🧵Let me make this uncomfortable truth loud and clear:

Healthy children and adolescents likely face higher risks from some (perhaps all) #covid19 vaccines than from natural infection

I.e., the risks of vaccination likely outweigh the direct individual benefits
To take the most obvious example, multiple high-income country regulators have restricted the use of the AstraZeneca vaccine in children and young adults

This is because the risks outweigh the direct individual benefits

Some people look at the figure above and say it doesn't include other things like longcovid, but there is precious little evidence that longcovid is common/severe in healthy children or young healthy adults (despite a lot of unverified claims about this)

What the figure above does not reflect is that average risk in a given age group includes those with risk factors for severe #covid19 like diabetes, heart & lung conditions, and obesity - risks in healthy people in that age group are significantly lower
If we are just talking about healthy children and adolescents, their risk of #covid19 is even lower than the average risk in their age group (where this average includes people with risk factors)

This is not just the AstraZeneca vaccine, as Pfizer is now associated with myocarditis in young healthy adults & teenagers

Given the extremely low risks of #covid19 in children & young healthy people, the risks of vaccination may well outweigh benefits

Some propose that we could just give children one dose of Pfizer (as the second dose has a stronger signal for myocarditis), or a lower dose of the vaccine

This is also because of reasonable concerns that risks of standard regimens may outweigh benefits

In recent history, regulators have restricted the use of other vaccines in children where there are concerns that risks outweigh benefits

For example, Australia stopped the use of an influenza vaccine associated with febrile seizures:

Likewise, European regulators restricted the use of another influenza vaccine associated with narcolepsy in children, which peaked at 6+ months after receiving the vaccine

It should be obvious that:

Harming healthy children with vaccines for a disease that is associated with extremely low risks in children is a bad idea, even if those harms are rare

Harming healthy children will undermine vaccine confidence

If we want to promote public health, and confidence in #covid19 vaccines as well as other vaccines, we should be extremely careful to determine that the benefits of childhood vaccination outweigh the individual risks before we make vaccines routine for healthy children
Note: I think it is fine to give current #covid19 vaccines to children and adolescents with health conditions that put them at high risk of severe #covid19, or for young healthy adults who make a free choice to be vaccinated

The more difficult case is young healthy children
Also note: it is fine to do more research to try to find safer vaccines / regimens of exisiting vaccines in younger age groups, but there is a big difference between research and (“emergency”) public health roll out where risks might outweigh benefits
Update: here is the German regulator making a sensible decision on Pfizer:

Only approved for adolescents with medical conditions / at increased risk of severe #covid19

Or those who consent to current risk & uncertainty in discussion with a doctor

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More from @ID_ethics

8 Jun
🧵New York's plan to run concerts with vaccinated and vaccinated sections

Raises some interesting issues (supposing spread of covid at such a concert, which is unlikely outdoors)

Should public health encourage the spread of #covid19 among the intentionally unvaccinated?

One response, as below, is that we should mix vaccinated and unvaccinated in order to reduce the probability of infection in the latter (i.e., indirect protection or herd immunity)


This might be a good strategy insofar as unvaccinated people want to be vaccinated but just haven't had access yet - it protects them until they get vaccinated

Read 9 tweets
29 Apr
@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden Regarding India, I first noted in July 2020 that we would eventually see bad news due to comorbidites (in the context of poverty and inequality), but that overall deaths per capita would be limited by the low population age - similar to current events

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden It is a tragedy, in the sense of the "remorseless working" of well-understood factors underlying public health in general, e.g. poverty

India spends <$30 AUD per capita on health

Australia spends >$7000 per capita
@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden Few people cared about the inequitable infectious disease burden in poor countries until it became fear pornography in the media

I have written, for example, about how deaths due to drug resistance are massively underestimated in countries like India

Read 16 tweets
2 Mar
1/ We reviewed Australian medical guidelines:

Some medical decisions are evidence-based, but many are not - and this varies by specialty

E.g., Australian antibiotic guidelines do not state the level of evidence for recommendations (which is often low)

2/ Previous reviews of American Infectious Diseases Guidelines found that only 14% of recommendations were based on the highest level of evidence

3/ One problem with a lack of evidence is that it leads to overtreatment:

Many antibiotic courses are longer than they need to be - sometimes because shorter courses haven't been tested in randomized trials

Read 4 tweets
25 Feb
Post-lockdown rebound of infectious diseases:

RSV is back in Australia with a vengeance - current cases in red below, usual incidence in black

Note that #RSV is far more dangerous to infants & young children than #covid19

To get a sense of #RSV vs. #covid19 in children:

In the UK:

- #RSV : usually kills 28-79 children per year

- #covid19 : a total of 7 children had died in paediatric intensive care up to November 2020

RSV data: jech.bmj.com/content/59/7/5…
covid19 data: picanet.org.uk/covid-19/
Post-lockdown rebound of #RSV will also harm adults, especially older adults:

RSV usually causes ~10,000 deaths per year among US adults aged >65

RSV in nursing homes has a fatality risk of 2-5%

Imagine if incidence doubles, as it has in Australia?

Read 6 tweets
23 Feb
Article title: coronavirus immunity is "short-lasting"

Article figure: median time to re-infection ~ 2.5 years

(Median = black vertical line below)

Most people would be happy with >2 years to reinfection, especially with reduced clinical severity...

The above is an example of how scientists and journal editors could better communicate findings and risks

The widespread and baseless fears that there would not be immunity to #covid19 could have been reduced, rather than increased, by more careful reporting of the same data
From the same study:

~50% of people infected with endemic coronaviruses still have higher levels of antibodies after 4 years

No reason to think that #covid19 would be wildly different

(antibodies don't necessarily = clinical protection, but still good data)
Read 5 tweets
26 Jan
Terminology thread:

rate ≠ risk
infection ≠ disease
quarantine ≠ isolation
social distancing ≠ physical distancing
prolonged PCR positivity ≠ shedding
virulence ≠ transmissibility

References to follow
1/ rate ≠ risk

A risk is a probability of a harm (of a given magnitude)

A rate is something that varies over time

2.1/ infection ≠ disease

Many infections are asymptomatic or even beneficial!

An infectious disease only occurs when the host-pathogen interaction results in harm (i.e., a harmful disturbance of normal host function)

Read 10 tweets

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