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I wouldn't be so cavalier in assuming that just because you don't die that everything is A-OK and you're 100% fine. Viral infections can do damage that isn't apparent until years later. For example, it's now well-established that HPV infection causes cervical cancer later in life, and HPV is basically symptom-free.

Chicken pox/varicella is another disease to which a lot of children gained natural immunity prior to vaccination being an option (“chicken pox parties” were still a thing when I was a kid in the 90s). We now know that the virus can lay dormant for years after the initial infection and come back later in life as shingles which, while not deadly, can be extremely painful and debilitating.

As someone who had shingles in their late 20s, it's not fun, but not awful either. Admittedly, apparently it's worse for the elderly.

On a 0 (feel fine) - 5 (2nd degree sunburn over a wide body area) - 10 (fractured rib) scale, I'd put it at a 6. And ran about 4 days before symptoms abated.

It felt a lot like really bad sunburn, to the extent that clothing (jeans) against my skin was exhausting and movement avoided. Was on the road at the time with a client, so would work all day, then get back to the hotel and immediately go to sleep.

As someone who has had shingles in my left eye for the last 4 years, I can tell you it's not something to mess around with. I didn't get the vaccine because everyone kept telling me to get it when I turned 60. Unfortunately, it decided to come out when I was 57.

I'm still on steroid eyedrops and take 2g of antiviral medicine every day to keep it somewhat in check.

Varicella is a herpes virus. It has almost nothing in common with coronaviruses, which don't lay dormant.

Nobody claimed COVID could lay dormant as a specific mechanism, but rather that it could cause unexpected long-term damage that diminishes quality-of-life and yet isn't caught in shallow "did they die Y/N" analysis.

Is there any evidence that COVID-19 causes more long-term damage to children than other endemic coronaviruses such as HCoV-OC43?

For the studies I've read, most long term damage appears to be caused by viral concentrations in disparate organs, as a result of uncontrolled infection (i.e. insufficient natural or vaccinated immune system effectiveness to keep it under control).

From reasoning, kids have stronger innate immune systems, but weaker adaptive immune systems, so we shouldn't see as many "runaway COVID" cases with organ damage, because the infection is blunted by their initial, innate response.

That said, if kids end up being an unvaccinated population for SARS-CoV-2... well, that's playing dice with evolution.

That doesn't answer the question. Yes kids have more effective innate immune response. But the vaccinated population can also serve as hosts for potentially evolving new variants. We've been playing dice with evolution of the other 4 endemic coronaviruses for centuries with no vaccines and so far nothing catastrophic has happened. Other than speculative fear mongering about what could happen, is there any actual scientific evidence to expect that SARS-CoV-2 will follow a different evolutionary trajectory?

https://www.thetimes.co.uk/article/covid-19-will-just-end-up...

Here's a better link: https://virologyj.biomedcentral.com/articles/10.1186/s12985-...

> We've been playing dice with evolution of the other 4 endemic coronaviruses for centuries with no vaccines and so far nothing catastrophic has happened.

SARS-CoV, MERS-CoV?

> is there any actual scientific evidence to expect that SARS-CoV-2 will follow a different evolutionary trajectory?

SARS-CoV-2 is now in more hosts than any other endemic coronavirus, due to its higher transmission rates. About half (~48% with single dose) of the world is now vaccinated (mostly in wealthy countries). Effectively zero children younger than 12 are vaccinated.

Vaccination produces a body that's much more resistant to replication, via viral suppression by the immune system.

Consequently, we're increasing the difficulty of SARS-CoV-2 reproducing in adults, while holding the difficulty of doing so in children constant.

You'd be foolish not to consider that risky from an evolutionary perspective.

You seem to have misunderstood. SARS-CoV and MERS are not endemic. Those are HCoV-229E, -NL63, -OC43, and -HKU1.

https://www.sciencedirect.com/science/article/pii/S006535271...)

In particular OC43 is a beta coronavirus genetically close to SARS-CoV-2. It is suspected to have caused the 1889 pandemic.

https://sfamjournals.onlinelibrary.wiley.com/doi/10.1111/175...

Now most of us still get infected with OC43 at some point in our lives. There is no vaccine. The resulting natural immunity protects us as we age. The virus has had plenty of opportunity to evolve more dangerous variants but hasn't done so.

I encourage everyone to get vaccinated against COVID-19 if they can, but you'd be foolish to think that significantly reduces the risk of a more dangerous mutation.

https://www.nature.com/articles/d41586-021-02689-y

> But if it's true that natural immunity + vaccination) is stronger than vaccination alone, is it worth it to leave her unvaccinated against Covid, at least for now, in order to get some natural immunity

No? If she does not get infected after vaccination the job is done. The goal is not 'theoretical maximum protection' the job is 'not getting sick'.

If she gets infected after vaccination (very possible), she will have less risk during infection and have improved protection after.

Vaccination first and then infection is definitely safer than the other way around.

Ofc the risk for young children is low either way, so going with the low risk of being unvaccinated might be something you are ok with.

But getting infected to get best protection against infection is kinda backwards.

Parent's goal is theoretical maximum protection. To which there appears to be a difference between infection + vaccination, vs vaccination + infection.

But the point is, if you're trying to get maximum protection from infection (the implicit being the damage that is caused from being infected), getting infected first seems to truly miss the point of the goal. You're taking on all of the risk of getting infected, in an effort toward lowering the risk of being infected.

To achieve maximum protection from infection you could simply kill your children before they have a chance to get infected.

Is "theoretical maximum protection" really the goal?

If your child is vaccinated - there is a lower chance she gets COVID-19 - the disease. And if she does get it - it will be milder. But she may not get it at all with the vaccine just because the immune system is trained to eliminate it upon entry. In the assumption that vaccine does not have any side effects, the strategy to vaccinate is strictly dominating in game theoretic sense.

Let alone the fact that she has much lesser chance of being the spreader.

I encourage everyone to get vaccinated if they can, however it provides only limited and temporary protection against infection and transmission.

https://www.nature.com/articles/d41586-021-02689-y

We'll be vaccinating our young kids as soon as FDA provides EUA. If it's approved then it's safer than doing nothing in their age group. The risks of infection with no vax, vaccinated infection, or reinfection ("natural immunity") are all tiny in kids; we're more interested in protecting the grownups they spend their time around.

One angle that I don't see discussed a lot is what parents will plan to do if ACIP doesn't recommend any SARS-CoV-2 vaccine for very young kids (i.e. not until they're 5+ or maybe even 12+). It's very possible they could find the tiny risks from vaccination outweigh the tiny risks from infection.

There could in principle be an interesting moral question. If vaccinating very young kids is almost but not quite harmless -- like it raises their risk of mortality from the equivalent of driving 100 road miles to driving 110 road miles -- but it dramatically reduces the risk that their adult caregivers will die, should they be vaccinated? If ACIP ends up looking at the data and saying that vaccinating the youngest kids is worse I don't think I'll be giving them a non-approved vaccine. I can see why people would do it, though; the magnitude of the risks could be similar to those incurred with air travel as a lap infant vs. being secured in a carseat.

> If it's approved then it's safer than doing nothing in their age group.

That's a lot of faith in a group currently suffering from brain & morality drainage due to.....

Please don't take medical advice from HN.

When you look at small children data, mind that there are some very high risk children out there. "Data from the first 12 months of the pandemic in England shows 25 under-18s died from Covid. [...] Around 15 had life-limiting or underlying conditions, including 13 living with complex neuro-disabilities." Another example, on TWiV 811 Dr. Daniel Griffin stated that risk of hospitalization is 4x for children with Down syndrome.

Where I get unease is the fact that there is no long term data of vaccine safety and effectiveness, in spite of the constant barrage of officials implying the contrary. What is the best path for kids to grow up, have their own children and have to ask themselves the same question? Is the answer 25 booster shots, one each year? How do vaccines interact with long term immune system? What about variants that have not evolved yet? We don't know.

Some choose 'if it ain't broken, don't fix it'. Some choose to put their faith in vaccines, 'the vaccine definitely helps in the short term, and there are minuscule downsides'. Some Amish refuse the vaccine on principle. Given the limited information we have, not sure there is a guaranteed right answer.

https://www.bbc.com/news/health-57766717

https://www.microbe.tv/twiv/twiv-811

Might I ask why do you not consider the reverse order of events?

Get the vaccine first and then natural immunity should a breakthrough infection occur. Seems like a much safer way to go about it.

My impulse is that you’re trading one thing where the long term side effects are not 100% known (mrna vaccine) for two things where the long term side effects are not 100% known (covid and the mrna vaccine), and that there’s substantially more reason to believe long covid is a thing than that there are long term side effects to the vaccine.

Bigger issue though is that there’s no way to know exactly how long natural immunity will be effective either, as we know it also can wane in regards to this coronavirus. Giving a child covid now may be pointless to the goal of giving stronger protection to a more problematic strain later, if the strain comes along after the natural immunity has faded.

Realistically though, given current stats, the only statically valid reason to get babies vaccinated is to help lower community spread. Whether that’s asking a baby to “take one for the team” or reasonable depends on how much of a risk you view the vaccine as to children given the current data. (My personal belief is that long covid is a marginally higher risk than vaccine side effects so there’s no reason not to also lower community spread, but there’s no reason to think the baby won’t be fine either way).

> hardly any 1-4 year olds have died

Yes. The risk of this is pretty miniscule I think.

> Of course, there's "long covid" and all the sort of long tail risks and concerns, but intuitively it feels like if the disease is not that deadly and dangerous when you're that young, there'd also be less risk of all these other side effects we're seeing, which tend to correlate, as far as I can tell, with how severe the disease was for the person in the first place.

Not so much. I'm in a facebook group for long covid sufferers (and anyone who is interested), and there are quite a few people saying their children are suffering from long covid symptoms (less severe in absolute terms compared to adults due to higher baseline energy in children, but still significantly affecting their lives).

I've heard +10% of people are getting long covid, and that it doesn't correlate strongly with the severity of the disease.

Overall I think it is a little tricky to judge with kids. One thing I would add that you may not have considered is that being vaccinated doesn't necessarily preclude gaining natural immunity in future.

> is it worth it to leave her unvaccinated against Covid, at least for now, in order to get some natural immunity?

I have wondered the same, but my uneducated conclusion is that sequencing is important. I want the first exposure to be controlled (e.g. vax) and not random in dosage, etc. So vax and then natural exposure is what I believe to be the ideal order.

Please also consider:

    Multisystem inflammatory syndrome in children (MIS-C) was first identified in April 2020 by doctors at children’s hospitals in the United States and the United Kingdom. The condition has also been called pediatric inflammatory multisystem syndrome (PIMS). MIS-C is an illness that can occur after COVID-19 infection and affects mostly school-age children. While the syndrome is rare, it can be dangerous.

https://www.hopkinsmedicine.org/health/conditions-and-diseas...

I think that one argument that does hold some weight is that each new infection is an opportunity for a new mutation and a new variant. This variant could be milder or it could be worse (delta). So in that view, vaccinating young children reduces the risk for all of us of a new variant arising that is much more infectious or even escapes the natural or vaccine induced immunity.

All that being said, one reason I live HN is that this question can be asked in a respectful manner and hopefully garner reasonable and respectful responses. Any other site this would turn into a flame war in 0.2us

I would encourage people to get vaccinated if they can, however we don't have strong evidence that this will reduce the risk of more dangerous variants. Vaccinated people can still get infected. They may clear the infection a little faster on average but the reduction is limited and temporary.

https://www.nature.com/articles/d41586-021-02689-y

Immunocompromised patients are a more likely source of new variants. They can suffer persistent infections giving the virus much more opportunity to evolve. Vaccination is less effective in such patients.

https://www.nejm.org/doi/full/10.1056/NEJMsb2104756

The Delta variant is already so infectious that it's probably already close to a local evolutionary maximum. Measles has a higher R0 but it's genetically very different.

There are 4 other endemic human coronaviruses including HCoV-OC43, another beta coronavirus very similar to SARS-CoV-2. It probably caused a worldwide pandemic that killed a lot of people in 1889, and still frequently kills frail elderly patients today. We don't have a vaccine for it and most of us probably get infected at some point in our lives. Yet even though it's had over a century to evolve it hasn't become dangerous to youths.

https://pubmed.ncbi.nlm.nih.gov/34254725/

So here’s my logic but sounds a bit different than yours…

While vaccinated people can be infected, the rate of infection is significantly reduced and therefore fewer opportunities for the virus to mutate.

But if the primary originator of variants are immunocompromised people then this wouldn’t be such a benefit.

Fundamentally, very viral replication has a similar probability of a mutation happening and so therefore (it seems to me) that immunocompromised people are only more likely to generate new variants bc their infections last so much longer. Is this correct?

The reduction in rate of infection for vaccinated people is limited and temporary. Over the long run vaccination will not significantly reduce opportunities for the virus to mutate. The real benefit of vaccination is reducing the risk of severe symptoms.

https://www.nature.com/articles/d41586-021-02689-y

Yes infections do tend to persist longer in immunocompromised patients with more total viral replication events over time and thus greater chance of a successful mutation. In addition there may be greater odds of recombination due to simultaneous infection with multiple strains, however that's somewhat speculative and I don't think it has been definitively detected.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220957/

You're not alone. We sent our K and 1st grade children back to school this fall expecting them to get (possibly asymptomatic) COVID at some point during the year. We're actually counting our blessings that this hit while they're at an age when they are likely to get some natural immunity without serious health complications. My wife and I are vaccinated, so hopefully any household contagion would be / will be moderate.

Immediate vaccination does not inhibit long term protection. If the vaccine efficacy wanes to a significant degree (which is not a given for each individual), then you are still in a better place than having never been vaccinated. The safest way to get covid is as a vaccinated person. Not the other way round. There is no "tak[ing] one for the team" here.

The immune system is more complicated than that. I have no answer on what the correct strategy is, but I contest the blanket statement that taking the vaccine has zero impact on long term protection. We need actual long term data and actual control populations.

On the doctrine of original antigenic sin

https://www.jstor.org/stable/985534

Original Antigenic Sin: How First Exposure Shapes Lifelong Anti–Influenza Virus Immune Responses

https://www.jimmunol.org/content/202/2/335

Original Antigenic Sin: the Downside of Immunological Memory and Implications for COVID-19

https://journals.asm.org/doi/10.1128/mSphere.00056-21

We have over a decade of data on this for coronaviruses.

I would not vaccinate my child with an mRNA vaccine unless the consequences of not doing so would negatively affect their lives (cannot attend school in person, prevented from extracurriculars, etc.). At the end of the day it is still an experimental treatment with unknown side effects one year out, but more so because getting sick and allowing their body's natural immune system to do its job is part and parcel of being human. I would not want my children growing up with immune systems that are dependent on man-made vaccines/treatments when the statistics undoubtedly bear out the fact that children's immune system are far and away more than capable of fighting off Covid-19.

Obviously the above all goes out the window if your child has chronic conditions like asthma, diabetes, or nervous system disorders that make them highly susceptible to complications from viral infections.

Never getting COVID is best.

Hybrid immunity is next best (natural + vaccine).

Vaccine is second best for most cohorts, because it comes with fewer side effects and the side effects typically aren't as bad.

Natural immunity is strong, but for most cohorts is more likely to have side effects compared to a vaccine.

Furthermore, the risk of side effects from COVID are lower if you are vaccinated. Therefore, given that breakthrough cases are still possible, I would suggest vaccinating first, then if they get it they get it and at least you get hybrid immunity in an order that is less risky than natural immunity followed by a vaccine.

For children, all of this is murkier. Also, if the likelihood of you catching Covid is low enough, there's absolutely no point getting vaccinated.

> Natural immunity is strong, but for most cohorts is more likely to have side effects

That’s a very generous and evenhanded way to say that

Over a long enough timeline, the likelihood of an unvaccinated person catching COVID is essentially 100%.

Over a long enough timeline, the likelihood of both vaccinated and unvaccinated people catching SARS-CoV-2 (the virus) is essentially 100%. Vaccination significantly reduces the risk of severe COVID-19 (the clinical disease) symptoms, at least for a while.

https://www.nature.com/articles/d41586-021-02689-y

We are pretty much in agreement. My point was that the OPs statement that there is no point in getting a vaccine if you are not going to get COVID was nonsense.

You want her to get infected first so she then has stronger protection... against getting infected again? Compared to having protection for the (potential) first infection (which would also extremely likely lead to a hybrid immunity afterwards, if it doesn't prevent an infection entirely)? I struggle to see the scenario where that's helpful.

Really doesn't make sense when you put it like that, doesn't it?

>Is it worth it to leave her unvaccinated against Covid, at least for now, in order to get some natural immunity?

Isn't the point of immunity against COVID to prevent COVID? What's the logic of getting COVID to get immunity against COVID?

But why not just take the vaccine? That way you reduce the number of bodies the disease can breed in and spread. That’s how you eradicate something.

Iceland, Sweden, Denmark and Finland have halted Moderna for young people, pending further investigation of side effects.

One shouldn't read too much into that.

Denmark and Sweden use Pfizer, Moderna, and J&J. Iceland uses those and AZ. Finland uses those and others.

When you've got 3 or more effective vaccines in use, it is reasonable to pause one to investigate it even thought its risk is tiny if it looks like that tiny risk might not be as tiny as the tiny risks from the others.

There are severe complications possible post covid for children (MIS-C) which makes this a very risky thing to do.

i wonder how many people were asymptomatic and thus weren't even aware. maybe those long-covid symptoms get diagnosed as something else if there is no known previous infection.

From 2020 to October 6th 2021, there were 58,167 deaths in the age group 0-17. 499 of those deaths are related to COVID-19. That's 0.86% (or: 99.99% of deaths happened due to other causes) [1]

The leading cause of deaths in this age group are accidents [2]. A lot of these accidents are preventable [3].

[1] https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

[2] https://www.cdc.gov/nchs/fastats/child-health.htm

[3] https://www.nhs.uk/conditions/baby/first-aid-and-safety/safe...

The problem in my opinion is accumulating lung tissue damage over a lifetime. I

If you have one covid infection per year with long damage, your life expectancy and quality drops quite a bit, even if covid is not killing you. The damage may only be perceivable to athletes and in later years though.