Failing our kids: Myocarditis in young boys
Guest post from David Allely, MS3
We are pleased to feature this post by Mr. David Allely, a third year medical student at Mt Sinai who writes on substack, where this essay also appears. The title is his.
Throughout the pandemic, one tactic used to minimize the harm of myocarditis is to provide statistics that lump together young people and old people, or boys and girls. Sadly, Eric Topol, mentioned in this essay is guilty of that error. This hides the safety concern because it is easy to distinguish a 20 year old man from a 40 year old woman or even a 20 year old woman.
I agree with many of the themes of this essay, and you can find my writings (opeds and academic papers) or videos on it here and here and here and here. Please watch this video which tells you just how ‘mild’ vaccine induced myocarditis really is.
Mr. Allely is a medical student, but a courageous one. I am glad he is joining our profession
Vinay Prasad MD MPH
Failing our kids
Myocarditis in young boys
This will be brief, I just wanted to demonstrate why personalized risk in medicine is the correct framework through which to make decisions about Covid vaccination. Dr. Eric Topol is a highly respected physician who many look to as a reliable broker of information. Here is a link to a thread he shared about a recent NEJM correspondence regarding the risk of myocarditis following vaccination in adolescents.
First, quick summary of what they said. They briefly mention that they had previously reported the risk of myocarditis from Pfizer vaccination in males from 16-29 years as 10.7 in 100,000. So roughly 1 in 10,000. For this study they looked at younger ages.
182,605 adolescents ages 12-15 were vaccinated with Pfizer’s mRNA shots from June to November 2021
20 possible cases and 9 confirmed cases were observed in this population.
The 9 cases all occurred within 35 days of the first dose. 8 of the 9 occurred within two weeks of the 2nd dose. This is consistent with the higher risk following second dose of mRNA vaccine
This puts the risk at 4.93 per 100,000 adolescents.
None of the 9 people with confirmed myocarditis died, the median time in the hospital was 3 days
Dr. Topol points to this data and claims that myocarditis from these vaccines is rare and mild:
Ignore his first point, that’s another topic that I don’t feel like addressing. The second point is a bit bold of a claim, but I’ll concede its vanishingly rare if it has happened at all. His claim about it being very rare and mild is what I would like to focus on briefly.
5 in 100,000 doesn’t seem like much to get worked up about, but let’s break the data down a bit. That is for boys and girls, and we know boys are at higher risk. 8 of the 9 confirmed myocarditis cases were boys, and the rate for boys ages 12-15 in this study was 8.68 per 100,000. That’s a little bit lower than the 10.7 in 100,000 they observed in men ages 16-29. I’ll concede that both of those numbers are low enough to reasonably call “rare”.
Whether a median of three days of hospitalization can ever be considered mild is another question. I would argue that if you take a healthy young middle school boy and put him in the hospital for a few days you’d damn well better be sure the upside from your intervention is far greater.
Note: Use of median in this context might be obscuring a case (or multiple) in which a child was hospitalized for quite a long time. This is purely speculation though, and perhaps a bit cynical.
So what risk do these boys face from Covid infection?
If we look at CDC data, we can get an approximate risk for adolescents ages 12-17 years:
“COVID-19 adolescent hospitalization rates from COVID-NET peaked at 2.1 per 100,000 in early January 2021, declined to 0.6 in mid-March, and rose to 1.3 in April. Among hospitalized adolescents, nearly one third required intensive care unit admission, and 5% required invasive mechanical ventilation; no associated deaths occurred.”
All of this data occurred before Covid vaccines were available to 12-15 year-olds, and many 16-17 year olds had not yet been vaccinated. So if we accept that vaccines decrease the risk of severe disease, these data is the worst case scenario, and better today. This is all not to mention the potential undercounting of overall infections in this age group due to the mild nature of Covid infection in this population. But let’s assume the numbers are correct.
At the peak of hospitalization from Covid in this age group, 2.1 per 100,000 adolescents were hospitalized with Covid. None died. Pfizer’s vaccine data from the NEJM study suggests that just under 9 per 100,000 adolescent boys were hospitalized with myocarditis. None died. So risk of hospitalization from Pfizer’s vaccine series may have been over four times as likely to land a young boy in the hospital than Covid over this time period.
Covid hospitalization in young men is rare and mild, if we want to use Dr. Topol’s standards. He also mentioned in his tweet thread that “the anti-vaxx world has gone berserk”.
I’ll admit I feel some anger when I think about Covid policy and vaccine requirements, etc. I am a healthy, 25 year old male. I took Moderna, which by all accounts has a higher risk of myocarditis than even Pfizer. I trusted our public health and medical institutions blindly in the early pandemic, based on my perception of an impressive track record and rigorous peer review.
That record is being tarnished and trust betrayed by sloppy science and overly broad mandates. I faced a far higher risk of being hospitalized with the vaccines I was mandated to take than if I had simply been infected with Covid.
The “anti-vaxx” slur is lazy and self-fulfilling. I have been saying for a while that this effort to equate criticism of these policies and risks of vaccines with standard vaccine series will sow more distrust in the vaccinations that actually matter for children to get (polio, MMR, etc). These data covered today suggest that we may have inflicted a greater number of hospitalizations on young boys by vaccinating them. The people that were behind these decisions and continue to implement them have no business guiding policy.
Mr Allely is a 3rd year medical student at Mt Sinai
Thank you, David. It still shocks me that making your completely reasonable points, based on the data itself, takes courage - but that is public health today in the US. Thank you for your courage.
Thanks for thoughtful writing. Weren't myocarditis cases then roughly 8/50,000 boys, and 1/50,000 girls? This further changes the comparison of rates.
And it is not trivial that we count all vaccine doses and myocarditis events (we have a semi accurate numerator and denominator), but nowhere near all covid cases (we don’t really know the denominator on the hospitalizations per covid case calculation). Asymptomatic infection and people who just don’t get tested are likely huge numbers, and if somehow included, would lower the rate of hospitalizations per covid infection. Also the hospitalization numerator is in question. Hospitalized WITH covid, or BECAUSE OF covid (admitted for elective surgery and screen positive for covid, vs. admitted in respiratory failure due to secretions and covid stuff).
So myocarditis : vaccines vs. hospitalization : covid comparisons with the above adjustments look even worse for vaccine in this age group of boys.