Zoom Out
My daughter just got her second Pfizer-BioNTech dose. Why?
Let’s start with why not:
NOT because I’m terribly worried about her risk for COVID-19. The risk of severe outcomes from COVID-19 in kids remains low and is dropping daily. Have kids been hospitalized and tragically died from COVID-19? Yes, absolutely. It’s just very unlikely. The American Academy of Pediatrics estimates that the risk of hospitalization is approximately 0.8% for kids under 18. As of May 29, CDC estimates that adolescent hospitalization rates are down to 0.6 per 100,000.
NOT because of the myriad fear-inducing headlines about the CDC’s MMWR report released Friday that stated that the rate of adolescent hospitalization from COVID-19 is going up. Let’s be clear: COVID case rates in teens did go up in March and April, during which time case rates went up in all age groups. But here’s the key point: the CDC’s report left out the last 5 weeks of data, during which time case rates and hospitalizations have reassuringly fallen for all ages. You can see this in the graph below from COVID-NET. I realize that it’s impossible to publish a report on data in real-time, but when the media seizes on OLD bad news, hysteria ensues.(For an excellent discussion of CDC’s recent report and the problems with it, click here.)
You can also see in the above graph that the case rates in the 12-17 year-olds are already very low compared to older individuals. Check out that gray line at the bottom! In fact, the risk of COVID to kids ages 5-17 is so low that back in March 2021, CDC used this age category as the reference group when explaining relative risk of COVID-19 to other age groups (meaning all other age groups were compared to them):
NOT because I got anxious over Rochelle Walensky’s TV message on Friday about the same MMWR report data where she stated (correctly) that one-third of hospitalized adolescents are being admitted to the ICU. To be clear, one third of a small number is a very small number. Nonetheless, transmission to a child is something we all want to prevent. The good news? Vaccinating adults is making a difference: the AAP reported last week on the lowest number of COVID cases in kids since June 2020. It’s misleading and anxiety-provoking to explain that cases were going up a month ago, along with cases in all age groups. I respect Rochelle Walensky’s desire to urge parents to vaccinate their teens but wish she had said something like this: “It’s very rare for kids to be hospitalized for COVID, but the risk isn’t zero and approximately 100 kids per week (out of 70-some million total kids in the US) are hospitalized right now, so please consider getting vaccinated yourself and think about vaccinating your teen to help protect themselves and other, more vulnerable people. It’s all hands on deck to get back to normal.” Recommending widespread vaccination is a great message, but fear isn’t motivating; it just makes people afraid.
NOT because of the (mostly pleasant) feedback I’ve received since my newsletter last week, where I wrote about framing a decision on whether or not to delay vaccine dose #2 for my teenage daughter. I fully recognize the anxiety in the air (I feel it, too!), particularly when thinking about kids. I’ve also observed that one of the main drivers of people’s anxiety during the pandemic has been the mixed messaging and uncertainty about who to trust. I get it. There are so many megaphones it can be hard to think. But let’s be clear: there’s a big difference between mixed messaging and the appropriate consideration of new and evolving data. Personally, I trust people who are intellectually honest, humble, and able to see all sides of an issue. I trust data over dogma. I agree with Johns Hopkins epidemiologist Jennifer Nuzzo who said on Saturday about CDC’s recent messaging, “You don’t convince people to vaccinate their kids by cherry picking from old data. That only erodes trust.”
My daughter’s take on all this? “Mom, it seems like we’re splitting hairs. The risks of the vaccine and the risks of COVID are both small. I just want to be done with this. Can’t I just get the second shot today?” And we did.
We got the second dose because:
I’m not too worried about myocarditis. A study published Friday suggests that the risk of myocarditis after COVID-19 vaccination appears to be rare, treatable, and non-fatal. Over 2.2 million 16-17 year-old teens have already received both doses of the Pfizer-BioNTech vaccine. Over 3 million kids ages 12-15 years have had dose #1 — the vast majority of them without adverse events. Fortunately we have the VAERS (Vaccine Adverse Event Reporting System) to capture cases which are then investigated in depth. Data from Israel, ahead of us by a few months having administered 10.6 million doses of Pfizer-BioNTech, estimates the risk of myocarditis to be approximately 1 in 3,000 (0.03%) to 1 in 20,000 (0.005%). The short story: the myocarditis risk is very small. Given that 7 cases have been found and investigated thoroughly so far, it is reassuring that the adverse event reporting system works well.
The relative risk of COVID-19 itself versus the risk of vaccination still favors vaccination. The risk of anaphylaxis is 0.46 per million. The milder side effects are readily treated with Ibuprofen or Tylenol.
The infertility myth is — again — a myth. The reports of irregular periods after the vaccine likely reflect the expected inflammatory response. I’ll be shocked if this turns out to be anything worrisome (irregular periods happen with so many normal adjustments to our female physiology!), but of course I will follow this closely.
Vaccinating my daughter with dose #2 protects other, more vulnerable people — like kids ages 11 and under who aren’t eligible for the vaccine. We know that the vaccine offers marvelous protection against COVID-19; it also dramatically reduces the risk of transmission to others. Data from Israel shows over 95% protection against infection.
And last, there’s a variant called the “Delta” (or the B.1.617.2 variant) that seems to evade protection from a single dose of the mRNA vaccine. What does that mean in real life, exactly? So far it looks like a single vaccine dose will protect us from severe disease but that two doses of the mRNA vaccine offers optimal protection. What about unvaccinated kids — should we panic? There’s really no need. We simply need all adults to get two doses and to crush this virus’ ability to spread with our collective immunity. We’re getting there! (More on the Delta variant later.)
The long story short? The risk of adverse events from the vaccine is tiny. The risk of kids getting seriously ill from COVID also is tiny. We’re debating tiny risks versus tiny risks. It’s time to zoom out.
If I teach my kids nothing else, it’s about keeping perspective. It’s that getting in the weeds to form your own opinions is critical; similarly, getting out of the weeds and looking at the big picture is critical. When we get edgy about tiny risks, we miss out on important parts of our life and can develop, well, chronic edginess.
To me the big picture includes thinking about our everyday mental health and lived experiences. The psychological and practical benefits of getting both shots have been enormous for my kids — and for so many of us fortunate enough to get them. Let’s also face it: many of our daily decisions stem from instinct, emotion, and practicality. I’d be lying if I told you that every choice I make is purely rooted in science. (If they were, I’d never drink wine, sit in the sun, or exceed the speed limit running late to my kid’s soccer game). In my humble opinion, health stems from an awareness of our biases and behaviors and the emotional states that inform them.
The perspective-giving icing on the cake? Our trusted pediatrician. He has helped keep my kids safe and sane for almost 20 years. We talked through the pluses and minuses of dose #2. After all, there’s no substitute for specific advice based on your child’s unique medical issues.
Here’s my daughter hot off the presses from dose #2. (Posted with permission.) Today she feels crappy (fever, aches, fatigue), but she knows it’s worth it. Plus, who doesn’t love popsicles and blue Gatorade for dinner — yes!
I will see you later this week. Until then, be well.