Covid-19 (Part 7) - The Battle Over Child Vaccinations and Long Covid (England/UK)

[Written on 2021-08-25 but unable to to finish due to increased ME/CFS impairment. Publishing 2021-09-16 just to have what's done out there, despite still missing most content on some topics.]

Previous Covid blog posts: Wave 1 - March/April 2020: Part 1, Part 2, Part 3; Wave 2 - Jan 2021: Part 4; Wave 3 - July/August 2021: Part 5, Part 6.

[Fig.1 data.gov.uk] Current (2021-08-25) UK state of Covid dashboard. (We have heave among the best health information reporting in the world!) Cases and hospitalisations continue to climb at a high level, respectively 25x and 11x the numbers of this time last year [Prof Pagel Twitter]. Despite it being mid-summer, usually the easiest time for our health service. 1st dose percentage recently took a small step backwards, with new eligibility of 16-18s (but little provision yet available, I believe).

As I worried in my Covid Part 4 "2021-02-11 point (2)", UK government's pandemic mitigation measures are being stripped away, now that our death rate is greatly diminished by vaccinations. Thankfully, these largely stayed a month or too longer than I expected. So the upsurge has been gradual, since Stage 3 lifting in May, with no further uptick on "Freedom Day" itself (19th July). I analysed the lack of uptick at the end of my part 5 post in sections (I) and (J).

◄A► Factors conspiring to infect *all* children with Covid:

(1) Obviously the Delta variant is far more infectious than previous strains. Viral loads may be ~1000x higher, hitting quicker, with first positive PCR tests <4 days from exposure, verses ~6 days with original strain, from Chinese study [MIT Medical via Twitter]. This probably makes children better spreaders and more susceptible [The Atlantic]. Although there's been disagreement between paediatricians either side of the Atlantic, with Brits suggesting that those in the US are being alarmist; the apparent severity purely the product of higher case numbers (in kids). Probably <2% of child Covid cases are hospitalised.

(2) With JCVI mysteriously not recommending childhood vaccination [Dr Gabriel Scally Twitter, Reuters], it looks like they and government are effectively aiming to maximise infections in children. Kind of by stealth, but e.g. [BBC] is pushing towards idea of infection instead of vaccination. This *might* maximise children's long term immunity to future strains, in conjunction with one booster vaccination dose (see section 4 of my previous part 6 blog). At a major cost to the health of some number of individuals, that is hard to fully quantify now, but I think will be more significant than they admit. I expect vaccines for kids will suddenly become available this Autumn, after a many of unaffected kids have already been infected, too. 1 dose schedule already talked about.

(3) There's no spare Pfizer in the UK, given that 21M first doses had already been given, by 11 August [Gov.UK], and we've only received our initial order of 40M total doses [Guardian]. So, second doses are already over-booked, as things stand. With our second order of 60M doses, made in April [Guardian], due to start arriving in September [Daily Mail]. Presumably after EU's initial 200M dose order completes [Reuters]?

MHRA has also now authorised Moderna for use in 12-17s, as a second option for JCVI to potentially go forward with [Sky News via Prof Devi Sridhar].

(4) UK experts, including (previous talked about) Andrew J Pollard (head of JCVI) are conveniently pushing a narrative that we should spare vaccinating our children to send a few million more doses abroad [BMJ]. Interesting about turn, that convieniently ignores our lack of appropriate doses. And flying in the face of UK Gov's cuts to foreign aid, blocking of paten waivers, virtually nothing delivered to Covax initiative yet, and general "me first!" grabbing of doses from everywhere, so far [Deepti Gurdasani Twitter].

(5) Mitigations removed in schools [BBC via Twitter]! England is perhaps the only country major country to have returning schools with none of the 3 main interventions to protect kids: vaccinations, mitigations (masks, bubbles, testing, contact isolation for all ages), or low community transmission [Prof Pagel Twitter]. More details in her [BMJ] blog post.

(6) No significant initiatives to improve ventilation in classrooms, still! A very limited (30 school) trial of air purifiers and UV lights is due to take place in Bradford [Independent via Paul Hunter Twitter]. Portable HEPA filter purifiers have been shown to significantly reduce the quantity of sub-micron particles (similar to size of Covid virion) in the air [News Medical Life Sciences]. New York schools, for example, have provision to check the ventilation status of all classrooms online in real time [NYC Department of Education]. While Ireland and Scotland are receiving CO2 monitors [Prof Pagel BMJ].

(7) Widely reported ONS study weirdly claims schools weren't hubs of infection [GovUK via Twitter]. Unsurprising that it "found that prevalence of the virus was lower in schools in June 2021 than in the autumn term 2020" - June 2021 was right at the start of wave 3, while Autumn 2020 was already very high transmission of wave 2. Study itself on [BMJ], with rebuking analysis here [Deepti Gurdasani Twitter].

(8) The Zoe app study, which was widely reported [], greatly underestimated the incidence of Long Covid in kids [].

() Long Covid 

() ME/CFS updated guideline publication paused, due to a few influential psychiatrics getting royal colleges of pysitians, etc, to kick up a fuss, at the last minute. They are undoubtedly determined to avoid losing their careers (over getting cause and treatment provision utterly wrong).

(10) GOV/PHE campaign focusing on people's (supposed inappropriate) anxiety with easing restrictions [Twitter], screenshot below. Effectively gaslighting the public, when our continued caution is all that's protecting unvaccinated and vulnerable from even more explosive spread.

(9) Scare headlines about child vaccination: "Teenage boys are 14 TIMES more likely to suffer rare heart complications from Pfizer" [Daily Mail via Kit Yates Twitter].

◄B►Why we should be protecting kids better:

• MHRA (Medicines and Healthcare Products Regulatory Agency) approved Pfizer for 12-15s on 4th June 2021 [Gov.UK]. Having "carefully reviewed clinical trial data in children" of that age, finding "benefits of this vaccine outweigh any risk". Extending their approval for 16+ given on 2 Dec 2020 [Gov.UK].

• Independent risk-benefit analysis also contradicts JCVI in greatly favouring vaccination of all adolescents [OSF Preprints].

• Parents overwhelmingly want their children to be vaccinated against Covid (Fig.0, below).

• Zoomers overtook the younger cohort of Millennials on first does uptake, showing higher interest of the young (Fig.0, below).

• Children already get a dozen or so vaccinations throughout childhood [e.g. CDC via Peter Kolchinsky Twitter]. Probably this familiarity aids the youthful enthusiasm.

• Long Covid in the young is even part of an NHS video vaccine drive [BBC via Kit Yates Twitter]! (Gov also says 1M letters have been sent out, inviting all 16-17s to receive a vaccine, with 360k 1st doses already given, to date.)

• Over half of cases in 6-16s (from a March-November 2020 study of 192 Covid diagnosed children in Italy) had at least 1 symptom for 120 days (~4 months) [Forbes via Twitter]. With 42% of that subset reporting daily activities being impaired. Tentative indications (from non-professional sources) that vaccination may reduce long-Covid incidence (which is very uncertain, still).

• ME has highest levels of severity in cases with childhood (0-19) onset [Hannah Davis Twitter]. So however many cases of Long Covid there are in kids, those failing to recover, becoming ME/CFS, are likely to be the worst impacted. As well as loosing the most years of healthy life, potentially.

• ONS 

• NHS boss saying they are already struggling now [], worst than winter, in a way, with pushing to catch up on a ballooning treatment backlog with staff utterly burnt out and this usually the most popular time to take time off (for school holidays).

• RSV and flu are taking off adding increasing additional burden on hospitals [Public Health Matters blog, Gov.UK]. They were thoroughly supressed by Covid measures, so population immunity to them has not been topped up (via infections). RSV has an opposite age susceptibility profile to Covid, mostly impacting young kids (especially those under 2 or premature infants). So, in a way, it is more of a direct concern, here. But both will impact paediatric ICU provision, which is even more specialist and limited than adult ICUs. And already near absolute capacity [?].

• Major events 2 weekends ago (music festivals, Premier league football, etc) probably raised transmission [Mirror via Twitter]. A small uptick in case rate increase has since been seen.

• Cases in Scotland, where schools already returned, have shot up to record highs (graph below)!

[Fig.0 - FT 2021-08-05 via Twitter] Admittedly, in e.g. US and France, there's been far greater vaccine hesitancy in adults, so more incentive to push ahead with children, sooner, to boost population immunity. 

[Fig.0 - Professor Pagel Twitter 2021-08-13] Despite blazing ahead on adult vaccinations, UK is way behind with children, verses all comparable countries (that Prof Pagel could find data for - France, Belgium, USA, Italy, Spain, etc).

[Fig.0 - ONS via Twitter] Strong parental interest in having children vaccinated (UK).

[Fig.0 via Prof Pagel Twitter and Meagan Kall Twitter] Zoomers (18 to 24 year olds) overtook some millennials (25 to 29) in first dose uptake. An indication that enthusiasm for vaccination is going to be even higher in kids.

[Fig.0 - CDC via Peter Kolchinsky Twitter] Childhood vaccine schedule (pre-Covid).

[Fig.0a - NHS] As of 2021-08-25The official symptoms lists still do not mention any of the top 4 symptoms for those vaccinated! These now look more like typical cold/flu symptoms. From the Zoe symptom tracking app [Fig.0b - via Twitter]: 

[Fig.0 - Mail Online via Kit Yates Twitter] Relative risk unhelpfully trumpeted. No deaths have been recorded from myocarditis side effects in children, and cases seemed to be resolving OK.

[Fig.0 - PHE Twitter] Jumping the gun on pushing public "back to normal".

[Fig.0 - BBC via Kit Yates Twitter] 2021-08-24 Scottish Covid cases soar to a new high as schools return from holidays.