Thread by @han_francis

#vaccineswork the Thai Pfizer #vaccination #myocarditis is making the rounds again because it has passed peer review and become a publication... naturally the usual actors are using it to stir up fear again, so lets deep dive into what the study did and its real conclusions.🧵

Two academic Thai hospitals decided to study the potential incidence of postvaccine myocarditis in the prospective fashion in Thai school age children. They studied 301 children, and got EKG/ labs/ echo/ and some cardiac MRIs to look for myocarditis. (2/10)

@P_McCulloughMD chooses to intentionally gloss over the statistical methods of the article by quoting the percentage of cardiovascular manifestations... remember it is very important to try and read beyond only the abstract to see how the number was calculated. (3/10)

The pt with an MRI unquestionably sustained myocarditis, and his followup MRI indicated recovery. Other work for example from Jain et al indicates some people with mRNA myocarditis do not recover completely, and these people deserve our sincere analysis and followup. (4/10)

The definition of ❤️ manifestation included the following. 7 patients were found to have abnormal lab markers but a few more had symptoms, leading to the quoted percentage of cardiovascular manifestations. These would be "probable myocarditis" per case definitions. (5/10)

The pts who sustained probable subclinical myocarditis, pericarditis, or myopericarditis are the most important patients in this study but, they form 7/301 (2%) of the total. If you had a small amount of premature atrial contractions after vaccination, thats less serious.(6/10)

They still count sinus arrhythmia as an abnormal heart rhythm, which in most US, NZ, UK, Australian, and Canadian paediatric cardiology centers would be incorrect. They could exclude patients who just had this by comparing pre-participation ECGs with post vaccination ECGs. (7/10)

Same applies to the other abnormal ECG findings; if a patient had 0.05% premature ventricular contractions before **and** after, it is not necessarily a vax induced finding. We don't have a table of pre vax ECGs to look at. In the clinic we don't give meds for rare PVCs.(8/10)

Conclusions: (1) doing bigger studies with post vaccination troponin plus cardiac MRI does add value to vaccination safety surveillance but, (2) please pay attention to how an article analysis is presented to you.(9/10)

(3) heart findings after vaccination have degrees of seriousness, and they aren't the same level of seriousness. (4) hyping large numbers of "cardiac manifestations" helps nobody. (5) work on a myocarditis mechanism is ongoing. (10/10)