By Glen Pyle and Jennifer H Huang
The heart has played a central role in Covid-19 since the beginning. Cardiovascular conditions are among the highest risk factors for hospitalization. A significant number of patients hospitalized with SARS-CoV-2 infections have signs of heart damage, and many recover from infection with lasting cardiovascular injury.
It’s not surprising that debates over Covid-19 vaccines frequently centre around issues involving cardiovascular health. The high-profile collapse of Danish soccer player Christian Eriksen in June initiated a myth about the link between sudden cardiac death and vaccination among athletes that persists several months later.
Perhaps the most common point of conflict concerning Covid-19 vaccines is the risk of myocarditis following immunization, particularly among young people.
What do the numbers tell us about ovid-19, vaccines and myocarditis?
What is myocarditis?
Myocarditis is an inflammation of the heart muscle most commonly caused by a virus like influenza, coxsackie, hepatitis or herpes. Other causes include bacteria, fungi, toxins, chemotherapy and autoimmune conditions.
Some viruses infect heart muscle and cause direct injury to the heart, while others cause heart damage indirectly through the immune system. Activation of the immune system in response to an infection triggers the release of chemicals in the body called cytokines, which help clear infections. In some cases, the levels of cytokines rise to unusually high levels to produce a “cytokine storm” that causes damage to heart muscle.
Myocarditis by the numbers
Before Covid-19 the incidence of myocarditis was between one and 10 cases per 100,000 people per year. Rates are highest in males between 18 and 30 years old. Interestingly, most cases of myocarditis in the highest risk group are in otherwise healthy and active people.
According to the U.S. Centers for Disease Control and Prevention, the risk of myocarditis after infection with Covid-19 is much higher, at 146 cases per 100,000. The risk is higher for males, older adults (ages 50+) and children under 16 years old. Soccer player Alphonso Davies, 21, of Canada’s national men’s team, was sidelined by heart inflammation after having Covid-19.
Myocarditis following Covid-19 vaccination is rare and the risk is much smaller than the risks of cardiac injury linked to Covid-19 itself.
Based on a study out of Israel, the risk of post-vaccine myocarditis is 2.13 cases per 100,000 vaccinated, which is within the range usually seen in the general population. This study is consistent with others in the United States and Israel which put the overall incidence of post-vaccine myocarditis between 0.3 and five cases per 100,000 people.
The kids are alright
The highest incidence of myocarditis after vaccination with mRNA vaccines has occurred within three to four days after the second vaccination in males who are under age 30. In pediatric data, the median age is 15.8 years, with most patients being male (90.6 per cent) and white (66.2 per cent) or Hispanic (20.9 per cent). Reliable data on booster shots in this age group is not yet available.
Most studies show a clear benefit of Covid-19 mRNA vaccination with respect to myocarditis. Only one study by Martina Patone, from the University of Oxford, and colleagues found more ambiguous results for those under 40 years of age based on myocarditis rates alone. However, if considering the other ill effects of infection with SARS-CoV-2 — both cardiac and not — there was still a strong benefit in immunizing younger people with Covid-19 vaccines other than Moderna, which research suggests has a higher risk for myocarditis than Pfizer’s vaccine.
Repairing the damage
The treatment for myocarditis varies depending on its severity. Adults with mild forms of myocarditis typically need only rest and non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen. More severe cases require medications or even mechanical circulatory supports like left ventricular assist devices to support heart function. In some cases when treatment is no longer effective, a heart transplant is required.
In a multicentre series of patients under 21 years old, those with mild symptoms received only NSAIDs or no anti-inflammatory therapy at all. Patients with more severe symptoms can receive stronger therapies including intravenous immunoglobulin, glucocorticoids or colchicine in addition to NSAIDs.
How serious is it?
Over 80 per cent of myocarditis cases not related to Covid-19 or Covid-19 vaccination resolve spontaneously, while five per cent of patients die or require a heart transplant within one year of diagnosis.
Adults who develop myocarditis from Covid-19 have poorer outcomes than non-myocarditis Covid-19 cases, including a higher risk of death. It should be noted that myocarditis associated with SARS-CoV-2 infection is just one of several heart conditions linked to Covid-19 with outcomes that are worse than non-Covid-19 cases.
In cases of myocarditis following Covid-19 vaccination, the vast majority of cases are mild and resolve quickly. In adults, 95 per cent of cases were deemed to be mild. Similarly, in children, 98.6 per cent are mild, and there has not been any reported need for mechanical heart support (extracorporeal membrane oxygenation, when blood is pumped outside the body to a heart-lung machine) or deaths. All children who had heart weakness had complete normalization of their heart function on followup.
The dynamic changes in the global pandemic, combined with rapid developments in research, make it challenging for the public to take in all the information about the risks and benefits of Covid-19 vaccines. In cases like this it is useful to turn to the guidance of medical organizations whose mandates are to protect the health and welfare of society.
Considering all of the available research, organizations including the American Heart Association, Canadian Cardiovascular Society, Heart and Stroke Foundation of Canada, Canadian Paediatric Society and the American Academy of Pediatrics encourage all who are eligible to be vaccinated against Covid-19.
That’s a message we should all take to heart.
This is an updated version of a story originally published on Jan. 17, 2022. It clarifies that a study found patients with myocarditis from Covid-19 had poorer outcomes compared to Covid-19 patients who did not develop myocarditis.
Do you have a question about Covid-19 vaccines? Email us at [email protected] and vaccine experts will answer questions in upcoming articles.
Glen Pyle is Professor at the Laboratory of Molecular Cardiology at the University of Guelph. Jennifer H Huang is Associate Professor of Pediatric Cardiology at Oregon Health & Science University.
The Conversation arose out of deep-seated concerns for the fading quality of our public discourse and recognition of the vital role that academic experts could play in the public arena. Information has always been essential to democracy. It’s a societal good, like clean water. But many now find it difficult to put their trust in the media and experts who have spent years researching a topic. Instead, they listen to those who have the loudest voices. Those uninformed views are amplified by social media networks that reward those who spark outrage instead of insight or thoughtful discussion. The Conversation seeks to be part of the solution to this problem, to raise up the voices of true experts and to make their knowledge available to everyone. The Conversation publishes nightly at 9 p.m. on FlaglerLive.
It is so sad when you realize that our Gov. Deathsantis and his “Josef Mengele” of a Surgeon General are not doing anyone here in FL any favors, and in fact are both putting lives at risk with their intentional governmental and medical malpractice. The sooner the lightbul flicks on in people’s brains to that fact, the better, and healthier everyone in this state will be. Unfortunately, I think too many have, and still are, happily gulping down the GOP cool-aid.
Totally agree. They are aided and abetted by the propagandists such as Tucker Carlson, Sean Hannity and Laura Ingram at Faux News who readily dispense this GOP cool-aid along with other false and misleading narratives regarding COVID-19 and vaccines to treat it. They do not care about the science behind vaccine efficacy. Their goal is to appeal to the right wing voting element and the low information MAGA folks who crave and consume this misinformation much to their own detriment.
So now we want to look at the numbers but when you look at Covid and kids you ignored the numbers and lied about them. Hospitals filled with children from covid and thousands dying….. Covid is statistically a non threat to children unless they had some other comorbidity ….. and yet you want to force kids to get the jab FOR NO REASON….
It’s this type of hypocrisy that is the issue.
We corrected the record on this elsewhere. Herman must not have seen it. It’s worth reposting, because Herman, who could ave us the trouble with a 30-second fact-check, is peddling dangerous misconceptions. Among the 4.1 million covid deaths worldwide as of November 2022, 0.4 percent, or over 16,100, were children and adolescents under 20, split almost evenly between those 0-9 and those 10-19, according to UNICEF. In the United States, as of the end of Christmas week, 1,593 children under 18 have died due to Covid, according to the CDC. In Florida, the state obscures the death toll among children, as it does with much to do with Covid, by cutting off the tally at 16 years of age. As of the latest report this week, 51 children younger than 16 have died in Florida due to Covid. The next category is for those between 16 and 29: in that category, 521 have died. None of these numbers reflect the millions of infected children (1 million in Florida alone), the millions of cases of long covid children are living with, the infections children passed on to adults and the elderly, the severe non-fatal complications children endure due to covid, and so on. As Children’s Hospital Colorado notes: “Throughout the pandemic, one of the so-called silver linings that people have clung to is that COVID-19 affects children less than it affects adults. Yet the idea that kids are not impacted by the virus is a myth that is as dangerous as it is inaccurate.”
It is also cruel and indefensible, and is among the disinformation tactics not tolerated here.
ages 0 to 4 in 2020 through present… 665 died of covid. Of those a majority had other comorbidity issues. Basically the same number of children die in car accidents EVERY YEAR. Should we demand that kids not be allowed to ride in cars?
Every life is precious but if you are going to worry about little kids and covid why don’t you care about kids in cars. Where is the equivalent out rage?
If it was not anything more than political BS you would be screaming for the banning of cars, swimming pools anything where kids can die.
Herman, you argument seems to be that the Covid vaccines are more dangerous than Covid itself. That simply is not true. Even in children, there is a small risk of death from Covid. There is no known (identified) risk of death from any of the vaccines.
Covid is a very infectious disease. According to the CDC, 95% of Americans have antibodies to Covid, either from infection or vaccination. In Florida 58.4% of the population has had Covid. Covid is not going away. The sole purpose of a virus is to infect and spread. Any variation (mutation) in the virus which helps it infect and spread is naturally favored (selected). The more people who are infected and spread the virus, the more likely that new variants will evolve. Every child, until they contract Covid and recover (or are vaccinated) helps to spread Covid.
The choice is clear, either vaccinate all children against diseases, including Covid, or allow them to get sick, spread those diseases to others, and in some cases die.
As to infants and kids in cars, the risk to them is real. That is why they are required to be in car seats or booster seats. Based on your position against mandatory vaccination, I assume you are also against “the government” forcing people to put their children in car seats.
Ben Hogarth says
Your arguments don’t fail on their face for a lack of factual basis, but for a lack of reasoned understanding and measurement of those facts. Comorbidity (in example), can be almost anything on a medical chart. A child with sleep apnea – comorbidity. A child with a history of obesity – comorbidity. A child with a heart murmur – comorbidity. Etc.
EVERYTHING is a comorbidity when you look at the list relative to Covid-19 or any other death. It’s funny you bring up fatal car accidents. I’ve found in statistical analysis and my own objective observations over the years that most deadly accidents require TWO points of failure – meaning (usually) both drivers made a mistake or could have avoided the accident if one of the two didn’t act a particular way. Does this mean that we can presume we don’t need basic traffic laws because it all comes down to people following them? No. That’s literally not how society operates – or ever has – any society.
From factual and TRUTH standpoint, Covid-19 related myocarditis and pericarditis (etc.) have been found since the early 2020 days of the pandemic to be far and exceeding any such increased risk relative to the Covid-19 vaccines. You’d know this if you actually read the hundreds of medical journals that were being released in the first few months (as I did). Your risk of one of these conditions from simply having Covid-19 FAR EXCEEDS any risk you would have by taking the vaccine. So in an overly simplified “which bad outcome is better” (lesser of two evils) thought experiment – VACCINES ARE STILL BETTER. Whoa, what a concept.
Without getting into further hyperbole or straight ad hominem, I can only say your arguments fail on their face (prima facie for the attorneys lurking) because the facts are neither being properly introduced nor analyzed. You may have cited some statistics, but your misgivings and totally desperate attempt to misrepresent those facts as some baseless truth only evidence your total incompetence in understanding these issues, or worse – your maligned intent.
FlaglerLive once again did an excellent job rebutting your flawed account of history. I can only say to anyone else who reads this – pick up a medical journal and throw out the television or podcast program that’s seeding such nonsense.
I don’t know why you would say that the coronavirus is a “non threat to children”. All you would have to do Herman is turn the TV news channel from faux infotainment where MAGA lies, false conspiracy stories, anti-science BS and fake political distractions rule the day every day, and try to learn some real facts by simply conducting very easy, fact-based google searches of COVID statistics from any number of sources at your fingertips on the computer or even your phone. The plain fact that you haven’t done so and keep spouting lies tells the rest of us all that we need to know about you, and that is unfortunately, that you apparently have no interest in the TRUTH about not only the undeniable facts regarding children who have acquired the virus and the numbers of them who became seriously ill and needed to be hospitalized or who died from a serious covid infection. And the remarkable thing is that even if, just for the sake of argument, no children had any danger of becoming infected themselves, how many children do YOU know who live completely independent lives without being in close proximity daily of older people who ARE way more vulnerable to becoming seriously ill or potentially having a life threatening outcome from a covid infection transmitted from a child? Older siblings, parents, aunts & uncles, grandparents, the kids’ teachers, baby sitters, etc., etc. ALL have been and will continue to be put at risk of infection, and had there not been a concerted effort to vaccinate children, many more children AND adults would have been put at risk. So your nonsensical falsehoods about children and the covid vaccine could not possibly be more dangerous and ill-informed!!!
So you propose not letting kids ride in cars. Twice as many kids die in cars than of covid. I want to make sure you are consistent with the protection of kids. You also are filling in your pool so no kids fall in and drown. Just making sure you are not a hypocrite.
Pierre Tristam says
Herman, your analogy defeats your point, it doesn’t make it. When seat belts and car seats were mandated for children riding cars—the vaccine equivalent of driving—would you have opposed those, too, because car crashes will happen anyway and children will die anyway? Does the drastic reduction in car-crash fatalities among children, enabled by seat belts and car seats, make no difference to you? You seem so infatuated with your analogy, you’re missing the forest for the trees.
Pierre you have missed the point. My original post was about numbers. Seat belts and air bags have saved thousands and thousands of children’s live every year. Yet over 600 die every year still die every year. 600 have dies in the last 2 years from Covid and again the majority of those had other issues. Yet, you and the others here are more concerned about 300 a year than and want them to get jabs for a vaccine that has not gone through extensive testing for long term effects on our kids, than slowing speeds down to 5 mph on the highway to save more of kids lives while driving? Why is that? Are those kids ok to put at risk by allowing their parents drive at crazy speeds over 5 mph??
Before you everyone continue to go bat shit crazy…. I had my shot, I had my booster and then got covid. I get my flu shot every year…. Yes, kids get other shots that are mandatory before going to school. They were used and tested much longer than the covid vaccines before they were mandatory and used technology that had been around for years and years not like that of the covid vaccines.
What I am saying here is you guys have your priorities screwed up. If you want to save lives, do something that will have a significant effect on the numbers. Stop kids from eating shit food and sitting in front of the TV playing games and getting fat. Get adults to take care of themselves and fight obesity, stop smoking blah blah blah……
If you all really cared about this and got away from your political bullshit and promoted something that would really make a difference in the numbers you would be taken seriously. But that seems to be impossible for some especially it seems for those on the left. Everything is political. That is why there is a divide in this country.
Pierre… how about running an article about how the vulnerable, are those that are obese and out of shape. How about showing those numbers? How about telling how if people took care of themselves and got off the couch AND got their shot they would be less vulnerable. But alas….that does not fit the political narrative of this entire situation and is shown in the other comments here.
@Due regard of what you have displayed here leads to this conclusion– you are:
Good luck, and good night.
Your analogy fails: Being in accidents in cars, and dying in cars, is NOT a spreadable deadly virus disease, and can in no way be used as a comparison. Hospitals and child care centers are suffering today just as badly from huge amounts of very sick children with COVID, RSV and the flu, and with their staff getting sick too.
Ben Hogarth says
Once again Herman I will simply explain WHY your entire logic is a fallacy (and premised on fallacy to boot).
There are about 74 MILLION children in the U.S. under the age of 18. This makes up about 22% of the entire U.S. population (for the statisticians in the forum). If we take a very conservative estimate that only 95% of these kids take only up to an average of 300 car rides (trips) in a given year – we get about 70 million children under the age of 18 with a total of 21 BILLION car trips. Again, this is a VERY conservative estimate.
So out of 21 BILLION car trips in a given year, about 730 of those trips resulted in a child fatality (2019) OR 0.0000000347% based on my math (hoping I’m not off a 0 here).
COVID-19 deaths in children (according to some official stats) show that about 0.26% of Covid-19 cases resulted in death. Statistical comparison shows there is a multi-factor difference in fatality occurrences between these two VERY different life (and death) events. Covid-19 is SUBSTANTIALLY greater.
And we have traffic safety laws. We have seatbelt regulations for automotive manufacturers. We now have no texting and driving laws. And we used to have widespread traffic safety education. What we don’t have is a way to force drivers not to be stupid or for parents to never drive their kids anywhere. That’s not something that has been on the table, because it’s in no way practical. Congress in recent years even lamented traffic deaths by rhetorically questioning whether ALL speeds should be relegated to no more than 35 mph to ensure almost no one ever dies by automobile. It was a bit of a Congressional hyperbolic gesture, but the point was made to the audience – how far is too far for policy?
Herman – you want to liken everything we (the government) did to protect people during the pandemic as some draconian plot or ploy to turn the U.S. into a 1984 epic. But the truth is that your murmuring of nonsense and absurdities is the sure way we get there.
Facts matter – when one uses them honestly and genuinely. Your misrepresentation of facts and logical fallacy as to how policy should apply them are equally destructive.
Bill C says
The Covid vaccine deniers credo: don’t confuse me with the facts, my mind’s already made up. The conclusion among vaccine deniers is based on the erroneous idea that the vaccine doesn’t work because people who’ve been vaccinated still get Covid. Fact: the death rate among unvaccinated people is still far higher than that among the vaccinated.
Flagler Thankful says
I’m super impressed that the editors of the local county news outlet are more qualified than the state’s surgeon general to offer commentary on vaccinations and side effects. I knew Flagler Live was incredible, but from now on I suggest everyone go there to seek medical advice.
Backhanded non-compliments aside, it’s rather obvious that Roger Rabbit is more qualified than the doctor even his own staffers call lapdog, so yes: on Covid—and with a more qualified doctor than the surgeon general on our board—we say with confidence: you’re safer getting your advice here than from the state surgeon general.
Dr. Ladapo MD PHD, acting in his own self interest, says whatever he thinks he has to say to climb the social ladder. Ladapo has promoted unproven treatments, opposed vaccine and mask mandates, questioned the safety of COVID-19 vaccines, and spread miscellaneous falsehoods, contradicting professional medical organizations, all in order to get the job of Florida Surgeon General. He’s called the Covid vaccine “nothing special”. He knows better. He has violated the Hippocratic Oath. Why doesn’t the AMA revoke his medical license?
Ray W. says
As a community service to FlaglerLive readers, several days ago the NIH released a long-term study of individuals whose fasting blood serum levels were consistently at the high end of the normal fasting blood serum range: between 135-146. The goal of the study was to focus on a form of chronic dehydration reflected by elevated fasting blood serum levels. After the first six years of the study, the investigating team reduced the original 15,752 people who ranged in ages of 45-66 at the outset down to 11,255 participants. Due to external factors related to obesity, and the associated difficulty of identifying symptoms of disease from multiple possible sources, many people were dropped from the study early on. The study lasted for 25 years, with personal interviews and many follow-up visits, plus studies of medical records.
Those participants who presented to their doctors with consistently high normal fasting blood serum levels (above 142) experienced a statistically significantly higher rate of early death, an increased rate of biological aging, and an increased burden of chronic organ disease.
FlaglerLive readers who have not yet adopted the socially accepted challenge of New Year’s Resolutions, please resolve to drink sufficient quantities of water every day.
I accept the idea that some readers will automatically oppose any study published by any government agency. I am too much of a Hegelian to think otherwise. Just reread the comments linked to the article above. Yes, I accept that many valuable critiques of the NIH study will eventually be published, and the initial findings will be either narrowed or expanded. Yes, I accept the idea that the human body is far too complex to ever produce a single study that properly accounts for every genetic variable related to fasting blood serum levels and its deleterious effects that can span generations.
Sometimes, one just has to accept the idea that science often can solve problems without providing all-encompassing answers. Problem solving and all-encompassing answering can be two completely different things. After all, our mathematics in the early years of computing allowed NASA to send astronauts to the moon and back, even though we lacked then, and now, Einstein’s lifelong goal of achieving his theory of everything (unified field theory). NASA’s goal did not require a unified field theory, it only required a form of mathematics sufficient to allow it to solve enough anticipated problems to complete the effort successfully. Without a unified field theory, we cannot ever answer everything, but we can solve enough problems to get us to the moon and back. Far too many FlaglerLive readers think that science is supposed to answer everything, when science never has been able achieve such a lofty goal. These people then emphatically claim that a study that doesn’t answer everything is flawed, when in fact the study just might help us solve a problem, which is the whole point. The purpose of science is to help us all, either individually or as a social whole, solve problems. It would be wise to remember that a tenet of the philosophy of science is that the human mind is capable of devising far more hypotheses than can ever be tested. Herman may be an example of this entirely human capacity. When FlaglerLive commenters insist that a study must provide answers, else it be discarded as flawed, they are missing the point. A study might help us solve problems without providing answers. Each new hypothesis, when tested, might expand the boundaries of our knowledge, but we are always behind in our reach for an answer to everything. This was why, early in the pandemic, scientists attached the term “novel” to SARS-Covid 2. That simple term meant that all previous studies pertaining to coronaviruses could not be directly applied to the new form of virus. It wasn’t considered a mere variant of an older virus; it was considered a new organism. Brand new studies needed to be tested and retested. Brand new hypotheses needed to be doubted. All claims and pronouncements needed to be hedged.
A study done on the effects of dehydration! Great. Many people are constantly under-dehydrated. That can and often does lead to other body ailments.
What’s the remedy?
Drinking 6-8 glasses of water and/or liquid (not dehydrating alcoholic beverages) a day.