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Comment by dcolkitt | Hacker News Reader

This headline is definitely a lot scarier than the actual body of the study.

The most likely cause of the heart damage by far is the systemic inflammation induced by pneumonia. We know this because pneumonia patients of all types often have heart strain afterwards[1]. But that damage is very rarely permanent as the risk subsides back to baseline given enough time.

Until we see evidence of heart issues in patients without pneumonia complications, we shouldn't be any more scared of covid-19 as we were before. In particular young and healthy people still have very little risk from infection. Patients who recover without serious complications should not be afraid of hidden heart damage.

[1] https://www.health.harvard.edu/heart-health/heart-attack-ris...

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> Until we see evidence of heart issues in patients without pneumonia complications

That's exactly what they're seeing, and why this article was written:

"An initial study found cardiac damage in as many as 1 in 5 patients, leading to heart failure and death even among those who show no signs of respiratory distress."

Unfortunately the article doesn't say what percent of people with cardiac damage did not have respiratory issues as well.

From the article:

Patients who had heart disease before their coronavirus infections were much more likely to show heart damage afterward. But some patients with no previous heart disease also showed signs of cardiac damage. In fact, patients with no preexisting heart conditions who incurred heart damage during their infection were more likely to die than patients with previous heart disease but no COVID-19-induced cardiac damage.

Isn't it likely that the patients who had no preexisting heart conditions actually had undiagnosed preexisting heart conditions?

Yeah, this logic is used often in epidemiology, and this thought comes to my head every single time.

We also don't probably know all the possible heart conditions out there!

Finally, while someone might not have a condition (disease), they also might not have good function of the heart, this is not considered a pre-existing condition. This tends to happen with people who are overweight, leading to arteriosclerosis, but since the norm has moved so far in one direction, our criteria for disease might have moved as well.

Finally, the lungs and heart work in coordination to bring oxygen to the rest of the body. If the lungs stop functioning (which may not have direct symptoms that we expect)... I think it's pretty easy to fill in the rest.

That's circular logic. If patient A dies of heart failure during a covid-19 infection, you should not be concluding that the patient likely had a heart issue prior to the covid-19 infection.

Sure, it might be the case, but you cannot draw any conclusion here unless you compare it to other pneumonia cases.

The heart damage would be more meaningful in patients who have had clean EKGs prior to being diagnosed with covid-19. Here in the US covid symptoms are most likely causing a good number of adults to see a doctor after decades of no medical checkups or for for the first time.

Your second statement undermines your first.

No, I don't think they do. Can you be more specific?

Worse than undiagnosed, they are unmanaged preexisting heart conditions.

If two people have similar heart damage but one knows about it and manages the hypertension that caused it, who is in worse shape if a disease adds stress to your system?

Hospitalization rates for people aged 20-44 are in the range of 15% to 20%. You might want to read up on the experience of COVID-19 hospitalization before you decide that there's little risk from infection.

https://www.statista.com/statistics/1105402/covid-hospitaliz...

That is percentage of confirmed cases that wind up with hospitalization.

However we mostly don't try to confirm cases if it won't affect the care we give. We just tell them to self-isolate. We therefore will not have good statistics on what percentage of cases are confirmed until after the immediate crisis is over and we test to see how many have antibodies.

So your figure is, "Of young people who have it severely enough to get tested, 15-20% get hospitalized." This says nothing about what fraction of cases are severe enough to get tested.

Also note that we undercount deaths. If a person dies and was never confirmed to have COVID-19, they are also not counted as a COVID-19 death. Nobody knows how big this undercount factor is.

All good points. But paulsutter's message remains: young people are at significant risk. Yes, the risk for older people and those with pre-existing conditions in higher. But the parent poster's characterization of the risk for young people as "very little" is dangerous.

This is also why I don't really like that some propose various "herd immunity" schemes - we simply don't know what the virus actually does to people in practice, even if it does not outright kill them. So it seems very irresponsible to propose schemes like that at this point in time.

Exactly. I know I'm waiting until they have herd immunity available for everyone.

The 15-20% number is very stale. The current numbers are under 3% across that cohort: https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

0–9 years 0 13 0·00% (0·00–0·00)

10–19 years 1 50 0·0408% (0·0243–0·0832)

20–29 years 49 437 1·04% (0·622–2·13)

30–39 years 124 733 3·43% (2·04–7·00)

40–49 years 154 743 4·25% (2·53–8·68)

50–59 years 222 790 8·16% (4·86–16·7)

60–69 years 201 560 11·8% (7·01–24·0)

70–79 years 133 263 16·6% (9·87–33·8)

≥80 years 51 76 18·4% (11·0–37·6)

More detail on above: published March 30th, the percentages are expected hospitalisations based on total population of infected (including mild/asymptomatic usually untested).

Data is from Table 3 near end of paper, table title: “Estimates of the proportion of all infections that would lead to hospitalisation, obtained from a subset of cases reported in mainland China“

I'm not sure I buy it as we don't have any idea how many people actually have the disease. I have to assume the denominator is of those tested, X% required hospitalisation. If it is those confirmed to have the disease, and because clearly the whole population hasn't been tested the results are skewed as we only test people with severe symptoms.

Right those population level samples only started on a limited basis in a few areas last week. For now the actual denominator is a total unknown; the range of upper and lower bounds is so wide as to be effectively useless for planning.

> The most likely cause of the heart damage by far is the systemic inflammation induced by pneumonia

Isn’t this premature given the lack of data?

We’re seeing an anomaly documented and being studied. It’s not cause for alarm. But neither does it merit such dismissal.

Perhaps you are correct that this is not a cause for alarm, but the way the headline and the first few paragraphs are written, it seems the author is trying to induce anxiety in people reading it, presenting heart damage as inevitable and factual.

I don't think it's premature, no. We have a lot of data indicating that it's a respiratory disease. It should be studied, almost any coronavirus anomaly is worth studying, but we know what conclusion to expect.

Based on all the YouTube videos by doctors I've watched, heart failure is a known, expected and quite common consequence of severe respiratory disease.

I would find a better authority than 'youtube doctors' for the health of anyone you love. Some are great, but all are in it for attention. The ultimate motives of many online attenion seekers, no matter their profession are, lets say, unclear.

They are better then random programmers on HN who think respiratory disease can't be linked to heart problem due to respiratory in name.

I don't think anyone's denied that respiratory diseases can be linked to heart problems. The question is whether they're linked through the normal mechanism of systemic failure, or if the coronavirus specifically targets heart tissue as the doctor in the article suggests.

I would not describe teachers or those who post on HN as "in it for attention". Though I have not posted on youtube, I see no reason to describe those who have as attention seekers.

agree on the overall point, but the ultimate motve seems plainly clear to me: stature and esteem. it's an underlying motive too widely shared among the animal kingdom to assume otherwise.

whether any given youtuber deserves that stature and esteem is certainly unclear, as that takes direct observation of the person over time to ascertain.

There are doctors on the front lines who would disagree. See interview of Cameron Kyle-Siddell: https://www.medscape.com/viewarticle/928156 Other info on Twitter: https://twitter.com/cameronks

There are plenty of dead young people. 1 in 500 from most data. I personally wouldn't describe that as low risk

Due to the fact that there's not a good agreed upon standard as what counts as a "covid19 death", there's absolutely no way you can draw any sort of meaningful death rate.

I.e. in Connecticut, there was a "covid19 infant death". Except that infant died at home due to a horrible accident. Arrived at the hospital deceased. Postmortem, was tested and coronavirus positive, therefore was counted as "Covid19 Death" and "infant dies of coronavirus!!!" in the news.

Death rates and case numbers are terribly skewed, and the data we have is abysmal.

CDC just massively changed the definition of what a "positive" case means. PCR tests have a notorious accuracy problem, so previously the definition of a positive case was consecutive positive PCR/RT-PCR tests.

Now the definition has changed to "if any test has ever come back positive, then positive".

To be clear, this new definition means that if you test positive, then have two consecutive negative tests, you're still counted as a positive case.

Just this redefinition could account for a large part of the increases in "positive" cases we're seeing.

Couple this with allocation of funds and resources based on positive cases and death totals, and you have a situation where it's in everyone's best interest to inflate the numbers as much as possible.

We saw the same issues during HIV/AIDS "crisis".

Be very skeptical of any numbers, rates and data you're seeing. At this point, the CDC and state agencies are refusing to publish their source data (which is very strange).

So then similar kinds of damage should occur in flu-induced pneumonia patients. (if those assumptions are true, etc)

myocarditis can happen from any virus infection it doesn't have to involve pneumonia

lots of young athletes die from it after coming back too hard/fast from flu

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