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Anish Koka Profile picture
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Mar 5 • 17 tweets • 5 min read
The preprint on vax myocarditis that broke the world: published. 🧵

TL/DR: findings strongly support individualized paediatric COVID-19 vaccination strategies which weigh protection against severe disease vs. risks of vaccine-associated myo/pericarditis
onlinelibrary.wiley.com/doi/10.1111/ec…
VAERS reports from 1.2021 - 6.2021 with dx of ‘myocarditis’, ‘pericarditis’, ‘myopericarditis’ or ‘chest pain’ for children aged 12–17 years.

Importantly, to be included in analysis all cases had 2 have cardiac enzyme leak/imaging abnormality c/w myocarditis.
In addition, a cardiologist reviewed all cases to adjudicate diagnoses, & all case data publicly reported here: bit.ly/Krug-MyoPerdic…
276 reports met initial search criteria; of these, 22 cases were excluded. Of the 253 myo/pericarditis cases included, 23 were female patient and 230 were male patient

Dose 2 rates for young boys 12-15 : 162/million, 16-17: 93/million
Much criticism focused on VAERS possibly being an overcount, as its a voluntary reporting database that isn't verified. But..

1. Clinical criteria required more than just a dx code (which is more rigorous than frequently cited covid myocarditis papers)
2. Rates here are similar to a number of other national/international estimates.
3. Matthew Oster, peds cardiologist/VRBPAC presenter : recent JAMA paper on VAERS myocarditis independently asserts that passive reporting in VAERS , high verification rate in their study, suggest VAERS rates are likely an undercount...
The reduction in hospitalization risk is a more challenging analysis in large part bc the denominator of total # of children that had COVID is a guesstimate (unlike the total # of children given vaccines). Here is what the authors summarized from the data
I'll just say that its hard for me to believe that if comparing apples to apples (young healthy boys) that rates of hospitalization for covid in this group exceeds 162 per million (what authors found in their study) or other studies in similar ballpark.
There are other factors to consider beyond protection of the individual, of course -- severely immunocompromised sibling, cohabiting with frail elderly grandparents etc. -- which is why authors conclusion is to individualize decision to vaccinate..
Must say the immediate reaction from many to attack these authors personally was shameful, and an embarrassment. The public is best served by a discussions which take into account the complexities at play here.
Other links for reference -

COVID myocarditis/MIS-C myocarditis and whether its worse than vaccine myocarditis .
More on COVID myocarditis vs. vaxx myocarditis
Thread on Oster/CDC paper on vaxx myocarditis rates referenced in current paper.
MIS-C myocarditis thankfully appears to be sig. more benign than vaxx myocarditis
Another paper which required myocarditis to be diagnosed only with addition of lab/imaging abnormality... shows rates of myocarditis above background only after vaxx roll out

Finally, that recent nature paper on longcovid cardiac complications.. what does it really show?

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Anish Koka Profile picture
Feb 14
How big of a problem is acute COVID myocarditis for children?

Pediatric cardiologist Dr. Matthew Oster, in his presentation to VRBPAC : “we had no cases to include in our analysis .. “
The majority of cases of myocarditis in children are based on its association with MIS-C .. but MIS-C myocarditis has almost no cardiac enzyme leak , and is not associated with any persistent cardiac changes on MRI in follow up.
Again compare this to vaccine myocarditis … where kids present with chest pain, have a higher troponin leak, and a third of these previously healthy kids have abnormal MRIs 3 months after..
Read 4 tweets
Anish Koka Profile picture
Feb 14
Important to put COVID - cardiac apocalypse papers in context.

Reports of Sars-COV2 and & cardiac proclivity have proliferated since early 2020.

Here is @JAMACardio saying that "78% of sur-
vivors had lingering heart disease, of which 60% had myocarditis"
Here's a frequently cited preprint studying health care workers that suggested rates of myocarditis, myopericarditis, and pericarditis at 26%, 11%, and 4% respectively long after sars-cov2 recovery.
But these studies relied heavily on abnormal cardiac MRIs only to make the diagnosis of myocarditis. The healthcare worker study only had 1 patient that leaked cardiac enzymes, & half had NO symptoms. Prior to 2020 you needed clinical criteria AND abnormal imaging.
Read 13 tweets
Anish Koka Profile picture
Jan 31
Curious to see how the expert really did ?

Expert : Anyone who who gets myocarditis post vaxx Wld have had it way worse If they had instead got COVID.

This is a theory countered by multiple data sets that show in young men, vaxx > Covid myocarditis 1/ Image
Next, expert notes Covid mortality in the young is 1/1000. He’s corrected by a sharp @joshzepps that the # is actually 1/10000 (500/5mil) & that 5 mil is prob an undercount.

So @joshzepps facts check his expert live to combat misinformation from expert 😂 2/
When @joshzepps brings up recent study in Nature from Oxford that shows higher rates of myocarditis with vaxx than COVID in young men specifically, Expert discounts this..saying Israeli data is better. He’s referring to this paper by Barda et al. In Sep 2021 which does show ⬆️ 3/ ImageImage
Read 14 tweets
Anish Koka Profile picture
Jan 26
"..risk of myocarditis after receiving mRNA-based COVID-19 vax was increased across multiple age & sex strata & was highest after the 2nd vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.."1/ Image
This estimate comes from the @CDCgov publishing in @JAMA_current using the VAERS (Vaccine Adverse Event Reporting System) database - a so called passive reporting system because reports are voluntary. Image
VAERS used appropriately is a way to pick up a signal of harm. Of 1991 reports of myocarditis, 1626 met the CDC definition for myocarditis. 73% were younger than 30 years, median age was 21, 82% occurred after the 2nd dose, 82% were male Image
Read 8 tweets
Anish Koka Profile picture
Jan 14
This is the myocarditis study that was brought up by journalist @joshzepps who 'debunked' @joerogan
tinyurl.com/2httdr9n
Only problem: paper made the diagnosis based on certain diagnostic codes that were charted. ICD10 codes listed include R01.1 (cardiac murmur unspecified)
Studies that are more rigorous about how myocarditis was defined (requiring lab abnormalities + imaging abnormalities + clinical symptoms) show vaxx myocarditis rates >> COVID myocarditis rates
There is a CDC report floating around that claims a 16x higher rate of myocarditis (this was mentioned by @drsanjaygupta on @joerogan ) . There are some basic major issues with this as well that I go into on this thread
Read 7 tweets
Anish Koka Profile picture
Dec 18, 2021
A quick word about Antibody Dependent Enhancement (ADE). Must say, there is nothing to suggest this is operative at present with Sars-COV2 or the vaccines for it, but the historical context is very interesting!
ADE occurs when the antibodies generated during an immune response recognize and bind to a pathogen, but instead of preventing infection, the complex allows easier access of the pathogen into the cell.

When vaccinated individuals fall ill this is but one possibility..
The other possibilities are :
1. A mild illness (evidence the vaccine worked to prevent more severe disease
2. A breakthrough (a term normally used to describe severe illness that results even after a vaccine, which cld mean the vaxx didnt work, didnt generate enough antibodies)
Read 9 tweets

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