One thing COVID-19 has taught us is that our government agencies do not have the best healthcare data collections systems. Part of the reason is the decentralized nature of the U.S. healthcare system. Another factor is the fact that we have healthcare privacy laws. Third, our non-defense and national-security government systems are often the last to be updated. Those contracts are often more focused on nepotism than competition. If you have ever visited the Social Security Administration, you know that the administrative systems are lacking.
Other countries take population healthcare data more seriously and produce much more reliable statistics than the CDC or Department of Health and Human Services (HHS). The HHS Protect dashboard draws in data from 200 separate systems but is limited. The CDC’s data limitations are similar. They are pulling in information from 50 states and a few territories with their own data collection methods and processes.
The United Kingdom, Israel, and several other European countries have better data collection for public health. During the COVID-19 pandemic, they have weathered the waves of the various variants ahead of us. Their assessments are made public and our agencies cite their data, yet at every step of the way, it seems our “experts” have no idea what might be coming. It is absurd.
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Let’s take COVID-19 and kids. Dr. Sean O’Leary, the vice-chair of the American Academy of Pediatrics (AAP) committee on infectious diseases, told Time magazine that the Delta variant is not causing more severe illness in children. The hospitalization rate for children remained at 2% during this spike, which is comparable to previous waves.
There was some panic in the media about an increase in hospitalizations among children during the Delta surge. The confounding variable in the Southeast was an off-season surge in respiratory syncytial virus (RSV). The symptoms of RSV are highly similar to COVID-19. Because of lockdowns, the CDC warned to expect an increase in RSV infections. RSV affects young children, along with the age group most vulnerable to severe illness and death from COVID-19.
In a typical year, according to the CDC, RSV causes:
- 2.1 million outpatient visits among children younger than five years old
- 58,000 hospitalizations among children younger than five years old
- 177,000 hospitalizations among adults 65 years and older
- 14,000 deaths among adults 65 years and older
By way of comparison using CDC data on pediatric hospitalizations, as of August 24, there have been about 14,000 hospitalizations of children under the age of five associated with COVID-19. The combined hospitalizations of those under 18 are approximately 40,000. This number is lower than the annual average for RSV for those under age five and covers nearly 17 months.
The CDC data does not delineate between hospitalizations with and for COVID-19. The only assessment to date in California demonstrated that 40% of pediatric hospitalizations attributed to COVID-19 were incidental. The child’s clinical record did not include symptoms of the virus. They just received a positive test upon admission for something else.
The U.K. data before the latest case spike is probably the cleanest available. It should not differ significantly due to the Delta variant. Alasdair Munro, pediatric registrar and clinical research fellow in pediatric infectious diseases at Southhampton Clinical Research Facility put out a detailed thread on the recent experience with children in the U.K. through the first 12 months of the pandemic. Munro calculated the rates per infection. He correctly pointed out that levels of testing vary widely across time. Using seroprevalence data from February of 2021, Munro determined that approximately three million children had COVID-19 infections in the first 12 months of the pandemic.
In the analysis, he was careful to carve out the data to delineate between hospitalizations and deaths with COVID-19 from those caused by COVID-19. This differentiation is something the CDC only does for breakthrough hospitalizations and deaths. The final tally for children under 18 was a hospitalization ratio of 1 per 750 cases and a death rate of 1 per 120,000.
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This analysis could be why the U.K. Joint Committee on Vaccination and Immunisation (JCVI) declined to recommend vaccination for children 12 to 15. While they did advise children with underlying conditions that put them at risk to get the vaccine, the Committee said the risk-benefit was “finely balanced.” The members wanted more information on the long-term effects of the heart inflammation experienced by some children following the Pfizer vaccine. According to Reuters:
“Of course these vaccines do work and would be beneficial to children in terms of preventing infection and disease, but the number of serious cases that we see of COVID in children this age are really very small,” JCVI member Adam Finn told Reuters.
“There are uncertainties about the long-term implications of (myocarditis), and that makes the risk-benefit balance for these children really quite tight and much tighter than we would be comfortable to make the recommendation.”
Using CDC’s estimates and the limited studies that have been done on pediatric hospitals and deaths to determine when COVID-19 is incidental rather than the cause, our experience is not that different from the United Kingdom’s. However, before we move to mandate vaccinations for teens or consider them for younger children, the CDC owes us better data.
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The agency could easily request that health departments review childhood hospitalizations and deaths attributed to COVID-19 to determine the role of the virus in the clinical record. There have been studies on the seroprevalence of COVID-19 antibodies in deer in Michigan, so there’s no reason why we can’t determine what it is for our children. Recent studies have demonstrated the effectiveness of natural immunity, and we can’t even credibly estimate how many children may have it.
The defining feature of a pandemic response should be how both the illness and the mitigation strategies affect children. It is becoming clear that the mitigation strategies have a much more significant impact on their mental health and cognitive development than the virus. The CDC owes parents the data to make appropriate risk-based decisions for their children before getting them vaccinated. Deciding to do it because adults are in the grip of media-generated mass hysteria is not “following the science.”
