[Bonjoy]

Over the course of a lifetime/childhood, I think ~100% is accurate for where we are headed.

If we're talking infection over a lifetime for an endemic virus, then maybe yes 100% or close to is to be expected. I think consideration of a shorter time frame, perhaps one or two years, is more practical for thinking about current actions.
What is meant by herd immunity rather depends on the group in question and the time frame. From a simplistic perspective though if 90% of the population is either double vaccinated or has already had the virus it's hard to see how the virus would sustain an r value >1 in order to pick off the last 10%. Eventually uninfected kids become vaccinated adults.

[slab_happy]

other than vaxxing kids which brings its own set of proportional serious side effects (I think a smaller proportion but am not sure).

Oh god yeah, far far far smaller.  A vaccine's not going to get licensed unless they know it's very safe; a vaccine for kids even more so, especially given that in this case the risk to kids of severe illness if they get Covid is very low (compared to the risk for adults). So the sort of risk-benefit trade-offs that make AZ worthwhile for older adults don't factor in.

Doesn't mean there's no possibility of serious side effects -- for example, looks like teens and young adults have a very small risk of myocarditis from the mRNA vaccines. But the current picture is that it's extremely rare, almost always mild (treatable with NSAIDs, gets better on its own), and the risk of myocarditis from getting Covid-19 itself is much higher:

https://www.forbes.com/sites/brucelee/2021/06/26/fda-rare-heart-inflammation-warning-for-pfizer-moderna-covid-19-coronavirus-vaccines/

[andy popp]

Woke up to the news that Denmark has bought 1.7 million doses of near-expiry Pfizer. Happy for Denmark (assuming they can scale up in order to deliver them to people, which I would trust they can). Having fully vaccinated just over 20% of the population Romania have apparently hit a very strong wall of vaccine hesitancy. The mind boggles.

[spidermonkey09]

other than vaxxing kids which brings its own set of proportional serious side effects (I think a smaller proportion but am not sure).

Oh god yeah, far far far smaller.  A vaccine's not going to get licensed unless they know it's very safe; a vaccine for kids even more so, especially given that in this case the risk to kids of severe illness if they get Covid is very low (compared to the risk for adults). So the sort of risk-benefit trade-offs that make AZ worthwhile for older adults don't factor in.

Doesn't mean there's no possibility of serious side effects -- for example, looks like teens and young adults have a very small risk of myocarditis from the mRNA vaccines. But the current picture is that it's extremely rare, almost always mild (treatable with NSAIDs, gets better on its own), and the risk of myocarditis from getting Covid-19 itself is much higher:

https://www.forbes.com/sites/brucelee/2021/06/26/fda-rare-heart-inflammation-warning-for-pfizer-moderna-covid-19-coronavirus-vaccines/

Thanks ; which I guess begs the question that if the risk/reward calculation is so obviously in favour of vaxxing children, why are the JCVI seemingly reluctant to recommend doing so? What am I missing?

[slab_happy]

which I guess begs the question that if the risk/reward calculation is so obviously in favour of vaxxing children, why are the JCVI seemingly reluctant to recommend doing so? What am I missing?

 

It's really unclear. One factor is that in the UK, with very high vaccine take-up in all the eligible groups, we might not need to vaccinate children to achieve herd immunity, or close to (though I think the numbers on that have changed with Delta's increased transmissibility).

Another factor is that we're squeezed for Pfizer and Moderna at the moment, so we wouldn't have the supplies to vaccinate children until much later in the year anyway (and may be prioritizing boosters for vulnerable groups instead).

So they may be figuring eh, no rush to make the decision now, we can err on the side of caution and wait and watch as even more data rolls in from the countries that are vaccinating the over-12s.

It's possible that they also anticipate that vaccinating children against Covid may be more controversial, and that therefore it's helpful if they're seen to be being slow and cautious rather than rushing. But that's all just me speculating.

Some of the debate:

https://inews.co.uk/news/health/covid-vaccine-children-coronavirus-jab-scientists-jcvi-vaccination-1039032

What I find disappointing is that they're not yet approving it for over-12s who are clinically vulnerable, because that should be an incredibly easy decision.

[TobyD]

other than vaxxing kids which brings its own set of proportional serious side effects (I think a smaller proportion but am not sure).

Oh god yeah, far far far smaller.  A vaccine's not going to get licensed unless they know it's very safe; a vaccine for kids even more so, especially given that in this case the risk to kids of severe illness if they get Covid is very low (compared to the risk for adults). So the sort of risk-benefit trade-offs that make AZ worthwhile for older adults don't factor in.

Doesn't mean there's no possibility of serious side effects -- for example, looks like teens and young adults have a very small risk of myocarditis from the mRNA vaccines. But the current picture is that it's extremely rare, almost always mild (treatable with NSAIDs, gets better on its own), and the risk of myocarditis from getting Covid-19 itself is much higher:

https://www.forbes.com/sites/brucelee/2021/06/26/fda-rare-heart-inflammation-warning-for-pfizer-moderna-covid-19-coronavirus-vaccines/

Thanks ; which I guess begs the question that if the risk/reward calculation is so obviously in favour of vaxxing children, why are the JCVI seemingly reluctant to recommend doing so? What am I missing?

As I understand it,  vaccination for children may make sense for the population as a whole but they are at sufficiently low risk in themselves that the tiny risk of adverse effects from the vaccine may be more significant than the disease risk,  or on a similar scale at any rate. Given this, its really not medically ethical to effectively give a group a medical treatment in order to benefit other groups. 

[spidermonkey09]

Yes, that was my feeling too; as per this thread from a JCVI member; it doesn't seem clearcut by any means. Particularly interesting was the following I thought. I still don't know what I think though!

Good points SH - think the lack of mRNA supplies is the real issue as you say, so best to just wait for more data from the US and elsewhere until supplies build up again.

Given the low risk of Covid for most teenagers, it is not immoral to think that they may be better protected by natural immunity generated through infection than by asking them to take the *possible* risk of a vaccine.

https://twitter.com/rwjdingwall/status/1410177453876731915

[slab_happy]

Given the low risk of Covid for most teenagers, it is not immoral to think that they may be better protected by natural immunity generated through infection than by asking them to take the *possible* risk of a vaccine.

Yeah, he's a sociologist rather than someone with any medical expertise, apparently, which figures because that's fucking bizarre. 

There's already a certain amount of evidence that if anything, natural immunity produced by Covid infection is less protective than immunity from vaccination. And Covid absolutely can hospitalize and even kill teenagers and kids.

https://www.theguardian.com/world/2021/may/23/children-with-covid-why-are-some-countries-seeing-more-cases-and-deaths
https://www.washingtonpost.com/health/interactive/2021/covid-children-deaths/

There are legit debates to be had, e.g. over whether we should be vaccinating healthy teenagers in the UK versus getting vaccines to healthcare workers and elderly people in developing countries.

But arguing that it's "safer" for kids to get Covid than be vaccinated is just ... without basis in the scientific evidence, to the best of my knowledge.

Also, I'll point out that the MHRA has already concluded that Pfizer is safe and effective for the 12-15 age group and that the benefits outweigh any risks:

https://www.gov.uk/government/news/the-mhra-concludes-positive-safety-profile-for-pfizerbiontech-vaccine-in-12-to-15-year-olds

The JCVI gives advice on government vaccine strategy; it's not its job to determine the safety of the vaccines.

[spidermonkey09]

Interesting; I had clocked he wasn't an epidemiologist but I am also wary of exclusively listening to narrow infectious disease experts on the issue; since I know nothing about it I have to presume he is on the JCVI for a reason and isn't a charlatan

I think from your posts you are firmly in the 'jab the kids when the jabs are available' camp which I think is my instinct as well; I am just confused since a lot of people much cleverer than me seem to think it isn't that simple, which makes me think I am missing something. Good links, thanks!

[Oldmanmatt]

Interesting; I had clocked he wasn't an epidemiologist but I am also wary of exclusively listening to narrow infectious disease experts on the issue; since I know nothing about it I have to presume he is on the JCVI for a reason and isn't a charlatan

I think from your posts you are firmly in the 'jab the kids when the jabs are available' camp which I think is my instinct as well; I am just confused since a lot of people much cleverer than me seem to think it isn't that simple, which makes me think I am missing something. Good links, thanks!

I agree, in part, however listening to a sociologist discussing medicine is a bit like asking an Advertising exec, who worked on Honda’s last campaign, why your car’s engine won’t start.

[mrjonathanr]

I am no medic but my understanding was what slaphappy says about developed immunity being very variable in its response to infection but consistent to inoculation.

Dangers of COVID exist for any age group.

Where is this stuff about vaccine dangers coming from? Not seen any evidence for it, bar a tiny% of thromboses. 

[slab_happy]

I think from your posts you are firmly in the 'jab the kids when the jabs are available' camp

*tilty hand-gesture*

Actually, more like the "jab the clinically vulnerable kids NOW, because they're in much more danger than healthy 20-somethings; maybe think about jabbing the healthy 16-17 year-olds later in the year as and when there's surplus, but also see the debate about whether it's better to get those jabs to more vulnerable people in developing countries" camp.

And re: the under-12s there won't be trials data for a fair while anyway (and fortunately transmission in that age group seems to be very low anyway), so no hurry.

As I said, I think there are legit debates to be had about the best strategy, tactically and morally. But the factual evidence about risks seems fairly clear.

since I know nothing about it I have to presume he is on the JCVI for a reason and isn't a charlatan

One would hope so! But he is certainly way outside his area of expertise when it comes to commenting on the medical data about the relative risks of vaccination and natural infection.

[spidermonkey09]

But the factual evidence about risks seems fairly clear.

What I don't understand is how this can be clear, yet the JCVI haven't said to do it yet. Taking on board your points about whether the vaccines might be better being shipped off elsewhere.

mjr; mostly from idle and occasional reading of pieces like this: https://news.sky.com/story/covid-19-really-close-call-on-whether-to-vaccinate-children-sage-adviser-says-12337901. The prof quoted here doesn't seem to think the data on safety is robust enough, although I'm sure others think otherwise.

I guess I feel like if I've learned one thing from the last few years of reading about science and public health more, its that very few things are unequivocally and obviously the right or wrong decision and the people most worth listening to are normally those saying 'well its complicated...'. Obviously these people are never quoted in the media as it doesn't give good copy!

[Bonjoy]

other than vaxxing kids which brings its own set of proportional serious side effects (I think a smaller proportion but am not sure).

Oh god yeah, far far far smaller.  A vaccine's not going to get licensed unless they know it's very safe; a vaccine for kids even more so, especially given that in this case the risk to kids of severe illness if they get Covid is very low (compared to the risk for adults). So the sort of risk-benefit trade-offs that make AZ worthwhile for older adults don't factor in.

Doesn't mean there's no possibility of serious side effects -- for example, looks like teens and young adults have a very small risk of myocarditis from the mRNA vaccines. But the current picture is that it's extremely rare, almost always mild (treatable with NSAIDs, gets better on its own), and the risk of myocarditis from getting Covid-19 itself is much higher:

https://www.forbes.com/sites/brucelee/2021/06/26/fda-rare-heart-inflammation-warning-for-pfizer-moderna-covid-19-coronavirus-vaccines/

Thanks ; which I guess begs the question that if the risk/reward calculation is so obviously in favour of vaxxing children, why are the JCVI seemingly reluctant to recommend doing so? What am I missing?

As I understand it,  vaccination for children may make sense for the population as a whole but they are at sufficiently low risk in themselves that the tiny risk of adverse effects from the vaccine may be more significant than the disease risk,  or on a similar scale at any rate. Given this, its really not medically ethical to effectively give a group a medical treatment in order to benefit other groups.

This is exactly what is already done with the annual flu vaccine given to children.

[mrjonathanr]

As I understand it,  vaccination for children may make sense for the population as a whole but they are at sufficiently low risk in themselves that the tiny risk of adverse effects from the vaccine may be more significant than the disease risk,  or on a similar scale at any rate.

I’d like to see some numbers for that. From a layman’s pov, I’d be far more concerned about a child having Covid than receiving a vaccine.

[slab_happy]

What I don't understand is how this can be clear, yet the JCVI haven't said to do it yet. Taking on board your points about whether the vaccines might be better being shipped off elsewhere.

mjr; mostly from idle and occasional reading of pieces like this: https://news.sky.com/story/covid-19-really-close-call-on-whether-to-vaccinate-children-sage-adviser-says-12337901. The prof quoted here doesn't seem to think the data on safety is robust enough, although I'm sure others think otherwise.

I wonder if it comes down to tactics again. We're very unlikely to be vaccinating teenagers until later in the year anyway, if we do do it, so we might as well sit back and wait for the real-life data to roll in from the US and Israel and the EU.

Even with good trials data, the laws of statistics dictate that you almost certainly won't see the one-in-a-million side-effects until you start vaccinating millions of people. Ergo, sit back and see if anything else like the myocarditis risk shows up and how it plays out, because data from millions of vaccinated teenagers is a lot more robust.

It occurs to me that we're also waiting on research to see if we'll need booster jabs for some people in more vulnerable groups (and which vaccines work best as boosters), so that's going to factor into supply issues -- you don't want to go ahead and start vaccinating teenagers if it's going to be much more crucial to have those jabs available to shore up waning immunity in the elderly or immunocompromised.

https://www.theguardian.com/world/2021/jun/30/nhs-draws-up-plans-to-roll-out-covid-booster-jabs-from-september

[Sidehaas]

My personal view on this as a parent is that I'd prefer not to vaccinate my 3yo until there is longitudinal data over several years. Yes the data for all these vaccines is pretty good and for the mRNA vaccines I understand the currently known risk balance is in favour of getting vaccinated in all age groups. (That's not the case for AZ/Jansen in young adults except when infection rates are very high, which admittedly they now are again in many areas.)

However the fact is that young kids are not at significant risk from covid, and to some extent I'd prefer the known risk to the unknown. In my own case this is especially true since he has already had covid and it was a mild cold (milder than several other colds he has had in the last 12 months.) It simply isn't possible to say there are no long term risks with the vaccine until you have long term data, which as far as I understand it is the reason that all the authorisations are still on an "emergency use" basis.

I think the strategy should be to vaccinate as many adults as we can (and I agree with SH about vulnerable kids), then prioritise the booster programme, and give any spares to adults that need them in other countries. By the time that we actually have any spares, if the government goes ahead with unlocking then I suspect most kids will have caught it or been heavily exposed anyway (this is not what I want, it's just a statement of fact.) Given this, I think the ethical discussion about vaccinating kids is largely academic. Longer term, once the virus is settled in endemic status both in the UK and most other countries, we will get the longitudinal data for the vaccines that we ideally need.

[Sidehaas]

it is the reason that all the authorisations are still on an "emergency use" basis.

Apologies, that's US terminology - I thought I should double check having posted; in the UK the situation is similar. Pfizer is still on its initial 'temporary authorisation.' AZ has progressed from that to its 'conditional marketing authorisation', which comes with a long list of conditions including committed plans to submit to MHRA reports from additional safety trials running out until the end of 2024.

[slab_happy]

Dr Viki Male (immunologist working on pregnancy at Imperial, quoted in the article) is also a badass and maintains a great explainer on what's currently known about Covid vaccines, pregnancy, fertility, and breastfeeding:

https://twitter.com/VikiLovesFACS/status/1367099701238116353

She's very good at answering questions on Twitter in a non-patronizing and non-combative way. Top science communication.

The excellent Dr Male is now doing a prospective study of short-term period changes related to the Covid vaccine, for anyone who has periods and has a shot coming up:

https://twitter.com/VikiLovesFACS/status/1410213258204790795

You can participate on dose 1 or 2.

[Oldmanmatt]

We have had multiple bubbles popping in the three Secondary schools around us in Torquay. Two of which we have children in.
At least 6 cases between the three, last week and I’ve just been notified my youngest daughter’s entire year 7 will be sent home in the next few minutes and not returning for at least a week. So, I have one in a different school, year 7 and they’re already part shutdown and another in year 9, in the same school as the youngest, who’s year is now the only one not affected in his school!
So, not sure how many new cases the schools have this week, but it’s quite a few.
Oh and I just had a text from my head youth coach, that he and his family are isolating because his 9 year old got sick on Tuesday and has just got back a positive PCR…

And that’s rural Devon.

Ladies and Gentlemen, hold on to your hats, this ride is leaving the station.

Edit:
Youngest just walked through the door.
There were only two children in her last lesson, prior being sent home and part of the decision has been due to staff being in isolation and a rumour of positive cases amongst the staff as well as children.

[SA Chris]

Keep them away from fruit juices

https://www.dailymail.co.uk/news/article-9725379/Pupils-using-FRUIT-JUICE-false-positive-Covid-test-results.html

[Will Hunt]

And that’s rural Devon.

Ladies and Gentlemen, hold on to your hats, this ride is leaving the station.

A quick look at the figures shows that cases have been steadily building since late May. There's a definite increase in pace at around the 20th June. Deaths have been fairly flat, even though we're nearly 2 weeks beyond when cases started to look exponential.

Is it not just going to be a wave of cases (which was always inevitable), mainly in the young, with a relatively small increase in deaths, predominantly among the unvaccinated and the very unlucky few whose vaccine doesn't protect them? Given that COVID is not going to go away isn't this completely inevitable?

[chris j]

Keep them away from fruit juices

https://www.dailymail.co.uk/news/article-9725379/Pupils-using-FRUIT-JUICE-false-positive-Covid-test-results.html

The president of Tanzania was well ahead of the game on this on - he claimed to get a positive test result from a paw-paw and also a goat in May last year...

[spidermonkey09]

And that’s rural Devon.

Ladies and Gentlemen, hold on to your hats, this ride is leaving the station.

A quick look at the figures shows that cases have been steadily building since late May. There's a definite increase in pace at around the 20th June. Deaths have been fairly flat, even though we're nearly 2 weeks beyond when cases started to look exponential.

Is it not just going to be a wave of cases (which was always inevitable), mainly in the young, with a relatively small increase in deaths, predominantly among the unvaccinated and the very unlucky few whose vaccine doesn't protect them? Given that COVID is not going to go away isn't this completely inevitable?

Yep; this to me is exactly why Whitty and Vallance are relaxed about opening things up on the 19th.

[Oldmanmatt]

And that’s rural Devon.

Ladies and Gentlemen, hold on to your hats, this ride is leaving the station.

A quick look at the figures shows that cases have been steadily building since late May. There's a definite increase in pace at around the 20th June. Deaths have been fairly flat, even though we're nearly 2 weeks beyond when cases started to look exponential.

Is it not just going to be a wave of cases (which was always inevitable), mainly in the young, with a relatively small increase in deaths, predominantly among the unvaccinated and the very unlucky few whose vaccine doesn't protect them? Given that COVID is not going to go away isn't this completely inevitable?

Yep; this to me is exactly why Whitty and Vallance are relaxed about opening things up on the 19th.

I did this a couple of days ago, but there hasn’t been a significant change in slope in the meantime:



Now, that’s obviously a down and dirty, photoshop comparison of cases (red) to hospitalisations (blue) and I compressed the Y axis by ~ 10, simply by altering the frame ratio; so it ain’t brilliant. It was easier than check data day by day against the autumn wave though.
It seems pretty obvious that the hospitalisation curve bears little similarity to the autumn, relative to cases, whereas the case rate escalation seem very similar.