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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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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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.

Church Registration in Vietnam Inches Along

Assemblies of God obtains ‘operating license,’ but quest for recognition continues.

HO CHI MINH CITY, October 23 (CDN) — The Assemblies of God (AoG) in Vietnam on Monday (Oct. 19) received an “operating license,” which the government described as “the first step . . . before becoming officially legal.”

This operating license gives permission for all of the congregations of the Vietnam AoG to “carry on religious activity” anywhere in the country for the next year. During this time the church body must prepare a doctrinal statement, a constitution and bylaws and a four-year working plan to be approved by the government before being allowed to hold an organizing assembly. These steps, AoG leaders hope, would lead to legal recognition.

The operating license is the first one granted since five were granted two years ago. The last of those five churches, the Christian Fellowship Church, was finally allowed to hold its organizing assembly in late September. According to an internal 2008 government Protestant Training Manual obtained by church leaders, this assembly was delayed because authorities observed large discrepancies between the number of followers the group claimed and the actual number, as well as other “instability.”

Vietnam News Service reported on Sept. 29 that the Christian Fellowship Church has “30,000 believers nationwide.”

Should the AoG achieve legal recognition, it would be the ninth among some 70 Protestant groups in Vietnam and the seventh since new religion legislation touted to expedite registration was introduced in 2004.

The AoG quest was typically long, and it is not yet over. Though started in the early 1970s before the communist era, the denomination was deemed dormant by authorities after the communist takeover and restarted in 1989. Strangely, the Vietnamese religion law requires a church organization to have 20 years of stable organization before it can even be considered for legal recognition.

Though the AoG had been trying for years to register, only this year did it fulfill the 20-year requirement in the eyes of the government. Sources said AoG’s resistance to strong pressure by the government to eliminate a middle or district level of administration may also have contributed to the delay.

Ironically, the official government news report credits the Vietnam AoG with 40,000 followers, while denominational General Superintendent Samuel Lam told Compass the number is 25,000. He also said he hoped the advantages of registration would outweigh the disadvantages.

With no more operating licenses being granted, the future of registration is in a kind of limbo. Sources said a lower level of registration in which local authorities are supposed to offer permission for local congregations to carry on religious activities while the more complicated higher levels are worked out has largely failed. Only about 10 percent of the many hundreds of applications have received a favorable reply, they said, leaving most house churches vulnerable to arbitrary harassment or worse.

Leaders of all Protestant groups say that they continue to experience government resistance, as well as social pressure, whenever they preach Christ in new areas. They added that evidence is strong that the government’s aim is to contain Protestant growth.

Hmong Christians who fled the Northwest Mountainous Region for the Central Highlands a decade ago, developing very poor land in places such as Dak Nong, reported to Compass that they were singled out for land confiscation just when their fields became productive. They said ethnic Vietnamese made these land grabs with the complicity of the authorities, sometimes multiple times.

At the same time, Human Rights Watch (HRW) reported on Oct. 19 that Vietnam has experienced a “sharp backsliding on religious freedom.” Among other incidents, HRW cited the late September crackdown on followers of Buddhist peace activist Thich Nhat Hanh. Some 150 monks were forcibly evicted from his sect’s Bat Nha Monastery in Lam Dong province on Sept. 27, and 200 nuns fled in fear the next day. As in recent land disputes with Roman Catholics involving thousands of demonstrators, authorities hired local and imported thugs to do the deed to present the image that ordinary local people were upset with the religion.

After a visit to Vietnam in May, the U.S. Commission on International Religious Freedom (USCIRF) recommended that the United States reinstate Vietnam as a Country of Particular Concern (CPC), the blacklist of religious liberty offenders. Vietnam had been on the list from 2004 until 2006.

The USCIRF, which experienced less government cooperation that on some previous visits,  observed that “Vietnam’s overall human rights record remains poor, and has deteriorated since Vietnam joined the World Trade Organization in January 2007.”

Some key Protestant leaders describe themselves as weary and frustrated at what they termed the government’s lack of sincerity, extreme tardiness and outright duplicity regarding religious freedom. They too said they believe that the lifting of Vietnam’s CPC status was premature and resulted in the loss of a major incentive for Vietnam to improve religious freedom.

Report from Compass Direct News