HeartDoc Andrew wrote:
> Michael Ejercito wrote:
>
>> https://www.reddit.com/r/LockdownSkepticism/comments/1fasuje/always_check_the_denominator_no_the_risk_of/
>>
>>
>> Always Check the Denominator
>> No, the risk of critical Covid disease is not 4% among healthy children.
>>
>> Kelley K
>> May 30, 2024
>>
>> I’ve been very busy lately with my actual job and some other things, so
>> I haven’t been writing much lately. I paused paid subscriptions for the
>> summer to try and get caught up. I’m not taking the summer off - I plan
>> to start writing again even while payments are paused. Hopefully you’ll
>> be hearing more from me soon! Today seemed like a good day to start…
>>
>> I woke up to this outrageous claim from CIDRAP in my Twitter feed:
>>
>>
>> This is not the first time that I’ve written about CIDRAP amplifying
>> misleading claims from a Covid study to amp up fears about Covid and
>> kids. They also misreported a study about Long Covid, claiming that 84%
>> of Covid survivors had Long Covid symptoms 2 years later. Like that
>> ridiculous Long Covid claim, the claim from their current tweet and
>> article on Covid risks among kids just doesn’t pass a basic sanity
>> check. Michael Mina did some basic math to show how absurd this claim is:
>>
>>
>> Unfortunately, the reporters at CIDRAP (along with many other Covid
>> journalists and even some scientists) seem to lack the common sense to
>> do these kinds of sanity checks on the data — because this keeps happening.
>>
>> A Meta-Analysis of “Risk Factors for Pediatric Critical COVID-19”
>> The study, “Risk Factors for Pediatric Critical COVID-19: A Systematic
>> Review and Meta-Analysis” is primarily about which comorbidities are
>> risk factors for severe Covid — it’s focused on severe cases and kids
>> with comorbidities. However, the study does include the 4% claim cited
>> by CIDRAP. I can’t access the full text of the published paper from the
>> Journal of the Pediatric Infectious Diseases Society, but the study’s
>> abstract does state: “In previously healthy children, the absolute risk
>> of critical disease from COVID-19 was 4% (95% CI, 1%-10%).” I wanted
>> more details of the underlying data, so I found the pre-print of the
>> study, and the following section of the Results is where this 4%
>> statistic comes from:
>>
>>
>>
>> Figure 4 from the study
>> This small section is the only mention of outcomes in children without
>> comorbidities, and it doesn’t include nearly enough caveats about the
>> underlying data. It is a poor conclusion to draw and shouldn’t have been
>> included in the abstract at all in my opinion. The abstract even says
>> that “the absolute risk for critical COVID-19 in children and
>> adolescents without underlying health conditions is relatively low,”
>> which doesn’t seem consistent with a 4% “absolute risk of critical
>> disease” from their results. In reality, the absolute risk among
>> previously healthy children is at least an order of magnitude lower than
>> that.
>>
>> Underlying Study Data
>> It should be obvious to the casual observer that the 4% was calculated
>>from a population that doesn’t represent typical healthy children. So I
>> looked up each of the 6 studies included in this subset of studies from
>> the meta-analysis. Of the 6 studies that looked at medical complexity, 4
>> were among hospitalized children (3 of the 4 in Brazil)1, one was among
>> 12-17-year-olds with symptomatic Covid recorded in medical records2, and
>> one was a large study of children with documented Covid in Mexico3.
>>
>>
>> Outcomes for Children without Comorbidities (data extracted from Figure
>> 4 above, population descriptions from underlying studies)
>> Also, all of the studies were from early in the pandemic (2020 and part
>> of 2021), so they were primarily first infections, they were primarily
>> pre-vaccine, and all were pre-Omicron. So they don’t tell us much about
>> the current situation, even among children who may be hospitalized with
>> Covid in 2024.
>>
>> The large study in Mexico included over 130,000 children and found 0.3%
>> of children with documented Covid infections and no comorbidities died
>> between March 2020 and mid-June 2021. And that is still biased to more
>> severe cases, because many asymptomatic and mild infections aren’t
>> documented in medical records. Despite the overwhelming findings from
>> this large study of children from the broader community (not just
>> hospitalized children), the study authors calculated an absolute risk
>>from a small subset of children from these 6 studies (less than 16,000
>> patients). They don’t provide any further details the subset that they
>> used for their calculations, but clearly the studies of hospitalized
>> children and symptomatic teens skewed the results significantly.
>>
>> Denominators Matter
>> There’s been much discussion about the importance of denominators
>> throughout the pandemic, but scientists, journalists, and others keep
>> making the same mistakes. When we use percentages to talk about Covid
>> outcomes or other things, we’re talking about a fraction of the
>> population. But it’s super important to understand WHICH population
>> we’re talking about. Outcomes among hospitalized patients, or among the
>> elderly, differ greatly from outcomes in the general population.
>>
>> Just like the percentage of adults who ride mountain bikes is much
>> higher among attendees at a mountain biking race than among all adults,
>> the percentage of children with critical Covid is obviously much higher
>> among children who are hospitalized for Covid than among all children.
>> We see this same error with Long Covid studies, where the findings are
>> percentages among patients at a Long Covid clinic, or among patients who
>> already have Long Covid, but are often reported as if they are
>> percentages among a representative sample of the population.
>>
>> The percentage of children with critical Covid outcomes is obviously
>> much higher among children who are hospitalized for Covid than among all
>> children.
>>
>> The Sad State of Covid Science and Journalism
>> The authors of this study were irresponsible to include the claim that
>> “the absolute risk of critical disease from COVID-19 was 4%” among
>> healthy children without comorbidities, without explaining that their
>> data was heavily biased toward patients already hospitalized with COVID.
>> Without that caveat, the 4% claim is a gross misrepresentation of the
>> underlying data. And this study isn’t from some obscure scientist at a
>> no-name institution — the senior author, Dr. Carlos Oliveira, is an
>> Assistant Professor of Pediatrics, Biostatistics, and Biomedical
>> Informatics & Data Science at Yale! Surely he knows that 4% of American
>> children didn’t have severe Covid outcomes. Why include that misleading
>> statistic in the paper?!?
>>
>> I also think the writers at CIDRAP needs to do a better job of
>> understanding and vetting the studies they report on to make sure their
>> reporting is accurate. They are a trusted voice for many people, and
>> their studies often get amplified by the Zero Covid crowd on Twitter. It
>> is profoundly unhelpful to continue scaring people with these misleading
>> and unrealistic statistics. Journalists need to understand the harm they
>> cause by publishing these irresponsible claims.
>>
>> By the way… I’m already seeing this same error with H5N1 (bird flu) in
>> the media as well, and will probably write more on that later. Many news
>> reports refer to a 50% “fatality rate”, but that’s only among known
>> cases that were previously documented. Among the 3 cases identified so
>> far in the US (one in 2022 and two this year), none have died. The two
>> known cases this year have only experienced eye infections.
>> UPDATE: The moment I published this, I saw that another case of H5N1 has
>> been identified in the US. That patient did have respiratory symptoms
>> but is recovering. (5/30/24)
>>
>> Thanks for reading Check Your Work! Subscribe for free to receive future
>> posts.
>>
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>> 1
>> (A) Ward JL, Harwood R, Smith C, Kenny S, Clark M, Davis PJ, et al. Risk
>> factors for PICU admission and death among children and young people
>> hospitalized with COVID-19 and PIMS-TS in England during the first
>> pandemic year. Nat Med. 2022 Jan;28(1):193–200.
>> (B) Oliveira EA, Colosimo EA, Simoes ESAC, Mak RH, Martelli DB, Silva
>> LR, et al. Clinical characteristics and risk factors for death among
>> hospitalised children and adolescents with COVID-19 in Brazil: an
>> analysis of a nationwide database. Lancet Child Adolesc Health. 2021
>> Aug;5(8):559–68.
>> (C) Hendler JV, Miranda do Lago P, Muller GC, Santana JC, Piva JP, Daudt
>> LE. Risk factors for severe COVID-19 infection in Brazilian children.
>> Braz J Infect Dis. 2021 Nov-Dec;25(6):101650
>> (D) Horta M, Ribeiro GJC, Campos NOB, de Oliveira DR, de Almeida
>> Carvalho LM, de Castro Zocrato K, et al. ICU Admission, Invasive
>> Mechanical Ventilation, and Mortality among Children and Adolescents
>> Hospitalized for COVID-19 in a Private Healthcare System. Int J Pediatr.
>> 2023;2023:1698407.
>>
>> 2
>> Campbell JI, Dubois MM, Savage TJ, Hood-Pishchany MI, Sharma TS, Petty
>> CR, et al. Comorbidities Associated with Hospitalization and Progression
>> Among Adolescents with Symptomatic Coronavirus Disease 2019. J Pediatr.
>> 2022 Jun;245:102–10 e2.
>>
>> 3
>> Sanchez-Piedra C, Gamino-Arroyo AE, Cruz-Cruz C, Prado-Galbarro FJ.
>> Impact of environmental and individual factors on COVID-19 mortality in
>> children and adolescents in Mexico: An observational study. Lancet Reg
>> Health Am. 2022 Apr;8:100184.
>
> In the interim, we are 100% prepared/protected in the "full armor of
> GOD" (Ephesians 6:11) which we put on as soon as we use Apostle Paul's
> secret (Philippians 4:12). Though masking is less protective, it helps
> us avoid the appearance of doing the evil of spreading airborne
> pathogens while there are people getting sick because of not being
> 100% protected. It is written that we're to "abstain from **all**
> appearance of doing evil" (1 Thessalonians 5:22 w/**emphasis**).
>
> Meanwhile, the only *perfect* (Matt 5:47-8 ) way to eradicate the
> COVID-19 virus, thereby saving lives, in the US & elsewhere is by
> rapidly (i.e. use the "Rapid COVID-19 Test" ) finding out at any given
> moment, including even while on-line, who among us are unwittingly
> contagious (i.e pre-symptomatic or asymptomatic) in order to
> "convince it forward" (John 15:12) for them to call their doctor and
> self-quarantine per their doctor in hopes of stopping this pandemic.
> Thus, we're hoping for the best while preparing for the worse-case
> scenario of the Alpha lineage mutations and others like the Omicron,
> Gamma, Beta, Epsilon, Iota, Lambda, Mu & Delta lineage mutations
> combining via slip-RNA-replication to form hybrids like "Deltamicron"
> that may render current COVID vaccines/monoclonals/medicines/pills no
> longer effective.
>
> Indeed, I am wonderfully hungry (
> https://groups.google.com/g/sci.med.cardiology/c/6ZoE95d-VKc/m/14vVZoyOBgAJ
> ) and hope you, Michael, also have a healthy appetite too.
>
> So how are you ?
>
I am wonderfully hungry!

Michael