Although schools aren't quite out yet, the weather is warming up and it's about time to think about relaxing in a pool or at the beach somewhere. I feel a little bit like we're treading water with respect to COVID-19 in the US, waiting to see what how our new omicron subvariants behave, how much the holiday weekend will bump up cases, and whether the upcoming FDA review of evidence for vaccines in the under-5 and -6 year-olds will result in the long-awaited authorization for young children.
Two Views of Disease Transmission
Recent lay press statements and comments from some of my colleagues alerted me to the fact that many may not be aware that the CDC has 2 tracking tools for measuring disease activity. Mentioned most often is the COVID-19 Community Level. This is directed at communities to help track if the infection rates are becoming severe enough to strain healthcare resources. It first looks at new cases in the past 7 days, whether below or above 200/100,000 population by county. It then looks at new hospitalizations and percent of staffed inpatient beds occupied by COVID-19 patients, with different cutoffs based on the new case count partition. The numbers are boiled down into Low, Medium, or High levels, though if the new cases are >200/100,000 population the minimum level is Medium. Guidelines for prevention strategies are then provided for individuals, households, and communities based on the Community Level.
Here's the big picture (weak pun intended):
Contrast this with CDC's Community Transmission Levels. You can see right away one source of confusion, this term is very close to Community Level above, but it's a different calculation for different purposes. This measurement is targeted specifically to help healthcare facilities, not for the communities at large. Levels are categorized into Low, Moderate, Substantial, and High based on new cases per 100,000 persons in the past 7 days (<10, 10-49.99, 50-99.99, and >100) and percentage of positive nucleic acid amplification tests in the past 7 days (<5%, 5-7.99%, 8-9.99%, and >10%). The higher of the 2 determinations determines the Community Transmission Level:
As you can see the 2 measurements have very different views for how things are going, but neither bode well for our DMV area.
Which Eligible Kids Should Receive Vaccine Now?
This is in part an answer to Michael Schwartz's question to me last week. All frontline pediatric healthcare providers are being asked what to do about vaccinating children now. From my viewpoint, it's a very simple answer, but the sticking point is how to communicate options to parents and children particularly if they aren't accustomed to weighing choices in medical care. From a risk/benefit perspective, one needs to weigh that ratio in 2 scenarios: getting the vaccine versus being infected. For the primary series in all age groups, it's not even a close comparison. The risks associated with vaccine are miniscule compared to being infected, even for a healthy child. The magnitude of those risks is at least 100-fold different. What makes it a little tougher is that the absolute risk of complications from infection is much lower in a healthy child than, say, for an old geezer like me. So, I can see where the hesitation by some parents originates.
The question of a booster dose, now authorized for the 5-11 year-olds, might take a bit more analysis. Again, we have tremendous reassurance about side effects, so it's more about benefits and timing of the booster. With the newest omicron subvariants now dominant in the US, no vaccine is particularly effective against infection itself, but benefit remains (if we can transpose from studies in older populations and in other countries) for prevention of symptomatic disease and need for visit to a healthcare provider. It's important for parents to consider individual circumstances such as high-risk contacts their children might have with grandparents, etc. If these kids are to receive a booster, now is a good time since nothing new is likely to be available until the fall at best.
I might add, in my broken record mode, that the press releases from vaccine manufacturers giving a preliminary vaccine effectiveness number are way too preliminary. The confidence intervals are huge, and also I would not base any decision on partial data reports from an entity with an overwhelming implicit bias in seeing their vaccines authorized.