8 ms·

The incidence of myocarditis and pericarditis in unvaccinated Covid patients

83 points by rgrieselhuber 4y ago

someNameIG 4y ago
From the full text: > It has recently been reported that the incidence of myocarditis and pericarditis is increased in COVID-19 patients during the acute illness [12]. However; whether or not myocarditis and pericarditis after the recovery period are a part of the long COVID-19 syndrome is yet unknown. Herein, we studied the incidence of myocarditis and pericarditis in a large cohort of COVID-19 patients after recovering from the acute infection. It's looking at myocarditis and pericarditis not in the acute phase, but post. And iirc there has been other papers showing there is an increased risk in a 12 month followup.
- baxtr 4y ago
  You did not include the most relevant part of the paper's abstract: > We did not observe an increased incidence of neither pericarditis nor myocarditis in adult patients recovering from COVID-19 infection.
  - someNameIG 4y ago
    I was more just pointing out that this was in the recovery phase, not during the acute infection. I've seen people use this paper as evidence that a covid infection does not increase the risk of CV incidents. And this seems to be an outlier anyway: > In conclusion, either symptomatic or asymptomatic SARS-CoV-2 infection is associated with an increased risk for late CV outcomes and has a causal effect on all-cause mortality in a late post-COVID-19 period. https://www.ajconline.org/article/S0002-9149(22)00655-5/fulltext https://www.ajconline.org/article/S0002-9149(22)00655-5/full... > In summary, using a national cohort of people with COVID-19, we show that risk and 12-month burden of incident cardiovascular disease are substantial and span several cardiovascular disease categories (ischemic and non-ischemic heart disease, dysrhythmias and others). The risks and burdens of cardiovascular disease were evident even among those whose acute COVID-19 did not necessitate hospitalization. https://www.nature.com/articles/s41591-022-01689-3 https://www.nature.com/articles/s41591-022-01689-3 > The 12-month risk of incidental cardiovascular diseases is substantially higher in the COVID-19 survivors than the non-COVID-19 controls. Clinicians and patients with a history of COVID-19 should pay attention to their cardiovascular health in long term. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00349-2/fulltext https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...
    - rgrieselhuber 4y ago
      > First, we censored cohort participants at the time of receiving the first dose of any COVID-19 vaccine. Second, we adjusted for vaccination as a time-varying covariate. What does this mean, specifically?
stuntkite 4y ago
I got OG Covid very early in 2020. I had something like a heart attack about six months later. It has not reoccurred. I suspect I had something kind of like a stroke a bit ago. The event was accompanied with very terrifying and specific neurological event. A loud noise that was only inside my head and unreal "sounding" that worked like a corkscrew from the right side of my head to the front while my vision dimmed. I legitimately thought I was about to die and was able to tell my partner so. It passed and I went to a doctor the following morning. More on that below. I've only noticed small motor function loss on my left side and some memory impairments. Since 2020 I have had what I call a "dinner plate in my chest". It goes away with some cardio exercise. I can feel my vascular system radiating from the center of my chest up the sides of my neck and out through my shoulders. It's got a bit of a slow ache and upper body stiffness when it's flaring up. When it's bad, sometimes I wake up with numbness that radiates from my chest out to my finger tips on the top sides of my arms. I have no problems taking deep breaths. The injury does not seem to be growing. After the cardiac issue I had in 2020, my bloodwork showed signs that there was a possible event. My EKG was fine. This was days after. I have a constant dull to really shitty headache in the top front inside my head that has been persistent from the thing that seemed like a mini-stroke. I have never really had headaches without a serious hangover. I couldn't see my regular GP, still haven't been able to, but the doc I did see basically told me she thought it was vertigo and I needed to clean my ears. She checked my reflexes and some other things and said she could not recommend any further action without more events. I know what vertigo is. I've experienced it on accident and on purpose. I am not experiencing random vertigo. She did not seem to take anything I was saying seriously. She also told me she found it offensive that I was swearing while describing the experience and a gentleman would refrain from such language. I think she's a fucking moron, but she's functionally just as helpful as my curious, smart, and compassionate GP. I'm 6' broad shouldered, and 210lbs. A bit chubby. I don't exercise a ton, but do some exercise, especially when the dinner plate flairs up. I don't smoke. I've had a chest x-ray and it shows what looks like scarring in vascular structures radiating from my lungs. The forms kind of look on x-ray like the "ground glass nodules" that some people are experiencing. It's VERY hard to get a doctor that wants to do anything with me about this stuff. The fact that cardio makes things better and not worse is counter intuitive from traditional issues that look the same like Angina Pectoris. I've said since I recovered the first time (I've had it at least once more post vaccination but nothing was quite as near death as the first) that I felt cognitively and physically like I was 10 years older. I turn 40 next year. New research has been coming out showing that some people suffering from long COVID show aging of their CV systems of about 10 years. It is going to take a long time to figure out what Long Covid is really doing to people. Some people that never showed symptoms get these things. Children are showing it too. The diagnostic criteria is really difficult and there is almost no treatment aside from some success with similar treatments used for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[0]. I have found that most doctors don't want to touch it with a 200ft poll. The Red Cross says I should join an online support group[1]. A lot of the research is being done by scraping subreddits for people reporting symptoms because they vary so wildly and seem to have little correlation with the perceived severity of infection. I suspect we may find a high correlation with exposure to heavy air born contamination. Like living in a very polluted city, exposure to lots of dust or chemicals, or living in a building with black mold for extended periods. The minor feeling or easy to ignore/temporary damage done by those experiences creating cellular damage that makes cells in CV systems pop like popcorn when COVID does its very unique number on vascular structures. The word Blood Foam was used once in a very early study on people who died from COVID. The images I remember from that study demonstrated that it is a pretty accurate term for what happens in the worst cases. I'm sure there are people with genetic properties that could just make them more susceptible as well. I would also not be surprised if it ended up being correlated to heavy metals, dust/fiber, or fungal exposure specifically one or a pair of those things, even staggered exposure, being the biggest contributor. I expect that once its mechanisms are understood, the condition will not share a designation with other known pathologies. An interaction to an exposure and the damage certain coronaviruses do when given the right scaffold. [0] https://www.frontiersin.org/articles/10.3389/fmed.2020.606824/full https://www.frontiersin.org/articles/10.3389/fmed.2020.60682... [1]https://www.heart.org/en/news/2022/03/31/after-covid-19-experts-say-watch-for-these-potential-heart-and-brain-problems https://www.heart.org/en/news/2022/03/31/after-covid-19-expe...
puffoflogic 4y ago
- sph 4y ago
  The title of the post needs to reflect the title in the article, except when it is blatant clickbait, and to allow for the HN title length limits. There is no question mark in the article's title.
  - puffoflogic 4y ago
    Dang disagrees, at least when it suits him. He has publicly stated that he adds ? to titles whenever he feels it is justified.
mmastrac 4y ago
I think we'll discover that the post-vax myocarditis and pericarditis were caused by pre-existing, latent COVID infections. This probably means that there's a large number of people walking around with completely asymptomatic infections until the body attacks it either because of a vaccination or it finally stumbles across it and generates an immune response.
- pstuart 4y ago
  A tag-along tangent to that: I'm curious as to the cases where there are adverse reactions to the vaccine, what is the probability/possibility that the individual's response would be comparable if exposed to the virus directly.
- nradov 4y ago
  Unlikely. Your hypothesis wouldn't explain the significantly higher rate of vaccine induced myocarditis in young males compared to females. Infection rates are similar between the sexes so there must be something else going on.
  - yellowapple 4y ago
    > significantly The studies I've seen largely indicate that it's insignificantly higher, at most. > vaccine induced There are far too many confounding variables to declare with any sort of honesty that it's "vaccine induced" - even if you could prove correlation (remember: correlation != causation). For example: > young males Gender disparities exist in youth athletics participation, and student athletes are well known to be disproportionately at risk of sudden death from undiagnosed myocarditis (see https://www.dukehealth.org/blog/preventing-sudden-cardiac-arrest-young-athletes https://www.dukehealth.org/blog/preventing-sudden-cardiac-ar... as one information source which predates COVID and the vaccines thereof). Young males being more likely to participate in activities which can cause myocarditis or worsen existing myocarditis would readily explain the gender disparity, in a way that neither infection nor vaccination likely would.
    - nradov 4y ago
capnrefsmmat 4y ago
When reading this sentence: > We did not observe an increased incidence of neither pericarditis nor myocarditis in adult patients recovering from COVID-19 infection. you should be careful not to interpret this as evidence of absence. The previous sentence gives confidence intervals: > Post COVID-19 infection was not associated with either myocarditis (aHR 1.08; 95% CI 0.45 to 2.56) or pericarditis (aHR 0.53; 95% CI 0.25 to 1.13). Here a 95% CI from 0.45 to 2.56 means that the data is statistically consistent with myocarditis being 0.45 times as likely in people with COVID infection, or 2.56 times more likely. The sample size here is simply not enough to be more precise, simply because myocarditis and pericarditis are so rare. (It's hard to be precise about the rate of something that happened in only nine COVID patients in the study!) Hence you should not interpret this as demonstrating no difference between people with and without prior COVID infection -- merely bounding the size of the difference that may exist, and saying it can't be more than roughly a factor of 2.5-3. To be blunt, the authors are wrong to say in their Conclusion that "Our data suggest that there is no increase in the incidence of myocarditis and pericarditis in COVID-19 recovered patients compared to uninfected matched controls." Again, the confidence interval shows that a 2x increased incidence of myocarditis would be consistent with the data. This is a widespread misinterpretation of statistics and one that has been around for decades, so please excuse me for taking every opportunity to complain. (e.g. https://www.statisticsdonewrong.com/power.html#the-power-of-being-underpowered https://www.statisticsdonewrong.com/power.html#the-power-of-...)
- jimcavel888 4y ago
- clairity 4y ago
  right, i was going to make a similar kind of critique (but probably less lucidly). the effect sizes are tiny and the confidence intervals overwhelm the supposed conclusions. seems to be motivated reasoning rather than impartial science. covid may cause a rise in heart disease in unvaxed individuals relative to vaxed, but this study does nothing to support, and especially doesn't prove, that contention. one thing it does reveal is that the overall incidence rates for myo-/pericarditis are pretty small, vaxed or otherwise. what would be more interesting is a comparative study of incidence relative to similar cardiopulmonary infections like the flu. that would tell us whether heart disease from covid is something to worry more about than our ambient worry over heart disease in general (which seems relatively mild compared to covid).
ars 4y ago
"Follow-up was censored on 28 February 2021, with minimum observation of 18 days." What does censored mean in this context?
- mertd 4y ago
  They stopped following up after that date. https://en.wikipedia.org/wiki/Censoring_(statistics) https://en.wikipedia.org/wiki/Censoring_(statistics)
colechristensen 4y ago
Covid sometimes infects heart tissue and that infection can linger long after you’re asymptomatic. It is not at all surprising that a vaccination after such an infection can cause cardiac symptoms as your immune system is tuned up and starts attacking the infection in your heart. This is A) rather uncommon and B) hard to verify scientifically. Not to mention that this not happening is a morality issue for a lot of folks because vaccine good, suggestions of side effects bad.
- matthewterhune 4y ago
  If this were the cause, I would expect to see similar rates of myocarditis from the viral vector vaccines, but it's much lower. The MRNA vaccines work by causing cells to produce antigens, which are presented on the cell surface and induce the immune system to attack the cell. We know now as well that the lipid vehicle doesn't stay at the injection site but distributes through the body to varying degrees. No need to posit a secondary mechanism - it's more likely the vaccine is just carried to the heart in some cases, is absorbed, and induces immune attack like it does in other tissue.
  - matthewterhune 4y ago
    The biodistribution of the viral vector vaccines is likely different and also dependant on what tissue the vector prefers to infect, so when it leaks out of the injection site you get side effects in other places (clotting and vascular effects) instead of the heart.
obsidience 4y ago
While I'm probably wasting my time here. I'm going to say what I think many aren't saying. We need to heavily study and reflect on the impact of vaccinations regardless of the outcome and IF "we made the right decision". This means comparing outcomes between the vaccinated and unvaccinated. While this study might be a step in the right direction, I feel there are too many in the medical, political and scientific spheres of influence that are shutting down such medical/scientific/humane study and debate. The silence is deafening. If I don't hear such debate, my mind goes full tinfoil hat and thinks of concepts such as the Tenth Man Rule. It's good to have a civil discussion and disagreement on ANY subject. The data is out there. Where is that disagreement? Where are those studies? What were the impacts on heart conditions, strokes, neurological, SADS and other medical conditions? The silence is truly deafening. And to further increase my chances of getting censored - it's those same spheres of influence that likely created COVID in the first place and continue to allow institutions to dabble with genetic modification of these viruses. No one cares about the definition of "gain of function". We (humanity) dabbled with the code of life and messed up; we messed up big. Let's learn from this mistake and move on.
- jjeaff 4y ago
  You seem to think that COVID was definitely man made, but we still don't have enough data to make any kind of assertion on that. Some recent finds lean more to a zoonotic source. As for censorship, I don't think anyone is censoring truly good studies on this stuff right now. And I don't think there is that much central control of the entire medical and scientific community. Take ivermectin, for example. Low power, poorly conducted studies trying to point to the benefits of Ivermectin to treat covid are still coming out. Doesn't seem like they are being censored.
- yellowapple 4y ago
  > The silence is truly deafening. If you're only hearing silence in the vaccination debate (which, mind you, has been raging since before the first SARS outbreak, let alone the current SARS 2: CoV Boogaloo), then you might want to get your ears checked ;) There is no shortage of medical professionals with all sorts of opinions on whether or not to vaccinate for any manner of disease, COVID included. Sure, the overwhelming majority have reached a consensus in favor of vaccination doing more good than harm (for good reason), but the tiny minority with contrary opinions are not at all being censored (if anything, they're being anti-censored, e.g. by social media posts and your usual gaggle of conspiracy-theory-peddling news outlets).
randm_sequence 4y ago
I love the discussion on the statistical power of the findings and the appropriate interpretation of those numbers. However, there is a much larger problematic aspect to this paper that is subtle but critical and is being overlooked in this discussion. Once you understand this bias you will realize that the paper's reported findings are most certainly dramatically understated. Put simply, not every single patient in the study was appropriately tested for myocarditis and/or pericarditis. The statistics provided by this retrospective cohort study depend on the outcome of patients traversing the healthcare system of the population in question. These statistics are really telling you the outcome of multiple probabilistic events (listed below). Once you think through each of these events, it quickly becomes apparent that all of the biases lead these conditions to be dramatically undercounted. 1. Patient sought healthcare 2. Patient reported symptoms doctor could identify as potential myocarditis and or pericarditis 3. Doctor recognized symptoms 4. Doctor ordered appropriate diagnostic testing 5. Radiologist recognized the condition. Let's look at each of these. 1. Given this was a retrospective study, we know that (1) happened 100% of the time. No problem here. 2 and 3. A patient with myocarditis may have one or more of the symptoms below. Some of these symptoms, such as swelling in the lower extremities, are likely a dead give away. However, most are extremely common in COVID. - Signs of a viral infection, such as body aches, joint pain, fever, headaches, vomiting, diarrhea or a sore throat. - Rapid or abnormal heart rhythms (arrhythmias). - Chest pain. - Shortness of breath, both at rest and during physical activity. - Swelling of your lower extremities (legs, ankles and feet). - Fatigue. I would wager that most patients who demonstrated one or more of these symptoms indicative for potential myocarditis/pericarditis were not actually tested for the disease. To get tested, a patient lacking extreme myocarditis would likely have to push and push hard to get the doctor to test. This *heavily* biases the results toward under counting. 4. Diagnosing COVID-caused myocarditis and pericarditis is hard. The typical standard of care, at least in the US, is an echocardiogram. This diagnostic ultrasound can indeed pick up some forms of the disease but multiple papers have shown that COVID-caused myocarditis and pericarditis can be invisible on an echocardiogram. The definitive scan is a specialized MRI machine capable of a particular scan sequence. This machine is hard to find even in major health centers (there are three of them total in the Washington DC area). The cost of an MRI is at least an order of magnitude more than an echocardiogram. The echo takes about 15 minutes whereas the cardiac MRI is about 90 minutes. Thus, it is highly unlikely that the doctors in question ordered the appropriate test that can actually detect the disease in question. This further biases the findings in the same direction. Finally, the study looks at patients from March 2020 and January 2021. The fact that COVID myocarditis and pericarditis can typically only be resolved on a specialized cardiac MRI was not common knowledge for most of the study period. Thus, the conclusions from this study are DRAMATICALLY underestimated.

83 points by rgrieselhuber 4y ago

From the full text: > It has recently been reported that the incidence of myocarditis and pericarditis is increased in COVID-19 patients during the acute illness [12]. However; whether or not myocarditis and pericarditis after the recovery period are a part of the long COVID-19 syndrome is yet unknown. Herein, we studied the incidence of myocarditis and pericarditis in a large cohort of COVID-19 patients after recovering from the acute infection. It's looking at myocarditis and pericarditis not in the acute phase, but post. And iirc there has been other papers showing there is an increased risk in a 12 month followup.

baxtr 4y ago
You did not include the most relevant part of the paper's abstract: > We did not observe an increased incidence of neither pericarditis nor myocarditis in adult patients recovering from COVID-19 infection.
- someNameIG 4y ago
  I was more just pointing out that this was in the recovery phase, not during the acute infection. I've seen people use this paper as evidence that a covid infection does not increase the risk of CV incidents. And this seems to be an outlier anyway: > In conclusion, either symptomatic or asymptomatic SARS-CoV-2 infection is associated with an increased risk for late CV outcomes and has a causal effect on all-cause mortality in a late post-COVID-19 period. https://www.ajconline.org/article/S0002-9149(22)00655-5/fulltext https://www.ajconline.org/article/S0002-9149(22)00655-5/full... > In summary, using a national cohort of people with COVID-19, we show that risk and 12-month burden of incident cardiovascular disease are substantial and span several cardiovascular disease categories (ischemic and non-ischemic heart disease, dysrhythmias and others). The risks and burdens of cardiovascular disease were evident even among those whose acute COVID-19 did not necessitate hospitalization. https://www.nature.com/articles/s41591-022-01689-3 https://www.nature.com/articles/s41591-022-01689-3 > The 12-month risk of incidental cardiovascular diseases is substantially higher in the COVID-19 survivors than the non-COVID-19 controls. Clinicians and patients with a history of COVID-19 should pay attention to their cardiovascular health in long term. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00349-2/fulltext https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...
  - rgrieselhuber 4y ago
    > First, we censored cohort participants at the time of receiving the first dose of any COVID-19 vaccine. Second, we adjusted for vaccination as a time-varying covariate. What does this mean, specifically?

stuntkite 4y ago

I got OG Covid very early in 2020. I had something like a heart attack about six months later. It has not reoccurred. I suspect I had something kind of like a stroke a bit ago. The event was accompanied with very terrifying and specific neurological event. A loud noise that was only inside my head and unreal "sounding" that worked like a corkscrew from the right side of my head to the front while my vision dimmed. I legitimately thought I was about to die and was able to tell my partner so. It passed and I went to a doctor the following morning. More on that below. I've only noticed small motor function loss on my left side and some memory impairments. Since 2020 I have had what I call a "dinner plate in my chest". It goes away with some cardio exercise. I can feel my vascular system radiating from the center of my chest up the sides of my neck and out through my shoulders. It's got a bit of a slow ache and upper body stiffness when it's flaring up. When it's bad, sometimes I wake up with numbness that radiates from my chest out to my finger tips on the top sides of my arms. I have no problems taking deep breaths. The injury does not seem to be growing. After the cardiac issue I had in 2020, my bloodwork showed signs that there was a possible event. My EKG was fine. This was days after. I have a constant dull to really shitty headache in the top front inside my head that has been persistent from the thing that seemed like a mini-stroke. I have never really had headaches without a serious hangover. I couldn't see my regular GP, still haven't been able to, but the doc I did see basically told me she thought it was vertigo and I needed to clean my ears. She checked my reflexes and some other things and said she could not recommend any further action without more events. I know what vertigo is. I've experienced it on accident and on purpose. I am not experiencing random vertigo. She did not seem to take anything I was saying seriously. She also told me she found it offensive that I was swearing while describing the experience and a gentleman would refrain from such language. I think she's a fucking moron, but she's functionally just as helpful as my curious, smart, and compassionate GP. I'm 6' broad shouldered, and 210lbs. A bit chubby. I don't exercise a ton, but do some exercise, especially when the dinner plate flairs up. I don't smoke. I've had a chest x-ray and it shows what looks like scarring in vascular structures radiating from my lungs. The forms kind of look on x-ray like the "ground glass nodules" that some people are experiencing. It's VERY hard to get a doctor that wants to do anything with me about this stuff. The fact that cardio makes things better and not worse is counter intuitive from traditional issues that look the same like Angina Pectoris. I've said since I recovered the first time (I've had it at least once more post vaccination but nothing was quite as near death as the first) that I felt cognitively and physically like I was 10 years older. I turn 40 next year. New research has been coming out showing that some people suffering from long COVID show aging of their CV systems of about 10 years. It is going to take a long time to figure out what Long Covid is really doing to people. Some people that never showed symptoms get these things. Children are showing it too. The diagnostic criteria is really difficult and there is almost no treatment aside from some success with similar treatments used for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[0]. I have found that most doctors don't want to touch it with a 200ft poll. The Red Cross says I should join an online support group[1]. A lot of the research is being done by scraping subreddits for people reporting symptoms because they vary so wildly and seem to have little correlation with the perceived severity of infection. I suspect we may find a high correlation with exposure to heavy air born contamination. Like living in a very polluted city, exposure to lots of dust or chemicals, or living in a building with black mold for extended periods. The minor feeling or easy to ignore/temporary damage done by those experiences creating cellular damage that makes cells in CV systems pop like popcorn when COVID does its very unique number on vascular structures. The word Blood Foam was used once in a very early study on people who died from COVID. The images I remember from that study demonstrated that it is a pretty accurate term for what happens in the worst cases. I'm sure there are people with genetic properties that could just make them more susceptible as well. I would also not be surprised if it ended up being correlated to heavy metals, dust/fiber, or fungal exposure specifically one or a pair of those things, even staggered exposure, being the biggest contributor. I expect that once its mechanisms are understood, the condition will not share a designation with other known pathologies. An interaction to an exposure and the damage certain coronaviruses do when given the right scaffold. [0] https://www.frontiersin.org/articles/10.3389/fmed.2020.606824/full https://www.frontiersin.org/articles/10.3389/fmed.2020.60682... [1]https://www.heart.org/en/news/2022/03/31/after-covid-19-experts-say-watch-for-these-potential-heart-and-brain-problems https://www.heart.org/en/news/2022/03/31/after-covid-19-expe...

puffoflogic 4y ago

sph 4y ago
The title of the post needs to reflect the title in the article, except when it is blatant clickbait, and to allow for the HN title length limits. There is no question mark in the article's title.
- puffoflogic 4y ago
  Dang disagrees, at least when it suits him. He has publicly stated that he adds ? to titles whenever he feels it is justified.

mmastrac 4y ago

I think we'll discover that the post-vax myocarditis and pericarditis were caused by pre-existing, latent COVID infections. This probably means that there's a large number of people walking around with completely asymptomatic infections until the body attacks it either because of a vaccination or it finally stumbles across it and generates an immune response.

pstuart 4y ago
A tag-along tangent to that: I'm curious as to the cases where there are adverse reactions to the vaccine, what is the probability/possibility that the individual's response would be comparable if exposed to the virus directly.
nradov 4y ago
Unlikely. Your hypothesis wouldn't explain the significantly higher rate of vaccine induced myocarditis in young males compared to females. Infection rates are similar between the sexes so there must be something else going on.
- yellowapple 4y ago
  > significantly The studies I've seen largely indicate that it's insignificantly higher, at most. > vaccine induced There are far too many confounding variables to declare with any sort of honesty that it's "vaccine induced" - even if you could prove correlation (remember: correlation != causation). For example: > young males Gender disparities exist in youth athletics participation, and student athletes are well known to be disproportionately at risk of sudden death from undiagnosed myocarditis (see https://www.dukehealth.org/blog/preventing-sudden-cardiac-arrest-young-athletes https://www.dukehealth.org/blog/preventing-sudden-cardiac-ar... as one information source which predates COVID and the vaccines thereof). Young males being more likely to participate in activities which can cause myocarditis or worsen existing myocarditis would readily explain the gender disparity, in a way that neither infection nor vaccination likely would.
  - nradov 4y ago

capnrefsmmat 4y ago

When reading this sentence: > We did not observe an increased incidence of neither pericarditis nor myocarditis in adult patients recovering from COVID-19 infection. you should be careful not to interpret this as evidence of absence. The previous sentence gives confidence intervals: > Post COVID-19 infection was not associated with either myocarditis (aHR 1.08; 95% CI 0.45 to 2.56) or pericarditis (aHR 0.53; 95% CI 0.25 to 1.13). Here a 95% CI from 0.45 to 2.56 means that the data is statistically consistent with myocarditis being 0.45 times as likely in people with COVID infection, or 2.56 times more likely. The sample size here is simply not enough to be more precise, simply because myocarditis and pericarditis are so rare. (It's hard to be precise about the rate of something that happened in only nine COVID patients in the study!) Hence you should not interpret this as demonstrating no difference between people with and without prior COVID infection -- merely bounding the size of the difference that may exist, and saying it can't be more than roughly a factor of 2.5-3. To be blunt, the authors are wrong to say in their Conclusion that "Our data suggest that there is no increase in the incidence of myocarditis and pericarditis in COVID-19 recovered patients compared to uninfected matched controls." Again, the confidence interval shows that a 2x increased incidence of myocarditis would be consistent with the data. This is a widespread misinterpretation of statistics and one that has been around for decades, so please excuse me for taking every opportunity to complain. (e.g. https://www.statisticsdonewrong.com/power.html#the-power-of-being-underpowered https://www.statisticsdonewrong.com/power.html#the-power-of-...)

jimcavel888 4y ago
clairity 4y ago
right, i was going to make a similar kind of critique (but probably less lucidly). the effect sizes are tiny and the confidence intervals overwhelm the supposed conclusions. seems to be motivated reasoning rather than impartial science. covid may cause a rise in heart disease in unvaxed individuals relative to vaxed, but this study does nothing to support, and especially doesn't prove, that contention. one thing it does reveal is that the overall incidence rates for myo-/pericarditis are pretty small, vaxed or otherwise. what would be more interesting is a comparative study of incidence relative to similar cardiopulmonary infections like the flu. that would tell us whether heart disease from covid is something to worry more about than our ambient worry over heart disease in general (which seems relatively mild compared to covid).

ars 4y ago

"Follow-up was censored on 28 February 2021, with minimum observation of 18 days." What does censored mean in this context?

mertd 4y ago
They stopped following up after that date. https://en.wikipedia.org/wiki/Censoring_(statistics) https://en.wikipedia.org/wiki/Censoring_(statistics)

colechristensen 4y ago

Covid sometimes infects heart tissue and that infection can linger long after you’re asymptomatic. It is not at all surprising that a vaccination after such an infection can cause cardiac symptoms as your immune system is tuned up and starts attacking the infection in your heart. This is A) rather uncommon and B) hard to verify scientifically. Not to mention that this not happening is a morality issue for a lot of folks because vaccine good, suggestions of side effects bad.

matthewterhune 4y ago
If this were the cause, I would expect to see similar rates of myocarditis from the viral vector vaccines, but it's much lower. The MRNA vaccines work by causing cells to produce antigens, which are presented on the cell surface and induce the immune system to attack the cell. We know now as well that the lipid vehicle doesn't stay at the injection site but distributes through the body to varying degrees. No need to posit a secondary mechanism - it's more likely the vaccine is just carried to the heart in some cases, is absorbed, and induces immune attack like it does in other tissue.
- matthewterhune 4y ago
  The biodistribution of the viral vector vaccines is likely different and also dependant on what tissue the vector prefers to infect, so when it leaks out of the injection site you get side effects in other places (clotting and vascular effects) instead of the heart.

obsidience 4y ago

While I'm probably wasting my time here. I'm going to say what I think many aren't saying. We need to heavily study and reflect on the impact of vaccinations regardless of the outcome and IF "we made the right decision". This means comparing outcomes between the vaccinated and unvaccinated. While this study might be a step in the right direction, I feel there are too many in the medical, political and scientific spheres of influence that are shutting down such medical/scientific/humane study and debate. The silence is deafening. If I don't hear such debate, my mind goes full tinfoil hat and thinks of concepts such as the Tenth Man Rule. It's good to have a civil discussion and disagreement on ANY subject. The data is out there. Where is that disagreement? Where are those studies? What were the impacts on heart conditions, strokes, neurological, SADS and other medical conditions? The silence is truly deafening. And to further increase my chances of getting censored - it's those same spheres of influence that likely created COVID in the first place and continue to allow institutions to dabble with genetic modification of these viruses. No one cares about the definition of "gain of function". We (humanity) dabbled with the code of life and messed up; we messed up big. Let's learn from this mistake and move on.

jjeaff 4y ago
You seem to think that COVID was definitely man made, but we still don't have enough data to make any kind of assertion on that. Some recent finds lean more to a zoonotic source. As for censorship, I don't think anyone is censoring truly good studies on this stuff right now. And I don't think there is that much central control of the entire medical and scientific community. Take ivermectin, for example. Low power, poorly conducted studies trying to point to the benefits of Ivermectin to treat covid are still coming out. Doesn't seem like they are being censored.
yellowapple 4y ago
> The silence is truly deafening. If you're only hearing silence in the vaccination debate (which, mind you, has been raging since before the first SARS outbreak, let alone the current SARS 2: CoV Boogaloo), then you might want to get your ears checked ;) There is no shortage of medical professionals with all sorts of opinions on whether or not to vaccinate for any manner of disease, COVID included. Sure, the overwhelming majority have reached a consensus in favor of vaccination doing more good than harm (for good reason), but the tiny minority with contrary opinions are not at all being censored (if anything, they're being anti-censored, e.g. by social media posts and your usual gaggle of conspiracy-theory-peddling news outlets).

randm_sequence 4y ago

I love the discussion on the statistical power of the findings and the appropriate interpretation of those numbers. However, there is a much larger problematic aspect to this paper that is subtle but critical and is being overlooked in this discussion. Once you understand this bias you will realize that the paper's reported findings are most certainly dramatically understated. Put simply, not every single patient in the study was appropriately tested for myocarditis and/or pericarditis. The statistics provided by this retrospective cohort study depend on the outcome of patients traversing the healthcare system of the population in question. These statistics are really telling you the outcome of multiple probabilistic events (listed below). Once you think through each of these events, it quickly becomes apparent that all of the biases lead these conditions to be dramatically undercounted. 1. Patient sought healthcare 2. Patient reported symptoms doctor could identify as potential myocarditis and or pericarditis 3. Doctor recognized symptoms 4. Doctor ordered appropriate diagnostic testing 5. Radiologist recognized the condition. Let's look at each of these. 1. Given this was a retrospective study, we know that (1) happened 100% of the time. No problem here. 2 and 3. A patient with myocarditis may have one or more of the symptoms below. Some of these symptoms, such as swelling in the lower extremities, are likely a dead give away. However, most are extremely common in COVID. - Signs of a viral infection, such as body aches, joint pain, fever, headaches, vomiting, diarrhea or a sore throat. - Rapid or abnormal heart rhythms (arrhythmias). - Chest pain. - Shortness of breath, both at rest and during physical activity. - Swelling of your lower extremities (legs, ankles and feet). - Fatigue. I would wager that most patients who demonstrated one or more of these symptoms indicative for potential myocarditis/pericarditis were not actually tested for the disease. To get tested, a patient lacking extreme myocarditis would likely have to push and push hard to get the doctor to test. This *heavily* biases the results toward under counting. 4. Diagnosing COVID-caused myocarditis and pericarditis is hard. The typical standard of care, at least in the US, is an echocardiogram. This diagnostic ultrasound can indeed pick up some forms of the disease but multiple papers have shown that COVID-caused myocarditis and pericarditis can be invisible on an echocardiogram. The definitive scan is a specialized MRI machine capable of a particular scan sequence. This machine is hard to find even in major health centers (there are three of them total in the Washington DC area). The cost of an MRI is at least an order of magnitude more than an echocardiogram. The echo takes about 15 minutes whereas the cardiac MRI is about 90 minutes. Thus, it is highly unlikely that the doctors in question ordered the appropriate test that can actually detect the disease in question. This further biases the findings in the same direction. Finally, the study looks at patients from March 2020 and January 2021. The fact that COVID myocarditis and pericarditis can typically only be resolved on a specialized cardiac MRI was not common knowledge for most of the study period. Thus, the conclusions from this study are DRAMATICALLY underestimated.