The CDC Should Do Better

A problem at the CDC

The CDC maintains two separate tallies for COVID-19 deaths. The first of these, the CDC’s COVID Data Tracker, which covers 83% of COVID-19 deaths thus far, reports that 534 children have died of COVID-19. This number is derived from “deaths reported by state, local, and territorial health departments”. The second of these, the provisional COVID-19 death counts from the National Center for Health Statistics, reports that 349 children have died of COVID-19. This number is derived from “information from death certificates” and it “offers the most accurate death counts”. I am unsure what explains the large discrepancy between these two numbers.

Things get more confusing. A CDC analysis found that death certificates have been very reliable overall this pandemic. Only 2.5% of them “had co-occurring diagnosis codes that could not be plausibly categorized as either a chain-of-event or significant contributing condition”. This included deaths such as suicide, homicide, and accidents. However, the CDC’s analysis found that of 182 death certificates for children under 18 years-old, 64 (35.2%) were unlikely to be due to COVID-19.

The National Center for Health Statistics notes that “most deaths from COVID-19 must be coded by a person” and that “COVID-19 should not be reported on the death certificate if it did not cause or contribute to the death”. They claim there is an “ongoing review of death certificates as they are received” and that they are “always working towards 100% completeness and accuracy of death certificates”. As such, I presume this tally would exclude a child who died in a car crash and tested positive for COVID-19, but I am not completely certain of this. It would be a problem if 35% of the deaths in either of the CDC’s tallies were incidental COVID-19 cases. Of course, undercounting pediatric deaths is likely a problem as well as there is no guarantee that every child who died of COVID-19 was reported to the CDC. One credible site maintained by three epidemiologists tallied 582 pediatric deaths by March 2021.

I was recently critical of a problematic editorial by Dr. Marty Markay questioning whether healthy children should be vaccinated against COVID-19. In that piece, Dr. Makary said that a “tremendous number of government and private policies affecting kids are based on one number”, the number of children killed by COVID-19. As policy is based on much more than this one number, this statement is completely false. However I completely agree with a core point of his essay that the CDC should give clearer information about how COVID-19 has affected children. Even the director of the CDC did not give a precise number during recent testimony, saying that about 400 children had died of COVID-19.

The virus is worse than the vaccine

It is possible to criticize the CDC and still recognize the benefits of the vaccine outweigh the risks of the virus. Despite Dr. Makary’s insinuation otherwise, no reasonable person would alter their opinion on this topic depending on whether the number of deceased children was 300 or 600. After all, if COVID-19 killed 300 children, that’s still 300 more children who died of the virus than of the vaccine, and 8.9 million adolescents have been vaccinated so far.

Of course death is not the only bad outcome from COVID-19, an often overlooked point. Many thousands of children have been hospitalized due to COVID-19, some in the ICU need mechanical ventilation. Thankfully most survive, but a handful really suffer. Even if every child who went to the ICU survived, preventing these devastating hospitalizations, as well as potential long-term symptoms (discussed here by Dr. Steven Novella) of COVID-19, would justify the vaccine, in my opinion. Complications of the vaccine, namely myocarditis, are real, but are less common and generally much less severe than hospitalizations due to the virus. There may be preliminary evidence that post-vaccine myocarditis is much less common than previously thought. According to one news report from Israel, there were just 3 cases out of 200,000 people vaccinated age 12-15.

Unfortunately, many people are under the illusion that COVID-19 is completely harmless to children, and as a result, things are currently not going well for children in many states (such as Arkansas, Florida, Texas, Oklahoma, Missouri, Mississippi, Alabama, Louisiana, South Carolina, Kansas, Tennessee, and Georgia). Overall, according to a report from the American Academy of Pediatrics and the Children’s Hospital Association, 72,000 children contracted the virus last week, compared to 39,000 just one week before. About 1 in 3,200 children are expected to contract multisystem inflammatory syndrome in children (MIS-C), a potentially devastating disorder that affects the GI tract, skin, and heart. In Florida, 32 children were hospitalized per day the last week of July. According to the American Academy of Pediatrics, which also tallies pediatric deaths, 9 children died from COVID-19 just last week.

Pediatricians are sounding the alarm bell:

According to Dr. Rick Barr, the chief clinical officer at Arkansas Children’s Hospital, parents of hospitalized children are “shocked” because the “messaging out there has been that kids don’t really get sick with Covid, and we didn’t see serious illnesses, except for rare instances, with the previous variant”. Having seen what COVID-19 has done to their child, parents of hospitalized children are now “encouraging other parents to get their kids vaccinated,” he said.

Fortunately, the vaccine seems to be working very well. According to Dr. Marcos Mestre from Nicklaus Children’s Hospital in Miami, “We have not yet admitted a child 12 and over who’s been vaccinated and required hospitalization”. Most countries with abundant supply are vaccinating adolescents. Even one of the last holdouts, the UK, recently decided to vaccinate 16 and 17-year olds. Predictably there are reports of parents regretting their decision to not vaccinate their child after they become seriously ill with COVID-19. I expect to see many more such stories in the future, and each one will be a preventable tragedy.

Though we will never get an exact tally, we deserve more reliable information about how many children have died of COVID-19 and the characteristics of these children. The CDC’s failure to provide this information has been a gift to those who exploit this inexactitude to spread fear, uncertainty, and doubt about vaccines, children, and COVID-19.