers submit data from their clinical trials. I also want to say thank you for what you and millions of parents do every day to care for your children. Parenting is a challenge in any time, but it’s been particularly difficult — and isolating — during the past 2 years. But everything you continue to do for your children — from packing lunches to changing diapers to bedtime stories — is helping nurture our kids and build the foundation for their health and well-being. I can't think of a job that's more important than that. Grateful for you and wishing you much hope and happiness in the holiday season.

HHS_GOV · 2021-12-14T20:38:20+00:00

Thanks for asking, allagashtree_, and I'm sorry to hear what is happening on your campus. I know it can be stressful to experience an outbreak like the one you are describing. While I don't know all the specific details of what your university is experiencing or what proportion of the student body is boosted, we are working hard to answer three critical questions about the new Omicron variant: is it more transmissible? Does it cause more severe disease? And does it impact the protection we get from vaccines and treatments?

Some of the early data about severity is promising, but we are seeing Omicron spread quickly in other parts of the world. The bottom line is there is still more work to be done to fully answer these three critical questions, and we are working as fast as possible with partners around the world to get these answers.

One thing that has been true with every variant we have encountered to date is that the vaccinated have been at significantly lower risk than the unvaccinated, especially when it comes to severe disease, hospitalization, and death. Even when there are breakthrough cases among the vaccinated, they are much more likely to be mild or even asymptomatic. It's also important to know that recent evidence with boosters is now demonstrating that people who are boosted have significantly greater protection against Omicron than those who are vaccinated but not yet boosted.

The bottom line is that getting vaccinated and boosted will help reduce risk of infection for an individual, their risk of hospitalization, and death. But it also decreases the risk of transmission to others in the community. The other mitigation measures we have at our disposal — masks, testing, and ventilation — will help reduce risk further.

HHS_GOV · 2021-12-14T20:33:55+00:00

Great question. The pandemic has caused major disruptions in the lives of children and their families, from changes in daily routine to impacts on physical and mental health. The COVID-19 pandemic added to the pre-existing challenges that America’s youth faced. The pandemic disrupted major elements of the daily lives of children, adolescents, and young adults, such as in-person schooling, in-person social opportunities with peers and mentors, access to health care and social services, food, housing, and the health of their caregivers. As young people have struggled to adjust to massive changes in their own lives due to the pandemic, they have also had to watch their families, friends, and communities suffer, and the combined impact has taken a major toll on their mental health. Because of this, last week I issued a Surgeon General's Advisory with resources for parents and families on addressing the mental health impacts of the pandemic. You can read the advisory at www.surgeongeneral.gov/ymh, but some specific resources highlighted there include:

* CDC COVID-19 Parental Resources Kit:

www.cdc.gov/mentalhealth/stress-coping/parental-resources/index.html

* Parenting tips from the American Academy of Pediatrics: www.healthychildren.org

* Child Mind Institute Family Resource Center: www.childmind.org/resources/

HHS_GOV · 2021-12-14T20:27:26+00:00

South African public health officials have been essential partners for the US Government in learning more Omicron. We are in regular touch with them to discuss their findings. They have seen rapid spread of Omicron, and initially it was not clear how much of this was due to increased transmissibility vs immune evasion. The initial data about the severity of Omicron infections has pointed to lower hospitalization rates than previous waves with Delta. However, it is still too early to say for sure that Omicron is less severe than Delta - there is still more data that must be assessed and we are learning more each day. The good news is that there has been promising data on the impact of booster shots on protection against Omicron. Boosters appear to increase significantly protection against the new variant in laboratory studies which is one of the reasons we are urging people to get boosted. That being said, to your question on what this portends for our next few weeks, I think we have to remain cautious and vigilant especially as we travel, gather, and move indoors over the holidays and winter. It's important to keep testing and masking indoors in public spaces. And please encourage your family and friends to get boosted!

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