Herewith two items of recent pandemic news: Some clarity on long Covid and its relation to two known autonomic conditions; and watching for cases of heart inflammation in young men after mRNA vaccination. Plus news briefs and a frippery.
Teens, mRNA, and the heart
The mRNA vaccines from Moderna and Pfizer had an easy time of it while the viral-vectored shots from AstraZeneca and J&J were being scrutinized for their possible association with rare blood clot conditions. Now it is the mRNAs that are in the spotlight because of rare heart conditions that have cropped up following vaccination, mostly in teenage boys and, to a lesser extent, young men.
Three weeks ago a group of CDC advisors who monitor vaccine safety met to discuss reports of myocarditis, inflammation of the heart muscle, in young men who had taken Pfizer’s mRNA vaccine. They concluded at the time that cases of myocarditis had not risen above the number normally expected in young people, and it is not known whether the vaccine triggers heart inflammation or not.
A week ago Israel’s health ministry concluded that there is a probable link between Pfizer’s vaccine, particularly the second shot, and myocarditis in males aged 16 to 30. The ministry put the incidence at 1 in 50,000 — but if only young males are considered, 1 in 5,000 of those vaccinated.
A study was published in Pediatrics last Friday — nothing of it is available online behind a paywall — describing seven myocarditis cases in young men in this country. The CDC has issued guidelines urging clinicians to watch for myocarditis and pericarditis (inflammation of the lining outside the heart) in their practices following vaccination, and to report any occurrences to a database of post-vaccination incidents. The CDC emphasizes that the dangers of Covid outweigh the slight chance of a heart complication, even if there turns out to be a link to mRNA vaccines, which has not been established.
None of the coverage I saw mentioned Moderna’s vaccine, only Pfizer’s, though they are quite similar in composition and operation.
Long haulers, POTS, and CFS
An article in Kaiser Health News reports on progress in coming to grips with (at least some cases of) long Covid. Some sufferers, who have been fortunate enough to make their way to the right specialists, have been diagnosed with postural orthostatic tachycardia syndrome, or POTS. This autonomic nervous system disorder affects control of involuntary functions such as heart rate and blood pressure.
One MD who contracted Covid-19 and developed long Covid found in her research that there are only 75 board-certified autonomic disorder doctors in all of the US. She made her way to one of them and received a diagnosis of POTS and chronic fatigue syndrome (CFS). The two have overlapping symptoms and often go together in sequelae of Covid-19, specialists say.
One specialist, Dr. Peter Rowe of Johns Hopkins in Baltimore, co-authored a recent paper on CFS cases apparently triggered by Covid-19. He said that every doctor he knows with expertise in POTS is seeing long Covid patients with POTS; and every long Covid patient he has seen with CFS also had POTS. He is not optimistic about the prognosis for his specialty: “Decades of neglect of POTS and CFS have set us up to fail miserably.”
There are no federally approved drugs to treat POTS or CFS, but experienced physicians have found a variety of medicines that can improve symptoms. Some patients recover over time with specialized physical therapy; others do not.
- MN’s positivity rate at 2.3% — This critical metric, the proportion of tests coming back positive, gives insight into how a disease is spreading in a community. It has been dropping steadily in Minnesota since early April and has now reached the low single digits. To me that signals that it is indeed safe to move about the cabin.
- Covid and the brain — This Washington Post article brings us up to date on what is known about the ways Covid-19 affects the brain, a question we have been following for a while. Little if any direct infection of neural tissue happens, apparently. One theory is that an immune over-response, perhaps initiated by brain swelling, causes neurological problems in both acute and long-tail phases of the disease.
- The Northwest Angle’s continuing lockdown — This geographical oddity, cut off from the rest of Minnesota by Canadian territory and Lake of the Woods, has struggled during the long months of the pandemic, and its struggles are not yet at an end. The NY Times brings visibility to the plight of the 100-odd Angle residents, who have missed out on one tourist and fishing season and are staring down the barrel of losing another. Canada relaxed its lockdown rules sightly to allow Angle residents to come and go to mainland US territory without testing or quarantining; but non-residents still may not visit. Pretty much the only industries on the Angle are hospitality and fishing tourism.
Frippery: Berthe Morisot
To reward your patience, the frippery today is a NY Times “close read” — the finest example I know of the use of interactive web technologies for education and elucidation. I learned all kinds of things about Impressionism and its (perhaps) least-explored practitioner, Berthe Morisot. The social and economic context in which the artistic school arose in France in the late 19th century was all new to me. “In 1875, [Impressionist paintings] were hardly… soothing. They were views of a society rocketing through modernization, and losing its bearings as it accelerated.”