Yet more evidence that “died suddenly” is not a real thing

If there has been one consistent narrative promoted by the antivaccine movement going back decades, it’s that vaccines are both ineffective and dangerous, which is why the “died suddenly” narrative that has arisen since the release of COVID-19 vaccines, in which the vaccines are supposedly causing healthy young people to drop dead unexpectedly, should not have surprised anyone. Consistent with the “died suddenly” conspiracy theory, historically one common claim that long predates the COVID-19 pandemic and COVID-19 vaccines has been that vaccines kill, in particular that they kill young people, children, and, of course, babies. The first time I encountered this claim was in the context of antivaxxers making the wildly false and implausible argument that “shaken baby syndrome” (now more properly called abusive head trauma) is a “misdiagnosis” for vaccine injury, to the point that antivaxxers even rallied around Alan Yurko, who two decades ago killed his girlfriend’s baby by shaking him and then tried to get off by claiming that the baby had died of vaccine injury. After that, I soon encountered conspiracy theories blaming vaccines for sudden infant death syndrome (SIDS) and then later blaming the HPV vaccine for the sudden deaths of teen girls and young women. Antivaxxers even made a conspiracy pseudo-documentary entitled Sacrificial Virgins: Not for the Greater Good, in case you didn’t get the message.

It’s therefore not surprising that the rollout of COVID-19 vaccines was soon followed by similar conspiracy theories about how the vaccines supposedly kill. Of these, perhaps the most famous is what I like to refer to as the “died suddenly” conspiracy theory, named after a meme and later a conspiracy pseudo-documentary from antivax right wing propagandist Stew Peters called—of course—Died Suddenly. The film is a deceptive mish-mash of fevered conspiracy theories claiming that COVID-19 vaccines have resulted in an epidemic of young people “dying suddenly” that, amusingly, were so bonkers that even some antivaxxers who considered themselves more “reasonable” balked at the film. That, of course, that don’t stop antivaxxers from claiming that sudden arrhythmic death syndrome (SADS), a syndrome known for decades before the pandemic in which people who were seemingly healthy suffer sudden cardiac arrest and death due to an arrhythmia, was in actuality all due to COVID-19 vaccines. (It’s not. It’s usually due to familial heart conduction defects or to unsuspected cardiac anomalies.)

One prominent variant of the “died suddenly” antivax conspiracy theory was the claim that young athletes were apparently dropping like flies, dying in huge numbers, all because they had been required to be vaccinated against COVID-19. So when Buffalo Bills player Damar Hamlin suffered a horrifying on-field cardiac arrest on national TV, which showed him undergoing CPR, nearly a year ago, antivaxxers falsely blamed the vaccine. When LeBron James’ son Bronny suffered a cardiac arrest during basketball practice, antivaxxers falsely blamed the vaccine. There even arose a conspiracy theory that claimed that COVID-19 vaccines have cause 2,024 cardiac arrests among athletes. When I looked at this claim in detail, I soon discovered that not only was the source obvious antivax astroturf, but a lot of these athletes were retired, had obviously died of causes not related to the vaccine, or had never even been vaccinated.

So, you might ask, is there any evidence to support the claim that vaccines are causing young adults, especially young athletes, to suffer sudden cardiac arrests? In a word, no. For example, six months ago I discussed how the number of out-of-hospital cardiac arrests has remained relatively stable since at least 2019. But what about young athletes? Just this week, a study was published that looked at that very question: Are there more young athletes dying suddenly of cardiac causes since the pandemic and the rollout of COVID-19 vaccines. If you know me and my history, I suspect that you’ll know the answer to that question: No.

The study, Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study, was just published online in Circulation, the official journal of the American Heart Association, and the title tells you exactly what the study is about. Basically, investigators led by Kimberly G. Harmon at the University of Washington tried to determine how many college athletes have “died suddenly” of cardiac causes over the last 20 years and whether the number has increased. Far from finding that more college athletes are “dying suddenly,” they actually found a decrease in the number of such deaths, as well as no increase in the overall number of deaths of college athletes, which means that sudden cardiac death has become a less common cause of death among such young adults. Let’s dig in.

The investigators looked at a time period from July 1, 2002 to June 30, 2022, examining four databases to identify collegiate athletes who had died (National Collegiate Athletic Association resolutions list, Parent Heart Watch database and media reports, National Center for Catastrophic Sports Injury Research database, and insurance claims). All athlete deaths were compiled into one database, with duplicates removed. For multisport athletes, the primary sport was classified as the sporting discipline with competitive season closest in time to their time of death.

Then, investigators tried very hard to determine the cause of death for each athlete who died of sudden cardiac death (SCD) during this 20-year time period:

The cause of each athlete death was determined through a combination of different methods, including review of autopsy and other official documents reporting cause of death, Internet searches for online media reports and obituaries, and e-mails or telephone calls to the next of kin, coaches, athletic trainers, coroners, medical examiners, scholarship foundations, or physicians involved in the case. Demographic characteristics including age, race, sporting discipline, and exertional status at the time of death (ie, exertional, nonexertional, or unknown) also were determined using these methods. If no medical examiner report or cardiac autopsy was available, race was determined by media reports or athlete photographs. A death was considered exertional if SCD occurred during exercise or within 1 hour of exercise cessation. SCD was defined as a sudden unexpected death attributable to a cardiac cause, or a sudden death in a structurally normal heart with no other explanation for death and a history consistent with cardiac-related death that occurred within 1 hour of symptom onset or an unwitnessed death occurring within 24 hours of the person having been alive. Unwitnessed deaths were not categorized as cardiac unless additional information such as autopsy, negative toxicology screen, or other information was available that could verify the death was cardiac.

Athlete deaths were categorized into different groups, including accident, cardiac, cancer, other medical, suicide, homicide, sickle cell trait, sports-related head injury, heatstroke, or unknown. If the cause of death could not be determined accurately, it was designated as unknown.

The authors found a total of 1,102 deaths of college athletes during that time period, of which 143 deaths were determined to have been from SCD. The breakdown of all deaths can be found in this figure:

The first thing that I noted is that, as one would expect from what we know about the causes of death among young people, trauma was by far the most common in this cohort.

Now here’s the graph of the main findings, the incidence of SCD normalized appropriately to athlete-years:

The authors report:

A total of 143 of 1102 cases (13%) were adjudicated to have a definitive or likely cardiac cause of SCD. Among these, 93 (65%) were identified by review of the autopsy, and the other 50 (35%) were identified by other methods, presented in Table 4. A cause of SCD was adjudicated in 118 of 143 cases (83%) reported from any source. Twenty-five of 143 cases (17%) were considered “cardiac unknown,” either in athletes with an exertional death with sudden collapse requiring cardiopulmonary resuscitation and no other clear cause (7 of 25) or among athletes with documentation of a likely SCD but with no autopsy or the autopsy performed did not have enough information to adjudicate a most likely cause of SCD (18 of 25).

The most common postmortem finding was autopsy negative sudden unexplained death (AN-SUD; 23 of 118 [19%]), followed by idiopathic left ventricular hypertrophy/ possible cardiomyopathy (20 of 118 [17%]) and hypertrophic cardiomyopathy (15 of 118 [13%]; Figure 3). Causes of SCD among only athletes with an autopsy available for review and adjudication (n=93) are presented in Figure S1. Two of 118 athletes (2%) were adjudicated to have an SCD secondary to hypokalemia, including 1 athlete with hypokalemia related to known bulimia nervosa and 1 athlete with known Gitelman syndrome. Commotio cordis accounted for 2 deaths over the 20-year time period, both occurring in the first 5 years of the study period.

Commotio cordis due to a sudden blow to the chest was, of course, the most likely cause of Damar Hamlin’s cardiac arrest.

In anticipation of antivaxxers going, “But, but, but…myocarditis!” the authors also reported:

Eight athletes were adjudicated to have myocarditis as a cause of SCD. Of these, only 1 case occurred after the first reported COVID-19 infection in the United States, and this case was giant-cell myocarditis per the local medical team and coroners, a pattern not associated with COVID-19.

There have been a tiny number of case reports of giant cell myocarditis after COVID-19 vaccination (one of which was after the J&J vaccine), but no clear evidence that the vaccine causes, but no strong evidence of causation, at least not compared to the risk of other forms of myocarditis reported after the vaccine. One case since the pandemic certainly doesn’t support antivax claims of an epidemic of SCD in athletes (especially due to myocarditis) due to COVID-19 vaccines.

There were some interesting observations, as well, regarding which athletes were more at risk of dying of SCD:

Male athletes had a higher incidence of SCD than female athletes (1:43 348 [95% CI, 1:36 228–1:51 867] versus 1:164 504 athlete-years [95% CI, 1:110 552–1:244 787]), and Black athletes had a higher incidence of SCD than White athletes (1:26 704 [1:20 417–1:34 925] versus 1:74 581 athlete-years [1:60 247–1:92 326]). The IRR for male athletes versus female athletes was 3.79 (95% CI, 2.45–5.88) and 2.79 (95% CI, 1.98–3.94) for Black race versus White race. Among the sporting disciplines with ≥5 cases of SCD, basketball and football had the highest incidence of SCD (1:19 164 and 1:31 743 athlete-years, respectively). When assessing incidence rates stratified by sex, race (Black versus White), NCAA division, and sporting discipline, Division I White male basketball (1:5848 athlete-years [95% CI, 1:2498–1:13 691]) and Division II Black female track and field athletes (1:24 942 athlete-years [95% CI, 1:4404– 1:141 294]) had the highest incidence rates of SCD between the sexes (Table 3). The overall incidence of SCD over a typical athlete’s career was 1:15,921 per 4 athlete-years. When considering a 4-year career, Divison I White male basketball players have an incidence rate of 1:1462 per 4 athlete-years and Divison I Black male basketball players have an incidence rate of 1:1924 per 4 athlete-years. After controlling for sex and race in multivariable logistic regression analysis, athletes participating in basketball were still at increased risk of SCD compared with other sports (odds ratio, 2.75 [95% CI, 1.73–4.34]; Table S2).

The authors note that it is unclear why there were these differences, particularly attributable to race, with Black male athletes playing basketball and Black female athletes competing in track and field being a higher risk than white male basketball players and white female track and field athletes, respectively. It is also interesting to note that 20% of SCD cases occurred among basketball players, who make up only 4% of all college athletes.

The article is, of course, not perfect. It is retrospective, and, as the authors readily concede, there is no mandatory reporting system for athlete deaths. Moreover, there is a paucity of information on genetic testing of athletes who died for mutations known to predispose to SCD due to arrhythmia. The authors also note that there is a lack of data on the number of athletes who suffered sudden cardiac arrest (SCA) but did not die because they were successfully resuscitated, noting that “lack of data on resuscitated SCA may lead to bias in the current study, because some athlete subgroups may be more likely to be resuscitated than others” and that “rates of resuscitated SCA in conjunction with SCD are important for a complete understanding of risk of conditions leading to SCA or SCD in young competitive athletes.”

Finally, the data used in this study is only a subset of data in that only athletes competing at NCAA institutions were included. However, I would note that, if the antivax conspiracy theories about how many many athletes have supposedly “died suddenly” due to COVID-198 vaccines had any germ of truth, one would expect to find an epidemic of NCAA student athletes who “died suddenly.” After all, why would they be immune compared to non-NCAA athletes, high school athletes, and young professional and amateur athletes competing outside of school-organized competitions? They wouldn’t.

And other evidence shows that such athletes are not dying at higher rates of SCD either:

Broader look from NCCSIR. Includes HS athletes as well.

Table 3 covers “indirect” events like heat stroke and SCA. Tables 6a and 6b cover fatalities.

No increase.

Link:https://t.co/LUtf0Awhvs pic.twitter.com/b1d2vs341Y

— BrainbellJangler (@WaitingForPerot) November 14, 2023

The researchers also note that it’s unclear why the number of deaths of college athletes from SCD has been declining, but in news reports have speculated:

“We don’t know why the rate of cardiac arrest deaths has been going down,” said study co-author Dr. Kimberly Harmon, a professor in the departments of family medicine and orthopedics and sports medicine at the University of Washington in Seattle.

“You could hypothesize that it’s because there are better emergency action plans when there is a cardiac arrest, more people who know CPR and clear access to a defibrillator,” she said. “When someone passes out suddenly, you should think cardiac arrest until evidence shows otherwise.”

The decrease could also be due to more screening, with colleges increasingly requiring athletes be cleared to play with an exam that includes an electrocardiogram (EKG or ECG), which measures the heart’s electrical activity and can detect dangerous heart rhythms. 

“The patterns on an EKG can also tell a lot about the shape and size of the heart,” Harmon said. “In athletes, we are primarily looking for electrical or heart muscle disease.”

It’s been shown that screening that includes an EKG will catch between two-thirds and three-quarters of athletes at risk, she said.

Basically, this study is yet another piece of evidence demonstrating that the “died suddenly” narrative by antivaxxers has no basis in evidence. If the vaccine were causing a tsunami of sudden death due to cardiac causes, we would have seen it by now. We have not. If the vaccines were causing huge numbers of athletes to be suffering SCD, we would have hard numbers suggesting this possibility. We do not.he very worst that can be said is that neither the number of out-of-hospital deaths due to cardiac arrest nor the number of athletes suffering SCD is increasing. Indeed, if this study is representative of what is happening, if anything, the incidence of SCD among young athletes is decreasing.

The “died suddenly” narrative is just another example of how, in the age of COVID-19, everything antivax that is old is suddenly new again. Antivaxxers have always claimed that vaccines kill, and most recently that HPV vaccines have been causing the deaths of “sacrificial virgins” due to SCD. There was no evidence that that was the case then, and there is no evidence that COVID-19 vaccines are killing young athletes (or young people in general) now. It’s yet another case of antivaxxers discovering a sad medical phenomenon about which they had previously been ignorant, being shocked, and concluding that it must be the vaccines causing it.