The risk of myocarditis in kids after mRNA vaccines is MUCH lower than was initially feared.

12-15 yo: 265 cases/18.7m doses = 1.4 cases/100k kids vaxxed
5-11 yo: 12 cases/8m doses = 0.12 cases/100k kids vaxxed

For context, the risk of getting struck by⚡️ is ~0.2/100k per year.
People asking about 16-17 yo males:

Yes we know that group has slightly higher (but still objectively low 7/100k) rates of myocarditis

The point is that rates of myocarditis are *even* lower in younger kids (5-15 yo) Hence ACIP’s recommendation that kids *should* get boosted.
As for the VSD data. In this dataset, among people aged 12-17yo, they reported 39 cases out of 1.1m vaccinations. Most were mild.

This is higher but still objectively very rare: 3.2/100k

Again, this safety data was used by ACIP to justify a stronger “SHOULD” recommendation
As for the Israeli data, they reported 136 cases of myocarditis out of 5.1m vaccinated.

This is a slightly higher rate among 16-19 yo males (15/100k) after the 2nd dose

Two caveats:
-99% of these cases were mild
-Smaller studies over/underestimate incidence in subgroups
Remember that the risk of myocarditis after COVID vaccination is *orders of magnitude* lower than the risk of myocarditis after COVID infection, even in young males.

A CDC study of people w/ COVID19 found that in <16 yo’s the incidence of myocarditis was 218/64,898 = 335/100k!

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More from @nickmmark

7 Jan
As someone who has dedicated a lot of time to studying and making #dataviz, let me explain why I dislike this NYT COVID graphic so much.

1/
It’s not that it’s a spiral - one of my favorite types of graphs is the Condegram spiral. (Named after Mark Conde)

It’s used in astronomy/meteorology to show changes the Earths magnetic fields (Kp index) & is used to visualize space weather.

2/ Image
Another awesome spiral graph - and one of the best examples of #dataviz ever IMO - is the Rose plots by Florence Nightingale.

These 1858 plots show the causes of mortality in Crimean war & make a compelling case that for improving conditions (particularly shelter in winter).
3/ Image
Read 11 tweets
4 Jan
The US hits a million COVID cases in one day. Shit.
Hospitalizations also rising rapidly.

The key is that “milder” ≠ “mild”

A variant that is 2x infectious but 30% less virulent is still very bad & has potential to overload our hospitals.
Also important: most people in the hospital don’t have COVID but everyone’s care is harmed when we don’t have enough staff.

Some hospitals have >30% of acute care staff out sick.

Today is a bad day to need the cath lab or OR.
Read 4 tweets
27 Dec 21
Finally read the new @American_Heart AHA guidelines & they are absolute garbage.

Providers shouldn’t delay compressions or defib to put on PPE? Seriously?!? It takes like 10 seconds to put on an N95!

1/
Also were they afraid to actually *recommend* vaccination?

How about saying “vaccines substantially reduce the risk of DYING or getting SERIOUSLY ILL from COVID. All healthcare workers *should* be vaccinated”

Instead they went with a toothless “may reduce their risk” blah
2/
Others have pointed out the utter hypocrisy of people who are NEVER the first responders to a code writing this guideline. This is true.

Also, logistically, who do they think will respond to a code when a dozen RNs are home sick after being exposed at the last one?
3/
Read 5 tweets
25 Dec 21
Nothing conveys so much scientific ignorance so concisely as “Dandelion 22.7pH”
It’s a common misconception that you can’t have a pH above 14.

You actually CAN have a strong base with pH >14 (or an acid with a pH <0). It’s just super duper hard to dissolve that much base in water.

🧪 Let’s look at what it would take to make a BASIC solution with pH=22!
1/
First off what do we mean when we say BASIC?

I guess it could be any of these things…
2/ ImageImageImageImage
Read 19 tweets
25 Dec 21
Doing a coding refresher while my kids were watching a movie, resulted in an epic crossover: Home Alone ICD10

First the title. 3 options:
Z62.29 Other upbringing away from parents
Z60.2 Problems related to living alone
T76.02XA Child neglect or abandonment, initial encounter
1/
The movies opens with household chaos. The protagonist (Kevin) is bullied by his older Brother “Buzz”.

Don’t worry there’s not one but two ICD10 codes for this:
1️⃣Y07.41 Sibling, perpetrator of maltreatment
2️⃣F93.9 Childhood emotional disorder, unspecified
2/
Kevin fears that Fuller (played by his real life brother Kieran) will wet the bed.

You can code this concern from Fuller’s perspective or from Kevin’s:
1️⃣N39.44 Nocturnal enuresis
2️⃣W55. contact with urine of unspecified mammal

3/
Read 32 tweets
23 Dec 21
More good news! FDA authorizes another oral COVID treatment today: molnupiravir

A short 🧵 about how molnupiravir (MOLN) works & how/when to use it.

1/
fda.gov/news-events/pr…
Molnupiravir is a pro-drug that is converted to the ribonucleoside analog N4-hydroxycytidine (NHC).

Phosphorylated NHC is incorporated into SARS-CoV-2 RNA by the viral RNA polymerase. This causes many mutations in the virus (“viral error catastrophe”), preventing replication.
2/
But wait aren’t mutations bad? Isn’t Omicron a bunch of mutations that make it more infectious?

The distinction is the *number* of mutations.

RNA viruses are error prone - accumulating on average 1-5 mutations with every copy.

MOLN induces many DOZENS of mutations at once.
3/
Read 18 tweets

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