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Data to support this assumption/conjecture, please. In the 0-5 group, deaths AND long-term complications are extremely EXTREMELY rare. Which is a good thing, because data for the vaccine trials in this group is really bad. The vaccine just isn't nearly as efficacious in this group as the 5 and older population.
Sure - Omicron apparently has a higher effect on the extremely young. Recent data from South Africa:

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And recent data from Utah:

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I know none of my colleagues (pediatricians) that are rushing to immunize this group currently. Hospitalizations are more rare than seasonal influenza in this group.
In terms of case-rate in light of Omicron - I'm not sure (where's your data? ;)). As a total population risk - COVID is still much more of a threat than the flu this winter thanks to anti-COVID measures.

mothers that are vaccinated while pregnant have been shown to deliver strong antibodies to their fetus', providing newborns up to 6 months of protection (6 months is pretty universal for the "fade off" of maternal antibodies).
Absolutely correct - pregnant mothers should absolutely get vaccinated.

Unfortunately I still hear crazy stories of people recommending the opposite, even doctors.
 

Yes, “mild” omicron is’t so mild for small kids.

I wonder why. Omicron is not as severe as others because it doesn’t enter lung cells as much as others since it doesn’t use TMPRSS. But they are better at using ACE2 which makes them more infectious to the upper respiratory track.

Do small kids have more ACE2 in lungs or is it because of other organs with ACE2 like intestines ?

 
Sure - Omicron apparently has a higher effect on the extremely young. Recent data from South Africa:

View attachment 770966


And recent data from Utah:

View attachment 770967


In terms of case-rate in light of Omicron - I'm not sure (where's your data? ;)). As a total population risk - COVID is still much more of a threat than the flu this winter thanks to anti-COVID measures.


Absolutely correct - pregnant mothers should absolutely get vaccinated.

Unfortunately I still hear crazy stories of people recommending the opposite, even doctors.

It's Friday, I'm lazy, about to grab a beer, but from the below, you can find the original source should you like:

Basically, young child and infant immune systems are not "like little adults". They respond sometimes very differently. This is probably:
1) why COVID (even Omicron) is FAR milder in this age group
2) why the vaccine doesn't produce robust immune response

I don't expect "adding a 3rd dose" will make much of a difference. More than likely, and this is a BIG IF, IF COVID becomes a standard vaccine for kids growing up, it will probably fall on the schedule to start around 5-6 years old. There doesn't appear to be much benefit for vaccinating earlier (see #2 above).
 
Basically, young child and infant immune systems are not "like little adults". They respond sometimes very differently. This is probably:
1) why COVID (even Omicron) is FAR milder in this age group
2) why the vaccine doesn't produce robust immune response

I don't expect "adding a 3rd dose" will make much of a difference. More than likely, and this is a BIG IF, IF COVID becomes a standard vaccine for kids growing up, it will probably fall on the schedule to start around 5-6 years old. There doesn't appear to be much benefit for vaccinating earlier (see #2 above).
The data I posted seems to counter #1 above. Now, the older populations do have some percentage of vaccinated people in the group so it's not apples to apples, but it sure looks like the 0-5 yo hospitalization rate for Omicron (Utah data) is very similar to the flu at around 120 hospitalizations / 100,000, and the flu shot is recommended for that age group. Not sure what the flu vax-rate is in the population, and I didn't look up CFR for that age group to compare.

Anyway, the data is still out - I view that as a good thing as it shows that they are doing the proper due-diligence.

What is still clear is that far too many people are still dying from COVID right now. We're rapidly approaching 1M deaths and ~2k people are dying every day.
 
What is still clear is that far too many people are still dying from COVID right now. We're rapidly approaching 1M deaths and ~2k people are dying every day.
Yes - unfortunately, the “mild” term has been much misunderstood leading to same of deaths as “severe” Delta.

A smaller % of a larger number can still be as bad as the larger % of a smaller number.

More than half the fatalities due to Covid have come after Vaccine availability showing how deadly politics of ignorance is.
 
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Data to support this assumption/conjecture, please. In the 0-5 group, deaths AND long-term complications are extremely EXTREMELY rare.

1 in ~4540 children below 5 died of COVID, cumulatively, vs. 1 in 9600 for all other children (teenagers are also at higher risk, so if you compare very young children to the 5-11 group the 0-4 group is actually closer to 3x higher risk). These are CFRs of course, not IFRs. And obviously these stats are progressively getting skewed by the availability of vaccinations for older groups - but I've posted this data before vaccines were widely available for the 5-11 group, and this vulnerability difference is still apparent in that data (you can look up the posts - for example, but I have posted earlier as well ). For Omicron the situation could be different, but generally young children have floppy airways and can be more vulnerable to respiratory diseases, as you are well aware, as you are a pediatrician. It's speculative, but I assume that's the reason for these stats looking the way they do, and it's not just a ascertainment bias issue (possible, but I think given the degree of difference, unlikely to be the only explanation).

Screen Shot 2022-02-18 at 6.42.04 PM.png


Which is a good thing, because data for the vaccine trials in this group is really bad. The vaccine just isn't nearly as efficacious in this group as the 5 and older population.

The doses they used are very small it seems (7ug instead of 100ug) and maybe they went too conservative. We'll hope that the response is strong enough for the three dose data. I suspect it will be. But we'll know in a few weeks.


Sure - Omicron apparently has a higher effect on the extremely young.

My data above is cumulative, but I've posted this before, prior to Omicron really pushing through, so it's possible to look at deltas and see how risk has changed for each group over time specifically for the Omicron period - though CDC death data lags so much that it's too early to. make that assessment. Not going to do that here as a result.
 
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1 in ~4540 children below 5 died of COVID, cumulatively, vs. 1 in 9600 for all other children (teenagers are also at higher risk, so if you compare very young children to the 5-11 group the 0-4 group is actually closer to 3x higher risk). These are CFRs of course, not IFRs. And obviously these stats are progressively getting skewed by the availability of vaccinations for older groups - but I've posted this data before vaccines were widely available for the 5-11 group, and this vulnerability difference is still apparent in that data (you can look up the posts - for example, but I have posted earlier as well ). For Omicron the situation could be different, but generally young children have floppy airways and can be more vulnerable to respiratory diseases, as you are well aware, as you are a pediatrician. It's speculative, but I assume that's the reason for these stats looking the way they do, and it's not just a ascertainment bias issue (possible, but I think given the degree of difference, unlikely to be the only explanation).

View attachment 771079



The doses they used are very small it seems (7ug instead of 100ug) and maybe they went too conservative. We'll hope that the response is strong enough for the three dose data. I suspect it will be. But we'll know in a few weeks.




My data above is cumulative, but I've posted this before, prior to Omicron really pushing through, so it's possible to look at deltas and see how risk has changed for each group over time specifically for the Omicron period - though CDC death data lags so much that it's too early to. make that assessment. Not going to do that here as a result.

When pFizer themselves decides that the efficacy data are bad enough that they are not asking for FDA approval, that should tell you something. ;)

They are "hoping" a 3rd dose makes things look better, but given that current vaccines provide only at best moderate coverage for the BA.2 sub-variant (this should really be called it's own variant right now - it's a totally different beast), which will be the dominant variant inside of 3-4 weeks, there is very little chance of the current vaccine being approved for this age group.
 
apples-to-apples comparison here is 7ug to 30ug.
Really should have looked this up. My recollection was very poor. It sounds like it's 3ug in the very young group, 10ug in children, and of course 30ug for ages 12 & up.

In any case 3ug is what has been used. I guess 10ug-3ug = 7ug. :)

When pFizer themselves decides that the efficacy data are bad enough that they are not asking for FDA approval, that should tell you something.

We'll see. I wouldn't expect high efficacy against Omicron with two doses, anyway. I think them waiting says it has low efficacy against symptomatic infection, just like it does for adults, with two doses. (Fortunately the third dose cut infections roughly in half, and ~5x better against severe disease)

I would guess that the vaccine will be approved for young children after the three-dose data is available (I'd expect it to show efficacy above 50%, at least in one of the subgroups), though it's possible it will be delayed pending results of further trials with higher doses. But we're all guessing!

It's hard to tell whether the differences are due to fundamental immune differences in children (keep in mind the response was quite strong in very young, very small children 6-24 months - but not from 2-4), or something to do with the dose. Pfizer and BioNTech Provide Update on Ongoing Studies of COVID-19 Vaccine | Pfizer

I’m certainly not arguing that children are just small adults, though. There may well be significant differences in their immune response.

I don’t think BA.2 will have much impact one way or the other on efficacy, as compared to BA.1, as it seems to be most likely just more transmissible, but with similar immune escape characteristics. That’s what the UK data said, at least early on.
 
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I don’t think BA.2 will have much impact one way or the other on efficacy, as compared to BA.1, as it seems to be most likely just more transmissible, but with similar immune escape characteristics. That’s what the UK data said, at least early on.
Yes, from all the studies I’ve looked at, no difference in immune escape.

There is mixed data about severity of BA.2 vs BA.1, though.
 
US cases levels are down to what we were seeing in late July:

View attachment 771976
But is this the last wave? That is the $64 million (inflation adjusted) question. Hopefully Omicron is just a highly contagious, endemic and not much more lethal version of the flu from now on. Any guesses on when we will know that?
 
Omicron is still more lethal than the flu. The case fatality rate is less than Delta though. It's just that we have a significantly higher number of cases, so the death toll is similar.
I don't give a darn about the rate, I care about the total.

I don't want to catch it, and I don't want to die from it. I don't want others to catch it, and I don't want them to die from it.

Clearly more are dying locally from Omicron, than did from Delta. Doesn't matter what percentage survived, it matters that more total humans died. Talking about how many survivors there are might as well be just whistling past the graveyard.

 
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