By Vinay Prasad
There is a new study out now from Germany regarding Children and COVID infection.
The authors begin by noting that there is uncertainty around the absolute risks of COVID to kids. Often, people divide (kids with bad outcomes) by (kids who present to the health care system) but this will always exaggerate risk, as it does not include all the kids whose symptoms are so mild they don’t seek health care. In other words, the denominator is smaller than the real denominator.
The German authors go on to do it the right way – they combine seroprevalance data with data on bad outcomes in kids. They divide (kids with bad outcomes) by (kids who had covid19).
Here is what they found for healthy kids with Covid-19:
- For healthy kids, the risk of going to the hospital is 51 per 100,000
- For healthy kids, the risk of going to the ICU is 8 per 100,000
- For healthy kids, the risk of death is 3 per 1,000,000 with no deaths reported in kids older than 5
- Kids 5 to 11 have a lower risk than kids <5 and adolescents 12 to 17
- Kids 5 to 11 have a risk of going to the ICU of 2 in 100,000; 0 died
- Among kids who died of COVID19, 38% were already on palliative/ hospice care.
- MIS-C/ PIMS was less common with delta
What’s the take away?
In May of 2021, Wes Pegden, Stef Baral and I argued in the BMJ that kids vaccination should proceed via biological licensing agreement pathway and not the emergency use authorization. Because these risks were so low, we must demand robust evidence and large trials to show that the potential benefits of vaccination outweigh potential harms.
The benefits (at best) are going to be very small— what is lower than 3 per million?—so even rare safety signals can tip the scale. We wanted large randomized trials. Our plea may have affected the UK which is not vaccinating kids 5 to 11 (due to uncertainty), and may have helped the FDA expand the sample size of the trial. Then Gruber and Kraus at FDA resigned and the EUA was granted.