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Natural (infection) vs vaccine immunity in young children
Hi all, I was fixated to the Covid discussion on TheCardBoard and when it moved over here I failed to migrate as I was dealing with Covid-19 issues in my work. I run a small k-12 school like community in Texas. I feel that as of July I was pretty on top of all the latest developments and that we had a superior plan for our education community coming into the year.

Recently, the parent of one of our young people has been challenging our approach to vaccines for the under 12 crowd. We have a risk basked process for bringing folks indoors and at the current rate of spread only vaccinated kids can come indoors. I was wondering if anyone can point me to discussions on the debate over vaccines for children under the age of 12. Else, if anyone has time, I would love to hear what you think (with resources or studies if immediately on hand) to some of the points he has raised in the email he just sent me pasted below:

Quote:I don’t mean to speak for my doctor; this is only my takeaway. 

He sees no reason to vaccinate [name] at this time.  He is supportive of vaccination in those without previous infection. 

He claimed there are over 90 studies contradicting the CDCs recent statement that vaccination is superior to prior infection and therefore he is entirely comfortable with [name's] current level of immunity.  

He said that, in adults, he sees a medical advantage to one dose of the vaccine in the previously infected. 

According to his research the one dose offers added immunity, and the second dose seems to not be able to have a significant impact. 

He seems to think that covid vaccination will remain totally unnecessary for previously infected 5-11 year olds.  

He feels that for those with obvious strong risk factors and those that had a severe initial infection, a case by case determination is warranted.  

He did write us a letter that says something like: vaccination is not medically indicated at this time and [name] has immunity making him clear for school, travel, etc…

For the moment we are following his lead on this.  

To further clarify my own assessment of the current data:

My problem with many publicized studies is they are using correlation as proof of causation. This approach dismisses many variables, including lifestyle. 

I wonder if the previously infected were less protected from Covid due to the lack of vaccine, or were they a section of society that was less careful?

In the Israel study, was there cultural shame on the previously infected? Were they more careful after their infection?  

The studies are likely not objectively able to fully address such questions.

In The States I suspect those who were both previously infected and unvaccinated were exceptionally careless about their exposure.  

I believe that this type of data limitation could explain the range of findings.  Infinite variables could be at play when trying to use correlation to prove causation.  

Correlation studies obviously have a place in science; overwhelming consistency is not to be discarded, but in this situation I think it is also necessary to look at studies that investigate the nuts and bolts of the typical immune response. 

I have not kept a reference list, but over the recent weeks I have read quite a few articles and studies that came across as conclusive about observable indicators of a robust, effective, and long term immune response in even very mild cases of previously infected. (The cdc study I keep referring to was peculiar in limiting their correlation statistics to only the hospitalized. Seems counting how many people stayed out of the hospital would also be a relevant metric)

My personal assessment so far, based on my inquiry, is that natural infection is slightly superior to vaccination.

Our approach has not been focused on risk to the young people alone, although we don't want kids getting infected at all given unknown longer term complications to the disease, but more so the risk of spread within our community and then outward into the broader local communities. So even if everything he says in the email is directionally correct, we are still thinking about people beyond the child in question. Nonetheless, any suggestions on where to look for information that would be more efficient than me doing a bunch of random searches would be super helpful. 

Apologies for rambling, and thank you.
I don't have any great resource to point you towards.   That said, most recent studies I have read indicate that the combination of natural infection and vaccination results in the most robust immune response.   So, points to vaccination no matter what prior infection status is.
EDIT: The CDC report referenced above is here

Welcome, NGC.   I remember you making available some information about your school's policy.  I spent a decade in Austin and have a best friend with a 10yo grandchild there, and a brother who is a physician.  I generally try to keep up with what is going on there, but not as closely as where I live.

Did you see this posting of links to the documents presented by & to the FDA about the Pfizer vaccine for 5-11 year olds?

I think most people will agree that the situation with regards to children is complex.  There are both short-term and long-term potential effects to the children and their caregivers (and then those they interact with). Effects of the vaccine on this age group are being estimated from effects on another age group.  The level of community infection over the next few months or years is unknown.

While the model isn't explained enough (IMO), the FDA did models of the benefits & risks (BR) of vaccines on children under various scenarios.  As models typically go, everything is an estimate based on some data that isn't perfect.  The FDA authors felt their estimate of excess myocarditis rate was high, but used it anyway as that was the data they had.

IMPORTANTLY, it appears that the numbers shown are only for the age group indicated (say, 5-11 yo males).  It does not show reductions in cases (and thus hospitalizations, cases of myocarditis, and deaths) for the total (all ages) US population if the 5-11 age group is vaccinated.  It only shows Benefits vs Risks among the 5-11 age group.

The BR presentation lists its major limitations as
  • Model assumption about constant incidence rate generates great uncertainty on the estimate of benefits
  • Vaccine efficacy may change due to new emerging variants of virus
  • Hospitalizations and ICU stays from COVID-19 and myocarditis are not equivalent and cannot directly compared
  • The benefit of reducing COVID related multisystem inflammatory syndrome in children may not be fully captured by preventable hospitalizations, ICU stays and deaths due to COVID-19
  • This BR risk assessment does not consider potential long-term adverse effects due to either COVID-19 or myocarditis
  • This BR assessment does not include secondary benefits (reducing COVID-19 disease transmission) and risks

Among the scenarios run, the only one that showed excess risks vs benefits was one in which COVID cases in the community dropped by 90% (basically from the high levels of Sep. to the lows of June).  Even then, the authors felt that the benefits might outweigh the effects when the uncertainties were factored in.


If I were to update the outlook over the last two weeks, it appears to me that vaccine effectiveness for the general population is dropping faster than expected, and that cases appear to be leveling off (deaths lag cases by 3 weeks or so) after dropping from the peak in early September.

If you look at the graph of infectons in the US
[Image: cases_11052021.jpg?_=58070] 
the number of infections begin to take off in the Aug-Sep time frames of both 2020 and 2021.  Think of that in relation to school starting.  However, interpreting the temporal patterns of infection is difficult because an unknown number of infections aren't reported, making it difficult to see when regions have relatively few people likely to get infected.  The number of repeat infections simply isn't available.  Note that the ratio of true infections to reported infections may be different from Dec. 2020 to Sep 2021.

The US tried voluntary vaccinations, but the failure of that plan shows in Sep. 2021.
The US has seemingly now taken a stance differently than I think it did for diphtheria, polio, and smallpox.  It is only indirectly forcing people to get vaccinations by having institutions (schools, companies) require them.  This leads to dilemmas when a school is asked to make an exemption.  If one exemption is made, why isn't everyone exempted?   Doctors, like the general population, have a wide range of opinions.  I'm sure there is at least one physician in the area that believes no child should be vaccinated and another physician that believes all children should be vaccinated.  (There was a farce in California that you could get marijuana with a prescription.  You can imagine how hard that was to find.)

From an individual's perspective, the safest & easiest course is if everyone else in their universe becomes immune without the individual getting the vaccination.   Clearly that doesn't work if large segments of the population choose that course.  

I guess if I were a small school, I would find an independent physician to evaluate requests for exemptions.   While most physicians hesitate to disagree with another physician (and so would tend to rubber stamp exemptions), having such a gate-keeper would be defensible and somewhat consistent. A lay-person overruling a MD wouldn't work well.  If the lay-person or MD disallows an exemption, there will be a dispute.  If the lay-person or MD allows an exemption, there may be a dispute from those that got the vaccine.

Remember that you have to set very clear guidelines and those guidelines have to be effectively and continually communicated.  (I don't know if you saw the post on the Cal football team.  One of the issues is that team members were thinking of rules from the July time frame (when cases were low) that had been changed in August when the first signs of vaccine effectiveness drop was seen by the CDC.  So the coach is claiming that the team followed the rules, but the Health Officer is saying otherwise.)
Thanks so much, all! I know it has been a long time since I posted this and then I stepped away as I dealt with a ton of urgent issues. I really appreciate the replies and this gives me some added structure to help think about the situation and how to respond to what I expect to be more and more families (who were fully on board with our approach but are now fatigued) asking why we are still so conservative relative to all the other schools. Omicron ironically makes things harder for us even though it seems to be much less harmful (but much more contagious so at a population level not necessarily less harmful). I think that having an independent physician review exemption requests is a great idea. Thanks, and I hope all are doing safe. Even though this is a very belated response I greatly appreciate it. Happy Holidays!

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