Businessman Steve Kirsch has never cared for a patient with COVID. Although he has no real-world responsibility for the consequences of his words, he has become an outspoken anti-vaccine advocate, loudly opining on what he would do if he had such responsibility.
His most recent salvo occurred in the context of the kerfuffle involving debates in medicine. I told Mr. Kirsch that while I would not participate in a live debate, he or anyone else has had always been welcome to write a rebuttal to any of the 100 articles I’ve posted here. To his credit, Mr. Kirsch accepted my offer, and provided 9 reasons—a veritable Gish Gallop—as to why he feels unvaccinated children should suffer from COVID in perpetuity. In this article, I will only discuss Mr. Kirsch’s first claim, to show how he tricks his readers by omitting evidence that dis-confirms his anti-vaccine narrative.
Mr. Kirsch felt that an article of mine, which accurately reported the rate of vaccine-myocarditis (1 in 19,000 for males age 12-17) from a recent Korean study, understated its true frequency. He wrote:
The Thailand prospective study showed a 3.5% rate of myo/pericarditis in teens. So doesn’t the existence of that study, which is very inconsistent with the rates in the studies you cited, prove that your first sentence is false and misleading? And how can you be so certain your studies are better? The anecdotes I’m aware of are numerous and they all favor the Thailand study as the most accurate estimate of the rate of myocarditis post-vaccination.
It might not seem that way, but there’s a lot to unpack here.
The Thailand study referenced by Mr. Kirsch examined adolescents who received the second dose of the BNT162b2 mRNA vaccine. It found, “one case of myopericarditis, four cases of subclinical myocarditis, and two cases of pericarditis among 301 participants.” It further stated that “the clinical presentation of myopericarditis after vaccination was usually mild and temporary, with all cases fully recovering within 14 days.”
Mr. Kirsch refused to share this information with his readers.
The clinical course of vaccine-myocarditis in the Thailand study is consistent with every other study thus far. The largest systematic review of adolescents and young adults summarized 23 studies involving 854 patients. It found “low incidence rate and largely favorable early outcomes of COVID-19 mRNA vaccine–associated myopericarditis in adolescents and young adults.” Even in those with abnormal cardiac imaging, a systematic review of 468 cases found that “all reported cases with abnormal cardiac MRI findings showed a favorable clinical course at the acute phase.” Another review of 276 cases reported that “Fortunately, most myocarditis cases associated with mRNA vaccines are mild in nature and do not have serious complications and require only a few days of hospital admission.” Another systematic review of 28 studies stated “the prognosis of this self-limiting condition is generally good.” As doctors have learned about the condition, they have altered their management of it. In a recent study from Canada, 56% of adolescents were sent home from the ER, while most others left after one day. Severe outcomes are possible, though they are exceedingly rare, with fulminant myocarditis being a literally 1 in a million event.
Mr. Kirsch refused to share this information with his readers.
Unsurprisingly, doctors who care for sick children didn’t share Mr. Kirsch’s concern about “subclinical myocarditis”. Pediatric cardiologist Dr. Frank Han, who has actually cared for patients with vaccine-myocarditis and published a report on 63 patients with it, discussed the Thailand study previously on SBM. He wrote:
The definition of subclinical myocarditis is a patient with lab, imaging, or EKG findings consistent with myocarditis, but minimal or no symptoms (minimal chest pain, shortness of breath, or palpitations for example). The crowd that is most anti-COVID vaccination is very supportive of the finding of subclinical myocarditis in this article without considering its limitations. Cardiologists have formalized the criteria for myocarditis to avoid diagnosing every person with troponin in the blood with myocarditis. This would be misdiagnosis and, unnecessarily frighten the patient. I particularly emphasize – even if it is coming from me – a speaker who analyzes articles critically when they do not fit the speakers preconceived notions, and fails to analyze critically when the articles do match their preconceived notions, is presenting you with a biased and possibly deceptive assessment of the world.
Though Mr. Kirsch dismissed Dr. Han as an “expert” with only 3,000 Twitter followers, Dr. Han has real-world responsibility for sick children. Unlike Mr. Kirsch, Dr. Han knows troponin is a very sensitive test that by itself is not diagnostic of myocarditis. Indeed, a vigorous game of soccer can elevate troponin levels in children. Additionally, in a study of 61 patients with suspected vaccine-myocarditis who were sick enough to undergo a cardiac biopsy, 21 of them did not have myocarditis, showing the potential for over-diagnosis. Mr. Kirsch refused to share any of this information with his readers as it would undermine his claim that “the Thailand study as the most accurate estimate of the rate of myocarditis post-vaccination”. In fact, a recent meta-analysis of 15 studies calculated a rate of 1 in 15,000 for males age 12-17. I expect their methods were more rigorous than his “anecdotes”, which may explain why hospitals were deluged with sick children during the Delta and Omicron waves, but no hospital in the world had to open a vaccine-injury unit. (I shared more studies here).
Mr. Kirsch refused to share this information with his readers.
It may be the case that I am minimizing “subclinical myocarditis.” However, if “subclinical myocarditis” from the vaccine is concerning, then the virus is much more worrisome. One study found elevated troponin in 7% of children who presented to the ER with COVID, double the rate found in the Thailand study. However, that study wisely concluded:
Routine troponin screening does not yield much information in previously healthy paediatric COVID-19 patients without any sign of myocardial dysfunction. Elevated troponin levels may be observed but it is mostly a sign of myocardial injury without detectable myocardial dysfunction in this group of patients.
Mr. Kirsch refused to share this information with his readers.
Of course, the virus can often cause overt, clinical myocarditis in children. A study of nearly 60,000 children found that “myocarditis was the condition with the strongest association with SARS-CoV-2 infection.” A recent meta-analysis found the vaccine caused myocarditis at a lower rate than the virus. It found:
None of the incidences of myopericarditis pooled in the current study were higher than those after smallpox vaccinations and non-COVID-19 vaccinations, and all of them were significantly lower than those in adolescents aged 12–17 years after COVID-19 infection.
In contrast to nearly all cases of vaccine-myocarditis in adolescents, COVID can cause severe cardiac complications, especially in children with Multisystem Inflammatory Syndrome in Children (MIS-C), which has affected over 9,400 American children, causing 79 deaths. One report of 95 patients with MIS-C found elevated troponin levels in 71% of the patients, and 53% had myocarditis. 62% of these patients received vasopressor support, 80% were admitted to an ICU, and 2 died. Other studies have reported acute heart failure in children with MIS-C, and other common cardiac complications of myocarditis due to MIS-C include “shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation”. Cardiac arrhythmias have led “to hemodynamic collapse and need for ECMO support” in some children. Another study found that an elevated troponin level in children with COVID wasn’t always clinically benign. It found:
Out of 7 patients with high troponin levels, 3 (42.9%) of them were admitted to the pediatric intensive care unit (PICU), 2 (28.6%) required oxygen support, and 1 (14.3%) required a mechanical ventilator.
A study that compared classic myocarditis, myocarditis due to MIS-C and vaccine-myocarditis in children found that:
COVID-19 vaccine-related myocarditis generally had a milder clinical course, with a lower likelihood of cardiac dysfunction at presentation and more rapid recovery when present…COVID-19 vaccine-related myocarditis is mild, and patients typically have evidence of normal ventricular function recovery at discharge from the hospital.
Mr. Kirsch refused to share this information with his readers, though of course, whether the vaccine or the virus causes more myocarditis is not the proper comparison, since COVID’s harrms are not limited to myocarditis and include strokes, seizures, amputations, long COVID, lung transplants, and death.
Even if one believes that “subclinical myocarditis” from the vaccine is worse than death from COVID, vaccine-myocarditis does not occur in children younger than 12. Anyone concerned with this side has no valid reason to oppose the vaccine in younger children, yet they always find a way. Around 12 million babies have been born since the start of the pandemic, and though they have the highest COVID risk by far of any children, none arrive with “natural immunity.”
Mr. Kirsch refused to share this information with his readers.
Obviously, the risks of the vaccine have to be weighed against its benefits. While the vaccine is not a magic bullet, there’s copious evidence it has already protected many children from COVID’s worse harms.
Mr. Kirsch refused to share this information with his readers.
Studies Mr. Kirsch Refused to Share
Olson |
In hospitalized adolescents, “179 COVID-19 case-patients, six (3%) were vaccinated and 173 (97%) were unvaccinated. Overall, 77 (43%) case-patients were admitted to an intensive care unit, and 29 (16%) critically ill case-patients received life support during hospitalization, including invasive mechanical ventilation, vasoactive infusions, or extracorporeal membrane oxygenation; two of these 29 critically ill patients (7%) died. All 77 case-patients admitted to the intensive care unit, all 29 critically ill case-patients, and both deaths occurred among unvaccinated case-patients.” |
Delahoy |
“Hospitalization rates were 10 times higher among unvaccinated than among fully vaccinated adolescents.” |
Wanga |
“Among 272 vaccine-eligible (aged 12–17 years) patients hospitalized for COVID-19, one was fully vaccinated.” |
Lutrick |
Vaccine effectiveness “…was 92% against SARS-CoV-2 infections irrespective of symptom status.” |
Zambrano |
“Among critically ill MIS-C case-patients requiring life support, all were unvaccinated…97/102 children with MIS-C were unvaccinated. None of the 5 vaccinated MIS-C patients required respiratory or cardiovascular life support (invasive mechanical ventilation, vasoactive infusions, or ECMO) compared to 38/97 unvaccinated MIS-C patients.” |
Levy |
“In 33 adolescents with MIS-C eligible for vaccination…0 had been fully vaccinated, 7 had received 1 dose.” |
Olson |
“Of the case patients, 180 (40%) were admitted to the ICU, and 127 (29%) required life support; only 2 patients in the ICU had been fully vaccinated. The overall effectiveness of the BNT162b2 vaccine against hospitalization for Covid-19 was 94%. The effectiveness was 98% against ICU admission and 98% against Covid-19 resulting in the receipt of life support. All 7 deaths occurred in patients who were unvaccinated.” |
Nygaard |
“We identified 51 MIS-C cases among unvaccinated individuals and one in a fully vaccinated adolescent.” |
Chang |
“Reports of MIS-C after COVID-19 vaccination occurred in only 1 per million individuals aged 12–20 years who received one or more doses of a COVID-19 vaccine.” |
Fleming-Dutra |
Estimated booster dose effectiveness in adolescents 2 to 6.5 weeks after the booster was 71.1%. |
Yousaf |
“The overall reporting rate for MIS-C after vaccination 1·0 case per million individuals receiving one or more doses in this age group.” |
Tan |
Vaccine effectiveness against hospitalization was 83% in children ages 5-11. |
Marks |
“A higher proportion of unvaccinated adolescents (70.3%) than fully vaccinated adolescents (40.8%) had COVID-19 as a primary reason for admission. A significantly higher proportion of unvaccinated adolescents were admitted to the ICU (30.3%) than were those who were vaccinated (15.5%).” |
Price |
Vaccine effectiveness against hospitalization was 68% in children ages 5-11 |
Lin |
Vaccine effectiveness against hospitalization was 88% in children ages 5-11, though this waned to 76% after several months. 7 children died, all unvaccinated. |
Messiah |
“Additional increased risk for persistent COVID symptoms >12 weeks included severe symptoms with initial infection, not being vaccinated and having unhealthy weight” |
Cohen-Stavi |
This observational study of effectiveness of the BNT162b2 vaccine among children 5 to 11 years of age showed a vaccine effectiveness of 51% against documented SARS-CoV-2 infection and 48% against symptomatic Covid-19 at 7 to 21 days after the second dose. |
Klein |
Overall, 2-dose vaccine-effectiveness against COVID-19–associated hospitalization was 73%–94%. |
Shi |
During the period of Omicron predominance (December 19, 2021–February 28, 2022), COVID-19–associated hospitalization rates in children aged 5–11 years were approximately twice as high among unvaccinated as among vaccinated children. Non-Hispanic Black children represented the largest group of unvaccinated children. Thirty percent of hospitalized children had no underlying medical conditions, and 19% were admitted to an intensive care unit. |
The larger lesson here is the wisdom of Brandolini’s law, which states:
The amount of energy needed to refute bullshit is an order of magnitude bigger than that needed to produce it.
I could (and might) go through the rest of Mr. Kirsch’s article, exposing its fake statistics, specious comparisons, and strategic omissions. However, my rebuttal here would not have been possible during a live “debate”, which explains why it’s a mistake to let performative anti-vaxxers turn children’s health into a disinformation display to satisfy their own need to be “heterodox”.