Some surprising data in the discussion of the COVID-19 vaccine for minors in United States
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Some surprising data in the discussion of the COVID-19 vaccine for minors in United States
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Some surprising data in the discussion of the COVID-19 vaccine for minors in United States.
On June 14 and 15, the US FDA discussed Moderna’s COVID-19 vaccine for minors aged 6 months to 17 years old and Pfizer/BioNTech’s COVID-19 vaccine for children aged 6 months to 5 years old (approved before the age of 5 years).
There was a lot of information about the outbreak in children, some very startling.
1. To what extent are minors at risk from the COVID-19?
Even the experts convened by the FDA gave polarized assessments on this issue. While the Moderna and Pfizer/BioNTech vaccines have been unanimously recommended by experts – all agree that minors should have access to vaccinations, especially children under 5 who have not yet had a vaccine approved for COVID-19, what is the actual danger of COVID-19 , different experts have given very different views.
Some experts pointed out that the number of deaths among young children due to the COVID-19 is similar to the number of people struck by lightning, which is an extremely unlikely event, and most children are fine without vaccination.
But at the same time, some experts point out that the threat of the COVID-19 to children is dangerously underestimated.
Such polarized views can also be seen from some data. According to CDC data, there are 13 million confirmed infections among minors in the United States (the actual number of infections may be much higher) [1]:
How many minors have died from the COVID-19 so far? As of June 2, 422 people aged 0-4 had died, and 644 people aged 5-17 had died. The risk of dying is less than 1 in 10,000 .
But at the same time, this is still enough to make the COVID-19 the top five causes of death among minors of all ages [1]:
The extreme polarization between individual risks and overall threats has also led to polarized judgments about the impact of the COVID-19 on minors.
2. Which minors will become seriously ill after infection?
For low-risk minors, when we see COVID-19 hospitalizations and even deaths, a common assumption is that there should be serious underlying medical conditions.
This is also my personal view. But according to the CDC, that perception is far from reality:
The CDC’s two different COVID-19 hospitalization tracking systems both show that half of young children (under 5 years old) hospitalized with COVID-19 have no underlying medical conditions , and one-third of children and teens hospitalized have no underlying medical conditions.
Considering that children with underlying diseases are a minority after all, relatively speaking, this group is indeed at higher risk .
However, minors without underlying diseases can account for such a high proportion of hospitalizations, which shows that for any child, there is still a risk of COVID-19 infection that cannot be ignored .
In addition, a very popular saying is that the hospitalization of the COVID-19 is exaggerated.
Many people are hospitalized for other reasons, which have nothing to do with the COVID-19.
They are classified as COVID-19 hospitalizations only because they test positive.
CDC clarified this point. According to different data collection methods, some theoretically have the possibility of hospitalization caused by non-COVID-19 income, but other CDC databases strictly identify the cause of hospitalization.
These different databases point to hospitalization.
The situation is similar. Therefore, it is not true that most of the so-called COVID-19 hospitalizations are not due to COVID-19 hospitalizations.
It should even be said that most of the COVID-19 hospitalizations announced by the CDC are really caused by the COVID-19 .
3. Is Omicron less of a threat?
The question of whether Omicron infection is not dangerous is often debated.
According to the data tracked by the CDC, the hospitalization rate of children and adolescents in Omicron increased significantly regardless of whether they were vaccinated [1]:
Another surprising thing is that many of the hospitalized cases during the Omicron period were indeed quite serious:
Previous articles comparing Omicron and past mutants gave the impression that Omicron was rarely hospitalized, and even if he was hospitalized, he would be discharged within a few days.
In fact, those comparisons are only a certain weakening of the pathogenicity of Omicron in the past, and the absolute pathogenicity cannot be ignored .
For example, among all minors, about 20% of the hospitalized population is admitted to the ICU.
Another startling statistic is the number of teenage COVID-19 deaths. 2022, which is dominated by various branches of Omicron, has not yet passed half a year, and the number of deaths among minors has exceeded the whole year of 2020, which is quite close to the whole year of 2021. Children under the age of 4 [2]:
There have been 147 deaths in 2022 as of June 2, and 221 for all of 2021. Children and adolescents have a similar trend [2]:
Even people who think Omicron is very dangerous would have a hard time imagining that this weaker strain could have such consequences in relatively low-risk juveniles.
4. The role of extremely high past infection rates is unknown
What is even more surprising is that Omicron has led to so many hospitalized deaths in the United States when serological investigations have shown that there have been a large number of past infections [1]:
From this CDC-cited serosurvey, past infection (positive N protein antibody) is very common in minors.
In January 2022, the proportion of minors in all age groups exceeded 50%, and in February it soared to 70%. But with such a high past infection rate, Omicron still caused the staggering total of deaths mentioned above, which can be said to be very surprising.
A recent JAMA serological survey showed that by December 2021, the positive rate of COVID-19 antibodies among American adults has exceeded 90% (including vaccination or natural infection) [3].
The problem is that with such a high seroprevalence rate, the number of deaths from the COVID-19 in 2022 will not be many.
Combined with similar observations among minors, two points have to be considered:
- Do these serological investigations represent the real situation? The JAMA paper sampling is a blood donation-based sample bank, and the CDC cites past infection serology studies as sampling in commercial medical blood tests. Are these samples representative of the actual situation in the United States? This is a question. In the FDA’s June 14 discussion, VRPBAC Chairman Dr. Monto pointed out that other serological tracking showed that the past infection rate of minors was not the same.
- Is the actual protection from past infections reliable? If more than 90 percent of U.S. adults have been protected by past infections or vaccinations by December 2021, as shown in the JAMA paper, then most of the nearly 180,000 deaths from 2022 to now are past infections but unvaccinated (most of the deaths were unvaccinated). Considering that the unvaccinated population is a minority of the population (more than 80% over the age of 5 have been vaccinated), is the actual protective effect of past infection limited?
We’ve always thought that higher vaccination rates combined with some people being naturally infected provide good protection. But are we overestimating the protective effect of natural infection?
Overall, these epidemic data for minors in the United States still point to the COVID-19 as a serious health threat even in a low-risk group.
As Marks , the FDA ‘s director of biologics, said, just because there are more deaths among older adults doesn’t mean that deaths among minors are nothing.
When more and more people believe that the COVID-19 has ended or should have ended, how to balance scientific understanding of individual risks with the overall threat of the disease will be a challenge.
References:
1. https://www.fda.gov/media/159222/download
2. https://www.fda.gov/media/159257/download
3. https://jamanetwork.com/journals/jama/fullarticle/2793517
Some surprising data in the discussion of the COVID-19 vaccine for minors in United States
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