Thursday, June 10, 2021

Think Twice Before Giving the COVID Vax to Healthy Kids/ Med Page Today

— Based on the data to date, there's no compelling case for it right now
A young girl wearing a protective mask receives the COVID-19 vaccine

The case to vaccinate kids is there, but it's not compelling right now. The Delta variant (B.1.617.2) could change the calculus depending on forthcoming data from the U.K., Singapore, and India where the variant may be demonstrating more contagious and virulent properties in younger people. By now we should all know that it is important to have humility in dealing with this virus. An increase in cases in the U.K. over the last few days is concerning and should be something we follow closely.

Returning to the discussion of the COVID-19 risk to kids (ages 0 to 12 years) right now, it's worth aggregating the best available data to date. In reviewing the medical literature and news reports, and in talking to pediatricians across the country, I am not aware of a single healthy child in the U.S. who has died of COVID-19 to date. To investigate further, my research team at Johns Hopkins partnered with FAIR health to study pediatric COVID-19 deaths using approximately half of the nation's health insurance data. We found that 100% of pediatric COVID-19 deaths were in children with a pre-existing condition, solidifying the case to vaccinate any child with a comorbidity.

Given that the risk of a healthy child dying is between zero and infinitesimally rare, it's understandable that many parents are appropriately asking, why vaccinate healthy kids at all?

To those parents, I would say the primary reason to give a healthy child the vaccine may not be to save their life, it's to prevent the multisystem inflammatory syndrome (MIS-C), which can be painful and have long-term health sequelae. According to the CDC, there have been 4,018 cases of MIS-C after COVID-19 with the average age being 9 years old. A total of 36 children died. Cases of MIS-C were heavily skewed toward minority children (62% were Hispanic/Latino or Black), likely due to the disproportionate rates of childhood obesity and chronic conditions in these populations. This finding again supports COVID-19 vaccination in any child with a medical condition, including being overweight.

It's also important to note that the COVID-19 exposure risk in children is not linear over time. Since new COVID-19 case rates began quickly declining in May, the weekly rate of new cases of MIS-C associated with COVID-19 has decreased to zero. And this week, a CDC report on child hospitalizations for COVID-19 in March and April, 2021 found zero deaths in the entire cohort of children studied.

There is an argument for vaccinating children to create a community benefit for kids. Vaccinating healthy kids can help reduce virus transmission to at-risk kids who choose not to get vaccinated or others who cannot get the vaccine. On the other hand, data from Israel suggest that when adult vaccination rates are high, transmission among kids is markedly reduced -- a trend now noted in the U.S. We also know that children are inefficient transmitters of COVID-19 compared to adults. That could potentially change with new information on the recent Delta variant, but so far it hasn't.

The extremely low chance of any benefit for healthy children is exactly why pediatricians like Richard Malley, MD, of Harvard, and Adam Finn, MD, PhD, of the University of Bristol, have passionately written to not "use precious coronavirus vaccines on healthy children." A recent editorial in The BMJ echoed this sentiment -- an argument also eloquently articulated by MedPage's own Vinay Prasad, MD, MPH. From a global perspective, two doses of a globally scarce, life-saving vaccine could be more equitably used to immunize a 65-year-old couple in India or Brazil (one dose for each person) rather than giving both doses to one 5-year-old healthy child. Accordingly, California's announcement to spend $116 million to pay people to get the vaccine when much of the world is begging for it in the midst of raging epidemics is a sad commentary on our country's excess, inequity, and ethnocentrism.

There may also be unique side effects in children from the second COVID-19 vaccine dose. Seven adolescent children were reported to have myocarditis within 4 days after receiving the second Pfizer vaccine dose. All were in boys ages 16 to 19. Both mRNA vaccines have been found to be 100% effective in preventing COVID-19 in kids. But anytime a medication is found to be 100% effective, it should call to question whether the dose is too high, the interval is too short, or if there is a need for the second dose at all. Pfizer is now looking at lower vaccine doses for children, as they mentioned Tuesday in their announcement that they are starting their vaccine trial in kids under age 12.

Importantly, and affirmed 2 weeks ago from a Washington University study, immunity is not just conferred by antibodies, it's also a function of memory B and T cells, which the study researchers suggested may confer long-lasting immunity. Given the near-zero risk of COVID-19 death in healthy children and the recent discovery of rare myocarditis complications immediately after the second dose, this should raise a discussion of whether a single dose is the more appropriate approach for healthy kids.

In my residency training, I was taught an old dictum many of you might be familiar with: "If you give someone blood, always give at least two units." It took decades for the medical community to undo that dogma. We now understand that there are rare but real harms to a second unit of blood. We have matured to recognize that if a second unit is not necessary, one unit is actually safer than two. We should similarly abandon the notion that the vaccine must always be given as two doses. In transplant patients for example, it may be three. In kids with natural immunity from prior infection, it may be none.

What about children who are confirmed to have had COVID-19 infection in the past? I would recommend avoiding COVID-19 vaccination. Looking at natural immunity in adults as a point of comparison, the observational and empirical data are overwhelming: natural immunity is real and it works.

Researchers from the Cleveland Clinic published a study this week that found "Not one of the 1,359 previously infected subjects who remained unvaccinated had a SARS-CoV-2 infection over the duration of the study." This is one of many studies showing that natural immunity is powerful. While the long-term durability of natural immunity is unknown, it's also unknown for vaccinated immunity. We can postulate with strong rationale, but to be true to the science, we have zero data beyond 18 months for either. In fact, there is more follow-up data on natural immunity than there is on vaccinated immunity. Based on accumulating data, children who have had COVID-19 should not get vaccinated, unless they are immunocompromised.

One final and minor consideration should be needle anxiety, which has no or minimal effect on most children but can be traumatic for some. For kids who should receive the vaccine and also have needle anxiety, cold therapy and vibrating devices, such as with the "Buzzy" device, can be applied to the skin injection site prior to injection and result in little to no pain.

In my opinion, the COVID-19 vaccine makes sense for any child who is overweight or has a pre-existing condition. It also may make sense for a teenager given their closer physiologic similarity to adults and the fact that historically, vaccines safe in adults have been safe in kids when dosed appropriately. But given the case-report level rarity of a healthy child dying of COVID-19, I would not recommend a two-dose vaccine regimen for a healthy child ages 0 to 12 years until we have more data. Each parent will have to assess their own child's individual risk, but in my opinion, the case to vaccinate young healthy kids is not compelling right now.

Marty Makary, MD, MPH, is Editor-in-Chief of MedPage Today and a professor at the Johns Hopkins School of Medicine, Bloomberg School of Public Health, and Carey Business School. He is author of The Price We Pay.


Anonymous said...

As of 10 June 2021 VAERS/CDC/Wonder data: shows 8 deaths of children 17 and younger following Covid-19 vaccination, as follows:

VAERS ID: 1242573-1
15 year old Colorado boy dies two days after first Pfizer/B Covid-19 shot,died on 4/20/21
Symptom, Cardiac Failure, heart failure

VAERS ID: 1243487-1
17 uear old Michigan boy died eight days after first Pfizer/B Covid-19 shot, died on 4/21/21
Symptom: self inflicted gunshot wound

VAERS ID: 1187918-1
15 year old New Hampshire girl died "3 or 4 days" after second Moderna Covid-19 shot, died on 4/6/21
Symptom: cardiac arrest
narrative: "I do not know the exact date of the first or second Moderna Vaccine. I am the PICU attending who cared for the patient after her cardiac arrest which we believe was about 3-4 days after her second Moderna Vaccine"

VAERS ID: 1307657-1
17 year old Ohio boy died four days after second Pfize/B Covid-19 shot, died on 4/23/21
Symptom: completed suicide

VAERS ID: 1349598-1
17 year old Ohio boy died four days after second Pfize/B Covid-19 shot, died on 4/23/21
Symptom: completed suicide
narrative [in part]: "On 19Apr2021, the patient received the second dose, and the patient was sick that day, headache/tired, diarrhea. On Tuesday (20Apr2021), the patient slept all day, headache, chills, diarrhea, no appetite, said he didn't feel right. Wednesday (21Apr2021), tired/headache unable to stay online for school, diarrhea, slept for large portion of day. Thursday (22Apr2021), not feeling himself, up more but headache, diarrhea. Friday (23Apr2021) diarrhea - took his own life by hanging himself in the reporter's basement in the morning hours. The patient did not have history or signs of depression, anxiety, or mental illness."

VAERS ID: 1199455-1
17 year old Wisconsin girl died eight days after [unk if first or second] Pfizer/B Covid-19 shot, died on 4/10/21
Symptom: cardiac arrest
narrative: "Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death"

VAERS ID: 1353097-1
15 year old girl unknown location died after moderna Covid-19 shot, date unknown
Symptom: cardiac arrest
narrative [in part]: "he reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (15 year old female received vaccine) had resolved. Concomitant medication use was not provided by the reporter. Treatment of events was not reported. Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded for the event of cardiac arrest. Follow up not possible as no contact details available"

Anonymous said...

I think a reasonable approach for children under 10 or so is monitor and if symptoms develop, administer IVM. Dr. McCulough recently pointed out that vaccinating children to protect adults is truly immoral, and not done in past.

Anonymous said...

I wish you had not posted this piece from little Marty, who has written a clearly deceptive article that throws in a few crumbs about not vaccinating children - but then writes elaborate lies as to why it really is a necessary step after all. This article is the definition of controlled opposition.

The reality is children, up to adulthood, have an incredibly robust immune system. It is far superior to the adult immune system which gets damaged in later years from all the Pharma crap they are exposed to. Thus, if children are exposed to Sars-CoV2, they will immediately kill the virus and will establish LIFETIME IMMUNITY - which is likely little Marty’s real fear.

So, little Marty’s idea is its better to inject them with a gene-editing medical procedure that may damage them for life - meaning it carries incredible risks - for an illness for which THEY HAVE NO RISK. Perhaps medical schools ought to require classes on LOGIC, because little Marty clearly doesn’t have any.

Then, to try to bolster the insanity of his proposal, in the 2’nd sentence he ups the fear ante with discussions of “the Delta variant” that may be more contagious, or MIS-C.

First of all, tests of Sars-CoV1 have shown that the immune system can easily handle variants that are materially different from the original. After all, the first time anyone encounters and clears a “novel virus” it’s likely 100% different than anything encountered before. So children, with an incredibly robust immune system, can handle Sars-CoV2, and any variants else quite easily. And they maintain that robust immune system well into their adulthood.

The human body is designed to give the young every means possible for survival, hence the young have the most powerful immune system on the planet.

The only thing it cannot handle is EVIL in the form of little Marty and his psychopathic friends Bill and Tony.

Anonymous said...

I agree this is pro vax [irrespective of safe vax] narrative, overall.

However, in the old days, we were trained to read as many sources as possible. For what used to be very obvious reasons.

Trust none of them, be skeptical, and being educated is about being able to sift out facts from which knowledge is gleaned, and understanding, that ongoing process, is the goal.

The logic of "not reading" or "not posting" material that clearly has agendas is a dead end, however.

An investigator investigating a crime may interview a known criminal.

This known criminal, the investigator may rightly know, may at best tell only 10% truth or maybe even 50% truth. And the rest lies and obfuscation and fairy tails.

Should this investigator, therefore, not interview this criminal, or not listen to what he or she says?

Of course not.

That 10% or 50% truth or knowledge is what this hypothetical investigator is looking for -- even from a known liar and criminal.

Until the Trump Phenomena from 2015 going forward, it was boilerplate that we would read different sources since no educated person would ever rely on just one or two or three sources from which to be able to form rational and logical and knowledgeable conclusions.

In summer of 2016, NYTimes announced it would begin to use a "different" "standard" to report on Trump.

Thereafter, Trump, like him or not, in many instances called out Big Media for their craven lies, and the contemporary era of FAKE NEWS was born.

This in turn created a most deplorable outcome: so-called "fact checkers".

This unctuous bunch form part and parcel the censoring/deplatforming bunch of lunatics, maniacs, and anti-science Big Media operatives in league with Western Empire's ongoing operation against the common man.

Advocating Dr. Nass to not publish this or that is as much a dead end as the above "fact checking" and anti science perspective.

This paradigm of not posting this or that, like the "fact checking" maniacs [who as part of their neo-fundamentalist mission also smear those they disagree with, along the way] --- this: all of it are road blocks on the road to provisional truths and understanding, which themselves are bridges to expand our provisional truths and understandings and knowledge-base --- or in other words: this is the deadest of dead ends. And it is nonsense to believe otherwise.

One will never know the enemy by burying one's head in the sand, never ever ever -- much less be in any position to challenge any of their deadly heinousness.

Also, Dr. Nass took the time this week to blog dozens of comments on this week's FDA Science Fiction. I watched most of it; should we not have paid attention to this, knowing ahead of time it is an operation to justify more harm to our children in this tragic and bitter failure of Western Civilization?

We all know it is very unlikely, at this time, that the most criminal of criminals in this crime still in progress may ever be sent to penal colonies where they belong; this does not mean, however, that as citizens we should not use the tools we have, including reading limited hang outs, in the very tiny tiny chance they all may some day be held accountable? What would it look like if half the congress ended up in jail, the president, members of the CDC leadership, NIH leadership, NIAID leadership, military leadership, etc. were all sent to penal colony? It would be a start to a long needed corrective movement. The alternative, which we are seeing more and more of: is more and more repression of us, we the people.

Anonymous said...

There is an important upcoming Senate Hearing titled:

COVID-19 Response and Recovery: Supporting the Needs of Students in Higher Education & Lessons on Safely Returning to Campus on Safely Returning to Campus

Being held : June 17, 2021

Please call your Senator from the list NOW and let them know you don’t believe our children should be forced to inject a potentially life-altering medical product against their will. These experimental products have already killed more than 5,000 people in the USA, and over 10,000 in Europe - and that is just the ones that have been reported in VAERS.

There are so many of our children that have already had and recovered from Sars-CoV2, so they already have a robust, life-long immunity, and medical experts warn the gene-editing procedure could be extremely dangerous to their health due to Antibody Dependent Enhancement (ADE), a known danger of mRNA technology.

It is time our Senators and Representatives in Congress forcefully slap down the demonic psychopaths in the FDA/CDC/NIH/NIAID. If not, then WE NO LONGER GIVE OUR CONSENT TO A ROGUE GOVERNMENT THAT IS INFLICTING HARM ON ITS OWN CITIZENS.


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