Child Covid Deaths: A Tale of Two Studies
Contradictory papers examined
Two papers on covid deaths in children have been released in the same week.
Gurdasani et al
Ladhani et al
Two versions of reality
The two papers appear to be in complete contradiction to each other, the first states that covid has killed more children in the US than other infectious diseases while the second states that covid deaths in children are so rare that we should instead focus on protecting children from the harms of measures designed to cut transmission in children.
How did the authors explain their papers? Clicking on the first tweets leads to the full papers.
Shamez Ladhani on his findings that only 20 healthy children have died in the UK
Deepi Gurdasani on calculating covid to be a leading cause of death in children.
Time to take a look at the papers
Gurdasani et al
The methodology is clear, rate of death for covid is compared to other diseases. Differences between how diseases are grouped are explained.
The conclusion compares to other non disease causes of death as well as other infectious diseases. Limitations are explained regarding how deaths are reported in the US, concluding that excess death statistics suggest covid as a cause of death are under reported.
Deaths increased during Delta and Omicron, the reason given being that considerably more children were infected in these waves. It recommends vaccination for all children and measures to reduce transmission, in particular ventilation.
Ladhani et al
The paper began with 185 children. The authors then conducted a review process which decided that 104 of the 185 deaths were not due to covid. How was this determined?
“Where there was insufficient information to ascertain whether the SARS-CoV-2 infection contributed to the death, the authors discussed the case with the clinician responsible for the CYP’s care to decide the most reasonable classification.”
The authors state that many of the death certificates were missing at the time of analysis. While death certificates stated covid as a cause of death, the authors thought that not enough information had been provided for many to ascertain covid was the cause. They also decided that some death certificates stating covid to be contributory were actually unrelated to covid.
What information did they have to determine that more than half of the 181 death certificates had been completed incorrectly?
They then categorised deaths into healthy children and three categories of comorbidity. Definitions of which conditions are considered commodities look to be using the definitions used for vaccination. Parents of children with various conditions have criticised what appeared to be a more narrow list of comorbidity eligible for boosters compared to what was considered clinically vulnerable earlier in the pandemic.
Where covid worsened underlying conditions resulting in death after more than a 100 days were not counted as covid deaths. This appears to have also occurred with some deaths within the 100 days after infection limit.
The 81 deaths they have left after their review process is used to calculate the individual risk for healthy children. A table is also produced showing how it was determined that only 20 healthy children have died from covid.
The author also chose not to include deaths from PIMS-TS, a severe post infection condition that has led to a number of deaths in children. This is despite the fact covid has been acknowledged by the authors in other papers as a cause of PIMS-TS.
The omission of these deaths in a paper looking at deaths due to infection seems inexplicable.
The paper also references a previous paper by some of the authors that looked at a group of 150,000 children where no deaths occurred due to Alpha and Delta, it seems odd to make mention of this smaller data set from the summer of 2021 when the ONS data shows hospitalisations and deaths were higher than for the original Wuhan strain.
A disconnect
James Neill who does statistics work for the charity Long Covid Kids has raised concerns regarding the Ladhani et al paper when compared to the UK’s Official for National Statistics.
Media Coverage
Gurdasani et al is still a pre-print and has yet to receive any coverage at the time of writing this.
The publication of Ladhani at al was accompanied by coverage in the Telegraph.
Dismissing the deaths of those not deemed “healthy” had been an ongoing theme of the Telegraph that has supported a herd immunity strategy of mass infection and the Great Barrington Declaration. The paper has supported calls to halt the vaccination of children.
It might be asked why this is the first time anyone has decided that death certificates are not as accurate as a review panel using the judgement of their experience without direct access to the clinical notes.
A reminder of the papers stated limitations.
Is it likely that these children would have died anyway? Does flu or RSV infect as many children as covid?
If 10% of children are not deemed “healthy” then this is 1.5 million children who have been dismissed by the Telegraph.
Ladhani does recommend vaccination to protect children with underlying health conditions, however it should be noted that he has repeatedly spoken against the vaccination of “healthy” children in younger year groups.
It should be noted that unlike Gurdasani et al the authors have not recommended ventilation in schools as a means of protecting vulnerable children.
The opinion of those at UKHSA is that preventing transmission in schools merely displaces infection into younger age groups and does not reduce the total number of infections per wave. Ladhani has also argued that over 90% of child infections occur outside of schools and children are less likely to be the index case in a household than adults. He has also stated that “even if masks worked” they would merely “prolong the pandemic”
The authors of the study are responsibly for the evidence base used by the JCVI when it initially decided not to offer vaccination to 12-15 year olds. With this study being produced by those working with the UKHSA this paper will be used as justification not to follow the US in offering vaccination to the under 5s.
The offer of vaccination for children turning 5 since September 2022 has already been withdrawn in the UK meaning children will have to wait until they are 12 before they have the choice of vaccination. JCVI minutes also suggest that vaccination for 12-15 year olds could be reviewed in the future, it’s likely this paper will be used by at least some of the authors to argue for the halt of vaccination for this age group.
Finally, its worth noting that this is reoccurring theme, last year a similar paper was produced claiming only 6 “healthy” children had died from covid.
