Si quiere leer la versión en español, pulse aquí. This is a deep dive into the epidemiology of COVID19 indicators among kids in the wake of Omicron. In this post, I frame the data a little differently to address “numerator thinking” vs. “denominator thinking.
It is always harder to act on a proposition than to take a passive stance. If something bad happens because we took an action, it feels like we are responsible. No parent wants to hurt their child, and even if there is a tiny chance of causing harm it is understandable why up to a third of American parents aren't getting their kids vaccinated voluntarily.
But unfortunately we are just as responsible for not acting. Seeing your child get sick, and worrying how bad it might get, and worrying about who else is about to get sick, should compel us to take control and choose the less risky proposition.
I’m sticking with the AAP, AAFP, FDA, and CDC recommendations, and an old school respect for expertise... and your post here reinforces all that! Thank you.
Thanks for a great article--as a pediatrician, I actually try to balance both numerator and denominator in helping my parents make decisions--such a tough time right now! I would love to hear more about type 1 diabetes risk post-COVID--but there may not be enough data to address this yet...
I'm curious if there are any new data related to incidence of Long COVID from breakthrough infections. Wondering if there are any updates since you last addressed this question in the summer. Thanks as always for your energetic commitment to this community even as you navigate the pandemic in your personal life.
A heartfelt thank you from a father of five for the work you do, the analytical brain cells you deploy, to provide this data and interpretation. Question -- have you seen / reviewed any meaningful data around natural immunity from prior infection? by covid variant (variant to variant), by severity of covid case, by age group?
Readers may make a cognitive mistake when they see "research out of the UK showing that long COVID19 is present in fewer than 2% of the population." The Office for National Statistics meant exactly what you said--about 1 person in every 50 in the UK has Long COVID. Not 2% of people who have had COVID, which would be an easy reading glitch. 2% of the entire population of the country, which includes people who have avoided infection with the virus so far.
Thank you for your analysis and explanation. This is a good example of the importance about clearly communicating the basis for your analysis. It also is a good demonstration about the importance of nuance and the benefit of approaching this informed by denominator AND numerator, rather than either/or. I empathize with you and other parents with little ones under 5 and worry about my 3 year old granddaughter.
This is another clear, fact-based article. Your voice is one of the most rational out here. Could you concentrate a future post on the risk to older people - the category I am in. Is it greater or lesser than other age groups - infection, hospitalization, deaths - can you separate for or with Covid for the over 65 population? There is a fair amount of variability among my cohorts for fraternization, based less on real risk, than attitude toward risk-taking, perhaps. Thank you for all you do. A service to all of us. Maggie Burns
Love the update - I have been talking numerator/denominator - glad you brought it out.
HOWEVER - you neglected to take on the unintended consequences from the virus mitigation.
Sometimes the cure is worse than the disease -
How many kids are dead from mental health disorders BECAUSE of the pandemic mitigation?
How many kids are suffering from mental health disorders now - that may be victims shortly.
What are the effects of stunted development and what is that metric?
This IMHO is the only thing missing from your most excellent update and its importance to place into perspective the deaths from COVID mitigation over deaths from COVID.
As a father of two children under the age of 5, I am very sympathetic to how frightening the pandemic can be for parents and how it plays into our core instincts to protect our children (of course, not even mentioning all of the insane disruption it has created in our lives).
I really liked the way you broke down numerator vs. denominator thinking. It's a good label/framework for acknowledging how people are approaching the data from different perspectives and helps us be empathetic to other perspectives.
That said I am a bit disappointed to see numerator thinking validated as equal. Yes, denominator thinking is of little consolation if your kid ends up being in the numerator. However, the inherent flaw with numerator thinking is that it is biased towards whatever you decide to focus on. Not only can numerator thinking logic create fear for pretty much anything where the numerator is > 0, it is not a measure of risk and is also of no use in comparing relative risks and outcomes.
For example, we can look at the number of children hospitalized due to COVID per day and agree that it is a larger numerator than we would like and feel comfortable with. But our bias shows based on what we decide to focus on and pay attention to. It is equally valid to ask - how many children are falling behind in their schooling or social/emotional development? That number is likely millions and a much larger number. That we choose to focus on one numerator and not another is an act of bias.
"Denominator thinking" doesn't eliminate all of that bias, but it does help us analyze the risk involved in a situation and also compare relative risks to each other.
Thank you for this post. It provides great info for parents still navigating life with an unvaccinated child under 5. Do you have any further info regarding the delay of the Moderna under 5 trial? I actually had not heard anything about this until I read the Slate article you linked at the end of this post! A bit of a gut punch today. Can definitely relate to the author of the article.
Outstanding article. I was never in the military but as a grandpa of 3, the youngest being 2 and a half, I feel like every day is a walk through a minefield of virus bombs. Your explanations give the situation perspective which helps a lot. Thanks!
Are we pretty much dependent on Pfizer for a vaccine for children under 5? I've been following Moderna info too but wondering if there's really any chance of getting a Moderna vaccine for young children first given that they don't have EUA for under 18 yet....
Dr. Jetelina, An advocacy group for expedited vaccines for children under 5 has been created on FaceBook. Would you consider joining or advising on the best advocacy routes at this time? https://www.facebook.com/groups/635645747482854/?ref=share
Thank you for this important information. My son is stuggling with the decision of whether or not to go ahead and get his children, 15 and 13, boosted now, or wait to get the next one that comes out. This is based on his concern that they get the current booster and before enough time has elapsed, there is a new, better one available and they end up unable to get it for a time. What is your thinking on this concept - the current booster now vs. holding out for the next one? The children are in public schools and sports now.
It is always harder to act on a proposition than to take a passive stance. If something bad happens because we took an action, it feels like we are responsible. No parent wants to hurt their child, and even if there is a tiny chance of causing harm it is understandable why up to a third of American parents aren't getting their kids vaccinated voluntarily.
But unfortunately we are just as responsible for not acting. Seeing your child get sick, and worrying how bad it might get, and worrying about who else is about to get sick, should compel us to take control and choose the less risky proposition.
I’m sticking with the AAP, AAFP, FDA, and CDC recommendations, and an old school respect for expertise... and your post here reinforces all that! Thank you.
Thanks for a great article--as a pediatrician, I actually try to balance both numerator and denominator in helping my parents make decisions--such a tough time right now! I would love to hear more about type 1 diabetes risk post-COVID--but there may not be enough data to address this yet...
I'm curious if there are any new data related to incidence of Long COVID from breakthrough infections. Wondering if there are any updates since you last addressed this question in the summer. Thanks as always for your energetic commitment to this community even as you navigate the pandemic in your personal life.
Well done by a gifted epidemiologist.
A heartfelt thank you from a father of five for the work you do, the analytical brain cells you deploy, to provide this data and interpretation. Question -- have you seen / reviewed any meaningful data around natural immunity from prior infection? by covid variant (variant to variant), by severity of covid case, by age group?
Readers may make a cognitive mistake when they see "research out of the UK showing that long COVID19 is present in fewer than 2% of the population." The Office for National Statistics meant exactly what you said--about 1 person in every 50 in the UK has Long COVID. Not 2% of people who have had COVID, which would be an easy reading glitch. 2% of the entire population of the country, which includes people who have avoided infection with the virus so far.
Thank you for your analysis and explanation. This is a good example of the importance about clearly communicating the basis for your analysis. It also is a good demonstration about the importance of nuance and the benefit of approaching this informed by denominator AND numerator, rather than either/or. I empathize with you and other parents with little ones under 5 and worry about my 3 year old granddaughter.
This is another clear, fact-based article. Your voice is one of the most rational out here. Could you concentrate a future post on the risk to older people - the category I am in. Is it greater or lesser than other age groups - infection, hospitalization, deaths - can you separate for or with Covid for the over 65 population? There is a fair amount of variability among my cohorts for fraternization, based less on real risk, than attitude toward risk-taking, perhaps. Thank you for all you do. A service to all of us. Maggie Burns
Love the update - I have been talking numerator/denominator - glad you brought it out.
HOWEVER - you neglected to take on the unintended consequences from the virus mitigation.
Sometimes the cure is worse than the disease -
How many kids are dead from mental health disorders BECAUSE of the pandemic mitigation?
How many kids are suffering from mental health disorders now - that may be victims shortly.
What are the effects of stunted development and what is that metric?
This IMHO is the only thing missing from your most excellent update and its importance to place into perspective the deaths from COVID mitigation over deaths from COVID.
As a father of two children under the age of 5, I am very sympathetic to how frightening the pandemic can be for parents and how it plays into our core instincts to protect our children (of course, not even mentioning all of the insane disruption it has created in our lives).
I really liked the way you broke down numerator vs. denominator thinking. It's a good label/framework for acknowledging how people are approaching the data from different perspectives and helps us be empathetic to other perspectives.
That said I am a bit disappointed to see numerator thinking validated as equal. Yes, denominator thinking is of little consolation if your kid ends up being in the numerator. However, the inherent flaw with numerator thinking is that it is biased towards whatever you decide to focus on. Not only can numerator thinking logic create fear for pretty much anything where the numerator is > 0, it is not a measure of risk and is also of no use in comparing relative risks and outcomes.
For example, we can look at the number of children hospitalized due to COVID per day and agree that it is a larger numerator than we would like and feel comfortable with. But our bias shows based on what we decide to focus on and pay attention to. It is equally valid to ask - how many children are falling behind in their schooling or social/emotional development? That number is likely millions and a much larger number. That we choose to focus on one numerator and not another is an act of bias.
"Denominator thinking" doesn't eliminate all of that bias, but it does help us analyze the risk involved in a situation and also compare relative risks to each other.
Thank you for this post. It provides great info for parents still navigating life with an unvaccinated child under 5. Do you have any further info regarding the delay of the Moderna under 5 trial? I actually had not heard anything about this until I read the Slate article you linked at the end of this post! A bit of a gut punch today. Can definitely relate to the author of the article.
Outstanding article. I was never in the military but as a grandpa of 3, the youngest being 2 and a half, I feel like every day is a walk through a minefield of virus bombs. Your explanations give the situation perspective which helps a lot. Thanks!
Are we pretty much dependent on Pfizer for a vaccine for children under 5? I've been following Moderna info too but wondering if there's really any chance of getting a Moderna vaccine for young children first given that they don't have EUA for under 18 yet....
Dr. Jetelina, An advocacy group for expedited vaccines for children under 5 has been created on FaceBook. Would you consider joining or advising on the best advocacy routes at this time? https://www.facebook.com/groups/635645747482854/?ref=share
Thank you for the information, it is very helpful. Do you think the Moderna vaccine will actually be authorized by late March or early April for kids under 5 as stated in this article (https://www.latimes.com/science/story/2021-12-17/whats-the-timeline-for-kids-under-5-to-get-a-covid-vaccine)? In the past I thought we were expecting Pfizer to still be first in the summer.
Thank you for this important information. My son is stuggling with the decision of whether or not to go ahead and get his children, 15 and 13, boosted now, or wait to get the next one that comes out. This is based on his concern that they get the current booster and before enough time has elapsed, there is a new, better one available and they end up unable to get it for a time. What is your thinking on this concept - the current booster now vs. holding out for the next one? The children are in public schools and sports now.