Autopsy-based characterization of myocarditis after anti-SARS-CoV-2-vaccination

As always, xkcd explains it best: https://www.explainxkcd.com/wiki/index.php/882:_Significant

Consider "traveling 230 miles by car is 1 micromort"... but that doesn't account for impaired driving or any of the other factors known to influence likelihood or survival of a car crash.

The numbers would likely change if you further specified them, but they are useful for the broad comparisons and risk analysis.

If you've got someone going skydiving every weekend, what does that do to their life insurance rates? Well, skydiving is 8 micromorts per jump. So that's 400 micromorts per year. And that goes into some insurance premium cost calculations.

From Wikipedia:

> Micromorts for future activities can only be rough assessments, as specific circumstances will always have an impact. However, past historical rates of events can be used to provide a ball park, average figure.

Another part of this is a study about risk acceptance.

> An application of micromorts is measuring the value that humans place on risk. For example, a person can consider the amount of money they would be willing to pay to avoid a one-in-a-million chance of death (or conversely, the amount of money they would receive to accept a one-in-a-million chance of death). When offered this situation, people claim a high number. However, when looking at their day-to-day actions (e.g., how much they are willing to pay for safety features on cars), a typical value for a micromort is around $50 (in 2009). This is not to say the $50 valuation should be taken to mean that a human life (1 million micromorts) is valued at $50,000,000. Rather, people are less inclined to spend money after a certain point to increase their safety. This means that analyzing risk using the micromort is more useful when using small risks, not necessarily large ones.

That last sentence is an important one when looking at this.

Would you be willing to be paid $150 to get vaccinated?

For example, according to "Challenges in Inferring Intrinsic Severity of the SARS-CoV-2 Omicron Variant" (https://www.nejm.org/doi/full/10.1056/NEJMp2119682?query=fea...): "This meaningful but fairly small difference [vs Delta] implies that omicron, alpha, and wild-type SARS-CoV-2 have similar intrinsic severity."

The meta-analysis is looking at that question that you are asking.

It also has all the papers that it cites for analysis and an analysis of its own limitations.

> The systematic review encompassed 113 studies, of which 27 studies (covering 34 geographical locations) satisfied the inclusion criteria and were included in the meta-analysis.

The closest I've seen to an answer is to remove accidental deaths (eg, hit by a car, firearms fatality, etc) but there's a huge range of arguable cases like stroke which is plausibly covid-affected. Second, you have the problem of comparing stats between locations that used different definitions, so it's harder to do post-hoc correlations.

The decisions seems to have been avoiding false-negative mistakes by increasing false positives in the first wave of analysis: "Let's include everything under a simple rule for covid stats so that we at least have some kind of worst-case baseline modelling with similar datasets, and we can figure out afterwards which are real and which aren't"

Anyway, just wanted to see if you actually have a better answer to the problem than the standard that was used.

The recent Paxlovid study supports this. It reduces deaths days 30-90. Deaths that would not be counted as Covid deaths. But they clearly are if paxlovid reduces them.

> "Individuals who have died with COVID-19, but not as a result of COVID-19 are included in the case counts for COVID-19 deaths in Toronto."

I don't know the particulars of Toronto Public Health, but this wasn't uncommon for immediate reporting vs death record reporting. Since, in many places, comprehensive death records can take a few weeks (or longer!) to go through the pipeline before ending up on finalized reports, it's useful to have more immediate death reporting during a pandemic. Such immediate reporting is necessarily going to be a little rougher around the edges, but it generally gets you pretty close to the real numbers.

But, it's absolutely true that this immediate reporting isn't perfect. Still, it's very useful, and usually close enough for near term needs. Taking the Toronto example, the main tradeoffs are that a) you include some deaths where Covid wasn't actually a contributing factor and b) you miss deaths where the person was never tested for Covid (especially applicable to deaths that occurred at home). Often, these two somewhat balanced themselves out, but only in places with fairly high levels of testing.

Then, in the medium to longer term, you can switch over to relying on more comprehensive death records. This helps to filter out non-causal scenarios (e.g. the "hit by bus, tested positive for covid, died" scenarios). It also helps add in cases that were initially missed (had symptoms of covid, never went to hospital, died at home, etc).

Finally, to validate numbers, we can also look at excess deaths. This helps ensure that we're not wildly off base with reported numbers. Excess deaths isn't a perfect metric to compare to, but it's still a great benchmark.

To wrap up this comment, let me respond to this:

> We have to be extremely cautious when considering any of the death-related statistics for this particular situation.

I fully agree, but.. I would suggest that your comment missed a lot of the accuracy refinement that happens in practice over the medium to longer term. Additionally, it's very much worth pointing out that, with additional analysis (from death records, from excess death analysis, etc), we've found that very few places were likely over-reporting Covid deaths, but that a significant number of places were under-reporting Covid deaths. So, yes, take shorter term Covid death stats with a grain of salt, but know that we've generally ended up reporting too low, not too high.

I don't believe that comparing those two is unreasonable.

However, to your last question that is what micomorts can answer.

The risk of death from a vaccination is 2.9 micromorts. The risk of death from contracting Covid-19 for a 25 year old is 100 micromorts. So 30x greater risk.. and those are directly comparable numbers.

The other point to consider - you're not always going to be 25. I'm much closer to the 55 bracket than the 25 bracket, and that represents a 40x increase in risk... so about 1200x greater risk than vaccination.

Assuming you remain a hermit for some number of years (and Covid-19 remains endemic), is there a point where you would change your mind on the value proposition of a vaccination? And if the answer is yes - why not do it now?

Yea, currently you're comparing 2.9 micromorts vs 100 micromorts. At 25, that comparison doesn't have too much to it. 100 micromorts is not something that I think too much about either (comparable to the risk of death while giving birth for the women out there). I've done road trips that racked up 100 micromorts cumulative (more if you add in the hiking and skiing micromorts on that trip).

I'll also note I'm older now than when I was when I did that roadtrip... and there are things that I would do now to further mitigate the risks that I took back then.

It's not wrong for your age, but it is something that should be said "yes, its a risk and it is a lot riskier."

That said, there's a number even beyond that 100 micromorts to consider.

New data shows long Covid is keeping as many as 4 million people out of work - https://www.brookings.edu/research/new-data-shows-long-covid...

> 1.6 million full-time equivalent workers could be out of work due to long Covid. With 10.6 million unfilled jobs at the time, long Covid potentially accounted for 15% of the labor shortage.

That 4M number is not part that I want to be part of. While I have better than average health insurance, the not-dying also has a significant risk to it too. It is harder to quantify as it isn't an accurate cause of mortality - but it is not something that should be ignored.

Many people here enjoy better than average salaries - consider the risk of going on long term disability for the next 40 to 60 years with the corresponding reduction in compensation. And yes, I know people who are no longer able to work on anything that has a deadline or expectations of attendance in meetings; their lifestyle has changed significantly from three years ago.

https://newsroom.heart.org/news/myocarditis-risk-significant...

> One might imagine that such cells would be targeted to at some some extent by CD8+ T cells that learn to recognize spike protein.

This is exactly what we want to see happen, and you're going to get CD8+ T-cells from the virus as well (and if you don't, then you're going to get very extremely ill).

The tissue distribution is a reasonably good point, but that should be considered in light of the evidence that the virus itself likes to hide out in places like the gut and that liver and gut activation after vaccination may be protective. And if that argument is wrong, that would be an argument to try to produce nasal mRNA vaccines.

And at this point we do have a really massive amount of data on the safety and efficacy of the mRNA vaccines and we're having to sift the data very closely to find effects lower than one in million. Other vaccines perform worse. I think it probably is because we're getting closer and closer to minimalism.

https://newsroom.heart.org/news/myocarditis-risk-significant...

" The cluster of deaths back in the summer helped kindle what is now a fire — a conspiracy theory that today peddles a list of dozens of doctors online, including the three who died in July, as well as — according to its own descriptions — several who drowned, one who was in the middle of biking 105 kilometres and a doctor who died coming down K2, a mountain deadlier than Everest. "

It started out as "three" doctors, now it is "dozens".

Genetic/History

    Ehlers–Danlos syndrome

    Loeys–Dietz syndrome

    Marfan syndrome

    Turner syndrome

    Familial thoracic aortic aneurysms

    Bicuspid aortic valve (BAV), which is an abnormal aortic valve

Diabetes, particularly uncontrolled diabetes

Lifestyle Habits

    Aneurysms of blood vessels in other parts of your body

    Chronic obstructive pulmonary disease (COPD)

    Cardiovascular conditions, such as atherosclerosis, coronary heart disease, and peripheral artery disease

    Unhealthy blood cholesterol level

    High blood pressure, which is the leading risk factor for thoracic aortic aneurysms but also a risk factor for abdominal aortic aneurysm

    Bacterial infections, which are a risk factor for thoracic aortic aneurysms.

    Kidney conditions, such as renal failure, chronic kidney disease, and polycystic kidney disease

    Obesity

    Pheochromocytoma external link , a rare tumors of the adrenal gland that can lead to high blood pressure

    Vasculitis

[2] https://www.ahajournals.org/doi/10.1161/circulationaha.110.0...

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198737/

[4] https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.26901

Sure. But if a person is aware that other countries have different policies, that gives them a legitimate reason to question whether the policy of their own country is correct. If a person looks into the matter, and decides not to follow the recommendations of their own government, because they think some other country's government is more likely to have got it right, such a person isn't necessarily being irrational/irresponsible/etc, nor would it necessarily be irrational/irresponsible/etc for them to share their conclusion with others.

> and conflate that it means that Denmark doesn't think vaccines were ever beneficial to people under the age of 50 (which is the leap in logic you often see on anti-vax sites)

Yes, many people do seem to conflate these two claims:

(1) "for healthy children and young people, the safety risk of additional doses of the vaccine currently outweighs the risk of COVID-19"

(2) "for healthy children and young people, the safety risk of any dose of the vaccine has always outweighed the risk of COVID-19"

While claim (1) is disputed, some highly respected medical experts agree with it; the same cannot be said for claim (2).

However, I think this conflation goes in both directions – some people who want to defend (2) do so by conflating it with (1); but conversely, some people attack (1) by conflating it with (2).

Some people can't distinguish reasonable scepticism about vaccinations from unreasonable scepticism.

Other countries compared to who? Not everyone here is from the same country as you :)

I don't think anyone is making a value judgment based on where the policy is from.

Now, much of the population has become either naturally or through vaccination much less susceptible to poor outcomes from a covid infection, and this is especially true of younger people.

So the response to covid was never really about the health of the population as much as it was about the health of the hospitals. The risk to the hospitals is now much lower and therefore the reasonable vaccination effort has now changed.

Any moron can understand the idea of a round Earth and stuff orbiting around it. It takes a genius to comprehend the sublime intricacies of ether vortex theory which explains how a flat Earth can still permit satellites to stay airborne over the plane.

I've met an extremely intelligent person who was convinced we never landed on the Moon and that Stanley Kubrick faked the whole thing and left clues to this in his production of The Shining. I've also met one who thinks the Nazis invented anti-gravity and are hiding the technology to this day in underground bases in Antarctica and South America.

The only reasonable course I can see is to not take any chances and vaccinate early and vaccinate often.

There is zero evidence for a "haha i told you you were being misled" position. You are performing either foolish or disingenuous logical gymnastics to equate something like "adjusted recommendations accordingly" with "it was intentionally misleading the whole time."

Show me a place where people haven't adjusted their behavior as the virus has evolved, more time has passed creating more data, vaccination rounds have been administered, death rates have evolved, and exposure/infection has happened. It ain't here in liberal California, so is there any such strawman place you're arguing against in the US? Go out on the street and look around and observe that people are being rational and adapting over time instead of keeping up your silly little "haha i'm smarter than you you fell for a hoax" keyboard battle.

Summarized: The Covid vaccines have real safety risks for which there is a body of evidence, that taken in totality, leads one to believe that the temporal and Absolute Risk Reduction of =< 0.85% is not worth the adverse events. Given the suppression of data around the true adverse events, and the time limited protections from the vaccines, it should be used sparingly after the patient is fully informed of the risks, and minimal protections provided. Given the uniqueness of each patient's medical situation though, patients are in the best position to decide if their comorbidities are sufficient to merit the risks of these vaccines. Similarly to the Nordic countries, any younger person without severe comorbidities < 50 should not take the vaccine, but they should be able to make their own decision fully informed of the risks and limited protection, and without any type of coercion.

I don't believe that all Covid vaccines share the same risks since the microgram dosing of the MRNA vaccines vary greatly, and the Novavax vaccine [2] [3] is coming onto the scene, unfortunately with a few of the same adverse events as the MRNA vaccines though

[1] https://www.tandfonline.com/doi/full/10.1080/14760584.2022.2...

[2] https://www.yalemedicine.org/news/novavax-covid-vaccine

[3] https://us.novavaxcovidvaccine.com/hcp

This is a red herring.

It's irrelevant if anyone feels that the 3rd or 4th or 5th dose of Pfiser's increases health risks. The problem is the misrepresentation of these findings. You cannot in good faith jump from "a residual number of people experience health issues when taking the 4th or 5th dose of Pfiser's vaccine" to "do not take any vaccine at all ever or you'll die" specially when they deny that COVID poses a threat and already killed over 6million people.

You're talking about health concerns of taking a vaccine when not taking the vaccine poses a far greater threat, and somehow that's left out of the equation. That's the problem: the disingenuous misrepresentation of the problem.

https://ourworldindata.org/grapher/cumulative-excess-deaths-...

I wonder what happened in 2020 and beyond that so many more died? It must just be the weather

Negative excess deaths through the pandemics were pretty common and very well explained.

Anyway, such concepts like "non-COVID excess" doesn't even start to make sense. Either you are determining the death causes, or you are doing statistical analysis over unknown causes.

There really should be real life DARWIN awards.

The great thing, it’s mostly right wing voters dying. :)

Likewise, the initial (honest) advice not to bother with masks for covid was based on the fact that covid, like other coronaviruses and influenza, is aerosol-borne and aerosol particles pass through surgical mask material easily (so wearing a 2nd tight-fitting mask over a surgical mask to get a better fit doesn't matter).

The u-turn on masks for covid wasn't based on science. The justification later given was that the earlier, correct advice not to bother with masks was a noble lie to conserve supplies of masks for healthcare workers. At the time, the reversal was publicly predicated on hand-wavey (and false) claims that covid might be droplet-spread (droplets are larger than aerosol particles and droplet emissions could conceivably be greatly reduced by well-fitted surgical masks with no gaps).

The top article you cite has all this information in it, and even mentions the base rate fallacy. It is criticizing the framing of the pandemic as a "pandemic of the unvaccinated" and trying to focus attention on the elderly, but that is orthogonal to the question of if the unvaccinated are disproportionately clogging up the hospital system. Both statistics are true. Everyone should still get vaccinated to reduce the load on the hospital system (although this concern is now fading as antivaxxers actually do pick up immunity the hard way). We should also focus on the elderly more.

As a simple example: if a population begins entirely susceptible and there's a vaccine from day 1 which is available and reduces the risks of hospitalization by 9x and 90% of the people get the vaccine, then the rates of hospitalization will be split 50/50 between the vaccinated and unvaccinated. Vaccinating the rest of the population would increase vaccination rates by 10% but would decrease overall hospitalization rates by 44%.

That's the normal load and it is scaled for it[*].

COVID is like a DDoS.

And there is no elastic cloud scaling for nurses, you can't just turn up more instances from a ready pool.

[*] Well maybe not any more, and lets not get into a discussion of the for-profit health care system.

No problem. Please sign this document stating that you will not seek treatment for Covid and that hospitals can legally refuse to treat you if you contract Covid.

But, see, that didn't happen. Instead what we wind up with are anti-vaxxers begging for the vaccine after they have been put on ECMO. Yeah, unfortunately it's too late at that point.

And even worse you are now soaking up a hospital bed for 4+ months that should have gone to someone who wasn't stupid.

And even worse that that is the dying person's family giving grief to the hospital staff because someone anti-vax dying of Covid doesn't fit their reality narrative. I could at least have some sympathy for the uneducated following foolish leaders. I have NEGATIVE sympathy for those who then abuse people trying to help them when the consequences come home to roost.

When I can see tears of relief in the eyes of a nurse simply by saying "Don't worry. I'm pro-vax." we have let the idiots have too much leeway.

These aren't comparable. Obesity or alcoholism aren't communicable and don't lead to outbreaks. If they did, we'd be having similar discussions as to Covid.

Even if this linked OP is just acting, I still find it very repulsive due to my previous experience. I wasn't referring to that comment anyway.

The answer to this question would also be socially and politically relevant and warrant its own study. But that doesn't make the author's study unsound or unable to serve as evidence, like you said.

I just looked. The Vaccine doesn't lower your risk of getting myocarditis if you still become infected by COVID.

Anyway, the children’s vaccine was authorized in the EU on the 19th of October 2022, after all Omicron strains were making rounds through the population.

In Germany at first one dose was recommended for 12-17 then one plus booster. Kids younger than 12 may be vaccinated on a case by case basis if there’s risk factors or the parent explicitly wants it. This means that the risk of Long Covid in this age range is not a “bigger deal” than the benefits and risk from the vaccine.

According to the RKI, there were 1500 vaccinated in the age range 0-4. And between <10% and 30% in the range 5-12 depending on state.

In conclusion, your dogmatic approach is not supported by the competent health organizations. Neither is it supported by parents.

[0]https://en.m.wikipedia.org/wiki/Mass_psychogenic_illness

There's ~3 possibilities after an infection happens:

* A person's innate immune system quickly fights off the virus. This is a generic set of defenses in our bodies that are always active, and if they succeed then you don't create antibodies in the first place.

* Detectable antibodies, meaning your innate immune system wasn't enough and your adaptive immune system took care of it.

* Antibodies have faded and are no longer detectable. You can still do a T-Cell test (more costly, may take longer?) to find out if you can rapidly create new antibodies, which would mean you're still good despite no longer having antibodies.

There's also the issue of the type of antibodies. The mRNA vaccines are only coding for the spike protein, so your body only learns to fight that - but the virus has mutated away from what's currently in the vaccines. Natural/recovered immunity creates a variety of antibodies that work against different parts of the virus, so that's still effective even against "vaccine escape" variants.

And what about those?

So yeah, I would prefer beliefs not garner you special privileges

Taking covid-related "religious" beliefs seriously only undercuts societal respect for actual religious belief.

We absolutely do, but that is a completely different conversation.

If that doesn't work for you I am sure you can't object to conscription as a societal burden.

Where are you going with this line of discussion? Or did you just want me to think of something that wasn't medical?

Fair assumption. But actually I'm Canadian and, while I knew COVID discourse was a clusterfuck in the US, I didn't realize that there were people that clearly knew better blatantly lying about this.

For instance, we KNEW that the best case scenario was 90% effectiveness for the MRNA vaccines. Seeing these people saying "you won't get COVID" is an absolute disgrace and people should lose their jobs and medical certifications for this.

You’ll have to excuse my skepticism, because setting things up so that we end up in a situation where it’s entirely unfalsifiable if the vaccine caused net harm in an individual has been par for the course. I reject the premise that even if it’s an immunological response shared by with COVID we should run with that to the assumption that catching COVID would have yielded a higher risk profile. That takes a far leap ahead of the science.

And the cost-benefit analysis being different for different age classes and comorbidity is exactly the reason why the vaccines was slowly expanded to larger demographics after starting with the most vulnerable people.

In fact, the side effects of the vaccine have been much more thoroughly tracked than many pollutants that are routinely introduced in everybody's life and which somehow never trigger such a reaction from you others who care so much about all this when it comes to vaccines. The amount of hazardous material that are being put in everything from food to cosmetics or kids' toys is appalling, but all you guys have to complain about is vaccines… You claim to care about under-tested frontier technology, but somehow aren't bothered with sunscreen or bisphenol S, why is that?

It's not unreasonable to think otherwise as well given that it was a rare occurrence and typically mild. Also, there were no young men in this study. "Median age at death was 58 years (range 46–75 years)", so you're drawing your own conclusions without data here.