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Comment by UncleOxidant | Hacker News Reader

Isn't he risk of myocarditis actually higher if you get infected with covid compared with getting a covid vaccine?

https://www.heart.org/en/news/2022/08/22/covid-19-infection-...

That's what the CDC claims now.

Earlier in pandemic 196k post Covid patients were monitored a year... "We did not observe an increased incidence of neither pericarditis nor myocarditis in adult patients recovering from COVID-19 infection."

https://pubmed.ncbi.nlm.nih.gov/35456309/

Did they also monitor the group of post covid patients who died from covid?

i.e. I would think that number has significant survivorship bias.

> Associations were stronger in men younger than 40 years for all vaccines. In men younger than 40 years old, the number of excess myocarditis events per million people was higher after a second dose of mRNA-1273 than after a positive SARS-CoV-2 test (97 [95% CI, 91–99] versus 16 [95% CI, 12–18]).

> The risk of vaccine-associated myocarditis is consistently higher in younger men, particularly after a second dose of mRNA-1273, where the number of additional events during 28 days was estimated to be 97 per million people exposed. An important consideration for this group is that the risk of myocarditis after a second dose of mRNA-1273 was higher than the risk after infection.

That's from the study you linked; for the group most at risk of vaccine myocarditis, the vaccine was associated with a higher risk than the virus. In this study, this was true for Moderna, with Pfizer being about equivalent risk to the virus (albeit without considering that the risk of infection remains after vaccination). However, there have been other studies that found this to be true for all mrna vaccines.

So to answer your question, its technically true, but only if you dilute the at-risk group by including the entire population.

No, not for younger men: the risk of myocarditis from the vaccine does not appear to offset the benefit. So if you only care about that one single dimension, younger men shouldn’t have the vaccine. That said, other costs and benefits matter far far more I think.

Absolutely terrible reporting in that link - instead look at the paper: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA....

  In men younger than 40 years, we estimate an additional 4 and 14 myocarditis events per million in the 1 to 28 days after a first dose of BNT162b2 and mRNA-1273, respectively; and an additional 14 , 11 and 97 myocarditis events after a second dose of ChAdOx1, BNT162b2, and mRNA-1273, respectively. These estimates compare with an additional 16 myocarditis events per million men younger than 40 years in the 1 to 28 days after a SARS-CoV-2–positive test before vaccination. [ChAdOx1 == AstraZeneca, BNT162b2 == Pfizer, and mRNA-1273 == Moderna]

  The risk of vaccine-associated myocarditis is consistently higher in younger men, particularly after a second dose of mRNA-1273, where the number of additional events during 28 days was estimated to be 97 per million people exposed. An important consideration for this group is that the risk of myocarditis after a second dose of mRNA-1273 was higher than the risk after infection.

Disclaimer: I try to be apolitical however there is a strong aura of bullshit around this topic so double check everything!

Except you can get infected even if you get the vaccine. In fact it seems to me that people got it despite the fact that they were vaccinated or not, without a particular logic.

Yes. In particular, the contents of the mRNA vaccines are a subset of what a covid infection produces.

The anti-vax stance is similar to the claims that tightly regulated nicotine vapes are worse than high tar cigarettes. (Except that you can just choose to not smoke, of course.)

I hear a lot of anti-vaxy stuff about how the spike protein is damaging in itself (implying that you shouldn't get the vaccine because you'll have spike proteins flowing around in your blood), but they seem to ignore the fact that when you get actual covid the virus is multiplying in your cells and spike proteins are more widespread and more numerous.

I see the argument here in this thread that the vaccine isn't really preventing you from getting covid at this point (which is probably largely true) but shouldn't being vaccinated mean that you'll have a lower viral load and shorter duration of illness?

> the virus is multiplying in your cells

The mRNA vaccines work by causing the spike protein to multiply in your cells. Yes, the mechanism is different - the virus copies itself and the spike protein just happens to be part of the virus, whereas the vaccine mRNA just causes the spike protein itself to be copied. Note that with the vaccine, you're getting a massive number of cells "infected" all at once, equivalent to quite a bit of virus self-replication. So the result is the same, a lot of spike protein floating around and doing damage. The main difference in result is that with the mRNA, there is an upper bound to the number of cells which can be infected (and which therefore have to be eliminated by your immune system), whereas with the virus there is effectively no upper bound. But that doesn't translate at all into a difference of how much damage the spike protein produced by X infected cells produces, and it doesn't mean that the number of infected cells with mRNA is significantly less than the number of infected cells you would have gotten with a successfully-fought-off infection. So it could do just as much damage.

> The main difference in result is that with the mRNA, there is an upper bound to the number of cells which can be infected

Reverse-transcriptase enzyme in liver cells in a lab has been shown to convert the mRNA vaccines into DNA. While it's unclear if it would actually be a permanent change to cells, DNA is a lot more stable than RNA and could hang around a lot longer than expected, and result in a lot more spike protein than expected.

https://www.mdpi.com/1467-3045/44/3/73

You're missing part of the argument: Vaccine-generated spike protein is free-floating, while virus-generated spike protein is attached to the virus. The free-floating spike protein is a lot smaller than the virus, so it can get a lot more places, and while some will break off of the virus and become free-floating it wouldn't be in anywhere near as large amounts as vaccine-generated spike protein.

It's been a while since I've looked at the ins-and-outs of the immune system, but doesn't this basically not hold up to scrutiny? Again, correct me if I'm wrong:

A) The general method of action of the vaccines is that the mRNA enters a cell (generally dendritic cells), the cell transcribes it into the spike protein, then the cell detects something off about the proteins and presents them on their cell wall for the immune system to respond to. The proteins aren't just "free floating" unless your immune response is

B) The likelihood of an immune response to an active infection never doing the same thing with cells that contain partially constructed virons / viron components, or achieving the same effect by breaking down full virons, is basically zero. So it's almost certain that an active infection would have "free-floating" proteins in some capacity as well.

catching covid always involves an infection of a respiratory tract (nose, mouth, etc) but not necessarily an infection in the bloodstream

covid vaccines are always present in the bloodstream after injection, even if injected intra-muscularly

an early study in japan showed only ~25% of the vaccine stays at the injection site

Why did you ask that as a question if you have the answer right there?

Understanding of this stuff can change, as evident by the fact that this post exists and research is just starting.

The problem seems to be that the vaccine isn't decreasing infection risk all that much. Is it also decreasing myocarditis risk among the infected? I've seen mixed results, so it isn't clear to me.

It is. With the exception of a very narrow age range of young men, the COVID vaccine is protective against heart disease alone, even ignoring all other outcomes.

> the COVID vaccine is protective against heart disease alone

Wait, what? As in people should just take it as a prophylactic for heart disease, without even taking covid into consideration? It seems like this would be shouted from the rooftops if it were true.

No - it's protective against negative COVID-19 outcomes just if you consider cardiovascular outcomes, ignoring all the others.

Young men on the other hand appear to face the biggest increase in COVID related heart attacks according to https://www.cedars-sinai.org/newsroom/covid-19-surges-linked..., so perhaps the vaccine remains their best option.

Indeed. In that group, it's merely...murky...rather than "This is definitively a bad idea".

The issue isn't Covid vs vaccine heart risks, it's that you're going to get Covid 100% after having the vaccine, so you've essentially doubled your risk. That's the issue.

That is such a biased study. They aren't comparing Covid postive + no vaccine with covid negative + vaccine. If that was the comparison 1st group fares better as they did not find any covid positive + non vaccinated being diagnosed with myocarditis.

Also their dataset had 13% covid positive rate. So ideally we should multiply the non vaccinated risk by 13%.

[0] https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA....

I don't know about the rest of your methodology and I'm suspicious of the concept of "Oh they forgot to multiply by 13%" cause you just don't multiply percentages (with very few exceptions). But more to the point, the group "Covid Positive + No Vaccine" has a high sampling bias built into it. Because you're sampling "People who lived through covid without the vaccine".

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