“If you are comparing IFRs and forgetting R0s, well…”

Epidemiologist Aris Katzourakis recently said,

If you are comparing IFRs and forgetting R0s, well…

To translate this into plain English, Dr. Katzourakis means that when describing the dangers of a virus to a population, two pieces of information are required. The first of these is the percentage of people who will die if they contract the virus, the infection fatality rate (IFR). The second is how contagious the disease is, the R0.

If I provided you with only one of these two metrics about a new virus, you might be able to tell me nothing about how many people would die were this virus to be unleashed on the world. How many people will die if a new virus has an IFR of 5%? No one can say. The answer depends entirely on how many people get it.

To give a real-world example, rabies kills essentially everyone who gets it. It has an IFR of 100%. However, since COVID-19 is infinitely easier to contract, it will kill hundreds of thousands of Americans this year, as it has for the past two years. In contrast, 5 Americans died of rabies in 2021, the highest number for a decade. I’d much rather get COVID-19 than rabies, but I’d be much safer if I were exposed to someone with rabies than COVID-19.

This is all very easy to understand. My children easily grasp these concepts.

Half the information

With this in mind, let’s examine a tweet by Dr. Vinay Prasad, a specialist in creating medical reversals, who not long ago assured us all that children didn’t need to be vaccinated against COVID-19 since their “risk of covid will decline precipitously” after “all adults are vaccinated“.

In this tweet, Dr. Prasad presented a graph showing that for children, the IFR for the flu is a bit higher than the IFR for COVID-19, though no one knows the exact IFR for either virus. I agree this is vital information. The vast majority of children with either disease will be fine. Parents should definitely vaccinate their kids against COVID-19 if they can, but they shouldn’t panic if their child contracts the virus.

But something is missing here. In that graph, COVID-19 looks not that much worse than the flu for elderly people. To understand why, I urge you to look at the original source for this graphic by John Burn-Murdoch.

It consists of two slides, with captions, below. Basically, he is saying that the original virus was more lethal than the virus we have circulating now, perhaps because it is intrinsically more mild compared to the original variant, but also because of better treatments and because many people are immune, both from the virus and the vaccine. The vaccine drastically increased the odds of someone surviving COVID-19. If few children were vaccinated, as would be the case had American regulators listened to Dr. Prasad, COVID-19 might still have an IFR identical to the flu. Additionally, this graph is just a snapshot in time. It would certainly have been different had it been made when the Delta variant was circulating. Who knows what the next variant has in store.

Moreover, this data is from England. While fewer children are vaccinated there compared to the USA, it also has a much lower pediatric obesity rates than many American states. Since obesity portends a poor outcome in children, American children are more vulnerable. The data cannot be extrapolated to children in Alabama or Texas. Finally, and tragically, the virus has already found and killed many of the sickest and most vulnerable people. The population that is available to the virus today is very different than at the start of the pandemic.

 

Dr. Prasad then implored journalists to share his truncated, out-of-context, graph in “every news story” about COVID-19 and children. He clearly wants his audience to believe that “For the unvaccinated child, COVID presents a health risk to children that is on par with the flu”. In a podcast from 2/2021 called “Should We Vaccinate Kids for COVID“, Dr. Prasad even said:

It is generally not controversial to argue that SARS-CoV-2 in kids is roughly, roughly the same as influenza, maybe even less severe than influenza, seasonal influenza in kids.

Of course, the IFR is exactly half of the information someone must know to understand how the two viruses have impacted children. It is generally not controversial to argue that a child with rabies is drastically more likely to die than a child with COVID-19. But that’s not a very useful thing to know in the middle of a pandemic, is it?

However, selectively omitting information to advance a grossly misleading narrative is Dr. Prasad’s speciality. I wrote about this previously saying:

Making factual errors is one way to understate the harms caused by COVID-19. Another way is to not mention these harms at all. Some doctors haven’t made blatant factual errors, as their arguments not to vaccinate children are essentially devoid of any facts at all. If ten data points are needed to understand the risks and benefits of the vaccine, they cherry pick the three that support their position.

I could have missed it, but I don’t think I’ve once seen Dr. Prasad simply acknowledge the total number of American children killed by COVID-19. In this instance, Dr. Prasad cherry-picked the fact that an individual child with COVID-19 has roughly the same low risk of dying as a child with the flu. But again something’s missing. Necessary information has been purposefully omitted.

What’s missing from Dr. Prasad’s repeated comparisons between COVID-19 and the flu is how many children have contracted these two viruses. What’s missing is how many children have been hospitalized with these two viruses. What’s missing is how many children have died from these two viruses. What’s missing is all that really matters.

When it comes to what really matters, the numbers couldn’t be clearer. That’s why Dr. Prasad refuses to share these numbers. COVID-19 is much more contagious than the flu and so mitigation measures that dented COVID-19 obliterated the flu. As the CDC states:

COVID-19 mitigation measures such as wearing face masks, staying home, hand washing, school closures, reduced travel, increased ventilation of indoor spaces, and physical distancing, likely contributed to the decline in 2020-2021 flu incidence, hospitalizations and deaths.

During the 2020-2021 flu season, a mere 9 children ages 5-11 years were hospitalized with the flu. Meanwhile, during this time COVID-19 hospitalized thousands of children this age, about 1/3 them needing ICU-level care. Since the start of the pandemic, over 1,200 children died of COVID-19, while 6 children died of the flu. Anyone who feels COVID-19 and the flu pose the same overall risk to children should write a rebuttal to my article called, “1,200 Equals 6”. (Since that sounds like a funny piece of satire and I wrote that article and will publish it tomorrow.)

Even considering pre-pandemic years, COVID-19 killed more children than most flu seasons. In 2021, with many mitigation measures still in place and millions of children safely vaccinated, the American Academy of Pediatrics added 556 children to its grim death tally.  Importantly, there is no guarantee that this tally captures every pediatric COVID-19 fatality, especially since states like Texas and Alabama stopped reporting this data. In contrast, the CDC states that, since pediatric flu deaths became nationally notifiable in 2004, the death toll ranged from a low of 37 (2011-2012) to a high of 358 (the 2009-2010 H1N1 pandemic).

These numbers undercount the true toll of the flu, since not all deaths are reported to the CDC. For example, the CDC would later increase the estimate of deaths to 1,090 during the H1N1 pandemic. However, the AAP’s incomplete tally of pediatric COVID-19 deaths in 2021 exceeds the highest estimated number of pediatric flu deaths for 10 of the past 12 flu seasons, years for which there were no mitigation measures of course (2014-2015 estimated 803 deaths and 2012-2013 estimated 1,161 deaths).* There’s no way to spin these numbers. COVID-19 is deadlier for children than the flu.

If more parents knew this, perhaps pediatric vaccination rates would not be so abysmally low. Sadly, some doctors look at these low vaccination rates and don’t think its a problem at all. Some of them worked very hard to make this a reality. They don’t work with sick children.

Of course, when it comes to vaccines, it doesn’t matter whether COVID-19 or the flu is more dangerous for children. The only thing that matters is which is safer for children, the virus or the vaccine. For both flu and COVID-19, the vaccine is much safer than the virus. Those who truly advocate for children want them protected against any disease that could hospitalize or even rarely kill them. For COVID-19, essentially all children who need life support, develop severe MIS-C, or die are unvaccinated. We also have to be humble about the possibility of long-term side effects.

Similarly, with regards to the flu the CDC states that, “among reported pediatric deaths, about 80% of those children were not fully vaccinated”. Instead of playing word games with statistics to deceive people about the risk of COVID-19, doctors should be reminding people that children shouldn’t die from the flu either. Six dead children from the flu is six too many. As Dr. Daniel Freedman stated,

Those comparing COVID in children to flu in children really seem to forget that pediatricians were encouraging flu vaccines in kids for years before this pandemic. Protect eligible kids from both vaccine preventable diseases. Not complicated.

Some of us want zero children to die because they weren’t vaccinated. It’s astonishing that this is so controversial.

1,200 is much larger than 6

The American Academy of Pediatrics added 72 deaths to its COVID-19 death tally in the past month. This is over ten times the number of children who died of flu since the pandemic started. It should be controversial to argue that SARS-CoV-2 in kids is roughly, roughly the same as influenza, maybe even less severe than influenza, seasonal influenza in kids. It should be humiliating to argue that SARS-CoV-2 in kids is roughly, roughly the same as influenza, maybe even less severe than influenza, seasonal influenza in kids. Yet, many doctors still do.

When it comes to dead children, 1,200 is much larger than 6.

Don’t trust anyone who tries to convince you otherwise.

  • Correction notice:  The original version of this article stated that only once had the CDC’s pediatric flu death estimate exceeded the AAP’s COVID-19 death tally for 2021. In fact, the CDC’s estimated flu burden exceeded this during the 2009 H1N1 pandemic, as stated in the original article, but also in 2012-2013 and 2014-2015. Thank you to the reader who pointed this out. I regret the error.

Author

  • Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.

Posted by Jonathan Howard

Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.