[C] Risk to children and young adults

Healthy children and young adults are at particularly low risk for bad outcomes (hospitalisation and death) from Sars-Cov-2 infection. In the first year of the pandemic, in the UK, under 2 in a million under 18-year-olds died from Sars-Cov-2 related illness. [i] [ii] Under 13-year-olds are particularly at low risk. They generally have ‘mild or no symptoms’ as they are efficient at generating SARS-CoV-2 protective antibody responses.[iii] A meta-analysis concluded: ‘many children experience clinically mild disease or remain asymptomatically infected. Although severe disease in children does occur, fatalities due to COVID-19 remain rare.’[iv] Another meta-analysis of 32 studies found that children and adolescents have lower susceptibility to infection than adults, and lower rates of secondary infection. This suggests that children and adolescents may play a lesser role in transmission of Sars-Cov-2.[v]

Children have more efficient antiviral responses than adults. Epithelial and immune cells in children’s noses are ‘re-activated and primed for virus sensing’. Children then produce antiviral cytokines (type I and III interferon) – which Sars-Cov-2 is highly sensitive to. Cytotoxic antiviral immune cell populations may also occur at higher levels in children than in adults. These factors may contribute to reduced virus replication and faster clearance in children, with the result that early stage infection is controlled more effectively, and children are at lower risk of being hospitalised with severe COVID-19.[vi]

As a consequence, it appears increasingly likely that healthy young adults and children are more at risk from the mRNA inoculation than from Sars-Cov-2 infection. [vii] The assertion that vaccinating children against Sars-Cov-2 will protect adults and that there will be a maximum expected utility benefit at a population level, remains largely hypothetical and increasingly, unethical.[viii] There is no consensus that mRNA treatment of children will assist to overall reduce hospitalisation and death across the population.[ix]

The current COVID-19 ‘vaccine’ is does not fill traditional norms around what a vaccine is. In fact, the mRNA BNT162b2 inoculant is distinctly different from traditional childhood vaccines. 4 issues (among others) are rarely articulated when the maximum utility benefit is broached:

The inoculant is not sterilising- it does not meaningfully prevent onwards transmission and cannot produce herd immunity in the population.
The inoculant appears to have a greater potential for harm from adverse events than childhood vaccines.
The inoculant wanes from between 4-6 months while traditional childhood vaccines are immunoprotective against the pathogen from years to decades.
Natural immunity will provide benefit to the child, and shift the population towards herd immunity.

Scientists have warned that vaccination of children may produce a counterproductive effect on population level health if children are dually exposed to a medical treatment that has side effects, and they are not provided with a chance to develop natural immunity.[x]

Because of these issues – it is important that government officials, the judiciary, the medical profession, teachers and parents, do not conflate the Sars-Cov-2 mRNA inoculants with traditional childhood vaccines.

Doctors who are aware of children’s low risk and respect the principle of informed consent and the maxim of first do no harm, have faced tremendous political and professional pressure to downplay mRNA inoculant risk.

For children who have multiple, chronic long-term health conditions, the evidence is much less clear. Sars-Cov-2 appears to magnify the underlying risks of children with chronic and life-threatening conditions.[xi] Children with multiple health conditions (multimorbidities) – particularly neurological, cardiac and gastrointestinal associated with the greatest risk - are at much more risk of hospitalisation and may be protected from vaccination in the short term. [xii] [xiii]

Those at risk were less likely to be healthy, and more likely to have a comorbid health issue. A recent study revealed that In Australia of 393 children presenting to 16 Australian hospitals over the period February- September 2020, 51 were admitted to hospital.[xiv] More than half of the group were 5 years old or younger. The study authors observed that ‘children with SARS-CoV-2 infections present with symptoms similar to those of other common viral illnesses in children’. Of this group, only 16 resulted in medical interventions, or 4% of the total cohort. Of these 3 children were critically unwell.

However, what is increasingly evident, is that those with multiple conditions will have weaker immune systems – it is likely any benefit of mRNA treatment will wane more quickly than in healthier groups.[xv] In addition routine vaccination may exacerbate the rise of new variants. As Danish researchers have explained:

‘Variants of concern have typically been the result of persistent infections in immunocompromised people that can cause the virus to mutate more frequently because the person's immune system cannot clear the virus as quickly as the immune system of a healthy person.’ [xvi] [xvii]

The question then, is should young people and children be exposed to a medical treatment every 6 months, whose therapeutic effect remains uncertain. Ethically, for children, perhaps the safest route is to engage an immunoprotective approach through multi-target medical and nutritional therapies with low risk of side effects, in combination with a low-glycaemic diet that can build the immune system.

In the current politically charged atmosphere, it is extraordinarily difficult to parse out how children and young people are at risk and how they should be protected. This is because this area is not black and white – it is grey – and the pandemic environment is dynamic. The scientific literature indicates that natural infection produces robust immunity, which is structurally protective to current – and likely future - variants of the Sars-Cov-2 virus.[xviii] [xix] [xx]

As the New York Times reported:

‘COVID-19 should also be put in the context of other risks. COVID-19 has a lower annual mortality risk to children than motor vehicle accidents, influenza (by this estimate) and, perhaps most importantly for the 5–14-year-olds, suicide.’[xxi]

The literature continues to support the fact that young people and children are at extremely low risk, while building a picture of the harm that comes from isolation, masking and the delay of more serious treatments.

As of October 2021, it is difficult to access a scientific paper demonstrating the increased risk to healthy children from Delta or other variants of concern. A recent paper iterated the risk to children with multiple health problems, stating ‘Risk of COVID-19 hospital admission was approximately doubled in those with the Delta VOC when compared to the Alpha VOC, with risk of admission particularly increased in those with five or more relevant comorbidities’.[xxii] There is evidence of virulence and case numbers, but little evidence to support hospitalisation and death. A paper by Boehme et al[xxiii] stated the delta variant had ‘driven up infection and hospitalization rates, including among those under 18 years of age’ – however the corresponding citations did not support the claim. Outbreaks in communities continue to show low risk of hospitalisation or death, demonstrating that when healthy young people and children are exposed, they are relatively resilient.[xxiv] [xxv]

Sweden’s death rate is an example of the predictive death rate for a healthy population. It demonstrates that healthy under 20-year-olds are at minimal risk. It shows a significant and distressing mortality rate for older groups, which has always been reflected in the scientific literature, and which demonstrates the importance of targeted policies that prevent hospitalisation and death in vulnerable groups. Professor Björn Hammarskjöld (Swedish assistant professor in paediatrics at Strömstad Academy, a retired chief in paediatrics, with a PhD in biochemistry) has reported reviewed the overall death rates of Sweden and considers that the overall excess mortality rates by year are stable.[xxvi]

Statista. Number of coronavirus (COVID-19) deaths in Sweden, by age groups (as of October 6, 2021)

However, this data cannot be conflated to include families and children with a history of diabetes, obesity, hospitalisation and – importantly – structural poverty and racism.

At risk children – disproportionately low-income families with multiple conditions

Poverty and dietary insufficiency are closely tied to risk from the Sars-Cov-2 virus and its variants. [xxvii] These groups are often poor, and brown, reflecting larger structural factors (increasing house prices, decoupled wages from productivity gains[xxviii]) that have been ignored by governments that often combine with structural racism to disproportionately impact these groups. A June 2021 paper looking at 204 children hospitalised from Covid-19, documented that 77% were black or Latino, and 70% had underlying medical conditions including obesity, chronic lung disease including asthma and neurological disorders. [xxix]

Unequal societies have resulted in an asymmetrical (and disproportionately greater) risk to young people and children that has not been articulated in public policy nor publicly-funded media. Healthy children are not at risk, while unhealthy children are not at risk. Unhealthy children are disproportionately from low-income families. In higher income OECD nations, societies that with higher inequality, nations that have been unable to structure health-protective policy that ensure families have access to adequate nutrition, and nations with entrenched racism and a history of colonisation and displacement, produce disproportionately unhealthy children. These nations, as a cluster, may also have less stringent legislation in place that protecting the independence of the fourth estate (media).

(Note: The issues raised do not negate the higher income families who struggle with unwell children, suffering from multiple overlapping health conditions. Nor do they seek to downplay the healthy profile of higher income Māori and Pasifika families with healthy children who are at little risk from adverse effects from Sars-Cov-2.)

While risk should not be underestimated, children with health issues may still be at very low risk of a tragic event. [xxx]

The U.S. FDA’s Vaccines and Related Biological Products Advisory Committee approved the Pfizer vaccine for children ages 5 to 11 on October 26, 2021. The members who approved the role out of vaccines to young children acknowledged in their meeting that they did not know the extent of which the vaccine prevented transmission, the fact that over 40% of children in the US presently have natural immunity, and that they do not know how long the purported benefits will last. As there are no long-term safety trials preceding the roll-out they acknowledged risk was unknown, stating ‘We’re never going to learn about how safe the vac is unless we start giving it & that’s just the way it goes. That’s how we found out about rare complications of other vaccines’.[xxxi]

Lockdowns place children at risk

What is increasingly clear is that lockdowns have had demonstrable negative impacts on young people and children. Ironically, the biggest risk to young people and children, obesity, with its suite of metabolic and inflammatory conditions, has increased in this cohort. ‘Children who rely on school-based health and mental health care, children from food insecure families, obese children, children at risk of abuse and neglect and homeless children are the most vulnerable to school closures.’[xxxii]

It is unethical and unscientific to not discuss the differential risk of a novel and relatively untested technology, particularly in relation to the health of young adults and children.

Side effects are a real risk.

Young people and children who are at little risk from Sars-Cov-2 infection, if injected with the mRNA treatment, will be at risk of a side effect. Inoculants designed to reduce symptoms of COVID-19 do have reported side effects. This includes events of thrombosis, thrombocytopenia, and haemorrhage. These may be related to the action of the spike protein which has potential to result in the production of a range of short to long term effects.[xxxiii] Anaphylaxis is a recognised condition and scientists have queried whether this results from allergenic compounds in the treatment. However, if children have had Sars-Cov-2 they may be at increased risk from side effects from a vaccine.[xxxiv] [xxxv]

As children have a lifetime ahead of them, it is important to ethically deliberate on the benefits of long-term natural immunity and the low risk for healthy young adults and children from Sars-Cov-2 infection.

For those considering vaccination, it may be important to discuss vaccine breakthrough risk, including for infants and children. This can promote an important discussion around protective therapies but also draw attention to risk factors for young people, such as nutrient deficiency[xxxvi] [xxxvii] and high glucose levels[xxxviii] [xxxix] [xl] which often arise from diets high in processed food.

Myocarditis is a rare but reported risk for young adults and there is an increasing body of literature describing the reported cases.[xli] [xlii] [xliii] [xliv] [xlv]A recent paper from Australia stated:

‘Thus, informed consent for mRNA COVID-19 vaccines should include information regarding the rare but potential incidence of myocarditis or pericarditis in the week following COVID-19 vaccination, and individuals should be advised of potential symptoms and the need to seek immediate clinical care. Although age (mainly ,30 years) and sex (mainly male) may alter general consideration of the rare risk for myocarditis after COVID-19 vaccination, discussion should consider an individual’s personal risk, based on their current health status, impact of severe COVID-19 disease and the risk of infection from locally circulating variants of SARS-CoV-2.’[xlvi]

Frequently the discussion on risk of an adverse event focuses on one risk factor, such as myocarditis. However, risk factors are cumulative across all the potential risks, so someone under 50 might have a particular risk ratio for stroke, pulmonary embolism, and Guillain-Barré syndrome and so on. A June 2021 paper by an international cohort considered the background incidence of 15 adverse events across Australia, France, Germany, Japan, the Netherlands, Spain, the United Kingdom, and the United States, and considered the incidence rate per 100,000 person years. The authors found substantial heterogeneity between databases, in effect, adverse events express similarly across different country data-sets, including for different age and gender.

From: Li et al 2021. Characterising the background incidence rates of adverse events of special interest for covid-19 vaccines in eight countries: multinational network cohort study. BMJ 2021;373:n1435 | doi: 10.1136/bmj.n1435

The Oxford-AstraZeneca and Pfizer’s vaccines have been associated most strongly with thrombotic events,[xlvii] and younger females may be more at risk.[xlviii] [xlix] Sweden and Denmark have recently paused the Moderna COVID-19 vaccine for people born later than 1991 – under 20 year olds.[l]

NEXT: [D] The burden of poverty & intergenerational racism

REFERENCES

[i] Smith et al. Deaths in Children and Young People in England following SARS-CoV-2 infection during the first pandemic year: a national study using linked mandatory child death reporting data. Research Square (2021)

[ii] University College London. Covid-19: Risks of severe illness in children shown to be very low July 9, 2021. https://www.ucl.ac.uk/news/2021/jul/covid-19-risks-severe-illness-children-shown-be-very-low

[iii] Sette & Crotty. Adaptive immunity to SARS-CoV-2 and COVID-19. Cell. (2021) 184:861-880

[iv] Gaythorpe et al. Children’s role in the COVID‑19 pandemic: a systematic review of early surveillance data on susceptibility, severity, and transmissibility. Nature Scientific Reports. 11:13903 DOI 10.1038/s41598-021-92500-9

[v] Viner et al 2021. SusceptibilitytoSARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

A Systematic Review and Meta-analysis. JAMA Pediatr. 2021;175(2):143-156.doi:10.1001/jamapediatrics.2020.4573

[vi] Loske et al. Pre-activated antiviral innate immunity in the upper airways controls early SARS-CoV-2 infection in children. Nature Biotechnology. (2021) https://doi.org/10.1038/s41587-021-01037-9

[vii] Kostoff et al. Why are we vaccinating children against COVID-19? Toxicology Reports (2021) 8:1665–1684

[viii] BMJ Webinar. Covid19 vaccination in children: evidence, ethics, and equity. September 10, 2021 https://www.youtube.com/watch?v=y6l9w3TIpyM

[ix] Abi-Jaoude et al. Opinion: Covid-19 vaccines for children: hypothetical benefits to adults do not outweigh risks to children. BMJ. July 13, 2021. https://blogs.bmj.com/bmj/2021/07/13/covid-19-vaccines-for-children-hypothetical-benefits-to-adults-do-not-outweigh-risks-to-children/

[x] Benn C. Rapid Response. Should we delay covid-19 vaccination in children https://www.bmj.com/content/374/bmj.n1687/rr-8

[xi] Ward et al. Risk factors for intensive care admission and death amongst children and young people admitted to hospital with COVID-19 and PIMS-TS in England during the first pandemic year. medRxiv preprint. https://doi.org/10.1101/2021.07.01.21259785

[xii] Bhopal et al. Children and young people remain at low risk of COVID-19 mortality. Lancet (2021) /10.1016/

S2352-4642(21)00066-3

[xiii] Harwood et al. Which children and young people are at higher risk of severe disease and death after SARS-CoV-2 infection: a systematic review and individual patient meta-analysis. medRxiv preprint (2021) 10.1101/2021.06.30.212597

[xiv] Ibrahim et al. The characteristics of SARS-CoV-2-positive children who presented to Australian hospitals during 2020: a PREDICT network study. MJA 215:5 6 September (2021)

[xv] Nordström et al. Effectiveness of Covid-19 Vaccination Against Risk of Symptomatic Infection, Hospitalization, and Death Up to 9 Months: A Swedish Total-Population Cohort Study. http://dx.doi.org/10.2139/ssrn.3949410

[xvi] Benn C. Rapid Response. Should we delay covid-19 vaccination in children https://www.bmj.com/content/374/bmj.n1687/rr-8

[xvii] Peacock et al. SARS-CoV-2 one year on: evidence for ongoing viral adaptation. J Gen Virol. 2021;102(4).

[xviii] Dan et al., Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection. Science (2021) Science 371: eabf406

[xix] Wang et al. Ultrapotent antibodies against diverse and highly transmissible SARS-CoV-2 variants. Science 373:eabh1766 (2021)

[xx] Cho et al. Anti-SARS-CoV-2 receptor binding domain antibody evolution after mRNA vaccination. doi: 10.1038/s41586-021-04060-7

[xxi] Leonhardt June 18. Kids, Covid & Delta. https://www.nytimes.com/2021/06/18/briefing/kids-covid-and-delta.html

[xxii] Sheikh et al. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. The Lancet 397:2461-2 Correspondence

[xxiii] Boehme et al. Pediatric SARS-CoV-2 seroprevalence in Arkansas over the first year of the COVID-19 pandemic medRxiv preprint (2021) https://doi.org/10.1101/2021.08.04.21261592

[xxiv] Lam-Hine et al. Outbreak Associated with SARS-CoV-2 B.1.617.2 (Delta) Variant in an Elementary School — Marin County, California, May–June (2021) MMWR 70-35:1214-1219

[xxv] Dougherty et al. SARS-CoV-2 B.1.617.2 (Delta) Variant COVID-19 Outbreak Associated with a

Gymnastics Facility — Oklahoma, April–May (2021) MMWR 70:28:1004-1007

[xxvi] Testimony Björn Hammarskjöld & Ulf Bittner. October 28,2021 https://odysee.com/@Corona-Investigative-Committee:5/Ad-hoc_16:b

[xxvii] Mertens & Peñalvo. The Burden of Malnutrition and Fatal COVID-19: A Global Burden of Disease Analysis.(2021) Frontiers in Nutrition. 7:619850 doi https://doi.org/10.3389/fnut.2020.619850

[xxviii] Stiglitz, J. (2013). The Price of Inequality: How Today's Divided Society Endangers Our Future. W.W. Norton & Company

[xxix] Havers et al. Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, (2021) MMWR 70:23;851-857

[xxx] Smith et al. Deaths in Children and Young People in England following SARS-CoV-2 infection during the first pandemic year: a national study using linked mandatory child death reporting data. Research Square (2021)

[xxxi] 170^th meeting of the Vaccines and Related Biological Products Advisory Committee – 10/26/2021 https://youtu.be/laaL0_xKmmA

[xxxii] Stavridou et al 2021. Obesity in Children and Adolescents during COVID-19 Pandemic. Children (2021) 8;135. Doi: 10.3390/children8020135

[xxxiii] Kostoff et al. Why are we vaccinating children against COVID-19? Toxicology Reports (2021) 8:1665–1684

[xxxiv] Raw et al 2021. Previous COVID-19 infection but not Long-COVID is associated with increased adverse events following BNT162b2/Pfizer vaccination. J Infect. 2021 Sep; 83(3): 381–412.

[xxxv] Monforte et al 2021. Association between previous infection with SARS CoV-2 and the risk of self-reported symptoms after mRNA BNT162b2 vaccination: Data from 3,078 health care workers. EClinicalMedicine 36:100914

[xxxvi] Pincemail et al. Oxidative Stress Status in COVID-19 Patients Hospitalized in Intensive Care Unit for Severe Pneumonia. A Pilot Study. Antioxidants (2021) 10:57.

[xxxvii] Shah et al. Low vitamin D levels and prognosis in a COVID-19 pediatric population: a systematic review. QJM (2021)

[xxxviii] Affinati et al. Severe hyperglycemia and insulin resistance in patients with SARS-CoV-2 infection: a report of two cases. Clinical Diabetes and Endocrinology (2021) 7:8

[xxxix] Ceriello. Editorial: Hyperglycemia and the worse prognosis of COVID-19. Why a fast blood glucose control should be mandatory. Diabetes Research and Clinical Practice. (2020) 163:108186

[xl] Calcaterra et al. Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children. Children 8:3834. (2021) 10.3390/children8050384

[xli] Bozkurt 2021. Myocarditis With COVID-19 mRNA Vaccines. Circulation. 2021;144:471–484.

[xlii] Wise 2021 Covid-19: Should we be worried about reports of myocarditis and pericarditis after mRNA vaccines

[xliii] Lane & Shakir 2021. Reports of myocarditis and pericarditis following mRNA COVID-19 vaccines: A review of spontaneously reported data from the UK, Europe, and the US. medRxiv preprint doi: https://doi.org/10.1101/2021.09.09.21263342;

[xliv] Marshall et al 2021. Symptomatic Acute Myocarditis in Seven Adolescents Following Pfizer-BioNTech COVID- 19 Vaccination. Pediatrics (2021) doi: 10.1542/peds.2021-052478

[xlv] Kim et al. Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination. JAMA Cardiol. (2021) doi:10.1001/jamacardio.2021.2828

[xlvi] Pepe et al 2021. Myocarditis, Pericarditis and Cardiomyopathy After COVID-19 Vaccination. Heart, Lung & Circulation. 30:1425-1429 https://doi.org/10.1016/j.hlc.2021.07.011

[xlvii] Tobaiqy et al 2021. Thrombotic adverse events reported for Moderna, Pfizer and Oxford-AstraZeneca COVID-19 vaccines: comparison of occurrence and clinical outcomes in the EudraVigilance database. medRxiv preprint doi: 10.1101/2021.09.12.21263462; t

[xlviii] Novak 2021. Adverse rare events to vaccines for COVID-19: From hypersensitivity reactions to thrombosis and thrombocytopenia. Int J Immun https://doi.org/10.1080/08830185.2021.1939696

[xlix] Brazete et al 2021.Thrombotic events and COVID-19 vaccines. Int J Tuberc Lung Dis 25:9;701-707

[l] Reuters. Sweden, Denmark pause Moderna COVID-19 vaccine for younger age groups. October 7, 2021. https://www.reuters.com/business/healthcare-pharmaceuticals/sweden-pauses-use-moderna-covid-vaccine-cites-rare-side-effects-2021-10-06/

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