This paper essentially 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. There have been similar studies before, but none (that I saw) broken down by age and sex like this.
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:
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.
I don't understand how you can be skeptical about lockdowns. The virus needs people to come in contact in order to spread. If you reduce contact you reduce spreading. It's the simple fact of the matter. Case closed.
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?
In an utopia where individual rights are not a matter of importance, lockdowns make perfect sense. Case in point is nearly every prison that locked their populace down to control the spread of the virus.
> I don't understand how you can be skeptical about lockdowns. The virus needs people to come in contact in order to spread. If you reduce contact you reduce spreading. It's the simple fact of the matter. Case closed.
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.
Thank you for the detailed response. I'm afraid you totally misunderstood my comment. I said: "Nobody denies lockdowns have damaging effects in other areas."
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
> 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.
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.
> 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.
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.
It seems that you are just ignoring my comment, and ignoring the overwhelming wealth of research and expert opinion on this topic.
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).
No, I'm ignoring where you're placing the goalposts. I agree with you that certain flavors of lockdowns do not provide sufficient benefits.
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.
I do not believe you are not having this discussion in good faith. If you can't respond to the actual concerns of lockdown skeptics (read: the expressed opinion of a substantial portion of the world's experts which enjoyed near-consensus until 1.5 years ago) then I don't understand what you are trying to do.
> 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_.
> Neither China nor New Zealand have implemented anything resembling a successful strategy in anything but the very short-term.
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.
There is a definite overlap in people skeptical of lockdowns and the vaccines, but the sub tries to steer clear of vaccine skepticism due to it being technically off topic, and something that would get the sub nuked.
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.
> given the rate of deaths are 10-20x worse than the worst flu years.
I have a hard time accepting this premise. Mostly because the flu was somehow eradicated at the outset of mass covid testing, many of the covid tests did not distinguish between the flu and covid. Furthermore, I believe that we actually responded to covid in a way that caused excess covid deaths by over counting deaths and actively suppressing unpatentable treatments for covid. I think we hospitalized people that didn't need to be hospitalized, and we told people not to do anything until they needed to be hospitalized. We then started putting too many people on vents, giving them Remdesiver(toxic with highly questionable efficacy), and putting covid patients in nursing homes with the most vulnerable population. Not to mention lockdowns that pushed a huge portion of the world into poverty, nutritional deficiency, and much more susceptible to adverse effects from disease as a result.
But those are just my thoughts- I don't think we have good enough data, nor will we ever- to actually make strong conclusions either way.
> the flu was somehow eradicated at the outset of mass covid testing,
Did you know "the flu" is actually many strains, the most prevalent of which changes season to season? It is not surprising to me that Covid "won out" this season. Plus a record number of people got the flu vaccine during the pandemic. Here is what the CDC says about lower flu numbers [1]
> many of the covid tests did not distinguish between the flu and covid.
That's just not true.
> lockdowns that pushed a huge portion of the world into poverty
What would you do to mitigate the spread of a pandemic?
Thanks for clarifying the flu details. As for lockdowns- hindsight is 20/20, but I would do the following-
Issue public health advisory encouraging people to eat healthier, exercise, and possibly even offer subsidies on healthy groceries and vitamins. Vitamin D deficiency is highly correlated to negative outcomes with covid infection. To this day, our federal health organizations haven't even issued statements encouraging people to eat healthier or even do something simple and easy like address vitamin D deficiency. The messaging has been negligent at best.
I would not engage in a fear campaign, and lock people inside. Most spread was occuring between family members confining themselves inside, and stress wreaks havoc on your immune system. We've been subjected to fear induced mass psychosis for the past two years, and as a result have acquired a learned helplessness when it comes to our personal health.
I would also take steps to address to hospital staffing and capacity issues. In the USA, hospitals always run at near capacity, for financial reasons. Instead of refusing to upset that delicate balance game they play, incentives should have been put into to place to bolster staffing so that hospitals wouldn't be overwhelmed. Simply not using hospitals had the effect of killing many more people that were now missing early health screenings.
I would have also liked to see only the most vulnerable be locked down, and only on a volunteer basis. A western, non authoritarian government, has no way to truly implement lockdowns effectively. Partial lockdowns have no benefits, since they didn't actually stop the spread of anything. Instead they caused irreparable harm where they were implemented with very little benefit. Basically security theater. I understand the original intentions, but the prolonged lockdowns, justified by poor metrics of "success" quickly became a political response instead of a scientific response.
Lastly, outpatient clinical attempts at treating covid with repurposed existing drugs should have been prioritized. Trump's warp speed and prep act created insane incentives to actively hamper any attempts to treat covid except pharma approved methods. This whole response feels like the AIDS response all over again, except with more media coverage, widespread corruption, and money at play.
I'm sorry you perceive the messaging as fear-based. Indeed the facts of a pandemic are scary but I don't think the intent of sharing facts is to induce fear. Rather, it is to share information and prepare the public.
Regarding hospital staffing, I'm not sure where money for that would come from if not largely paid by patients or insurance plans. I certainly wouldn't want to see that whole system become state-owned. We should encourage rather than stifle competition.
> the flu was somehow eradicated at the outset of mass covid testing, many of the covid tests did not distinguish between the flu and covid.
What do you mean when you say that tests did not distinguish between COVID and the flu? Are you referring to simultaneous infection? I'm not aware of any PCR or antigen tests for COVID which would produce positive results for flu patients. Nor any antigen or rapid molecular assays for the flu which would produce positives for COVID patients.
Seems much more reasonable that social distancing and masking significantly reduced flu transmission.
Which appears to use one sentence, taken out of context (read the very next sentence), from a CDC post recommending that PCRs be used to test for both flu and covid simultaneously because, well, we're in flu season and people might have either one when they show up at a hospital sick.
The flu has a basic reproductive rate much lower than the coronavirus. By the time mass covid testing started and flu season came, the public health measures were so severe one would expect them to basically eradicate the flu, and they were keeping COVID close to the rate of eradication, but were relaxed every time before that happened.
> Mostly because the flu was somehow eradicated at the outset of mass covid testing (...)
Perhaps all those basic public health measures implemented to contain and eliminate the spread of air borne diseases such as COVID or the flu is a factor?
I mean,the lockdowns alone have a clear and critical and measurable (and measured) impact in lowering the spread of COVID. Wouldn't it be possible that staying away from people with the flu was also a factor in not catching the flu?
Attempts to measure the impact of lockdowns have produced a wide range of results. The impact is far from clear and there are numerous confounding variables that are impossible to control. The data has been manipulated for political purposes on both sides of the issue.
"Worst" flu years must be quite selectively chosen. Clearly the Spanish Flu was much worse than COVID.
If you go by age-adjusted excess mortality then most countries reached levels last seen about a decade ago, more or less. The UK for example I think was 'rolled back' to 2007/2008 levels of mortality, Sweden back to 2012.
So 10x worse than worst flu years just doesn't seem right at all and I wonder where you got that stat. One thing that is clear is that the general population systematically over-estimates the severity of COVID by orders of magnitude.
There's a similar French poll out there, probably they exist for many countries. IFR estimates in these polls are wild, like 100x-200x higher than the correct values. So it's worth checking that you're familiar with the true numbers, as many people aren't, yet think they're well informed.
> Is r/lockdownskepticism also skeptical of vaccination?
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.
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.
> 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.
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).
COVID wasn't eliminated via lockdown. New Zealand wasn't really locked down up until quite recently, they "just" closed their borders and completely screwed all their citizens who were outside the country at the time. That appeared to work for a while but now they're having COVID waves anyway, and when that started it turned out they hadn't really bothered vaccinating because they felt COVID wasn't a problem for them.
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.
> It's true that only China and Taiwan have retained Covid-Zero status in the face of Delta
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.
It's a mix of focused protection and "we can't control it, it's a force of nature like the weather".
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).
First half I agree, second half builds on a sense of suspicion and mistrust over the other and on a sense of having “them” figured out, which is a nice pleasure to indulge in, but I don’t buy it at all
> Since May 2021, people living in counties that voted heavily for Donald Trump during the last presidential election have been nearly three times as likely to die from COVID-19 as those who live in areas that went for now-President Biden. That's according to a new analysis by NPR that examines how political polarization and misinformation are driving a significant share of the deaths in the pandemic.
> 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).
That's a horribly misleading comparison. Compare the risk of illness with severity similar to heart complications, or compare death rates. Don't compare one to the other.
The majority of myocarditis cases due to the vaccine don't even require hospitalization.
Source? One friend with this exact issue was never hospitalized, was told that it couldn't possibly be due the vaccine, but ended up with several visits to a cardiologist and now had to deal with the long term effects. So no- there was no hospitalization. Technically. And they will never show up in any data set either. Because we aren't even tracking this stuff correctly in the USA.
Yes, your friend had no hospitalization. We don't count people who see a doctor a few times and have long term side-effects as hospitalized from COVID, so in an apples-to-apples comparison the example of your friend should not go into that column.
> 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)
In that case, I'm wondering how valuable the hospitalization metric is. Someone can be incidentally hospitalized, and discharged with no serious long term issues, the ER is the only option for many non insured in the USA, while a life altering long term side effect may never result in hospitalization, but is something that should go into the risk profile of either catching covid or an adverse reaction to the vaccine. But we have to work with what we have.
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.
It's quite rare to be incidentally hospitalized. If you are hospitalized, you are very very sick. You don't get hospitalized for a broken arm, you get a cast and maybe some painkillers and you're sent home.
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.
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
There are many hospital patients who are admitted for other conditions and diagnosed with asymptomatic COVID-19 during routine admission screening. This is particularly common among pediatric patients.
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.
Even before covid, hospital resources in many countries are quite limited, a big responsibility of ER doctors is to triage patients, they would not hospitalize anyone for non-serious reasons just because you asked (in the UK). You can be hospitalized without a firm diagnosis if your symptoms possibly indicate something life threatening like stroke.
> The majority of myocarditis cases due to the vaccine don't even require hospitalization.
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.
Such a person would be included as a COVID-19 death in the statistics because those data sets all assume correlation = causation, actually you don't even need to test positive at the time of death. Any positive within 28 days of the death is sufficient. But the death certificate might record the cause differently, depending on arbitrary factors like how hard working the relevant staff are feeling that day.
I say we are all still in the experimental ... we are trying to figure things out phase but really we aren't totally sure. Learning as we go... OMG!!
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 would presume so, though I don't have any numbers on me right now. Myocarditis was not the biggest risk from covid, lung damage/blood clots/strokes where iirc.
That graph in that tweet is included in the study's PDF. It's the very last page of the PDF and has more graphs too.
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.
I've seen similar research about the risk of miocarditis.
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 paper essentially 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. There have been similar studies before, but none (that I saw) broken down by age and sex like this.
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.
They might still be right; this is only a pre-print, only focused on one specific aspect of COVID and the effect size is small.
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.
> the most likely explanation is they misunderstood something and were just wrong
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.
> They might still be right; this is only a pre-print, only focused on one specific aspect of COVID and the effect size is small.
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...
I think it’s generally true. Check out the discussion sections of the primary sources, they are usually pretty forthcoming about the limitations of the data and methodology.
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)
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
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 don't know. I feel that many people got unfairly labelled as "anti-vaxxer" because they simply opposed to forced vaccination --not the efficacy of the vaccine itself, based on the argument that risk of death from covid was relatively very low for healthy adults and children. And given the time constrains for the vaccine production and trials, it would have been prudent to assume that the side effects associated with the vaccines would not be fully revealed in time.
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.
People were labelled anti-vaxxers because they were opposed to forced vaccination? I can't say that this is a sentiment that's new to me.
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.
> 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.
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.
> I don't know. I feel that many people got unfairly labelled as "anti-vaxxer" because they simply opposed to forced vaccination
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!>>
I have seen many people arguing for the vaccines as an effective treatment whilst defending people's choice to refuse the vaccine. Though I got vaccinated, I was surely forced to do so else I would've lost my job, but I delayed as much as I could. However, I was very clear to advise my parents (in their late 60s) to be the first in lie to take the vaccine because I knew the risks associated with COVID far outweighed any risk associated with the vaccine. And I know of many people with similar views, though they apply to a different age group, like many parents not wanting to vaccinate their children because they understand how rare of a event is death from covid for a healthy kid.
> 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.
As did many news media organizations - only up until the election, that is. [0] Then everyone was a conspiracy theorist immediately after.
Government of Ontario (Province in Canada) published data months ago showing that young men were at higher risk from heart issues. Nobody cared and the all the local and federal news outlets refused to report on the numbers.
Right, so the rate is 200 cases per million vaccinations.
The COVID rates are 450 cases per million vaccination.
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.
> So the statement that COVID has a higher risk of myocarditis is still true.
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...
Ontario was reporting age/sex-delineated data to this effect as early as the summer - all while the media and public health officials were advising Ontarians (including < 40 yr old males) to "take the first vaccine you're offered."
Did he qualify the statement or make it in general? If he didn't qualify it, he is simply incorrect.
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.
Did you just accuse him of making conclusions without evidence while responding with absolute certainty?
This discussion is about discussing an actual study that can back up the calculatio of covid vs vax side effects. Afaik, prior to that there hasn't been such evidence so all the risk calculations were essentially pulled out of one's bottom.
Since you're accusing him of insufficient evidence for his mere hypotheticals, can you actually provide evidence for your absolute statements?
With Covid moving so fast it's not really feasible to rely on peer-reviewed data alone. Once a paper gets reviewed things have usually changed (like new variants). Pre-prints are very necessary because of this.
Of course it's not optimal, you either have unreliable or outdated data.
Just to point out you're making assumption of someone's competency, ability, and then go yourself to make vague and broad, unbacked claims; you do seem to be parroting common mainstream talking points to counter-narrative talking points - just observation of mine.
Likewise, there are actual answers regarding background levels of myocarditis, etc, and in fact it's far more complex than either of us are going to begin to discuss here.
And in regards to mortality rate, pretty much all research/numbers show that comorbidities/underlying health is the main factor - and which we could dive into the nuance, however your final claim immediately is obviously dismissable - but the easiest rebuttal is to parrot back to what seems to be a highly arrogant attitude: what makes you so sure your analysis (or sources) are so correct?
> Despite this you have immediately concluded that the media is lying to you and making it up as they go along.
This is not true, although reading my post back I can somewhat see why you would think that. I stated
> So where were these people and the media getting their information from, or were they just making it up?
The paragraph immediately following this was intended as an "and if they were making it up" continuation. I will edit my original post to clarify.
> Why are you so sure this analysis is correct?
One thing this study has going for it over the media and internet commenters just stating things like "scientists and doctors say that" is that here, we actually see some data, rather than the media or others basically saying the data exists, somewhere out there, source: "just trust us".
This preprint is actually a companion paper to their already published paper in Nature where they do not stratify by age and sex together.
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.
Wow, I just got the Pfizer booster a few days ago and I'm an under-40 male who has previously had pericarditis... I was worried about the risk being greater than the reward for my age group but didn't have the age-stratified data to prove it. Kind of regretting it now, especially since I only got it at the urging of my wife. I just needlessly increased the odds of a giving myself a heart issue for absolutely no reason.
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 :)
To be fair, we're still talking about 1:10,000 odds. You're much more likely to, for example, be hit by a car in the next year, even if you're in a high-risk category.
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.
What are the odds of being hit by a car in the next year? I'm honestly curious, so I googled what I could find. From what I find the odds of an injury from an accident are 1:8393 which does support your statement (assuming every accident is getting hit 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).
CDC best guess mortality risk for his age group is 500/1000000 if he gets an infection. I would say risk probably not outweighing the benefit if it doesn’t prevent infection outright.
That is a laughable analysis. You are comparing the risk of death to the risk of a serious side effect. Why not compare apples to apples and compare the risk of heart complications requiring hospitalization (a fraction of the myocraditis and pericarditis cases caused by the vaccine) to the hospitalization rate of infection? You can normalize that by the 75% efficacy against Omicron if you want.
Who says the vaccine prevents heart complications from infection? All the statistics I’ve seen compare mainly mortality. From a pure risk vs reward of vaccine vs no vaccine, measuring mortality seems reasonable. When in history have we vaccinated to prevent side effects?
> When in history have we vaccinated to prevent side effects?
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%
So what is the mortality rate of the vaccine? Because this is the myocarditis rate, and the vast majority of cases didn't even require hospitalization. If you want to compare mortality rates, share a link.
And yes, the virus prevents heart complications from infection, because it prevents symptomatic infection.
It’s pretty evident at this point it doesn’t prevent 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.
3 doses of pfizer seen to have more thab 75% protection against even Omicron.
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.
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.
That is for a few hospitals. The flu is not serious to lead to an actual, complete, collapse of the healthcare system as a whole where no resources are left to treat immediately life threatening conditions. That's what we were facing with COVID.
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.
> So what is the mortality rate of the vaccine? Because this is the myocarditis rate, and the vast majority of cases didn't even require hospitalization.
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).
This is actually not the case. In the UK, outpatient treatment and observations are considered to result in an admission, even if there is no inpatient care (hospitalization).
It largely depends on the affected area... It can kill you instantly if it takes conduction centers, kill you years later if it damages the muscle or it can leave no consequences at all. It can go unnoticed and still leave you with long term damages.
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.
If you got Pfizer, your risk is lower than Moderna for myocarditis. Fairly similar to COVID-19 itself according to this paper. There is also pericarditis and cardiac
arrhythmia that they covered in their original paper https://www.nature.com/articles/s41591-021-01630-0#Sec30
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.
I don't think that's the right question to ask. Obviously my chances of surviving COVID would be higher with the vaccine than without. The real question is, which has an overall higher risk for someone of my age, sex, and health status, a COVID infection or the vaccine? I honestly don't know the answer to that question.
I mean, if you really wanted to base your opinions on science, you wouldn’t hold off on vaccines based on a single study that is not even in the meta-analysis level, no? And since you’re the type who likes to be sure, I wonder if your hesitancy to take the vaccine is grounded on professional medical advice, at all?
A doctor can't provide me with data that doesn't exist. I actually did ask a friend who's an ER doc about whether or not I should get one of the mRNA boosters, given that I have a history of pericarditis. He said that, based on the available studies, the risk of getting pericarditis/myocarditis from COVID is far greater than the risk of getting it from the vaccine, but he also conceded that he didn't know of any studies that specifically examined the risk for someone who has a history of pericarditis.
Also, the study that we're all discussing here is a preprint that was posted on December 25th, so this age-stratified data obviously wasn't available when I decided to get the booster on the 17th.
My point was that you're going to get terrible advice here, so what the hell are you even doing?
The overall level of intellect displayed in Hacker News COVID threads is of the holy shit, there goes my faith in humanity level of quality. Just my opinion but you are barking up the wrong tree here. (these are important questions for a person who has been treated for a heart condition to bring up with their doctor)
No matter how right you are, or feel you are, you can make your substantive points thoughtfully and within the rules here, so please do that instead. As a bonus, your arguments will be more effective that way.
> The overall level of intellect displayed in Hacker News COVID threads is of the holy shit, there goes my faith in humanity level of quality.
Weird, this is one of the only forums online where I can read relatively civil, data-based discussions between people with opposing viewpoints that don’t devolve into calling each other anti-vaxxers or sheep.
Sure there is the typical HN Dunning-Krueger noise from computer scientists discussing biology, but overall I enjoy reading the exchanges in these threads.
There’s really not an equivalent forum on Reddit or Twitter with this high quality discussion around narrative-busting data.
After only looking at the charts at the end of the PDF, they seem to indicate that the 3rd dose (booster) of the Pfizer vaccine raises your myocarditis risk about as much as the 2nd dose of Moderna's.
There are large CIs around the mean increase with Pfizer booster, but the mean doesn't fall into the confidence interval for second dose Moderna. Does not appear to be tracking as commensurate.
In the chart, the IRR from infection is 2.02, 95% CI 1.13-3.61. The IRR for 3rd dose Pfizer is 7.6, 95% CI 1.92-30.15.
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.
> In summary, the risk of hospital admission or death from myocarditis is greater following COVID-19 infection than following vaccination and remains modest following sequential doses of mRNA vaccine including a third booster dose of BNT162b in the overall population.
> 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.
An animal study found that aspiration during injection could reduce the risk of vaccine induced myocarditis. It hasn't been reproduced in humans but this seems like something worthy of further research.
Aspiration is pulling back the syringe plunger prior to injection to ensure the needle tip is in the correct tissue and not in a vein. This isn't typically done for COVID-19 vaccinations, and there is some controversy in medical circles about whether this should be a standard procedure.
I saw a statistic of Denmark (who are aspirating) vs Norway (who aren't), and vaccine complications[0] were something like 1 in 25.000 in Denmark vs 1 in 15.000 in Norway[1], so there was a clear difference.
[0] Or myocarditis specifically?
[1] Don't quote me on these numbers, they are ballpark numbers from my memory
It is apparently a means to double check and make sure you are injecting into a muscle and not into a blood vessel by seeing if you can draw blood at that site before you actually inject anything.
The vaccine is intended to be an intramuscular injection. The risk of myocarditis is possibly linked to an accidental intravenous injection. With aspiration, the person performing the injection has a chance to detect that they hit a blood vessel instead of the muscle and try again.
It seemed likely early on that the risks of vaccination exceeded the benefits for healthy young people, but the argument was they should get vaccinated anyway so they wouldn't be able to transmit the virus to someone more vulnerable. Now that it's clear vaccination doesn't prevent transmission, the argument for vaccinating healthy young people is pretty weak.
>Now that it's clear vaccination doesn't prevent transmission
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 viral load in vaccinated infections has been demonstrated to be the same as unvaccinated infections in multiple studies now. And a perfect example is here in Ontario where 80% of the cases are in vaccinated individuals even though 77% of the population is actually vaccinated.
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.
This study has several issues which are rightly pointed out by the author:
> 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.
"Although the mechanisms for development of myocarditis are not clear, molecular mimicry between the spike protein of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and self-antigens, trigger of preexisting dysregulated immune pathways in certain individuals, immune response to mRNA, and activation of immunologic pathways, and dysregulated cytokine expression have been proposed."
"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."
The spike protein RNA vaccine saturates the body causing an inflammatory response especial so in certain muscles that use lipids (vaccine contains lipid as a transport mechanism) as a primary source of energy such as the heart muscle. A good interview of this is [1] Joe Rogan Experience episode #1747 - Dr. Peter A. McCullough
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.
The 30 micrograms of ribonucleic acid in an mRNA vaccine dose get folded into protein and make their way into the lymph nodes in your armpit. They do not “saturate the body”.
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.
The fact the CDC recognizes myocarditis results from infection of vaccination does not support your claim that it is a direct result of "spike protein saturating the body".
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.
I don't understand what you're defending against. The science proves you wrong.
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.
Well, yes, the spike protein induces an immune response. That's the entire purpose of using it as an antigen in a vaccine. If you don't see the daylight between that and your original claim that 'saturating the body with spike protein' which gets uptaken in tissue in the heart as metabolic substrate which then results in myocarditis, I don't know what to say.
You misquoted him twice; he said "The spike protein RNA vaccine saturates the body" and clarified he was referring to the response mechanism of the vaccine by saying "the vaccine saturates", which you referred to in the first sentence of the comment I'm replying to. It seems like you two are discussing the same thing, as a third party.
I don't think I'm misrepresenting them even if I paraphrased. The vaccine doesn't saturate the body, and there's no evidence the heart is subject to these side effects due to lipid vesicles being uptaken from circulation because the heart uses them as substrate. Then to not leave any doubt, they cite McCullough on the topic who is way off the rails beyond available evidence.
Your second sentence seems like the most promising path to helpful discussion. It sounds like you're saying the Khan preprint is wrong because of an association with McCullough, but I don't know the name and it doesn't appear in the study (I haven't listened to the podcast.) I'm sure there's more to what you mean by disagreeing with the mechanism the other user proposed.
"Moderna's (MRNA.O) COVID-19 vaccine is up to four times more likely to cause inflammation of the heart muscle, a very rare side effect, than its rival vaccine from Pfizer-BioNTech (PFE.N)"
> The 30 micrograms of ribonucleic acid in an mRNA vaccine dose get folded into protein and make their way into the lymph nodes in your armpit. They do not “saturate the body”.
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.
> 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.
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.
Peter McCullough's take flies in the face of the weight of subject matter experts and published evidence on the topic. If you like podcast format, perhaps listen to ZDoggMD's dissection of McCullough's interview https://zdoggmd.com/peter-mccullough/
I've heard one semi plausible theory so far.. but take it with a huge grain of salt because of the theorists reputation.
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.
A bit off-topic but why does PDF export sometimes produce these incredibly, seemingly gratuitously fugly font renderings? The size and spacing of the letters seems to be random. Like, here's a giant d in the middle of a word for no reason.
PDF rendering is the bane of my existence. I've found it stunningly difficult to generate an acceptable output from a source format like Markdown, and the process usually requires massive dependencies and fiddly configuration to get something close to what you want. Don't even try to produce numbered headings or a cover page unless you're willing to write the whole thing in LaTeX from start to finish, but who knows if you'll ever get the table to appear in the right spot on the page. :D
I wish these papers were printed in journals that publish the reviewer comments. In fact i think it should be a requirement for all journals. Unfortunately all online commentary ends up becoming a pissing contest where everyone is trying to outwit each other instead of attacking the paper itself from all angles.
Oh god yes. Considering the leech-like synecdoche journals are for all that stinks in academia at the moment, I really wish they'd try and make a better place for public discussion between experts than Twitter spats.
There are probably far too many papers that academics have discovered flaws in but don't have time to do anything about
i am agreeing with you and parent comment, there is definitely room for growth in how these journals are presented. i think having access to the full discussion would be an amazing step forward for the science community as well as those who are interested in grasping a deeper understanding of how and why the discussion decided to go with their findings
One shortcoming of this and every other study comparing seropositives is that they obviously underestimate such cases 2 to 3 fold. Also further stratifying to “healthy males” would have seen an even more prominent rise.
I am sad that only now this has become an open issue. Meanwhile, women are still fighting over menstrual cycle changes post vaccination.
"Traditional vaccines" are by no means free of side effects. The smallpox vaccine is a live vaccine and causes much more severe side effects than mRNA COVID-19 vaccines, including myocarditis [1]. This risk was accepted since smallpox is incredibly dangerous.
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.
> This risk was accepted since smallpox is incredibly dangerous.
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?
Over the long run your risk of catching a SARS-CoV-2 infection approaches 100%. The virus can never be eradicated and we'll all be exposed to it occasionally. Vaccination — and other measures to strengthen your immune system — can reduce the risk of serious COVID-19 symptoms to fairly low levels.
There is no evidence that the "vaccine only works for a couple of months".
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.
WTF - then why are "booster shots" needed? In my country they are moving towards recommending them after three months already.
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.
Yes, and WAY higher than the risk of serious symptoms for the virus. For males 18-29 the risk of hospitalization is 0.4% compared to 0.1% for myocarditis, and most myocarditis cases do not require hospitalization. Risk of severe disease is of course much more than risk of hospitalization.
That 0.4% chance is not random though - it's heavily weighted toward 18-29 year olds with severe existing co-morbidities, extremely high BMI's, etc.
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.
I am older than 40 and according to qcovid my risk of hospitalization is about 0,1%, so I doubt your 0,4% number. I am slightly overweight, which increases my risk by about 20%. But I doubt all the 18-29 year olds in your group are so obese that they get to 0,4%.
qcovid.org gives an evaluation of the risk of catching and then being hospitalized from Covid, whereas your sources give the risk of being hospitalized when tested positive for Covid. Depending on the testing regime, the latter number may also be biased towards people who are already sick, as they may be more likely to be tested.
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:
https://twitter.com/VPrasadMDMPH/status/1475145220618526729