“Died suddenly” put to bed. NO increase in sudden heart death during pandemic and vaccine rollout

Gui the Science Guy wrote:

Harambe wrote:

Link:jamanetwork.com/journals/jamanetworkop...

We can stop posting every news article now

I’ll preface this by saying that I have no dog in this fight. I’m not a Covid vaccine pusher nor am I anti-vax, so neither side can claim that I am in one group or another. I did receive the Moderna vaccine. I am in the sciences and in my capacity I do review journal submissions from time to time.

Now with that out of the way, I have to say that this is a poor study and neither “side” should claim “victory” - as if there is one in science.

There are notable flaws that compromise its conclusions. A key issue lies in the reliance on an external reporting system via the NCCSIR. As someone who actual has worked with dataset from here, this approach inherently risks underreporting, as it depends on third parties to report incidents of SCA/SCD. Cases that occur in less-monitored environments or when survivors or next-of-kin do not consent to data collection are likely to be excluded. This introduces selection bias and undermines the comprehensiveness of the dataset. A more robust reporting mechanism, perhaps one that involves mandatory submissions from medical institutions, would have reduced the risk of missing cases and improved data reliability. I assume that there is no such data available and that is why the authors used the NCCSIR data. It’s just not reliable though.

Although it’s relatively minor part of the study, the classification of race and ethnicity using media reports or photos is methodologically flawed. That’s just a terrible way to do it. They should have just left it out and said the data was not available. This gives me great pause about who reviewed the study.

The study’s comparison of pre-pandemic and pandemic periods also presents problems. While they note a decline in college athlete participation during the pandemic, this 2.5% figure may understate the broader impact of pandemic-related disruptions, especially in youth and high school sports where lockdowns and restrictions were more severe. The pandemic not only altered participation levels but also likely affected reporting practices, medical access, and training regimens, all of which could confound the analysis. A more detailed exploration of these confounding variables is necessary to contextualize the results accurately.

The lack of Individual level data on COVID-19 infection and vaccination is perhaps the most significant limitation of the study. Without such data, the study cannot directly evaluate the relationship between these factors and SCA/SCD risk, making its conclusions about the absence of increased risk speculative. The small number of myocarditis cases reported (3 pre-pandemic and 4 during the pandemic) is insufficient to draw meaningful conclusions, especially without linking these cases to infection or vaccination status. Counter to their assertion, the absence of evidence is not evidence of absence; the dataset’s limitations preclude definitive conclusions about COVID-19 or vaccination risks.

They also overstate the study’s findings by dismissing concerns about COVID-19 and vaccination risks without sufficient supporting evidence. While the data suggests no significant increase in SCA/SCD cases, they really fail to account for alternative explanations such as changes in physical activity, deconditioning, or mental health stressors. The findings are more suggestive rather than conclusive.

I would give this study a C+/B-. There are so many limitations and issues with it. The study’s findings should be interpreted cautiously by both “sides.” Sorry boys, no win for either one of you.

Gui the Science Guy wrote:

. . . They also overstate the study’s findings by dismissing concerns about COVID-19 and vaccination risks without sufficient supporting evidence. While the data suggests no significant increase in SCA/SCD cases, they really fail to account for alternative explanations such as changes in physical activity, deconditioning, or mental health stressors. The findings are more suggestive rather than conclusive. . . .

Harambe wrote:

Gui the Science Guy wrote:

I’ll preface this by saying that I have no dog in this fight. I’m not a Covid vaccine pusher nor am I anti-vax, so neither side can claim that I am in one group or another. I did receive the Moderna vaccine. I am in the sciences and in my capacity I do review journal submissions from time to time.

Now with that out of the way, I have to say that this is a poor study and neither “side” should claim “victory” - as if there is one in science.

There are notable flaws that compromise its conclusions. A key issue lies in the reliance on an external reporting system via the NCCSIR. As someone who actual has worked with dataset from here, this approach inherently risks underreporting, as it depends on third parties to report incidents of SCA/SCD. Cases that occur in less-monitored environments or when survivors or next-of-kin do not consent to data collection are likely to be excluded. This introduces selection bias and undermines the comprehensiveness of the dataset. A more robust reporting mechanism, perhaps one that involves mandatory submissions from medical institutions, would have reduced the risk of missing cases and improved data reliability. I assume that there is no such data available and that is why the authors used the NCCSIR data. It’s just not reliable though.

Although it’s relatively minor part of the study, the classification of race and ethnicity using media reports or photos is methodologically flawed. That’s just a terrible way to do it. They should have just left it out and said the data was not available. This gives me great pause about who reviewed the study.

The study’s comparison of pre-pandemic and pandemic periods also presents problems. While they note a decline in college athlete participation during the pandemic, this 2.5% figure may understate the broader impact of pandemic-related disruptions, especially in youth and high school sports where lockdowns and restrictions were more severe. The pandemic not only altered participation levels but also likely affected reporting practices, medical access, and training regimens, all of which could confound the analysis. A more detailed exploration of these confounding variables is necessary to contextualize the results accurately.

The lack of Individual level data on COVID-19 infection and vaccination is perhaps the most significant limitation of the study. Without such data, the study cannot directly evaluate the relationship between these factors and SCA/SCD risk, making its conclusions about the absence of increased risk speculative. The small number of myocarditis cases reported (3 pre-pandemic and 4 during the pandemic) is insufficient to draw meaningful conclusions, especially without linking these cases to infection or vaccination status. Counter to their assertion, the absence of evidence is not evidence of absence; the dataset’s limitations preclude definitive conclusions about COVID-19 or vaccination risks.

They also overstate the study’s findings by dismissing concerns about COVID-19 and vaccination risks without sufficient supporting evidence. While the data suggests no significant increase in SCA/SCD cases, they really fail to account for alternative explanations such as changes in physical activity, deconditioning, or mental health stressors. The findings are more suggestive rather than conclusive.

I would give this study a C+/B-. There are so many limitations and issues with it. The study’s findings should be interpreted cautiously by both “sides.” Sorry boys, no win for either one of you.

It’s certainly better evidence than posting Oklahoma City Register stories about a tragic death and saying “vaxxed.”

Heart deaths dropped slightly compared to pre-pandemic. That should dramatically shift your evaluation of the “died suddenly” claims, no? Remember, the claim on the other side is “these deaths are skyrocketing, they barely happened before.”

Sure, it’s possible that other factors (what exactly?) canceled out an increase caused by COVID/vaccines. But that’s highly, highly unlikely to there simply being a null effect from COVID and the vaccines.

The primary goal of the study is not to conclusively prove that COVID/vaccines weren’t bad for young people cardiovascular system, but to answer the question “did young heart deaths increase?” In an actually rigorous manner.

It’s absolutely a victory for me and a defeat for the antivaxxers who spent the last years manufacturing controversy by spamming the boards with tragic news stories.

Monkeys Skyping wrote:

Gui the Science Guy wrote:

. . . They also overstate the study’s findings by dismissing concerns about COVID-19 and vaccination risks without sufficient supporting evidence. While the data suggests no significant increase in SCA/SCD cases, they really fail to account for alternative explanations such as changes in physical activity, deconditioning, or mental health stressors. The findings are more suggestive rather than conclusive. . . .

They follow a methodology that plausibly would show an increased risk if the signal were strong enough and don't find it. That's all.

They aren't explicitly "dismissing concerns", they're simply saying they didn't find evidence supporting those claims in a good faith effort to find such evidence. The unspoken bit is that it really ought to be the people claiming there is a problem providing decent quality evidence.

Also, they literally say the findings are "suggestive" and list some of the same limitations of the methodology that you've pointed out. Not clear why you imply otherwise . . .

This cohort study found no increase in SCA/SCD in young competitive athletes in the US during the COVID-19 pandemic, suggesting that reports asserting otherwise were overestimating the cardiovascular risk of COVID-19 infection, vaccination, and myocarditis. Many athlete cases shown in social media video montages occurred before the pandemic yet claimed COVID-19 infection or vaccination raised the risk of SCA/SCD. Paratz et al 4 also showed no association between out-of- hospital cardiac arrest and the COVID-19 vaccination in young people, and Daems et al 5 found no evidence that COVID-19 mRNA vaccination increases the risk of SCA/SCD in athletes.

Our study is limited by the potential for missed cases, variable participation during the pandemic, including a 2.5% decline in college athlete participation in 2020 to 2021, 6 and incomplete data on causes. Although SCA/SCD in young athletes requires more robust preventive strategies, this study suggests the COVID-19 pandemic did not increase SCA/SCD risk in athletes.

Gui the Science Guy wrote:

Monkeys Skyping wrote:

They follow a methodology that plausibly would show an increased risk if the signal were strong enough and don't find it. That's all.

They aren't explicitly "dismissing concerns", they're simply saying they didn't find evidence supporting those claims in a good faith effort to find such evidence. The unspoken bit is that it really ought to be the people claiming there is a problem providing decent quality evidence.

Also, they literally say the findings are "suggestive" and list some of the same limitations of the methodology that you've pointed out. Not clear why you imply otherwise . . .

I understand your points, but I believe some aspects deserve further clarification.

You mention that the methodology would plausibly detect an increased risk if the signal were strong enough, and I agree that the study's intent appears to be a good faith effort to investigate these claims. However, the limitations I highlighted—such as reliance on an external reporting system like NCCSIR, underreporting risks, and lack of individual-level data on Covid infections or vaccinations— directly impact the study's ability to detect such a signal with confidence. While the authors didn't find evidence supporting concerns about increased SCA/SCD risk, the limitations of their data introduce a risk of false negatives. In other words, the absence of evidence may not equate to evidence of absence.

I also disagree with the suggestion that the authors aren't dismissing concerns. They explicitly conclude that the data suggests no increased risk during the pandemic and caution against concerns about Covid or vaccinations. While their conclusion is technically "suggestive," as you noted, their framing arguably downplays the dataset's limitations. I’m not implying they acted in bad faith, but their conclusions, as presented, do overstate the reliability of the findings. A more balanced interpretation would have emphasized the study’s inability to definitively address these concerns due to methodological constraints.

I agree that those raising concerns should provide decent quality evidence. At the same time, when a study is presented as counterevidence, its limitations must be scrutinized to ensure it holds up to the same standard. In this case, the gaps in the dataset, the lack of consideration for confounding variables, and the speculative nature of some conclusions leave room for skepticism. Rather than a “victory” for one side, I see this as a call for more rigorous research to fill the gaps and provide stronger evidence one way or the other.

I hope this helps clarify my perspective. I'm not dismissing the study outright— I simply believe its findings should be interpreted cautiously given the significant limitations.

Cheers,

Gui

Gui the Science Guy wrote:

Harambe wrote:

It’s certainly better evidence than posting Oklahoma City Register stories about a tragic death and saying “vaxxed.”

Heart deaths dropped slightly compared to pre-pandemic. That should dramatically shift your evaluation of the “died suddenly” claims, no? Remember, the claim on the other side is “these deaths are skyrocketing, they barely happened before.”

Sure, it’s possible that other factors (what exactly?) canceled out an increase caused by COVID/vaccines. But that’s highly, highly unlikely to there simply being a null effect from COVID and the vaccines.

The primary goal of the study is not to conclusively prove that COVID/vaccines weren’t bad for young people cardiovascular system, but to answer the question “did young heart deaths increase?” In an actually rigorous manner.

It’s absolutely a victory for me and a defeat for the antivaxxers who spent the last years manufacturing controversy by spamming the boards with tragic news stories.

I appreciate your perspective, but I’d like to elaborate on a few key points. While I agree that this study is a step up from anecdotal claims like those you referenced, I believe it’s critical not to oversimplify its findings or implications.

A slight drop in heart deaths compared to pre-pandemic levels is worth noting, but it doesn’t necessarily invalidate concerns about the potential cardiovascular risks of Covid or vaccinations. The limitations I highlighted—particularly the incomplete dataset, potential underreporting, and lack of individual-level data on covid infections or vaccination status—make it impossible to draw definitive conclusions about the relationship between these factors SCA or SCD. The study doesn't account for confounding variables like changes in sports participation, deconditioning, or disruptions in medical access during the pandemic, etc. which could easily offset any potential increases. Assuming a null effect based on these limitations is speculative at best.

You mentioned that the study’s goal wasn’t to prove that Covid or vaccines didn’t negatively impact young people’s cardiovascular systems, but rather to address the broader question of whether heart deaths increased. I agree that this is a reasonable goal; however, the conclusions presented in the study go beyond merely reporting a lack of increase. The authors assert that concerns about Covid or vaccine-related risks to young athletes’ cardiovascular health are unwarranted, which, in my view, overstates the evidence at hand.

I’d alap caution you against framing this study as a “victory” for one side or a “defeat” for another. Science isn’t a zero-sum game, and the nuances of this study—both its findings and its limitations—should encourage further research and careful consideration rather than triumphalism or dismissal. Both “sides” can misuse data to fit their narratives, but as you pointed out, what matters most is rigorous, unbiased analysis. I don’t believe this study fully meets that standard due to the significant methodological and interpretive issues I outlined.

I believe the study should be interpreted cautiously and critically, without overstating its conclusions or dismissing valid concerns. I hope we can agree that more robust and comprehensive research is needed to better understand these complex issues.

Cheers,

Gui

Harambe wrote:

Gui the Science Guy wrote:

I appreciate your perspective, but I’d like to elaborate on a few key points. While I agree that this study is a step up from anecdotal claims like those you referenced, I believe it’s critical not to oversimplify its findings or implications.

A slight drop in heart deaths compared to pre-pandemic levels is worth noting, but it doesn’t necessarily invalidate concerns about the potential cardiovascular risks of Covid or vaccinations. The limitations I highlighted—particularly the incomplete dataset, potential underreporting, and lack of individual-level data on covid infections or vaccination status—make it impossible to draw definitive conclusions about the relationship between these factors SCA or SCD. The study doesn't account for confounding variables like changes in sports participation, deconditioning, or disruptions in medical access during the pandemic, etc. which could easily offset any potential increases. Assuming a null effect based on these limitations is speculative at best.

You mentioned that the study’s goal wasn’t to prove that Covid or vaccines didn’t negatively impact young people’s cardiovascular systems, but rather to address the broader question of whether heart deaths increased. I agree that this is a reasonable goal; however, the conclusions presented in the study go beyond merely reporting a lack of increase. The authors assert that concerns about Covid or vaccine-related risks to young athletes’ cardiovascular health are unwarranted, which, in my view, overstates the evidence at hand.

I’d alap caution you against framing this study as a “victory” for one side or a “defeat” for another. Science isn’t a zero-sum game, and the nuances of this study—both its findings and its limitations—should encourage further research and careful consideration rather than triumphalism or dismissal. Both “sides” can misuse data to fit their narratives, but as you pointed out, what matters most is rigorous, unbiased analysis. I don’t believe this study fully meets that standard due to the significant methodological and interpretive issues I outlined.

I believe the study should be interpreted cautiously and critically, without overstating its conclusions or dismissing valid concerns. I hope we can agree that more robust and comprehensive research is needed to better understand these complex issues.

Cheers,

Gui

I appreciate your valiant defense of scientific rigor and you’re right this study doesn’t prove causation or lack thereof.

However, most real world decisions, including those in public health, are made without the maximum theoretical rigor in evidence.

We are always forced to judge on the balance which side is correct. In this case it’s absolutely overwhelmingly in favor of the “vaccine doesn’t kill young people camp.” A study like this that gives extremely strong evidence that the vaccine did not kill young people - and therefore the conspiracy theorists are wrong - is absolutely a victory. No other way to frame it when the other side is committed to spreading propaganda that puts people’s health at risk.

Lastly I’ll say I’m always a little suspicious of lengthy nit-picks of good faith scientific efforts and then… crickets… when danM posts his 4th “died suddenly” news article of the month. It seems you agree with us that the conspiracies about the vaccine are total BS, though, so appreciate the effort posting.

Harambe wrote:

I appreciate your valiant defense of scientific rigor and you’re right this study doesn’t prove causation or lack thereof.

However, most real world decisions, including those in public health, are made without the maximum theoretical rigor in evidence.

We are always forced to judge on the balance which side is correct. In this case it’s absolutely overwhelmingly in favor of the “vaccine doesn’t kill young people camp.” A study like this that gives extremely strong evidence that the vaccine did not kill young people - and therefore the conspiracy theorists are wrong - is absolutely a victory. No other way to frame it when the other side is committed to spreading propaganda that puts people’s health at risk.

Lastly I’ll say I’m always a little suspicious of lengthy nit-picks of good faith scientific efforts and then… crickets… when danM posts his 4th “died suddenly” news article of the month. It seems you agree with us that the conspiracies about the vaccine are total BS, though, so appreciate the effort posting.

Gui the Science Guy wrote:

Harambe wrote:

I appreciate your valiant defense of scientific rigor and you’re right this study doesn’t prove causation or lack thereof.

However, most real world decisions, including those in public health, are made without the maximum theoretical rigor in evidence.

We are always forced to judge on the balance which side is correct. In this case it’s absolutely overwhelmingly in favor of the “vaccine doesn’t kill young people camp.” A study like this that gives extremely strong evidence that the vaccine did not kill young people - and therefore the conspiracy theorists are wrong - is absolutely a victory. No other way to frame it when the other side is committed to spreading propaganda that puts people’s health at risk.

Lastly I’ll say I’m always a little suspicious of lengthy nit-picks of good faith scientific efforts and then… crickets… when danM posts his 4th “died suddenly” news article of the month. It seems you agree with us that the conspiracies about the vaccine are total BS, though, so appreciate the effort posting.

Thank you for your response. I'd like to start by clarifying that I’m new to this message board and, unfortunately, I’m unfamiliar with "danM" or his posts. My critiques and comments are entirely based on the content of this study and the broader implications it raises, not on any previous discussions or dynamics here.

That said, I’d like to address your framing of this study as a "victory." While I understand the temptation to see scientific findings as wins or losses in the context of public debates, science is not a battleground designed to crown victors. The goal of science is to advance our understanding of complex issues through rigorous, unbiased investigation. Studies aim to provide evidence that can be critically analyzed, replicated, and built upon—not to settle scores or end debates. A study that claims victory, especially in topics like this, risks oversimplifying nuanced realities and, worse, losing credibility among those who expect cautious and balanced conclusions.

Scientific studies, especially in fields impacting public health, should aim to minimize biases, acknowledge limitations, and present findings as part of an ongoing exploration of truth. This study, for all its merits, has significant methodological limitations, as we both seem to agree. These limitations prevent it from being the conclusive evidence some might hope for, and they underscore the need for more comprehensive research that accounts for confounding factors, robust data collection methods, and clearer causal pathways.

Your point about real-world decision-making relying on less-than-perfect evidence is valid; public health and policy often have to act on incomplete data. However, acknowledging the constraints of a study is not "nit-picking." Rather, it’s essential for ensuring that decisions based on these findings are made cautiously and responsibly, especially when lives are at stake. Dismissing valid critiques as mere nit-picking risks creating a dichotomy where any questioning of methods or interpretations is seen as an attack rather than an effort to improve scientific rigor.

Finally, while I do agree that baseless conspiracy theories harm public health and distort science, I think we must avoid the urge to overcorrect in response. Treating any one study as definitive or framing its results as a "defeat" for one group can inadvertently mirror the very behavior we criticize: reducing complex phenomena to simplified narratives. Instead, we should champion a commitment to ongoing inquiry and a willingness to refine our conclusions as more data becomes available.

This study makes a meaningful contribution to the conversation, but its findings should be interpreted critically and with caution. Science, at its best, is a collaborative and iterative process, not a competition. I hope we can both agree that the ultimate "victory" lies in improving our collective understanding and fostering public trust in scientific inquiry.

Cheers,

Gui

Harambe wrote:

Gui the Science Guy wrote:

Thank you for your response. I'd like to start by clarifying that I’m new to this message board and, unfortunately, I’m unfamiliar with "danM" or his posts. My critiques and comments are entirely based on the content of this study and the broader implications it raises, not on any previous discussions or dynamics here.

That said, I’d like to address your framing of this study as a "victory." While I understand the temptation to see scientific findings as wins or losses in the context of public debates, science is not a battleground designed to crown victors. The goal of science is to advance our understanding of complex issues through rigorous, unbiased investigation. Studies aim to provide evidence that can be critically analyzed, replicated, and built upon—not to settle scores or end debates. A study that claims victory, especially in topics like this, risks oversimplifying nuanced realities and, worse, losing credibility among those who expect cautious and balanced conclusions.

Scientific studies, especially in fields impacting public health, should aim to minimize biases, acknowledge limitations, and present findings as part of an ongoing exploration of truth. This study, for all its merits, has significant methodological limitations, as we both seem to agree. These limitations prevent it from being the conclusive evidence some might hope for, and they underscore the need for more comprehensive research that accounts for confounding factors, robust data collection methods, and clearer causal pathways.

Your point about real-world decision-making relying on less-than-perfect evidence is valid; public health and policy often have to act on incomplete data. However, acknowledging the constraints of a study is not "nit-picking." Rather, it’s essential for ensuring that decisions based on these findings are made cautiously and responsibly, especially when lives are at stake. Dismissing valid critiques as mere nit-picking risks creating a dichotomy where any questioning of methods or interpretations is seen as an attack rather than an effort to improve scientific rigor.

Finally, while I do agree that baseless conspiracy theories harm public health and distort science, I think we must avoid the urge to overcorrect in response. Treating any one study as definitive or framing its results as a "defeat" for one group can inadvertently mirror the very behavior we criticize: reducing complex phenomena to simplified narratives. Instead, we should champion a commitment to ongoing inquiry and a willingness to refine our conclusions as more data becomes available.

This study makes a meaningful contribution to the conversation, but its findings should be interpreted critically and with caution. Science, at its best, is a collaborative and iterative process, not a competition. I hope we can both agree that the ultimate "victory" lies in improving our collective understanding and fostering public trust in scientific inquiry.

Cheers,

Gui

Pointing out that people spamming the message board with threads about young athletes dying from the vax are wrong is not an over correction.

Their conspiracies have so little evidence to support them, are argued in bad faith, and do huge amounts of harm to public acceptance of life saving vaccines.

The victory lies in debunking people claiming that the vax is killing young athletes. Any tone less strong than that is inconsistent with the evidence at hand.

People spreading conspiracies in bad faith deserve to be defeated and this study helps put and important, deadly piece of propaganda to rest.

Here’s the careful decision I’ve made from these new data: antivaxx propagandists are even more embarrassingly wrong than before. The vaccine continues to be demonstrably safe and effective for all groups for which it was approved.

Surely that’s something a fellow scientifically minded person can agree with?