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Comment by GhostVII | Hacker News Reader

The team reviewed 662 MIS-C cases reported worldwide between Jan. 1 and July 25

So does that mean there are only a total of 662 cases reported worldwide? Because if so, this doesn't seem to be a significant issue.

Edit: yes, it seems like there are only a few hundred cases in the US [0], not a significant risk. I've seen this article in a few places and everyone seems to interpret it as saying a significant portion of children have a damaged heart after COVID, which just isn't true. Not a problem with the article, just peoples critical thinking skills.

[0] https://www.cdc.gov/coronavirus/2019-ncov/covid-data/infogra...

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I don't think anyone is systematically screening positive COVID cases for this kind of damage. The 662 is the severely affected ones that end up in the ICU, but how many others have inflammatory damage?

You don’t need to systematically screen for it. MIS is obvious and dramatic when it occurs.

Probably a lot, but mild heart inflammation just isn't a very big deal. It's a common complication of viral diseases in general.

Yep, but this syndrome happens weeks AFTER disease, so it's causes by some kind of damage to tissues, not by virus or toxins directly.

Can your sources? This differs from things I have been reading.

From linked article:

> Case studies also show MIS-C can strike seemingly healthy children without warning three or four weeks after asymptomatic infections, said Alvaro Moreira, MD, MSc, of The University of Texas Health Science Center at San Antonio. Dr. Moreira, a neonatologist, is an assistant professor of pediatrics in the university’s Joe R. and Teresa Lozano Long School of Medicine.

You're currently in the comments section of a hacker news post of a source on the syndrome occurring weeks after infection.

I don't see how the tissue damage taking weeks to accumulate to the point of medical emergency means the virus can't be the cause.

Is that true? It's my understanding that inflammation can persist for weeks after a disease or injury even without permanent damage.

Can you elaborate on how common is common? Also when does it become problematic?

Conventional wisdom in the literature is that about 10% of flu cases develop it. (one source: https://casereports.bmj.com/content/12/7/e228201?rss=1) I'm not aware of any rigorous data, because it's hard to detect.

It becomes problematic when the inflammation is unusually severe, although I believe that in practice it's just never diagnosed unless it's severe enough to impact your quality of life.

And very few young children have tested positive. People under 18 are in the tens of thousands, iirc- 662 is a LOT.

Very few young children present any meaningful symptoms meaning testing of them suffers from substantial adverse selection bias. 662 is probably rounding to zero.

Correct, 15% of athletes who shows some or no symptoms ended up with myocarditis:

https://www.nytimes.com/2020/08/23/sports/ncaafootball/colle...

If we screened kids who merely tested positive and found 15% had serious longer term reprecussions, how would this change opinion surrounding policy?

Careful, Myocarditis isn’t necessarily indicative of long-term heart damage. Mild myocarditis is not uncommon with any viral infection.

Myocarditis should be watched for, but it’s critically important that we discuss severity and relative occurrence rather than reducing the discussion to a binary yes/no.

Sadly, whenever you see a news article that omits specific statistics it’s prudent to check the facts. It’s easy to drive clicks by removing critical details to make side effects sound more permanent or more common than they are.

Is it common for Athletes to have to sit out the year because they caught the flu? Flu is so pervasive.

FTA:

”But as Daniels’s survey awaits the rigors of peer review, it has received scant attention, in part because Ohio State has refused to make public any testing data about its athletes”

So this is an unpublished, un-peer-reviewed paper where the data aren’t available. Basically, someone said something, and the New York Times reported it as fact. That’s simply incredibly irresponsible. So far we’ve seen one of these myocarditis scares debunked completely:

https://mobile.twitter.com/ProfDFrancis/status/1298499595056...

and just yesterday, the Penn State doctor had to apologize for admitting that the “30% of all athletes have myocarditis” headline he instigated was essentially hearsay:

https://www.google.com/amp/s/www.nj.com/rutgersfootball/2020...

We should be very careful about extrapolating any sort of pre-publication data in this area.

> Not a problem with the article, just peoples critical thinking skills.

I'd say it's a problem with the ways news outlets and articles in general phrase headlines. "Post-Covid syndrome" implies it happens after getting covid. Yet if you read the article: "[MIS-C], believed to be linked to COVID-19..."

So really headline should say something like: "MIS-C, a syndrome linked to <1% of children post-covid, damages children's hearts."

> MIS-C, a syndrome linked to <1% of children post-covid, damages children's hearts

There is also never causality discussed in all these post-covid syndrome articles.

With many millions of confirmed cases, you are guaranteed that some people who have had covid will get unrelated diseases later on after recovering. With <1% of cases linked I don't think this is worth worrying about.

They also leave out context. Regular old flu and other respiratory infections are leading causes of permanent damage resulting in asthma. So... How does this compare in quantity and scale?

Depends on your definition of "significant". That's a tremendous amount of lifelong morbidity that will affect those children around the world. They may need heart transplants, multiple surgeries, hospitalizations, etc. Just because it won't affect a lot of people doesn't suddenly make it insignificant.

When I say it is insignificant, I'm saying that it is not nearly as big of a problem as the other risks from COVID. When a million people have died from COVID, and millions of children have been infected with COVID, I view any COVID symptom that affects less than 1000 people worldwide as insignificant relative that.

Now it is very possible that we will realize that over the period of years, some significant percentage of children with COVID are affected by this. But so far the data doesn't support this.

This article appears to be a summary of the original paper. But, it leaves out some critical points - i.e.:

- The papers "Discussion" section concludes with: "MIS-C is rare but the potential long-term sequelae from this disease are currently unknown."

Also, the fact that it says:

- ”Children might have no symptoms, no one knew they had the disease, and a few weeks later, they may develop this exaggerated inflammation in the body.“ and then a few sentences later - "...100% had fever, 73.7% had abdominal pain or diarrhea, and 68.3% suffered vomiting."

Seems contradictory.

It’s not contradictory. The children experienced none of the typical COVID symptoms during their initial infection, which present themselves in 2-14 days. Hence, they’re categorized “asymptomatic.” Subsequent to the infection (3-4 weeks), they develop MIS-C, which manifests with the cited symptoms.

Just because it won't affect a lot of people doesn't suddenly make it insignificant.

It makes it put into context. Literally any virus, bacteria, fungi or parasite can cause myocarditis. There are about 200,000 cases of it per year.

https://www.mayoclinic.org/diseases-conditions/myocarditis

My friend’s eight year old daughter had a cold about 9 years ago that turned into myocarditis. A year on the heart transplant list using some unapproved device from Mexico to assist her heart beating, the a heart transplant, then rejection a couple years later and then a second heart transplant. From a cold.

I'm curious. I'm not aware of any ECMO or LVADS designed or made in Mexico. Do you know what it was called?

the pandemic is not over. information is limited. it is not possible to definitively draw this conclusion yet. it is possible it is significant.

The significant observation is that there is a possible pathway from Covid infection to MIS-C...

Maybe we're doing what we can, but I wish we were putting more effort into collecting data around mid to long-term effects and their likelihood because not knowing that makes it hard to make informed decisions.

My money is on this being between rare and uncommon because I'd expect to hear more specific reports on it. Widespread things surface a lot faster.

Until there is hard data that shows it is a significant problem, this is just more covid FUD. There are rare complications with pretty much every disease. Doesn’t mean it deserves to be a concern in term of public health.

Do you understand the difference between precautions, hedging, and FUD?

Pre caution. Pre. You can’t wait for all the data and then decide. That’s postcaution.

You’ll never ever have all the data. You can however once you have a statistically significant sample size say with a high degree of confidence and that’s completely sufficient.

It’s also fair to say there’s been an awful lot of fud. Not least is the whole “reinfections” business. Your immune system mounted a sufficient response to clear the virus and then just immediately forgot how? That would be an absolute novelty to medical science.

Plus at the same time we are told we must be locked down until there is a vaccine, which of course will only happen if we ever develop immunity!

Ahh but I’m sure it’s different when a doctor injects inactivated our attenuated viruses.

Could you help me understand how India, with 4x the population of the USA and almost no mask wearing, has 1/3 the cases of the USA?

Is it possible that your risk assessment of the virus is too heavily influenced by the confounding variable of your own personal fear?

Less consistent reporting of statistics, or fewer tests, or being at an earlier stage of spread, or effective contact tracing.

No test = No case

Indian politicians have mastered https://en.wikipedia.org/wiki/Electoral_fraud

https://www.worldometers.info/coronavirus/

How many cases do you need to get a statistically significant sampling? Somehow we know what SARS does to a human with just a couple hundred cases. At some point we’re going to have to say we have a pretty good idea. India alone has 4,000,000 cases.

But we don’t know what SARS would’ve done if it became a pandemic illness, because it’s a whole other set of conditions at that scale.

We’re not anywhere at the point where we have a clear picture of the long term health consequences of this disease because enough time has not passed since it began spreading.

This is an initial review of a troubling new complication. It will likely take years for us to understand it’s full effects, whatever they are or are not.

It's the same for a lot of things regarding COVID19. People treat all these complications as something really scary, ignoring the plenty of cases where people didn't even know they had any illness at all.

In reality, many folks are already living with significant nerve damage from HSV-1 and EBV (Epstein-Barr Virus -- common cause of mononucleosis), and that's kind of old news these days.

EBV/mono, for example, would often cause tiredness for months on end, due to the permanent Central Nervous System (CNS) damage. It's very common as well -- much more so than COVID19; the neverending tiredness as a result of mono is very common as well. Yet when was the last time EBV made the news?

> everyone seems to interpret it as saying a significant portion of children have a damaged heart after COVID, which just isn't true.

We don't know what percentage of children without this inflammatory condition have heart damage. In fact it's probably true based on the monitoring of college football players, we just don't know for sure yet.

Fwiw, there's a lot of conflicting information there. Even the doctor who was quoted with the 30-35% number based on Big 10 athletes said it was actually "closer to 10%" the next day once he was all over the news.

Original correction:

https://twitter.com/BonaguraESPN/status/1301644428025540608

Mayo Clinic doctor's who's been advising may sports leagues came out contradicting it.

https://twitter.com/MJAckermanMDPhD (there's a lot here in recent posts)

And here is a more complete interview with him as a followup to this a couple of days ago:

http://dailyorange.com/2020/09/mayo-clinic-doctor-advises-my...

Other team numbers that don't show any significance cases (in Clemson's case, 0 occurrences).

https://twitter.com/ADavidHaleJoint/status/13015813652389560...

NFL has also had zero (trying to locate that source).

You won't win.

A large portion of the internet is now of the thinking that 1 is too many. They will not admit it but they are anti-abortionists in their thinking and in their behavior. No matter what numbers or facts they see it does not change their emotional response - much like an anti-abortionist.

This large portion of the internet follows the media to find something new to be scared of each day. As soon as they find out a study or news article wasn't correct they latch on to the next study in an attempt to justify their fear.

This large portion of the internet also claims they follow "the science". They do not. They follow whatever scary story is in the news that day. As the days go by more and more facts pile up that this virus was never the threat we thought it was - yet they disregard it and continue to say they follow "the science".

More and more information piles up every day yet they don't change their mind or their position. Just like those anti-abortionists. Just like science deniers.

> They will not admit it but they are anti-abortionists in their thinking and in their behavior.

Between BLM and COVID, neo-puritanism is in full swing.

Neo-puritanism. Love it. Great term!

You got my upvote and support.

I've changed political parties because of it.

It's fascinating watching this madness take hold of the world and hear people actually say thinks like:

   "Don't think for yourself, let the experts do it for you"

   "I think people should be FORCED to do the reasonable thing"

These kind of ideas are becoming main stream now. Any questioning of the narrative or critical thought is demonized. Even if shown to be correct like Sweden. There are no more discussions, things are black and white. The threat of force whether via job loss or police action or censorship is ever present for thought crime. You are simply not allowed to have unsanctioned non main stream opinions anymore.

Cancel culture and PC culture have destroyed numerous careers in the court of popular opinion even if exonerated in the legal system.

Newspapers and media are censoring things at levels not seen in quite some time.

Brave new world were entering.

Democracy is at risk but not from where were being told.

I've moved into the "void" political and social party.

This article was submitted to HN a month ago. Got 9 upvotes. Too true and too real.

The Cancel Culture Checklist: Six signs that show you're not just being criticized; you're being canceled.

https://www.persuasion.community/p/the-cancel-culture-checkl...

What a great article. Thanks for posting. Recognize every single one of those in recent incidents.

What do you mean by the Sweden mention here?

I have a feeling you know what I mean. Easy to google as well.

Sweden has beaten Coronavirus with no mask law, with no quarantine, and their deaths per capita are on par with the average of Europe.

If you try to debate using an arbitrary categorization like 'nordic countries' please provide citations for why that arbitrary categorization is more useful than then comparisons with the category of Europe in aggregate.

I am not sure which way you are trying to portray it? Sweden as a good example or a bad one?

You pick one element of that context (no hard mask wearing rules) and conclude that it must be because of that when it's much more likely that other elements (or their combination) would explain the result. For all we know, if Sweden had a more stringent mask wearing rule they might have had even fewer cases and deaths.

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