This is a loaded question, but since covid is and will be endemic, when do we get on with our lives and start facing the mountains of other public health issues? It seems like our vaccination effort was extremely successful and had an amazing effect and there isn’t likely to be any radical new intervention for years to come.
I'm not saying I necessarily agree with that -- I think the number of "people who want protection but can't get it" will be uncomfortably large -- but this is my guess of when society as a whole will decide to move on.
Honestly, I think this means the future looks like the present, but more so. The places that will be hit the hardest will be more working class and in places that under invest in health and welfare. That's already the current trend, certainly in the US -- look at where medicaid expansion following the ACA has and hasn't happened, for instance, and who has access to decent health care and who doesn't. In some ways I think we're lurching back to previous centuries, where diseases like cholera, dysentry, typhus, etc were endemic, and could certainly affect the wealthy and professional classes, but were primarily scourges of the working class.
Children are at exceptionally low risk from Covid. It's time to stop with fear, uncertainty and doubt, and deal with facts.
https://www.nature.com/articles/d41586-021-01897-w
In the US, 340 children under 17 have died from Covid. Total. During the same period, 187 have died from the flu, and over 51,000 children have died from all causes:
https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#Se...
The reason the vaccines aren't being approved for children is that there is compelling evidence that children are at greater risk from the vaccines than the virus. This is why (for example) approval for vaccination of children and teenagers is split across Europe, and the UK has restricted access to only children with known vulnerabilities:
https://www.bloomberg.com/news/articles/2021-07-19/u-k-to-gi...
https://www.voanews.com/covid-19-pandemic/european-countries...
> At that point the majority of those who actively want protection will be able to get it.
This is less about what the children want, and more about anxious adults want, and that is unconscionable. Kids are largely at the mercy of their parents, so it's essential that the regulatory bodies tread carefully on this issue. We don't need kids to be vaccinated to reduce Covid to a manageable seasonal illness on par with the flu.
Let's hope the die keep rolling up to that result with each succeeding variant!
It's likely, yes, but why on earth would we want to just accept that?
The flu, for instance, bounces around in severity and kills tens of thousands per year in the US. Few of those are kids, so what? If we're happy to let the virus continue to transmit in any populations, it'll change in various ways. One year a variant may pop up that'll be more harmful to those kids. At some other point a variant may pop up that'll be more elusive against adult immunity, etc. Over years, how many lives does that add up to? Why wouldn't we aggressively try to vaccinate as many people as possible before those things happen?
Success wouldn't be guaranteed even if people weren't opposed to it for various spurious reasons but it would be nice if we believed we could accomplish hard things...
Well first, that has nothing to do with what I wrote. I made a very specific argument about how fear -- hysteria, really -- is driving our reaction to what is right to do for children.
But second, it isn't "statistically foolish"...it's just a basic understanding of biology and our rather poor history of eradicating viral diseases. Statistics don't come into play here either way.
Reasonable people can disagree on whether or not Covid can be eradicated, but you have to be delusional to think that this will be accomplished on any sort of timeline that is relevant to our lifetimes.
That noted, and since I did engage in your comment on the risk to children, I am curious about your statement that my response is inconsistent with what we know. As I understand it, we don't actually know why children have been less susceptible to illness so far, do we? I've seen plenty of theorizing, but I haven't seen any reporting indicating these are more than theories so far. If there's some reliable reporting on this topic I missed, I'd definitely be happy to see it!
Well, everything is a theory, but the most plausible one I've seen is that ACE2 expression is age-dependent. Young kids don't have much of the receptor the virus needs.
More than 4 million people have died so far. If you're going to say it was "fear mongering" then buzz off.
4 million died, so COVID coverage has the most accurate fear-to-reality alignment the news has ever had.
> https://journals.plos.org/plosbiology/article?id=10.1371/jou...
So that's not wild speculation, it's a well-educated concern.
So let's be clear: the claim is that the virus can mutate, therefore, any particular outcome is equally likely?
If I speculate that the virus will mutate into a hemorrhagic fever, like marburg or ebola, is that reasonable?
If I speculate that the virus will lose its pathogenicity, is that reasonable?
(hint: all of our best data suggests that the IFR of the Delta strain is considerably lower than previous strains: https://assets.publishing.service.gov.uk/government/uploads/...)
There's obviously a limit to how much you can speculate about "continued change". At some point, it just becomes a scary story.
No.
Did you actually read the study I linked?
Outcomes that enhance transmissibility are always being selected for. Things like higher viral load in the vaccinated.
That which spreads, spreads.
All things being equal, pathogenicity is neutral and gets down-selected when the pathogenicity conflicts with the ability to spread. But with two different populations, the feedback loop that of down-selective pressure against spread limitations due to pathogenicity may be broken. If it spreads in one population which requires characteristics that make it lethal in the other population.
Yes. It makes the general argument (not specific to Covid) that is known to any evolutionary biologist: partial selective pressure causes an organism to evolve away from that pressure. It's why we tell people to take their entire course of antibiotics.
It in no way implies that the organism will evolve to do anything else. You wrote this:
> Additionally, we know that leaky vaccines and continued spread may cause greater pathogenicity.
This is NOT supported by evidence, except in the completely silly sense that the virus "may" do anything, if it is allowed to continue existing.
If we partially vaccinate, SARS-CoV2 "may" evolve legs and do a little dance...but it probably won't (...and for that matter, it probably will hit an upper limit on transmissibility as well. But now I am speculating, if only in an evidence-based manner.)
Until then, we both know they're not.
But as I said, there's nothing terribly surprising about the idea that pathogens mutate to escape selective pressure. It's right out of biology 101. It would be tremendously surprising if those pathogens became more virulent, which is what you're trying to claim.
That's where you set up the silly straw man you've been battling.
> be tremendously surprising if those pathogens became more virulent
[citation needed]
I notice your profile you have a biology background. I don't, and am guessing most people here don't either, so I'd find it helpful to get an explanation of why you find a change that puts children at more risk unlikely (and I bet others would too).
The short answer is that evolution is random. It isn't an intentional process. The virus isn't trying to become more infectious, or deadlier, or...anything, really. It's just a random process, filtered by some outside force(s). And in this case, the relevant outside forces acting on the virus are: 1) the human immune system's ability to see the virus, and 2) the virus' ability to bind to our cells.
If you're vaccinated (but not previously infected), your immune system can basically only efficiently recognize a bunch of little chunks of the spike protein of the virus -- the piece that allows the virus to bind to your cells. So any random mutations to that spike protein are potentially beneficial, in that they can maybe hide the virus from your immune system, or maybe increase how tightly the virus binds to your cells, or they can be potentially detrimental, in that they can maybe cause the virus to bind less tightly to your cells, or make the spike protein misshaped or something. Or they can do nothing at all.
These are essentially the only "forces" related to vaccines that are guiding the evolutionary process: forces that attempt to change the structure of the spike protein to either escape the immune system, increase cellular affinity, or decrease cellular affinity. The vaccines do nothing to influence anything else. All other dimensions are random, with respect to the vaccine.
Viruses are pretty stupid. If you want to imagine that the virus could become "more fatal" (somehow; it's not clear how this would happen), it has to be done within this framework. There was to be some process that is selecting for the viruses that are "more fatal", and that process needs to be somehow more efficient when only a fraction of the human population recognizes the little bits of the spike protein encoded by the vaccines.
Can this happen? Sure, anything is possible. Is it plausible? No, not really.
If they simply suppress symptoms without reducing transmission, the current vaccines being administered may have a similar perverse evolutionary effect (although at least they're not actively selecting for worse strains).
The "time to stop with fear" and to stop catering to "anxious adults" can equally apply to this persons crusade to not vaccinate children. A mild mannered moderate can both not be scared of their children having a severe covid reaction AND get their child a jab when its available, if risk assessment reveals there to be benefit.
The links I provided -- particularly the last three -- document the points I made regarding relative risk. You just have to read them.
You said, your last 3 links in particular. The third to last is the CDC about covid not vaccines.
The Bloomberg article said "The British position is driven by fears of rare cases of myocarditis -- an inflammation of the heart muscle -- and pericarditis -- an inflammation of membranes around the heart -- in younger people who have had the Pfizer and Moderna vaccines."
The VOA article said "Those opposed to vaccinating teenagers argue the risks of adverse reactions outweigh the benefits."
So I ask, what substantiation do you have. Because all youve given is fear. Is there a case of myocarditis death after a vaccine? 79% of young people (around 1000 total) have recovered. Are you expecting the rest not to recover?
Im curious how you calculate risk? Covid deaths 17, mrna vaccine deaths 0? How is the vaccine a greater risk? Are you comparing long term side effects? How do you have those statistics? I still contend that your claim that children are at "greater risk" (of what?) from the vaccine is unsubstantiated at this point. What you are doing is exactly what you accuse others of doing, instilling fear over reason.
I dont believe reality reflects your purview. https://www.theadvocate.com/baton_rouge/news/article_27d70fa...
Then proceeds to dispense with their own "FUD" about scared parents desperately trying to vaccinate their children.
Apparently no one else can think for themselves.
You could say that about basically the entire relationship that society has with children nowadays... tragically.
Why would covid 19 be any different.
And that's ignoring any potential long term organ damage.
> The studies did not evaluate rates of less-severe illness or debilitating ‘long COVID’ symptoms that can linger months after the acute phase of the infection has past. “The low rate of severe acute disease is important news, but this does not have to mean that COVID does not matter to children,” says paediatrician Danilo Buonsenso at the Gemelli University Hospital in Rome. “Please, let’s keep attention — as much as is feasible — on immunization.”
Death is not the only bad outcome to be avoided.
> The reason the vaccines aren't being approved for children is that there is compelling evidence that children are at greater risk from the vaccines than the virus.
A Nature article [0] says:
> Most of those affected have recovered, and the data suggest that the risk of these conditions is “extremely low”, says paediatrician David Pace at the University of Malta in Msida — about 67 cases per million second doses in adolescent males aged 12–17, and 9 per million in adolescent females in the same age group.
There are ~48 million kids under 12 in the US. Assuming they are evenly split between male and female, that would mean 1,824 cases of myocarditis and pericarditis if 100% of them were vaccinated. Given that nowhere near 100% of children have been exposed to COVID and yet 340 have died, I don't see clear evidence here that the vaccine is more risky than not being vaccinated.
And this is yet another illustration of the point I was making about fear, uncertainty and doubt: the Nature article didn't say that there is proof that children will have "long Covid"...it says that these particular studies didn't address the question.
By this standard, anyone can make up any speculation of something that might happen to children someday, and we'll use that speculation to demand fearful responses, indefinitely. There is no end to this logic.
Fortunately, the well-controlled evidence is increasingly pointing to the conclusion that "long Covid" is not a serious risk to children -- and that, more generally, Covid appears to be similar to other viral infections in terms of long-term symptoms:
https://twitter.com/apsmunro/status/1421415741706981376
Again, lots of hysterical speculation in this area, not much good data. But the better the data gets, the less legitimate the early, speculative claims appear.
> There are ~48 million kids under 12 in the US. Assuming they are evenly split between male and female, that would mean 1,824 cases of myocarditis and pericarditis if 100% of them were vaccinated.
The myocarditis issue disproportionately affects young boys. Your calculation is incorrect.
> Given that nowhere near 100% of children have been exposed to COVID and yet 340 have died, I don't see clear evidence here that the vaccine is more risky than not being vaccinated.
Be that as it may, the UK and about half of the EU countries disagree with your assessment, including a number of experts here in the US, as well:
You are also speculating, but simply about different things. You're speculating about harm from the vaccine, or about infection that don't happen. One way to avoid going down that speculation rabbithole is to defer to experts whose job it is to weigh the pros and cons and crunch the numbers.
https://services.aap.org/en/news-room/news-releases/aap/2021...
"The American Academy of Pediatrics (AAP) recommends vaccinating all children ages 12 and older who are eligible for the federally authorized COVID-19 vaccine."
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommend...
"CDC recommends everyone 12 years and older should get a COVID-19 vaccination to help protect against COVID-19."
https://www.hopkinsmedicine.org/health/conditions-and-diseas...
"Yes. Experts, including those at Johns Hopkins, believe that the benefits of being vaccinated for COVID-19 outweigh the risks. Although COVID-19 in children is usually milder than in adults, some kids can get very sick and have complications or long-lasting symptoms that affect their health and well-being. The virus can cause death in children although this is rarer than for adults."
> The myocarditis issue disproportionately affects young boys. Your calculation is incorrect.
I took that into account when calculating.
> including a number of experts here in the US
At national scale, you can find experts that will tell you anything. The consensus opinion of the major US health authorities is that the vaccine is a net benefit for children.
No, I've provided evidence of that. It's not speculation: young boys are seeing disproportionate levels of vaccine-induced myocarditis
> One way to avoid going down that speculation rabbithole is to defer to experts whose job it is to weigh the pros and cons and crunch the numbers
Indeed, that's all I've done here.
> "The American Academy of Pediatrics (AAP) recommends vaccinating all children ages 12 and older who are eligible for the federally authorized COVID-19 vaccine."
We're talking about kids under 12.
> "CDC recommends everyone 12 years and older should get a COVID-19 vaccination to help protect against COVID-19."
We're talking about kids under 12.
> Experts, including those at Johns Hopkins, believe that the benefits of being vaccinated for COVID-19 outweigh the risks.
And other experts disagree with those experts (the ones I linked to, above). Now what?
That's the problem with blind appeals to authority...you can always find another authority. I'm getting pretty tired of seeing news reporters credulously using the phrase "experts say", and applying no critical thought to what they're actually saying.
In this case, you can find legitimate "experts" on both sides of the debate, and both deserve to be heard.
The UK is often on the wrong side of health vs. quackery, in recent decades originating then spreading more ‘expert’ FUD to set back global disease eradication than perhaps any other first world country. That doesn’t mean the UK is mistaken now, but it does indeed suggest a more careful and less credulous deconstruction of “the UK’s” balance of belief.
I don't think that was my tone, but interpretation is up to the reader, I guess.
An accurate, concise statement of my opinion is that the vaccines should probably not be approved for kids under 12 at this time, and that this does not meaningfully affect our ability to get past the current hysteria, which we should be doing with great haste.
The article also mentions that most of those myocarditis have already recovered while none of those dead came back to life (I am assuming so anyways). Since I see you post to COVID questions often, what would you consider to be "more risky?" It is clear teens are on the low end of personal risk from COVID, but they also put others at increased risk of complications, such as their parents, in addition to their own mild risks.
This depends so heavily on personal circumstance that all I can say is "consult with your doctor". There are kids for whom the tradeoff is obviously in favor of getting the vaccine, and others for whom it isn't.
From a high-level perspective, I tend to agree with the logic outlined here (same link as in previous comment):
In my case, with no prior history of any heart conditions, I experienced a racing heartbeat, crushing chest pain and pain that radiated from my chest to my head beginning 2-3 days after the vaccination. Doctors I saw were generally skeptical that this could be caused by the vaccine; their first instinct was to discount any possibility that it might be vaccine related.
I'm now significantly more distrustful of public vaccination campaigns for covid-19, and the side effect data for such. There seems to be a strong incentive, or some underlying cultural bias to underreport this.
Low risk of death, yes. But still a substantial risk of long lasting severe effects: https://assets.publishing.service.gov.uk/government/uploads/...
A complete loss of sense of taste, or chronic fatigue are both entirely possible outcomes with children, and at this time, it's not clear at all how long these effects last.
Conversely, the effects of myocarditis, while unpleasant, are fairly well understood (and at least one physician I've spoken to was of the opinion that the vaccine related risk was overstated, as the base rate in that age group was bound to be higher than reported, due to the mild nature of most cases, so some of the elevated rates appear to be due to closer post-vaccination scrutiny).
[1] https://www.medrxiv.org/content/10.1101/2021.05.16.21257255v...
https://youtu.be/73KWHPsw-ag?t=525
He states that '4% seropositive having symptoms after 12 weeks', but omits to mention that 2% of seronegative have symptoms after 12 weeks too...
Also he doesn't mention the 9%/10% rate split at 4 weeks, or the symptoms:
Tiredness, Headache, Congested or runny nose, Stomachach, Sleep disturbances, Cough
So he's making the case for child vaccination on the basis of 2 extra seropositive children having one or more of the above symptoms.
And, BTW, the study authors themselves note the limitations as follows:
'Limitations include the relatively small number of seropositive children, possible misclassification of some false seropositive children, potential recall bias, parental report of child’s symptoms, and lack of information on symptom severity.'
The study authors concluded that:
'Seropositive children, all with a history of pauci-symptomatic SARS-CoV-2 infection, did not report long COVID more frequently than seronegative children. This study suggests a very low prevalence of long COVID in a randomly selected population-based cohort of children followed over 6 months after serological testing.'
Physicians are ethically forbidden from recommending a medical treatment that’s a harm to the patient, even if it’s in the interest of society.
Vaccines work at the population level, physicians don't check if you're going to benefit, society benefits. That is still ethical, depending on the ethical framework. I don't think doctors truly hold the Hippocratic Oath as ground truth, most probably don't believe in Apollo, for example.
It's as if, as long as people survive in some form, we shouldn't care.
There has been an uptick of other diseases, including diabetes. Pancreas cells also have ACE-2 receptors and get infected.
It's extremely irresponsible to dismiss the virus' effect on children at this stage.
EDIT: we are also conflating our vaccines, which are manufactured, stable, controlled and much more understood, with a virus, which is multiplying, uncontrolled and mutating. We don't mess with viruses.
This is not FUD, we simply need to be careful with pathogens.
https://news.ycombinator.com/item?id=28042539
TL;DR: there's not much evidence that these things you are concerned about are happening in children, and the best evidence suggests that they are not.
This discussion about all of these things that might/could/maybe/possibly happen to kids who get Covid, but we don't have evidence for it? That's called "speculation".
Even if kids don't die and just get sick enough to take up beds that still puts stress on limited hospital resources that other children need.
The CDC data doesn't seem to show an unusual surge in hospitalizations for kids (0-17) [1].
But the LDH data does show a significant increase in cases for kids [2] (and local news has reports from local hospitals citing highest-ever covid-positive child patients [3]).
Of course if the nymag article is correct and it's just a short spike then that would be a relief for many people.
[0] https://www.youtube.com/watch?v=UzxWZ8qe0oU&t=2005s
[1] https://covid.cdc.gov/covid-data-tracker/#new-hospital-admis... [Jurisdiction: Louisiana, By Jurisdiction and Age Group]
[2] https://ldh.la.gov/coronavirus/ [cases over time by age group]
[3] https://www.theadvocate.com/baton_rouge/news/article_27d70fa...
Our biggest remaining group is the 12-and-under population (which needed a new set of tests to figure out the new dosage. Young children weigh much less than an adult and therefore need much lower doses...). The current estimates are maybe October before this children are authorized.
https://www.wsj.com/articles/cdc-covid-19-coronavirus-vaccin...
I'm all for being annoyed people who could get the vaccine but decided not to, but we shouldn't throw the actual babies out with the proverbial bathwater, right?
Wasn't that what this was all about? Who cares if people get the coronavirus? All that matters is not developing severe SARS-Cov-2.
Anyway, all I'm doing is sticking to restaurants that have outdoor seating, wearing my mask in stores, and keeping distant from strangers on the sidewalk, so it is pretty relaxed compared to the height of the non-vaccinated pandemic.
OP is clearly talking about Alberta changing the laws about self-isolation. At some point, we are going to have to transition to using the same 'cultural norm' framework in dealing with Covid that we do with the flu.
Or we could do much better and transition to the Asian cultural norm and wear a g.d. mask when sick, and preferentially stay t.f. home when ill.
Spreading disease is a stupid, stupid norm in our culture.
I am hoping that this bad habit has died unmourned during the COVID pandemic. I have no intention of of commuting to an office when I have a cold, and every intention of telling others who have one to go home already.
For example, in Australia we have a 92-94% vaccination rate against measles (differs slightly by state) with the disease considered eliminated in 2014 [0]. Even still, in 2019 there was a small outbreak in Western Australia that lead to a big contact tracing effort and some forced isolation/quarantine of close contacts [1].
[0] https://www.health.gov.au/health-topics/immunisation/childho...
[1] https://www.abc.net.au/news/2019-10-25/inside-the-operation-...
We (or at least, public health authorities; indiviudal citizens whose attention doesn't drop below the top story in the news are a different story)... haven't stopped facing the mountains of other public health issues.