Coronavirus Sars-CoV-2/Covid-19 Megathread

[alfred russel]

Bottom line: AR doesn't give a fuck about other people's kids.

Talk about moving the goalposts!

"15 days to slow the spread" and keep hospitals from being overwhelmed turns into putting life on hold for a year as we wait for vaccines. When I complained back then, and said the risks don't justify the cost on an individual basis, I was accused of not caring about old people.

The vaccines come sooner and are more effective than anyone anticipated, but wait! for the very lowest risk populations they haven't been approved yet so we still can't go forward. And now in a post vaccine world when I say the risks don't justify the costs, I am accused of not caring about children.

[Grey Fox]

Yes.

We have to wait for everyone.

[Jacob]

Talk about moving the goalposts!

Okay

I didn't put down any goal posts, so in no way have I moved them.

... I am accused of not caring about children.

Do you care about people's kids?

[Jacob]

From Nature

Kids who get Covid are at risk for long Covid, and being asymptiomatic or having mild symptoms does not seem to indicate a lower chance of suffering long term effects compared to kids who have more severe symptoms.

To what degree the symptoms of long Covid are just that, or due to other factors is unknown at this time; and the long term impact of long Covid are unclear (does it last six months? A lifetime?).

Long COVID and kids: scientists race to find answers

Children get long COVID too, but researchers are still working to determine how frequently and how severely.
Dyani Lewis
 
A doctor tends to a child who may have COVID-19, in a heath care centre in New Delhi, India
Children with COVID-19 are at risk of developing long-term symptoms. Credit: Naveen Sharma/SOPA Images/LightRocket via Getty

As COVID-19 has ripped through communities, children have often been spared the worst of the disease's impacts. But the spectre of long COVID developing in children is forcing researchers to reconsider the cost of the pandemic for younger people.

The question is particularly relevant as the proportion of infections that are in young people rises in countries where many adults are now vaccinated — and as debates about the benefits of vaccinating children intensify.


Will COVID become a disease of the young?

Most people who survive COVID-19 recover completely. But for some, the poorly understood condition that's become known as long COVID can last for months — maybe even years. Nobody yet knows.

The condition was first described in adults. But several studies have now reported a similar phenomenon, including symptoms such as headache, fatigue and heart palpitations, in children, even though they rarely experience severe initial symptoms of COVID-19.

Estimates of how common long COVID is in children vary wildly. Researchers say that pinning this down is crucial, because decisions about school closures and vaccine roll-outs can hinge on the risk the virus poses to children. Getting solid numbers is "very, very important", says Pia Hardelid, a child-health epidemiologist at University College London.

Alarm bells

Paediatrician Danilo Buonsenso, at the Gemelli University Hospital in Rome, led the first attempt to quantify long COVID in children. He and his colleagues interviewed 129 children aged 6–16 years, who had been diagnosed with COVID-19 between March and November 2020.

In January, they reported in a preprint that more than one-third had one or two lingering symptoms four months or more after infection, and a further one-quarter had three or more symptoms. Insomnia, fatigue, muscle pain and persistent cold-like complaints were common — a pattern similar to that seen in adults with long COVID. Even children who'd had mild initial symptoms, or were asymptomatic, were not spared these long-lasting effects, Buonsenso says.

The findings, published in a peer-reviewed journal in April1, sparked a deluge of e-mails and calls from anxious parents. "It was like we opened the door, and everyone — mostly parents themselves — were starting to say, 'Okay, so maybe this is something we should ask about,'" he says. The hospital now runs a weekly outpatient clinic to meet demand.

Data released by the UK Office of National Statistics (ONS) in February and updated in April also sparked concern. They showed that 9.8% of children aged 2–11 years and 13% aged 12–16 years reported at least one lingering symptom five weeks after a positive diagnosis. Another report released in April found that one-quarter of children who were surveyed after discharge from hospital in Russia post-COVID-19, had symptoms more than five months later2.

The numbers reported aren't as high as they are for adults. The ONS data, for instance, show that about 25% of 35–69-year olds had symptoms at 5 weeks. But the numbers still set off alarm bells, because severe COVID-19 in children is much rarer than in adults, and most kids were therefore assumed to have been spared the impacts of long COVID, says Jakob Armann, a paediatrician at Dresden University of Technology in Germany.

If 10% or 15% of children, irrespective of the initial severity of the disease, do have long-term symptoms after all, "that's a true problem", he says, "so this needs to be studied".

Not so high

But Armann suspects numbers might not be that high. Long-COVID symptoms include fatigue, headache, difficulty concentrating and insomnia. He says that other pandemic-related phenomena, such as school closures and the trauma of seeing family members sick or dying from COVID-19 could result in those symptoms too, and artificially inflate long-COVID estimates. "You need a control group to tease out what is truly infection-related," he says.

He and his colleagues have been taking blood samples from secondary-school children in Dresden since May 2020 to track rates of infection. In March and April this year, surveys were taken from more than 1,500 children — nearly 200 of whom had antibodies indicating previous SARS-CoV-2 infection — to see how many reported long COVID.

In May, Armann's group reported in a preprint that it found no difference in rates of symptoms reported by the two groups3. "This was kind of striking," says Armann, and suggests that long COVID in children is probably lower than some studies have indicated. That doesn't mean that long COVID doesn't exist in children, he says, but it does mean the number is probably below 10%, a level that would have been picked up in the study. The true figure is perhaps as low as 1%, he says.

Does vaccinating adults stop kids from spreading COVID too?

Hardelid tapped into data gathered by the Virus Watch study, which tracks infections and symptoms in more than 23,000 households across England and Wales. As they reported in a preprint in June, she and her colleagues found that 4.6% of children with evidence of SARS-CoV-2 infection had persistent symptoms lasting more than 4 weeks4.

Another UK study, posted as a preprint in May, found a similar rate. Of more than 1,700 schoolchildren who tested positive for SARS-CoV-2, 4.4% had symptoms, such as headache, fatigue and loss of smell, that persisted; 1.6% had symptoms that remained for at least 8 weeks5.

It will also be important to determine how long the condition lasts in children, says Armann. Headaches or trouble sleeping for just 6 months is a vastly different problem from having these symptoms all their life, even if it only happens for 1%, he says.

Defining the problem

Buonsenso says that one of the challenges in working out how many kids develop long COVID is that there are no set diagnostic criteria in adults, let alone in children. Surveys to detect symptoms usually cast a wide net, and are not yet specific enough to tease out long COVID from other conditions, he says. Nevertheless, he is convinced that some children — perhaps 5–10% of those with COVID-19 — do develop the condition.

If psychological distress were a big factor in the symptoms he's seeing, as Armann has suggested, Buonsenso argues there would have been more children with symptoms from the first wave of infections in 2020, when restrictions were harshest in Rome. Instead, the second wave resulted in more cases of children with symptoms of long COVID, he says.

A proper definition of long COVID is urgently needed, says Hardelid, so that studies can determine how much of a problem it presents in children, and which children are most at risk.

One suggestion, following a review of the literature in adults by the UK National Institute for Health Research, is that long COVID could be a collection of four different syndromes, including post-intensive care syndrome, post-viral fatigue syndrome and long-term COVID syndrome6. This could be the case in children, too, says Hardelid.

Buonsenso has also been looking at immunological changes that occur in people with long COVID, to see if there are biological markers that could lead to treatments. In a small study posted as a preprint in May, he and his colleagues found that only the children with long COVID showed signs of chronic inflammation following infection7.

Such investigations into the biological basis of long COVID could have far-reaching effects. In general, we know very little about chronic post-viral conditions, says Buonsenso, because most clinical attention, and funding, has focused on the acute phase of infections.

[Sheilbh]

Just to note that since that article (which cites some UK studies) two very large UK studies have completed and it looks like self-reported long-covid symptoms in kids (one study was in teenagers, who are more like adults, the other in kid kids) seems to be around 5% and of them 98% stop reporting symptoms after 8 weeks.

Obviously that goes with other studies that have shown that you are more likely to have long covid symptoms if you have a serious case of covid. Kids are less likely to get it, if they do it's less likely to be symptomatic and they're less likely to spread it, they're less likely to get serious cases, end up in hospital, in intensive care or die - at every stage of covid children are at lower risk which also needs to be taken into account when worrying about long covid.

For what it's worth there's also been another UK study in relation to what demographic factors seems most susceptible to long covid (lasting more than 12 weeks) and the profile was a middle aged, overweight, caucasian woman with asthma. Those demographic factors seem to be risks for long covid.

[Jacob]

How did the risk of long covid compare between unvaccinated children and vaccinated adults?

[Sheilbh]

How did the risk of long covid compare between unvaccinated children and vaccinated adults?

No idea - I don't think we're that far yet Those reports I mentioned have all been in the last month or two. My understanding is that it looks like vaccination reduces the risk of long covid by about 50%.

I mentioned before but the UK vaccine body's position is that the benefit of the vaccine (including long covid) for under-16s marginally outweighs the risk from side effects, but it's not strong enough to recommend universal vaccination (they've said kids with a number of medical conditions should be vaccinated - with one dose). But we are an outlier on this.

They've said social considerations like the impact on education or the impact of other measures like testing or quarantine and the indirect benefits of a vaccination campaign (protecting others) are outside their remit. Those considerations may justify a universal vaccination campaign - but their view (based on UK, European, US and Canadian data) is the direct health benefit to kids is very marginal.

But the risks generally are very low for kids - this was a helpful thread I thought from earlier this week by a paediatric registrar, who is currently lead fellow on the booster shot clinical trials in the UK:

Alasdair Munro
@apsmunro
Sep 6
Because England has excellent population data on #COVID19, we can make pretty accurate estimates of risk to children

Fortunately, these risks are extremely low

1/
Note when possible that we want to know rates *per infection*, not per positive test

This is because tests are contingent on how much you test, which is different across time and places

Risks per infection are much less changeable, and what we really care about

2/
Let's take the first 12 months of the pandemic up until Feb 28th 2021

Estimates based on seroprevalence are around 25% children <18 were infected by this point (16+ was >30%, younger will be a bit lower)

There are 12mil children in England, so this is 3mil infections

3/
By that point there were 5000 admissions <18

We know from ISARIC data at least 20% of these were incidental positive tests, so max 4000 admissions due to COVID-19

That's a hospitalisation : infection ratio of 1 :750

4/
By that time there were 61 deaths with a positive test

Of these, only 25 were caused by COVID-19

That's a death : infection ratio of 1 : 120,000

5/
As there is no definition for "long covid" in children, the best we can do is estimate relative risk from the CLoCK study of having 3 or more symptoms 12w after a COVID-19 test

30% if tested positive, 16% if tested negative

RR=1.8 if positive for SARS-CoV-2

6/
Approximate risks to children from SARS-CoV-2 infection summary:

Hospitalisation: 1 in 750
Death: 1 in 120,000

Test +ve for SARS-CoV-2, symptoms at 12w RR=1.8

7/
https://researchsquare.com/article/rs-689684/v1

https://coronavirus.data.gov.uk/details/download

https://ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19infectionsurveyantibodydatafortheuk/13may2021#percentage-of-adults-testing-positive-for-covid-19-antibodies-by-single-year-of-age-in-england-wales-northern-ireland-and-scotland

https://researchsquare.com/article/rs-798316/v1

8/

[The Minsky Moment]

I 100% don't care about a bunch more dead americans that are dumb enough not to get vaccinated.

You are entitled to the opinion; however, it is in tension with your previous point - well taken - that the more the virus continues to spread and circulate, whether inside or outside the US, the greater the risk of more malign variants developing. 

[Sheilbh]

You are entitled to the opinion; however, it is in tension with your previous point - well taken - that the more the virus continues to spread and circulate, whether inside or outside the US, the greater the risk of more malign variants developing.

Which is another reason I'm a little dubious about prioritising booster shots or vaccinating very low-risk groups like kids rather than focusing on the rest of the world where vaccination rates are still very low because of lack of supply.

Obviously the best would be to spend enough to expand capacity so we could do both.

[alfred russel]

Do you care about people's kids?

Why would you possibly think I don't?

12-18 months ago I was posting long cost vs. benefit analyses and arguing that for non elderly the societal restrictions were far too excessive. You guys made the counterargument "what about the elderly, you are only thinking about yourself". Even if that was true, do you in anyway doubt that I think for 40 somethings the cost benefit analysis showed it was worth it to socialize publicly etc. even before vaccines were available? Assuming that I made that judgment for 40 somethings, how could you plausibly think I'd come to an opposite conclusion for kids who are much less risk?

[alfred russel]

I 100% don't care about a bunch more dead americans that are dumb enough not to get vaccinated.

You are entitled to the opinion; however, it is in tension with your previous point - well taken - that the more the virus continues to spread and circulate, whether inside or outside the US, the greater the risk of more malign variants developing.

The US is less than 5% of the world's population. I'm skeptical that a major push to get people to wear masks is going to move the needle significantly in the US, and to the extent it does will probably be disproportionately in the lower risk of transmission groups (vaccinated people), and I'm doubtful of a global impact on new variant strains from that. I'm certain that the energy used to try to get people to wear masks again would be better spent forcing people to get vaccinated.

I see no tension.

[Jacob]

Why would you possibly think I don't?

Over the many years here on languish you generally frame all your arguments to be about how something affect you personally. Generally it seems to me that dismiss concerns about the potential impact on others as just being "too bad" or "not my problem". On top of that, I don't recall you ever making any kind of argument or statement that indicated an exception for children.

But I could be wrong, of course. Maybe you do care about other people's kids. Which is why I asked you if you do, in case I got you all wrong.

12-18 months ago I was posting long cost vs. benefit analyses and arguing that for non elderly the societal restrictions were far too excessive. You guys made the counterargument "what about the elderly, you are only thinking about yourself". Even if that was true, do you in anyway doubt that I think for 40 somethings the cost benefit analysis showed it was worth it to socialize publicly etc. even before vaccines were available? Assuming that I made that judgment for 40 somethings, how could you plausibly think I'd come to an opposite conclusion for kids who are much less risk?

I never plausibly thought you'd come to the opposite conclusion.

There's a pretty simple heuristic for predicting your conclusions on languish and that's "what's the most convenient for Dorsey" (with a solid secondary of whatever makes for an iconoclastic argument).

You, of course, add a whole bunch of actual arguments - sometimes earnest, sometimes obviously trolling, frequently somewhere in the middle - but the conclusion is typically the same, namely "the only rational conclusion is whatever serves me personally the best, and any potential consequences are completely acceptable, not my concern, and/ or over stated."

[viper37]

Bottom line: AR doesn't give a fuck about other people's kids.

Talk about moving the goalposts!

"15 days to slow the spread" and keep hospitals from being overwhelmed turns into putting life on hold for a year as we wait for vaccines. When I complained back then, and said the risks don't justify the cost on an individual basis, I was accused of not caring about old people.

The vaccines come sooner and are more effective than anyone anticipated, but wait! for the very lowest risk populations they haven't been approved yet so we still can't go forward. And now in a post vaccine world when I say the risks don't justify the costs, I am accused of not caring about children.

I'm not gonna dwell on the past, especially since I haven't read the exchange , but, you have to admit that a year down the line, we have much fewer restrictions and the virus has mutated, something that did not seem to be happening for like a year, and then it seems to be very quickly evolving.

I do not know if it's because many countries butched their response to the 2nd and 3rd wave that is happening, I have no clue.  All I know, is, it changes thing in terms of collective immunity.

Something you were advocating in march/april 2020, to "take it on the chin".

From what I hear, some of your hospitals, especially in deep Red States are still overwhelmed.  As long as we haven't found a solution for that, we have to keep some protective measures.

I long for the day when I'll no longer have to wear a mask, I really, really, really, really, really hate that thing.

But until we get nearly everyone vaccinated, I fear we must suffer in silence.

[Sheilbh]

Just to pick up on vaccine acces, Covax has announced they will only be able to deliver 75% of the anticipated vaccines in 2021.

Basically it's the combination of Novavax not getting to authorisation yet, manufacturing issues with AZ and J&J, plus India still blocking exports to deal with their delta wave. Obviously none of the mRNA vaccines are donating - and given that (from what I've read) we know they don't actually need to be super-chilled I feel like they need to be put under pressure to start donating.

Sinopharm are bringing forward their 2022 deliveries and countries have been donating AZ, J&J and Moderna doses - but these changes aren't enough to offset the supply issues they're having elsewhere.

This is an issue we have the money and the expertise and the technology to solve and it would allow the world to open safely quicker. This should be an absolute no brainer - but I fear we'll do nothing (maybe a few more donations) and just let it happen. It's infuriating (especially in the wider context of giving booster shots to people who aren't high risk).

[jimmy olsen]

1 in every 500 people in the US are now dead from the Coronavirus

Similarly, about 7,000 in every 500 people in the US are dead from cancer and 12,000 in every 500 are dead from heart disease.

So what are you saying? The US is now populated by the undead?

Tim is using all time deaths from covid in his numerator and current living people in his denominator. Figured that would be cool in my comparison too.

The US has only been around two and a half centuries, you're saying 38 times the current population has died from those two diseases.   

I made the numbers up without any thought. I was only trying to point out that Tim was using a numerator of total dead and denominator of current alive and that isn't a great metric.

Worldmeter uses deaths per million, but my number is more intuitive. Saying 5,925 out of every million in Peru have died of Covid is not as intuitive as saying 1 in every 169 have died of Covid.

https://www.worldometers.info/coronavirus/#countries