[elcritch]

I’m not a doctor but fairly well versed in inflammatory conditions for personal medical reasons. Myocarditis is primarily an acute condition. According to Google its onset is quick, and most people don’t suffer chronic forms. That’d imply that if myocarditis doesn’t happen in the first 1-7 days it seems very u likely it’d occur after that period. https://www.myocarditisfoundation.org/research-and-grants/fa...

[lamontcg]

I had viral pericarditis after a cold one time, but it appeared about 2 months after I had recovered.

That's pretty common with autoimmune conditions triggered by IgG autoimmunity response.

But we understand autoimmunity in response to individual exposure to antigens pretty well and while 1-7 days is probably too short to see a lot of responses, over 3 months is highly unlikely. There can be a long tail of certain individuals having autoimmune responses up until 2 years later, but in a population study if you capture nearly all the responses after 3 months. If you don't see anything 3 months later then there's no hidden long-term effects waiting to happen years later.

And there's nothing fundamentally unique about the mRNA vaccinations that would cause anything different. It is just a dose of mRNA that looks like any other mRNA payload from a virus which is wrapped in a lipid package that fuses with the lipids in your cell wall (and we understand the allergy to PEG that some people have against the lipid nanoparticle itself). All of the 200 years of understanding of vaccinations and hundreds of years of autoimmune conditions subsequent to viruses still apply to the mRNA vaccines. The "no we don't understand anything about these new things and the clock starts from zero" is just a fantastically ignorant argument based on no understanding of what the vaccines are built from and what vaccines and viruses are and how they interact with the immune system.

So both of you are kind of wrong. 7 days is too short, but 90 days is all you need.

[elcritch]

Thanks, good to know about pericarditis. I’m not well versed on that or myocarditis and in particular the IgG or T-Cell response mechanism. Though the little I’ve read seems to indicate myocarditis is still primarily due to an acute immune response, but can re-occur or turn into a more autoimmune condition (chromic myocarditis or perhaps pericarditis).

That said I would normally give the benefit of doubt that the authors of a paper in the Lancet are more well versed on myocarditis and it’s behavior. It looks like they do adjust all their comparisons to odds ‘per 100,000 person-days’. If done properly that would adjust from an event basis to per-time basis or rate which could account for long tail reactions.

Using 90 days would risk including non-vaccine related myocarditis risks as well, which is perhaps why the lancet paper uses the time rate basis. If someone got a normal cold after a month and got pericarditis that'd skew the results as an example. Though I was disappointed to not see statistical analysis or comparison to normal occurrence rates of myocarditis without vaccine exposure, etc. though I didn’t thoroughly check their references, etc.

[busymom0]

Check out this Kaiser Permanente Northwest study which points out the flaw in the "first 1-7 days" logic:

https://onlinelibrary.wiley.com/doi/10.1002/pds.5439

> The encounter methodology identified 14 distinct patients who met the confirmed or probable CDC case definition for acute myocarditis or pericarditis with an onset within 21 days of receipt of COVID-19 vaccination. When we extended the search for relevant diagnoses to 30 days since vaccination, we identified two additional patients (for a total of 16 patients) who met the case definition for acute myocarditis or pericarditis, but those patients had been misdiagnosed at the time of their original presentation. Three of these patients had an ICD-10-CM code of I51.4 “Myocarditis, Unspecified;” that code was omitted by the VSD algorithm (in the late fall of 2021). The VSD methodology identified 11 patients who met the CDC case definition for acute myocarditis or pericarditis. Seven (64%) of the 11 patients had initial care for myopericarditis outside of a KPNW facility and their diagnosis could not be ascertained by the VSD methodology until claims were submitted (median delay of 33 days; range of 12–195 days). Among those who received a second dose of vaccine (n = 146 785), we estimated a risk as 95.4 cases of myopericarditis per million second doses administered (95% CI, 52.1–160.0).

One of the author also did a podcast where she pointed out how the way some insurance claims (especially those from outside facility) works is that it takes a few weeks to receive the claim and it to get registered correctly. So they often get missed in short period windows.

When they took into account the correct numbers, they found rates of 537.1 per million for MALES aged 18-24.

Here in Ontario, our government reports rates of 200.2 per million in males aged 18-24. Note that Ontario stopped giving Moderna to under 30 year olds and also made the dosing interval to be 8 weeks but our rates of myocarditis continued to climb.

> most people don’t suffer chronic forms

This is misleading. There is no such thing as mild myocarditis. Inflammation of your heart muscle has to be taken seriously, even if you end up in the hospital for a couple days, that's not the end of inflammation because it leads to scarring and permanent damage. Heart is the only organ that's going to keep you alive the longest and any damage to the heart has to be taken seriously especially if you are balancing it with a condition that in itself is very low risk to youth.

Around 88% of the cases occur in males and up to 96% of the cases are hospitalized. Requires no exercise for 6 months and 6 month follow up Cardiac MRI still shows damage:

https://www.jpeds.com/article/S0022-3476(22)00282-7/fulltext

And since the COVID vaccine doesn't prevent infection, you may end up compounding the risk if you get myocarditis first from the vaccine and then again from infection.

The largest study on this topic has been of 23.1 million residents across four Scandinavian countries — Denmark, Finland, Norway, and Sweden. They found that:

> in young men 16 to 24 years of age, the risk for myocarditis after vaccination with either the Pfizer or Moderna vaccine is higher than the risk for myocarditis after COVID-19 infection.

> "We show that the risk of myocarditis after COVID infection is lower in younger people and higher in older people, but the opposite is true after COVID vaccination, where the risk of myocarditis is higher in younger people and lower in older people"

> "In the group at highest risk of myocarditis after COVID vaccination — young men aged 16 to 24 — the Pfizer vaccine shows a five times higher risk of myocarditis versus the unvaccinated cohort, while the Moderna vaccine shows a 15 times higher risk"

https://www.medscape.com/viewarticle/972453

Actual study:

https://jamanetwork.com/journals/jamacardiology/fullarticle/...

This finding from Scandinavian countries also seems to match the update to the Nature study which found the risk of myocarditis in under-40 males to be greater from the vaccine than from COVID. Discussed here few months ago:

https://news.ycombinator.com/item?id=29697780

[elcritch]

I only have time to checkout out your first article. It seems plausible the KPN folks might have caught a tail-end effect of myocarditis in Covid vaccination. However the Kaiser numbers don’t appear that different or concerning to me as an educated lay person. They’re not an order of magnitude higher AFAICT without re-normalizing the units used in the TFA and the KPN paper. AFAICT from the error bars on table 2 in the KPN paper they have pretty wide error bars and CI. That makes sense given that even with on the order of a 100k+ vaccinations you only get 16 cases occurring.

TFA presents their data in a form seemingly normalized to 100,000 person-days not just events-per dose. This would potentially also capture much of the long tail effect. Though I’m not well versed in the odds ratio statics most common in these sort of medical studies.

Now that being said I am actually somewhat concerned of the lifetime cumulative risk of specifically Covid-19 vaccinations. Particularly if it becomes standard practice to get a new booster every 6 months for the rest of your life. Luckily that practice seems to be ebbing as Covid-19 has become endemic. TFA reports higher rates after the second dose, and excluded booster shots AFAICT. It’s possible booster doses could present the same or higher risk of myocarditis in particular if you’re targeting the exact same spike protein. Some quick back of the napkin calculations show a lifetime risk approaching the fatality risk of say omicron of you did get a dose every 6 months, and the risk was constant. Both of those conditions seem unlikely. For example susceptible people would likely be “weeded out” and the myocarditis risk would drop, and it’s doesn’t seem likely people will gets bi-annual boosters. Also the dosing of mRNA vaccines will likely get better and methods for treating rare events like myocarditis will improve.

[marvin]

> I am actually somewhat concerned of the lifetime cumulative risk of specifically Covid-19 vaccinations. Particularly if it becomes standard practice to get a new booster every 6 months for the rest of your life

I think it's valuable to have this public debate in general, and also regarding the quarantine measures. Quarantine measures have been criticized as something of a ratchet that doesn't have anything to do with disease, but rather with authorities controlling the population.

And I guess in some locales that criticism has strong merit. But in my locale, all the extraordinary laws enacted to mandate social distancing, quarantines and so on were rolled back this spring, triggering a big Covid wave that turned out to be (in line with health authority expectations) relatively harmless due to vaccinations and previous exposure. Some businesses struggled with their headcount for a few weeks, but within reason. And the laws weren't re-instated. So I recently caught covid along with seven others at a small party, where someone was coughing without covering their mouth all night and of course no one considered wearing a mask. But this is now all in line with official policy. Literally forbidden one year ago, on multiple counts, in principle punishable with jail but generally fines.

So I do think it's important to follow up on these arguments. It's always a cost-benefit judgement, and it's ultimately a democratic, political question. Not something that can be decided by a bureaucrat. I've always figured that everyone getting booster shots every six months for 30 years sounded almost parodically excessive, but certainly there have been a few voices demanding that.

[raydev]

> relatively harmless due to vaccinations and previous exposure

This year's dominant strain was significantly less lethal/debilitating for unvaccinated people as well.

The restrictions are still reasonable in hindsight, especially in places like Canada where hospital capacity was quickly overwhelmed in all waves leading up to and until this Spring.

Restrictions obviously can't create a world with "COVID zero" but it can slow down the infection rate so that hospitals can still treat other emergencies (although, again, in Canada it was barely enough). Kinda hard to run a hospital as usual if you have 30 people per day rolling in and they never leave.

[native_samples]

This year's COVID waves are quite harmless also to unvaccinated people. It's because Omicron is less dangerous, not because of vaccination, but of course public health authorities will ignore this and claim victory. What else can they do? Public health is a dangerous concept by construction because the social costs of them admitting they were wrong are so high.

[ImPostingOnHN]

when surmising that the only reason someone hasn't "admitted" they were wrong (and assuming you are right), is fear of the social costs, it's always good to take a step back and see if you are actually the one unable to admit being wrong, for the same reason

[native_samples]

What social costs? I'm a nobody on the internet. Although outside of HN I've posted things about COVID and the failures of public health, they had little impact because I'm not a part of that community. As a consequence:

1. I have no career in public health or academia to defend.

2. If I was wrong (I'm not) then it might hurt my standing a bit, but lots of people on the internet have opinions on random topics that other people think are wrong and they still manage to get jobs, create products, get customers etc.

3. Likewise, being right also doesn't help my career or life very much.

Contrast this to people like Ferguson or Fauci:

1. Their entire professional existence hinges on the perception that they are experts in disease.

2. If they were wrong (they are) then it'd not only hurt their standing a bit, but cause hundreds of millions or billions of people to hate them viscerally due to the staggering costs of what they insisted on. It would also destroy their self-esteem and result in them knowing that they'd done evil things, making them some of the most notorious people in history.

3. In contrast, if they were right, they .... get to keep their current jobs, salary and social status, more or less.

Frankly if I did work in public health it'd be very hard to imagine ever admitting to mistakes either. Public health operates through government force and COVID policies in particular involved forcing people to do things harmful to themselves at great cost to themselves, against their will. You have to believe you made the right calls if you're in that position, it's the corrupting influence of power. If you didn't you'd immediately quit in shame and never show your face in polite society again, so the only ones that survive in that world are the merciless ones who can never admit they are wrong. Which is exactly what we see!

[justinjlynn]

I'm impressed by the number of specific studies and writings you've gathered which happen support your conclusion. Tell me, what evidence and studies have you collected and evaluated which do not support it?

[suture]

This comes across a bit disingenuous. Do you have evidence to the contrary? If so why not state what it is or that such evidence exists? I believe the Earth is spheroidal in shape and also haven’t collected evidence that supports it being flat. It’s not reasonable, in general, to look up the pros/cons of each belief. In the present case are you suggesting that people are cherry picking the studies to conform to a preconceived belief?

[justinjlynn]

Yes, to your questions; however, do note that I am not the one publishing this unsatisfactory metastudy. As such the burden is on the publisher to produce something of value by looking up the pros and cons and comparing the two. Otherwise, anyone could just punch up google, print out the results for "flat earth" and claim to have done research which says you should believe it. Obviously, that's not the case.

[suture]

This is not an academic forum and so the standards are a bit relaxed. Typically people post their beliefs along with a snippet of the reasons for said beliefs. Then others who disagree sometime respond by presenting contrary evidence. No one has a burden as such. We are not academicians beholden to standards of thoroughness.

My suggestion is that had you responded by stating that there are contrary studies and that those studies are better then your post would have been a lot clearer. At least it would have put the idea that the evidence presented was suspect into my mind. As it is it came across as unclear who has the stronger position objectively speaking.

[justinjlynn]

Yes, of course, you're right. Unfortunately, Brandolini's Law often applies quite strongly. I simply do not wish to always subject myself to that and only wish to alert readers of the comment thread to think critically about the parent comment's contents. That is - the target of my comment is not the parent comment's author, but the reader of the parent comment. Generally, this is sufficient to meet my aims.

[mattwilsonn888]

What conclusion, besides the one you projected? He responded to a bunch of separate points the first of which actually addresses 'other studies.' Did you read it or have any thoughts on it?

[justinjlynn]

I've read a number of these studies. My thoughts are that a number of them have confounders which are not well controlled for, and they often have limited statistical power, representation issues, or other technical faults which impact their expected validity. Further, in most cases, reproduction of the study is generally not possible. In any case, individual studies simply listed supporting a particular conclusion particularly without a listing of similar studies which present opposite conclusions - and a direct comparison therein - does not a metastudy make. What's attempted here is a metastudy and, as a metastudy, it's quite lacking.

[xyzzyz]

Have you ever asked this question anyone else in any other context, when presented with scientific evidence?

[esperent]

It's an extremely important question to ask and especially when someone dumps a wall of text and a ton of studies on you that all support one viewpoint:

* Have you also evaluated studies that don't support this?

* If not, why not? Are you only looking for studies that support what you want to prove?

* If you have also looked at studies showing negative results, why have you decided not to include them here?

[jseban]

That's not really how debates work.

[esperent]

It is absolutely how debates about science work.

[justinjlynn]

Yes and, especially, of myself.