Lisa Marie Presley’s death and the pandemic show how careful we need to be with information on ‘sudden deaths’

Why are more young people dying suddenly?

I’ve been asked this question many times during this pandemic. Particularly after Damar Hamlin, a 24-year old Buffalo Bills football player, suffered a cardiac arrest during an NFL game earlier in the month, and again after Lisa Marie Presley had a fatal cardiac arrest on January 12.

Almost immediately after Hamlin’s event, cardiologists were appearing on sports shows explaining a rare condition called “commotio cordis” where a blow to the chest can cause ventricular fibrillation, a life-threatening heart rhythm. Meanwhile on social media, messages and videos were making false claims that these cardiac emergencies were due to the Covid-19 vaccine or prior infections.

Lisa Marie Presley died aged 54 after being admitted to hospital on Thursday, her mother Priscilla said. After the news broke, social media was awash with conspiracy theorists attempting to falsely link Presley's death to vaccines.

These tragic scenarios illustrate the misinformation, disinformation and just plain confusion which has clouded our lives during the past three years. Rumors and urban legends are not new to the medical landscape. They are often challenging to confront because there may be some elements of truth to the claims. For example, one common health myth we often hear focuses on cold air causing pneumonia. While pathogens can stay suspended longer in cold, dry air and immune defenses especially in our nasal passages can be impaired, cold air by itself is not infectious.

Another fuel for misinformation is that we often categorize life as if we live in a binary world where there is only good or evil, truth or lies, health or disease. But we know that patients can have multiple causes and diseases. Fortunately for Damar Hamlin, his physicians understood this and have investigated the underlying issues that resulted in his cardiac arrest.

While there have been reports that mRNA vaccines and Covid-19 infections can lead to cardiac complications, one study’s lead author stresses that, "the risk of myocarditis following Covid-19 vaccination was quite small compared to the risk of myocarditis after Covid-19 infection." In another study, published in Frontiers in Cardiovascular Medicine in August 2022, researchers found that the risk of myocarditis is more than seven-fold higher in persons who were infected with SARS-CoV-2, the virus that causes Covid-19, than those who were vaccinated.

Prior to the pandemic, I treated patients who were young, male athletes requiring medical and surgical interventions for structural abnormalities of their heart muscle, vessels and electrical pathways. Two patients who were in their early 20’s had even experienced “sudden death” while playing sports. One was a marathon runner and another was a college soccer player. Their hearts stopped suddenly and they collapsed on the field; luckily, they received immediate medical care and were successfully resuscitated. They were found to have abnormal electrical pathways in their hearts which caused cardiac arrythmias. Structural abnormalities are the most common cause of sudden cardiac events among competitive athletes.

The CDC estimates there have been 942,431 excess deaths in the United States that are directly and indirectly associated with COVID-19. Excess deaths are defined as the difference between observed number of deaths in specific time periods and the expected number of deaths in the same time period. From 2021 to the 43rd week of 2022, there have been 124,000 excess deaths in the US among 0-to 44-year-olds compared to 2015-2019. One insurance company estimates that the death rates among those aged 18-64 are currently up by 40%.

Is it due to the underlying disease caused by this infection, the delayed or missed diagnosis and treatment of other health conditions or something else entirely? It is this vagueness that can fuel conspiracy theories, including those that focus on vaccine side effects.

There is no indication that excess deaths are vaccine related, the CDC states. SARS-CoV-2 acts like a Trojan horse finding the Achilles heel. Where there is susceptibility, it invades and destroys cells, tissues and organs. It damages the vasculature, dysregulates the immune system and is neurotropic. Long Covid or post-acute sequelae of Covid-19 (PASC) can have a constellation of over 200 symptoms which can occur weeks and months after even mild or asymptomatic infection. There are also reports of vaccine adverse events or side effects.

Dissecting the individual impact of infections, vaccines and/or underlying conditions can be difficult. For example, I have a relative who was diagnosed with diabetes in 2021. Though they were not symptomatic for Covid-19 prior to this diagnosis, they had been in high risk situations and could have had an asymptomatic infection. I assumed that the virus caused this new diagnosis since studies have shown over 66 percent increased risk of diabetes post-infection. However, I also found studies which revealed a smaller risk for vaccine-induced hyperglycemia. Furthermore, they had increased weight and stress levels since the pandemic began, and there is also a family history / genetic predisposition for diabetes. What was the etiology? Could it be just one or all of the above? This demonstrates how challenging it can be to establish the exact cause and effect.

There are several factors that can shape our beliefs -- the political climate, pop culture, where we grow up, etc. The politicising of mask wearing and vaccines cannot be ignored; nor can the knowledge that the virus is constantly mutating and evolving. And information about the safety and effectiveness of vaccines is rapidly changing despite not always being immediately accessed by the general population.

We are entering a paradoxical time in this pandemic. So many advances have been made, but the virus still remains a step ahead. To mitigate fear or to fill in any voids, we seek “information” that is in sync with how we see our world and fits our beliefs. It is essential to critically review the data by asking who is conducting and funding the studies? Is there any bias or motivation behind the claims? Is this research study statistically significant?

To navigate these turbulent waters, we need to stop paddling and assess the situation. Are those who are considered “anti-vaxxers” making claims out of malignant intention or is it altruism shadowed by the fervor of discourse? A robust and respectful public discussion which allows all parties to share their information, as well as concerns, is needed.

In medicine, we often say that sunlight is the best disinfectant. Allowing in the light and increasing transparency can help to heal the wounds inflicted during this pandemic.

Saralyn Mark, MD, hosts the ‘Always Searching’ podcast and is a former medical/policy advisor for the White House, NASA and US Department of Health and Human Services.