Large study from South Korea on transmission from children

4,427 Views | 41 Replies | Last: 5 yr ago by HotardAg07
HotardAg07
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AG
You will see this discussed a lot in the coming weeks in the school reopening debate. If you wanted to see the conclusions without the media filter, read here:

https://wwwnc.cdc.gov/eid/article/26/10/20-1315_article

The primary conclusions are that young children 0-9 do transmit at half the rate of adults but the 10-19 group may transmit equal or higher to adults.
cone
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counter point

HotardAg07
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I posted the study so you can read it in entirety and make your conclusions without the media and pundit lens. They discuss their process, limitations, etc. It does seem to be the largest and most robust study of its type.
CompEvoBio94
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That's a very weak counterpoint.

It is not terribly surprising that a small fraction of index cases would be <20 years old. Presumably, the international travelers are most likely to be index cases. Additionally, younger people are less likely to be symptomatic, so there is probably a bias against detecting them as index cases.

There are plenty of caveats to the study (as noted in the study discussion of the paper itself). But low fraction of young people among the index cases does not run counter to the idea of 10-19 year olds spreading the virus at a rate similar to adults.
culdeus
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10-19 is a huge range. I know there are difficulties in breaking it down further, but still.

This is seemingly being proven out here where day cares are seeing few cases but summer camps where older kids are in the mix are spreading this thing bigly, and college kids are just factories for the stuff.

Once case counts go down you might see a push to start with the elems for a time.
fat girlfriend
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What I think is hard to figure:

closing schools but leaving restaurants open and playing youth sports and having daycare.
Player To Be Named Later
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I can somewhat wrap my head around elementary aged kids possibly not spreading this thing as much..... although it just doesn't make a lot of sense since they spread every other damn germ known to man back home to everyone in the house.

Now middle school and high school kids? No reason to think they wouldn't spread it any less than an adult.
eric76
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A local woman has covid-19 as does at least one of her kids. Her ex-husband also has it. And his new wife and their two kids.

I don't think that the woman and her ex-husband get close at all. It seems to me that the kids are the most likely vector between them.
Player To Be Named Later
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Our school district looks like they will offer the choice of online or in person. Parents will need to make that choice by a certain date, and it's for the year. Doesn't sound like bouncing back and forth.... want to go in person? You're going all year.... and vice versa.

I think I like it... let the families who are certain their kids won't spread it send their kids to school all year. Those who aren't sure, or who have high risk kids/family members, can opt out.
CowtownEng
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Player To Be Named Later said:

Our school district looks like they will offer the choice of online or in person. Parents will need to make that choice by a certain date, and it's for the year. Doesn't sound like bouncing back and forth.... want to go in person? You're going all year.... and vice versa.

I think I like it... let the families who are certain their kids won't spread it send their kids to school all year. Those who aren't sure, or who have high risk kids/family members, can opt out.


This response is Chuck Todd level smarmy.
deadbq03
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fat girlfriend said:

What I think is hard to figure:

closing schools but leaving restaurants open and playing youth sports and having daycare.
I'm probably skinning this from the opposite side, but yeah the inconsistency is brutal.

Another one: Masks are mandatory in public, but you can take it off and sit in a confined space sharing circulated AC with others if it's inside a restaurant.

It was even dumber in CA - mandatory masks but bars open.

Regardless of what someone thinks about Covid, these mixed-measures are confusing and frustrating. If Covid is a big deal, the restaurants and bars ought to be closed; if it's not, then there's no need for masks... you can't really have it both ways.
cc_ag92
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We know why they're open. The business community demanded it.

The leadership has been so mixed and jumbled from the very beginning. It's no wonder we're all confused.

I will note that it is more possible to socially distance within a distance than in a classroom. when the restaurants are at 50% or 75%. There's no way to skip desks in a classroom when classroom caps are not changing.
Keegan99
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AG
The study authors GUESSED at the direction of transmission. You CANNOT do a study that purports to make conclusions about direction of transmission where you begin by guessing at direction of transmission.

In Iceland they actually sentenced sequenced virus genomes and determined the direction of transmission.

The Iceland study, based on much more robust research, reached the opposite conclusion.


Keegan99
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AG
Also, age is a continuous variable. Binning 10-19 is suspect. A 10 year old is nothing like a 19 year old.

And as others have said, there is a small n problem.

The primary reason why the number of suspected index cases for children is so low is because so few show serious symptoms. The mere fact that the suspected count of "index cases" for children and teens is so low refutes the claim. It's a conditional probability problem.

Keegan99
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The Iceland study.






The Iceland study actually did serious lab work. This Korean study? Not so much.
HotardAg07
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Keegan99 said:

The study authors GUESSED at the direction of transmission. You CANNOT do a study that purports to make conclusions about direction of transmission where you begin by guessing at direction of transmission.

In Iceland they actually sentenced sequenced virus genomes and determined the direction of transmission.

The Iceland study, based on much more robust research, reached the opposite conclusion.





They didn't guess, Keegan. Read the thread for the full explanation, but tbh the explanation was right there in the paper if you didn't pick and choose what you were reading for.

Keegan99
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They played with numbers. And for teenagers, it was a very small set of numbers that could be influenced by chance.

They did not do lab work.

Iceland did lab work.
Keegan99
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Also, Bergstrom lost ALL claim to objectivity when he mocked Levitt and implied that Levitt was stupid - and then Levitt turned out to be right.

He's not interested in truth.



Keegan99
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AG
We also don't even know if the household index cases are true index cases. Given the varying incubation period, a teenager might show symptoms prior to an adult despite the presymptomatic or paucisymptomatic adult being the source.


Again, Iceland proved direction with genetic sequencing.

In terms of robustness, this is tissue paper. The Iceland study is sheet metal.
Keegan99
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Another issue with the study is the odd gap between the household and non-household rates for the 10-19 bin.

If they were transmitting more, why no similar bump in the non-household rate?




That uncharacteristic bump likely means one of a few things:

* Teenagers really do transmit intra-household more than both younger and much older cohorts, but mysteriously do not do so outside the home.

* There is an influence of chance in the small sample.

* The direction of transmission is backwards, and teenagers were incorrectly identified as "index cases" for households.
HotardAg07
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Keegan99 said:

Also, Bergstrom lost ALL claim to objectivity when he mocked Levitt and implied that Levitt was stupid - and then Levitt turned it to be right.

He's not interested in truth.






He literally said "maybe they are"

Later, he admitted Leavitt was right:


And would you like me to pull tweets from Leavitt where he was wrong? Does that make everything he says not worth reading?
Keegan99
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The UK'S s top pediatrician sees similar flaws.











A professor at the Harvard School of Public Health? Likewise.

Keegan99
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It's not that Bergstrom was wrong. It's the lack of professionalism and mocking tone. Without thoughtful and respectful consideration, he publicly tsk-tsk'd Levitt's work and publicly implied that a Nobel Prize Winner was stupid.
CompEvoBio94
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Is there a published paper or preprint on the Iceland outbreak that focuses on transmission rates?

Gudbjartsson et al (https://www.nejm.org/doi/full/10.1056/NEJMoa2006100#article_supplementary_material ) looks to be a very nice paper, but the age-related analyses seem to focus on test positivity rather than transmission. That is probably because the sample size is much smaller than the S. Korean paper (1,221 positive people vs 5,706 index cases).

Also note that Figure S6 of the Gudbjartsson et al paper:
https://www.nejm.org/doi/suppl/10.1056/NEJMoa2006100/suppl_file/nejmoa2006100_appendix.pdf#page=20
seems to give a take-away message that the teenagers look pretty much like adults. So, that makes it seem like there is not much of a difference between the Park et al paper on S. Korea and the published work on Iceland. (Note: that figure depicts a stepwise regression where they included an effect for age 10 and under; it is not a test formal test of whether or not teenagers have identical susceptibility to SARS-CoV-2 as older folks. Also note that the figure is % that test positive, not transmission rate).
Keegan99
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Age is a continuous variable, so I think we need to define "teenagers".

Risk of infection and transmission increases with age. That's pretty well understood, I think?

The primary issue with the Korean paper is, as stated above, the indication that the 10-19 age bin transmits with the same efficacy as the 70-79 age bin. And they only do so in the home. Their rates of community transmission are smoothly in line with surrounding age cohorts. That points to a significant error.


I'll see if I can find the Icelandic study. Stefansson has made public statements about confirmed transmission direction from the sequencing.
CompEvoBio94
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Both the Icelandic prevalence data and the Korean transmission data indicate lower risks for the 0-10 age range. I agree with that, and that seems to be good news for day car and elementary schooling.

Age is continuous, but there is no real reason to assume that the risk of infection is linear. It could look quite a bit like a step function. I don't think we have have enough data to known the shape of the function that maps age to risk of transmission for people in the 10-20 age range.

I agree that it seems somewhat unlikely that viral load and transmissability spikes in the teenage years and then again later in life. The confidence intervals for the transmission rate for 10-20 year olds in the Korean paper are fairly wide. I think it is plausible that for after some age (12?, 11? I don't claim to know), they basically transmit like adults. I'm willing to be convinced otherwise, but I haven't seen much evidence (e.g. the supplemental figure from the Icelandic paper doesn't make it look like the teenagers are much different from the 20-30 year olds). But I certainly haven't read many COVID papers, so I'm not claiming that "if the evidence exists, I'd know about it"

TBH, my guess (and it is not much firmer than a guess) would be that the high point estimate of transmission for the 10-20 age range in the Korean study is a combination of (1) sampling error, and (2) the fact that a lot of those folks spend a lot more time indoors in multi-person homes compared to the 20-29 year olds. That would increase their chance of transmitting to household members, but no difference in transmission outside the home.

Edit: missing word corrected. "after age" -> "after some age"
bay fan
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S
deadbq03 said:

fat girlfriend said:

What I think is hard to figure:

closing schools but leaving restaurants open and playing youth sports and having daycare.
I'm probably skinning this from the opposite side, but yeah the inconsistency is brutal.

Another one: Masks are mandatory in public, but you can take it off and sit in a confined space sharing circulated AC with others if it's inside a restaurant.

It was even dumber in CA - mandatory masks but bars open.

Regardless of what someone thinks about Covid, these mixed-measures are confusing and frustrating. If Covid is a big deal, the restaurants and bars ought to be closed; if it's not, then there's no need for masks... you can't really have it both ways.
I don't completely disagree with you but the reality is, if you are pre symptomatically contagious and wear a mask half the places you go, you are spreading fewer germs half the time. It's not the all in we need but it's better then nothing. Personally I think we bungled this terribly. We got pretty close to a decent outcome but reopened far to quickly so we ended up with shutting down in April/May for basically nothing and now have a ruinous problem As we can't commit to Re open or shut down.
cone
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it's as if there wasn't an economic imperative driving the reopening
deadbq03
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I agree something is better than nothing and politicians have to take what they can get. It's just frustrating. Pardon my venting.
GAC06
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What cone said. Shutting down until the virus was gone was never an option. If anything we shut down far too long.
WoMD
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deadbq03 said:

fat girlfriend said:

What I think is hard to figure:

closing schools but leaving restaurants open and playing youth sports and having daycare.
I'm probably skinning this from the opposite side, but yeah the inconsistency is brutal.

Another one: Masks are mandatory in public, but you can take it off and sit in a confined space sharing circulated AC with others if it's inside a restaurant.

It was even dumber in CA - mandatory masks but bars open.

Regardless of what someone thinks about Covid, these mixed-measures are confusing and frustrating. If Covid is a big deal, the restaurants and bars ought to be closed; if it's not, then there's no need for masks... you can't really have it both ways.

Bars are all closed again.


A better example would be when using California (there are so many to be honest) - mandatory masks but "protesting" and rioting outside is still allowed. Thankfully, now inside protesting is no longer allowed, so this should allow us to flatten the curve effectively.

The fact that people here are blaming EVERYTHING except the protests is amazing to me. I just don't get how they can defend this with a straight face.
deadbq03
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GAC06 said:

What cone said. Shutting down until the virus was gone was never an option. If anything we shut down far too long.
I agree. In fact, I don't think we needed a full shutdown at all.

But we did need a commitment and plan much earlier than we got one. The full shutdown was a lazy overreaction after waiting too long.

And then the full reopen was a lazy overreaction to the full shutdown.

Now the pendulum is swinging the other way...
GAC06
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We didn't have a full reopen. Restaurants were at 75% and bars at 25% before we went backwards right? Still no sports or large gatherings
cone
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the early shutdown bought time and the ability to learn more during that time

but it was always going to have a ticking clock attached to it

we decided to use it early and everywhere. but it's not something that really can be prolonged or repeated
deadbq03
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GAC06 said:

We didn't have a full reopen. Restaurants were at 75% and bars at 25% before we went backwards right? Still no sports or large gatherings
We didn't technically have a full shutdown either but I'm sure you knew what I meant.
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