Thread by @han_francis

Congrats to the team out of #southkorea for completing a huge #COVID19 💉 #myocarditis study on their entire population to better characterize immunization myocarditis for all of us. Let's talk about what the paper really showed, instead of what the pundits think it showed.

I know how much work it is to coordinate all the moving parts and all the healthcare professionals to put together something like this, so if you ever meet this team, they deserve a digital round of applause.

The primary objective was to look at the medium term and long term outcomes of COVID vaccine myocarditis, count the amount, stratify by age, and find out what the most severe outcomes were. There were several levels of results, some of which confirm other studies, others are new:

1. The overall rate of myocarditis in 44.2 million people was 1/ 100 000, in everybody added together, including down to 12 years of age.

2. The males had it more than the females.
3. The mRNA vaccines (moderna > pfizer) caused myocarditis the most (with the addition of prior works, we can interpret this as certain people having cytokinopathies, predisposing them to myocarditis).

4. The severe myocarditis formed 19.8% of total myocarditis casese (this is the highest amount of severe myocarditis ever reported), but this formed 0.22/ 100 000 overall.

5. Dose 1+2 created more myo than the 3rd dose.
6. Total rate of myocarditis in the most at risk age group, 12-39, = 1/52540 (calculated by dividing amount of myocarditis diagnosed divided by total population in the age group) (this is on the smaller end compared to others)

7. Sudden cardiac arrest patients were found to have myocarditis by autopsy.
8. 0 kids died.
9. The hand-waving on twitter about people dying in droves from 💉 myocarditis, did not pan out.

When expanded to a population the size of the United States, this study proves that the risks from COVID disease exceed the risk from COVID vaccine myocarditis in the deaths, even in the teens, and especially in the morbidity.

https://twitter.com/DrJohnHhess/status/1665131601481838592?s=20

What is peculiar about this study?
1. So far it is uncertain why they are reporting the highest rates of severe myocarditis in the world. Maybe there are genetic differences in susceptibility (this certainly pans out in dilated cardiomyopathy, a different heart condition).

2. One of their severe myocarditis that went on to heart transplant turned out to be giant cell myocarditis, which is a different immunologic condition from vaccine myocarditis (the cells respond differently).

3. They reported vaccine myocarditis diagnoses even out to 42 days after initial vaccination, which suggests to me that some of the myocarditis may be autoimmune from another mechanism (this diagnosis is more dangerous than vaccine myocarditis which may account for the severity).

4. Now that so many people have had COVID even multiple times, and we do not have a good test to tell between viral myocarditis and COVID vaccine myocarditis, some of the myocarditis could have been COVID viral myocarditis (I hope the viral panel they used excluded COVID).

Recall that @VirusesImmunity has demonstrated that autoimmune myocarditis carries a different cell signature than vaccine myocarditis.

Take home points:
1. #Myocarditis could be a serious condition but the overall amount of vaccine myocarditis that goes on to serious myocarditis is a really tiny number. I'm not sure the reason why this study is reporting the highest number yet seen.

Like anyone else, I hate to see people dying from COVID vaccine myocarditis.
2. When medical attention is given, myocarditis can be diagnosed early and treated.
3. All the bad things that can happen from #COVID disease, are worse than the equivalent from COVID vaccine.

4. This is a role model study on how to figure out the epidemiology of #myocarditis at a country level. #Cardiologist adjudication using Brighton collaboration criteria and #CDC case definition criteria are key, not just logging on to OpenVAERS.

3.