No, a German “autopsy report” didn’t show COVID-19 vaccines as “likely” cause of sudden deaths

Social media posts claiming that there has been a spike in people who “died suddenly” due to COVID-19 vaccination made the rounds in late November 2022, thanks to a popular film that rehashed debunked claims about COVID-19 vaccines and conspiracy theories.

More recently, a study published at the end of November 2022 in the journal Clinical Research in Cardiology provided food for yet more claims running in the same vein. The study by Schwab et al., titled “Autopsy-based histopathological characterization of myocarditis after anti-SARS-CoV-2-vaccination”, reported that out of 25 people who had died unexpectedly and within 20 days of COVID-19 vaccination, five of those people showed signs of myocarditis for which no other cause was identified except COVID-19 vaccination^[1]. 

Some social media users cited the study, implying that COVID-19 vaccines were deadly and that avoiding vaccination is safer than getting vaccinated (see examples here and here).

An article written by Will Jones for the website The Daily Sceptic, promoting this claim, also went viral through social media posts, examples of which can be seen here and here. Jones, who holds a PhD in political philosophy, asserted that the study meant it was now a “firmly established” fact that COVID-19 vaccines are responsible for sudden deaths. The article was republished by the Brownstone Institute, a website that published COVID-19 and vaccine misinformation. The claim received more than 7,600 interactions to date, according to social media analytics tool CrowdTangle.

The study doesn’t permit epidemiological conclusions to be drawn and doesn’t sufficiently rule out alternative causes of death apart from vaccination

However, experts who weren’t involved in the study found that such an interpretation isn’t substantiated by the work actually done in the study. 

Cardiologist Christopher Labos told Health Feedback that “The study by Schwab et al. doesn’t actually establish how common myocarditis post vaccination is, whether it is actually higher than the background rate (because many things can cause myocarditis), nor how likely someone is to die when they develop myocarditis”.

In fact, the authors of the study cautioned against the type of claim made in the article, stating that “The nature of our autopsy study necessitates that the data are descriptive in quality and does not allow any epidemiological conclusions in terms of incidence or risk estimation”.

In an email to Health Feedback, Konrad Steinestel, head of pathology at the Bundeswehr Hospital Ulm, also said that the headline misrepresented the findings of the study,  explaining that only 8.6% of the 35 unexpected deaths included in the study were interpreted by the authors to be causally linked to the vaccine, a result consistent with two other studies^[2,3].

Furthermore, the authors’ interpretation rested on the assumption that COVID-19 vaccination was responsible for these cases of sudden death because they occurred shortly after vaccination. “[T]his is a rather large assumption,” said Labos, given that the authors also managed to identify alternative explanations for the cause of death in the cases.

The German Registry for COVID-19 Autopsies (Deutsches Register von COVID-19 Obduktionen in German) at the Uniklinik RWTH Aachen, which is supported by the Federal Association of German Pathologists and the German Society of Pathologists, told Health Feedback that “there is no definite proof that the cases of myocarditis [in the study] occurred due to the COVID-19 vaccines”, highlighting the lack of a control group in the study.

In a Twitter thread, Frank Han, a cardiologist at the University of Illinois in Chicago, considered the study’s histopathological methods of diagnosing myocarditis to be one of its strengths, calling it the “gold standard”. But he also made a similar observation as Labos, noting that “the patients reported to have died of myocarditis had pulmonary and vascular findings consistent with atherosclerosis and pulmonary congestion in some cases” and that “it’s unknown why [the study authors] think atherosclerosis was noncontributory”.

Steinestel also came to the same conclusion, stating that “the study by Schwab et al. does not establish a mechanistic link between vaccination and (epi)myocarditis”. However, he thought that more autopsy studies would be necessary to identify risk factors for adverse events following vaccination. “[T]oo few autopsies are currently being performed,” he said.

The study’s senior author, Peter Schirmacher, was interviewed by Jones for the article, but didn’t respond to Health Feedback’s request for comment. In an August 2021 article for the Süddeutsche Zeitung, a German daily newspaper, Schirmacher asserted that, of more than 40 people autopsied within two weeks of COVID-19 vaccination, 30 to 40 percent of them died because of the vaccination. That said, Schirmacher also claimed to have been vaccinated and stated that he didn’t oppose vaccination.

In the same article, the Süddeutsche Zeitung reported that the head of the Standing Committee on Vaccination in Germany, Thomas Mertens, had questioned the basis for Schirmacher’s claim, stating that he didn’t know of any data justifying it.

Health Feedback reached out to Jones for comment. In response, Jones denied that there was anything inaccurate or misleading in his report of the study.

Cardiac risks from vaccination are lower than from COVID-19

The discovery that certain adverse events, like blood clots and myocarditis, are associated with COVID-19 vaccination has become a mainstay of COVID-19 vaccine misinformation, as previous Health Feedback reviews on the subject attest to. However, claims that cast doubt over the safety of COVID-19 vaccines frequently gloss over the fact that scientific evidence so far shows that vaccine-associated risks are lower than COVID-19-associated risks.

“The risk of cardiac complications post-COVID is very high and your risk of getting myocarditis is much higher if you catch COVID-19,” Labos said, citing a study by scientists at the U.S. Centers for Disease Control and Prevention. The study reported a 16-fold increase in the risk of myocarditis in COVID-19 patients compared to people who didn’t get COVID-19^[4].

Moreover, in cases of vaccine-associated myocarditis that do happen, “the vast majority of cases are mild and resolve completely within days,” he said, pointing to studies in the U.S. and Israel^[5,6].

The German Registry for COVID-19 Autopsies team also emphasized the same point, stating that “There are numerous well-performed studies on an epidemiological level that clearly showed the protective effects of vaccines; even the number of COVID-associated myocarditis cases is higher compared to those induced by vaccines”.

In summary, the study by Schwab et al. doesn’t support the claim that sudden deaths are likely due to COVID-19 vaccination. The data provided in the study was descriptive in nature and therefore cannot be used to draw epidemiological conclusions about the incidence of myocarditis or risks from COVID-19 vaccination. Furthermore, experts didn’t find that the study had sufficiently ruled out alternative causes of death in the autopsies performed, thus the data alone doesn’t establish a causal relationship between the myocarditis diagnoses and COVID-19 vaccines.

While COVID-19 vaccines have indeed been associated with an elevated risk of certain adverse events like myocarditis, COVID-19 itself is associated with greater risks, including cardiac complications. To date, the scientific evidence shows that the benefits of COVID-19 vaccines outweigh their risks.

The study by Schwab et al. was an autopsy study that describes some of the pathology characteristics in people who may have developed myocarditis. The study by Schwab et al. doesn’t actually establish how common myocarditis post vaccination is, whether it is actually higher than the background rate (because many things can cause myocarditis), nor how likely someone is to die when they develop myocarditis.

In this autopsy series they examined cases of sudden death and assumed that because they occurred shortly after vaccination, that the vaccine was responsible. But this is a rather large assumption. Also worth remembering that in most of the autopsies they performed they did find an alternative explanation for the cause of death.

Data from the CDC and Israel show that the risk of myocarditis post-vaccination is low and that the vast majority of cases are mild and resolve completely within days^[5,6]. The risk of cardiac complications post-COVID is very high. Your risk of getting myocarditis is much higher if you catch COVID-19^[4].

The article misrepresents the actual content of the study. In fact, only 8.6% of the investigated deaths in the study were interpreted to be causally linked to the vaccine (3/35, Table 2), in line with findings from Schneider et al. and the meta-analysis by Sessa et al.^[2,3]. The authors state that: “the data are descriptive in quality and does not allow any epidemiological conclusions in terms of incidence or risk estimation”.

It is true that further autopsy studies are needed to further identify risk factors for adverse events following vaccination, and too few autopsies are currently being performed. However, the study by Schwab et al. does not establish a mechanistic link between vaccination and (epi)myocarditis. As they state in the Discussion section of their study: “we cannot provide a definitive functional proof or a direct causal link between vaccination and myocarditis.”

The authors of the study state: “The reported incidence of (epi-)myocarditis after vaccination is low and the risks of hospitalization and death associated with COVID-19 are stated to be greater than the recorded risk associated with COVID-19 vaccination. Importantly, infectious agents may also cause lymphocytic myocarditis with a similar immunophenotype, thus meticulous molecular analyses is required in all cases of potentially vaccination-associated myocarditis”.

German Registry for COVID-19 Autopsies (Deutsches Register COVID-19 Obduktionen):

There is no definite proof that the cases of myocarditis occurred due to the COVID-19 vaccines. One limitation in this aspect is the lack of a control group, i.e., what number of subjects in a similar population of such deaths would also show similar findings?

The authors of the paper themselves state that their data is merely descriptive and “does not allow any epidemiological conclusions”. The authors also correctly state that the study does not prove a causal link between the COVID-19 vaccines and myocarditis.

There are numerous well-performed studies on an epidemiological level that clearly showed the protective effects of vaccines; even the number of COVID-associated myocarditis cases is higher compared to those induced by vaccines.

UPDATE (15 December 2022):

The review initially reported Dr. Christopher Labos to be affiliated with the Queen Elizabeth Health Complex. This is incorrect as the affiliation wasn’t current. We have corrected the review to reflect this.

UPDATE (14 December 2022):

This review was updated to include Jones’ response to our request for comment in the fourteenth paragraph and to include the comment by the German Registry for COVID-19 Autopsies team after the ninth paragraph. The comment by the Registry further supports our verdict and did not change it.

REFERENCES

• 1 – Schwab et al. (2022) Autopsy-based histopathological characterization of myocarditis after anti-SARS-CoV-2-vaccination. Clinical Research in Cardiology.
• 2 – Schneider et al. (2021) Postmortem investigation of fatalities following vaccination with COVID-19 vaccines. International Journal of Legal Medicine.
• 3 – Sessa et al. (2021) Autopsy Findings and Causality Relationship between Death and COVID-19 Vaccination: A Systematic Review. Journal of Clinical Medicine.
• 4 – Boehmer et al. (2021) Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021. Morbidity and Mortality Weekly Report.
• 5 – Mevorach et al. (2022) Myocarditis After BNT162b2 COVID-19 Third Booster Vaccine in Israel. Circulation.
• 6 – Hause et al. (2022) Safety Monitoring of COVID-19 Vaccine Booster Doses Among Persons Aged 12–17 Years — United States, December 9, 2021–February 20, 2022. Morbidity and Mortality Weekly Report.