09 November 2021

Public Service Message: Your healthy toddler / preschooler / grade schooler is at almost zero risk from covid

 COVID 19 is real.
It has killed a lot of people.
It has made a lot of people sick.
Vaccines are good. 
I am vaccinated.  

In the world wide panic over this new pandemic, however, we, collectively, seem to have conflated several facts which, independently are all accurate.

- COVID spreads faster than most deadly diseases.
- COVID has a high rate of hospitalizations in certain high risk groups, specifically the elderly, and those with known, serious health issues, such as heart disease, cancer, or diabetes.
- Middle aged people with no known health condition, occasionally get very sick, and in rare instances even die from COVID
- Young people sometimes catch covid.

From these facts has come the belief that children are at high risk due to the COVID epidemic.

It is easy to see, if one gets information from the news or any other media source, how this mistake would be easy to make - those rare exceptions get a lot of attention.  Even if you go straight to the original data sources, it can be difficult to get to the truth, because almost no one publishes data on age, preexisting health issues, and severity of outcome, independently.

I came across a way to conceptualize the risk by age in a way that makes sense, intuitively: 
Just think about the risk of dying of heart disease.

Like covid, heart disease kills people of all ages, and like covid, its prevalence gets exponentially larger as the age of the person increases.  Kids sometimes have heart disease, but it is really rare.  Middle aged people do on occasion, and the elderly die of it quite often.
As it turns out, the relative rates of death by covid and heart disease are actually reasonably close all throughout the curve.

Here are some actual hard numbers, comparing the risk for a healthy person of each age group of dying of covid, and comparing it to the rate of overall death due to heart disease as well as the death rate due to car crashes.

A 0.01 rate translates to a 0.00001% chance, or 1 in ten million. There's twice as good a chance of dying from getting hit by lightning. 

Note that the numbers for adjusted covid risk are actually likely to be generous.  The reason for this is that I simply can't find reliable data for the percentage of cases that have known major pre-existing health conditions, by age.  All sources that mention it agree that those with them are "over represented", or that "most" cases have them.  Some sources find a rate of 100% among young children, others 50% among all "children", which includes 15-18 year olds.  One CDC report finds the rate to be 94%.
Overall, including the full population across all ages, the comorbidity rate (the percentage of people who have at least one other contributing factor besides covid as a cause of death) is actually 94%, although it is unclear what percentage of those were necessarily pre-existing (vs caused by covid).

The people who collect the data simply don't release the source material granularly enough to answer the relevant question.  Overall, from all the data I can find, the overall average rate of all covid deaths (across age groups) who had preexisting major health issues (things like cancer, neurologic conditions, or diabetes, not just obesity or asthma) ranges somewhere from 70% to 100%.
It seems likely that that rate increases as age decreases.
However, to err on the side of caution and be generous with my assumptions, I take the lowest estimate, 70%, and applied it across all age groups.  
In other words, when you look at the risk data for the whole population, and you want to apply it to yourself or a loved one, and that person does not have any preexisting major health condition, you have to correct for that.  The rate of covid deaths per 100,000 population of 0.03 among all young children translates to a rate of 0.01 when you subtract the 70%.  
That is what is reflected in the 3rd column, marked "adjusted".  It represents the overall risk of covid for a healthy individual of that age.  

It does not take into account local rates or outbreaks, vaccination rates, gender, time variances, etc, but the truth is, while those factors affect the numbers, none of them affects them anywhere close to as much as age.  The countries with the least and those with the most fatalities both have the exact same age curve, and the safest places still lose more elders to covid that the highest case count countries lose young children.  Depending on what sources you search for, you may find different numbers and adjust mine slightly up or down, but it won't affect the overall point.

One of the most significant things to notice is that at nearly every age group, there is a better chance of a random person dying of heart disease than there is an otherwise healthy person dying from COVID.
Of course, in one sense this isn't a "fair" comparison, because the person who dies of heart disease obviously has a major health condition (heart disease), but the point is to help conceptualize the relative risks.  We understand intuitively that a relatively healthy 80 year old has a decent chance of having a potentially fatal heart attack, but this is not something that even crosses our minds to worry about in our children.  No one suggests grade schoolers should take daily aspirin or that its critical that preschools have automated defibrillators on the walls for easy access, because the chances of an otherwise healthy child suddenly having a heart attack, while not zero, are vanishingly low.

This is exactly how we should be thinking about covid, because the risk vs age curve is almost exactly the same.  In fact, the age range of 1-10 is actually 125 times more likely to die of heart disease than from COVID.  
At any age group, if you aren't worried about heart attacks, you shouldn't be worried about covid, because your risk of heart attack is lower than your risk of covid.

That same age group is 367 times more likely to die from a car crash!  Car crashes outcomes don't vary by pre-existing conditions, so this is an even more direct and relevant comparison.  Think about how many hours your child has spent in a car, how many miles, how many trips.  If this is something you can allow, and still sleep at night, it makes absolutely no sense to change anything about your life specifically to shield your child from the risk of covid.  In fact, the risk of covid doesn't eclipse the risk of car crashes until you reach middle age.

One last thing.  A lot of people acknowledge healthy children almost never die of covid, and hospitalization are extremely rare (the rate of hospitalization in the 1-10 age group is 0.06, or 0.15 adjusted) - but they worry about so-called "long covid".
While there has been a lot of reporting about it, and a small but percentage of children self-reporting symptoms, the few legitimate independent studies of the issue demonstrate rather conclusively that it does not actually exist.  The symptoms described by those who supposedly have long covid are exactly the same, and occur with the exact same frequency in those children who have had covid and those who (confirmed by testing) have never had it.
In other words, covid has nothing to do with it.  
Every study or report which claims to have examples of long covid in children doesn't bother to actually check for similar "symptoms" in children who never had it, and without this most basic control of every valid scientific and medical study, their conclusions are worse than completely worthless.  
They serve to validate people's fears while maintaining a false air of scientificiness, generating lots of views and clicks (and ad revenue) while causing people to be less informed and less able to make objective risk calculations.

It is easy enough for us to all see how transparently anti-maskers and anti-vaxxers are really just being loyal to former president Trump and the ideology of conservatism in general, and yet we seem to have quite the blind spot to just how much of the extremeness a reaction we have to this situation is driven by the exact same political loyalty, just in the opposite direction.  You wear a mask when walking alone on an empty street not because there might be covid wafting on the breeze, but so that anyone who might drive by or look out their window and see you will realize you are one of the Good people who didn't vote for Trump.  We've internalized so much that it's hard to be objective about any related issue, and suddenly this disease which pretty much just affects the elderly and the already sick in any significant numbers is the number one threat to our vulnerable children.
Except the reality is it just isn't.  

It's important to take some basic precautions to avoid children getting COVID, because they can be carriers, and spread it even though they themselves may have only minor symptoms or be entirely asymptomatic, and that can be dangerous for the more vulnerable people they may in contact with: grandparents, teachers, any one they spend time around who is older than 60 or has health issues, and because the more covid spreads generally, the more likely high risk groups end up exposed.

But don't be careful for the sake of protecting the children themselves. 
If you want to be really careful, and avoid exposing your child to risk of death or serious injury, stop allowing them in motor vehicles.

You don't have to take my word for it.
Here is a bunch of information:

"Our report found a mortality rate of zero among children without a pre-existing medical condition "

"Six of the children [in England] who died due to Covid-19 didn’t appear to have an underlying health condition, researchers said."

"Our report found a mortality rate of zero among children without a pre-existing medical condition "


"Between January 4, 2020 and January 2, 2021, there were 105 deaths attributed to COVID among children under 15. To put this in context, there were 26,273 total deaths in this age group from all causes over this period"

"Being a child aged 1 to 17 is 99.9 percent protective against the risk of death and 98 percent protective against hospitalization"

“Your Unvaccinated Kid Is Much Safer Than a Vaccinated Grandma.”

"94% of patients who died from COVID-19 had complicating conditions"

"Among patients aged ≥19 years, the percentage of non-ICU hospitalizations was higher among those with underlying health conditions (27.3%–29.8%) than among those without underlying health conditions (7.2%–7.8%); the percentage of cases that resulted in an ICU admission was also higher for those with underlying health conditions (13.3%–14.5%) than those without these conditions (2.2%–2.4%) (Table 2). Small numbers of COVID-19 patients aged <19 years were reported to be hospitalized (48) or admitted to an ICU (eight). In contrast, 335 patients aged <19 years were not hospitalized and 1,342 had missing data on hospitalization. Among all COVID-19 patients with complete information on underlying conditions or risk factors, 184 deaths occurred (all among patients aged ≥19 years); 173 deaths (94%) were reported among patients with at least one underlying condition."

If you’re the parent of a high school student with no preexisting conditions, your child’s chances of dying from Covid-19 (if they even get it) is about 1 in 100,000. If your child is under 11 years old, the odds are literally 1 in a million.