Both COVID-19 illness, caused by infection with the SARS-CoV-2 virus, and COVID-19 vaccination, ostensibly to prevent SARS-CoV-2 infection and serious COVID-19 morbidity, have been associated with the development of myopericarditis, i.e., inflammation of the heart muscle itself (myocarditis) or its suspending sack (pericarditis). This brief review demonstrates, first, the dubious association between SARS-CoV-2 infection and myopericarditis, and second, the robust association between COVID-19 vaccination, especially with mRNA vaccines, and myopericarditis, including, in particular, the study of fatal cases upon autopsy.
The direct relationship between SARS-CoV-2 infection and myocarditis remains tenuous at best. Recent ecological, controlled retrospective cohort and autopsy data do not support an association. The overall absence of support for a specific ‘SARS-CoV-2 myocarditis syndrome’ from focused autopsy studies of presumed myocarditis deaths is consistent with findings from general necropsy studies of COVID-19 deaths. These investigations have established SARS-CoV-2 infection leading to fatal COVID-19 is indeed, as the name implies, a respiratory illness. Wong et al., for example, described how, “No overt pathological findings attributable to SARS-CoV-2 infection could be recognised outside of the lung… [B]eyond the respiratory tract [SARS-CoV-2 infection] does not induce any major pathology… in fatal cases.”
A systematic review of primarily spontaneously reported data from the U.K., USA and European Union/European Economic Area (EU/EEA), beginning with vaccine launch through mid-March 2022, found 0.22% (n=30) of 13,571 Covid vaccine-associated myocarditis or pericarditis events were fatal. These data are complemented by a much smaller, but growing autopsy literature. The limited necropsy data characterising COVID-19 vaccine-associated deceased persons with myocarditis and myopericarditis repeatedly affirm heart-related pathologies directly attributable to very recent vaccination. Such findings contrast with the lack of definitive epidemiologic or autopsy evidence for a unique SARS-CoV-2 infection myocarditis, as Caforio et al. note:
Strong evidence for a SARS-CoV-2 role in direct infection of cardiac myocytes leading to virus induced myocarditis in patients is missing… [T]here is not yet definitive EMB [endomyocardial biopsy]/autopsy proof that SARS-CoV-2 causes direct cardiomyocyte damage in association with histological myocarditis.
Tables 1-3 detail the published autopsy findings from six fatal cases of post-Covid mRNA vaccine-associated myocarditis. The etiologies for cases 1 and 2 were most consistent with an epinephrine-mediated ‘toxic myocarditis’, whereas cases 3-6 evidenced hyperinflammatory myocarditis. Ultimately, after extensive investigation, each case was deemed a Covid vaccine-caused fatal myocarditis.
Dr. Andrew Bostom is a physician currently affiliated with the Brown University Center for Primary Care and Prevention, and was an Associate Professor of Medicine and Family Medicine at the Warren Alpert Medical School of Brown University from 1997 until June 2021. As a clinical trialist and epidemiologist he designed and completed the largest randomised, controlled trial conducted in chronic kidney transplant recipients.