I'm against it at this time in normal healthy teens due to low risk of COVID complications and questionable risk of myocarditis with Pfizer.

If they have risk factors (obesity, immune issues, diabetes, heart defects, etc) it is worth the risk.

Son 17 got his because he is overweight(not my doing) and working.

He got both Pfizer shots and no problems.

I would hold off till > 25 based on current data.

KidDoc said:

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I'm against it at this time in normal healthy teens due to low risk of COVID complications and questionable risk of myocarditis with Pfizer.

If they have risk factors (obesity, immune issues, diabetes, heart defects, etc) it is worth the risk.

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If only colleges would take your advise....

Background: I am an adult pulmonology & intensive care physician at a tertiary referral hospital in Atlanta. I am father to twin 13 year-old boys and a 7 year-old boy.

The twins are vaccinated and the little guy will be vaccinated as soon as it's available to him.

On an individual level, the absolute risks of either <major complications from COVID-19> or <major complications from vaccination> are LOW. However, the more pertinent statistic is the RELATIVE risk of <complications from COVID-19> vs <complications from vaccination.> If the chance of outcome "A" is 1:1,000,000 and the chance of outcome "B" is 20:1,000,000 then we can agree that both outcomes are unlikely. Nevertheless, outcome "B" is 20x more likely than outcome "A." That matters on a population level. Humans are objectively poor at assessing risk, especially at scale.

As it relates to our scientific understanding of the issues, I've seen so many people here and elsewhere state that "we know the risks of COVID-19 but we don't know enough about the vaccination." This is backwards thinking. We don't know a fraction of what we need to know about the long-term sequelae of infection, even in people who experienced mild cases. On the other hand, mRNA vaccination technology is approaching 20 years of study and these vaccines continue to be amongst the most scrutinized in history. Certainly there is more to be learned about vaccinations - but how long are we willing to wait to learn those "unknowns" while the known threat (which can absolutely be mitigated with vaccination) continues to needlessly kill thousands of citizens?

Everyone who dies of COVID-19 was essentially killed by the person who spread the infection to the decedent. Your child will probably be fine if he contracts COVID-19 - but what about the unvaccinated 45 year-old baseball coach to whom your child spread the infection? 10 days later he's on a ventilator Don't think it can happen? Come spend a day with me in the ICU.

CMP-00- said:

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Everyone who dies of COVID-19 was essentially killed by the person who spread the infection to the decedent. Your child will probably be fine if he contracts COVID-19 - but what about the unvaccinated 45 year-old baseball coach to whom your child spread the infection? 10 days later he's on a ventilator Don't think it can happen? Come spend a day with me in the ICU.

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Why isn't the baseball coach vaccinated?

Good input but in your scenario the 45 year old should/could have gotten vaccine- still not 100% but would massively decrease his risk.

I just have trouble with my patients with the "Do no harm" part of being a physician. If I know a viral infection has nearly no chance of killing or hospitalizing that patient it is hard to justify the risk of a vaccine that appears to be causing myocarditis (currently ~1000 reports) . If the patient has risk factors it is certainly worth it, but vaccinating all healthy teens/children seems like an imbalance in the risk vs benefit equation at this time.

You can argue for herd immunity and to decrease the risk of mutation but unless we are vaccinating the entire world mutation is still going to happen.


Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination | CDC

Yes.
As an example my 22 year old son, who has had Type 1 DM since age 8, is vaccinated as that is a clear risk factor.

Unless the teen has certain conditions (BMI >90ish percentile, cystic fibrosis, immunodeficiency, etc.) I would say the extra benefit of vaccination for covid is similar to the health benefits of regularly running 11 miles instead of 10. You're tossing water in the ocean at that point. And because children are such poor vectors of transmission, I don't believe an evidence based argument can be made for mass vaccination of this demographic meaningfully decreasing spread, especially with so many 18-65 individuals still unvaccinated.

KidDoc said:

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I'm against it at this time in normal healthy teens due to low risk of COVID complications and questionable risk of myocarditis with Pfizer.

If they have risk factors (obesity, immune issues, diabetes, heart defects, etc) it is worth the risk.

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Has anybody looked at the risk of COVID causing myocarditis vs vaccine causing myocarditis. Remember in this same demographic, myocarditis was a huge concern a year ago - even cited by the BIG 10 for cancelling the season. There were definitely athletes that I can remember that missed part if not all season due to myocarditis. My point being that rarely myocarditis in that demographic seems to be a result of the immune response to COVID and you aren't necessarily decreasing the risk of myocarditis by not getting vaccinated given that COVID is now endemic. If the rates of myocarditis are similar then I'd rather absolutely rather get the vaccine than COVID.

chap said:

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CMP-00- said:

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Everyone who dies of COVID-19 was essentially killed by the person who spread the infection to the decedent. Your child will probably be fine if he contracts COVID-19 - but what about the unvaccinated 45 year-old baseball coach to whom your child spread the infection? 10 days later he's on a ventilator Don't think it can happen? Come spend a day with me in the ICU.

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Why isn't the baseball coach vaccinated?

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Probably because he made a "personal risk assessment" based on logic that ignores everything CMP said.

CMP, people are going to disagree with you here based on the fact that you're addressing your argument toward kids getting vaccinated (like InfectionAg saying they aren't a significant vector). And while I don't know which of you is correct regarding kids, I will say that so many adults need to understand what you're saying and apply it to their own decision to get vaccinated. Thank you for explaining it so clearly.

The myocarditis rate with COVID is very very low. And you are assuming all children will get COVID eventually which is not a guarantee. But giving them a shot is something you can control and if you avoid cardiac inflammation but passing on the shot and gambling on them maybe getting COVID then being one of the tiny percentage that gets myocarditis it gets really tough to make a decision.

Again doctors are supposed to do no harm if possible. If the risk of vaccine is tiny and the risk of serious complications from infections is also tiny-- is it worth the risk of vaccine for that patient?

The CDC & AAP are coming at it from a population medicine perspective which I can understand. But if we just vaccinate the high risk teens I think the risk v benefit is MUCH more clear.

It was a serious question. In your example, why are you giving responsibility to an unvaccinated teenage kid (or his parents) but not to the unvaccinated adult?

You're basically telling parents that they need to vaccinate their kids to help protect adults that they come in contact with who are themselves making the choice to not get vaccinated.

"Children are LESS LIKELY to be significant vectors for infection" is VERY different than "Children are NOT vectors for infection."

This is what is talked about when it's said that humans are bad at assessing risk at scale. Math is hard and numbers boggle the mind. Even if children are 75% less likely (making up a number for effect) to propagate infection through a community, there are tens of millions of children living in the U.S. Given time and mounting infections and what we know about R values, that's still a lot of transmission. RIGHT NOW, SARS-CoV-2 is sweeping through Summer camps in Texas and other states: much is still not certain but it seems entirely implausible that counselors and a handful of adults are exclusively responsible for sending scores of kids home with unwanted (often hidden) viral baggage, or that those children don't in-turn pass that same baggage off to people in their local communities. I don't doubt that the magnitude of effect is smaller when examining the effects that children have but I wonder how many preventable deaths are enough to warrant every eligible citizen doing his/her part to limit infection?

Of course the CDC and AAP are approaching this at a population level - is there really any better way in a WORLDWIDE PANDEMIC?

I am advising that ALL eligible persons be vaccinated because is the BEST way we can limit preventable deaths.

Would it mean more to you if I'd used the example of a fully vaccinated adult currently on a ventilator after contracting COVID-19 from his vaccine-eligible-but-unvaccinated grandchild? Because I have first hand experience with that happening RIGHT NOW. Thank goodness it's rare, but it's a real number. Like I asked in another reply, how many such cases are "too many?"

maybe you shouldn't be here on the covid board if you have to resort to name calling

I wish I could count how many times I've started a response like that and deleted it. You'll probably get wrist slapped or banned but I think you are saying what quite a few of us are thinking.

I appreciate your acknowledgment (and that of the "quite a few of us" referenced by AggieAuditor) that this complex and important topic has exceeded your capacity to participate in civil discourse. At least the rest of know who we're dealing with.

Blackstreet said:

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I wouldn't "tout" relative risk when the numerator is in the single digits (or low double digits) and the denominator is in the millions. Go tell people to buy 10 lottery tickets instead of one. After all "their relative risk" of winning is much higher as it's 10 times higher right???

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see:

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That matters on a population level. Humans are objectively poor at assessing risk, especially at scale.

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I've had 0 MIS-C cases in my practice, which doesn't mean anything really.

There are lots of nasty viral associated syndromes that are thankfully rare but you don't see us rushing to develop and push vaccines for Coxsackie virus, RSV, West Nile etc. MIS-C is rare enough where it is not a good justification for vaccination in otherwise healthy kids.