Hi Yoshi,
Not surprisingly, we've received a lot of comments and questions in response to the last few emails I've written about kids, Covid, and the Covid vaccines.
This is one of the most important issues of our time—and perhaps our lives—so it makes sense that interest in this topic is high.
In this email, I'd like to respond to a few of the most common topics that came up in your comments.
Kids should get vaccinated against Covid because the vaccines protect against multisystem inflammatory syndrome in children.
Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.
Some have argued that we should vaccinate all children to protect them from MIS-C. This is largely based on a report published by the Centers for Disease Control and Prevention (CDC) on January 7, 2022, suggesting that vaccination reduces the risk of MIS-C by 91%.
There are at least six reasons why this argument does not make sense, given where we are in the pandemic: - The risk of MIS-C was already incredibly low when the Delta variant was predominant: 5 in 1,000,000, according to a study in JAMA in 2021. This is the most accurate study on MIS-C incidence done to date because they adjusted for the fact that many kids with Covid are asymptomatic and don't get tested, which results in lower than actual case numbers. Even if the CDC report is accurate, the absolute risk would be reduced from 0.0005% to 0.00005%. This doesn't sound as impressive, does it?
- The risk of MIS-C is likely to be even lower with the Omicron variant. Studies around the world have confirmed this, as has the director of the CDC. One analysis from the UK suggests that mortality from Omicron may be 97% to 99% lower than from Delta.
- The current vaccines are less effective against Omicron. A recent study found that "... the effectiveness of 2 doses of COVID-19 vaccines against infection (irrespective of symptoms or severity) is substantially lower for Omicron than Delta, and that VE [vaccine efficacy] against Omicron infection was only 37% ≥7 days following a third dose."
- The majority of children in the U.S. have already had Covid, and natural immunity is likely to protect against MIS-C. A paper published in Nature Immunology in December 2021 found that both the innate (initial antibody response) and adaptive (later T-cell response) immune reaction to SARS-CoV-2 is much stronger in children than in adults.
- The CDC study showing that vaccination reduces the risk of MIS-C did not control for confounding factors. We know that MIS-C is nine times more common in Black and Hispanic kids and three times more common in Pacific Islander and Asian kids than in white kids. Children of color have significantly lower vaccination rates, and due to disparities in the social determinants of health, on average, they also have greater exposure to diet, lifestyle, and environmental factors that might increase their risk of MIS-C. It's likely that these factors play just as large of a role as—if not larger than—vaccination status in determining the risk of MIS-C.
- The risk of adverse events from the vaccines significantly outweighed the risk of MIS-C from Covid—even before Omicron. As I documented in a previous email, the risk of myocarditis in boys 12 to 17 years old is between 94 and 162 in 1,000,000. This means that the risk of myocarditis from a vaccine is between 19 and 32 times higher than the risk of MIS-C in this population.
And now you'll know how to interpret articles in the media claiming that we should be "alarmed" by an increase of MIS-C. For example, a headline in the New York Daily News warns: "Children's hospitals see disturbing rise in MIS-C." But in the article, the only evidence presented for this is the anecdotal reports of a few hospital directors and a CDC report claiming a 12% increase in cases. At an incidence of 5 per 1,000,000 kids, a 12% increase would shift that to 5.6 per 1,000,000. Again, absolute numbers are often more revealing to look at than relative percentage increases.
Given the dramatic surge in cases around the country, it would not be surprising to see a commensurate, slight upward trend in MIS-C cases. Of course, if we could wave a magic wand, we'd eliminate all cases of MIS-C (and Covid, while we're at it). But giving kids the Covid vaccine without real evidence that it will help more than harm is not a logical solution.
Kids should be vaccinated to protect against Long Covid.
This argument falls flat for similar reasons: - Long Covid was already very rare, even when Delta was predominant. A study published in the Lancet in August 2021 found that 98% of children with Covid-19 had completely recovered by week 8. The incidence of Long Covid is likely to be even lower with Omicron since it is a far milder variant.
- There is little evidence that vaccines protect against Long Covid. In fact, the largest and best-controlled studies have found no protective effect of vaccines against Long Covid. For example, this study of >10,000 breakthrough infections found that two doses of the vaccine did not protect against "long Covid features."
Here is a chart (from the UK Health Security Agency week 50 vaccine surveillance report) that shows the rate of new cases, normalized per 100,000 people, in the UK from November 15 to December 12, 2021, according to vaccination status. Omicron was surging in the UK during this period, so it gives us a good indication of vaccine effectiveness against this variant.
We can see from this chart that in all age groups other than <18 and >70 (which are likely confounded by higher rates of testing), the incidence of new Covid cases is higher in the vaccinated than the unvaccinated.
And here is a similar report from the public health department in Ontario, Canada:
Again, we see a higher rate of new cases per 100,000 in the fully vaccinated than we do in the unvaccinated or partially vaccinated.
What about boosters? Don't they help?
We can see in the figure below from a study out of Ontario that boosters do provide some additional protection. (Look at the gray circles on the right side of the figure, where it says, "Any mRNA," "BNT 162b2" (Pfizer), and "mRNA-1273" (Moderna).
But that protection is weak (<40% for all but Moderna), and its duration is almost certainly short-lived. From the conclusion of the paper:
"While VE [vaccine effectiveness] against Omicron infection is substantially lower than against Delta infection, a third dose of mRNA vaccine affords some level of protection against Omicron infection in the immediate term. However, the duration of this protection and effectiveness against severe disease are uncertain."
We can also look at Iceland, where >80% of the population has had two doses of the Covid vaccines, and ~50% have had a third dose (booster):
If the vaccines and boosters did much to prevent Omicron cases, Iceland would not be seeing such a dramatic "hockey stick" spike in cases.
One might argue, "Well, if the boosters provide some additional protection, even if short-lived, why not offer boosters more frequently—and indefinitely?"
Setting aside the fact that the effectiveness and safety of frequent boosters has not been studied in adults, much less in children, the data that we already have on vaccines and Omicron doesn't inspire confidence in this approach.
What's more, there's a risk that frequent boosters might weaken our natural immune defense against Omicron as well as future variants of the virus that may emerge.
Regulators in the European Medicines Agency warned of this in a recent press briefing:
"Boosters 'can be done once, or maybe twice, but it's not something that we can think should be repeated constantly,' Marco Cavaleri, the EMA head of biological health threats and vaccines strategy, said at a press briefing on Tuesday. 'We need to think about how we can transition from the current pandemic setting to a more endemic setting.'"
The World Health Organization also recently released a report indicating that, for multiple reasons (including the evolution of the virus), regular booster shots may not be a viable strategy:
"... a vaccination strategy based on repeated booster doses of the original vaccine composition is unlikely to be appropriate or sustainable." [Emphasis added]
They also explicitly added that, even if boosters or new vaccines are offered for Covid in the future (given that it is transitioning to an endemic virus), those vaccines will need to:
"be more effective in protection against infection thus lowering community transmission."
Just as with MIS-C, if we could wave a magic wand and eliminate Long Covid as a possibility, we'd do that. But without evidence that vaccines actually reduce the risk of Long Covid—especially now that Omicron is dominant, and especially without exposing them to a higher risk of other adverse effects, like myocarditis—it doesn't make sense to suggest universal vaccination of 5- to 11-year-olds on this basis.
Hospitalization of kids is surging with Omicron, so we should vaccinate kids to protect them.
You've probably seen a bunch of headlines recently about child hospitalizations increasing, like this one from NBC News:
Child Covid hospitalizations are up, especially in 5 states
But if you read beyond the headline (which few people do), you'll find that many of these hospitalizations are "with Covid," rather than "from Covid." This means that kids are being admitted for other reasons but are testing positive for Covid on admission. According to Dr. Paul Offit, a vaccinologist at Children's Hospital of Philadelphia:
"However, he said, his hospital has seen a lot of kids test positive for Covid without necessarily showing symptoms or getting sick.
"'We test anybody who's admitted to the hospital for whatever reason to see whether or not they have Covid, and we're definitely seeing an increase in cases. However, we're really not seeing an increase in children who are hospitalized for Covid or in the intensive care unit for Covid,' Offit said."
This fits with other data I've shared previously, suggesting that two-thirds of new Covid hospitalizations are in patients who only test positive for Covid after being admitted for another reason.
What about vaccination? Do we have data that giving kids the current vaccines will reduce their risk of hospitalization from Omicron?
I am doubtful of this claim for several reasons.
First, we know that, even before Omicron, the risk of Covid was extremely low for healthy children. A study out of Germany looked at just over 400,000 healthy 5- to 11-year-old kids with no pre-existing conditions who tested positive for Covid-19. They found: - A rate of hospitalization of 8.5 per 100,000 (1 in 11,750)
- A rate of ICU admission of 2 per 100,000 (1 in 50,000)
- A rate of death of ZERO (there was not a single death in this age group)
The CDC reports that a total of 803 children have died since the start of the pandemic. (Most of these children had serious pre-existing conditions.) To put this in perspective, that is fewer than the number of children that die from the flu and respiratory syncytial virus (RSV) in a typical year.
Second, available data on Omicron so far suggest that it is is far milder than Delta and previous variants. For example, some new research suggests that the mortality rate from Omicron may be up to 97% to 99% lower than it was with Delta.
We also have data from two studies—one out of Scotland, and one out of South Africa—suggesting that the risk of hospitalization from Omicron is between 65–80% lower than it was with Delta.
If we apply these reductions in risk to the already low rate of hospitalization in healthy children from the German data above, we get an adjusted risk of hospitalization of 2.4 per 100,000 (1 in 46,667).
This means that a healthy child's risk of hospitalization from Omicron is almost 17 times lower than their risk of hospitalization from the flu (39.8 per 100,000)!
Another question we have to ask is, "Do we have evidence that the current vaccines are effective at reducing hospitalization in children who are infected with the Omicron variant?"
We do not. In fact, we don't even have evidence that the vaccines reduce the risk of hospitalization from previous variants. As I explained in a recent email, because severe illness in kids is so rare, there wasn't a SINGLE case of severe Covid-19 or a SINGLE death from Covid-19 in the 2,268 kids that Pfizer studied to obtain their Emergency Use Authorization (EUA) by the CDC.
This meant that Pfizer had to estimate the potential benefit by looking at the antibody response generated by the vaccine in the kids' blood—rather than actual outcomes like hospitalization, which they weren't able to do because no child in the trial was hospitalized for Covid-19.
And with a risk of hospitalization from Omicron in healthy kids of only 2.4 per 100,000, the vaccines would have to be incredibly effective at reducing symptomatic disease—without causing an equivalent or greater number of adverse reactions—in order to make sense.
But that's not what we're seeing so far. The chart below illustrates data published by the public health department in Ontario, Canada:
What we can see is that hospitalization rates have increased in people who are fully vaccinated. Despite how it may appear, this chart does not suggest that the vaccinated have a higher risk of hospitalization than the unvaccinated, because the numbers are not adjusted by population. A high proportion of Ontario's residents are vaccinated, so there is a greater pool of vaccinated people than unvaccinated people that could contract Covid and be hospitalized.
Still, I've charted the data back to August 10th. You can see that the hospitalization rate was higher in the unvaccinated than both the fully and partially vaccinated until roughly December, when the Omicron variant became dominant. From that point forward, the rate of hospitalization in the fully vaccinated increased much more significantly. This suggests that the current vaccines may not protect against severe disease and hospitalization as much as they did with previous variants.
Finally, as I've documented elsewhere, like all medical treatments, the vaccines are not harmless. Using the CDC's data, we can conservatively estimate the risk of an adverse event from the vaccines in kids 5 to 11 years old of 1 in 1,104.
This is dramatically higher than the adjusted risk of hospitalization from Omicron in healthy children (1 in 46,667).
Given all of this, rushing to vaccinate all healthy children 5 to 11 years old against Covid is not a reasonable strategy, even if there has been a slight increase in the rate of hospitalization (which is dubious, for the reasons I mentioned earlier).
There are, of course, many other steps we can take to protect ourselves and our children from Covid, in particular, and viruses and other pathogens, in general: - Eat a nutrient-dense, whole foods diet.
- Ensure adequate intake of immune-supporting nutrients, like vitamins A, C, D, E, and K2, and zinc.
- Get enough sleep and physical activity.
- Take immune-supporting supplements and herbs prophylactically and at the first sign of symptoms.
I hope this information has been helpful.
In health,
Chris
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I know this is a lot of information to read through and absorb, but I offer it in the hope it is a help to you :)
Have a great week, and as always, please feel free to pass this along!
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