🧵4/x The crux of his argument is skepticism whether the benefits are worth the trouble (1) on a societal scale re: mandates or even recommendations & (2) re: individual benefits to children
🧵5/x Some points (re: long COVID, preventing re-infection) are about absence of direct evidence
Personally this doesn’t sway me much. Inaction in face of uncertainty has risks too.
(For the first few months after immunization w mRNA COVID-19, people get strong protection vs infection: even w lots of exposure, most people have low likelihood of infection. After that, efficacy vs infection closer to 50%)
🧵7/x I think these vax efficacy (VE) numbers seem “not-worth-the-effort”-low to many people bc
(1) original VE vs OG SARS-CoV-2 was SO good (“anchoring”)
and
(2) we all interpreted efficacy as protection against lifetime risk instead of (correctly) like a rate
🧵8/x With the COVID virus everywhere, illness disruptive to family & civic life, & long term effects of repeated childhood infections unclear, a 50% efficacy vax seems valuable:
1-2 infections per yr instead of 2-4…
Or maybe even 0 in a given year instead of 1 or 2
🧵9/x Despite doubts about efficacy, the author recommends giving the vaccine to kids who have ⬆️ risk of hospitalization *given* infection
“High-risk” strategies like these are intuitive to people, but the math often doesn’t work the way people think it does
🧵10/x Basically it’s a denominator problem.
Say u can reliably identify* the 1% subset of highest risk kids…say they have 10x(!) risk vs others
(*harder than it sounds)
Do you eliminate nearly all kid hospitalization by focusing on high-risk & not lower risk 99%?
No
🧵11/x For more on the high-risk strategy, I highly recommend Geoffrey Rose’s 1985 classic article "Sick Individuals and Sick Populations" (reprinted in @IntJEpidemiol).
🧵12/x Another argument that the author makes is about opportunity cost: Do efforts to vaccinate children against #COVID19 reduce more impactful efforts to improve child health?
🧵13/x Full disclosure:
I am attracted to this argument in theory, but I’m skeptical based on experience: it’s often used in bad faith, with no specific strategy or $ to ramp up highly impactful efforts X in place of Y (thing they don’t like)
We end up with no Y & no better X
🧵14/x But, assuming the author is sincere (I actually do), this argument is HIGHLY context-specific.
The author is from the UK, I’m in the US South. It’s possible this is a strong argument, given their system. But I’ll focus here, on the system I’m experiencing
🧵15/x In US states like TN & FL here, kid-COVID vaccination is not an organized state effort displacing other kid-health policies.
Instead, the states’ anti-kid-COVID-vax political movement are on-ramps and engines to weaken other childhood immunization programs
🧵16/x A final consideration:
If we don’t vaccinate against COVID when kids are little, then when should we do it?
🧵17/x A lot of his argument is, Almost all the kids already had COVID so 🤷🏾♀️…
I have several objections to this argument, but I’ll focus on the big picture:
🧵18/x Going forward, is there some optimal age for vaccinating against COVID-19?
Or would he just go with a high-risk strategy of restricting immunization campaigns to subgroups w some threshold of risk *given infection*? (The medical model, “high-risk strategy”)
🧵19/x I like the idea of starting the #COVID19 vaccination sequence when people are young bc the side effect profile is best then and you have greatest likelihood of catching people before their first #SARSCoV2 infection.
🧵20/x These are my quick thoughts
These vaccines aren’t perfect.
And there are trade-offs in public health and medicine (and parenting, for that matter!)
But one of my guiding parenting strategies is, Don’t let the perfect be the enemy of the good
They do SO much (their COVID vaccine clinics are just a small part of their efforts). I’ve been impressed by their resources and on-the-ground efforts.
I’m glad to live in a place w such a strong public health dept
• • •
Missing some Tweet in this thread? You can try to
force a refresh
🧵Last week, I got a new gadget - a carbon dioxide (C02) monitor!
Some thoughts below (1/x)
🧵Before I start, a reminder from chemistry/biology:
C02 is a “trace gas” we humans & other animals breathe out
Humans breathe it out in greater concentrations than it occurs in the air. So C02’s a good marker for lingering breath in stale air
(2/x) en.wikipedia.org/wiki/Carbon_di…
🧵 First observation: C02 monitors are expensive!
The expert consensus is that Aranet 4 is the cheapest high-quality monitor around, which is what I got.
I’ve been aware of this gadget for a while and have recommended it to others
🧵 1/ This week, a friend told me that her pre-K child had Covid
And I responded badly
🧵2/ First a story: 7 years ago, I had a high-risk pregnancy (22 week PPROM)
One of the worst moments of that pregnancy was during a routine ultrasound that showed (predictably, given my Dx) that my amniotic fluid level was very low
🧵3/ The MD doing the ultrasound knew I was an epidemiologist and talked to me like a peer, sharing a relevant journal article, etc.
And she said, casually, w/ detachment, something like,
This is just the body’s way of ending a non-viable pregnancy
In 2019, I was on a planning committee for a scientific conference. One of our duties was a “hot topics” session — a hard task when you’re planning a year in advance
We were trying to predict, What will be relevant & topical in epidemiology in 2020?
Second, this thread especially grabbed my attention coming on the heels of yesterday’s @NIH_ORWH virtual conference on gaps in research about the health needs most particular to women orwh.od.nih.gov/research/2021-…
🧵1/ When we don’t get #SARSCoV2 transmission low, the most vulnerable - the old, the immunocompromised, the just plain unlucky whose bodies can’t mount a robust immune response to vaccines - they pay a high price
🧵2/ I know many people in US see #COVID19 primarily in personal terms. Their risk to others is not a main priority…
Others argue that the unlucky vulnerable should just “shield” themselves indefinitely, as if being old or sick means that you are no longer a social being
🧵3/ And others argue that the shortening of life for the old in particular is not that great a tragedy bc they would have died soon anyway*