A good title to a bad essay

Dr. Martin Kulldorff, one of the authors of the Great Barrington Declaration (GBD), recently penned an article for his new employer, the right-wing think tank the Brownstone Institute titled “Vaccines Save Lives“. This sounds like an article I might agree with. However, I was dismayed that it mostly argued against vaccinating children. He wrote,

While anyone can get infected, there is more than a thousand-fold difference in mortality risk between the old and the young…

For older people, who are at high risk of dying from Covid, the benefit of the vaccine greatly outweighs the small risks of a serious adverse event, so it is a no-brainer to be vaccinated.

The same is not true for children. Their Covid mortality risk is miniscule and less than the already low risk from the annual influenza, so the vaccine benefit for healthy children is very small. It will take a few years until we know the Covid vaccine risk profile, and until then, we do not know whether there is more benefit or harm in vaccinating children.

There are several problems with these statements: the omissions, the factual errors, and the logic flaws.

Omissions and factual errors: COVID-19 is worse than the flu for children

Let’s start with the omissions and the factual errors. Happily, the vast majority of children with COVID-19 will be just fine. But small risks multiplied millions of times add up, and so COVID-19 has harmed children much more than the flu. Yes, a young child with the flu might fare slightly worse than a child with COVID-19, but COVID-19 is much more contagious, and so it has much done more damage overall. Consider that a child with Ebola is in much greater danger than a child with COVID-19, but the children of New York City were significantly safer when Ebola came to our city than when COVID-19 arrived. Ebola is very hard to contract, while COVID-19 seems impossible to avoid. As such, COVID-19 has killed 30 children here so far, while no child even contracted Ebola. COVID-19 is a greater threat to children than Ebola. This is all extremely basic stuff. My children can easily grasp these concepts.

The numbers are clear, and anyone who claims the flu is more dangerous than COVID-19 for children is either completely ignorant, blatantly lying, or, like Dr. Kulldorff, trying to trick their readers with word games.

The past two years, with COVID-19 mitigation in place, the flu killed just one child. During this same period, according to the CDC’s Covid Data Tracker, over 1,000 children have died of COVID-19 in the US, with mitigations in place, making it one of the leading causes of pediatric deaths. Even in normal years, the flu killed fewer children than COVID-19. According to the CDC:

Since 2004-2005, flu-related deaths in children reported to CDC during regular flu seasons have ranged from 37 to 199 deaths. (During the 2009 H1N1 pandemic, 358 pediatric flu-related deaths were reported to CDC from April 2009 to September 2010.)

The true flu deaths are higher given incomplete reporting. For example, the CDC would later increase the estimate of deaths to 1,090 during the H1N1 pandemic. COVID-19’s pediatric death toll will soon surpass this grim milestone and undoubtedly would have done so long ago had the policies of the GBD been widely implemented. The single highest estimate from any other year was that 434 deaths may have occurred. Meanwhile 527 children died of COVID-19 thus far in 2021. As with the flu, there is no guarantee that 100% of pediatric COVID-19 deaths are captured in the AAP or CDC tallies.

Death is the worst outcome from COVID-19, but it is not the only bad outcome. This year, the flu sent 9 children ages 5-11 years to the hospital this year, while COVID-19 sent over 8,300 children this age to the hospital. According to the CDC, over 73,000 children (of all ages) have been hospitalized, and they did not start collecting data until August 2020. Other CDC sites estimate that 266,500 children have been hospitalized with COVID-19.

Though these children thankfully survived, many were very sick, needing ICU-level care and mechanical ventilation. Some pediatric COVID-19 survivors suffered strokes or encephalitis. Others needed lung transplants or amputations. 5,973 children have had MIS-C thus far, though this may be a substantial undercount. In one study, 80% of children with MIS-C went to the ICU and 20% needed mechanical ventilation. 52 children have died of MIS-C.

Despite these numbers, Dr. Kulldorff wants his readers to believe that the flu, which killed a single child, is worse for children than COVID-19, which has killed over 1,000 children, including 38 children in the last week alone. Up is down, left is right, and we have always been at war with Eastasia.

Of course, Dr. Kulldorff didn’t bother including any of these basic numbers in his article. In fact, beyond sharing the factoid that there is a “thousand-fold difference in mortality risk between the old and the young”, Dr. Kulldorff’s article didn’t include any statistics at all. Readers of Dr. Kulldorff’s article won’t learn anything about how COVID-19 has affected children.

Instead, Dr. Kulldorff wants his readers to know how much he’s suffered this pandemic, an omnipresent theme in articles by authors of the GBD. For example, he actually wrote that he was “fired by the CDC for being too pro-vaccine”. Dr. Kulldorff also wants his readers to know that nothing less than the fate of the entire planet hinges on adopting his policies. He actually wrote that “not forcing the vaccine on the young or those with natural immunity” will not just save lives but will also “keep our country together” and “may even help keep the world together.” Of course, no one is being “forced” to get vaccinated, which is why so many young people are still getting sick. Maybe Dr. Kulldorff can expand in a future article why keeping our country and the world together necessitates mass infection of children with a virus that will absolutely kill a very small percentage of them.

Omissions and factual errors: The vaccine can keep children safe

Moreover, there’s no plausible reason to think children will have a reaction to a vaccine years from now that is not apparent today. Though it’s standard anti-vaccine hogwash to claim otherwise, vaccines almost never have side effects that aren’t apparent within a short time. Many millions of children have been vaccinated since the early summer. If Dr. Kulldorff can think of something specific that might plausibly arise out of thin air several years from now, he should share his thought process. At present, his reasoning seems to be merely that a bad outcome years in the future is not technically impossible.

Notably, the vaccine has proven extremely effective in keeping children alive and out of the hospital. It’s no surprise that all the pediatricians I surveyed on social media decided to vaccinate their children. One study found that “Hospitalization rates were 10 times higher among unvaccinated than among fully vaccinated adolescents”. Another study of adolescents assessed the efficacy of the vaccine in this age group. It found:

Among 179 COVID-19 case-patients, six (3%) were vaccinated and 173 (97%) were unvaccinated. Overall, 77 (43%) case-patients were admitted to an intensive care unit, and 29 (16%) critically ill case-patients received life support during hospitalization, including invasive mechanical ventilation, vasoactive infusions, or extracorporeal membrane oxygenation; two of these 29 critically ill patients (7%) died. All 77 case-patients admitted to the intensive care unit, all 29 critically ill case-patients, and both deaths occurred among unvaccinated case-patients.

Dr. Kulldorff also doesn’t want his readers to know about any of these studies, and so he doesn’t mention them. Contrarian doctors never do.

In contrast to vaccines, many viruses do have long-term sequelae. To the extent that we have to worry about the long-term consequences of anything, COVID-19 is clearly the much bigger concern. Dr. Kulldorff doesn’t want his readers to know this either.

Logical flaws

Now onto the logical flaws. Think how ridiculous this sounds as an argument not to vaccinate children: “Children’s Covid mortality risk is miniscule and less than from a lava pit full of hungry sharks, so the vaccine benefit for healthy children is very small”. Yet, this is essentially the same argument Dr. Kulldorff tried to make by comparing COVID-19 to the flu. Even if he were right that the flu posed a greater risk to children than COVID-19, it doesn’t follow from this that children shouldn’t be vaccinated against COVID-19. After all, I can name many viruses that pose a lower risk to children than COVID-19. The existence of these milder viruses doesn’t strengthen the case to vaccinate children against COVID-19, except to note that we vaccinate children against these viruses, such as the flu, all the time.

It also doesn’t matter that older people are more likely to die of COVID-19. This is true, but useless information – like a salesman telling you the car you might purchase costs less than a nuclear submarine. To continue with the car analogies, arguing that children don’t need vaccines because grandma is in more danger is like arguing that sober drivers don’t need seat belts because it’s more dangerous to drive drunk. I hope you are able to recognize by now that these absurd comparisons are simply rhetorical sleight of hand tricks used by writers who are desperate to minimize COVID-19’s impact on children and are afraid to level with their readers.

Obviously, only one thing matters – which is safer for children, the virus or the vaccine? My children can easily grasp this very simple concept as well. However to answer that question, readers need to know some very basic facts. Every day, 2-3 children die of COVID-19, in part because their parents didn’t know the vaccine is much safer than the virus. Maybe things would be different if people with large platforms like Dr. Kulldorff had the courage to share the facts and the desire to educate parents.

How sad

This genre of fact-free articles, full of fantasies of persecution and delusions of grandeur, are certainly pathetic, but they are no longer surprising. COVID-19 contrarians never provide their readers with basic information. They have the good sense to know that normal people wouldn’t feel it’s appropriate to use the word “miniscule” when talking about a virus that has killed over 1,000 children and sent tens of thousands of them to the hospital. We don’t talk this way about children who die in school shootings, thankfully.

Notably, I’ve never read an essay against vaccinating children where the author even attempted to educate their readers about the basic facts I’ve outlined above. I know I talk about this a lot, but here’s why I think this is so important. These doctors know that presenting all the data in a thorough and nuanced manner makes an incredibly strong case to vaccinate children against COVID-19, and so they conceal the facts and treat “mild” and temporary myocarditis from the vaccine as a fate worse than death from the virus. No semi-rational author could include all the relevant facts and still conclude that it’s a bad idea to vaccinate children. I challenge Dr. Kulldorff or anyone else to write such an article, including all the above facts, and prove me wrong.

I have no idea what might lead intelligent doctors to omit crucial information, spread disinformation, and make fallacious arguments to obscure the fact that COVID-19 vaccines can save children’s lives, especially in an article titled “Vaccines Save Lives”. Certainly, there was nothing I saw in the GBD to suggest the authors would be against vaccinating children.

However, I would speculate that Dr. Kulldorff knows that honestly presenting the facts would undermine the rationale behind the GBD, which divided people into “vulnerable” and “not vulnerable” categories. Acknowledging that COVID-19 significantly impacted, even killed, a large number of people in the “not vulnerable” group would mean Dr. Kulldorff might have to consider that its most basic premise was flawed. If he recognizes that it’s important to protect children with the vaccine today, it would be a tacit admission that maybe it wasn’t such a great idea to purposefully expose them to the virus in the past.

For contrarian doctors anchored to their ideas and sheltered from their consequences, it’s easier to erase 1,000 dead children, ignore overwhelmed pediatricians, and disparage an effective vaccine than to consider they could have been wrong. How sad.

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.