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This article: https://www.cidrap.umn.edu/covid-19/myocarditis-rates-surged-during-covid-and-stayed-high-study-suggests

Study: The Impact of COVID-19 Infection and Vaccination on Myocarditis Incidence: A Comparative Analysis of Pre-, Peri-, and Post-Pandemic Eras https://onlinelibrary.wiley.com/doi/abs/10.1002/ccd.70659

From article:

>[…]

>Cases rose 80% above baseline during COVID

>Before the pandemic, myocarditis hospitalizations were relatively stable, with annual case counts ranging from 67 to 71 between 2017 and 2019. During the pandemic, hospitalizations climbed sharply, reaching 103 cases in 2020, 128 in 2021, and 139 in 2022, for an increase of roughly 80% above baseline. Population-level analyses have shown that COVID infection was tied to a roughly 16-fold increased risk of myocarditis, note the authors. 

>Myocarditis hospitalizations did not return to baseline after the pandemic began to wane. Researchers recorded 96 myocarditis admissions in 2023 and 105 in 2024, about 46% higher than prepandemic levels.

>There are several plausible explanations for elevated myocarditis rates in the post-pandemic period, note the researchers, including persistent cardiac inflammation following a COVID infection, lingering immune system dysregulation, and ongoing circulation of COVID. 

>[…]

>Vaccine-related myocarditis ‘unlikely contributor’ to hospital cases

>While myocarditis associated with mRNA vaccination has been documented, cases are rare, the authors note, and most occurred among young males. Post-pandemic myocarditis patients identified in this study were generally older and had multiple chronic conditions. 

>“Furthermore, observational studies have demonstrated vaccination to be associated with reduced COVID‐19 disease severity, mortality, and length of hospital stay, making vaccine-associated myocarditis an unlikely contributor to myocarditis-related hospital admissions.”

>[…]

From study:

>ABSTRACT

>Background

>The coronavirus disease 2019 (COVID-19) pandemic introduced a surge in cardiovascular complications, with myocarditis emerging as a concern due to both direct viral effects and rare vaccine-associated events.

>Aims

>This analysis examines the incidence and outcomes of myocarditis in patients across a large healthcare system in the Washington, DC Metropolitan Area, focusing on periods before, during, and after the COVID-19 pandemic.

>Methods

>A retrospective cohort study was conducted using electronic health records from the MedStar Health System (2017−2024). Myocarditis cases were identified using ICD-10 codes, with cases stratified by pre- (2017−2019), peri- (2020−2022), and post-COVID-19 (2023−2024) pandemic periods, as well as by association with COVID-19 infection and/or vaccination. The overall incidence and inpatient mortality of myocarditis were compared over these eras.

>Results

>This study included 778 myocarditis patients admitted between January 2017 and December 2024, categorized into pre-COVID-19 (n = 207), peri-COVID-19 (n = 370), and post-COVID-19 (n = 201) periods. Total myocarditis incidence surged during the peri-pandemic period, peaking in 2022, and declined in 2023-2024. In the post-pandemic period, total myocarditis remained elevated and higher than in the pre-pandemic era. During the pandemic and post-pandemic periods, myocarditis patients were older, included a higher proportion of African American individuals, and had a greater burden of cardiometabolic comorbidities, compared to pre-pandemic myocarditis hospitalizations.

>Conclusion

>This study demonstrates a marked increase in myocarditis cases during the COVID-19 pandemic, driven initially by a surge in COVID-19-related myocarditis. Notably, total myocarditis cases remained elevated in the post-pandemic period compared to pre-pandemic levels. These findings, particularly the increased post-pandemic myocarditis patients, warrant further investigation into underlying risk factors and long-term outcomes.

Full thread: https://xcancel.com/elisaperego78/status/2057164765496041725

Related:

• [October 2022] Long COVID advocate Dr. Elisa Perego speaks on the pandemic and the need for global elimination https://www.wsws.org/en/articles/2022/10/10/elis-o10.html
• [October 2020] Why we need to keep using the patient made term “Long Covid” https://blogs.bmj.com/bmj/2020/10/01/why-we-need-to-keep-using-the-patient-made-term-long-covid/
• [October 2020] How and why patients made Long Covid https://www.sciencedirect.com/science/article/pii/S0277953620306456
• [March 2026] Overview and Pathophysiology of Long COVID https://www.mdpi.com/2673-8112/6/3/53

>Abstract

>Background Although health problems may persist beyond 4 weeks after SARS-CoV-2 infection, evidence on long-term ophthalmic sequelae is limited. We conducted a binational, population-based cohort study to evaluate the association between postacute sequelae of SARS-CoV-2 infection and the risk of multiple ophthalmic diseases.

>Methods Data were collected from two large cohorts: South Korea (discovery cohort; n=15,992,761) and Japan (validation cohort; n=12,218,680), including individuals aged ≥20 years who were infected with SARS-CoV-2. Cox proportional hazards models with propensity score-based overlap weighting were used to estimate HRs, with analyses stratified by COVID-19 severity and SARS-CoV-2 variant period.

>Results In the overlap-weighted discovery cohort, 4 041 250 individuals (mean age 52.52 years (SD 11.52); 59.1% male) were included. SARS-CoV-2 infection was associated with a long-term increased risk of any ophthalmic disease (HR, 1.23 (95% CI, 1.22–1.25)). Elevated risks were observed for glaucoma (1.21 (1.19–1.23)), cornea and conjunctiva diseases (1.22 (1.21–1.23)), blepharitis (1.19 (1.17–1.22)), retinopathy (1.17 (1.15–1.18)), uveitis (1.11 (1.01–1.22)) and neuro-ophthalmic diseases (1.11 (1.06–1.15)). The risk of ophthalmic diseases gradually attenuated over time after SARS-CoV-2 infection. The risk was more pronounced among individuals with severe COVID-19. The associations between SARS-CoV-2 infection and the risk of ophthalmic diseases were generally consistent across the pre-Delta, Delta and Omicron eras. Similar patterns were consistently observed in the validation cohort.

>Conclusions Our findings suggest an increased risk of postacute ophthalmic sequelae following SARS-CoV-2 infection, underscoring the need for sustained clinical vigilance across a broad range of ophthalmic conditions.

>Highlights

>• Essential workers who developed COVID-19 have white matter dysregulation.

>• Changes to white matter are associated with specific neurological symptoms.

>• Inflammatory imaging might help clinicians to validate patient reported symptoms.

>Abstract

>Background

>Essential workers, many of whom were infected with coronavirus disease (COVID-19) at work before vaccination, developed Neurological Post-Acute Sequelae of COVID-19 (N-PASC) at high rates.

>Method

>To characterize white matter abnormalities associated with N-PASC and to examine correlates of symptomatology, we recruited 54 participants with N-PASC and compared them to 26 participants with no COVID-19 history or who recovered from acute COVID-19 without PASC into a neuroimaging study to profile the cerebral connectome starting from 1/1/2021-12/31/2024. Diffusion parameters from whole-brain white matter and cortical gray matter analyses were examined with multi-shell diffusion MRI data. Correlational tractography was used to examine the nature and extent of white matter changes.

>Results

>Participants with N-PASC lasting, on average, 2.7 years had global and tract-specific white matter alterations after adjusting for demographics across measures of white matter health. Correlational tractography located pronounced bilateral changes to the fornix and minor forceps, possibly providing indirect evidence of axonal injury or demyelination in these regions. But diffusion measures alone cannot determine the specific underlying biological process. Diffusion measures were associated with the presence of fatigue, executive impairment, anosmia and mood disorders, but not brain fog.

>Conclusions

>Results identify changes in N-PASC consistent with neuroinflammation that help explain cognitive dysfunction, providing insights into the long-term cerebral implications of COVID-19 and suggesting that symptoms may reflect evidence of a cerebral changes persisting years after symptom onset.

>Key Points

>Question  Is early oral antiviral use associated with a lower risk of post–COVID-19 condition (PCC) among outpatients with COVID-19?

>Findings  In this cohort study including 7699 outpatients, early oral antiviral use was associated with a significantly lower risk of PCC in the primary adjusted analysis. Participants receiving antivirals were less likely to fail to return to usual health by day 84.

>Meaning  These findings suggest that early oral antiviral use may help reduce the risk of PCC and support recovery in outpatients with COVID-19.

>Abstract

>Importance  Post–COVID-19 condition (PCC) contributes substantially to long-term morbidity after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Information about the effectiveness of oral antivirals in preventing PCC in outpatient populations remains limited.

>Objective  To evaluate the association between early oral antiviral use and PCC risk among outpatients with COVID-19, with and without risk factors for severe disease.

>Design, Setting, and Participants  Prospective, nationwide, multicenter, registry-based cohort study conducted at 51 acute-care hospitals across Japan during the predominance of Omicron sublineages JN.1 and KP.3. Outpatients aged 12 years or older with laboratory-confirmed COVID-19, symptom onset of 5 days or less before enrollment, and no recent anti–SARS-CoV-2 treatment were enrolled between February and October 2024, with follow-up through February 2025. The primary analysis population included participants with complete baseline covariates and valid day 28 and day 84 assessments.

>Exposures  Oral antiviral use (ensitrelvir, nirmatrelvir, or molnupiravir) at enrollment vs no antiviral use.

>Main Outcomes and Measures  The primary outcome was PCC, defined as persistence of 1 or more of 5 prespecified symptoms (cough, shortness of breath, malaise, smell disorder, or taste disorder), with the same symptoms reported on both days 28 and 84. Exploratory outcomes included failure to return to usual health by day 84.

>Results  Among 7699 participants (2181 receiving antivirals: 1131 [51.9%] male; median [IQR] age, 58.0 [41-71] years; and 5518 without antivirals: 2928 [53.1%] female; median [IQR] age, 45.0 [29-57] years), most had mild COVID-19 (7599 participants [98.7%]) and received 2 or more vaccine doses (6902 participants [89.6%]). Participants receiving antivirals were older and had more comorbidities; other baseline characteristics were similar between groups. After prespecified adjustment, antiviral use was associated with a lower risk of PCC (adjusted risk ratio [aRR], 0.86; 95% CI, 0.78-0.93). Results were consistent for ensitrelvir (aRR, 0.86; 95% CI, 0.79-0.95) and molnupiravir (aRR, 0.81; 95% CI, 0.67-0.98). Failure to return to usual health by day 84 was less common among participants receiving antivirals than among participants without antivirals (9.9% vs 12.9%; aRR, 0.77; 95% CI, 0.67-0.89).

>Conclusions and Relevance  In this cohort study of outpatients with COVID-19, early oral antiviral use was associated with a lower risk of PCC. These findings suggest that early antiviral treatment may help mitigate long-term consequences of SARS-CoV-2 infection.

>Highlights

>• mRNA vaccines cut severe COVID-19 risk in infection-naïve kids aged 6–11.

>• BNT162b2 and mRNA-1273 both effectively reduced emergency room visits.

>• High protection was maintained for children with underlying health conditions.

>• Results confirm the value of primary series vaccination during Omicron waves.

>Abstract

>Background

>Although COVID-19 is typically less severe in children, pediatric infections contribute to transmission and severe disease, particularly in those with comorbidities. This study evaluates the vaccine effectiveness (VE) of BNT162b2 and mRNA-1273 against Omicron BA.2/BA.5 in Taiwan, an infection-naïve population at the time of vaccine introduction.

>Material and methods

>This nationwide observational study utilized the National Health Insurance Research Database and the National Immunization Information System. We included children aged 6–11 years who completed a two-dose primary series between May and June 2022 or remained unvaccinated. Propensity score weighting (PSW) adjusted for age, sex, and health status. Outcomes included SARS-CoV-2 infection confirmed via emergency department (ED) visits or hospitalization, and moderate-to-severe COVID-19. VE was estimated using weighted logistic regression.

>Results

>Among 347,715 children, 115,449 received BNT162b2, 91,531 received mRNA-1273, and 140,735 were unvaccinated. Compared with unvaccinated children, adjusted VE against ED-confirmed infection was 58.8% (95% CI: 53.6%–63.4%) for BNT162b2 and 73.9% (95% CI: 69.3%–77.8%) for mRNA-1273. For moderate-to-severe disease, VE was 69.9% (95% CI: 58.0%–78.5%) for BNT162b2 and 75.5% (95% CI: 63.2%–83.6%) for mRNA-1273. Protection remained consistent across clinical subgroups.

>Conclusions

>A two-dose primary series of BNT162b2 or mRNA-1273 provided substantial protection against moderate-to-critical COVID-19 and reduced ED-confirmed infections during the Omicron period. These results support the public health value of pediatric mRNA vaccination in preventing severe outcomes in settings with low prior infection rates.

>Abstract

>Introduction

>The continual emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants drives the need to update evidence on coronavirus disease 2019 (COVID-19) severity and disease burden, and better understand the impact on prevention, treatment, and healthcare systems.

>Methods

>This systematic review aimed to determine relative disease severity, through comparative measures of hospitalization, intensive care unit admission and mortality, between SARS-CoV-2 variants of concern emerging since Omicron was first identified. A protocol was registered a priori (PROSPERO ID: CRD42024619193). Systematic searches of MEDLINE and EMBASE databases were conducted in November 2024 and supplemented by conference searches from 2022–2024. Population, Exposure, Comparisons, Outcomes (PECO) criteria were used to screen publications for inclusion. Critical appraisal tools published in the Joanna Briggs Institute (JBI) Handbook for Evidence Synthesis were used to assess the risk of bias of the primary studies included. The outcomes associated with Omicron variants, identified by sequencing or predominance periods, included hospitalization, admission to intensive care, death, and various composite endpoints.

>Results

>Thirty-two studies fulfilled the eligibility criteria, most reported on relative disease severity for early Omicron BA.5 (n = 23) and XBB (n = 24) variants. Overall, COVID-19 severity appeared largely comparable across the various Omicron subvariants. Among the subset of studies that directly compared various severity outcomes to earlier SARS-CoV-2 variants (n = 7), some reported modest increases or decreases in severity. However, these differences were generally not statistically significant. Five studies stratifying outcomes by the presence of comorbid conditions noted that comorbidities were predictors of significantly worse COVID-19 disease outcomes (p = 0.000–0.027).

>Conclusions

>Overall, this systematic review found the severity of COVID-19 disease to be comparable among Omicron subvariants. As SARS-CoV-2 subvariants continue to emerge, these results highlight the continuing need for vaccination against SARS-CoV-2 infection alongside early antiviral intervention to support short-term management and long-term reduction of COVID-19-associated morbidity and mortality.

Full article: https://archive.ph/NDeMb

Related:

• Detection of SARS-CoV-2 in aerosol and surface samples in high acuity hospital settings during community epidemic waves – implications for risk-based infection control https://www.resmedjournal.com/article/S0954-6111(26)00080-6/fulltext
  • Study: SARS-CoV-2 RNA found in 39% of hospital air samples during outbreaks, despite good ventilation https://www.cidrap.umn.edu/covid-19/study-sars-cov-2-rna-found-39-hospital-air-samples-during-outbreaks-despite-good

This study: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0345041

Related:

• Diseases can spread between apartments via shared ventilation, study shows https://www.colorado.edu/today/2026/05/12/diseases-can-spread-between-apartments-shared-ventilation-study-shows [on this study]
• [May 2006] Environmental transmission of SARS at Amoy Gardens [pdf] | [pdf mirror]
• [December 2013] Severe Acute Respiratory Syndrome Beyond Amoy Gardens: Completing the Incomplete Legacy https://academic.oup.com/cid/article/58/5/683/365793

From present study:

>Abstract

>During the COVID-19 pandemic, airborne transmission of SARS-CoV-2 via respiratory aerosols was a critical concern in indoor environments. In the city of Santander, Spain, an outbreak in a multi-family residential building during a period of low community transmission revealed vertical clustering of 15 cases in four homes. The building’s design included single interior bathrooms without windows in each home, ventilated by a shared vertical bathroom duct system. Field measurements, computational fluid dynamics (CFD) simulations, and multi-zone airflow modeling were performed to evaluate vertical disease transmission potential in the Santander building. Epidemiological and genetic data combined with the field-collected data and modeling indicated that the most plausible transmission route was the bathroom vertical ventilation duct system, which facilitated movement of infectious aerosol between vertically connected homes. Additionally, operating the kitchen exhaust fan can augment the movement of aerosols between occupied spaces increasing the potential for infection. Recommendations for mitigating future risks include the installation of forced air exhaust fans with non-return flaps in bathroom ducts.

>Abstract

>The temporal and spatial distributions of the 2003 severe acute respiratory syndrome (SARS) outbreak in Amoy Gardens of Hong Kong was reexamined using all confirmed cases. The outbreak actually extended to nearby residential complexes. Airborne spread was the most likely explanation, and the SARS coronavirus could have spread over a distance of 200 m.

>Abstract

>Patients with earlier SARS-CoV-2 variants are at increased risk of venous and arterial thromboembolic (VTE, ATE) events. Here we aimed to contextualise the incidence of thromboembolic events among patients with COVID-19 during the Omicron period. We conducted a population-based cohort study using electronic health records from the UK (CPRD GOLD), the Netherlands (IPCI), and Spain (SIDIAP) within the DARWIN EU^(®) network. Two cohorts were included: a pre-pandemic population (2017–2019) and individuals infected with SARS-CoV-2 during the Omicron-dominant period. We estimated incidence rates (IRs) of VTE, ATE, and other cardiovascular events at 30-, 60-, 90-, and 180-days post-infection. Crude incidence rate ratios (IRRs) and age-sex standardized incidence ratios (SIRs) were calculated relative to the pre-pandemic cohort. Analyses were stratified by prior infection, vaccination status, and immunocompromised status. In total, we included over 7.6 million individuals (CPRD GOLD: 5.28 M; IPCI: 1.59 M; SIDIAP: 0.75 M) in the general population cohort, and about 0.8 million individuals (CPRD GOLD: 248,847; IPCI: 330,200; SIDIAP: 200,563) in the COVID-19 Omicron cohort. Crude IRs varied by outcome and data source. For VTE, IRs per 100,000 person-years were 136 [95%CI 131–141] in SIDIAP, 167 [164–169] in CPRD GOLD, and 264 [259–270] in IPCI. Elevated SIRs for VTE and ATE were observed following SARS-CoV-2 infection, highest within 30 days and persisting up to 180 days. In CPRD GOLD, the VTE SIR was 3.61 [2.45–5.53] at 30 days, decreasing to 1.88 [1.52–2.34] at 180 days. Higher SIRs were observed among immunocompromised individuals and those without prior infection. Our findings indicate that among individuals diagnosed with SARS-CoV-2 infection during the Omicron-dominant period, observed rates of thromboembolic events exceeded expected background incidence, particularly in the early post-infection period.

The post: https://x.com/WHO/status/2054775008015114744

Related:

• World health statistics 2026: monitoring health for the SDGs, sustainable development goals https://www.who.int/publications/i/item/9789240122482
• Global health gains face threat of reversal https://www.who.int/news/item/13-05-2026-global-health-gains-face-threat-of-reversal

>Key Points

>Question  How effective is COVID-19 vaccination in preventing transmission of SARS-CoV-2?

>Findings  In this cohort study of 362 primary case participants with SARS-CoV-2 infection and their 763 household contacts, 62% of household contacts were infected with SARS-CoV-2. Household contacts of primary case participants vaccinated 6 months or less before onset had nearly one-half the infection risk compared with contacts of unvaccinated primary case participants.

>Meaning  These findings suggest that COVID-19 vaccination may have an indirect benefit of decreasing transmission and thus reducing overall exposure to SARS-CoV-2.

>Abstract

>Importance  COVID-19 vaccine effectiveness (VE) is typically studied in the context of reducing the risk of severe illness and death. Few studies have estimated VE in preventing transmission and infection with current levels of SARS-CoV-2 population immunity.

>Objective  To estimate COVID-19 VE against transmission and infection within households.

>Design, Setting, and Participants  This cohort study was a prospective, case-ascertained household transmission study (performed in New York, Tennessee, and Washington) in which the first household member with confirmed SARS-CoV-2 infection (primary case participant) was identified through outpatient settings and enrolled with their household contacts from January 1, 2024, to January 31, 2025. Participants provided demographic information, and COVID-19 vaccination history was verified by study staff. After enrollment, participants were instructed to collect daily nasal swabs for 10 days regardless of symptoms. Nasal swabs were tested for SARS-CoV-2 via reverse transcription–polymerase chain reaction.

>Exposure  COVID-19 vaccination history in primary case participants and household contacts categorized as time from most recent vaccination to COVID-19 onset in the primary case participant (≤6 months, 7-12 months, >12 months, and unvaccinated [reference group]).

>Main Outcomes and Measures  Household contacts were considered infected if at least 1 swab tested positive for SARS-CoV-2. Secondary infection risk was calculated as the number of infected contacts divided by the total number of contacts. Adjusted relative risk (ARR) of infection was estimated using a multivariable Poisson regression model, with generalized estimating equations accounting for household-level clustering. Vaccine effectiveness was calculated as 1 minus the ARR of the primary case participant and household contacts’ vaccination status to estimate VE against transmission and against infection, respectively.

>Results  This analysis included 362 primary case participants (median [IQR] age, 35 [10-53] years; 199 female [55.0%]) and 763 household contacts (median [IQR] age, 29 [12-44] years; 399 female [52.3%]). SARS-CoV-2 infection was detected in 476 household contacts during follow-up for a secondary infection risk of 62.4% (95% CI, 58.7%-65.5%). Household contacts of primary case participants vaccinated 6 months or less before onset had a lower infection risk compared with contacts of unvaccinated primary case participants (ARR, 0.57 [95% CI, 0.35-0.93]). There was no statistically significant difference in infection risk based on vaccination status of household contacts.

>Conclusions and Relevance  In this cohort study, recent COVID-19 vaccination was associated with a reduced risk of SARS-CoV-2 transmission. These findings suggest that COVID-19 vaccination may have an indirect benefit of decreasing transmission and thus reducing overall exposure to SARS-CoV-2.