AAP Lies about Myocarditis Risk to Children from COVID-19 Vaccine

On October 26, 2021, the New York Times published an opinion piece by Dr. Lee Savio Beers, the president of the American Academy of Pediatrics (AAP), whose purpose in writing was to persuade parents to get their children jabbed with a COVID-19 vaccine. To that end, Beers claimed that “the risk of developing myocarditis after a Covid-19 infection is much higher than the risk of developing myocarditis after the vaccine.”^[1]

To support that claim, she cited an article published by the AAP that reported about a study by CDC researchers who “say” that their findings support their “assertions” that “the benefits of vaccination outweigh the risks.”[2]

Evidently, nobody at the AAP bothered to verify that assertion from the CDC researchers by actually examining the data presented in the study. The AAP has simply parroted the claim, even though the data indicate that the risk of myocarditis from the COVID-19 vaccine may be many times greater than the risk of myocarditis from SARS-CoV-2 infection.

The AAP article cites two CDC studies, each published in the CDC’s publication Morbidity and Mortality Weekly Report (MMWR). As the AAP reported, the first study found that the overall risk among patients with COVID-19 was 0.146%, which was an increased risk compared to patients without COVID-19. As also reported by the AAP, the second study estimated that, among males aged 12 to 29 years, there were “an estimated 39 to 47 cases of myocarditis for every million second doses of vaccine.”[3]

The AAP reported the CDC’s assertion that these data show that the risk from infection is greater than the risk from vaccination as though this was a scientifically proven fact, even though these figures do not actually tell us that.

Neither of the two CDC studies actually compared the risk of myocarditis from SARS-CoV-2 infection with the risk of myocarditis from COVID-19 vaccination. Neither the CDC nor the AAP actually used the data from these studies to make that comparison. Just because there is an increased risk of myocarditis associated with COVID-19 and vaccine-associated myocarditis is estimated to occur rarely does not mean that the risk from infection is greater than the risk from vaccination.

Nevertheless, we can use the data from these studies to do what the CDC and AAP failed to do, which is to do a meaningful comparison to estimate whether risk of myocarditis is greater with infection or with vaccination.

We are limited in our ability to do so by the limitations of the design of the two studies, but if we have (1) an estimate of the myocarditis risk among hospitalized children, (2) an estimate of the risk among vaccinated children, and (3) an estimate of how many children need to be vaccinated to prevent one COVID-19 hospitalization, then we can calculate how many cases of vaccine-related myocarditis we can expect to occur for every one case of COVID-19-related myocarditis prevented.

In her New York Times article, Beers falsely characterizes the first of the two CDC studies as having estimated the risk of myocarditis among the total number of children infected with SARS-CoV-2. That is not what was done in this study. Rather, the study estimated the risk a myocarditis diagnosis among patients who sought medical care and were diagnosed with COVID-19.[4]

Obviously, the rate of myocarditis among children who were taken to the hospital is likely to be much higher than the rate among all children who experience SARS-CoV-2 infection. After all, most children who are infected remain asymptomatic or develop only mild cold-like symptoms.

For the president of the AAP to equate the myocarditis risk among children taken to the hospital with the risk for all children who are infected is not only unscientific but willfully dishonest.

The CDC’s study design introduces ascertainment bias, which in this case is a selection bias that is likely to result in an overestimation of the overall risk of myocarditis in children with SARS-CoV-2 infection. For our purposes, we can safely assume that the CDC’s estimate of the risk of myocarditis among patients with COVID-19 is an upper bound in terms of generalizability to all children who are infected.

Additionally, the study describes patients hospitalized with COVID-19 but not necessarily for COVID-19, and one study estimated that around 40% of children in the hospital with COVID-19 were there for other purposes, with the COVID-19 diagnosis being incidental to the reason for their visit.[5] While this would not bias their estimate upward (since these children do represent cases of infection), it’s important to note that the risk of children being hospitalized because of COVID-19 in the first place can also be overestimated.[6]

Now, as reported by the AAP, the CDC researchers found this risk to be 0.146% overall, across age groups. The AAP doesn’t mention it, but the risk for children aged under 16 years was lower at an estimated 0.133%. Therefore, the first of the two CDC studies cited by the AAP gives us a risk for the general population of one myocarditis case per 685 COVID-19 cases (0.146%) and for children under age 16 a risk of one myocarditis case per 752 COVID-19 cases (0.133%).[7]

That risk estimate was calculated by dividing the number of COVID-19 cases with a myocarditis diagnosis (86) into the number of COVID-19 cases (64,898). Since this risk estimate included children with outpatient care, it does not tell us precisely the risk for hospitalized children, for whom we should assume the risk is higher. The study does not specify a proportion of COVID-19 cases that were inpatient versus outpatient, but another study found that 46.7% of pediatric patients with a COVID-19 diagnosis received inpatient care.[8] If we assume all myocarditis cases were hospitalized and retain the numerator while reducing the denominator to 30,307 to liberally estimate the risk of myocarditis only for hospitalized children, the risk would be 0.284%, or one myocarditis case per 352 hospitalized COVID-19 cases.

Next, we need to have an estimate of the risk of vaccine-related myocarditis and an estimate of the number of children who need to be fully vaccinated in order to prevent one child from being hospitalized with COVID-19. Helpfully, the second of the two CDC studies cited by the AAP provides us with both.

That second study estimated the risk of myocarditis among males aged 12 to 29 years at 40.6 cases per million second doses of COVID-19 vaccine. That’s one case of myocarditis for every 24,631 fully vaccinated males.[9]

Again, our own analysis is limited due to the limitations of the respective designs of the two studies. We do not have estimates to be able to compare exact age groups; under sixteen for the COVID-19 group and 12 to 29 for the vaccinated group is the closest we can come to be able to make a comparison. But, then, again, the AAP claimed that the data from these studies shows that the risk is lower for vaccinated children, so we must make do with what we’ve got.

Another limitation of the second CDC study is that the estimate of myocarditis risk was based on data from the Vaccine Adverse Event Reporting System (VAERS), for which underreporting of vaccine-associated adverse events is a known problem.[10] The underreporting would bias the CDC’s study toward underestimating the risk among vaccinated children. However, for our purpose here, we may set aside this problem and proceed by taking this estimate at face value, as does the AAP.

The second CDC study also provided an estimate that, for every one million children aged 12 to 17 who are fully vaccinated, the number of COVID-19 hospitalizations prevented is 215 for males and 183 for females (see Table 2).[11] To give vaccination the full benefit of the doubt, we can go with the higher number and assume 215 hospitalizations prevented for all sexes. Therefore, we can estimate that to prevent a single child from being hospitalized with COVID-19, the number of children in this age group who need to be fully vaccinated is 4,651.

Again, an exact comparison isn’t possible due to the differing stratification of data in each study by age groups and sex, but if there is one case of myocarditis per 352 children hospitalized with COVID-19, and if 4,651 children need to be fully vaccinated to prevent one hospitalization, then we can reasonably estimate that to prevent a single case of COVID-19-related myocarditis, the number of children who need to be vaccinated is 1,637,152.[12]

Now, if over 1.6 million children need to be vaccinated to prevent a single case of COVID-19-related myocarditis, and if the risk of vaccine-related myocarditis is one case per 24,631 fully vaccinated children, then for every one case of COVID-19-related myocarditis prevented, we can expect an occurrence of 66 cases of vaccine-related myocarditis.[13]

Given the limitations of this analysis arising from the limitations of the CDC’s own study design, one could reasonably argue that the data presented in the two studies cannot be used to estimate the risk of myocarditis from SARS-CoV-2 infection versus vaccination. After all, again, neither study was designed to do so.

Remember, though, that this is the very same data that the AAP cites to support the claim that the risk of myocarditis is greater from infection than from vaccination. And, again, what the data actually indicate, if we do try to use it to make a meaningful comparison, is that the risk of vaccine-related myocarditis is far higher than the risk of myocarditis associated with SARS-CoV-2 infection.

I would challenge anyone who wishes to insist that the AAP is correct and not lying to parents to provide an alternative analysis using the data from these two CDC studies to show that the risk is lower with vaccination. I personally don’t see how it could be done.

Given that the data roughly indicate that 66 children will experience myocarditis after vaccination for every one case of COVID-19-related myocarditis prevented, several additional conclusions can be drawn.

First, obviously, the CDC cannot be trusted to accurately and honestly communicate the significance of its own researchers’ findings.

Second, obviously, the AAP cannot be trusted to accurately and honestly communicate what scientific research actually tells us about the risks versus benefits of vaccines.

Third, obviously, we cannot trust mainstream media sources like the New York Times to accurately and honestly communicate to the public what the science says.

Fourth, obviously, parents cannot meaningfully exercise their right to informed consent when they are being lied to about what the science says and so are instead making decisions about vaccinating their children on officially sanctioned disinformation.

[Correction appended, December 18, 2021: As originally published, this article referred to patients included in the first of the two CDC studies as “hospitalized”. However, outpatients, who are not considered “hospitalized”, were included in the study along with inpatients. It can be reasonably assumed that the risk of myocarditis to children who receive inpatient care would be higher compared to those who do not. Therefore, I have updated this article to try to correct for this by adjusting the risk estimate upward based on data from another study estimating the proportion of inpatient versus outpatient care for children diagnosed with COVID-19 in a hospital setting. The descriptions of the study population have been corrected (not all patients were hospitalized), the additional source cited, additional analysis provided, and numbers recalculated to correct for a presumed proportion of patients who were hospitalized as opposed to receiving outpatient care. The originally calculated numbers without that adjustment were one myocarditis case per 753 hospitalized COVID-19 patients; 3,497,552 children fully vaccinated to prevent one hospitalization for COVID-19; and 141 vaccine-related myocarditis case for every one COVID-19-related myocarditis case prevented. Using an assumed higher risk for children who received inpatient care versus those who did not, I have adjusted these numbers to one myocarditis case per 352 COVID-19 hospitalizations; 1,637,152 children fully vaccinated to prevent one COVID-19 hospitalization; and 66 vaccine-related myocarditis cases to prevent one COVID-19-related myocarditis case, respectively.]

References

[1] Lee Savio Beers, “Yes, You’ll Want to Vaccinate Your Kids Against Covid. An Expert Explains Why.” New York Times, October 26, 2021, https://www.nytimes.com/2021/10/26/opinion/covid-vaccine-kids.html.

[2] Melissa Jenco, “Study: Myocarditis risk 37 times higher for children with COVID-19 than uninfected peers”, AAP News, August 31, 2021, https://publications.aap.org/aapnews/news/16388.

[3] Ibid.

[4] Tegan K. Boehmer et al., “Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021”, MWWR, August 31, 2021, http://dx.doi.org/10.15585/mmwr.mm7035e5.

[5] Amy Beck and Monica Gandhi, “Adjudicating Reasons for Hospitalization Reveals That Severe Illness From COVID-19 in Children Is Rare”, Hospital Pediatrics, August 1, 2021, https://doi.org/10.1542/hpeds.2021-006084.

[6] One could argue that if the 40% of children in the first CDC study were not there because of COVID-19, they should not be included in the calculation. If we assume 40% were there for other reasons, then instead of 86 myocarditis cases per 64,898 children, the denominator would be 38,939 children, which would result in a risk of 0.221% rather than 0.133%. This in turn would result in 85 cases of vaccine-related myocarditis for every one case of COVID-19-related myocarditis prevented. (See the remainder of this article for how this calculation is done.)

[7] Boehmer et al.

[8] Alexander Muacevic and John R Adler, “Pediatric Patients with SARS-CoV-2 Infection: Clinical Characteristics in the United States from a Large Global Health Research Network”, Cureus, September 12, 2020, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7552107/.

[9] Julia W. Gargano et al., “Use of mRNA COVID-19 Vaccine After Reports of Myocarditis Among Vaccine Recipients: Update from the Advisory Committee on Immunization Practices — United States, June 2021”, MMWR, July 9, 2021, http://dx.doi.org/10.15585/mmwr.mm7027e2.

[10] Jeremy R. Hammond, “How You’re Being Lied to about the Risks of Getting a Flu Vaccine Annually”, JeremyRHammond.com, January 11, 2019, https://www.jeremyrhammond.com/2019/01/11/how-youre-being-lied-to-about-the-risks-of-getting-a-flu-vaccine-annually/#vaers. 106th Congress, 2nd Session, House Report 106-977, Sixth Report by the Committee on Government Reform, The Vaccine Injury Compensation Program: Addressing Needs and Improving Practices, October 12, 2000, https://www.congress.gov/106/crpt/hrpt977/CRPT-106hrpt977.pdf. US Department of Health and Human Services, “Guide to Interpreting VAERS Data”, accessed January 30, 2018, https://vaers.hhs.gov/data/dataguide.html. David A. Kessler et al, “A New Approach to Reporting Medication and Device Adverse Effects and Product Problems”, JAMA, 1993, https://www.fda.gov/downloads/Safety/MedWatch/UCM201419.pdf. S Rosenthal and R Chen, “The reporting sensitivities of two passive surveillance systems for vaccine adverse events”, American Journal of Public Health, December 1995, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615747/. Jeremy R. Hammond, “Fact Check: WHO Scientist Caught Lying to Public about Vaccine Safety”, JeremyRHammond.com, February 11, 2020, https://www.jeremyrhammond.com/2020/02/11/fact-check-who-scientist-caught-lying-to-public-about-vaccine-safety/. Ross Lazarus, “Electronic Support for Public Health – Vaccine Adverse Event Reporting System (ESP:VAERS) – Final Report”, Agency for Healthcare Research and Quality, US Department of Health and Human Services, 2010, accessed October 10, 2019, https://healthit.ahrq.gov/ahrq-funded-projects/electronic-support-public-health-vaccine-adverse-event-reporting-system.

[11] Gargano et al.

[12] 352 x 4,651 = 1,637,152

[13] 31,637,152 ÷ 24,631 = 66