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Today the Physician Mom Facebutt group has a query about teens returning to sports after Covid-19. What is the timing? Especially if the kid is not very sick.

This brings up another query: "Also, not cards or peds, but asking an honest questions - isn't there a certain level of myocarditis with many common viruses? Is COVID that much higher or are we just paying attention to it more? This is an honest question as I don't know."

From a pediatric cardiologist: "150 cases per million in Covid vs 9 per million for Gen pop. Still extremely low. Influenza, Coxackie, adenoviruses, and Parvovirus B19 all can do the same possibly at an even higher incidence. Without significant symptoms its safe to move onto full activity as tolerated."

Many many infectious diseases, viruses and bacteria, can cause rare and very bad complications. Mononucleosis, for example. We check teens for an enlarged spleen. If it is swollen and they get hit hard, it can rupture. A ruptured spleen is one of those surgical emergencies doctors hope never to see because it bleeds faster than you can imagine. The surgical mantras are NEVER touch the spleen and NEVER mess with the pancreas. The spleen can start hosing blood if it is "nicked" and pancreatitis is very very bad when some one is trying to heal from a surgery.

So all the fuss over myocarditis confuses physicians a little. Myo is muscle, cardia is heart, itis is inflamed. Inflamed heart muscle. We use antiinflamatories and check heart enzymes to be sure it is not a heart attack. Then we have the person rest and be quiet, to let the heart heal. Teens heal very nicely, much faster than 80 year olds. With Covid-19 the risk of myocarditis is 4 times higher from the infection itself (2) than from the vaccine.

However people are scared and when they are scared the amygdala and the limbic system take over and they get mad and yell. All of the defense mechanisms kick in. Breathe. Slow down. Think.

A conservative friend tells me that the conservative news reports that Long Haul happens in unimmunized but is much less likely in immunized. I don't know. I don't see much about it on the sites I tend to use, which swing a bit liberal and sites like the CDC and WHO and Mayo Clinic. Certainly everyone was unimmunized to start with and people who survived Covid-19 from the earlier time are the first ones who got Long Haul. Some people have been sick for a year. The numbers I have been seeing are up to 50% of hospitalized and between 10-30% of not hospitalized. It is still really a lot. There has been a report that Omicron can cause Long Haul, but I have not seen any percentages yet. My guess would be that people are less likely to get Long Haul if immunized, but that it is still possible. Hopefully a lot less than 30%.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html
https://www.i24news.tv/en/news/coronavirus/1629975361-unvaccinated-coronavirus-patients-at-four-times-risk-of-myocarditis-israeli-study
https://www.verywellhealth.com/breakthrough-infections-long-covid-might-be-possible-5196097
https://www.acsh.org/news/2021/12/21/long-haul-covid-symptoms-won%E2%80%99t-quit-where%E2%80%99s-data-16010
https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
https://www2.ed.gov/about/offices/list/ocr/docs/ocr-factsheet-504-20210726.pdf

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