Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses (genes and protein coat), and on it goes.
• Variant- also known as a mutation, a variant strain of a virus is the same species of virus but with a change in the genetic code.  The change is minor if it has no impact on contagious the new variant is, or how deadly it is, or if it allows the virus to neutralize our vaccines. Variants that substantially increase harm are now listed by Greek letters, the most troublesome one now is Omicron.

• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS-CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Symptoms- the experience of being ill, for example- fever, cough, headaches, loss of smell etc.
• Asymptomatic– literally means “without symptoms”.  For COVID-19 it refers a person infected with the virus but has no and will have not symptoms
• Presymptomatic– This is a person who was infected with SARS-CoV-2, and will feel sick, but hasn’t yet
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• PCR Test–  swabs the nose to detect the genes of the COVID virus.  The genes if detected are almost certainly there, but they can persist long after contagion ends.  Very few false positives, positives can be trusted.
• Antigen Test (the home kit)- swabs the nose to detect the proteins on the coating of the COVID virus, the spike proteins.  If it does not detect those proteins, you are almost certainly not infected, negatives can be trusted.  These proteins are also on the coating of many common cold viruses, so one positive test may indicate you have a cold rather than COVID.  Two positive home tests though reliably indicate you have COVID.
• Vaccine Terms
• Vaccine or Immunization– a dose of a substance that activates your immune system, as if you have the actual infection you are hoping to prevent, leaving you in fact protected from having that infection.
• Efficacy– the percentage of people immunized with a particular vaccine who will not get infected if exposed to the target infection.  For example, a COVID-19 vaccine will be said to be 95% effective if 95% of people immunized with that particular COVID-19 vaccine will not get COVID-19 if exposed to COVID-19
• mRNA– DNA works by dictating exactly which proteins your cell will make.  The message on how to construct each protein is delivered to the cell machinery that makes proteins by a piece of genetic material called messenger RNA, or mRNA
• mRNA vaccine– an mRNA vaccine places a small bit of mRNA code that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected
• Viral vector vaccine– a viral vector vaccine takes a harmless virus that is known to infect people reliably and places that weakened virus in a person where that virus will in fact infect the person.  The virus is not only weakened, but also attached to a set of genes  that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected.

At a time when COVID has killed over 6 million people around the world, when it is raging deadly surges in East Asia, when it is obvious to all who care to look that the COVID vaccine saves lives, now is not the time to be misled by details of a vaccination study.

The study in question did show that children ages 5-11 experience more rapid loss of protection from COVID vaccine than 12-15 year olds, but it strongly supported the conclusion that COVID vaccination works well in 5-11 year old children and offers substantial protection to them.

The Study Details

First of all, here is the study- https://www.medrxiv.org/content/10.1101/2022.02.25.22271454v1.full.pdf+html

Secondly,  the study findings are preliminary, they have not yet been reviewed by other experts, so when that happens, we may find some of the conclusions change in response to careful review and scrutiny.

With all that in mind, here is summary of this study.

Doctors in the state of New York looked at four groups of children across the whole state during just 2 months- December ’21 and January ’22.

1. Every child ages 5-11 years old who was unvaccinated
2. Every child ages 5-11 years old who was vaccinated (2 doses)
3. Every child ages 12-17 years old who was unvaccinated
4. Every child ages 12-17 years old who was vaccinated (2 doses)

Then they looked at two comparison groups.  How did each age groups’ vaccinated and unvaccinated groups compare in two ways:

• Chance of catching COVID
• Chance of ending up in the hospital with COVID

For any comparison of two groups, you simply take the chance that out of 100 kids in a group something will happen, and then ask, what’s the chance that will happen to 100 kids in the other group.  We can take a silly example to illustrate.

Let’s say we want to know the impact of wearing shoes on preventing getting hurt if you step on glass.  And now let’s look at the experience of 100,000 kids with shoes, and 100,000 kids without shoes who step on glass.  And let’s say that of the 100,000 of those unfortunate kids who walk on glass with no shoes, about 10,000 get cuts.  That would be one in 10 or 10% of the 100,000 who get hurt.  And now let’s look at the 100,000 kids with shoes walking on glass and say 10 of them get cuts, some glass pieces are that sharp and large.  In this group wearing shoes, only 1 in 10,000 get hurt, or about 0.01%.

The difference between the bad outcome in the protected group is 10-.01, the reduction in harm, divided by 10, the original harm, or 9.99/10, or 99.9% reduction in harm.  We could say this in this way: wearing shoes protected kids with a shoe efficacy level of 99.9%.

This is just what these doctors did.  They found that in the state of New York, 365,502 5-11 year old children (younger) were immunized during the Omicron surge, and 852,354 12-17  year old children (older )were immunized during the Omicron surge.

They then compared the immunized younger kids to the unimmunized younger kids, and then did the same for the older kids.

Here is what they found.

Soon after COVID vaccination, the older and younger kids both found similar levels of protection from the vaccine:

The level of protection against catching COVID initially after the vaccine for older kids was 68%.

The level of protection against catching COVID initially after the vaccine for younger kids was 66%.

The level of protection against being hospitalized initially after the vaccine for older kids was 85%.

The level of protection against being hospitalized initially after the vaccine for young kids was 100%.

A month after vaccination, the bad news is that the immunity faded in both groups and more rapidly in the younger:

The level of protection against catching COVID a month after the vaccine for older kids was 67%.

The level of protection against catching COVID a month after the vaccine for younger kids was 11%.

The level of protection against being hospitalized a month after the vaccine for older kids was 73%.

The level of protection against being hospitalized a month after the vaccine for young kids was 48%.

The trends

Soon after immunization, the ability of the vaccine to prevent catching Omicron COVID for both older and younger children was weaker than against the original COVID virus.  You may recall that for the original COVID virus, vaccines blocked catching COVID at levels of about 95%.  With Omicron, that number dropped to about 66% for the 5-11 and 12-17 year olds.  This seems due to the stunning ability of the Omicron variant to infect. a pattern seen over and over again around the world.  And like the rest of the world the vaccine had its greatest impact on sparing everyone vaccinated from severe levels of illness that could kill you.  For the younger 5-11 year old group, that protection soon after the shot was complete, no child in this age group got hospitalized for having COVID, none.  And in the older group the risk of getting so sick  you need a hospital dropped, but only to 85%, still a lot of protection.

The disappointing news comes in looking at the chance of catching COVID a month after the vaccine.

The level of protection from the vaccine against catching COVID didn’t change much for the older children, but essentially collapsed to 11% in the 5-11 year olds.  This is the number generating headlines calling the COVID vaccine ineffective for young children.

But this headline is not correct for these two reasons:

1. The COVID vaccine does protect 5-11 year olds as well as older children for the time soon after the 2nd dose.
2. The drop in protection is most pronounced in the risk of catching COVID, not in the risk of being hurt by COVID.  Even a month after vaccination, 5-11 year olds still saw their risk of getting hospitalized if infected drop by half!

So, the COVID vaccine clearly works for the young children ages 5-11 years old.  It’s ability to stop the spread fades in a month and that is disappointing, but its ability to prevent severe disease remain substantial.

And so we come to the fundamental question, why would we ever deny our 5-11 year old children the very real protection the COVID vaccine offers them.  The protection against infection fades, but the protection against severe harm remains quite strong.  Why deny them this protection?

Why the fade?

These data are too new to have explanations for them but it seems reasonable to think that several possibilities could explain the trends, again we do not know which of these, or which combination of these are explanations in reality:

1. The Omicron virus is more aggressive in younger children, at least in its ability to infect people.  This seems an unlikely explanation given the overwhelming trends that the younger you are the weaker the virus is overall, but it should still be listed as a possibility.
2. The basic mechanism of the vaccine is weaker the younger you are.  This seems unlikely given that we have never seen a vaccine work more weakly in 5-11 year olds than 12-17 year olds, why would this vaccine break that trends, but again, it needs to be considered.
3. The 5-11 year olds have a substantially lower dose in their vaccine.  This is the explanation that makes the most sense to me at this time.   Everyone ages 12 and up through adulthood all get the same dose per Pfizer shot- 30 micrograms (mcG) of vaccine material.   But the 5-11 year  olds only get 10 mcg, a full 2/3 less vaccine material.  This seems a very plausible reason.

Why give our younger children so much less in their vaccines?  I understand the reasoning.  The more mcg of vaccine the more protection, but also the more side effect, and the thinking has been that since the younger you are, the milder the COVID, perhaps a smaller dose could provide enough protection while reducing the burden of side effects.

The key point is that we are all united in trying to find the right amount to put into this vaccine, to achieve protection and minimize shot reactions.  I support trying out lower doses in younger children, these data suggest a slightly higher dose may be needed to ensure protection lasts longer against infection.

BOTTOM LINES:

1. Recent headlines could suggest that the COVID vaccine for 5-11 year olds does not work.  But it does work!
2. The issue sits squarely in the area of how well the vaccine protects you against catching COVID.  Omicron has punched a hole in that protection for all ages, including our young.
3. But soon after immunization, our young children get as much protection from the COVID vaccine as older children.  The problem shows up a month later, when protection against catching COVID truly does plummet in the 5-11 year olds, not in those 12 and up.
4. The more important question is whether the vaccine protects against the harm of COVID really hurting you, so badly you need to be admitted to the hospital or worse.  On this front, the COVID vaccine fades in effectiveness in both the 5-11 and 12-17 year old age group, but still provides substantial protection.
5. We do not know why the COVID vaccine protection against catching COVID fades so rapidly in 5-11 year olds, but my bet is on the choice to make the vaccine for them only 33% the amount given to all 12 and older.
6. Going forward, why deny anyone you love the protection the COVID vaccine offers, and vaccine strategists may want to consider upping the dose for younger children.

My One Takeaway Sentence:

This study changes nothing about the urgency of getting everyone 5 years old and older fully vaccinated against COVID- this is THE MOST IMPORTANT step any of us can take to protect those we love against this awful disease, get vaccinated NOW.

To your health,
Dr. Arthur Lavin