Thread by @han_francis

#COVID19 #vaccineswork #Pathtwitter one of the pathology groups affiliated with The German Center for Infection Research (DZIF) put out an autopsy study on some adults who were found to be deceased after COVID immunization. Lets analyze: link.springer.com/article/10.100….

35 deceased were analyzed and 10 were found to have obvious other causes of death, but 5 of this group were particularly concerning to the authors because those had findings of myocarditis and also died without obvious warning symptoms. This isn't the full story though.

I do like their procedure used to arrive at the histopathologic diagnosis of myocarditis (our professions gold standard criteria); that part is secure. Part of their core conclusion is the decedents died of an arrhythmia from myocarditis - this is a hard diagnosis to establish...

without an EKG, but its always been that way. It would have been nice to see the conduction system as supporting evidence. We occasionally have people wearing EKG monitoring devices or defibrillators that catch a deadly heart rhythm: the diagnosis is secure in those situations.

They also say that proof the decedents didn't have COVID was from NP swab and medical record review. Primary multiviral PCR testing in the study tested for all viruses except SARS-COV2.

A few slides staining for nucleocapsid would be a more secure way of showing the patients did not have any significant virus present in the heart muscle.

In the supplementary table, the patients reported to have died of myocarditis had pulmonary and vascular findings consistent with atherosclerosis and pulmonary congestion in some cases. Based upon the paper it's unknown why they think atherosclerosis was noncontributory-

Especially when atherosclerosis is one of the leading causes of cardiac death in the adult autopsy. Maybe it just wasn't in the heart - this seems to be what their description of the pathology slides said.

I wouldn't be too surprised about their statement about no comparable myocarditis in the last 20 years - this is a new type of myocarditis so the cellular pattern is allowed to be novel. CD4 T cells have been reported in prior myocarditis frontiersin.org/articles/10.33….

Because this study is specifically focusing on autopsy specimens, it cannot be used to establish a rate or rate ratio of fatal post immunization myocarditis - you need epidemiological studies for that. Summary:

1. The study does establish diagnoses of myocarditis using standard criteria however the patient background does leave a little question as to whether other diagnoses were contributory too.

2. There is a lack of immunohistochemical staining to look for SARS-COV2, which may leave the assumption that these people did not have residual virus - up for debate.

3. If you do have chest symptoms after a COVID immunization, seek out medical attention immediately; patients generally do well with medical help. Many of the patients in the study did not seek medical attention.

4. This type of study is going to be one of the puzzle pieces that will help us crack one day, why the myocarditis happens, but it is not the right study design to figure out a rate of myocarditis. Its much, much more helpful than "Died Suddenly" 😉

5. Long COVID is still a bad player - if this study convinced you to avoid immunization all together, at least talk with a long COVID patient and consider mitigating COVID.

Long COVID will upend your life (and is bad for the economy by the way). +

6. Multiple streams of evidence point to increased risk of major cardiovascular events even after recovery from mild COVID. jamanetwork.com/journals/jama/… . Some of that is going to be the reason why we have more excess deaths jamanetwork.com/journals/jama/… .

Where this study is the most useful is to help confirm the histological criteria for COVID immunization myocarditis. It is naturally being oversimplified by the usual actors. Don't let anyone oversimplify COVID studies to you.