#DiedSuddenly Was BS: Why Did We Believe It?

This transcript has been edited for clarity. 

Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I’m Dr F. Perry Wilson from the Yale School of Medicine.

I suppose, in retrospect, it was inevitable. The moment that COVID-19 vaccines were approved in what was an unprecedented scientific effort, the backlash began. There have always been vaccine skeptics, but this response was worse, fueled by suspicions that the work done to create these vaccines was somehow too fast and was turbocharged by the amplifying effect of social media. 

There is a bit of a hack to getting your voice amplified on Twitter — now X — or Facebook, or any engagement-based platform: Inflame emotions. And few anti-vaccine trends were more powerful in 2021 than the one with this hashtag: #DiedSuddenly.

The stories were heartbreaking: young people, healthy, struck down in the prime of their life, with no symptoms to speak of. One moment playing soccer or football, the next in cardiac arrest. 

If you were on social media at the time, you couldn’t get away from that hashtag. The implication, that these deaths were due to vaccination, was ghoulish. But more ghoulish was the ravenous way the reports of virtually any death were quickly followed by a chorus of online voices asking whether the person was vaccinated or not. 

If your only access to information was via social media, then you would have thought we were in the midst of a second epidemic. Even a “documentary,” called Died Suddenly, was made about the phenomenon, streamed on Rumble and Twitter and promoted by Marjorie Taylor Greene. Anti-vaxxers actually ended up opposing the film, saying it was so poorly researched that it must have actually been a form of controlled opposition . But that’s neither here nor there.

This week, I’m going to show you a new study that confirms, in addition to studies that have already been released, that this #DiedSuddenly thing was, for lack of a better word, bullsh-t. 

But I want to use it as a springboard to talk about just why a campaign like #DiedSuddenly was so effective, the errors in our cognitive processes that cause us to believe these things — or worse, share them online — and how we might avoid those traps in the future.

Let’s get one thing out of the way early: There was no increase in sudden cardiac arrest or sudden cardiac death among young people during the COVID pandemic. That is the conclusion of this study, "Sudden Cardiac Arrest Among Young Competitive Athletes Before and During the COVID-19 Pandemic ," appearing this week in JAMA Network Open, from Jonathan Drezner and colleagues at the University of Washington. 

To understand this study, you need to know that the National Center for Catastrophic Sport Injury Research keeps, and has kept since 2014, a database of virtually every cardiac arrest and sudden death that occurs  among middle school, high school, and college athletes. This operates through active surveillance as well as direct reporting. In fact, researchers will track down social media reports of sudden cardiac arrests and deaths to add to the database if, for some reason, the NCAA did not report them.

In other words, this is pretty much the definitive count of these events in the United States over time. So let me dispense with the prologue and show you the numbers.

In the 3 years prior to the pandemic, there were 203 cases of young athletes who suffered cardiac arrest or sudden cardiac death. In the first 3 years of the pandemic, there were 184 cases of young athletes who suffered cardiac arrest or sudden cardiac death. There is no statistical difference. There is no spike during the pandemic, either due to the COVID virus itself or due to vaccines. There is simply no signal. This “phenomenon” was not real.

These data add to this study, appearing in this study, appearing in, finding no association between vaccination and the risk for out-of-hospital cardiac arrest in the broader population in Australia. That’s that flat blue line despite the spike in infections and vaccinations that occur toward the end of the timeline.

That’s it. #DiedSuddenly was wrong.

So, why was it so compelling? Now that the panic of the pandemic has subsided, as has the use of that damnable hashtag, perhaps we can use our retrospectoscope to identify exactly why this idea had such a hold on people. It speaks to a number of well-described cognitive biases.

The first concept to be aware of is something called the illusion-of-truth effect. This is a well-described cognitive bias where we are more likely to believe something is true if we’ve heard it before, regardless of whether we believed it the first time around. It’s the simple power of repetition. You see something, you see it again, you see it again, you see it again, and it lodges in your brain. 

This is a cognitive bias tailor-made for social media. What does “going viral” mean, beyond everyone repeating something that someone has tweeted or posted or whatever? Beyond that — social media algorithms, by their nature, show you things you’ve engaged with before — they keep ringing that bell, so to speak. 

Let’s say the first time you saw a story of someone who died suddenly, you were skeptical; you investigated and found, for example, that the story actually occurred prior to the pandemic. You are still more likely to believe the next “died suddenly” story. And the next one more so, and so on and so on. It’s just the way our minds work. This is the illusion-of-truth effect and it is very dangerous.

The second cognitive bias that #DiedSuddenly exploits is known as the affect heuristic. This is a mental shortcut where we rely on our emotional response to something — our feelings — to make judgements about it, as opposed to facts. When a story elicits joy, or anger, or fear, or sadness, we are more likely to believe it is true. It’s the “shark attack” bias. Sure, we all know, rationally, that being killed by a shark is incredibly unlikely. But we hear a story about someone being killed by a shark and it changes our calculus dramatically about going into the ocean. 

And finally, there is good old-fashioned motivated reasoning. This occurs when there is a conclusion we want to be true, and we tend to believe facts in support of that conclusion and disregard facts to the contrary. Politicians are great at this, by the way. This is a huge problem when it comes to medical misinformation, because — again, thanks to the internet — there are falsehoods out there that, if we choose to believe them, lead us to conclusions that are much better than reality. We may believe the falsehood that avoiding sugar cures cancer because of our fear of chemotherapy. 

We may believe that a juice detox can “reset” our health because the reality of sustaining meaningful lifestyle change over time is simply too daunting. Or, in the case of a new vaccine that makes us nervous, we may embrace the excuse that people die suddenly from it to justify our reluctance to take it in a world where there are lots of pressures to take it.

Oh, and I almost forgot: There is always grifting. While I am sure that many people espousing this #DiedSuddenly nonsense were true believers, others were trying to make money off of the fear. People sell merchandise with the hashtag. People offer online supplements to “detox” vaccines. People monetize their social media followers. They write books and charge subscriptions to newsletters. And no, I’m not going to link to any of these things. You can find them if you want.

So, there you have it. COVID vaccines did not lead to a rash of sudden deaths in young athletes. COVID itself didn’t either. All the hype was just that — hype. And the reasons we believe it are as old as human psychology. May we be wiser next time.

F. Perry Wilson, MD, MSCE, is an associate professor of medicine and public health and director of Yale’s Clinical and Translational Research Accelerator. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape. He posts at @fperrywilsonand his book, How Medicine Works and When It Doesn’t, is available now.