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Tracy Høeg, MD, PhD Profile picture
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25 Sep, 4 tweets, 2 min read
MMWR AZ 🌵 mask study #1 limitation:
-Not adjusting for community cases in Maricopa Co (R) rising more during the study (see Figures)
-They adjusted for pre-study case rates, but that was not enough
-remember ~ 95% of school cases come from the community!
cdc.gov/mmwr/volumes/7… Image
Maricopa also had a lower vaccination rates: 47.6% vs 59.2% in Pima.

Likely the entire story here is more school cases in schools w/o mask mandates (mostly in Maricopa) due to higher comm. case rates related to lower vax rates. How did this become a mask story?🤔
Since I am literally sitting on the side of a soccer field in Stockton, for further info, I want to refer you to @VPrasadMDMPH 's discussion of these two MMWR studies & why we unfortunately can't learn about the effectiveness of masks from them. vinayprasadmdmph.substack.com/p/two-new-cdc-…
Here were my main critiques of the other (Budzyn et al) mask study in MMWR ⬇️

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More from @TracyBethHoeg

Tracy Høeg, MD, PhD Profile picture
12 Sep
I want to answer 2 questions we are frequently receiving about our study (which are excellent questions!):
1. Why did you use 120-day COVID hospitalization risk rather than overall COVID hospitalization risk?
2. But isn't post COVID myo *more* common than post-vax myo? 1/
2/ The US infection-hospitalization risk in the peds population is too uncertain bc we don't have reliable seroprevalence numbers. Based on a v recent analysis of UK data there is about a 1/750 chance for a child to be hospitalized/infection. TY @apsmunro
3/ We used 120-day hospitalization/population (just as the CDC did in their analysis) because there was less uncertainty about its accuracy. It also allowed us to include multiple rates in our model & incl. recent delta rates, as shown below from COVID-NET gis.cdc.gov/grasp/covidnet…
Read 12 tweets
Tracy Høeg, MD, PhD Profile picture
10 Sep
It's important to note, it's the CDC's estimates of myocarditis in boys & young men that have been the outliers. Israel & Canada reporting similar rates of post-vax myo to the 1/6,000 from our study. TY @_lewisy for the Israeli data ⬇️ medrxiv.org/content/10.110…
And rates from Moderna may be significantly higher:

And those Moderna rates are predicted to be even higher in the 12-17 year old boys:

Read 4 tweets
Tracy Høeg, MD, PhD Profile picture
9 Sep
Our group's analysis of pediatric post-vax myocarditis rates stratified by age, sex & dose. An extensive harm-benefit analysis is included w/consideration of presence or absence of comorbidities

Thanks @drjohnm @KrugAlli & @ifihadastick for the teamwork
medrxiv.org/content/10.110…
"For boys 12-17 without medical comorbidities, the likelihood of post vax dose 2 CAE is 162.2 & 94.0/million respectively. This... exceeds their expected 120-day COVID-19 hospitalization rate at both moderate (August 21, 2021 rates) & high COVID-19 hospitalization incidence"
I agree with @DrJBhattacharya highlighting @adamhfinn of JCVI here stating how cautious we need to be with our vaccination recommenations in this low risk group

Personal bias: I am a mom of 10 and 13 year old boys & want the best for them & all kids

Read 6 tweets
Tracy Høeg, MD, PhD Profile picture
2 Sep
Nice depiction in @Forbes showing COVID in schools vs. from schools vs in the community as observed in Wood, Co, WI. As senior author of this study, it was tempting for me to believe this pattern was contingent on masking kids, but for many reasons I have come to doubt this 🧵:
First, around 8% of the kids in the study were not compliant with masking. Second, kids ate lunch indoors (unmasked, of course). Third, the Scandinavian experience has been similar to Wood Co where school spread minimal but kids unmasked (eurosurveillance.org/content/10.280…).
Fourth, as my son says "Mom, kids just take off their masks when the teachers aren't looking." [aka child compliance].
Read 7 tweets
Tracy Høeg, MD, PhD Profile picture
1 Sep
Something that strikes me as off with this study if only 1.8% of kids tested positive for COVID during the 10 month study period (64,898/3.7 million). This seems way too low and would inappropriately inflate post-COVID myocarditis risk in kids.
cdc.gov/mmwr/volumes/7…
For reference, seroprevalence was estimated to be 25.3% among kids at the beginning of February. covid.cdc.gov/covid-data-tra…
Re the myo study ⬆️, I would tend to look at 218 total (86 in kids with covid) cases of myocarditis out of 3.7 mill kids over 10 months of the pandemic as reassuring. But this points out why it is crucial to get the denominator right. Please correct me if I have misunderstood.
Read 5 tweets
Tracy Høeg, MD, PhD Profile picture
5 Aug
Fascinating. Looking at the @CDCgov 's COVID-NET, you see that it has been the 0-4 year olds driving up COVID hospitalization rates recently. 5-17 year olds have decreased/remained stable. I wonder if the recent RSV surge is resulting in some infant RSV cases being labeled COVID.
COVID-NET: gis.cdc.gov/grasp/covidnet…

RSV typically affects this 0-4 age group and, a child hospitalized for RSV may be labeled "covid" if they test positive for COVID.

Figure below via @contrarian4data showing recent increase in RSV in the US (syndromictrends.com).
And this ⬇️. Please teach me. Tell me if I am wrong. I don't have all the answers (I suppose that is obvious).

Read 4 tweets

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