Late last week Florida's Surgeon General, Dr. Joseph Ladapo released new guidance on Covid vaccinations. For men, 18-40, mRNA vaccines - those produced by PFE and BNTX and MRNA - are discouraged. In support of his decision, Dr. Ladapo cites department analysis that found a significant increase in cardiac deaths among young men.
Ladapo's guidance, of course, contradicts the CDC's recommendation that everyone 6 months and older be vaccinated and anyone over 12 get boosted. Given that, the reaction so far has been a bit more muted than I would have expected and certainly less than when Ladapo recommended against vaccinating babies and toddlers. Perhaps it is just a matter of people getting used to Florida charting its own course on all things pandemic.
More likely the wisdom of a universal vaccination policy - and not one that targets population subsectors most likely to benefit - intending to do the impossible, eradicate a virus, is being challenged by the lived experience of millions of Americans. Much of the criticism Ladapo's analysis did receive was for, basically, not being academic enough. It is an odd response because you really do not need much to conclude something has driven up mortality in young Floridians.
First, the risk of myo/pericarditis in young men in close proximity to vaccination is now well documented and generally accepted as a risk by the FDA's AdCom and acknowledged by the CDC. How much of a risk has been left to independent researchers and foreign public health agencies. (Dr. Tracy Hoeg discusses myo/pericarditis with me here. Dr. Aditi Bhargava discusses mRNA technology here.)
Second, death of the young is almost always from non-natural causes like suicide, homicide and drug overdoses. An elevation of cardiac deaths should ring alarm bells almost immediately. That is not necessarily the case in older cohorts where causes of death are more diverse. Excess mortality in older cohorts remains a cause for concern but harder to reach a conclusion easily. In Florida, some of the confounding factors like lockdowns, job loss, closed schools are not a consideration. The state returned to normal operations in spring 2020 and had dragged recalcitrant cities and counties along by September.
Lastly, the CDC - the very agency advocating for a continue universal vaccination policy - publishes each week all cause mortality data by age and jurisdiction. Without much effort you can make the chart above. If it were a stock chart, you would be asking what happened in the summer of 2021? What changed again at the end of the year?
Of course, part of the spike is the COVID delta variant. However, it began its meaningful contribution to mortality about August 7th, about a month after all cause mortality accelerated. By the beginning of October, it had subsided but it took about another month for all cause mortality to do the same. In the week ending August 7th, 110 people aged 25-44 died of Covid but 382 died of everything. The 2019 average was 192 all cause deaths per week. About 80 more young people died that week than what we would expect.
Other than the disease itself, vaccine mandates by the federal government and private employers, which began in summer 2021, offer the only plausible cause. Disney, for example, imposed mandates on Aug. 2, 2021. Most of those mandates ended with adverse court decisions in the winter of 2021.
It is nearly impossible to come up with another external factor that would knock the mortality of people 25-44 so far off normal trend.
Not that some haven't tried.
The blue check medical Twitterati that did weigh in on Dr. Ladapo's analysis, argued the cardiac deaths in young people are a result of a COVID infection. We have already spent enough time ridiculing the CDC's "long-COVID" theory which relied on EHR data, among other significant flaws. The chart also tells you that defense is probably not going to hold up. If Covid-associated cardiac deaths drove the spike in all cause mortality, why did it not begin until spring 2021? Why did it recede so rapidly in late 2021? Why is it not following the wave of Covid outbreaks even just a little?
Here is the data from last week's release. See for yourself.
Emily Evans
Managing Director – Health Policy
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