You may have heard “all eyes on Israel” throughout the pandemic as it was the first country to roll out the COVID vaccination program and become the first real-world test. What was happening in Israel was shortly expected to occur across the world thereafter. Newly published research titled, “Increased emergency cardiovascular events among under-40 population in Israel during vaccine rollout and third COVID-19 wave,” from January 2019 to June 2021 will be reviewed in this blog post.
Cardiovascular Consequences of COVID
Identified as adverse outcomes of COVID are cardiovascular events such as blood clots, heart attack, myocarditis and cardiac arrest (CA). Similarly, the same outcomes have been reported as side effects of the COVID vaccines. Coming to the headlines more recently is the high association between the mRNA vaccines and myocarditis in children and young to middle-aged adults.
The CDC recently released a warning regarding the risk of vaccine-related myocarditis. Follow up studies are currently underway or are to be started to assess the short- and long-term effects of this risk in young individuals. Studies have shown that myocarditis is a “major cause of sudden, unexpected death in adults less than 40 years of age.” It is often underdiagnosed or can be misdiagnosed as acute coronary syndrome (ACS). There is concern that an increase in the rate of myocarditis could also lead to an increase in other severe adverse outcomes such as ACS and CA.
Goal of Study
Assessing the connection between cardiovascular events and the vaccines is challenging due to under- and over-reporting. Given the increased risk of cardiovascular consequences, the following retrospective study was conducted. The goal of the study was to:
- “Examine the association between CA and ACS incidents in the 16–39-year-old population”
- Assess causal factors of COVID infection rates and the vaccine rollout
This is a retrospective study, using an IEMS data system to analyze all calls made to EMS that were related to CA and ACS over a two-and-a-half-year period, from January 1st, 2019, to June 20th, 2021. The call data was coupled with COVID infection rates as well as vaccination rates during the same time period.
To assess how the call counts to EMS changed over time from a “normal period” to “pandemic period,” data was compared prior to the pandemic to during the pandemic and vaccine rollout.
The IEMS system used in the study included all calls received through Israel’s national emergency phone number. Each report included the patient age and verified call type for either CA or ACS. Cardiac arrest related to trauma, suicide or drug overdose were excluded from the data. Using the Israel Government Database Portal, data on COVID cases and vaccinations were obtained, including the number of vaccines and new weekly COVID cases by age group across Israel.
CA was determined based on:
- Collapse described by the caller
- Patient’s EKG
- Indicators observed by paramedics such as unresponsiveness and agonal breathing
ACS was determined based on:
- Patient’s EKG
- Symptoms including chest pain, shortness of breath
- Medical history and physical examination
“These protocol and diagnoses were the same throughout the entire study period (2019–2021), allowing for a consistent comparison between the call counts during the baseline, pandemic, and vaccination periods.”
Year-to-year Trends in CA and ACS Calls
The year-to-year change showed a statistically significant increase of over 25% in both CA and ACS call volume among patients aged 16-39 during January to May of 2021, compared to the same time period the year prior.
Cardiac arrest and acute coronary syndrome call volume increased significantly for both genders as follows:
- Males: Increase of 25% for CA calls and 21.3% for ACS calls
- Females: Increase of 31.4% for CA calls and 40.8% for ACS calls
Association Between COVID Vaccines and EMS Call Volume
A statistically significant correlation between vaccine doses and CA and ACS call volume was demonstrated. There was no correlation between new COVID infections and CA and ACS call volume.
The following graph shows these trends. CA and ACS call volume, depicted by the red curve, increased in early January of 2021, tracking closely with the second vaccine dose curve in blue. The grey curve, representing COVID infection counts, supports the lack of association between infection and call counts. Early in March of 2021, the Israel Ministry of Health approved one vaccine dose for individuals aged 16 and over, who had already had COVID. A second increase in call volume was observed around mid-April which tracks closely with individuals who recovered from COVID and then had a single vaccine dose after, shown in green.
During the COVID vaccine rollout in Israel between January and May of 2021, this study found an increase of over 25% in both CA and ACS calls to EMS among people aged 16-39, compared to the year before the pandemic. There was no association demonstrated between COVID infection rates and CA and ACS call volume.
This study “underscores the need for the thorough investigation of the apparent association between COVID-19 vaccine administration and adverse cardiovascular outcomes among young adults.” Further investigations and data are warranted to fully assess and understand the risk-benefit of the mRNA vaccines.
Have an awesome day! Dr D
Reprinted with permission from Regenerative Medicine Center.