COVID-19 vaccine shots at Dover Air Force Base

New research has found that patients who developed inflammation of the heart, or myocarditis, after receiving an mRNA vaccine for COVID-19 had fewer complications in the 18 months after hospitalization than those who developed it from contracting COVID-19 or some other cause.

The population study, conducted in France and published online Monday in JAMA[1], found that hospital readmission rates, diagnoses of other heart-related conditions, or instances of death were significantly lower in the group that received the vaccine.

The long-term effects of COVID-19 and COVID-19 vaccines are a concern for the U.S. military, which saw nearly 500,000 cases of the coronavirus[2] in the first two years of the pandemic and required all members to get the vaccine[3].

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The study findings were the same regardless of age, according to the research, although the authors noted that post-vaccine myocarditis patients, who were mainly healthy young men, "may require medical management up to several months after hospital discharge."

"Although patients with myocarditis after COVID-19 mRNA vaccination appear to have a good prognosis near hospital discharge, their longer-term prognosis and management remain unknown," wrote the researchers, led by Laura Semenzato, a statistician with EPI-PHARE Scientific Interest Group.

The Defense Department vaccinated more than 2 million service members from December 2020, when the U.S. Food and Drug Administration issued an emergency use authorization for the Pfizer and Moderna COVID-19 vaccines, through December 2022, according to the Pentagon.

The vaccines used a novel mRNA technology to stimulate the body's immune response to the illness, using messenger RNA to instruct cells to make pieces of the virus' spike protein to trigger an immune response.

As early as February 2021, the U.S. military began seeing patients who developed myocarditis after receiving their COVID-19 vaccine series.

Military.com began tracking the cases[5] shortly after a civilian member of the Pentagon press corps and a Military.com reporter who serves in the National Guard[6] developed the condition, although the Pentagon did not confirm it had additional cases until April.

In a report to Congress last September on troop health following the Defense Department's COVID-19 vaccine mandate, which went into effect in August 2021, a Pentagon official said 25 service members developed myocarditis in early 2021 but did not give a total number of cases for the force over the years.

The report said the rate for service members developing myocarditis was 57 cases per 100,000 "person years," which measures the number of people across the observation time, versus 98 cases per 100,000 person years among those who contracted COVID-19 in 2021.

The Department of Veterans Affairs[7], which could be asked to provide disability compensation for veterans who have long-term health effects from COVID-19 contracted on active duty or from the vaccine, has 11 ongoing studies on long-term coronavirus.

"The VA research program remains tightly focused on understanding the long-term impacts

of COVID-19," wrote VA Under Secretary for Health Dr. Shereef Elnahal in an article in Federal Practitioner last November. "At the same time, the VA is committed to using lessons learned during the crisis in addressing high priorities in veterans' health care."

Dr. Harlan Krumholz, a cardiologist at Yale School of Medicine[8] who was not involved in the French study, said the latest research provides reassurance to patients and doctors about the possible long-term effects on the heart and body of post-vaccine myocarditis.

But, he noted, while the study focuses on the outcomes at 18 months after hospitalization -- what Krumholz described as "meaningful follow-up," it does not provide insight into longer-term outcomes.

"In general, myocarditis at a young age can potentially lead to chronic heart issues like arrhythmias or heart failure in some patients, though many recover fully. Ongoing monitoring is important," Krumholz wrote in an email Tuesday to Military.com.

For the study, researchers examined 4,635 patients ages 12 to 49 who were hospitalized for myocarditis in France from Dec. 27, 2020, to June 30, 2022.

Of those, 12% developed post-vaccine myocarditis within seven days of getting the immunization while 6% developed post COVID-19 myocarditis and 82% had a conventional form of the condition.

While the number of patients who developed myocarditis after contracting the illness was smaller than the vaccine group, they were hospitalized and had rates of complications or death similar to those who developed regular myocarditis.

The study noted, however, that one patient with post-vaccine myocarditis required extensive medical interventions and died after leaving the hospital, with myocarditis likely the cause of death.

"While outcomes were generally favorable, some patients required ongoing medical management for several months after discharge. Also, 3% of those who had post-vaccine myocarditis were rehospitalized ... over the subsequent 18 months," noted Krumholz after reviewing the study.

Myocarditis can result from a viral infection or an overactive immune response to an illness. The reason why some people, especially young men, develop myocarditis after getting a COVID-19 mRNA vaccine is not well understood. Krumholz said it likely involves an "exaggerated immune response," occurring in roughly 1 to 10 of every 100,000 vaccinated individuals.

The JAMA study has its limitations, as researchers were able to look only at hospitalizations for myocarditis and not all potential cases during the time frame. They also did not include details on the severity of cases and based their research on medical diagnoses, relying on the accuracy of medical providers.

The researchers noted that the American Heart Association and the American College of Cardiology guidelines advise patients with myocarditis to refrain from competitive sports for 3 to 6 months and to have their health condition assessed prior to the resumption of sports.

They also said that, while several studies have reported "reassuring results" for the prognosis of post-vaccine myocarditis, patients with the low likelihood of poor outcomes, residual symptoms and cardiac abnormalities have been detected up to a year after illness.

The study, the researchers said, should be "taken into account for ongoing and future mRNA vaccine recommendations."

"Overall, this study provides important data on medium-term outcomes, but continued research on longer-term prognosis is still needed," Krumholz added.

Related: As New Vaccines Near Delivery, General in Charge of Distribution Says He's 'Ready to Execute'[9]

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Three people wave to others as they walk into a building. A fourth person near them applauds.In order to know how human life can adapt to a foreign environment like Mars, we first have to replicate those conditions on Earth.

On June 25, 2023, four NASA volunteers entered a habitat at Johnson Space Center in Houston to simulate life on the red

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Airman stationed at Robins Air Force Base takes a random drug test

The opinions expressed in this op-ed are those of the author and do not necessarily reflect the views of Military.com or the Department of Defense. If you would like to submit your own commentary, please send your article to This email address is being protected from spambots. You need JavaScript enabled to view it.[1] for consideration.

For almost 20 years, "Don't Ask, Don't Tell" stood as a limit on the private lives of thousands of service members. Its repeal in 2011 was considered a victory for personal liberty and a way to expand the pool of citizens eligible to serve.

There's another area where social norms have changed rapidly and the military is out of step with the broader public -- marijuana use. In service of protecting individual freedoms and fortifying the military's labor pool, I propose a new declaration: "Don't Ask, Don't Test." The Department of Defense should stop asking whether its members use marijuana, and the military should stop testing for it.

The military does not routinely breathalyze its sailors for alcohol, an arguably more destructive substance for military members[2]. It should likewise stop the outdated obsession of regularly testing for THC.

Imagine a force in which talent, energy and intelligence are prioritized regardless of off-duty recreational vices. Consider the savings in time, money and energy: The military tests more than 2 million service members annually and has a sizable urinalysis establishment to support the effort.

This change could relieve commanding officers of a burden and spare them the frustration of prosecuting their own service members. A sailor "popping positive" meant administrative man-hours for our urinalysis officers, our legal officer and our commanding officer, and major frustrations for that sailor's work center, not to mention the workload for other personnel external to our unit.

Like with President Bill Clinton's original policy, this new "Don't Ask, Don't Test" policy should apply to recruitment as well as to current service. Take my branch for example: The Navy recently suffered a 20% recruitment shortfall from its goals[3]. In an attempt to enlarge the pool of recruits, it has continually lowered standards with interventions that overtly diminish the organization's mission. Rather than recruit and capture the large block of American cannabis users, the Navy is piloting accepting recruits with lower ASVAB entrance exam scores[4], down to the 10th to 30th percentiles.

The National Institutes of Health reports[5] that nearly 30% of American 12th graders have used cannabis. Other studies show even greater numbers, with almost 20% of 12th graders reporting using marijuana within 30 days of polling[6]. Regular use is significant among the American populace.

Which pool of labor would more directly accomplish the mission: a distributed 30% of American cannabis users, or 20% of the empirically lowest ASVAB entrance test performers?

Accepting lower entrance exam scores is hardly the only compromise: The Navy is also experimenting in reducing high school and GED requirements[7], lowering fitness requirements[8], and relaxing up-or-out policies[9] (keeping underperforming sailors around).

The modern military is built upon managing, maintaining and fighting complex hardware. The enlisted sailors in my avionics division often had complicated engineering and maintenance diagrams to understand in order to perform their duties. Officers must have the aptitude to make quick tactical decisions with their assets. A force of fighting machines requires more brain than brawn; diminishing the human-capital base should be the last resort of an aspirational service like ours.

Understandably, leadership is handcuffed by marijuana being a Schedule 1 controlled substance. I cannot fault the Department of Defense for failures of the greater federal government. To its credit, the security establishment has some leeway for excusing marijuana use several years past[10] and an existing -- although very convoluted[11] (Table 2.20) -- marijuana waiver program. The Navy is even issuing waivers for traceable amounts of THC discovered during boot camp[12]. But this does not solve the problem of the large numbers of citizens who intend to continue to use.

Military leadership cannot, should not, and need not go so far as to "allow" illegal substances or create conflicts between the Uniform Code of Military Justice and federal law. They need only turn a blind eye to off-duty use. Currently, the DoD tests only for steroids on an ad-hoc basis[13] (likely, if it meaningfully detracts from the mission). They ought to do the same for marijuana.

To be clear, recreational drug use itself may still be detrimental to the military's mission, even confined to weekends and the same off-duty limits as alcohol. But we ought to disfavor interventions that directly diminish the mission (objective widespread reductions in talent) relative to those interventions that do so only tangentially (marginal disruptions from occasional marijuana misuses). Why should we administer routine tests that threaten to compromise our own readiness?

As states adjust their laws, and as cultural forces shift, the military too must adapt.

-- Jasper Burns is a former Navy lieutenant, law student at Stanford Law School, and Knight-Hennessy scholar. He previously served as a White House social aide, and as a military fellow at McKinsey and Company. 

© Copyright 2024 Military.com. All rights reserved. This article may not be republished, rebroadcast, rewritten or otherwise distributed without written permission. To reprint or license this article or any content from Military.com, please submit your request here[14].

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