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Comment on Myocarditis Cases Reported After mRNA-Based Covid-19 Vaccination

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It's important to mention that catching COVID also causes myocarditis https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm

Edit: this article says out of 192 405 448 people, 1626 had myocarditis, or about 0.0008%.

In contrast, the CDC estimates COVID has a 0.146% chance to give you myocarditis.

I don't have the numbers to answer this but which groups are getting myocarditis also matters. If covid causes myocarditis in 1 out of 100 people in an age group prone to myocarditis, but mRNA causes myocarditis in 15 out of 1000 people in an age group that doesn't get myocarditis, then then we should be very concerned about the mRNA myocarditis and adjust our policies accordingly.

Again, I made up those numbers and I'm not saying mRNA is worse. My point is that we should take a more nuanced and honest view than "they both cause it" or even "X has a great rate; therefore Y is better"

Prior reports have done this examination

https://www.nature.com/articles/s41591-021-01630-0

the increased risk of myocarditis after vaccination was higher in persons aged under 40 years. We estimated extra myocarditis events to be between 1 and 10 per million persons in the month following vaccination, which was substantially lower than the 40 extra events per million persons observed following SARS-CoV-2 infection.

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

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.

mRNA-1273 is the Moderna vaccine. As your quotation notes, that same age group shows no significant difference in myocarditis risk following infection versus following the Pfizer vaccine. https://www.medrxiv.org/content/medrxiv/early/2021/12/25/202...

Currently, worldwide is still at "promoting vaccines at all cost because Covid is worse than Black Death". So doubt these research results would be freely allowed to get published or supported. China now only doing trials on mRNA (many countries stopped using their non-mRNA vaccines). India hasn't fully vaccinated their people yet. Large part of Africa is even worst situation. So at least 2-3 billions people havn't exposed fully to mRNA benefits or negative effects. Take dengue vaccine that was shelved in Philipines which requires multi years to see its side effects. We are now just entering year 2 or mRNA. Give it 10 years to know "acceptably" mRNA vaccine increases unnecessary risks of heart-related problems. If you know personally doctors working in vaccines research field you probably will know the negatives better. Many doctors scared to even mentioned these negatives for fear of retaliations (this is worlwide phenomena right now). There is a reason FDA needs 75 years to disclose mRNA vaccine related papers. There is also a reason why all statistics on negatives effect of vaccines is so few. Try mention any of those on Youtube or Facebook now and you'll almost instantly get retaliation as anti-vaxxers.

They're very likely to be causing myocarditis through the same mechanism involving the spike protein, which means your scenario is unlikely. Myocarditis prevalence among college athletes who have recovered from a COVID-19 infection (even asymptomatic) is so high that some conferences require comprehensive cardiac testing before they can return to play. https://www.thecardiologyadvisor.com/general-cardiology/hear...

Exercising while infected is known to increase risk. If you get the vaccine, you will be told not to exert yourself for some time after. If you get infected, you might have no idea that you should stop exercising unless and until you're symptomatic. https://www.bvhealthsystem.org/expert-health-articles/covid-...

I was not told to not exert myself when I got my 2 doses. I was however told that if I experienced any negative symptoms, just nap through it essentially.

I don't disagree with that nuance, I was just trying to get ahead of the inevitable anti-vaccine propagandists that will use this study out of context for their own narrative.

"Conclusions Men are significantly more susceptible to myocarditis than women. Young men are especially at risk for acquiring myocarditis, while women are affected most commonly at the postmenopausal age. The proportion of hospital admissions caused by myocarditis has an inverse, logarithmic association with age."

from : https://heart.bmj.com/content/99/22/1681

It's not one or the other any more, as You can easily catch symptomatic Covid being fully vaccinated, question is; does risk multiply, sum or maybe the vaccine somehow protects against it.

Sure there are breakthrough cases, but if you are unvaccinated the chances of catching covid are still much higher. And if you get myocarditis with the vaccine (which is rare) you will get it much worse with covid.

Actually, data from the only places which break this stuff out properly (like the UK) shows the rate amongst vaccinated people is massively higher than the rate amongst unvaccinated people. It's been like this for quite some time. Effectiveness is sharply negative by anywhere between 50% and 300% depending on age group.

easily

I'd remove that word. It's more uncommon to get symptomatic covid in vaccinated vs unvaccinated.

We still need to investigate whether myocarditis risks exceeds vaccine benefits in very young people.

vaccinated vs unvaccinated.

Unvaccinated is two groups that are wildly different:

Those who've had Covid and those who haven't. Depending on where you are, unvaccinated may be majority share recovered, in which case this is an incorrect statement:

It's more uncommon to get symptomatic covid in vaccinated vs unvaccinated.

That statement is still true if you split by those who have had Covid and those who haven't. In both groups, those who have been vaccinated are less likely to get symptomatic covid.

According to which study? During Delta it did not appear to be significant difference.

https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm?s_cid=mm...

"rates among unvaccinated persons with a previous COVID-19 diagnosis were 29-fold lower (95% CI = 25.0–33.1) than rates among unvaccinated persons without a previous COVID-19 diagnosis in California and 14.7-fold lower (95% CI = 12.6–16.9) in New York. Rates among vaccinated persons who had had COVID-19 were 32.5-fold lower (95% CI = 27.5–37.6) than rates among unvaccinated persons without a previous COVID-19 diagnosis in California and 19.8-fold lower (95% CI = 16.2–23.5) in New York."

Asking for a "significant" difference is just using weasel words to note that each individual post-Delta study is not powered to detect a difference with those very small slices and no metanalysis having been completed yet. Every single study has shown a point estimate difference that is consistent with vaccination conferring additional protection on those who have previously recovered.

I'm using the term correctly and whether the numbers combine to indicate technical statistical difference won't impact that small difference, it would just reduce the error bars. Taking new york high end vaccine effectiveness 23.5x and worst case natural immunity 12.6x you reduce your hazard ratio by factor of 2. That is absolute worst case for natural immunity and best case for vaccine. It will be a lot closer to 1 perhaps 1.2x. Now compare that to you worst case baseline reduction of 12.6x already and how much more do you have to gain? Are you for all practical purposes protected enough?

I'm using the term correctly
it would just reduce the error bars.

Significance is about the error bars. You are not using the term correctly.

The statement that you originally claimed to be incorrect remains true. It did not make any value judgments about whether a group is immune enough. It only made a factual claim that one group is less likely to get a symptomatic infection than another.

With omicron it is not uncommon. Family of 4, all of us vaccinated to the max, we all got it. Also my brother, many neighbors.

In my larger extended family, we are also vaccinated "to the max". None of us have gotten it. These anecdotes don't mean a lot.

Anecdotes become data at large n sizes. :) Also, if you’re theoretically vaccinated, wouldn’t that mean you don’t display symptoms if you contract the virus? Your family may have gotten omicron but the vaxx was effective and so you didn’t get sick enough to notice. That’s what the expert consensus, viz that the vaxx is effective, would predict, right?

Yes, the potential exists that some or all of us have had covid cases that were completely asymptomatic because we were vaccinated… which then just speaks to the miraculous effectiveness of these vaccines.

Agree. It’s hard to even remember any similarly successful pharmaceuticals. Maybe Lipitor or one of the recent hep c drugs, but I think Pfizer pulled in like 20 billion in the last year alone. Even more “miraculously effective” once you consider that it will be a few times a year drug rather than a “one and done.” Project Lightspeed was arguably the greatest achievement of our federal government since FDR.

I don’t know any unvaccinated people who have gotten omicron. Every single one has been vaccinated, most have been fully boosted.

People need to understand COVID is not one thing. Delta was very different from alpha, omicron wildly different from Delta, etc… They all have spike proteins sure, but so does the vaxxx.

No reason to remove that word. Here are data for 2 doses of mRNA for effectiveness against Omicron infection. Follow the red line from figure 1 on page 27 of the PDF. Over time, it is 0%.

https://www.medrxiv.org/content/10.1101/2022.01.07.22268919v...

Seems weirdly selective to point to "over time it is 0%" ... well yes, I assume that if I never get another vaccination that at some point in time I may be susceptible to COVID.

What this study does show is that with a booster shot you are offered significant immunity against COVID, including omicron. I'll take 50 or 60% over 0% any day of the week.

I am incredibly grateful for the vaccines, which have done (and continue to do) a tremendous amount of heavy lifting as far as global health and reducing severe illness and hospitalization is concerned, despite those who like to pretend that they are pretty much useless.

What this study does show is that with a booster shot you are offered significant immunity against COVID, including omicron.

The confidence interval is between 10%-60% for the booster, oddly selective of you to pick the highest number. The FDA standard is to have at least 50% VE, with lower bound CI >30% for EUA.

What this study does show is that immunity is trending down and will likely hit 0 within a few months once the antibody response wanes. So yes, omicron does spread easily which is the original point I was contesting.

In addition to this it is well known now that for men under 40 the risk of myocarditis from the vaccine outweighs the risk from the virus: https://vinayprasadmdmph.substack.com/p/uk-now-reports-myoca...

https://www.nature.com/articles/s41591-021-01630-0.pdf

From the Nature article

“We esti- mated an extra two (95% confidence interval (CI) 0, 3), one (95% CI 0, 2) and six (95% CI 2, 8) myocarditis events per 1 million people vaccinated with ChAdOx1, BNT162b2 and mRNA-1273, respectively, in the 28 days following a first dose and an extra ten (95% CI 7, 11) myocarditis events per 1 million vaccinated in the 28 days after a second dose of mRNA-1273. This compares with an extra 40 (95% CI 38, 41) myocarditis events per 1 million patients in the 28 days following a SARS-CoV-2 positive test.”

Vaccine = +2-10 myocarditis events

COVID infection = +40 myocarditis events

And…

“the increased risk of myocarditis associated with the two mRNA vaccines was present only in those younger than 40.”

I don’t see how you justify saying that the vaccine risk outweighs the risk form infection. That increase in myocarditis from vaccines was only present in men under 40 but the increase was still less than the increase from the virus.

but the increase was still less than the increase from the virus.

Incorrect, you can clearly see from figure 2 on page 11 that the second dose of Moderna had a higher risk than the virus. Is there a reason you omit this?

That increase in myocarditis from vaccines was only present in men under 40

The paper doesn’t contain a breakdown in the sex difference. This was for men and women.

The authors have an updated pre-print that breaks it down by sex and both Pfizer and Moderna had higher rates than the virus for men(page 13): https://www.medrxiv.org/content/10.1101/2021.12.23.21268276v...

If the authors fixed the denominator for viral infection (i.e. used sero-prevalance), it would look even worse.

In addition to this it is well known now that for men under 40 the risk of myocarditis from the vaccine outweighs the risk from the virus

Absolutely false as noted by the other reply to this comment.

Absolutely false as noted by the other reply to this comment.

Don’t just blindly trust someone else’s comment.

You can clearly see from figure 2 on page 11 that the second dose of Moderna has a higher risk than the virus. The updated preprint also shows this for Pfizer.

https://www.nature.com/articles/s41591-021-01630-0.pdf

https://www.medrxiv.org/content/10.1101/2021.12.23.21268276v... (page 13)

My other point on vaccine effectiveness against omicron stands as well.

If I'm reading both summaries correctly:

Rates of myocarditis after 2nd shot for males 16 to 17 years of age: 105.9 per million doses of the BNT162b2 vaccine

Rates of myocarditis from COVID-19: 1500 per million cases

I rewrote both stats to be in the form of "x per 1 million" but I don't think that's a fair thing to do. Not everyone is going to get both a vaccine and get covid.

What's a better comparison? Rates of myocarditis for a unvaccinated person (roughly rate of getting covid multiplied by rate of myocarditis if getting covid) versus rates of myocarditis if vaccinated?

stats are hard, explaining stats are even harder. I'm already screwing this up.

The numbers are so different that it doesn't matter very much how you compare. It would be different if only 5% of unvaccinated people contract the disease, or if the vaccine reduced the likelihood of infection by only 5%.

It's also true that VAERS may be underreporting cases.

I hear that a factor of a 100X is common. The system is made so that the least amount of effect are reported.

Personally I know someone who had a heart attack 3 day after second dose (60yo female) The doctor dismissed the possibility of a causation by the vaccine, this case is not reported even if the person almost died.

Is covid still worse than the vaccine with Omicron, I don’t know, probable. But I know that most side effect are not reported.

A crazy thing is that the Myocardis rate can be reduce 3X by a 2 second procedure at vaccination (verifying that the injection is not in a vein)

Yeah. My partner got a moderately severe skin rash after her Moderna vaccine. She tried to report it but was ignored by everyone. Now it finally comes out that Moderna can cause severe skin rashes...

VAERS is only one data source and not a particularly good one. We have vaccination records linked to medical histories in electronic health record systems and insurance claims databases.

Right, it sucks, but EMR systems are private and not accessible for research by public entities.

Vaccine Safety Datalink is a much better source.

RAW VAERS data is a POS source of data. Plenty of Anti-Vaxxers submit false data to it and even non Anti-Vaxxers submit symptoms that correspond to anything within a month of taking the shot.

It's probably true that cases are under reported in both groups. Many people with myocarditis might just go along with their day because the symptoms aren't especially worrisome to them. You can imagine the cohort of people with political affiliations that say COVID isn't worth worrying about might not see a doctor even if the symptoms are worrisome.

These numbers are not even remotely comparable. The CDC number includes ages groups that are much more likely to have severe infections. The CDC number you cited is also based on hospitalized cases, which select for severity

You can't just compare the overall myocarditis rate from the vaccine with the one from COVID like that. Doing so makes the incorrect assumptions that you definitely will get COVID if you're unvaccinated, and that you definitely won't if you are. Let w=the chance the vaccine gives you myocarditis, x=the chance COVID gives you myocarditis, y=the chance you get COVID if you're unvaccinated, and z=the chance you get COVID if you're vaccinated. The proper comparison is then between w and x*(y-z), not just between w and x.

Also, are you only counting the number of reported and confirmed vaccine-caused cases, but then comparing that to an estimate of the total number of COVID-caused cases?

I am fully vaccinated and, as I'm typing this, recovering from COVID.

Do tell me more about this vaccine/disease exclusivity. I must be doing something wrong.

You will get the jab but for being symptomatic with covid, that's already a small chance. 5% * 0.146% ~~ 0.007

That is not true for every age group.

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