Readers on Gas, Breastfeeding Antibodies and an Apology

This newsletter will be on a short hiatus while I catch up on teaching, but I’ll be back sometime next week.

But before I go: A reader follow-up, and answers to some questions on new evidence on breastfeeding and pregnancy antibodies. And, yes, an apology.

Readers on Gas

A number of you wrote me after the gas stove posts, and your thoughts were so helpful I wanted to share. They came in three forms.

  1. A number of people pointed out a key non-asthma reasons to avoid gas stoves (and gas heat): the contribution of natural gas to climate change. This is among the central arguments of that NEJM article I cited at the end of the piece. This is absolutely correct and worth factoring in, especially when thinking about new construction.

  2. Several people pointed out that if you are worried about air quality, you can get an indoor air monitor, which can give you a sense of how your indoor air quality is, and how it varies with cooking. If you do choose to get a portable hepa filter, you can also then monitor how it is working.

  3. Finally, a number of you pointed out that induction cooking has gotten much more accessible and affordable over time. Someone sent this link to an portable induction cooktop from Amazon (reminder: you also need magnetic-bottom cookware to use this). They said they don’t always use it, but for many kinds of cooking it’s better than gas (see some discussion of the tradeoffs here). This suggests another intermediate approach along with the Hepa filter.

Hope this helps and thank you to all of you for input!

Breastfeeding & Pregnancy Antibodies

As vaccination has expanded we are starting to see increasing vaccine access for pregnant and breastfeeding people. And we’re starting to get evidence on the role of vaccine-produced antibodies in these people. It’s going good!

Breastfeeding We already knew that for people who recover from COVID-19 there are antibodies present in their breastmilk. Now, data from a very very small sample of six people, shows that antibodies are also present in people who are vaccinated. This isn’t surprising given what we know about how vaccines work.

This is cool! And it suggests it is possible breastfeeding infants could get some protection via breastmilk. Whether this will actually translate to infant immunity isn’t yet clear and will not be until we have much more data which actually tests infants for antibodies. I wrote about this a few weeks ago and we’re pretty much at the same place now.

Vaccines give you antibodies. These get into breastmilk. From there, unknown.

To the people who wrote to ask whether they should restart breastfeeding their toddler in response to this after they are vaccinated: unless you are dying to for other reasons, I’d say no.

Pregnancy Vaccination during pregnancy could lead to antibodies to COVID-19 in newborns. Does it?

We have the first evidence on this. It is based on a sample size of one, so it’s more what we’d call a case report. A health care worker received the Moderna vaccine at 36 weeks of pregnancy and her infant was born with antibodies present in her cord blood.

Will this be universal? Will it differ based on when you are vaccinated during pregnancy? How long does it last? We do not know any of these answers yet. We surely will learn them over the next months.

For now I read this as one more plus in the get-the-vaccine-column for pregnant women. It’s a good idea for you, and possibly protective for your infant.

A Note on My Recent Piece in the Atlantic

Many people were upset by my piece in the Atlantic last week. In that piece, I analogized unvaccinated children and vaccinated grandparents. That analogy is only a partial one, and it should not have been highlighted in the headline of the piece, where it lacked context and qualifiers.

The premise of the article was that once all adults have vaccine access, which the Biden Administration has suggested will happen by early summer, children do not need to be left behind. I suggest this is the case for two reasons. The first is that they will be protected by the lower case rates which we expect to result from a high vaccination level. The second is that they are at low risk for serious illness even if infected. These points have been widely made elsewhere (in this New York Times story, for example). And I stand by these points: I do not think we need to leave kids behind once we think it is safe for adults to be out and about.

Where I fell short is in the analogy with vaccines.

I thought this would be a helpful frame for thinking about risks of serious illness and death.  Rather than quoting the CDC directly and saying the risk of death is 2,800 times higher for an unvaccinated older adult than a 5-to-17-year-old child I converted that rate to a “vaccine equivalent.” However, the vaccine analogy does not carry over when we’re thinking about infection or transmission. Children are less likely to be infected overall, but the ratio is more like 2-to-1 than 2,800-to-1. I said this directly in the article, and it is why the piece was forward-looking, focusing on a time when we anticipate lower case rates due to wider adult vaccination.

But the headline missed these nuances. Moreover, the analogy could have been interpreted to suggest children do not need to be vaccinated once vaccines are available for them, which is not the case.

There are other things I could have emphasized. I didn’t stress that the situation is different for higher risk children, or emphasize the importance of equitable vaccine distribution to the BIPOC communities who have suffered disproportionately in the past year.

I haven’t wavered in my view that we should think carefully about risks and tradeoffs, or that we should recognize that taking some risks is part of life. But the way I expressed this idea, in particular in a one-phrase headline summary of a complex and challenging issue, was incomplete. I appreciate you holding to me account, and I will do better going forward.

Weigh in!

Keep the thoughts coming. I don’t always write back, but I read everything.

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