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Comment by hnuser847 | Hacker News Reader

Wow, I just got the Pfizer booster a few days ago and I'm an under-40 male who has previously had pericarditis... I was worried about the risk being greater than the reward for my age group but didn't have the age-stratified data to prove it. Kind of regretting it now, especially since I only got it at the urging of my wife. I just needlessly increased the odds of a giving myself a heart issue for absolutely no reason.

Edit: somebody else pointed out that the significantly elevated risk was only observed for Moderna (mRNA-1273). Pfizer (BNT162b2) only has a slightly elevated risk after the 2nd and 3rd doses. Looks like I'll be okay after all :)

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To be fair, we're still talking about 1:10,000 odds. You're much more likely to, for example, be hit by a car in the next year, even if you're in a high-risk category.

I tend to run numbers here and compare to events I'm worried or not worried about. I can live with 1:10,000 risks.

What are the odds of being hit by a car in the next year? I'm honestly curious, so I googled what I could find. From what I find the odds of an injury from an accident are 1:8393 which does support your statement (assuming every accident is getting hit by a car).

https://www.iii.org/fact-statistic/facts-statistics-mortalit...

Do you have better stats?

https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in...

Good ballparks:

* 1:10,000 odds of being killed in or by a car.

* 1:100 odds of being injured in or by a car.

Your page, by the way, suggests 1:2000 for accidents. 49.3:100,000 = 1:2000, not 1:8393. The 1:8393 is for car accidents (which I guess includes being in a car, rather than just hit by a car).

CDC best guess mortality risk for his age group is 500/1000000 if he gets an infection. I would say risk probably not outweighing the benefit if it doesn’t prevent infection outright.

Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...

That is a laughable analysis. You are comparing the risk of death to the risk of a serious side effect. Why not compare apples to apples and compare the risk of heart complications requiring hospitalization (a fraction of the myocraditis and pericarditis cases caused by the vaccine) to the hospitalization rate of infection? You can normalize that by the 75% efficacy against Omicron if you want.

Who says the vaccine prevents heart complications from infection? All the statistics I’ve seen compare mainly mortality. From a pure risk vs reward of vaccine vs no vaccine, measuring mortality seems reasonable. When in history have we vaccinated to prevent side effects?

> When in history have we vaccinated to prevent side effects?

Polio.

* Around 72% have no symptoms.

* Around 25% have flu-like symptoms.

* The remaining 3% develop serious symptoms/damage.

* Paralytic polio hits around 0.5%, of which around 5-10% die when the paralysis reaches the lungs.

So including all infections, not just paralytic polio as you'll find in most searches (where they give the 5-10% statistic), the death rate was around 0.01% - 0.025%

https://www.cdc.gov/polio/what-is-polio/index.htm

So what is the mortality rate of the vaccine? Because this is the myocarditis rate, and the vast majority of cases didn't even require hospitalization. If you want to compare mortality rates, share a link.

And yes, the virus prevents heart complications from infection, because it prevents symptomatic infection.

It’s pretty evident at this point it doesn’t prevent symptomatic infection.

Death rate on both is close to 0. My point is if the vaccine doesn’t prevent infection (protecting other people) the vaccine risk vs reward is negligible for this age group. It should be purely up to the person to make their own decision. Not anyone else’s. Treat it like the flu shot.

I was vaccinated when I saw 90% at preventing infections, but now that’s been disproven I’ll call it how I see it. I’m moving on.

3 doses of pfizer seen to have more thab 75% protection against even Omicron.

It was 90% before mutations for two doses

The death rate on both are very low but much higher for the virus. However, the risk of hospitalization is significant with the virus, and much, much higher than with the vaccine.

I don't want to be hospitalized. That's a very bad time. The people that may die because I took up a hospital spot probably agree.

The flu doesn't threaten to collapse the healthcare system without vaccines. COVID does.

> The flu doesn't threaten to collapse the healthcare system without vaccines.

Yeah it does, even with vaccines...

(2014) https://www.nbcdfw.com/news/local/flu-patients-fill-north-te...

(2015) https://abcnews.go.com/Health/flu-closes-schools-flusters-ho...

(2016) https://www.theguardian.com/society/2016/mar/10/nhs-hospital...

(2017) https://www.france24.com/en/20170111-french-hospitals-cancel...

(2018) https://time.com/5107984/hospitals-handling-burden-flu-patie...

It's a pretty consistent pattern: Every flu season, hospitals are overwhelmed by the flu. Those links are just from date-range searches and copying the first result (hence bouncing around countries); each year had plenty more from other countries.

That is for a few hospitals. The flu is not serious to lead to an actual, complete, collapse of the healthcare system as a whole where no resources are left to treat immediately life threatening conditions. That's what we were facing with COVID.

Even with unprecedented non-pharmaceutical interventions and with vaccines, many first world countries were at the point where they had to cancel cancer surgeries that were not immediately crucial to survival. That's not something that happens with the flu.

Now the flu is very serious as your links show. The flu vaccine is around 40% effective against hospitalization (https://pubmed.ncbi.nlm.nih.gov/33378531/), and around 70% of seniors are vaccinated against the flu, for a total reduction of around 28%.

If we removed that reduction, the flu could still not be severe enough to lead to a complete collapse of the healthcare system without serious intervention. With COVID, that is guaranteed to happen.

But you're right in that the flu is a serious disease that puts a lot of strain on the healthcare system and I can understand how my comment could lead to underestimating that.

> So what is the mortality rate of the vaccine? Because this is the myocarditis rate, and the vast majority of cases didn't even require hospitalization.

No, this is the rate of hospitalization or death due to myocarditis.

> The outcomes of interest in this study were hospital admission or death from myocarditis. Myocarditis was defined as the first hospital admission in the study period or death using International Classification of Diseases (ICD)-10 codes (Supplementary Table 6).

This is actually not the case. In the UK, outpatient treatment and observations are considered to result in an admission, even if there is no inpatient care (hospitalization).

See : https://www.nhs.uk/nhs-services/hospitals/going-into-hospita...

You are asking when in history we vaccinated to prevent infectious disease induced morbidity?

When have we vaccinated to prevent infectious disease induced side effects excluding morbidity.

> When have we vaccinated to prevent infectious disease induced side effects excluding morbidity.

Whenever we vaccinate to prevent mortality; generally we vaccinate to mitigate both morbidity and mortality from a disease.

What do you mean by 'side effects' of infectious disease excluding morbidity? Positive side effects of infection?

Your overall odds of death from covid went down. And as I understand it, myocarditis often goes away on its own or can be treated at home.

It largely depends on the affected area... It can kill you instantly if it takes conduction centers, kill you years later if it damages the muscle or it can leave no consequences at all. It can go unnoticed and still leave you with long term damages.

> It can go unnoticed and still leave you with long term damages.

That‘s the scary part imho, it appears that the long-term adverse cardiac risk is pretty much unknown.

> myocarditis often goes away on its own

I was under the impression myocarditis was when some heart tissue died and doesn't recover.

It's inflammation of the heart muscle.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/my...

There is a wealth of info about this known condition on the web including symptoms and treatment. If you have concerns, ask your GP, they're there to help you.

Myocarditis is an inflammation that can, and often does, heal fully.

You are confusing it with ischemia (heart attack basically), where cells are no longer supplied with oxygen and die.

If you got Pfizer, your risk is lower than Moderna for myocarditis. Fairly similar to COVID-19 itself according to this paper. There is also pericarditis and cardiac arrhythmia that they covered in their original paper https://www.nature.com/articles/s41591-021-01630-0#Sec30

Unfortunately not stratified by age and sex there (what a shame when it is obviously greatest interest here, what were they thinking, like actually, what were they thinking?) but the risk should be clearly higher for COVID-19 as it is non-existent for vaccines.

As such, the original paper was bad as they did not stratify by important parameters but this paper might be even worse as they do not include other complications that would significantly change the picture.

I also feel wary about the method they are using - perhaps somebody could share thoughts about this? They used self controlled case series (SCCS) for IRR. I am not fully confident that this kind of analysis can be used for such data in this setting.

Legit question--would you have higher chances of surviving COVID-19 had you gotten it without the vaccine?

I don't think that's the right question to ask. Obviously my chances of surviving COVID would be higher with the vaccine than without. The real question is, which has an overall higher risk for someone of my age, sex, and health status, a COVID infection or the vaccine? I honestly don't know the answer to that question.

I mean, if you really wanted to base your opinions on science, you wouldn’t hold off on vaccines based on a single study that is not even in the meta-analysis level, no? And since you’re the type who likes to be sure, I wonder if your hesitancy to take the vaccine is grounded on professional medical advice, at all?

No, not unless Pfizer was a typo and you meant Moderna.

After only looking at the charts at the end of the PDF, they seem to indicate that the 3rd dose (booster) of the Pfizer vaccine raises your myocarditis risk about as much as the 2nd dose of Moderna's.

There are large CIs around the mean increase with Pfizer booster, but the mean doesn't fall into the confidence interval for second dose Moderna. Does not appear to be tracking as commensurate.

ah sure, I don't think I would have called them "commensurate" – but was I wrong to think of both rates as "elevated"?

heh, re-read my comment and I totally said "about as much", so never mind. Sloppy on my part.

No. 3rd dose Pfizer is not statistically significantly worse than infection for myocarditis.

Am I missing something obvious?

Am I reading too much from the error bars in the Incidence Rate Ratio charts? Or did I misinterpret the charts some other way?

In the chart, the IRR from infection is 2.02, 95% CI 1.13-3.61. The IRR for 3rd dose Pfizer is 7.6, 95% CI 1.92-30.15.

Because the confidence interval of the Pfizer 3rd dose contains the datapoint for infection, there is a pretty good chance that the 3rd dose is not anymore likely to lead to myocarditis than COVID, and the result isn't statistically significant at p<=0.05. We can't say for sure.

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