How COVID affects the heart, according to a cardiologist

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Garry Jennings, University of SydneyAs the pandemic has progressed, researchers have begun to understand how COVID-19 impacts our bodies.

Early in the pandemic, risk factors such as heart disease, high blood pressure and diabetes were quickly associated with an increased risk of severe illness and death from COVID.

We now know that, among the myriad ways it can damage our health, the virus can affect the heart and directly cause a range of heart complications.

Also, mRNA COVID vaccines like those from Pfizer and Moderna have been linked with heart inflammation. But this is very rare, and you’re much more likely to get heart inflammation from COVID infection than the vaccines.

Here’s what we know so far.

How does COVID affect the heart?

The SARS-CoV-2 virus can directly invade the body causing inflammation. This can impact the heart, causing myocarditis and pericarditis — inflammation of the heart muscle or outer lining of the heart.

Inflammation from COVID can also cause blood clotting, which can block a heart or brain artery causing a heart attack or stroke.

COVID can also cause abnormal heart rhythms, blood clots in the legs and lungs, and heart failure. Our understanding of how COVID causes heart inflammation and injury to the heart muscle is becoming clearer, though there’s more to learn.

Persistent symptoms from the virus, called “long COVID”, have been reported in about 10-30% of people who’ve contracted COVID.

One study on long COVID, published in July, found common cardiovascular symptoms include heart palpitations, fast heart rate, slow heart rate, chest pain, visible bulging veins, and fainting.

Of roughly 3,700 study participants, over 90% reported their recovery lasted more than eight months.

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Read more:
The mystery of ‘long COVID’: up to 1 in 3 people who catch the virus suffer for months. Here’s what we know so far

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The Delta variant, first identified in India in October 2020, is highly transmissible. It’s the variant responsible for lockdowns in New South Wales, Victoria and Queensland.

Although data is still emerging, it may cause more severe disease, and anecdotally may increase the chances of heart complications.

A Scottish study found the risk of hospital admission from COVID was around double in those with Delta variant compared to the Alpha variant (which originated in the UK). It also found Delta was spreading most commonly in younger people.

The good news is two doses of either the Pfizer or AstraZeneca vaccines remains effective in preventing Delta complications.

COVID vaccines and the heart

Scientists have discovered a link between the Oxford-AstraZeneca vaccine and a rare blood clotting syndrome.

There’s also a link between mRNA COVID vaccines and a rare side effect of heart inflammation (myocarditis and pericarditis). This seems to be most common in males under 30 and after the second vaccine dose.

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Read more:
The benefits of a COVID vaccine far outweigh the small risk of treatable heart inflammation

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But this is very rare. Of the 5.6 million Pfizer vaccine doses administered to Australians so far, there have only been 111 cases of suspected (not confirmed) heart inflammation reported up to August 1. There have been no reported deaths associated with this vaccine side effect in Australia.

Recovery from this heart inflammation is generally good. The benefits of vaccination against COVID far outweigh the potential risks of these generally mild conditions.

Nevertheless, if you experience any change in symptoms after having a COVID vaccine, including chest pain, an irregular heartbeat, fainting or shortness of breath, you should seek prompt medical attention.

The vast majority of people with heart conditions are safe to get vaccinated. But if you have had myocarditis or pericarditis in the past six months then speak with your doctor or cardiologist.

Don’t delay getting your heart checked

Many people have been reluctant to seek medical attention amid the pandemic. This includes for both urgent and routine care of heart disease. Longer delays between the onset of the symptoms and hospital treatment are being reported in countries including England, Italy and China. This makes long-term heart damage more likely.

One study found global hospital admissions for heart attacks have decreased between 40% and 50%. An Australian study found a 21% reduction in cardiac surgery at Sydney’s Royal Prince Alfred Hospital between March and June 2020.

It’s important you don’t neglect your heart health even amid the pandemic. If you ever think you’re having a heart attack, call triple zero (000) immediately.

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The author would like to thank the National Heart Foundation’s Amanda Buttery and Brooke Atkins for their help with this article.

Garry Jennings, Professor of Medicine, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The benefits of a COVID vaccine far outweigh the small risk of treatable heart inflammation

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Jonathan Noonan, Baker Heart and Diabetes Institute and Karlheinz Peter, Baker Heart and Diabetes InstituteRepeated COVID-19 outbreaks in Australia have once again highlighted the need for rapid and widespread vaccination. We are extremely fortunate the global scientific community has been able to develop a handful of highly effective vaccines in such a short time.

As with any vaccine or medicine, the COVID vaccines do carry small risks. The rare blood clotting disorder caused by the AstraZeneca vaccine — thrombosis with thrombocytopenia syndrome, or TTS — has largely dominated the headlines.

But we’re also seeing reports of a potentially increased risk of myocarditis and pericarditis (heart inflammation) following the mRNA COVID-19 vaccines, developed by Pfizer/BioNTech and Moderna.

Here’s why this shouldn’t be cause for concern.

First, what are myocarditis and pericarditis?

There are three main types of heart inflammation: endocarditis, myocarditis, and pericarditis. These involve inflammation of the inner lining of the heart, the heart muscle, and the outer lining of the heart respectively.

Viruses, including the SARS-CoV-2 virus that causes COVID-19, are the most common cause of myocarditis and pericarditis. Essentially, the inflammation the immune system generates to combat infections can inadvertently lead to inflammation of the heart.

In the very rare cases of myocarditis and pericarditis observed after vaccination with a COVID mRNA shot, it’s possible a similar thing might be happening. That is, the vaccine causes the immune system to generate some level of inflammation so it’s prepared to mount a response against SARS-CoV-2, and this inflammation is partially misdirected to the heart.

But the risk is very small, and the conditions are treatable.

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What’s the risk?

The exact incidence of myocarditis and pericarditis following vaccination is still being defined, and it remains to be proven that mRNA vaccines are truly the cause of these conditions — although it seems likely.

In Australia, of roughly 3.7 million doses of the Pfizer vaccine administered up to July 11, the Therapeutic Goods Administration (TGA) reports there have been 50 cases of suspected myocarditis or pericarditis. This suggests a risk of one per 74,000 vaccines. The TGA notes most people who developed these conditions have recovered or are recovering.

However, given the relatively small number of vaccinations administered in Australia, it’s important to consider more complete data from countries with higher vaccination rates.

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How rare are blood clots after the AstraZeneca vaccine? What should you look out for? And how are they treated?

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The United States’ Centres for Disease Control and Prevention (CDC) had received 1,226 reports of myocarditis following 296 million doses of mRNA vaccines administered up to June 11. This equates to a risk of roughly one in 240,000 doses. These cases were mostly in young men and predominantly occurred after the second dose.

Independently from vaccines, myocarditis occurs in roughly 23 per 100,000 people worldwide per year (we don’t have reliable figures for pericarditis). This shows us there’s a much lower risk from vaccination than exists in the population generally.

Symptoms to look out for

Normal side effects of COVID-19 vaccines include headache, fever, chills, muscle or joint pain, fatigue and nausea.

In contrast, chest pain, irregular heartbeat, heart palpitations, shortness of breath and light-headedness could indicate myocarditis or pericarditis. Symptoms of these conditions have generally occurred within seven days of vaccination. Anyone who experiences these symptoms should seek medical attention.

In most cases, myocarditis and pericarditis can be successfully treated with anti-inflammatory drugs, such as aspirin and corticosteroids.

In Israel, 95% of cases recently investigated were classified as mild. Similarly, the CDC has reported most patients in the US have recovered quickly.

While this very small risk of heart inflammation following vaccination may be alarming, it’s crucial to understand the risk of heart damage following severe COVID-19 is far greater.

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Read more:
Explainer: what is inflammation and how does it cause disease?

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COVID-19 and heart damage

Damage of the heart muscle is a common consequence of coronavirus. Research shows it occurs in up to 28% of patients hospitalised with COVID-19.

Importantly, the risk of death is markedly higher in COVID-19 patients who sustain heart muscle damage. While we need further research to understand precisely how COVID-19 damages the heart, myocarditis and pericarditis are major causes of the heart damage found in COVID-19 patients.

The benefit outweighs the risk

The recent limits applied to the use of the AstraZeneca vaccine in younger age groups suggests the relatively low risk of COVID-19 in Australia justifies being highly selective over vaccine use.

But while Australia has done incredibly well at containing COVID-19, the risk of transmission here remains high given the global COVID-19 situation. We’re seeing this daily as we contend with outbreaks and lockdowns around the country.

Myocarditis and pericarditis are potentially associated with the mRNA vaccines, but these complications are extremely rare, most often mild, and seem to be treatable.

As has been the consistent message from the medical and scientific communities throughout this pandemic, the benefit of COVID-19 vaccines significantly outweighs the risk of rare side effects. This is particularly true for the highly effective mRNA-based vaccines as COVID-19 continues to spread around the world.

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Read more:
What are the side effects of the Pfizer vaccine? An expert explains

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Jonathan Noonan, Research Officer, Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute and Karlheinz Peter, Interventional Cardiologist, Alfred Hospital; Professor of Medicine and Immunology, Monash University; Professor and Head, Department of Cardiometabolic Health, University of Melbourne; Lab Head, Atherothrombosis and Vascular Biology and Deputy Director, Baker Heart and Diabetes Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Heart

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Two Christians Slain in Attack Outside Church in Pakistan

Muslim youths kill two, wound two others after dispute over teasing of Christian women.

KARACHI, Pakistan, March 22 (CDN) — Two Christians were gunned down and two others are in a serious condition with bullet wounds after Muslim youths attacked them outside a church building in Hyderabad last night, witnesses said.

Residents of Hurr Camp, a colony of working-class Christians in Hyderabad in Sindh Province, were reportedly celebrating the 30th anniversary of their Salvation Army church when a group of Muslim youths gathered outside the building and started playing music loudly on their cell phones. They also started teasing Christian women as they arrived for the celebration, according to reports.

Christians Younis Masih, 47, Siddique Masih, 45, Jameel Masih, 22, and a 20-year-old identified as Waseem came out of the church building to stop the Muslim youths from teasing the Christian women, telling them to respect the sanctity of the church. A verbal clash ensued, after which the Muslim youths left, only to return with handguns.

Witnesses told Compass by phone that the Muslim youths opened fire on the Christians, killing Younis Masih and Jameel Masih instantly, and seriously injuring Siddique Masih and Waseem. The injured men have been transferred to a hospital in Karachi, the provincial capital of Sindh.

Younis Masih is survived by his wife and four children, while Jameel Masih was married only a month ago, and his sudden death has put his family into a state of shock.

“My son had gone to the church to attend the anniversary celebrations from our family…a few hours later we were told about his death,” a wailing Surraya Bibi told Compass by telephone from Hyderabad. “I got him married only a month ago. The cold-blooded murderers have destroyed my family, but our most immediate concern is Jameel’s wife, who has gone completely silent since the news was broken to her.”

She said the local police’s indifference towards the brutal incident had exacerbated the Christians’ sorrow.

“The police were acting as if it was not a big deal,” she said. “They did not register a case until late at night, when all of us blocked the main Hyderabad Expressway along with the two dead bodies for some hours.”

Jameel Masih’s paternal uncle, Anwar Masih, told Compass that police were biased against the Christians, as “none of the accused has been arrested so far, and they are roaming the area without any fear.”

He said police had taken into custody some teenagers who had no involvement in the killings.

“This has been done just to show their senior officials that they are not sitting idle,” he said.

Anwar Masih said the families had little hope for justice, because “if we have to dishonor the dead bodies by placing them on the roads to get a case registered, what should we hope for when the investigations begin?”

He said that during their protest, some leaders of the Muttahida Qaumi Movement, a regional political party known for its secular but often violent ideology, arrived and suggested the Christians retaliate against the Muslims.

“We told them that as Christians we are not going to take the law into our hands,” Anwar Masih said.

He said that Jameel Masih’s father, Sardar Masih, and the other Christians would visit the Baldia Colony police station Wednesday morning (March 23) to see whether there has been any progress in the investigation.

“Please pray for us,” he said.

Compass made efforts to contact Hyderabad District Police Officer Munir Ahmed Sheikh to ask about progress in the case and whether any of the named suspects have been arrested by police, but the calls were unanswered.

The killing of the two Christians comes a week after another Christian, sentenced to life imprisonment on false blasphemy charges, died in Karachi Central Prison. The family of Qamar David claims he was murdered on March 15, while conflicting reports from the jail suggest that he died of heart failure.

If David died from torture, yesterday’s killings bring the number of Christians murdered in March alone to four, the most prominent among them being Federal Minister for Minority Affairs Shahbaz Bhatti, who was assassinated in Islamabad on March 2 for opposing the country’s controversial blasphemy laws.

Report from Compass Direct News
http://www.compassdirect.org

Police in Sudan Aid Muslim’s Effort to Take Over Church Plot

With possibility of secession by Southern Sudan, church leaders in north fear more land grabs.

NAIROBI, Kenya, October 25 (CDN) — Police in Sudan evicted the staff of a Presbyterian church from its events and office site in Khartoum earlier this month, aiding a Muslim businessman’s effort to seize the property.

Christians in Sudan’s capital city told Compass that police entered the compound of the Sudan Presbyterian Evangelical Church (SPEC) on Oct. 4 at around 2 p.m. and ordered workers to leave, claiming that the land belonged to Muslim businessman Osman al Tayeb. When asked to show evidence of Al Tayeb’s ownership, however, officers failed to produce any documentation, the sources said.

The church had signed a contract with al Tayeb stipulating the terms under which he could attain the property – including providing legal documents such as a construction permit and then obtaining final approval from SPEC – but those terms remained unmet, church officials said.

Church leader Deng Bol said that under terms of the unfulfilled contract, the SPEC would turn the property over to al Tayeb to construct a business center on the site, with the denomination to receive a share of the returns from the commercial enterprise and regain ownership of the plot after 80 years.

“But the investor failed to produce a single document from the concerned authorities” and therefore resorted to police action to secure the property, Bol said.

SPEC leaders had yet to approve the project because of the high risk of permanently losing the property, he said.

“The SPEC feared that they were going to lose the property after 80 years if they accepted the proposed contract,” Bol said.

SPEC leaders have undertaken legal action to recover the property, he said. The disputed plot of 2,232 square meters is located in a busy part of the heart of Khartoum, where it has been used for Christian rallies and related activities.

“The plot is registered in the name of the church and should not be sold or transfered for any other activities, only for church-related programs,” a church elder who requested anonymity said.

The Rev. Philip Akway, general secretary of the SPEC, told Compass that the government might be annoyed that Christian activities have taken place there for many decades.

“Muslim groups are not happy with the church in north Sudan, therefore they try to cause tension in the church,” Akway told Compass.

The policeman leading the officers in the eviction on Oct. 4 verbally threatened to shoot anyone who interfered, Christian sources said.

“We have orders from higher authorities,” the policeman shouted at the growing throng of irate Christians.

A Christian association called Living Water had planned an exhibit at the SPEC compound on Oct. 6, but an organization leader arrived to find the place fenced off and deserted except for four policemen at the gate, sources said.

SPEC leaders said Muslims have taken over many other Christian properties through similar ploys.

“We see this as a direct plot against their churches’ estates in Sudan,” Akway said.

The Rev. John Tau, vice-moderator for SPEC, said the site where Al Tayeb plans to erect three towers was not targeted accidentally.

“The Muslim businessman seems to be targeting strategic places of the church in order to stop the church from reaching Muslims in the North Sudan,” Tau said.

The unnamed elder said church leaders believe the property grab came in anticipation of the proposed north-south division of Sudan. With less than three months until a Jan. 9 referendum on splitting the country according to the Comprehensive Peace Agreement of 2005, SPEC leaders have taken a number of measures to guard against what it sees as government interference in church affairs.

Many southern Sudanese Christians fear losing citizenship if south Sudan votes for secession in the forthcoming referendum.

A top Sudanese official has said people in south Sudan will no longer be citizens of the north if their region votes for independence. Information Minister Kamal Obeid told state media last month that south Sudanese will be considered citizens of another state if they choose independence, which led many northern-based southern Sudanese to begin packing.

At the same time, President Omar al-Bashir promised full protection for southern Sudanese and their properties in a recent address. His speech was reinforced by Vice President Ali Osman Taha’s address during a political conference in Juba regarding the signing of a security agreement with First Vice President Salva Kiir Mayardit (also president of the semi-autonomous Government of Southern Sudan), but Obeid’s words have not been forgotten.

Akway of SPEC said it is difficult to know what will become of the property.

“Police continue to guard the compound, and nobody knows for sure what the coming days will bring,” Akway said. “With just less than three months left for the South to decide its fate, we are forced to see this move as a serious development against the church in Sudan.”

Report from Compass Direct News

Government crackdown on missionary presence could get worse

The Kazakh government continues to put pressure on foreign missionaries attempting to obtain visas to stay in the country. The Kazakh church is prepared for matters to get worse, reports MNN.

"Foreign involvement for the purpose of missionary work in Kazakhstan becomes increasingly difficult to happen," confirms Eric Mock, vice president of Ministry Operations for Slavic Gospel Association.

Norwegian news network Forum 18 conveys a number of instances in which the Kazakh government has denied visas to foreign missionaries of various minority faiths. A missionary visa, as it is, lasts only 180 days and cannot be renewed.

Mock says there is some fear that the visas will become even more restrictive. According to Forum 18, the Nur Otan Party has even created a document calling for further crackdown on "non-traditional faiths." Forum 18 quotes a report as saying, "The Nur Otan Party should devote special attention to the activity of non-traditional religious movements of destructive character. The destructive impact of such movements is very great."

With clear contempt toward the presence of evangelical Christian missionaries as well as missionaries for other minority faiths, the church as well as ministries like SGA need to prepare for any change. "[We need to] be sure that we do not assume that the world that we minister in today is the same that we minister in tomorrow," says Mock.

Whether or not missionary presence is increasingly restricted does not directly affect SGA, since their ministry mainly focuses on helping nationals. Still, won’t a crackdown harm the church? Mock says not as much as you might think.

"There is one thing that I saw [in Kazakhstan] that mostly encouraged my heart," explains Mock. "I saw a group of ethnic Kazakh young men who God has raised up with a passion to reach their own people. I had not really seen that in the past; it [had been] more of a Russian Baptist influence, but now I’m seeing Kazakh Baptist."

As long as changes don’t happen too abruptly, Mock says he believes the church will be able to handle any blows headed their way. The energy generated by young church leaders could be just what the Kazakh church needs to become self-sustaining. "With this new generation coming up, I think even with law changes, God has raised up this younger generation to make a profound impact for the sake of the Gospel."

If laws are passed too quickly or even just gradually, their effects will still of course be evident in the church. Mock says the best thing that we can do for them now is to pray. "There is nothing more important than praying for the believers in Kazakhstan to be passionate in reaching their own people, and to see more churches planted with that same commitment to advance the Gospel."

Report from the Christian Telegraph

Church under Attack in Indonesia Agrees to Change Venue

Congregation accepts offer under condition that government build them permanent building.

JAKARTA, Indonesia, September 29 (CDN) — A West Java church has agreed to move temporarily to a government-selected site following Islamist harassment that included a Sept. 12 attack on two of its leaders.

The Batak Christian Protestant Church (Huria Kristen Batak Protestan, or HKBP) in Ciketing village, Bekasi, decided in a congregational meeting on Sunday (Sept. 26) to accept a government offer to move worship services to the former Organization and Political Party (OPP) building on the condition that local officials will keep a promise to build a new house of worship for them within two years in the Mustika Sari district.

The Rev. Luspida Simanjuntak, who received hospital treatment after she was struck with a wooden plank by suspected Islamic extremists in the Sept. 12 attack, said that the church was ready to stop struggling.

“We are tired of being intimidated and terrorized,” Pastor Simanjuntak said. “We will be able to worship quietly and peacefully.”

Church lawyer Saor Siagian said that the church had accepted the temporary move with the understanding that the Bekasi municipal government must fulfill its pledge. The government will build a new church building to replace the structure the church is leaving on a 2,500-square meter lot belonging to PT Timah, the Government Tin Mining Co. in the Mustika Sari area of Bekasi. The lot is zoned for general and social facilities.

The government had suggested two alternative locations: the PT Timah lot and a 1,900-square meter parcel in the Strada Housing area. The congregation and leaders of HKBP Ciketing chose the PT Timah property.

The first HKBP Ciketing worship service in the former OPP Building took place without incident on Sunday, with the Bekasi government providing buses to transport the congregation to the new site. Pastor Simanjuntak said the congregation is thankful for the new temporary site, but it does not accommodate the entire congregation. The 10-meter by 14-meter building accommodates 250 people, but normally 300 attend services, and some had to stand outside, she said.

Dozens of police guarded the location.

Zaki Oetomo, a Bekasi city official, told Compass that the building could be used rent-free for two years, with an extension possible if the church desired. The government has offered to provide the buses to transport the congregation to and from the site every week.

 

20-Year Wait

The Ciketing church originally met in the Pondok Timur Indah housing development with 10 families in 1990, and therefore has generally been called the HKBP Pondok Timur Indah.

“By 1995 it had grown to 30 families,” Manorangi Siahaan, a church member, told Compass.

In those days the worship services were held in different members’ homes. Manorangi acknowledged that the house church worship did spark some small protests.

Between 1990 and 2010, the church leaders requested building permits three separate times, in 1995, 2000 and 2010. Not once did the local government respond, church leaders said.  

By 2005 the congregation had grown to 150, and church leaders bought a 2,170-square meter lot in Ciketing village, near Bekasi City, to construct a church building. They built a semi-permanent structure, which was later torn down because they lacked a building permit under pressure from an Islamic group claiming to speak for the local citizens. As a result, the congregation went back to worshipping in homes on a rotating basis.

In 2007 the congregation had grown to 300 people. They bought a house in Pondok Timur Indah, in the Mustika Jaya area of Bekasi City, to use for worship. The Bekasi government sealed the house on March 1 under pressure from Islamic groups. On July 2, the government sealed the house a second time because the congregation was continuing to worship there. Then on July 11, the church was forced to move their worship service to a vacant property in Ciketing, which had been readied for a church building. This site was about 3 kilometers from their property in Pondok Timur Indah.

Protests by Islamic groups mounted each Sunday at the Ciketing site, culminating in the attack on Pastor Simanjuntak and elder Hasian Sihombing, who was stabbed in the stomach and heart.

Report from Compass Direct News