Risk of myocarditis following sequential COVID-19 vaccinations by age and sex [pdf]
medrxiv.org
medrxiv.org
It reads:
> Despite more myocarditis events occurring in older persons, the risk following COVID-19 vaccination was largely restricted to younger males aged less than 40 years, where the risks of myocarditis following vaccination and infection were similar. However, the notable exception was that in younger males receiving a second dose of mRNA-1273 vaccine, the risk of myocarditis was higher following vaccination than infection, with an additional 101 events estimated following a second dose of mRNA-1273 vaccine compared to 7 events following a positive SARS-CoV-2 test.
This guy made a graph of their data, which makes it a little more clear:
As another commenter as has pointed out, the graph in question in included in the PDF version of this preprint (which you can see here: https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v...).
I want to add: "this guy" is Vinay Prasad, a professor of oncology at UCSF and an incredibly prescient thinker through the COVID-19 pandemic, and someone with whome I've had the joy to correspond and repeatedly be impressed by his straightforward, evidence-based, dry-witty way of thinking, writing, and speaking.
He's a significant up-and-come in medical science, without a doubt, and someone to follow if you are interested in science-based policy.
We had the pleasure of hosting an AMA with him on /r/lockdownskepticism which you may find enjoyable and educational: https://www.reddit.com/r/LockdownSkepticism/comments/m0ll33/...
Nobody denies lockdowns have damaging effects in other areas.
That leaves a discussion about what kinds of lockdowns are worth the benefits they bring. But seems to me the sub isn't geared towards finding that truth?
Just to check in with you - and this is honestly meant as a check-in and not an insult: do you realize how unabashedly privileged you sound? I ask this first because I know that for me, I often don't realize when I make statements that reflect my own privilege, and I find that when that happens, it's almost always a chance to learn something new and important. I hope that is the case here.
Let's look at how lockdowns _actually_ interdict spread:
I'm reasonably affluent. Long-time remote worker in a fairly elite engineering position. I am able to sit in my home and order everything I need delivered to me. I live in a two-generation household, and I'm the oldest. We are all at low risk for adverse outcomes from SARS-CoV-2. In fact, for us, the risk is statistically difficult to distinguish from any other year's circulating pathogens.
Meanwhile, the person delivering things to me (and thus entering and leaving dozens of restaurants and stores every day to obtain the things for me and my affluent neighbors) is far more likely to live with a higher-risk relative and also more likely to live in a three-generation home (which is a fairly dire situation in light of this pathogen).
Let's imagine that my delivery worker lives with his 82-year-old grandmother with untreated high blood pressure. For her, in contrast to me, the risk this year is _nothing_ like that resulting from a typical year's respiratory pathogens. It's perhaps as much as 100x higher. Her risk of hospitalization - which she is also less likely to be able to afford - may be as high as 10%, compared to my small fraction of a percent.
As the months go on, I'm "protected" from infection. Instead of being able to adjoin the cohort of the highest spread acuity and then isolate (which I believe is my civic duty as a low risk person, to protect my higher-risk neighbors), I have to wait a year or more for my inevitable infection.
But that's not the end of the world, right? I had to mostly socially isolate and work remotely for a while, cancel a bunch of trips, etc. But all in all, nothing to cry over.
Now: what about my delivery driver and his grandma? For them, my delay in getting infected comes at an enormous cost. Namely, it increases the overall chance that the high-risk members of their family will be infected. They might possibly be able to interdict infection across their three-generation household for a few weeks, but not for years.
Now perhaps you see the actual first-order impact of lockdowns: they don't simply "slow the spread", they actually break one of the most important tools humans have in our collective ability to fight infectious disease: our social proclivity to facilitate differences in spread acuity _by risk_. We are actually very good at ensuring that young, healthy people share pathogens and develop community immunity quickly.
By preventing that, we protect only those privileged enough among us to isolate more-or-less indefinitely. In other words, lockdowns don't change spread acuity, they just shift its stratification from being by risk (which is great for preventing adverse outcomes) to being by socioeconomic status (which is arguably the worst possible approach if the goal is to prevent adverse outcomes). My friend Jay Bhattacharya at Stanford refers to this situation as "let it drip" (a play on words in the face of "let it rip", a sophomoric slogan used by opponents of traditional vertical risk stratification).
So, what we're saying is that we can observe not only the collateral consequences of lockdowns (which of course are devastating), but also an undesirable impact in first-order effects: lockdowns which are long enough to decrease spread acuity in the low-risk tier also increase first-order death in the high-risk tier.
This is the reason that lockdowns (previously referred to as "quarantine of the healthy") are advised against in the published pandemic plans prior to 2019. By all means, go to Google Scholar (or your search engine of choice for scholarly material) and drive yourself down this memory lane. You'll be astounded and almost certainly come out the other end a lockdown skeptic.
What I'm saying is, is that lockdowns technically work. Keep everyone inside (including the delivery guy) and spreading will be reduced. Let's take this one step further. What if we could (hypothetically) isolate the entire planet for 1 month. We might just completely irradicate a whole bunch of deceases. But of course it would come at a cost.
Lockdowns are just one of the tools we have at our disposal. There's no doubt they work. Viruses don't spread telepathically. This in itself is nothing to be skeptical about. The only question is if the benefits outweigh the costs. A better name for the sub would perhaps have been: /r/lockdownpolicyskepticism
I doubt we'd eradicate any disease which is a significant threat to humankind with a month of isolation, for two reasons:
* In the case of many pathogens, there are extreme outliers who remain contagious for months (and of course with others, such as some retroviruses, it is normal to remain contagious indefinitely).
* There are sufficient animal reservoirs for many pathogens (including SARS-CoV-2 and influenza and many other respiratory pathogens) that, no matter how long humans isolate, they'll be exposed rapidly upon emergence.
> There's no doubt they work.
I'm not sure how you can say this, when a giant chorus of experts from all of the world's foremost institutions of medical research have expressed exactly this doubt.
I appreciate the exercise of your hypothetical, but even in the extreme case you present, it's far from clear that it will have an impact which reduces adverse outcomes. And in the real world, with its imperfections? I see no reason to believe that lockdowns have any positive impact, first- or second-order.
There's no doubt. It's scientific fact that the virus cannot spread when its host doesn't occupy spaces that other people do. Besides it being a "rain is wet" kind of thing, it's also backup up by scientific research.
The discussion is about what flavor of lockdown offers sufficient benefits that outweigh the costs. And if such flavors can be enforced.
Do I understand correctly that you are saying, for example, that lockdowns will somehow eliminate a virus from animal reservoirs? Or stop spread within a household? Or ameliorate rare but important cases in which a host remains contagious for much longer than is typical?
Horizontally interdiction is sometimes possible with pathogens with spread via the fecal-oral route, or STIs, or arboviruses, or hemorrhagic fevers, etc.
But a highly contagious respiratory pathogen with robust, worldwide animal reservoirs? I do not agree that it is "scientific fact" (whatever that phrase even means) that mere separation of humans can achieve a reduction in adverse outcomes (setting aside, as you rightly acknowledge, the collateral effects).
But you seem to be under the impression that there exists no form of lockdown that works. That's simply not true. We've already seen various real-world examples of successful lockdowns. China did them. New Zealand did so successfully in 2020. Italy did them when they were first hit.
Lockdowns simply work. The virus cannot spread between people that are isolated from each other. That's simple scientific fact. It's scientifically known how the virus transmits itself.
Take a simple experiment. 2 rooms opposing sides of the planet. 1 person in each room. 1 person infected. 1 person uninfected. There's simply no way the infected person can infect the uninfected person. They would need to get into contact with each other to allow the virus to spread.
If you keep the entire population locked up. If you implement a total curfew. Police the streets so that everyone stays inside. There is no doubt spreading will be reduced significantly. But we don't want to live in China.
So the question isn't if lockdowns work. They work perfectly. The question is what form of lockdown outweighs the costs to warrant putting them in place.
> We've already seen various real-world examples of successful lockdowns. China did them. New Zealand did so successfully in 2020. Italy did them when they were first hit.
This is absolute, total nonsense. Neither China nor New Zealand have implemented anything resembling a successful strategy in anything but the very short-term. Both are still dealing with this virus, and are _further_ from endemic equilibrium than Florida and Sweden (which also made terrible mistakes obviously).
> Take a simple experiment. 2 rooms opposing sides of the planet. 1 person in each room. 1 person infected. 1 person uninfected. There's simply no way the infected person can infect the uninfected person. They would need to get into contact with each other to allow the virus to spread.
I don't understand how you can tell this story when it is so obviously empirically false.
There were _zero_ infected people only two years ago. Now there have been billions of cases.
It seems that you don't really fully believe in germ theory? Or something?
In your experiment, I guarantee the uninfected person will eventually become infected, via contact with animal reservoirs if not the normal course of living and making contact for routine purposes such as acquiring food and medical care.
I'll give you an even more strident experiment: take two people, both uninfected with H3N2, no demonstrable cases at all in the entire world in the human population (such as happens some years with influenza near the equinox or during a period of strong viral interference). What do you think will happen? Obviously both of them will become infected because of the enormous and enduring reservoir in the bird population.
Now consider that coronaviruses are even more infectious and have a wider diversity of animal reservoirs.
Seriously: how do you think pandemics emerge? Even though there is an endemic H3N2, pandemic H1N1 (or other influenza A subtypes) still break out, starting with _zero_ cases. Or do you deny that pandemic influenza is still possible?
Horizontal interdiction does not work with respiratory pathogens. Not on small or large scales. Pathogens which are sufficiently deadly can burn themselves out without being transmitted to an available susceptible, but this is a different phenomenon.
> If you keep the entire population locked up. If you implement a total curfew. Police the streets so that everyone stays inside. There is no doubt spreading will be reduced significantly.
In such a scenario, you're correct that spreading in the community will likely be less acute, but spread within households will likely be more acute. And then what? The virus will be no nearer to endemic equilibrium than when you started. So you'll have to facilitate the same acute spread you blocked in the first place.
> So the question isn't if lockdowns work. They work perfectly.
This is just a completely indefensible position in light of the data. No nation on earth has eliminated the virus, nor achieved endemic equilibrium with a lockdown in place. Every place that has done testing has found positive animal reservoirs. Just... stop.
> The question is what form of lockdown outweighs the costs to warrant putting them in place.
This is true, but it's not only the collateral damage that is to be measured. It is also the first-order effects, such as more acute spread in the household, delayed endemic equilibrium, etc. In addition to the collateral damage, lockdowns appear to cause more adverse outcomes _from the pathogen in question_.
I think New Zealand was free from Covid for maybe 1 year? I wouldn't call that short-term. While many countries were locked down, they were enjoying parties and festivals. If they would've kept themselves isolated from the rest of the world, they'd still be Covid-free.
> In such a scenario, you're correct that spreading in the community will likely be less acute
Yes, so that was the point. Lockdowns work to reduce spreading. We are in agreement.
> , but spread within households will likely be more acute.
Spreading within households would only occur for those households containing an infected person. This wouldn't be a very large percentage of the total households. 2 ~ 4 weeks later those households would've been recovered. A significant reduction would've been achieved. But it would come at great costs. And would only delay the inevitable once everything opens up again.
And do you think covid is worse than or same as the flu?
Not that you asked me- I would classify it as "different" than the flu, that it affects different individuals differently, and that the original variant was definitely something more scary than the flu. Especially due to the novelty of the spike protein. Now- I view omicron as about as dangerous as the flu for a much smaller subset of people than the flu is dangerous for. Especially when you account for age and comorbidities. The flu kills children, while covid generally does not.
It's a very heterogenous sub, but I don't think you'll find the kind of anti-vax thinking that suggests that, eg, childhood vaccination is unhelpful to a society, if that's what you're asking. If you are asking more strictly about sentiment toward the currently available SARS-CoV-2 vaccines, I think that by and large we think they're a marvel of engineering, but have an array of assessments and opinions regarding pandemic-timeline vaccination, what it's meant to accomplish, and whether genuine public health decisions in such a context can ever be made independently of profit motivations of vaccine makers. As for the mod team, I think I can confidently say that we view the vaccines as very useful tools and owe the engineering teams (both who have worked these decades to make mRNA platforms a reality and those who lost sleep to crank these vaccines out) a debt of gratitude.
> And do you think covid is worse than or same as the flu?
By "the flu", I presume you mean the H3N2 influenza which began as the 1968 pandemic and has since been endemic, causing seasonal outbreaks most years, rather than epidemic influenza which of course happens from time to time (eg, the 2009 H1N1 pandemic).
I don't think there's any remaining need to speculate: the wealth of evidence clearly demonstrates that COVID-19 is far more likely than seasonal influenza to result in hospitalization and death for the elderly with comorbidities, less likely than influenza to do so in young and middle-aged healthy people, and similarly likely as influenza for people in the middle.
This has been evident, and has held true, since last summer, when John Ioannidis published this paper on the topic: https://www.sciencedirect.com/science/article/pii/S001393512...
I want to point out that opposition to lockdowns, almost without exception, does not turn on the population mortality rate of the pathogen in question. In fact, if the pathogen were even more dangerous, we suggest that lockdowns are likely to be an even worse idea.
Lockdowns necessarily cause stratification by socioeconomic status rather than by risk. Even in an 'effective' lockdown, we still see spread among the "essential workers" who keep society going, and in their households, which are disproportionately likely to be multigen.
To the degree that lockdowns actually slow spread, this means that people in the high-risk tier (in this case, mostly elderly people) have to isolate _longer_ to wait for the spread to complete among the lower risk tiers. This may be acceptable for affluent households with remote jobs and the ability to have all of their needs met via delivery, but is obviously untenable for our marginalized neighbors who cannot afford periods of extended isolation.
How do you explain countries like Vietnam, China, Taiwan, New Zealand, Australia, where Covid was eliminated from their societies via lockdown (and border control to prevent re-introduction) before the Delta variant spread? It's true that only China and Taiwan have retained Covid-Zero status in the face of Delta, but it seems like the success of lockdowns turns upon characteristics of the pathogen including its population mortality (the more deadly the virus, the more likely the population will support and assist in extreme measures to control and eliminate it within national borders).
As for other places, for some reason COVID seems less severe in east Asia in general. You left out Japan where COVID has not been particularly serious and which also used quite light measures, especially in the early days.
Really, this has been done to death by now. Lockdowns don't have any effect. Some people thought they did because the natural wave pattern happened to overlap with when lockdowns were brought in and epidemiologists - perhaps the most useless form of expertise in the world - were united in believing that COVID wasn't going to be seasonal, for no obvious reason. So they just ascribed the fall in cases to their brilliant policies instead of the true cause. Once COVID came back at different times in different countries much more data became available and it started to show the truth: NPIs like lockdowns, masks, contact tracing etc were all useless. Only very early and very harsh border controls seemed to have much effect, and even then only temporarily.
China now has local transmission in Xian, known for the terracotta warriors. It's arguable they never stopped local transmission and simply stopped reporting cases and deaths accurately once covid took off outside China. They stopped recording deaths at around 4,000 in March 2020.
The latter is not mere fatalism, by the way. It's simply acceptance that at this time, with our current level of understanding and abilities, we cannot stop respiratory illnesses from spreading and frankly, even claims about stopping "severe illness" are all horribly confounded by massive conflicts of interest and a culture of dishonesty in public health. As this paper is now showing, in fact, Moderna was advertised as perfectly safe and an obvious no-brainer tradeoff free improvement. In fact it's not, it's taken a very long time to realize this, and in fact there's certainly a lot of cases that the medical system isn't aware of. As such we cannot actually say whether the vaccines are helping or harming over-all because the damages inflicting aren't being measured properly, or at all. And indeed in many parts of the world excess death is actually positive in 2021, instead of negative as it should be given an effective vaccine (overhang from 2020 pushing it down + effective vaccines reducing COVID excess to zero).
> argues that the risk of myocarditis in under-40 males getting 2 shots is greater (perhaps much greater) than the risk of getting it from COVID
The way I read this is the risk of myocarditis is greater with vaccination, but this does not tell me about the overall risk of serious illness/death from Covid for vaxed VS unvaxed.
So - risk of myocarditis goes up - but is it still overall safer to be vaccinated for the under 40 males, or not?
Not pushing any angle or side here - just looking for clarity (as much as possible).
Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
The majority of myocarditis cases due to the vaccine don't even require hospitalization.
Here is the source: https://www.nejm.org/doi/full/10.1056/NEJMoa2110737:
> A total of 76% of cases of myocarditis were described as mild and 22% as intermediate; 1 case was associated with cardiogenic shock (Out of 100 cases)
Another question- if I go into the hospital for a broken arm, then fail a covid test- am I counted as a covid hospitalization? I remember watching one video early on in the pandemic of a "whistleblower nurse" lamenting the scenario where a patient would be admitted into the hospital for some reason, test negative for covid, be held for quarantine, then test positive for covid- presumably because they caught covid while in the hospital.
If you are sick enough to be hospitalized, you are likely to be sick enough that COVID is dangerous to you and requires medical attention.
The vast majority of people hospitalized with covid have long term side effects. You need to be seriously in bad shape to be hospitalized. See: https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
Since we're doing anecdotes, I have a friend who recently got an infection (not COVID) that left him bedridden and so dizzy he couldn't walk more than few steps, the doctors decided against hospitalization as he presented to the hospital because his symptoms were too mild. They ran a few tests, determined it was an infection, prescribed antibiotics and sent him home.
So yes, hospitalization is a very good predictor. Fyi, hospitalization rates for the general population is right around 0.1%, more or less, and definitely a lot less for people under 40, in normal times
And if you show up to the ER they don't send you to a hospital bed, they don't have hospital beds to give out like candy these days. Even if you have a suspected heart attack (based on cardiac enzymes in your blood not just clutching at your chest acting like you're in a stage play) then you're still going to be waiting hours for a bed to open up. Someone with the sniffles isn't ever getting close to a bed.
Interestingly, this stood out to me:
> The outcomes of interest in this study were hospital admission or death from myocarditis. Myocarditis was defined as the first hospital admission in the study period or death using International Classification of Diseases (ICD)-10 codes (Supplementary Table 6).
In other words, this study didn’t even attempt to measure the rate at which myocarditis occurred in each group - only the rate at which people were hospitalized or died from myocarditis.
Another thing that gave me pause: If someone with COVID-19 developed myocarditis, was hospitalized, and died… I would expect their reported cause of death to be COVID-19, not myocarditis.
I mean the CDC recommended the J&J shot earlier this year now many months later they recommend against. Scary..along with this research here ... yikes!
I wish the study's age group was more specific (the authors admit they don't have enough data for the 13-17 age group to make it more specific). Aka, I would like to see 10 year age group intervals. From other studies, the risks is highest in 16-24 if I remember right?
There's a study out of Public Health Ontario, ON, Canada which compares the risks depending upon the intervals between first and second dose.
https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v...
They compared people after vaccination to themselves before vaccination and calculated the increase.
My concern is that after vaccination people changed their behavior exposing themselves more to humans and all the viruses and bacteria capable of infecting humans most of which were never researched for their effect on rusk of miocarditis.
This additional risk in this particular age group and gender might be because they (possibly) changed their social behavior the most after they got vaccinated.
This is especially fascinating to me because for months I noticed that whenever I or anyone else would bring up the fear of myocarditis from the vax (which I ended up not experiencing, by the way, that I know of - and I got two shots of Moderna which I specifically chose because it has more antibodies) a slew of people would show up to admonish, bring up the typical "anti-vaxxer!" arguments, and state that the risk of getting it from COVID was far far greater. I recall every media article on the subject stating the same thing.
So where were these people and the media getting their information from, or were they just making it up?
And if the latter is the case, it's when people and the media do things like this that people either begin to distrust science more, or use it as another example of why science shouldn't be treated like religion and how the media and people picks and chooses which scientific information to share with the public to fit the narrative they're pushing. It's just sad all around.
But if they are wrong, the most likely explanation is they misunderstood something and were just wrong. Ironically, as is well known but bears repeating, the vocal "follow the science" types tend more to be believers in authority figures than people who care what science says. They aren't especially motivated by evidence.
Actual scientists will usually be circumspect until the evidence is overwhelming.
I think you're giving the media far too much credit especially when it comes to this issue. Remember, this is a media that actively called a legitimate, low-side-effect profile, WHO-listed essential drug "horse paste" or at least actively made comparisons to it, and a media that sowed fear and doubt about the vaccine while Trump was still President.
I think the time is long gone for giving the media the benefit of the doubt on things like this. Scientists sure, but the media, absolutely not.
There was a study of Canadian data (Ontario) recently as well which interestingly showed large differences depending on the combo (Pfizer/Pfizer, Pfizer/Moderna, Moderna/Moderna, Moderna/Pfizer) of 1st and 2nd shot: https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v...
It feels so good to read that. I hope that is actually the case, and all the hysteria we're seeing these days is media overamplification.
This in general has been what has kept my uncertainty factor high on the question of omicron’s virulence, while you can find plenty of news headlines misrepresenting the research (on both sides of the issue).
(I’m a scientist, but my field is not bio- or medicine-adjacent)
a. A male b. Under 40 years old c. Took the Moderna vaccine
So the statement that COVID has a higher risk of myocarditis is still true.
The media and those people got their information from existing data. This data was correct for the original question. However it wasn't delineated by age and by vaccine, and it's only after that you can make another argument.
So yes, the media was right, not the antivaxxers. There is no shenanigans. Unless you have a source that predates this paper saying that the Moderna vaccine has a higher risk of myocarditis specifically for men under 40 that happens to be antivaxx for completely unrelated reasons as myocarditis risk from the vaccine is much lesser than the overall risk from COVID for any demographic.
I believe the right move would've been to let people decide, especially after became clear that vaccination did not protect against infection in the medium run with Israel data being abundantly clear already in late spring of this year. I still believe vaccination rates amongst the old would have been extremely high, protecting those who are at-risk the most. I saw this happening in countries like Brazil, old people rushed to take the jab despite no clear mandates in the beginning of the mass vaccination campaign --although a lot of people got the Sinovac which are not as effective as Pfizer or Moderna.
> This preprint agrees that the risk of myocarditis is significantly higher, except if you are a. A male b. Under 40 years old c. Took the Moderna vaccine
A few things to consider, the paper's calculated myocarditis risk post covid is overestimated as it is impossible to know how many people actually caught the virus. It is reasonable to assume that the actual delta (risk myocarditis post vax vs risk myocarditis post covid) is actually larger, I believe this is just the tip of the icerberg.
Also, the bit about Males only. Pretty sure if you stratified the population even further, you'd find that young females are also at a significantly higher risk of myocarditis for vax vs post covid. As some mentioned here, it would be nice if the age intervals were a bit more stratified.
The Israel data clearly showed that the vaccine was protective against infection in the medium term. Just not as much as originally.
>A few things to consider, the paper's calculated myocarditis risk post covid is overestimated as it is impossible to know how many people actually caught the virus. It is reasonable to assume that the actual delta (risk myocarditis post vax vs risk myocarditis post covid) is actually larger, I believe this is just the tip of the icerberg.
We actually don't know that. We see from this data that you can have myocarditis without the usual symptoms of a strong immune reaction. For all we know, there could have been a hundred thousand cases of myocarditis from COVID that didn't come with associated COVID symptoms and resolved themselves, going without any diagnosis.
Actually, we generally don't even know the real rate of myocarditis in the general population. It's relatively common that someone is admitted to the hospital for another symptom and myocarditis is diagnosed, without the patient even noticing.
As for females, for any age, there is zero statistically significant result for myocarditis included to the vaccine, at all. So for all we know, the vaccine may cause zero myocarditis in females. It's almost certain that further stratification would help.
The reason why there was not anymore stratification is because myocarditis due to the vaccine is so rare that if you do stratify it, you cannot come to any conclusion.
It's possible that there is a misestimation of the background risk. However, given that most cases of myocarditis are mild, the vast majority of myocarditis cases without a positive COVID test almost certainly went undiagnosed, so this is a fair comparison. Cases that have been diagnosed can also be misatributed to background risk, if there are no other covid symptoms and thus no covid test is administered.
Yes, but wouldn't we expect this to apply to both groups at the roughly same rate?
> As for females, for any age, there is zero statistically significant result for myocarditis included to the vaccine, at all. So for all we know, the vaccine may cause zero myocarditis in females. It's almost certain that further stratification would help.
This is not true according to the pre-print (https://www.medrxiv.org/content/10.1101/2021.12.23.21268276v...), page 10. In fact, it shows that Moderna's second dose is associated with higher incidence rate against baseline. Though if we compare with post-covid, there is an overlap in the 95% CI --though IRR for 2nd dose Moderna is higher.
> The reason why there was not anymore stratification is because myocarditis due to the vaccine is so rare that if you do stratify it, you cannot come to any conclusion.
Fair point. Yes, certainly further stratification would lead to a loss in statistical power and making the point estimates meaningless, but it would be nice to see it in case there is still some point estimates that show statistically significant results because I suspect that the risk of myocarditis goes up inversely with age.
Unlikely because the most of the same people chose not to get vaccinated themselves well before any mandates or requirements came into force, and were posting arguments online warning people not to get the vaccine or that it hadn't been sufficiently tested - as you yourself do in this post.
This indicates that they weren't just opposed to forced vaccination, but opposed to this vaccination in particular. It was quite rare to see someone post something along the lines of <<Everyone should get vaccinated, and you are in more danger from COVID-19 if you don't get vaccinated than from side effects if you do. However, I am opposed only to forcing the vaccine on you. Please get vaccinated yourself instead!>>
As did many news media organizations - only up until the election, that is. [0] Then everyone was a conspiracy theorist immediately after.
[0]: https://www.cnn.com/2020/09/01/health/eua-coronavirus-vaccin...
https://twitter.com/KoenSwinkels/status/1443335179012038656
It includes a screenshot from this report, which is now updated through to December:
https://www.publichealthontario.ca/-/media/documents/ncov/ep...
So I did remember correctly, and it was indeed lower than infection, presumably because it wasn't delineated by vaccine, also IIRC Moderna is contra-indicated for young men in Ontario.
Yes but it's misleading, and whether or not you want to argue it's deliberately so, is another debate. Are men under 40 who are considering Moderna (or don't even know what vax they're going to get since both are considered fairly equal) not worthy of being informed that their risk of myocarditis is actually potentially higher than if they got COVID? That doesn't make much sense to me, if it does to you then at what threshold would they be worthy of being informed that the blanket statement that's been being thrown around, doesn't actually apply to them? I seem to recall most people arguing that "COVID isn't actually that bad" not having an acceptable argument because while it's true for many people, for other groups of people, COVID actually is bad...
Additionally, if he suggested that for any demographic the vaccine is more dangerous than COVID, even if he mentioned that it was only for one demographic and only for one vaccine, he was wrong and remains wrong.
In principle this is bad because we know already very well that it affects more young men.
I think they made the situation even worse by stratifying only for myocarditis and not for pericarditis and cardiac arrhythmias that according to their paper are much more likely with COVID-19 because it did not register at all for vaccines.
This means that people are now getting a very wrong/incomplete picture of the risk benefit relationship.
Naturally cardiac issues are not the only possible problems because COVID-19 is systemic disease that can affect many organs and can cause a lot of trouble even without hospitalization.
Edit: somebody else pointed out that the significantly elevated risk was only observed for Moderna (mRNA-1273). Pfizer (BNT162b2) only has a slightly elevated risk after the 2nd and 3rd doses. Looks like I'll be okay after all :)
I tend to run numbers here and compare to events I'm worried or not worried about. I can live with 1:10,000 risks.
https://www.iii.org/fact-statistic/facts-statistics-mortalit...
Do you have better stats?
Good ballparks:
* 1:10,000 odds of being killed in or by a car.
* 1:100 odds of being injured in or by a car.
Your page, by the way, suggests 1:2000 for accidents. 49.3:100,000 = 1:2000, not 1:8393. The 1:8393 is for car accidents (which I guess includes being in a car, rather than just hit by a car).
Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
Polio.
* Around 72% have no symptoms.
* Around 25% have flu-like symptoms.
* The remaining 3% develop serious symptoms/damage.
* Paralytic polio hits around 0.5%, of which around 5-10% die when the paralysis reaches the lungs.
So including all infections, not just paralytic polio as you'll find in most searches (where they give the 5-10% statistic), the death rate was around 0.01% - 0.025%
And yes, the virus prevents heart complications from infection, because it prevents symptomatic infection.
Death rate on both is close to 0. My point is if the vaccine doesn’t prevent infection (protecting other people) the vaccine risk vs reward is negligible for this age group. It should be purely up to the person to make their own decision. Not anyone else’s. Treat it like the flu shot.
I was vaccinated when I saw 90% at preventing infections, but now that’s been disproven I’ll call it how I see it. I’m moving on.
It was 90% before mutations for two doses
The death rate on both are very low but much higher for the virus. However, the risk of hospitalization is significant with the virus, and much, much higher than with the vaccine.
I don't want to be hospitalized. That's a very bad time. The people that may die because I took up a hospital spot probably agree.
The flu doesn't threaten to collapse the healthcare system without vaccines. COVID does.
Yeah it does, even with vaccines...
(2014) https://www.nbcdfw.com/news/local/flu-patients-fill-north-te...
(2015) https://abcnews.go.com/Health/flu-closes-schools-flusters-ho...
(2016) https://www.theguardian.com/society/2016/mar/10/nhs-hospital...
(2017) https://www.france24.com/en/20170111-french-hospitals-cancel...
(2018) https://time.com/5107984/hospitals-handling-burden-flu-patie...
It's a pretty consistent pattern: Every flu season, hospitals are overwhelmed by the flu. Those links are just from date-range searches and copying the first result (hence bouncing around countries); each year had plenty more from other countries.
Even with unprecedented non-pharmaceutical interventions and with vaccines, many first world countries were at the point where they had to cancel cancer surgeries that were not immediately crucial to survival. That's not something that happens with the flu.
Now the flu is very serious as your links show. The flu vaccine is around 40% effective against hospitalization (https://pubmed.ncbi.nlm.nih.gov/33378531/), and around 70% of seniors are vaccinated against the flu, for a total reduction of around 28%.
If we removed that reduction, the flu could still not be severe enough to lead to a complete collapse of the healthcare system without serious intervention. With COVID, that is guaranteed to happen.
But you're right in that the flu is a serious disease that puts a lot of strain on the healthcare system and I can understand how my comment could lead to underestimating that.
No, this is the rate of hospitalization or death due to myocarditis.
> The outcomes of interest in this study were hospital admission or death from myocarditis. Myocarditis was defined as the first hospital admission in the study period or death using International Classification of Diseases (ICD)-10 codes (Supplementary Table 6).
See : https://www.nhs.uk/nhs-services/hospitals/going-into-hospita...
Whenever we vaccinate to prevent mortality; generally we vaccinate to mitigate both morbidity and mortality from a disease.
That‘s the scary part imho, it appears that the long-term adverse cardiac risk is pretty much unknown.
I was under the impression myocarditis was when some heart tissue died and doesn't recover.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/my...
There is a wealth of info about this known condition on the web including symptoms and treatment. If you have concerns, ask your GP, they're there to help you.
You are confusing it with ischemia (heart attack basically), where cells are no longer supplied with oxygen and die.
Unfortunately not stratified by age and sex there (what a shame when it is obviously greatest interest here, what were they thinking, like actually, what were they thinking?) but the risk should be clearly higher for COVID-19 as it is non-existent for vaccines.
As such, the original paper was bad as they did not stratify by important parameters but this paper might be even worse as they do not include other complications that would significantly change the picture.
I also feel wary about the method they are using - perhaps somebody could share thoughts about this? They used self controlled case series (SCCS) for IRR. I am not fully confident that this kind of analysis can be used for such data in this setting.
Am I reading too much from the error bars in the Incidence Rate Ratio charts? Or did I misinterpret the charts some other way?
Because the confidence interval of the Pfizer 3rd dose contains the datapoint for infection, there is a pretty good chance that the 3rd dose is not anymore likely to lead to myocarditis than COVID, and the result isn't statistically significant at p<=0.05. We can't say for sure.
> However, the risk of myocarditis following vaccination is consistently higher in younger males, particularly following a second dose of RNA mRNA-1273 vaccine.
This is an important reminder for policy makers and the public that vaccination policy cannot be reduced to a simple dichotomy.
Vaccines can be beneficial for the overall population AND present excess risk for certain sub-populations. Stratifying by age and sex is essential for discussions on this topic to be accurate and productive.
Moreover, it takes a long time and a large sample size for these anomalies to be detected with significant statistical power. Let's do our best to avoid frustrated bickering, we need all the patience and empathy we can muster.
https://academic.oup.com/cid/advance-article/doi/10.1093/cid...
[0] Or myocarditis specifically?
[1] Don't quote me on these numbers, they are ballpark numbers from my memory
https://askinglot.com/what-does-it-mean-to-aspirate-an-injec...
You seem to be assuming the answer to that is either true or false. Isn't it much more likely that vaccines prevent some transmission and the question is how much.
The shots might be helpful as a potential severe symptom mitigator which wanes but it should never have been called a "vaccine" as it neither prevents infection, nor prevents transmission.
positive -> vax infections 1/3 less likely than positive -> unvax - seems like it did prevent (some) infection for Delta at least.
> Owing to the small sample size, the authors were not able to establish the vaccine effectiveness against asymptomatic infections versus symptomatic infections. This limitation together with the unconfirmed source of transmission in many of these index-contact pairs, suggests that the low SAR reported here should be interpreted with caution.
> this study unfortunately also highlights that the vaccine effect on reducing transmission is minimal in the context of delta variant circulation.
> They report that peak viral loads showed a faster decline in vaccinated compared with unvaccinated people, although peak viral loads were similar for unvaccinated and vaccinated people.
> Time since vaccination in fully vaccination contacts was longer for those infected than those uninfected, suggesting that waning of protection might have occurred over time, although teasing out general waning versus reduced vaccine effectiveness due to delta is challenging owing to so many confounding factors.
The study is meaningless without disclosing how long after the vaccination is he study done. While the study does mention waning effectiveness, it doesn’t mention (as far as I can find) how long after the vaccination did they do the sampling.
Other studies show that in the first 2 months, the breakthrough is less likely and viral load is less but after that, the breakthroughs become more common and by 4-6 months, the viral load becomes the same.
This is observable in my province here in Canada where vast majority of the vaccinations occurred after June 10th (we had under 10% vaccination till June 10). So in the first few months of the honeymoon period, breakthroughs were less common. However after 3-4 months, they became more and more common.
And now that omicron is here, it’s become wildly common. While only 77% of Ontario population is vaccinated, 80% of cases are fully vaccinated.
Another thing to mention is that the study doesn’t mention the age, comirbidiies and obesity level of the individuals. It’s shown in other studies that older people, obese and those with comorbidities have higher viral loads and shed the virus for longer. And the effectiveness also wanes quicker in these groups along with in men. So there are too many variables.
These shots should never have been labelled a vaccine based on these factors.
Like what's the mechanism?
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA....
"An potential avenue for vaccine-associated myocarditis may be a nonspecific innate inflammatory immune response, or perhaps an interaction between the encoded viral spike protein of the mRNA and an as-yet undetermined cardiac protein. Studies have hypothesized that the antibodies generated in response to the mRNA spike protein may react with surface antibodies of the cardiomyocytes of susceptible hosts, provoking an inflammatory reaction and associated tissue damage."
https://www.tandfonline.com/doi/full/10.1080/14760584.2022.2...
[1] https://open.spotify.com/episode/0aZte37vtFTkYT7b0b04Qz
Edit: [2] The CDCs myocarditis page on this since the Dr. McCullough is upsetting people here. And just so to pre-emptively dismiss any attacks that I am anti-vax I am fully vaxed and boosted. But talking about side effects or risks apparently puts one in said camp. Nuance is dead.
[2] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/my...
Joe Rogan interviews are not a reliable source of medical information. Rogan is a COVID conspiracy theorist of the “just asking questions” variety. For anyone unconvinced about this, and values diversity of opinions in their media diet, the recent episode of Decoding the Gurus is worth a listen.
https://decoding-the-gurus.captivate.fm/episode/joe-rogan-ju...
I am not making any claims that are unsupported by the CDC's own data.
Just because a response is rare doesn't make it any less true.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/my...
It is an immune response, not a direct effect of the protein. If it was a response to the protein, it wouldn't occur primarily after the second dose of Moderna, it would occur with equal likelihood after both first and second doses.
The inflammatory response is primarily triggered by the [1] spike protein.
"We observed that spike (S) protein potently induces inflammatory cytokines and chemokines including IL-6, IL-1β, TNFα, CXCL1, CXCL2, and CCL2"
I'm curious to see the fuller data set on adolescent males since it does seem initially that moderna may be more likely to trigger this rare myocardial response due to its much higher potency.
The S1 and S2 components of the spike protein linger in the body for up to 12 months. So it would seem that the second dose would be harsher since there is already a reserve of S in the body.
[1] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7987013/
https://www.reuters.com/business/healthcare-pharmaceuticals/...
I am pro-vaccine, but this isn't really true.
Note that we have animal studies that used luciferase mRNA to see where mRNA medications are transported and translated. There's some systemic transport no matter what, even with IM administration.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624045/
> Intravenous and intraperitoneal and to a lesser extent intramuscular and intratracheal deliveries led to trafficking of mRNA-LNPs systemically resulting in active translation of the mRNA in the liver for 1–4 days.
https://i.imgur.com/YSCFUQS.png
Yes, the muscle in your arm does a lot of the production of the spike protein, and a lot of that spike protein is captured by the lymph nodes in your armpit. But decent chunk of the mRNA goes to your liver, too, and a big amount of spike protein circulates systemically no matter where it's produced.
Edit: 100 per million, thanks for the correction. 0.01% of people.
That's still very safe, but it's good to be accurate.
(I am an under 30yo male who is fully vaccinated, just to be clear)
Peter McCullough in his recent Joe Rogan interview suggested it may be due to the mRNA vaccines nano lipids. He said the heart, brain, and reproductive organs are "sponges" for the nano lipids. Thus these organs are getting exposed to more spike proteins than else where in the body. The damage from spike proteins is otherwise well documented.
2 questions we can use to vet this: 1. are there significant cardiovascular differences between genders, and 2. Do we see significantly more myocarditis in Pfizer vs astrazeneca.
Other than that I don't have enough medical knowledge to dispute it, but no one seems to have picked up on it in the medical community.
If it's not something that can be quickly dismissed on first principles then I think it would an interesting area to study.
There are probably far too many papers that academics have discovered flaws in but don't have time to do anything about
I am sad that only now this has become an open issue. Meanwhile, women are still fighting over menstrual cycle changes post vaccination.
I read myocarditis is partly caused by the mechanisms of producing the spike protein.
Can't we just go back to traditional vaccines?
Inactivated vaccines appear to be quite ineffective against severe COVID and I have read that experts are doubtful about long-term protection against severe cases as well.
One alternative might be recombinant protein vaccines like the one from Novavax. This one was just approved in the EU and apparently the phase-3 trial went well. Of course, rare side effects (like myocarditis in mRNA vaccines) can only be measured once at least a few million people have been vaccinated. Also the longevity of the protection is still unknown.
[1] https://jamanetwork.com/journals/jama/fullarticle/201967
In particular, it was way more dangerous than COVID is. To figure out an acceptable level of side effects, wouldn't it be better to compare COVID to other diseases of a similar danger level?
It seems likely that future Covid strains will be less deadly, too, just as the flu has years that are more or less deadly than others.
Also, isn't a fraction of the population immune to begin with?
The vaccine has continued to show efficacy against hospitalization and death (severe covid) even as there has been some waning in infection immunity over a period of multiple months (more than 2 or a couple months though). See e.g. https://www.cdc.gov/mmwr/volumes/70/wr/mm7049a2.htm "During February 1–September 30, 2021, mRNA vaccine effectiveness in preventing COVID-19–associated hospitalizations among U.S. veterans ≥120 days after receipt of the second dose was 86% for Moderna and 75% for Pfizer-BioNTech vaccines"
Future covid strains may be more or less deadly - data coming in on Omicron indicates it's more deadly than original COVID but perhaps slightly less deadly than delta. Still quite dangerous to an unvaccinated or immune naive individual.
I don't have a English language resource ready, but this article in a renowned German science magazine shows protection against severe illness is drastically reduced after six months for the current vaccines: https://www.spektrum.de/news/wie-lange-schuetzt-der-impfstof...
For example from the chart, after 6 months the protection from Biontec is only 30% of the protection in the beginning.
“ The effectiveness against severe illness seems to remain high through 9 months, although not for men, older frail individuals, and individuals with comorbidities. This strengthens the evidence-based rationale for administration of a third booster dose.”
Possible difference between the Swedish study and the CDC - time period comparison of 4 months (120 days) vs 9 months (270 days) - differences in Swedish population or statistical errors.
Just eyeballing CDC data on who is dying of coronavirus it’s very hard to see how any statistical analysis could show the vaccine not “working” - the smaller unvaccinated population is making up a majority of hospitalizations and deaths in the USA, and most vaccinated persons haven’t received a booster in USA.
https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-s...
https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitali...
For an otherwise healthy 18-29 year old, it appears that the risks from taking the vaccine are comparable / slightly exceed the risks of getting Covid.
Your statement that most myocarditis cases do not require hospitalization is inconsistent with the public health data Ontario is releasing - it's closer to 60%+ of (confirmed) myocarditis cases that require hospitalization.
(https://twitter.com/KoenSwinkels/status/1462266769880621056/...)
According to the dataset you are citing, the rate of myocarditis for 18-29 yo. is 129 per million, which is 0.0129%.
COVID hospitalization rates are 0.4%.
So with that dataset instead of this one, you run as 40x higher chance to be hospitalized from COVID than from vaccine-related myocarditis.
And it is quite likely that comorbities have an effect in vaccine-related myocarditis hospitalizations.