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Apr 28, 2022Liked by Katelyn Jetelina

"The CDC reported that infection-induced immunity increased from 44 →75% among 0–11 year olds and 46→74% among 12–17 year olds from December 2021 to February 2022."

Given the general understanding of what "immunity" means, I think that characterization of what the CDC reported is misleading. What they reported was an increase in the seroprevalence of infection-induced SARS-CoV-2 antibodies, not immunity. While there is a strong correlation between the presence of SARS-CoV-2 antibodies (infection-induced or vaccine-induced) and immunity against a SARS-CoV-2 infection (or reinfection), one could have such antibodies (especially at low titers) and not be immune to a SARS-CoV-2 infection.

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Some questions and feedback:

1) KJ: "More than 11,000 children were hospitalized in 25 states, and five times as many children ages 4 and younger were hospitalized compared to previous waves."

How do these rates compare with general hospitalization rates for children for other ILI respiratory viruses during flu season? 11,000 sounds like a large number, but it probably only represents between 2%-6% of pediatric hospitalizations, no? Sources I've found indicate roughly 150,000 non-neonatal pediatric hospitalizations per month can be expected, though it doesn't break down by cause only noting "Respiratory diagnoses—pneumonia, acute bronchitis, and asthma; mood disorders; appendicitis; and epilepsy/ convulsions were the most common specific conditions for which children were hospitalized" [1]. CDC indicates in the < 5 cohort alone as many as 26,000 hospitalizations in a flu season [2]. How much higher was hospitalization rates during Omicron than baseline? Than high flu seasons like 2017?

2) KJ: "Of the 5-11 year olds hospitalized during Omicron wave, 90% were unvaccinated, 30% did not have an underlying condition, and 20% required ICU admission."

Is this statistically significant considering when the study began 80% of the 5-11 cohort was unvaccinated and by the time the period ended 7 out 10 were still unvaccinated? [3] Isn't this a base rate fallacy? Especially once you break by ethnicity and the rates converge?

Additionally, the study period is 14 weeks yet they group partially vaccinated along with unvaccinated which as they admit as one of the limitations: "Third, analyses based on vaccination status are biased toward the null because partially vaccinated children were grouped with unvaccinated children." < there was no reason to do this, they had the data to break cohorts. And a previous version stated they also included anyone who was fully vaccinated but got covid within 2 weeks of 2nd dose as "Unvaccinated" as well, though a stealth update removed that verbiage. That makes this far less impressive.

No to mention "There were no significant differences for severe outcomes by vaccination status." undercuts the benefit of a non-sterilizing vaccine.

3) KJ: "The disease profile also slightly shifted with Omicron. A JAMA study found Omicron was associated with a 3-fold increase in hospitalized Upper Airway Infections (like croup) compared to prior variants."

Is there possibility the increase was due to children returning to school in far greater numbers after a large % of the country missed school in 2020-2021? (Pre-Omicron period studied was March 1, 2020, to December 25, 2021 compared to December 26, 2021, to February 17, 2022 for Omicron) Scanning other countries which didn't participate in the "keep kids out of school" approach (half of Europe, all Nordic countries, etc) I am not finding papers noting rising UAI in these countries (easily could be I am simply missing the research, so if anyone finds something please link).

Also, the "3 fold increase" is relative increase, overall the absolute increase of +2.6% seems unremarkable considering the sampling methods.

4) KJ: "During the Omicron wave, Kaiser Family Foundation reported COVID19 was the fourth leading cause of death for 5-24 year olds."

That would be notable if there were say, 100 different causes of deaths in that age cohort normally distributed. Then ranking #4 would be noteworthy. Instead, there are between 10-15 causes deaths (depends how you group accidents mainly how granular you want) with a front loaded pareto distribution. A more accurate phrasing would be "During the Omicron wave, COVID19 accounted for 1.3% of deaths for 5-24 year olds". The rise in homicides, overdoses, and suicides in this age group I believe is the larger concern, as it accounts for nearly all excess deaths in that cohort.

5) Regarding the infographic from the Health System Tracker, how do we reconcile the fact that Covid bounced back to the #1 cause of death for 65+ despite being 95% vaccinated? Credit was given to the vaccine as Covid dropped from #1 to #6 between Jan 21 and June 21, but now that it climbed back to #1 what is the explanation?

6) KJ: "With an Omicron sweep, it’s still incredibly important to get kids vaccinated. Thankfully, this is coming for us parents with kids under 5."

In Sweden, they don't recommend the vaccine for children under 18 without comorbidities. Despite this and other controversial approaches (kids back in school May 2020, kids not masking, overall the lowest masking rates in the world for adults, limited lockdowns, etc) they have among the best outcomes in the world with zero excess deaths under age 75 throughout the entire pandemic [4] and the 2nd lowest total excess deaths worldwide (only beaten by Norway).

How to reconcile that outcome with our approach which placed us as the leader in excess deaths?

7) Why did the CDC MMWR not report on prior infection status? That is, how many of the hospitalized children were there with a repeat infection? They certainly had this data given the charts they accessed, why not detail it?

8) Why did the CDC fail to break down comorbidities by vaccination status? Again, they had this info but neglected to present it. I can only assume they left it off because it made no difference.

9) Considering 5-11 vaccination was only approved November of 2021 and this study is Dec-Feb, doesn't the data from this report actually show the vaccine only has a 50% efficacy and wanes quickly given how many vaccinated children were still hospitalized?

Appreciate any feedback, thanks!

[1] https://www.hcup-us.ahrq.gov/reports/statbriefs/sb187-Hospital-Stays-Children-2012.jsp

[2] https://www.cdc.gov/flu/highrisk/children.htm

[3] https://data.cdc.gov/Vaccinations/COVID-19-Vaccination-and-Case-Trends-by-Age-Group-/gxj9-t96f

[4] https://imgur.com/a/Pbuu0rI - you can recreate using Tabell 2 from https://www.scb.se/en/finding-statistics/statistics-by-subject-area/population/population-composition/population-statistics/pong/tables-and-graphs/preliminary-statistics-on-deaths/

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Apr 28, 2022Liked by Katelyn Jetelina

Thank you so much for this update! Thank you for your amazing writing and commitment to explaining the complicated science in a clear manner.

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Thanks for this. Fingers crossed for June!

I am sharing a NYT article and discussion I found interesting and frustrating. https://www.nytimes.com/2022/04/27/opinion/covid-vaccine-kids.html?smid=url-share

My 2 cents as a grandmother and public health professional: I know that the science has been evolving rapidly and even the best experts have been on a learning curve throughout this pandemic - BUT the chronology in this article shows what frustrates me: the behavioral science was ignored or not taken as seriously as virology, medical treatment, and other "hard sciences". As a result faulty assumptions and policy decisions were made by key government agencies about the public - and a strong dose of paternalism was swallowed without question. This appears to be the case in the recent decisions delaying authorization of a vaccine for the youngest children. The data is clear that the mRNA vaccine poses no/few safety issues for children, that it prevents serious illness and deaths, and that 2 doses are at least somewhat effective for children ages 0 to 5. I would like to see FDA and CDC authorize at least one of the vaccines for 0 to 5 year olds NOW, don't let the quest for how to best roll out the messaging slow down the process, and let patient parents decide for themselves in consultation with their doc. Comments?

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Thanks again for this and all your work and updates in this newsletter.

I was incredibly disappointed and frustrated last week when the news leaked that the FDA might wait for Pfizer data before evaluating the Moderna application. They said they wanted to because the Pfizer vaccine might be more effective. The Pfizer vaccine, if it works at all, will require a third dose two months later (if I recall) plus two more weeks for full effectiveness, so it will take three months for a full course versus five weeks for a full Moderna course. Add in waiting the few extra weeks for the data, and the FDA would be condemning children under 5 to a third full summer of no protection and even starting school in the fall still unprotected!

If Moderna's vaccine works, it should be approved as soon as possible. Would it be appropriate to start a petition asking the FDA to act on the Moderna application immediately? You have a platform on which to publicize such a petition.

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Thanks for this great overview! Can you provide a link or source for the 90 day (or less) antibody data for Omicron? I live in Lithuania and they have a (terrible!) rule here that kids have to wait 150 days post-COVID to get vaccinated. So I have a kiddo who caught COVID two weeks before her fifth birthday and is not just about at her 90 day mark and I can't get her vaccinated. It's super frustrating and I'm working on a letter to local health authorities encouraging them to at least change the number to 90 days rather than 150.

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Thank you for this update. When I saw the headline about Moderna today, I was eager for your thoughts! Can you please say more about the issue of low efficacy in the Moderna vaccine? Specifically around how this might impact decisions around precautions going forward?

I have a 6 year old (who is fully vaccinated with Pfizer) and a two year old. We are all still masking indoors, with the exception of the two year old because he won't keep it on. So he doesn't go many places. I was really hoping that once we were all fully vaccinated, we could stop masking indoors when transmission is low. Should I rethink this given Moderna's low efficacy? If so, how? (I'm sorry for the clunky way I'm phrasing this; I'm having trouble articulating my thoughts!)

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Apr 28, 2022·edited Apr 28, 2022

Any word on a booster for the 5-11 crowd? We know a booster helped significantly for adults against Omicron. But I've heard little to nothing about a booster for the 5-11s even though we're nearing the 6 month post-approval mark for them.

(I have two in that range, and somehow we've managed to avoid COVID thus far.)

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I was so hoping for a May approval, but now it's looking like I'll have to decide if my daughter who turns 5 in late June should get the Moderna or wait a few weeks for Pfizer 5-11 dose. I'm guessing the older kid vax is best, but will be kicking myself if she gets sick in the intervening 2-3 weeks. More fun pandemic parental math!

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Hi Katelyn,

I wanted to thank you so much for YLE. It has been of huge assistance to me in trying to navigate all the 'noise' surrounding COVID-19, and vaccination. I am in Australia where the COVID-19 vaccine is currently approved for those aged 5 and over. My son is about to reach that age, and as such my reading and research on the vaccine has reached fever pitch. As a fellow parent, I'm really interested that you appear to be very pro-vaccine in children, and was hoping to clarify a few points for my better understanding if I may?

Firstly, if you say above that 11,000 children were hospitalised in the US because of Omicron, and we assume (extremely conservatively) that 10% of children in the US were exposed to Omicron (I'm being extremely conservative here to make a point, because obviously we cannot know how many children were infected due to under-reporting of rapid antigen tests, as well as undetected cases which were asymptomatic etc etc) then that translates to a risk of ~0.2% chance of a child being hospitalised due to Omicron COVID. My understanding is that the rate of hospitalisation suspected to be attributed to the vaccination in children is higher than this. Still miniscule, but materially higher than 0.2% of those children who have received the COVID-19 vaccine. Am I correct? And if so, given that we are looking at a risk-reward scenario, I just don't see how vaccinating my son for COVID-19 stacks up (bearing in mind he is vaccinated against Polio, MMR, Whooping Cough etc, so I am not an anti-vaxer, I am just a Mum weighing up the risks of giving my son a vaccine for which long term effects cannot yet be known and short term effects are being reported vs. the risk of him getting seriously ill from COVID itself)?? I would be so appreciative of you enlightening me here as I am really struggling to find factual, conspiracy-free information on this front.

Secondly, it is my understanding that the current vaccines being used for COVID-19 have not been updated to reflect new variants and as such all prior studies on the abilities of the vaccine to reduce the transmission of the disease are redundant when considering the Omicron variants. Is this factually correct or incorrect? (I did read your post on pediatric vaccine effectiveness and note that the data is not yet statistically significant given the recency of the rollout to children, so I'm more specifically referring to transmission here). I am reading such contradictory information on this but consider both my son's personal health, as well as a societal need to reduce transmission, when making vaccine decisions, and it is my understanding that if my son was to take the current COVID-19 vaccine, it would not make him any more or less likely to catch and transmit the Omicron variant. I am desperate to know whether this understanding is correct, or wildly incorrect, and would so appreciate your advice.

Sincerest of thanks for your consideration of these questions, and for all the work you are doing to better help the average person understand the very complex issues which this disease is throwing up.

Margaret.

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Pfizer is still enrolling kids in trials.... a new location opened up in Phoenix and my daughter has her first appointment May 18th. Isn't that a red flag that Pfizer won't be ready and/or they're worried their data isn't enough?

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At home with 2 month old newborn. Grandfather planning flight to visit. What safeguards/protocol do you recommend-PCR vs rapid antigen tests, when, how often/how long? Quarantine? Please help!

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Not related, but can you please address the paxlovid rebound situation? Experiencing it now and the news articles aren’t clear. But twitter is exploding with scary stuff. Now I’m regretting taking paxlovid. Thanks!

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What does the science and state of where we are in this pandemic say about socializing without masks in small groups if all are vaccinated and boosted? Is it relatively safe to eat in restaurants? Here in Houston I think we are under 1.0, but it’s hard to know what to use as the guide.

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The remdesivir approval isn't limited to hospitalized children . It also includes those "Not hospitalized and have mild-to-moderate COVID-19 and are at high risk for progression to severe COVID-19, including hospitalization or death. " https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-approves-first-covid-19-treatment-young-children

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I’m curious is pfizer trial kids would be deemed ineligible for Moderna if approved first (if when unblinded they were active vax recipients)? I’m concerned about the results of the Pfizer 3rd dose being not great, but wonder what that’ll mean for kids with 3 doses already if the results are not great. I wish they would all hurry up.

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