Hmm. I guess I'm not as worried about the "4.4% for at least 28 days" number as you are, because when I compare to the flu, there have been years where there was a bad flu circulating around and anecdotally it sure seemed like at least one out of twenty kids I knew who got the flu was still not feeling great 3-4 weeks later.
The 56 day number is rather more concerning, though! Two months seems like a long time for a kid to be sick, and going back to the flu analogy, I don't think I've ever seen a kid who was sick for two months from the flu (and there are enough kids in our school/other communities that odds are, if this were common at the 2% rate, I feel like I would have heard about it).
I think we're looking at things in that paper that are more severe than what one would see with a bad flu, particularly in that 28-day range. By 14 days even a very severe influenza should be wrapping up and any lingering symptoms are very mild. That doesn't seem to be the case here.
But we agree on the 56 day item. That's the item of biggest concern here. I'm surprised it only drops by about half over that additional month.
I keep seeing that Lancet study described on social media as "reassuring," indicating that long COVID is "rare" in kids, even by people I respect. Of course, it's neither of those things, for reasons well articulated by you. Under normal circumstances, seeing a parent willingly subject their kid to a one-in-fifty chance of permanent injury would warrant a call to Child Protective Services.
I do wonder, though, if the apparently low incidence of post-acute symptoms in children relative to adults tells us anything about the mechanism(s) underlying long COVID. Certain autoimmune conditions are less common in children. And children may be less likely to harbor dormant viruses that could perhaps be reactivated by SARS-CoV-2 infection.
Yeah, I don't want to speculate too much about post-acute COVID symptoms but certainly I think it's reasonable to compare adults and children in terms of the former group having a more extensive immunological history. I do think there's a possibility that the accumulated immune environment in adults may have something to do with all of this, but it's hard to say exactly what.
1. Based on your readings of Covid in children, if a 5 year old tests postive for Covid and is asymptomatic, what is the chance of later illness? How long after the positive result is the child safe to travel?
2. In a breakthrough case in a 67 year old adult with mild symptoms, would you recommend monoclonal treatment as an extra precaution?
1) I really can't say. We don't know enough yet. Asymptomatic infections may not have the same long-term dynamics, though. As far as the timing to travel after the positive test result, there's CDC guidance on this, saying that a person who tested positive should isolate until 10 days have passed from the positive test.
2) I would recommend that person talk to their physician. I'm not licensed to make a specific treatment recommendation here. However, I would also note that monoclonal antibodies are specifically indicated for use in adult and pediatric patients with mild-to-moderate COVID-19 who are not hospitalized. While I cannot recommend the use of any specific medical intervention, I do think that this patient's profile clearly matches the indication for these products. A physician should be able to make that determination for certain, though.
The Scientist tracks all known vaccine candidates.
Scary stuff in there, for me. Many (many!) Chinese and Russian vaccines have entries like this one: "Clinical testing was completed by the end of September, according to Reuters. In October, Russian President Vladimir Putin announced its approval ahead of a Phase 3 trial, NPR reports, and on November 30, Reuters reported that the country will begin mass vaccinations." (Russian "Vector" vaccine.) There are several vaccines being administered widely, not just in those two countries, that have not actually had a Phase 3 trial.
It's scary because people who think they're protected (even though there is no way to know if that's the case) will act as if they're safe, increasing the spread. No distancing, no masks--they're vaccinated, after all.
This is a cool resource! The Russian ones are particularly worrying because in many cases they lack any sort of outside validation. Most of the Chinese entries have something specific that I look for here--an emergency authorization from the WHO. Those involve a real review and a data package. I'm not seeing that for the Russian entries, largely.
Isn't "Vector" a terrible name for a vaccine (in English)? I'm actually asking your professional capacity as a pharmaceutical communications expert.
An Australian friend just mentioned that their government is now telling people not to wait four weeks for their second vaccine shots--to just get them ASAP and "not worry about long term immunity."
I'd be worried about "effective immunity," because as far as I am aware there is no data showing that a two-week wait between AstraZeneca shots will actually produce it.
Hmm. I guess I'm not as worried about the "4.4% for at least 28 days" number as you are, because when I compare to the flu, there have been years where there was a bad flu circulating around and anecdotally it sure seemed like at least one out of twenty kids I knew who got the flu was still not feeling great 3-4 weeks later.
The 56 day number is rather more concerning, though! Two months seems like a long time for a kid to be sick, and going back to the flu analogy, I don't think I've ever seen a kid who was sick for two months from the flu (and there are enough kids in our school/other communities that odds are, if this were common at the 2% rate, I feel like I would have heard about it).
I think we're looking at things in that paper that are more severe than what one would see with a bad flu, particularly in that 28-day range. By 14 days even a very severe influenza should be wrapping up and any lingering symptoms are very mild. That doesn't seem to be the case here.
But we agree on the 56 day item. That's the item of biggest concern here. I'm surprised it only drops by about half over that additional month.
I keep seeing that Lancet study described on social media as "reassuring," indicating that long COVID is "rare" in kids, even by people I respect. Of course, it's neither of those things, for reasons well articulated by you. Under normal circumstances, seeing a parent willingly subject their kid to a one-in-fifty chance of permanent injury would warrant a call to Child Protective Services.
I do wonder, though, if the apparently low incidence of post-acute symptoms in children relative to adults tells us anything about the mechanism(s) underlying long COVID. Certain autoimmune conditions are less common in children. And children may be less likely to harbor dormant viruses that could perhaps be reactivated by SARS-CoV-2 infection.
Yeah, I don't want to speculate too much about post-acute COVID symptoms but certainly I think it's reasonable to compare adults and children in terms of the former group having a more extensive immunological history. I do think there's a possibility that the accumulated immune environment in adults may have something to do with all of this, but it's hard to say exactly what.
Lisa Schwartz just now
Hi John,
Two questions:
1. Based on your readings of Covid in children, if a 5 year old tests postive for Covid and is asymptomatic, what is the chance of later illness? How long after the positive result is the child safe to travel?
2. In a breakthrough case in a 67 year old adult with mild symptoms, would you recommend monoclonal treatment as an extra precaution?
Thank you!!!
Lisa
Hi Lisa! Good to hear from you.
1) I really can't say. We don't know enough yet. Asymptomatic infections may not have the same long-term dynamics, though. As far as the timing to travel after the positive test result, there's CDC guidance on this, saying that a person who tested positive should isolate until 10 days have passed from the positive test.
2) I would recommend that person talk to their physician. I'm not licensed to make a specific treatment recommendation here. However, I would also note that monoclonal antibodies are specifically indicated for use in adult and pediatric patients with mild-to-moderate COVID-19 who are not hospitalized. While I cannot recommend the use of any specific medical intervention, I do think that this patient's profile clearly matches the indication for these products. A physician should be able to make that determination for certain, though.
Hi, John,
I though this resource might be interesting to you:
https://www.the-scientist.com/news-opinion/track-covid-19-vaccines-advancing-through-clinical-trials-67382
The Scientist tracks all known vaccine candidates.
Scary stuff in there, for me. Many (many!) Chinese and Russian vaccines have entries like this one: "Clinical testing was completed by the end of September, according to Reuters. In October, Russian President Vladimir Putin announced its approval ahead of a Phase 3 trial, NPR reports, and on November 30, Reuters reported that the country will begin mass vaccinations." (Russian "Vector" vaccine.) There are several vaccines being administered widely, not just in those two countries, that have not actually had a Phase 3 trial.
It's scary because people who think they're protected (even though there is no way to know if that's the case) will act as if they're safe, increasing the spread. No distancing, no masks--they're vaccinated, after all.
This is a cool resource! The Russian ones are particularly worrying because in many cases they lack any sort of outside validation. Most of the Chinese entries have something specific that I look for here--an emergency authorization from the WHO. Those involve a real review and a data package. I'm not seeing that for the Russian entries, largely.
Isn't "Vector" a terrible name for a vaccine (in English)? I'm actually asking your professional capacity as a pharmaceutical communications expert.
An Australian friend just mentioned that their government is now telling people not to wait four weeks for their second vaccine shots--to just get them ASAP and "not worry about long term immunity."
I'd be worried about "effective immunity," because as far as I am aware there is no data showing that a two-week wait between AstraZeneca shots will actually produce it.