Incidence and risk factors of myocarditis following Covid-19 vaccination | Hacker News Reader

Incidence and risk factors of myocarditis following Covid-19 vaccination

bmj.com

3 pointsMuchoMaas9 comments

Such studies should compare the risk to the covid-19 infection itself vs. the risk to vaccination and infection to the risk of vaccination. Whatever comes from vaccination is present in (far) greater supply during infection. Other than the lipid particle and whatever is used to deliver the mRNA.

And given the various non-mRNA vaccines, there should be a non-random difference shown between the various alternatives, as they stimulate an immune response via different mechanisms. Hell, maybe the problem comes from the immune response itself... If that's the case, there should be some correlation of effect vs. intensity of response. This has already been shown wrt cytokine storm, but this is discussing other forms or results of inflammation.

> Such studies should compare the risk to the covid-19 infection itself vs. the risk to vaccination and infection to the risk of vaccination.

I'm not sure why that comparison would be relevant, since vaccination does not zero out the risk of infection or developing myocarditis from that infection. The risks are cumulative, not mutually exclusive.

It also doesn't seem clear to me that spike protein exposure is necessarily higher from infection than vaccination, as you assert. Do you have any studies that show this? The only comparisons I've seen have been between the levels of anti-spike antibodies, which are much higher following vaccination.

Age stratification is also an important consideration here. A large Israeli study found no increase in incidence of myocarditis among ~200,000 unvaccinated individuals who contracted SARS-CoV-2: https://euroweeklynews.com/2022/07/08/no-increase-myocarditi...

If the risks are cumulative, I would expect such studies will show that. If they're not, the risks would relate directly to which of 3 conditions are present. And I have to assume that there are (far) more spike proteins created in an infection than due to the mRNA vaccine as there is no reproduction in the latter case - it only expresses what it can while the mRNA "instructions" last. In the case of infections, viruses covered in spike proteins result.

A viral infection doesn't last forever either. There may be no reproduction with mRNA, but an infection is limited by the control exerted by the immune response. To use an absurd example to demonstrate the point, if you used a dose 100x or 1000x higher than the actual shots, might that result in higher levels of spike exposure than a mild asymptomatic SARS-CoV-2 infection? If so, then we've established that this is an empirical question, not something that can be reasoned about with a priori assumptions.

I'm sorry... What is the point that you're trying to make? That mRNA spike protein lasts forever while viruses are cleared in a week or so? That they're different? I assume they're effectively similar from any source and if there's a problem it should increase with increasing level.

There is a risk from the vaccine: spike protein + delivery package. I think there's a greater risk from the vaccine: more spike protein, risk of cytokine storm, etc. If you don't like mRNA vaccines, there are a number of alternatives using different mechanisms to deliver material to train the immune response. But the spike protein is a good target as it's absolutely required for transmission.

Perhaps they'll find a region of the virus that is (relatively) invariant and develop vaccines to that. So far, the human immune system has been unable to do this.

My point is that your continuing assertions that an unvaccinated infection must result in higher levels of spike protein exposure than Covid-shots-plus-the-eventual-infection-you'll-still-get-anyway is not really backed up by anything. It's just an assumption you are making. Beyond that, naive comparison of the levels involved may not fully capture the level of clinical risk: maybe the mRNA causes higher levels of spike detached from an intact virus, or maybe it causes it to spread to parts of the body which an infection doesn't.

The ideal here would be to have a randomized control group which could be compared to various different vaccination profiles on an ongoing basis to assess overall risk and outcomes on a population levels, but that's impossible because all the control groups were promptly vaccinated the second EUAs were granted.

Age stratification is an important consideration. A 12 year old comorbidity-free male's risk of a cytokine storm from a COVID infection is effectively nil, but his risk from the COVID vaccines (which many have been required to take to participate in school activities) is substantial.

They tried to create coronavirus vaccines for 50 years and failed terribly. So far it seems to have been a good bet that all those issues were not magically solved in 9 months of "Operation Warp Speed."

> If you don't like mRNA vaccines, there are a number of alternatives using different mechanisms to deliver material to train the immune response.

Yes, one such alternative, which is perfectly safe for a large proportion of the population, is natural SARS-CoV-2 infection.

Way more infectious that the vaccine, though, and probably not any more effective. Nobody's caught the vaccine from the exposure that I've seen mentioned.

It seems like you're under a misapprehension that there is some mutually exclusive tradeoff of "vaccine vs infection" to be made, but this is not the case. It's well established now that natural immunity is more effective and longer lasting than the vaccines. And again there's no point in the infectivity comparison because whether someone is vaccinated or not makes no difference to their odds of contracting or spreading Covid -- if anything, the current level of case rates in highly vaccinated countries vs less vaccinated ones suggests the vaccines have made infection more likely.

> Incidence of myocarditis is probably the highest in males aged 12-29 years and more likely with Moderna than with Pfizer mRNA vaccines; longer dosing intervals might be beneficial

> Most cases of myocarditis are mild and self-limiting, but data on children and some severe cases are limited

It seems we still don't know the root-cause for why this can happen, but at least it appears to be mostly a rare and mild side-effect.

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