Two Doctors Share the Latest on Myocarditis and COVID-19
The connection between myocarditis and COVID-19 has received a lot of attention in the news and social media. We sat down with two doctors — Dr. Sathish Mallenahalli Chikkabyrappa, pediatric cardiologist at Seattle Children’s, and Dr. Anita Chopra, internal medicine physician at UW and its Long COVID clinic — to discuss myocarditis and COVID-19.
Thank you for joining us, doctors. Let’s start with a definition. What is myocarditis?
Dr. Chopra: Myocarditis is inflammation of the heart muscle. Although the condition is uncommon, it most often occurs when your body is fighting a viral infection. People of all ages can get myocarditis.
What are the symptoms of myocarditis?
Dr. Chopra: Chest pain or chest discomfort, shortness of breath, and/or a feeling of fast beating, fluttering, or pounding of the heart are the most common symptoms.
What is the treatment for myocarditis?
Dr. Chopra: For most patients, myocarditis improves on its own with rest and non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen.
Dr. Chikkabyrappa: Agreed — and I’d add hydration to that list. In more serious cases, we give antibodies that fight off bacteria (immunoglobulins) and viruses and anti-inflammatory hormones (corticosteroids).
Myocarditis may be more frequent than people think. Even common infections, such as a cold, can cause very mild myocarditis. In these cases, you may not even notice it, and it resolves on its own. However, more serious cases of myocarditis can be life-threatening emergencies, especially if they’re infection related.
Can COVID-19 infection cause myocarditis?
Dr. Chopra: Yes, and if you’re unvaccinated, it’s a significant risk. Getting at least one dose of the COVID-19 vaccine cuts the risk of myocarditis from COVID-19 infection in half.¹
Studies have found that unvaccinated patients with COVID-19 were 16 times more likely to develop myocarditis than patients without COVID-19.
Cases of myocarditis are more likely to occur in adults with comorbidities (chronic conditions or illnesses), such as cardiovascular issues, diabetes, and uncontrolled high blood pressure.
Can the COVID-19 vaccine cause myocarditis?
Dr. Chopra: Yes, but the risk is very low. For example, in people assigned male at birth age 12–15, the risk of developing myocarditis from a dose of the Pfizer vaccine is 0.007% — that’s 7 in 100,000. In people assigned male at birth age 16–17, the risk is 0.01%, or 1 in 10,000.² The risks are even lower among people assigned female at birth.
Dr. Chikkabyrappa: My team led a study that produced similar results — the COVID-19 vaccine is extremely unlikely to cause myocarditis.
Dr. Chopra: The key thing for people to understand is that the risk of myocarditis from vaccination is much lower than the risk of myocarditis from COVID-19 infection.³
Dr. Chikkabyrappa: And, the rare cases of myocarditis caused by the COVID-19 vaccine are more mild and more likely to resolve on their own than myocarditis caused by COVID-19 infection. A lot of the unvaccinated children we saw required hospitalization and ICU treatment for COVID-19-related myocarditis.
All that is to say: get vaccinated. If you do have any type of reaction following a vaccine, please report it using the Vaccine Adverse Event Reporting System (VAERS).
What would you say to someone who is on the fence about getting the COVID-19 vaccine because of the risk of myocarditis?
Dr. Chopra: As a primary care physician, I would say a few things:
- The risk of getting myocarditis from the vaccine is very low.
- Most cases of vaccine-related myocarditis are self-limiting, meaning they resolve on their own.
- Unvaccinated COVID-19 infection has serious risks. These include not only myocarditis, but also serious respiratory symptoms and lasting damage to the body.
- The vaccine reduces your risk of Long COVID. I am a lead physician in the Long COVID Clinic at UW Medical Center, and we are seeing thousands of patients who had COVID-19 before the vaccine and are still suffering with Long COVID symptoms to this day.
If parents are concerned about the vaccine or have any questions about COVID-19 vaccines for their children, please talk to your pediatrician or family medicine doctor.
Dr. Chikkabyrappa: The benefits of the vaccine are far higher than the risks. We’ve seen unvaccinated COVID-19 patients with lasting effects from this inflammation of the heart muscle, and the vaccine is the best way to minimize your risk.
What about children who play sports — are they at higher risk for myocarditis? Should they still get the COVID-19 vaccine?
Dr. Chikkabyrappa: Yes, they should get the vaccine. There is no evidence to suggest that playing sports increases the risk of myocarditis from COVID-19 vaccination. A child is much more likely to develop myocarditis from a random viral infection than from the vaccine. Treatment and recovery for children are the same as for adults: rest, proper hydration, and NSAIDS, like ibuprofen.
COVID-19 and flu vaccines do have common, mild side effects such as fatigue, headache, chills, nausea, fever, and pain or tenderness at the injection site. If you’re concerned about these side effects and your child’s sports or other activities, consider timing the vaccine so that your child has a day or two off after getting the vaccine.
And as always, if you have questions or concerns about potential myocarditis symptoms in your child, see your health care provider or pediatrician.
Where can people learn more about myocarditis and the COVID-19 vaccine?
Dr. Chopra: We have great resources right here at the Department of Health. UW has done great vaccine equity work. CDC guidance goes hand in hand with this information as well.
Dr. Chikkabyrappa: You can also get information from your primary care provider — they will have all this information and be happy to talk with you about it. If you feel confident about getting the vaccine after talking with your provider, you might be able to get the vaccine during the same visit.
Besides getting the COVID-19 vaccine, what else should people do to stay healthy this spring and summer?
Dr. Chopra: I have four suggestions:
- I would highly recommend the RSV vaccine for adults 60 and older. RSV has been a big factor in hospitalizations and respiratory complications this season.
- Please get the flu vaccine. We are still seeing a lot of flu cases right now. It’s not too late to get one!
- Parents, make sure your kids are up to date on the measles vaccine.
- Consider your individual risk and health conditions regarding entering and masking in crowded indoor spaces. Hopefully we will see less transmission of respiratory viruses as gatherings move outdoors in nicer weather.
Dr. Chikkabyrappa: I’d add a couple of things:
- If you have underlying health conditions that put you at greater risk for getting seriously sick from COVID-19 or other infections, consider wearing a mask in crowded indoor settings. Similarly, if you’re sick, consider wearing a mask in indoor spaces to protect those around you.
- Hand hygiene! Wash your hands with soap and water often, especially before eating.
Dr. Chopra: Yes, I’ll say it too: wash your hands! We’re seeing a lot of strep right now, and frequent hand washing will help reduce your risk.
