CR: COVID-19 --Political Talk

[Anastasis 23,469]

12 hours ago, GRHorn said:

Your son has already received the vast majority of the benefit from the first dose while almost all of the risk of adverse effects for teenage boys is with dose 2. If you are uncomfortable with proceeding then don’t. Of course that’s not what the cdc says, but there is a good case to be made that it should be revisited, specifically the guidance for your son’s demographic. 
 

These are people from very reputable academic facilities such as UCSF. One of the main authors has “progressive” in his bio if it makes you, or others, feel better. Talk to your pediatrician. Good luck. 

 

 

I know that certain people are just going to neg rep this post and do the CR thing, but this perspective in not unreasonable.  IMO, the tipping point is 15 yo generally, with slightly different considerations for males and females. All of the safety events being observed are exceedingly rare, but so are serious adverse outcomes related to COVID under that age.  One dose might be a sweet spot tbh, esp in that 12-15 male age band. My 12 yo daughter just got her second dose.  My sons are too young, but it will be a complicated decision because of some pre-existing CV issues with one of them.  We considered delaying the 2nd PFE dose for the daughter, but decided to pull the trigger and everything has been fine.

 

[ChuckNorrisActionJeans 2,675]

.....and what about transmission to others ... and serving as a host to potential variants. It's never just about the individual

[GRHorn 105]

1 hour ago, Anastasis said:

 

 

I know that certain people are just going to neg rep this post and do the CR thing, but this perspective in not unreasonable.  IMO, the tipping point is 15 yo generally, with slightly different considerations for males and females. All of the safety events being observed are exceedingly rare, but so are serious adverse outcomes related to COVID under that age.  One dose might be a sweet spot tbh, esp in that 12-15 male age band. My 12 yo daughter just got her second dose.  My sons are too young, but it will be a complicated decision because of some pre-existing CV issues with one of them.  We considered delaying the 2nd PFE dose for the daughter, but decided to pull the trigger and everything has been fine.

 

Thank you sir, I appreciate that. 
 

I will expand a little and you may not agree with this and that’s cool. Given the obvious risks and benefits for that cohort, I think the biggest reason that the CDC didn’t adjust the dosing regimen is that they see pursuing the “greater good” of vaccinating more people as being worth the risk to these young males. 
 

I could not disagree more. Essentially we are pressing forward vaccinating these kids with an unaltered schedule, for a disease that doesn’t even really make them sick, to protect older people. That’s a warped thing to me. You protect kids first. Every other disease that kids are vaccinated for, except maybe chickenpox, can make you pretty sick. And chicken pox can give you shingles later in life.
 

These teens most often have minimal symptoms. And don’t get me started on little kids. My 7 and 3 year olds had it and outside of one day of being tired they had not even a sniffle or other symptom.
 

This is no longer an emergency. People should chill out.

 

[GRHorn 105]

14 minutes ago, ChuckNorrisActionJeans said:

.....and what about transmission to others ... and serving as a host to potential variants. It's never just about the individual

Exactly as my post said. 
 

So we need to use kids to help protect old people? Under questionable risk/benefit breakdown? That’s just messed up. Listen to what you’re actually saying.  

Edited July 8, 2021 by GRHorn

[ChuckNorrisActionJeans 2,675]

9 minutes ago, GRHorn said:

Exactly as my post said. 
 

So we need to use kids to help protect old people? Under questionable risk/benefit breakdown? That’s just messed up. Listen to what you’re actually saying.  

The data showing risk/benefit vastly favors young people in that age group getting vaccinated.  Everything you say  beyond that is either troll-dom or ignorance.

[JimmyJames 12,271]

14 minutes ago, GRHorn said:

Exactly as my post said. 
 

So we need to use kids to help protect old people? Under questionable risk/benefit breakdown? That’s just messed up. Listen to what you’re actually saying.  

You’re just an anti vaxer troll spreading propaganda. Why should anyone with a brain listen to a word you say?

[JimmyJames 12,271]

29 minutes ago, GRHorn said:

Thank you sir, I appreciate that. 
 

I will expand a little and you may not agree with this and that’s cool. Given the obvious risks and benefits for that cohort, I think the biggest reason that the CDC didn’t adjust the dosing regimen is that they see pursuing the “greater good” of vaccinating more people as being worth the risk to these young males. 
 

I could not disagree more. Essentially we are pressing forward vaccinating these kids with an unaltered schedule, for a disease that doesn’t even really make them sick, to protect older people. That’s a warped thing to me. You protect kids first. Every other disease that kids are vaccinated for, except maybe chickenpox, can make you pretty sick. And chicken pox can give you shingles later in life.
 

These teens most often have minimal symptoms. And don’t get me started on little kids. My 7 and 3 year olds had it and outside of one day of being tired they had not even a sniffle or other symptom.
 

This is no longer an emergency. People should chill out.

 

Your internet persona is a psychopath designed to get people killed. Hope then the 50 cents in rubles is worth it all.

Edited July 8, 2021 by JimmyJames

[UncleSonny 6,572]

3 hours ago, GRHorn said:

So we need to use kids to help protect old people? Under questionable risk/benefit breakdown? That’s just messed up. Listen to what you’re actually saying.  

This is neither here nor there because your point is BS, but wait until you find out how wars are fought and justified. 

[gmr548 16,580]

Maybe GRHorn is attempting to make a point in good faith, maybe he’s not. Unfortunately, if he is, he’s very much the boy who cried wolf. When you’re consistently trolling people start to treat you as such.

I don’t have kids so I don’t have a dog in the fight and I do understand why parents would be more cautious with their children. Do find it interesting that cardiovascular issues associated with COVID for college athletes was generally dismissed as a nothing burger in the name of being able to watch football on Saturdays, but now that it’s personally real some folks are singing a different tune. It’s easy to read that as general dismissiveness of the vaccine or risks from COVID.

[Don Johnson 4,753]

7 hours ago, ChuckNorrisActionJeans said:

.....and what about transmission to others ... and serving as a host to potential variants. It's never just about the individual

The others in this equation should be vaccinated.  If not, that's their problem.

[WhatTheBuck 28,781]

20 hours ago, 4th&Five said:

 

“Getting vaccinated could save your life.”

Kind of the whole point of vaccines throughout history.

[GRHorn 105]

1 hour ago, gmr548 said:

Maybe GRHorn is attempting to make a point in good faith, maybe he’s not. Unfortunately, if he is, he’s very much the boy who cried wolf. When you’re consistently trolling people start to treat you as such.

I don’t have kids so I don’t have a dog in the fight and I do understand why parents would be more cautious with their children. Do find it interesting that cardiovascular issues associated with COVID for college athletes was generally dismissed as a nothing burger in the name of being able to watch football on Saturdays, but now that it’s personally real some folks are singing a different tune. It’s easy to read that as general dismissiveness of the vaccine or risks from COVID.

1- it was a nothing burger, that had nothing to do with football. 
2- those were also consenting adults. 

[GRHorn 105]

8 hours ago, ChuckNorrisActionJeans said:

The data showing risk/benefit vastly favors young people in that age group getting vaccinated.  Everything you say  beyond that is either troll-dom or ignorance.

I’m afraid you’re the ignorant one. 

Spoiler

For the first half of 2021, the mRNA vaccines looked to be near perfect. The trials reported more than 90% efficacy for the Pfizer and Moderna vaccines. Both provided near 100% prevention of severe COVID-19 and after hundreds of millions of adults received the shots, no signal of harm emerged.

I, like any rational person, see a positive benefit-harm ratio from the vaccines for adults.

Younger People?

After a "positive" trial in which just over 1100 kids aged 12 to 15 years received an mRNA vaccine, a movement arose to vaccinate young and old alike. I put "positive" in quotes for two reasons:  The first is that this trial measured noninferiority of the immune response, not clinical outcomes. That was necessary because so few kids get sick with COVID-19. The other reason is that the authors claimed a favorable safety profile, but 1100 kids is not enough to inform the safety of a vaccine that will be given to many millions.

 

Then came a signal of myocarditis in young people, then another, and another, and now one in slightly older (median age, 25 years) military recruits. These reports complicate matters because young people have the lowest risk from COVID-19.

A debate arose: some argued to slow the deployment of vaccines for children, while the CDC noted that the benefit-harm profile is favorable.

 

The aim of this column is to argue that when it comes to vaccinating young people at low risk from the virus, parents and younger people should be allowed to weigh the vaccine decision with their clinicians without anyone being tarred as an antivaxxer.

 

What About the Myocarditis?

Medicine is full of euphemisms that hide reality: we say "cardioversion" instead of "shock"; "ablate" instead of "burn";  "fibrosis" instead of "scar." The term "myocarditis" sterilizes and obscures heart injury due to excess inflammation.

Emergency medicine doctor and frequent contributor to the New York Times, Jeremy Faust, MD, called postvaccine myocarditis "self-limited troponinemia." CDC director Rochelle Walensky, MD, recently described postvaccine myocarditis in young people as "mild."

I disagree; calling myocarditis mild reminds me of the saying about minor surgery. Minor surgery is surgery on someone else; mild myocarditis is something that happens to other folks' kids.

Humans have only one heart; inflaming it at a young age is not a small thing.

University of Michigan cardiologist Venk Murthy, MD, a specialist in imaging, rebutted the "mild" framing with comments on Twitter: "people with myocarditis are usually counseled to limit activity, placed on 1 or more meds and are at lifetime increased risk of cardiac complications. This can have profound consequences."

 

As an electrophysiologist, I see the complications of myocarditis: heart failure and ventricular arrythmia due to scar. Availability bias notwithstanding, heart rhythm doctors feel the asymmetry of myocarditis risk. Although it is true that most myocarditis resolves without issue, it is also true that sometimes it does not.

 

A radiologist who reads cardiac magnetic resonance scans might oppose this framing by saying myocarditis occurs on a spectrum and even patients with severe myocarditis mostly recover. Pediatricians might counter my framing by saying that most of the affected kids recovered and were discharged from the hospital. Public health experts could argue that 300-plus kids died of COVID-19 and no one as yet has died from the vaccine, so the benefit-harm ratio favors the vaccine.

 

These are all true statements, but that's not how people make medical decisions. Regular people are not emotionless robots who decide using odds ratios. Most people do not calculate risk, they feel risk. People have special circumstances and make judgments relative to their benefit-harm situation. To persuade people with charts and statistics belies an understanding of clinical practice.

 

For example, let's say the parents (or grandparents) of a teenager have pre-existing conditions. These special circumstances tip the balance, and the parents decide to vaccinate the adolescent. Contrast that with, say, young parents who have no risk factors. This family feels less risk from the virus, and they might feel more regret if their child developed myocarditis. They want to see more data before making the decision.

 

Both scenarios depict rational decision-making. It's how medical decisions should be made: with judgment and benefit-harm balances and considerations of special circumstances.

 

Stats and Data 

At the June 23 FDA meeting, Tom Shimabukuro, MD, gave a vaccine safety update, and two CDC doctors (Megan Wallace, DrPh, and Sara Oliver, MD) gave a benefit-risk discussion of mRNA vaccines in young people.

 

They both used many slides. Yet I need only two data points to support my argument that parents and adolescents should be allowed to make judgments based on their unique situation.

 

The first is slide 13 of the benefit-risk presentation, which shows the risk for hospitalization in a young person in the last 3 months from COVID-19 as less than 1 in 100,000. The other comes from slide 27 of the Shimabukuro talk, which shows the rate of myocarditis in 12- to 17-year-old boys after the second dose of mRNA as 132/2,039,871, or about 6/100,000.

 

Suffice it to say that rates that low allow for consideration of special circumstances and judgment. But that's not what has happened. The CDC concluded "the benefits still clearly outweigh the risks for COVID-19 vaccination in adolescents and young adults," and in a tweetwith 500 retweets, Faust listed the stats and concluded: "#vaccinate," with a peace sign emoji.

 

What About Societal Good? 

Some might argue that shared decisions don't apply to communicable disease prevention. Vaccination of an individual helps others by reducing transmission and promoting herd immunity. For example, human papillomavirusvaccine in boys reduces the future risk for cervical cancer in women.

 

I see two problems with this argument in the case of SARS-CoV2.

 

The mRNA vaccines are so effective at preventing severe COVID-19 disease that US citizens need not depend on others for protection. If someone wants to be protected, they can simply get the shots. Recent reports from Israel on the rise of cases due to the Delta variant support my point: these were cases , not hospitalizations.

 

The second problem with the societal-good argument is that the signal of myocarditis from the vaccine is strong enough to be more than correlation. I am not an ethicist, but it seems dubious to force young people to expose themselves to a risk for an unknown benefit to society. Once again, data from Israel are instructive: cases and hospitalizations plummeted earlier in the year without mandating vaccinations in the young.

 

Other countries see the need for nuance in vaccinating the young: advisors in the United Kingdom have decided not to support vaccination for kids under 18. In Germany, the Standing Vaccination Commission advised that only children with pre-existing conditions receive the vaccine. And the Dutch health counsel has invited kids with pre-existing conditions or those living in a household with a family member who cannot be vaccinated to receive the mRNA vaccine.

 

Benefits of Waiting 

The recent FDA presentation on myocarditis provided three clear signals. There were many more cases after the second shot; males were more often affected; and the age groups with the highest incidence were 16- to 24-year-olds.

 

Given the extremely low levels of circulating SARS-CoV2 in the United States, public health experts have time to consider different options for young people: would one shot (especially in younger males) offer a better benefit-harm calculus? Should we study lower doses in children? Should we test young adults for signs of recovered infection and delay vaccination in those with natural immunity?

 

Conclusion: The Danger of Absolutism 

In the United States, rates of vaccine uptake among vulnerable adults remain less than ideal. This is not from lack of knowledge. Americans can now observe the vaccine efficacy directly from the evidence in the digital space but also in their communities where cases have plummeted.

 

In my clinic, I occasionally see at-risk adults who refuse the vaccine. This makes me intensely curious. These are folks taking preventive cardiac medications with a fraction of the efficacy of the (free) mRNA vaccines.  

 

I could be wrong, but I can't help thinking that absolutism about vaccine decisions in the young, or the minimization of harm from myocarditis, might reduce trust in messaging.

 

Consider that earlier in the pandemic there was intense coverage of a flawed paper on myocarditis after SARS-CoV2 infection. Hundreds of news outlets wrote scary headlines, and college sports were almost canceled. Subsequent studies found no evidence that the virus had any special proclivity for heart inflammation.

A neutral observer might wonder: well, if folks were that excited about myocarditis in young people after the infection, why are they not equally worried about this early signal of harm from the vaccine?

 

As I write this column, many major universities will mandate vaccines for college-age kids. Some hospitals will require the mRNA vaccines for all employees—including the 18-year-old who works in engineering, has no patient contact, and who recovered from COVID-19 a few months ago.

 

Maybe, just maybe, a more humble and nuanced approach to vaccination in low-risk young people would improve trust and vaccine uptake?

 

[Don Johnson 4,753]

 

[Don Johnson 4,753]

10 hours ago, 4th&Five said:

 

You really have to hand it to China on how they handled this.  Less than 5,000 deaths.  Incredible.

[Captainant 27,669]

34 minutes ago, GRHorn said:

I’m afraid you’re the ignorant one. 

  Reveal hidden contents

For the first half of 2021, the mRNA vaccines looked to be near perfect. The trials reported more than 90% efficacy for the Pfizer and Moderna vaccines. Both provided near 100% prevention of severe COVID-19 and after hundreds of millions of adults received the shots, no signal of harm emerged.

I, like any rational person, see a positive benefit-harm ratio from the vaccines for adults.

Younger People?

After a "positive" trial in which just over 1100 kids aged 12 to 15 years received an mRNA vaccine, a movement arose to vaccinate young and old alike. I put "positive" in quotes for two reasons:  The first is that this trial measured noninferiority of the immune response, not clinical outcomes. That was necessary because so few kids get sick with COVID-19. The other reason is that the authors claimed a favorable safety profile, but 1100 kids is not enough to inform the safety of a vaccine that will be given to many millions.

 

Then came a signal of myocarditis in young people, then another, and another, and now one in slightly older (median age, 25 years) military recruits. These reports complicate matters because young people have the lowest risk from COVID-19.

A debate arose: some argued to slow the deployment of vaccines for children, while the CDC noted that the benefit-harm profile is favorable.

 

The aim of this column is to argue that when it comes to vaccinating young people at low risk from the virus, parents and younger people should be allowed to weigh the vaccine decision with their clinicians without anyone being tarred as an antivaxxer.

 

What About the Myocarditis?

Medicine is full of euphemisms that hide reality: we say "cardioversion" instead of "shock"; "ablate" instead of "burn";  "fibrosis" instead of "scar." The term "myocarditis" sterilizes and obscures heart injury due to excess inflammation.

Emergency medicine doctor and frequent contributor to the New York Times, Jeremy Faust, MD, called postvaccine myocarditis "self-limited troponinemia." CDC director Rochelle Walensky, MD, recently described postvaccine myocarditis in young people as "mild."

I disagree; calling myocarditis mild reminds me of the saying about minor surgery. Minor surgery is surgery on someone else; mild myocarditis is something that happens to other folks' kids.

Humans have only one heart; inflaming it at a young age is not a small thing.

University of Michigan cardiologist Venk Murthy, MD, a specialist in imaging, rebutted the "mild" framing with comments on Twitter: "people with myocarditis are usually counseled to limit activity, placed on 1 or more meds and are at lifetime increased risk of cardiac complications. This can have profound consequences."

 

As an electrophysiologist, I see the complications of myocarditis: heart failure and ventricular arrythmia due to scar. Availability bias notwithstanding, heart rhythm doctors feel the asymmetry of myocarditis risk. Although it is true that most myocarditis resolves without issue, it is also true that sometimes it does not.

 

A radiologist who reads cardiac magnetic resonance scans might oppose this framing by saying myocarditis occurs on a spectrum and even patients with severe myocarditis mostly recover. Pediatricians might counter my framing by saying that most of the affected kids recovered and were discharged from the hospital. Public health experts could argue that 300-plus kids died of COVID-19 and no one as yet has died from the vaccine, so the benefit-harm ratio favors the vaccine.

 

These are all true statements, but that's not how people make medical decisions. Regular people are not emotionless robots who decide using odds ratios. Most people do not calculate risk, they feel risk. People have special circumstances and make judgments relative to their benefit-harm situation. To persuade people with charts and statistics belies an understanding of clinical practice.

 

For example, let's say the parents (or grandparents) of a teenager have pre-existing conditions. These special circumstances tip the balance, and the parents decide to vaccinate the adolescent. Contrast that with, say, young parents who have no risk factors. This family feels less risk from the virus, and they might feel more regret if their child developed myocarditis. They want to see more data before making the decision.

 

Both scenarios depict rational decision-making. It's how medical decisions should be made: with judgment and benefit-harm balances and considerations of special circumstances.

 

Stats and Data 

At the June 23 FDA meeting, Tom Shimabukuro, MD, gave a vaccine safety update, and two CDC doctors (Megan Wallace, DrPh, and Sara Oliver, MD) gave a benefit-risk discussion of mRNA vaccines in young people.

 

They both used many slides. Yet I need only two data points to support my argument that parents and adolescents should be allowed to make judgments based on their unique situation.

 

The first is slide 13 of the benefit-risk presentation, which shows the risk for hospitalization in a young person in the last 3 months from COVID-19 as less than 1 in 100,000. The other comes from slide 27 of the Shimabukuro talk, which shows the rate of myocarditis in 12- to 17-year-old boys after the second dose of mRNA as 132/2,039,871, or about 6/100,000.

 

Suffice it to say that rates that low allow for consideration of special circumstances and judgment. But that's not what has happened. The CDC concluded "the benefits still clearly outweigh the risks for COVID-19 vaccination in adolescents and young adults," and in a tweetwith 500 retweets, Faust listed the stats and concluded: "#vaccinate," with a peace sign emoji.

 

What About Societal Good? 

Some might argue that shared decisions don't apply to communicable disease prevention. Vaccination of an individual helps others by reducing transmission and promoting herd immunity. For example, human papillomavirusvaccine in boys reduces the future risk for cervical cancer in women.

 

I see two problems with this argument in the case of SARS-CoV2.

 

The mRNA vaccines are so effective at preventing severe COVID-19 disease that US citizens need not depend on others for protection. If someone wants to be protected, they can simply get the shots. Recent reports from Israel on the rise of cases due to the Delta variant support my point: these were cases , not hospitalizations.

 

The second problem with the societal-good argument is that the signal of myocarditis from the vaccine is strong enough to be more than correlation. I am not an ethicist, but it seems dubious to force young people to expose themselves to a risk for an unknown benefit to society. Once again, data from Israel are instructive: cases and hospitalizations plummeted earlier in the year without mandating vaccinations in the young.

 

Other countries see the need for nuance in vaccinating the young: advisors in the United Kingdom have decided not to support vaccination for kids under 18. In Germany, the Standing Vaccination Commission advised that only children with pre-existing conditions receive the vaccine. And the Dutch health counsel has invited kids with pre-existing conditions or those living in a household with a family member who cannot be vaccinated to receive the mRNA vaccine.

 

Benefits of Waiting 

The recent FDA presentation on myocarditis provided three clear signals. There were many more cases after the second shot; males were more often affected; and the age groups with the highest incidence were 16- to 24-year-olds.

 

Given the extremely low levels of circulating SARS-CoV2 in the United States, public health experts have time to consider different options for young people: would one shot (especially in younger males) offer a better benefit-harm calculus? Should we study lower doses in children? Should we test young adults for signs of recovered infection and delay vaccination in those with natural immunity?

 

Conclusion: The Danger of Absolutism 

In the United States, rates of vaccine uptake among vulnerable adults remain less than ideal. This is not from lack of knowledge. Americans can now observe the vaccine efficacy directly from the evidence in the digital space but also in their communities where cases have plummeted.

 

In my clinic, I occasionally see at-risk adults who refuse the vaccine. This makes me intensely curious. These are folks taking preventive cardiac medications with a fraction of the efficacy of the (free) mRNA vaccines.  

 

I could be wrong, but I can't help thinking that absolutism about vaccine decisions in the young, or the minimization of harm from myocarditis, might reduce trust in messaging.

 

Consider that earlier in the pandemic there was intense coverage of a flawed paper on myocarditis after SARS-CoV2 infection. Hundreds of news outlets wrote scary headlines, and college sports were almost canceled. Subsequent studies found no evidence that the virus had any special proclivity for heart inflammation.

A neutral observer might wonder: well, if folks were that excited about myocarditis in young people after the infection, why are they not equally worried about this early signal of harm from the vaccine?

 

As I write this column, many major universities will mandate vaccines for college-age kids. Some hospitals will require the mRNA vaccines for all employees—including the 18-year-old who works in engineering, has no patient contact, and who recovered from COVID-19 a few months ago.

 

Maybe, just maybe, a more humble and nuanced approach to vaccination in low-risk young people would improve trust and vaccine uptake?

 

This article makes good points about individuals, but the desired outcome from vaccinating children isn't to make them safer from the virus but rather to remove them as a transmission vector. Ultimately I agree with his thesis of "it's each parents decision", but it should be remembered that stopping a pandemic is heavily dependent on stopping its transmission vectors.

[GRHorn 105]

57 minutes ago, Captainant said:

This article makes good points about individuals, but the desired outcome from vaccinating children isn't to make them safer from the virus but rather to remove them as a transmission vector. Ultimately I agree with his thesis of "it's each parents decision", but it should be remembered that stopping a pandemic is heavily dependent on stopping its transmission vectors.

Exactly. Using kids (specifically 12-17 year old boys) and putting them at risk to protect the elderly or non-immunized adults. 
 

[jimmyjazz 45,957]

You need to show that young peoples' risk of heart issues from the vaccine is greater than the risk of heart issues from Covid.  So far, you've completely ignored that point.  Now throw in all the other bad shit that can happen with Covid.  Now throw in the greater good aspect concerning the community.

[GopherRock 1,765]

1 hour ago, Don Johnson said:

You really have to hand it to China on how they handled this.  Less than 5,000 deaths.  Incredible.

They also had to enforce 6 weeks of absolute, lock-apartments-shut-from-outside, lockdown to do that. On top of that, their COVID vaccines don't work. 

[lmao 178]

I followed the rules and got vaccinated, but the people who aren't getting vaccinated are not getting vaccinated, especially since things are pretty much back to the pre-covid days restrictions wise. It sucks, but that's reality. You see people on twitter routinely sparring all day about this but its a fruitless endeavor. 

Edited July 8, 2021 by lmao

[GRHorn 105]

47 minutes ago, jimmyjazz said:

You need to show that young peoples' risk of heart issues from the vaccine is greater than the risk of heart issues from Covid.  So far, you've completely ignored that point.  Now throw in all the other bad shit that can happen with Covid.

One example is in the article I linked. It doesn’t specifically compare heart issues from covid, but I’d say hospitalizations roughly equal “all the other bad shit that can happen with covid.”
 

At the June 23 FDA meeting, Tom Shimabukuro, MD, gave a vaccine safety update, and two CDC doctors (Megan Wallace, DrPh, and Sara Oliver, MD) gave a benefit-risk discussion of mRNA vaccines in young people.

 

They both used many slides. Yet I need only two data points to support my argument that parents and adolescents should be allowed to make judgments based on their unique situation.

 

The first is slide 13 of the benefit-risk presentation, which shows the risk for hospitalization in a young person in the last 3 months fromCOVID-19 as less than 1 in 100,000. The other comes from slide 27 ofthe Shimabukuro talk, which shows the rate of myocarditis in 12- to 17-year-old boys after the seconddose of mRNA as 132/2,039,871, orabout 6/100,000.

47 minutes ago, jimmyjazz said:

Now throw in the greater good aspect concerning the community.

Again from that article. Well stated IMO. 
 

Some might argue that shared decisions don't apply to communicable disease prevention. Vaccination of an individual helps others by reducing transmission and promoting herd immunity.
 

I see two problems with this argument in the case of SARS-CoV2.

 

The mRNA vaccines are so effective at preventing severe COVID-19 disease that US citizens need not depend on others for protection. If someone wants to be protected, they can simply get the shots. Recent reports from Israel on the rise of cases due to the Delta variant support my point: these were cases , not hospitalizations.

 

The second problem with the societal-good argument is that the signal of myocarditis from the vaccine is strong enough to be more than correlation. I am not an ethicist, but it seems dubious to force young people to expose themselves to a risk for an unknown benefit to society. Once again, data from Israel are instructive: cases and hospitalizations plummeted earlier in the year without mandating vaccinations in the young.

[BrickHorn 18,235]

45 minutes ago, lmao said:

I followed the rules and got vaccinated, but the people who aren't getting vaccinated are not getting vaccinated, especially since things are pretty much back to the pre-covid days restrictions wise. It sucks, but that's reality. You see people on twitter routinely sparring all day about this but its a fruitless endeavor. 

Only because half of Americans are belligerent idiots. But at least Twitter is preserving their idiocy for later reference. See all the “Covid is a hoax!” tweets by dipshits who end up dying on a ventilator two months later. 

And when Covid-19 becomes endemic, we can go back and identify the morons who opened the door to the variants we will be dealing with on an annual basis. We can look back, quote a tweet, and say “Thanks a lot, asshole. YOU caused this.”

[ChuckNorrisActionJeans 2,675]

1. Nobody's forcing anyone. In some cases, there are consequences for refusing the vaccine. 

2. No, advising caution in vaxxing young people will sure as fuck not increase trust of the vaccine in older, unvaccinated groups. JFC.

[Anastasis 23,469]

Regarding the discussion on pediatric vaccination, the context of the original question was related to a 12 year old boy that had already received the first dose, and a parent concerned about the risk/benefit of the second dose. The points about transmission vectors, COVID-related CV events, risk/benefit etc. seem to be coming from a perspective of no vaccination vs. vaccination, but that really isn't the increment relevant to the particular question.

We know that the cardiac ADEs are strongly related to second dose admin in kids, young males specifically. We also know that the immune response to the vax is stronger in children than <16 compared to individuals 16-25, and we know that there is a strong first dose effect in adults. Unfortunately the trial used to secure the pediatric EUA did not report immune response after first dose or include a single dose only arm.  That is unfortunate, but we know 1m after 2nd dose the immune response is ~75% stronger among kids age 12-15. The incremental risk/benefit for second dose has to take all of these factors into consideration imo, and those factors will increase the 2nd dose incremental risk side of the equation while reducing the incremental benefit side, relative to an assessment of first dose or two dose regimen as a whole.  It's not as simple and clear cut as some of the responses make it out to be. 

From population health perspective there is no doubt that vaccination is clearly favored across all ages and sexes. The delta variant tilts the scales even more heavily. The CV events are exceedingly rare, and this sort of thing is to be expected when you roll out hundreds of millions of doses of anything. But there also has to be some room for individualized weighing of risk/benefits as well. Like I mentioned up thread my, 12yo daughter has been fully vaccinated, but the calculus might be different for my 10yo son with some CV issues. I would be an easier call if there were not pre-existing CV factors in play. We'll have to discuss the issue with his cardiologist when the time comes. 

Edited July 8, 2021 by Anastasis

[Sawbonz 27,562]

11 hours ago, ChuckNorrisActionJeans said:

.....and what about transmission to others ... and serving as a host to potential variants. It's never just about the individual

Um it is also about the individual if cardiomyopathy is among the risks

[Sawbonz 27,562]

26 minutes ago, ChuckNorrisActionJeans said:

1. Nobody's forcing anyone. In some cases, there are consequences for refusing the vaccine. 

2. No, advising caution in vaxxing young people will sure as fuck not increase trust of the vaccine in older, unvaccinated groups. JFC.

So we should lie for the greater good? Fuck that

[ChuckNorrisActionJeans 2,675]

5 minutes ago, Sawbonz said:

So we should lie for the greater good? Fuck that

Nope, not saying we should lie at all. I was specifically responding to the arguments the doctor was making in that article. 

[Sawbonz 27,562]

1 minute ago, ChuckNorrisActionJeans said:

Nope, not saying we should lie at all. I was specifically responding to the arguments the doctor was making in that article. 

So you agree, given what we know about the increase in cardiac side effects with 2nd dose, it is reasonable to consider individual risk in deciding Whether to give your teenage boy a second dose, and reasonable to prioritize the wellbeing of one’s child over the goal of herd immunity?

[Bozo_Casanova 26,462]

3 hours ago, GRHorn said:

I’m afraid you’re the ignorant one. 

hoo boy

[jimmyjazz 45,957]

Of course individual risk should be assessed.  It just has to be put in context, which could include questions like

- what is the likelihood of contracting covid with just one dose?  how does this change with variant?

- what is the likelihood of suffering similar cardiac issues if one does contract covid?

- what is the likelihood of suffering other significant health issues, including long haul effects, if one does contract covid?

 

It also seems that demographic should be included when making these assessments, because from what I have read, the cardiac issues following dose #2 tend to cluster among athletic males.

[Bozo_Casanova 26,462]

24 minutes ago, Sawbonz said:

Um it is also about the individual if cardiomyopathy is among the risks

I was in Group 1 because of my cardiomyopathy, FWIW

[Neonmoon 38,129]

1 hour ago, lmao said:

I followed the rules and got vaccinated, but the people who aren't getting vaccinated are not getting vaccinated, especially since things are pretty much back to the pre-covid days restrictions wise. It sucks, but that's reality. You see people on twitter routinely sparring all day about this but its a fruitless endeavor. 

Excluding children because of complicating factors, anyone above 16 that doesn’t get vaccinated is contributing to the spread of covid and incubation of variants that are more deadly to the vaccinated and people who can’t get vaccinated for health reasons. These people should be shamed, ridiculed, and outcasts from ordinary life. 

[JimmyJames 12,271]

3 minutes ago, Neonmoon said:

Excluding children because of complicating factors, anyone above 16 that doesn’t get vaccinated is contributing to the spread of covid and incubation of variants that are more deadly to the vaccinated and people who can’t get vaccinated for health reasons. These people should be shamed, ridiculed, and outcasts from ordinary life. 

But, muh freedoms!!

[Incredulity 11,674]

2 hours ago, GopherRock said:

They also had to enforce 6 weeks of absolute, lock-apartments-shut-from-outside, lockdown to do that. On top of that, their COVID vaccines don't work. 

Narrator:  They didn't have 5000 deaths.

Edited July 8, 2021 by Incredulity

[Sawbonz 27,562]

3 minutes ago, Incredulity said:

Narrator:  They didn't have 5000 deaths.

Username checks out 

[C-Man 27,228]

4 minutes ago, Incredulity said:

Narrator:  They didn't have 5000 deaths.

[lmao 178]

11 minutes ago, Neonmoon said:

Excluding children because of complicating factors, anyone above 16 that doesn’t get vaccinated is contributing to the spread of covid and incubation of variants that are more deadly to the vaccinated and people who can’t get vaccinated for health reasons. These people should be shamed, ridiculed, and outcasts from ordinary life. 

That's fine. However, if your goal is to get vaccine-hesistant people vaccinated, shaming and putting them in a seperate tier prob isn't going to help. Another problem I see is that this is being broken down on political party lines. White Trump supporters aren't the only people who are avoiding the vaccine. African-Americans age 40 and under are most likely to avoid the vaccine.

https://www.wsj.com/articles/young-black-americans-are-most-likely-to-avoid-covid-19-vaccine-11614378542

https://www.cnn.com/2021/07/03/us/vaccine-hesitancy-younger-americans-georgia/index.html

[C-Man 27,228]

Yeah Texas?

https://www.cnn.com/2021/07/08/health/undervaccinated-clusters-covid-risk/index.html

Quote

(CNN)A new data analysis identifies clusters of unvaccinated people, most of them in the southern United States, that are vulnerable to surges in Covid-19 cases and could become breeding grounds for even more deadly Covid-19 variants.

The analysis by researchers at Georgetown University identified 30 clusters of counties with low vaccination rates and significant population sizes. The five most significant of those clusters are sprawled across large swaths of the southeastern United States and a smaller portion in the Midwest.

Unvaccinated people are 'variant factories,' infectious diseases expert says

The five clusters are largely in parts of eight states, starting in the east in Georgia and stretching west to Texas and north to southern Missouri. The clusters also include parts of Alabama, Arkansas, Louisiana, Oklahoma and Tennessee, and are made up of mostly smaller counties but also cities such as Montgomery, Alabama; Shreveport, Louisiana; and Amarillo, Texas.

Most of these states are currently seeing increases in Covid-19 cases.

"Parts of the country are just as vulnerable if not more vulnerable than they were in December, 2020," said Shweta Bansal, an associate professor of biology at Georgetown University. Bansal heads up the US COVID-19 Vaccination Tracking project, which has been gathering data on the US vaccine rollout since it began in December.

Those vulnerable clusters put all of the United States -- and to some extent, the world -- at risk for going back to 2020, since high-transmission areas can become breeding grounds for Covid-19 variants that could go on to evade Covid-19 vaccines.

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"These clusters of unvaccinated people are what is standing in the way of us putting this virus down permanently," said Dr. Jonathan Reiner, a CNN medical analyst and professor of medicine and surgery at George Washington University.

Millions of unvaccinated people in the clusters

About one-third of Americans have not received even a single Covid-19 shot -- and the Georgetown analysis shows that these people are not evenly spread around the United States.

Delta variant now makes up more than half of coronavirus cases in US, CDC says

Analyzing county vaccination data from the US Centers for Disease Control and Prevention and state health departments, the Georgetown researchers found 30 clusters of counties throughout the US that have low vaccination rates compared to the national average and also have significant population size.

The five most significant clusters together include more than 15 million people. Of those, only 27.9% are fully vaccinated -- far lower than the national rate of 47.6%.

The county data is not without its flaws. When someone gets a shot, their home county is supposed to be noted in state records, but the system doesn't always work perfectly. In the Georgetown analysis, at least 90% of all vaccinations were recorded with the person's home county, Bansal said.

In some cases, the Georgetown data differs from CDC data because Bansal and her team were able to obtain additional data directly from state health departments.

Here's what is known about the Delta variant of coronavirus

While the clusters do encompass some sizable cities, 92% of the counties in the clusters have a population of less than 100,000.

The federal government has been engaging with churches and organizations such as the YMCA to encourage Covid-19 vaccination in areas like these, US Surgeon General Dr. Vivek Murthy told CNN.

"These are extraordinary partners in reaching communities [in rural areas] where health care access isn't as easy as it is in urban areas," he said.

Clusters give virus opportunities to mutate

The Delta variant, which now comprises more than half the cases in the United States, is the latest in a long string of Covid-19 variants that have spread more easily and in some cases caused more severe illness.

That's why the clusters are so worrisome. Each time a virus spreads, it has an opportunity to learn how to mutate.

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Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

"We know that if you give the virus the opportunity to circulate and replicate, you give it the opportunity to generate more variants," Dr. Anthony Fauci, President Joe Biden's chief medical adviser, told CNN.

The Delta variant has learned how to evade Covid-19 vaccines to a small degree, but they still offer excellent protection against severe disease and hospitalization.

The fear is that the next variant might be able to outsmart the vaccine more thoroughly, causing problems even for parts of the country that have high vaccination rates.

"We've been lucky with the variants so far that they've been relatively susceptible to our vaccine, but the more you roll the dice, the more opportunities there will be for a resistant variant," Reiner said.

CNN's Justin Lape contributed to this report.

 

[jimmyjazz 45,957]

1 hour ago, GRHorn said:

The other comes from slide 27 ofthe Shimabukuro talk, which shows the rate of myocarditis in 12- to 17-year-old boys after the seconddose of mRNA as 132/2,039,871, or about 6/100,000.

Out of curiosity, I looked up annual statistics for myocarditis, which showed 3.1M people were afflicted worldwide in 2017.  Assuming a population of 7.8B, this would indicate a rate of 40 cases per 100,000 people.  Now, that encompasses all demographics, but this quote on the Myocarditis Foundation's website is telling:

Quote

While we often associate cardiovascular conditions with elderly populations, myocarditis can affect anyone, including young adults, children and infants. In fact, it most often affects otherwise healthy, young, athletic types with the high-risk population being those of ages from puberty through their early 30’s, affecting males twice as often as females.

So, if young athletic males dominate disease occurrence, what might we assume is their affliction rate?  20 per 100,000?  25?  15?  I don't know.  I do know that 6 per 100,000 doesn't stand out.  Has anyone done the work to prove that a 2nd dose is actually responsible?  As is often said, correlation is not causation.  (Let me be clear, I didn't look at pericarditis, so I'm not making any bold claims, just literally asking questions.)

 

Myocarditis Foundation

 

 

[WBT 20,572]

32 minutes ago, C-Man said:

Those vulnerable clusters put all of the United States -- and to some extent, the world -- at risk for going back to 2020, since high-transmission areas can become breeding grounds for Covid-19 variants that could go on to evade Covid-19 vaccines.

These people sadly will FAAFO but this variant fearmongering is overblown.  These areas in the US with total population of 15 million and <30% vaccination rate put the world at risk? 

The worldwide vaccination rate is 11.7%.  India and Indonesia are ~5%.  Brazil, Russia, Mexico, and Japan are ~15%.

Edited July 8, 2021 by WBT

[Sawbonz 27,562]

1 hour ago, C-Man said:

Yeah Texas?

https://www.cnn.com/2021/07/08/health/undervaccinated-clusters-covid-risk/index.html

 

That circle on the left is probably herpes

[Don Johnson 4,753]

2 hours ago, Neonmoon said:

Excluding children because of complicating factors, anyone above 16 that doesn’t get vaccinated is contributing to the spread of covid and incubation of variants that are more deadly to the vaccinated and people who can’t get vaccinated for health reasons. These people should be shamed, ridiculed, and outcasts from ordinary life. 

How about instead of ridiculed, just not protected anymore?  And when they get Covid, sympathy is optional.

[27-25 2,047]

1 hour ago, Don Johnson said:

How about instead of ridiculed, just not protected anymore?  And when they get Covid, sympathy is optional.

If the only thing that happened to such people who chose not to be vaccinated is that they died I'd be all for the live and let live.  But that's not the whole story.  Those dicks are the probable vectors for the Epsilon, Zeta, Eta, Theta, ... Omega variants.  They'll pass that new version on to a large number of people before they croak.  Sooner or later one of those variants is going to be different enough that the vaccines we do have now won't suffice, then we're back in the suck.  Rinse and repeat.

And as pointed out in another post, yes, the low vaccination rates elsewhere (in many cases having to do with total unavailability instead of something silly like political leanings) are a problem too and perhaps even a bigger one.  Delta originated, if I recall correctly, in India.  So the entire world needs to step up.

[Anastasis 23,469]

Pfizer announcing a vaccine update to target the delta lineage. 
 

[washparkhorn 9,939]

8 minutes ago, Anastasis said:

Pfizer announcing a vaccine update to target the delta lineage. 
 

https://www.msn.com/en-us/health/medical/pfizer-says-it-is-developing-a-covid-booster-shot-to-target-the-highly-transmissible-delta-variant/ar-AALVTyd

 

Edited July 8, 2021 by washparkhorn
correct link

[Anastasis 23,469]

37 minutes ago, jimmyjazz said:

Out of curiosity, I looked up annual statistics for myocarditis, which showed 3.1M people were afflicted worldwide in 2017.  Assuming a population of 7.8B, this would indicate a rate of 40 cases per 100,000 people.  Now, that encompasses all demographics, but this quote on the Myocarditis Foundation's website is telling:

So, if young athletic males dominate disease occurrence, what might we assume is their affliction rate?  20 per 100,000?  25?  15?  I don't know.  I do know that 6 per 100,000 doesn't stand out.  Has anyone done the work to prove that a 2nd dose is actually responsible?  As is often said, correlation is not causation.  (Let me be clear, I didn't look at pericarditis, so I'm not making any bold claims, just literally asking questions.)

 

Myocarditis Foundation

 

 

These slides from CDC ACIP get at the expected event rates and first dose/second dose effect. Expected and actual event rates (per VAERS) are exceedingly small compared to the number of doses administered, but there is a pretty clear association with second dose in particular. Real question in my mind is what are the predisposing factors beyond just sex and age.  

 

 

 

 

[Don Johnson 4,753]

11 minutes ago, 27-25 said:

If the only thing that happened to such people who chose not to be vaccinated is that they died I'd be all for the live and let live.  But that's not the whole story.  Those dicks are the probable vectors for the Epsilon, Zeta, Eta, Theta, ... Omega variants.  They'll pass that new version on to a large number of people before they croak.  Sooner or later one of those variants is going to be different enough that the vaccines we do have now won't suffice, then we're back in the suck.  Rinse and repeat.

And as pointed out in another post, yes, the low vaccination rates elsewhere (in many cases having to do with total unavailability instead of something silly like political leanings) are a problem too and perhaps even a bigger one.  Delta originated, if I recall correctly, in India.  So the entire world needs to step up.

Variants are going to happen elsewhere, no matter if we reach 100% here.  We aren't isolated.  Doesn't mean we shouldn't try.  Its just naive to think the variants are going to be caused by the 2% of world population that is unvaccinated here.

So let's just not protect them anymore.  If they get it, they either build immunity or die and no longer are vectors. Everyone has had the chance.  Some chose poorly.

[jimmyjazz 45,957]

8 minutes ago, Anastasis said:

These slides from CDC ACIP get at the expected event rates and first dose/second dose effect. Expected and actual event rates (per VAERS) are exceedingly small compared to the number of doses administered, but there is a pretty clear association with second dose in particular. Real question in my mind is what are the predisposing factors beyond just sex and age.  

I assume "expected" is the baseline rate prior to covid; i.e., un-vaccinated.

It seems those numbers don't really jibe with the 3.1M annual cases I mentioned from the myo website.  Something doesn't seem to add up.

[PenelopeWitherspoon 19,101]

28 minutes ago, Don Johnson said:

Variants are going to happen elsewhere, no matter if we reach 100% here.  We aren't isolated.  Doesn't mean we shouldn't try.  Its just naive to think the variants are going to be caused by the 2% of world population that is unvaccinated here.

So let's just not protect them anymore.  If they get it, they either build immunity or die and no longer are vectors. Everyone has had the chance.  Some chose poorly.

Part of that unprotected IMO means that they have to pay for hospitalization and health care out of their own pocket (Medicare will not cover it, nor should insurance) should they get COVID and CHOSE to be unvaccinated.  Fuck them.  Stupidity should be a pre-existing condition.

[Don Johnson 4,753]

10 minutes ago, PenelopeWitherspoon said:

Part of that unprotected IMO means that they have to pay for hospitalization and health care out of their own pocket (Medicare will not cover it, nor should insurance) should they get COVID and CHOSE to be unvaccinated.  Fuck them.  Stupidity should be a pre-existing condition.

I’m fine with that. Of course that can open Pandora’s box as to not covering avoidable illnesses.  Probably more likely non vaccinated see an increase in rates.