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Comment by jjeaff | Hacker News Reader

I think the most important data point you should compare in this case is the rate of myopericarditis in young men who get COVID.

It's somewhat irrelevant what the rate is in past vaccines.

Two things seem pretty clear from the data. The first is that myocarditis rates are much higher in unvaccinated young men who get COVID than those who get the vaccine. And the second is that you almost certainly will get COVID eventually.

One hypothesis is that the spike protein in the vaccine is what causes the myocarditis. If you are scared of that, then you should be really scared of how much more spike protein you are going to have in your body if you get COVID unvaccinated. The spike protein in the vaccine does not replicate. In COVID, it obviously does. If I had to guess, I would say that anyone who gets myocarditis from the vaccine probably would have had a very bad time with COVID.

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> Two things seem pretty clear from the data.

Not according to this data. Turns out that myocarditis rates are higher in vaccinated young men, the complete opposite of your clear data's claim!

https://www.medrxiv.org/content/10.1101/2021.12.23.21268276v...

This study has multiple issues as did the original study it is accompanying but what got published in Nature Medicine https://www.nature.com/articles/s41591-021-01630-0

First the original study did not stratify based on age and sex - a huge failure because potential issue among young men was well known problem.

This preprint tries to fix this but as the original study compared also other cardiac adverse events like pericarditis and cardiac arrhythmias, the preprint does not. It is important because the rate of other complications was not elevated among vaccinated.

This study uses self-controlled case series. This means that they compare against previous incidence rates in the study group (vaccinated, covid-19). This would be possibly more or less fine if they compared two treatments but even then there is big potential for selection bias (the choice of treatment is based on preexisting conditions) but is even higher when you compare treatment and disease - covid-19 is harder for people with comorbidities, when you make a comparison within this group, you can most likely expect higher preexisting prevalence of heart conditions and therefor lower IRR.

This preprint and the orginal paper do not contain any mentioning of unvaccinated. It very likely means that the covid-19 group also contains patients who were vaccinated and had lower rate of AE.

Finally, this study design includes people with previous incidence. Hearth problems are very often recurrent. While it is important to know if vaccination of covid-19 will reintroduce the condition, it is not very interesting for most of the people because incidence rate of these conditions is very low. What is real interest here is how prevalent it is among people who did not have it previously.

Now I am really interested to find out the truth here. This preprint and the orginal study does not help me in this unfortunately.

I completely agree; nothing here is conclusive at all. I just can't stand flippant statements like, "the data is clear," when it isn't, at all. Those kinds of people are directly contributing to the social divide about science.

A preprint, but included because it is specifically for young men. 6x more likely to get myocarditis from COVID than vaccine. https://pubmed.ncbi.nlm.nih.gov/34341797/

There are now a multitude of studies indicating the prevelance of myocarditis from COVID 19. Many of which are broken down by age, so you can see how much higher the prevelance is vs vaccine side effects.

We have a pretty good idea of how bad the myocarditis issue for COVID is because we had a good long time without a vaccine. There were very large increases in myocarditis in 2020 vs 2019.

The real problem is that people like yourself jump to the first contradictory study you can find and tout it as proof or simply muddy the water from what many of the experts are saying. The reality on this particular issue is that quite a bit of research has already been done. A quick search will pull up multiple studies on myocarditis rates with covid, most of which have age breakdowns.

That preprint you linked estimates a rate per million of 561 for myocarditis, for young adult males.

OP's preprint show a rate per million of 537 for young adult males on their second dose.

I would say the research definitely isn't conclusive yet. For young adults, whether the vaccine is safer than getting COVID is an open question, but we do know the absolute risk for both (vaccination or getting COVID) is small.

There is one difference: Singer et al paper excludes all patients with previous cardiac incidents.

I agree.

I wanted to specify that I find these attempts to but vaccination and covid-19 into perspective very important. This is first study that I know so far has truly attempted to do so. Now in current state they create more confusion and possible harm but they have the data so they should be able to fix these issues.

https://pubmed.ncbi.nlm.nih.gov/34341797/

That study says 6x more likely to get myocarditis from COVID than vaccine. Specifically in young men.

Yes, I know this study. Thanks. I think this is better reference https://www.medrxiv.org/content/10.1101/2021.07.23.21260998v...

These papers are not directly comparable.

Singer et al paper estimates first occurrence of myocarditis without any previous cardiovascular history and without previous vaccination against COVID-19. The OP paper does not have this specification so the results of these papers are not directly comparable.

In addition the Singer et al paper includes also pericarditis, myopericarditis (myocarditis and pericarditis occurring together) in addition to myocarditis. Considering that pericarditis is more prevalent in COVID-19 patients and is missing in vaccinated https://www.nature.com/articles/s41591-021-01630-0 OP papers clearly is overestimating the difference.

"And the second is that you almost certainly will get COVID eventually" this wasn't true until Omicron. Social distancing, proper masking, and maintaining good ventilation were all ways to dramatically lower your chances of getting any of the previous strains.

And Omicron is so much milder it would be shocking if myocarditis rates remain higher than in vaccinations.

"The spike protein in the vaccine does not replicate. In COVID, it obviously does." This is misleading. The spike protein is created similarly in both cases, both from RNA being introduced into the cells.

"If I had to guess, I would say that anyone who gets myocarditis from the vaccine probably would have had a very bad time with COVID." This very much is a guess as we don't know the mechanism for what is causing myocarditis.

My guess is that we'll find much lower levels of vaccine myocarditis in countries which aspirate injections, dramatically lowering the rate of inadvertent intravenous injections. And we'll find that the cause of SARS-COV-2 myocarditis differs greatly from vaccine induced myocarditis.

> Omicron is so much milder

It's milder when measured by overall hospitalization rates (covering vaccinated + unvaccinated + past infection), but is there evidence that it is milder for unvaccinated individuals specifically? Genuine question, happy to learn.

Solid data is still hard to come by, but preliminary analyses from the week of Dec 20 have omicron as moderately less virulent than Delta, and on par (+/- 10-20%) with the original strain.

Good discussion of various pieces of the picture here: https://thezvi.wordpress.com/2021/12/23/omicron-post-9/

I don't know that we know that. But given the UK death rates I'm guessing we'll be happy. I don't know anyone still unvaccinated, but I certainly hope omicron is milder for the people are aren't.

unless omikron spread to vaccinated people preferably , or if vaccination rates increase a lot between delta and omikron, the fact that the increase in omikron cases doesn't produce an increase in hospital ICU prooves it's also not as lethal to non-vax

> this wasn't true until Omicron

You don’t understand what people mean when they say that. The premise of everyone getting covid is based on the continued mutation and evolutionary pressure to more contagious and less deadly variants. The emergence of an Omicron-like variant is exactly what people meant when they said “everyone will get covid”.

No, they did not. What they meant was that already Delta is so contagious that only very limited amount of people can avoid it - r0 ~ 6-8 will make sure of it that ~85-90% of people must be immune to stop its spread.

Seasonal flu has r0 = 1.3. This means that it does not affect 75% of the population. The formula is p = 1 - (1/r0) to find out at what level of immunity the disease will die out.

Original Sars2 had r0 = 3, this meant that about 60% immunity level is needed. This is from where to original need of 70% of vaccinated comes from - vaccines do not give 100% immunity so you have to account for that.

Delta messed everything up. With p=85% and vaccine efficiency of 70% (because nobody, except Israelis dared to think about boosters first), you need more than 100% vaccinated - everyone gets is either vaccinated and lucky or vaccinated/unvaccinated and will get infected.

The fact is, that the vast majority of people who refuse to get the vaccine, are also the same people not taking enough precautions to avoid contracting COVID.

If you want the absolute safest option, then don't get the vaccine and take extreme precautions to avoid catching COVID. But that is unrealistic for the vast majority.

> Two things seem pretty clear from the data. The first is that myocarditis rates are much higher in unvaccinated young men who get COVID than those who get the vaccine. And the second is that you almost certainly will get COVID eventually.

Wouldn't you need to look at the

P(covid | no_vaccine) * covid_myocarditus_risk

P(covid | vaccine) * covid_myocarditus_risk + vaccine_myocarditus_risk

Also this should be during the vaccine covid prevention efficacy window

Given that it is well documented that the vaccine reduces the severity of the disease I would also expect it to modify the risk of myocarditus in some way (I assume that it reduces the risk)... That further complicates the picture...

P(covid | no_vaccine) * covid_myocarditus_risk(no_vaccine)

P(covid | vaccine) * covid_myocarditus_risk(vaccine) + vaccine_myocarditus_risk

There is data to suggest this isn’t the case.

Can you point me to it?

Yeah, this is the logic and data that I used. I plan on engaging in fairly 'risky' behavior when I can (social dancing), so I'm assuming I'll catch Covid at some stage, so I'd rather catch it with a vaccine (as I think the risk of vaccine+covid is less than unvaccinated covid). At current rates of 20,000 cases/day, everyone in New South Wales will get Omicron in just over a year, so unless you totally isolate yourself from society, it's highly likely everyone will catch it at some point.

And we do not know if omicron causes more heart issues than the vaccine.

Interesting, thanks, I had not heard/seen that before.

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