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Covid and the Heart: It Spares No One – Johns Hopkins

publichealth.jhu.edu

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Re: Covid and the Heart: It Spares No One – Johns Hopkins

#41

Post by usefulcat »

the_doctah wrote: post #29
exo-pla-net wrote: post #12

Earlier quoted context omitted.

If you're referring to cases of myocarditis caused by vaccination itself, the cases are negligible: 2.3 per 100,000 [1]. Compare that with the apparent near-certainty of heart damage (and likely brain damage) if you contract COVID while being unvaccinated, and the decision to not get vaccinated is not just selfish but self-destructive. [1] https://www.nejm.org/doi/full/10.1056/NEJMoa2110737

Please knock it off with the "selfish" nonsense. Even if everyone got vaccinated, the virus would still get passed around. Then, when the next variant inevitably arises, and everyone's immunity wears off, we're back at square one. The anti-anti-vax crowd is just a walking meme at this point.

You have a valid point, but hospital beds are still a finite resource. So in that sense, yeah, it is selfish to not get vaccinated in the absence of other mitigating factors, since vaccination prevents hospitalization in a large majority of cases.

Re: Covid and the Heart: It Spares No One – Johns Hopkins

#43

Post by timr »

It's worth saying that all of Al-Aly's papers so far have had the same basic structure, and the same basic problems: they take a population of older, sicker people (veteran's administration data), compare to some synthetic, non-randomized control group (this is where the "study of 15M" comes from), then extrapolate from that comparison to everyone. This is problematic for a few reasons:

* the older, sicker population is simply not representative of the population at large. No amount of normalization or adjustment can truly fix this.

* Moreover, the normalization process creates a "modeling problem" -- it's too easy for the researcher to find whatever outcome he's seeking by mucking with the weightings. With methods like this, you have to be very careful interpreting the results, because tiny details in the methods matter a lot.

* the signals in the data often are smaller in magnitude than the covariates in the study population (e.g. finding an X% difference in thing Y, when the population is more than X% sicker, overall)

* Use of ICD (medical billing) codes for a study like this is fraught. Choice of codes can create/remove a small signal in the data, and yet, it's not always clear that certain codes should be used (basic example: do you use the ICD code for a bypass graft as a "cardiac event" in a study like this? Almost certainly, a heart bypass surgery reflects a life-long problem, not an acute event due to Covid.) Again, methods matter a great deal here.

* Al-Aly is...less than transparent...about the size of the observed effect and its dependence on age and health. Often these details are buried in supplemental materials, and then he goes in the news media and makes bombastic claims about something "even happening in younger populations", based on a relatively weak effect size extrapolated in younger, healthy people.

* Relatively strong claims are made about small differences in outcome. For example, I just saw one last night from Al-Aly that turned a 13 per 1000 difference in outcome (1.3%), into a breathless claim of "over 40% increased risk". Mathematically true, perhaps, but utterly misleading (also, the difference was observed primarily in the oldest people, so the citing mean difference was simply wrong).

I could go on. Point is, please don't take this study as definitive. This is one paper, and Al-Aly has an agenda.

Re: Covid and the Heart: It Spares No One – Johns Hopkins

#44

Post by Retric »

TrevorJ wrote: post #39
exo-pla-net wrote: post #23

Earlier quoted context omitted.

False. > We went into it thinking that [the risk] was going to be most pronounced and evident in people who smoked a lot or had diabetes, heart disease, kidney disease, or some [other] risk factors. What we found is that even in people who did not have any heart problems start with, were athletic, did not have a high BMI, were not obese, did not smoke, did not have kidney disease or diabetes—even in people who were p…

>They found that even mild COVID damaged otherwise healthy people's hearts so badly that their risk for heart problems are now comparable to those of obese people. False. The study did NOT look for heart damage in the study population as a proximal cause for other cardiac events, it simply looked at incidence of cardiac events. Your interpretation is one possible explanation as to why this might be, but the study nei…

False…

Increased incidents is in support of that conclusion, but does not provide direct evidence of it. An important but subtle difference.

Re: Covid and the Heart: It Spares No One – Johns Hopkins

#45

Post by SnowProblem »

We should expect some heart damage because it happens after the flu too, but this study is flawed. If you had covid but weren't tested, you were put into the control group, meaning the conclusions they draw (ie. 5% increase in heart problems after a year) are going to be higher than in reality.

Re: Covid and the Heart: It Spares No One – Johns Hopkins

#46

Post by avgDev »

anamax wrote: post #34
andrew_ wrote: post #27

Earlier quoted context omitted.

New studies are suggesting links to nerve damage as a cause for long-covid symptoms https://www.nbcnews.com/health/health-news/long-covid-sympto...

My question is how different covid-19 is. One of the things that has come out of Covid-19 is how little was actually known about flus, despite the fact that flus have been killing 30-70k Americans each year for decades. This ignorance is "interesting" because "we need to be ready for the next Spanish flu" has been at the core of the "give us more money for research" argument for decades. For example, it looks like we…

I think going forward we are going to learn a lot more about these long term issues. Before COVID, getting chronic fatigue from flu was mostly ignored by the medical community. Now, with popularity of covid a lot more doctors are aware of some possible neurological issues.

There have been case studies, research and support groups for these things for many years. However, handful of physicians treating patients. I am now seeing more doctors seeing patients with odd symptoms at clinics all over the US, some even have ads targeting long covid.

I think we are going to make some major advancements in the next 10 years, and I'm happy many suffering quietly will be heard.

Re: Covid and the Heart: It Spares No One – Johns Hopkins

#47

Post by dash2 »

kragen wrote: post #11

A more accurate headline would be "it spares 93%–97% of people," though the interview meticulously omitted almost all quantifiable information. The hazard ratios in the paper smitty1110 cited https://www.nature.com/articles/s41591-022-01689-3?s=08 are mostly 1.49–1.85, which as I understand it means that people with covid were 1½–2 times as likely to experience the condition, pericarditis or stroke or whatever, than…

I now feel much less happy than I did. "Significant increase" could mean anything. A risk ratio of 1.49-1.85 is a huge increase. These conditions are rare but not that rare. Now I should be twice as worried about them? Oosh. Will someone at least tell me that Omicron's not so bad?

Re: Covid and the Heart: It Spares No One – Johns Hopkins

#48

Post by jdmichal »

xorfish wrote: post #40
kragen wrote: post #11

A more accurate headline would be "it spares 93%–97% of people," though the interview meticulously omitted almost all quantifiable information. The hazard ratios in the paper smitty1110 cited https://www.nature.com/articles/s41591-022-01689-3?s=08 are mostly 1.49–1.85, which as I understand it means that people with covid were 1½–2 times as likely to experience the condition, pericarditis or stroke or whatever, than…

The increased risk affects everyone, even if the risk doesn't materialize for everyone.

"At increased risk for being at increased risk" is theoretically meaningful, but practically nonsensical unless you can tell which group someone falls into. If you can't, you may as well collapse all the probability into either being at increased risk or not.

Re: Covid and the Heart: It Spares No One – Johns Hopkins

#49

Post by throwaway22032 »

kragen wrote: post #11

A more accurate headline would be "it spares 93%–97% of people," though the interview meticulously omitted almost all quantifiable information. The hazard ratios in the paper smitty1110 cited https://www.nature.com/articles/s41591-022-01689-3?s=08 are mostly 1.49–1.85, which as I understand it means that people with covid were 1½–2 times as likely to experience the condition, pericarditis or stroke or whatever, than…

It's baffling that a public health institution would discredit themselves so obviously in this way.

I don't understand the world that these people live in. It's like they don't understand the concept of trust _at all_, they're a few iterations of doubling down on just going into some sort of echochamber nonsense.

The headline isn't even true in the superlative sense (e.g. maybe it spares the odd person, but we make a reasonable allowance for that in colloquial speech.). It's in fact the case that it spares the vast majority - most of us have zero detectable symptoms, both during infection and after the fact.

Re: Covid and the Heart: It Spares No One – Johns Hopkins

#50

Post by TrevorJ »

Retric wrote: post #44
TrevorJ wrote: post #39

Earlier quoted context omitted.

>They found that even mild COVID damaged otherwise healthy people's hearts so badly that their risk for heart problems are now comparable to those of obese people. False. The study did NOT look for heart damage in the study population as a proximal cause for other cardiac events, it simply looked at incidence of cardiac events. Your interpretation is one possible explanation as to why this might be, but the study nei…

False… Increased incidents is in support of that conclusion, but does not provide direct evidence of it. An important but subtle difference.

Lack of evidence supports precisely nothing.
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