My essay, one year later

One year ago, I wrote an essay titled “COVID-19 and Balancing the Risks: The Vaccine or the Virus” in which I advocated vaccinating children in light of the Delta variant, which was just starting to spread in the US. I noted that Australia had locked down due to Delta, and a chief health officer there claimed it could be spread by “fleeting contact”. To avoid alarmism, I appropriately noted that “Obviously this is not scientific proof” and said “Hopefully we’ll know more definitive information about this soon.” However, I also felt that the “Delta variant will likely move faster than science’s ability to adequately evaluate” different approaches to mitigating it. While we all want pristine scientific evidence, time is not an unlimited luxury this pandemic, and decisions must be made with incomplete information.

Pressing my case to vaccinate children, I said that “I suspect that most everyone will gain immunity to COVID-19 eventually. It’s just a question of whether it’s through the vaccine or virus”. I also added,

Of course, the Delta variant is unlikely to be the last variant, and it’s not implausible a variant may arise that is significantly more dangerous to young people.

Precaution in the face of a rapidly changing threat has been a theme of my writing since my first essay on SBM when I said,

It is not inconceivable that a COVID-19 variant could significantly affect children and spread widely before we could widely vaccinate children.

My critic, one year later

Not everyone saw it this way. One podcasting, contrarian cardiologist thought my concerns about the Delta variant were 😂.

My critic continued,

Is it possible Howard & co. Are correctly predicting Armageddon unless the kids aren’t forced to be vaxxed ? Maybe.. (we’ll know in 2 weeks🙄) But that is far from certain, so giving parents some choice in the matter (even an alternative vax regimen) seems smart.

COVID, one year later

Of course, I never predicted “Armageddon” nor have I ever argued that kids should be forcibly vaccinated against the will of their parents. My critic just made that up to make me look bad. Though it’s disingenuous to put words in someone’s mouth to argue against something they never said, my critic was accidentally right about one thing – two weeks later, pediatricians would start to learn what the Delta variant could do, especially to unvaccinated children.

It wasn’t 😂 funny.

Pediatric hospitalizations increased to their highest level of the pandemic, and one study found that “pediatric hospitalization, ICU admission, mechanical ventilation, and death all peaked” later that summer. I wasn’t joking when I observed that contrarian doctors’

Sarcastic requests to wait “two more weeks” have often turned out to be reliable indicators of when cases would start soaring again.


Though the Omicron variant was milder for any individual child, its increased contagiousness meant that it hospitalized 5 times more children than the Delta variant. Over 130,000 children have been hospitalized thus far, the vast majority in the past year. Recent CDC data for the youngest children shows that less than 15% of COVID hospitalizations were for incidental infections, and just over half of hospitalized children had no underlying medical conditions. Overall, about 20% of hospitalized children need treatment in the ICU, and 5% are sick enough to need mechanical ventilation. There have been over 4,500 cases of MIS-C in the past year, and 60-70% these children are sick enough to need care in the ICU.

My critic had previously belittled pediatric hospitalizations, noting there were “75 million children under 17” in the US. Notably, he didn’t minimize vaccine-myocarditis that way. Nor should he, even though it is rare and nearly always has a favorable clinical course.

Most tragically, over 1,000 children have died of COVID since my critic guffawed at COVID variants, many of them old enough to be vaccinated. I encourage you to read about some of them to remind yourself these children are more than just statistics on a government website.

Though the vaccine isn’t perfect, it has been consistently shown to lower the rate of “critical illness” in children with both Delta and Omicron and to protect them against MIS-C. One study, which encompassed the time when the Delta variant was dominant, found that “Hospitalization rates were 10 times higher among unvaccinated than among fully vaccinated adolescents”. Another study found that:

Nearly 90% of the 397 children hospitalized during Omicron’s predominance had not gotten COVID-19 shots. Cumulatively, the hospitalization rate was more than two times higher among the unvaccinated. About 30% of the children hospitalized had no underlying conditions, and about 20% required time in the intensive care unit (ICU).

The vaccine has prevented a lot of suffering for children, and the youngest are finally on the cusp of being vaccinated. Anyone who opposes vaccinating children today is anti-vaccine. There’s no virtue in pretending otherwise.

 

Déjà vu

Today the headlines are ominous once again. One recent article was titled “S. Africa Child Admissions Exceed Elderly Amid Covid Strains“. According to this article,

The number of South African children younger than nine admitted to hospital with Covid-19 has overtaken the proportion of patients aged over 80 for the first time as new omicron strains dominate infections, the country’s biggest health insurer said.

Once again, I won’t pretend these warnings are scientific proof. Once again, I will argue that as these variants spread in the US and pediatric hospitalizations creep upward, parents should choose to vaccinate their children before we find out for sure what they can do.

Maybe this year, doctors sheltered from the care of sick children will realize that variants with the potential to hospitalize and kill them can’t just be brushed away with 😂 and that sarcastic requests to wait two weeks🙄 rarely age well.

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.