I must admit that I never thought that I’d be writing about Justin Bieber on SBM for any reason, but such are the strange times that we live in today that I find myself doing just that. Sure, I could imagine Bieber being featured on this blog for being yet another celebrity spreading antivax misinformation, for example, but to my knowledge I’ve never heard of him doing that. Also, being the old fart that I am, I must confess that I’m not a Belieber and never have been. Such is life. However, over the weekend Bieber’s name started bubbling up on my social media feeds, with fans sharing a video that posted to Bieber’s Instagram feed, which I’ll repost here:
From a story in Rolling Stone:
Bieber explained that the entire right side of his face was unable to move, and he could only smile and blink on the left side.
“As you can see, this eye is not blinking. I can’t smile on this side of my face. This nostril will not move. So there’s full paralysis on the side of my face,” he said in a video posted on Instagram.
The singer said he hoped fans now understood why he had to cancel a set of tour dates. “So for those who are frustrated by my cancellations of the next shows, I’m just physically, obviously not capable of doing them. This is pretty serious. As you can see.”
“Obviously, my body’s telling me I gotta slow down,” he said, before adding that he’d take the time to “rest and relax” before heading back on the road.
Along with getting plenty of rest, Bieber said he was also doing facial exercises to “get my face back to where it’s supposed to be.”
“It will go back to normal. Just time and we don’t know how much time that’s gonna be, but it’s gonna be okay,” he said. “And I have hope, and I trust God, and I trust that this is all for a reason. I’m not sure what that is right now. But in the meantime, I’m gonna rest.”
The health update comes a few days after he was forced to postpone a number of tour dates, citing health concerns and saying his sickness was “getting worse” without providing additional details.
Whatever my opinion of Justin Bieber as a performer (he’s obviously talented but just not my cup of tea), I couldn’t help but feel empathy for him as he apologized to his fans for canceling a number of upcoming shows because he physically can’t do them, and demonstrated how one side of his face is paralyzed. We’ll discuss potential causes in a moment (hint: it wasn’t a vaccine, COVID-19 or otherwise), but first let’s take a look at the sadly predictable reaction. On Friday, Steve Kirsch stated explicitly Why I’m 99% certain that Justin Bieber’s facial paralysis was caused by the COVID vaccine, subtitling it, “Was it vaccine related? That’s what the math says. Here’s my calculation.” As usual, his “math” rests on a misinterpretation of the Vaccine Adverse Events Reporting System (VAERS) database, the assumption that everything reported to the database is caused by the vaccine, and the confusing of correlation with causation, all using his usual chicanery, in which he makes up a figure to inflate an estimate that he doesn’t like. Meanwhile, a fake news site (Vancouver Times, rated as a questionable source) posted an article claiming that Bieber blames the COVID-19 vaccine for his Ramsay Hunt syndrome and saying that the “vaccine ruined my life.“ The article consists mainly of Tweets and a reference to a Daily Mail article that, while sensationalistic, does not, as the fake news site claims, report that Bieber blamed the vaccine for his condition and plans on suing Pfizer.
Then, of course, there’s always Twitter:
We’ll discuss Justin Bieber’s wife Hailey Bieber and her stroke in a moment (something I had not known about prior to the stories about Bieber’s facial paralysis bubbling up over the weekend and that Steve Kirsch also claims), but first one antivaxxer, ironically, came close to the answer without actually realizing it.
No, Bieber’s facial paralysis is not due to the COVID-19 vaccine, but far more likely a consequence of what usually causes Ramsay Hunt syndrome, a sequelae of varicella zoster virus (VZV) infection not unlike shingles. Let’s go through this story step-by-step, starting with Justin Bieber’s Ramsay Hunt syndrome, continuing to the questions about Hailey Bieber’s stroke, and then continuing in a more general fashion to discuss how antivaxxers (1) immediately blame any health problem suffered by a celebrity on vaccines and (2) blame any unexplained death they can on the vaccines. Is it possible that vaccination might reactivate dormant VZV? Yes, but it’s certainly not proven, and it’s not even clear if Bieber received a COVID-19 vaccine.
Ramsay Hunt syndrome is not vaccine injury
The simplest way to think of Ramsay Hunt syndrome is as a subset of shingles. Specifically, it’s shingles that affects the facial nerve near where it emerges near the ear, which is why it’s also known as herpes zoster oticus, to signify its relationship to the ear. There, it can cause the usual (and well-known) painful rash with vesicles (blisters) of shingles on the face, facial paralysis, and hearing loss. I must admit that I did not recall ever having heard of Ramsay Hunt syndrome before, although likely it was covered in medical school. I had certainly heard of and even encountered shingles that involves the facial nerve; indeed, when the skin lesions associated with shingles involve the temporal or zygomatic branches of the facial nerve, it can even endanger the eye.
A review in BMJ Neurology, Neurosurgery & Psychiatry about Ramsay Hall syndrome notes:
The strict definition of the Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth. J Ramsay Hunt, who described various clinical presentations of facial paralysis and rash, also recognised other frequent symptoms and signs such as tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus. He explained these eighth nerve features by the close proximity of the geniculate ganglion to the vestibulocochlear nerve within the bony facial canal. Hunt’s analysis of clinical variations of the syndrome now bearing his name led to his recognition of the general somatic sensory function of the facial nerve and his defining of the geniculate zone of the ear. It is now known that varicella zoster virus (VZV) causes Ramsay Hunt syndrome.
Compared with Bell’s palsy (facial paralysis without rash), patients with Ramsay Hunt syndrome often have more severe paralysis at onset and are less likely to recover completely. Studies suggest that treatment with prednisone and acyclovir may improve outcome, although a prospective randomised treatment trial remains to be undertaken. In the only prospective study of patients with Ramsay Hunt syndrome, 14% developed vesicles after the onset of facial weakness. Thus, Ramsay Hunt syndrome may initially be indistinguishable from Bell’s palsy. Further, Bell’s palsy is significantly associated with herpes simplex virus (HSV) infection. In the light of the known safety and effectiveness of antiviral drugs against VZV or HSV, consideration should be given to early treatment of all patients with Ramsay Hunt syndrome or Bell’s palsy with a 7–10 day course of famciclovir (500 mg, three times daily) or acyclovir (800 mg, five times daily), as well as oral prednisone (60 mg daily for 3–5 days).
From the video, I couldn’t see whether Bieber had the classic vesicular rash on his ear or in the mouth. As for epidemiology, another review notes:
Ramsay Hunt syndrome affects both immunocompetent and immunocompromised patients and has an incidence of about 5 per 100,000 people per year; in contrast, the incidence of Bell palsy is much higher, at about 15-30 per 100,000 people per year. Ramsay Hunt syndrome accounts for roughly 7% of acute facial paralysis cases, with zoster sine herpete comprising approximately 10% of those.
Ramsay Hunt syndrome can present in anyone, and there are cases reported in patients ranging from 3 months of age to 82 years, although patients in their 7th and 8th decades are most susceptible. Factors that increase the risk of herpes zoster will increase the incidence of Ramsay Hunt syndrome, including stress, chemotherapy, immunocompromise, infection, malnutrition, and others.
So basically Ramsay Hunt syndrome is a facial paralysis syndrome that is considerably less common than Bell’s palsy that is caused by VZV, which is the virus that causes chickenpox. As with shingles, VZV can, after chickenpox infection, remain dormant in ganglia and nerves, to be reactivated later. My review reading also reveals that the prognosis for Ramsay Hunt syndrome is not as good as it is for Bell’s palsy. Only 70% of those suffering from Ramsay Hunt syndrome recover normal or near-normal facial function, while over 90% of Bell’s palsy patients do, which might follow from the observation that more than twice as many Ramsay Hunt patients present with complete paralysis of half the face compared to Bell’s palsy.
Since VZV infections are usually self-limited, the treatment of Ramsay Hunt syndrome is generally geared towards decreasing the incidence of late complications, which can include spastic facial paralysis and postherpetic neuralgia, as well as synkinesis, which is due to aberrant nerve regeneration that leads to nerves connecting to the incorrect muscles and can manifest itself as, for example, a twitching of the mouth during eye closure or winking during a smile. (I’m sure that Steve Novella can go on and on about synkinesis.) In general, the treatment is a combination of oral antiviral medications plus steroids. Recovery, when it occurs, can take months, and the worse the initial paralysis, the less likely a full recovery is, although there is nearly always some recovery.
The point to remember here is that Ramsay Hunt syndrome is actually fairly well characterized. Its cause is known, the reactivation of dormant varicella zoster virus in the ganglion leading to the facial nerve, just as shingles is due to the reactivation of dormant varicella virus in another nerve distribution. Why the virus reactivates might not be well understood but it is well understood that it is the virus that causes the syndrome. It is not a vaccine or vaccines.
In fact, one great thing about the chickenpox vaccine is that it can also prevent shingles and Ramsay Hunt syndrome, as was noted over the weekend by some on Twitter:
Likely Bieber never got the chickenpox vaccine because he had chickenpox as a child and the vaccine wasn’t offered until he was older. As for the COVID-19 vaccine, I can find no information about when or even if Bieber was ever vaccinated against COVID-19, meaning that this supposed correlation between vaccination and Ramsay Hunt syndrome is purely speculative. Even if there were evidence that COVID-19 vaccines could somehow trigger the syndrome, there’s no evidence that Bieber ever had the vaccine within a plausible timeframe for it to be related to his current condition. Indeed, there are case reports of COVID-19 infection resulting in Ramsay Hunt syndrome. It’s antivaxxers doing their damnedest to blame his condition on vaccines, in the absence of not just evidence but even a plausible correlation.
But what about Bieber’s wife, Hailey Bieber?
Hailey Bieber’s “small stroke”
In March, stories started appearing in the media about Hailey Bieber suffering a “small stroke”, for instance, as this article in People Magazine describes:
Bieber shared a screenshot of the Notes app on her Instagram Stories on Saturday, March 12. In the message, she revealed details about her hospitalization on Thursday, March 10 while she was having a meal with her husband, Justin Bieber.
“On Thursday morning, I was sitting at breakfast with my husband when I started having stroke like symptoms and was taken to the hospital,” the 25-year-old wrote. “They found I had suffered a very small blood clot to my brain, which caused a small lack of oxygen, but my body had passed it on its own and I recovered completely within a few hours.”
Unsurprisingly, given the diagnosis of a small stroke, then as now, antivaxxers were quick to blame COVID-19 vaccines, a claim that, as you can see from some of the Tweets that I included in this post, they’re returning to since her husband’s announcement that he has been diagnosed with Ramsay Hunt syndrome; I will not rehash that with additional examples. What I will mention is that her stroke was actually not a full-blown stroke, but rather what is colloquially called a “mini-stroke”, a common lay term for a transient ischemic attack (TIA). TIAs occur when there is blockage of a blood vessel to the brain that resolves on its own, often from a small clot being dislodged and traveling to the brain.
From a news story a month ago:
The 25-year-old model explained how her fingertips went numb and she lost her ability to speak.
“The right side of my face started drooping,” she said.
Dr. Ryan Fillmore, neuro-intensivist and medical director of the stroke program at Novant Health Presbyterian Medical Center, said Bieber’s symptoms were classic signs of a stroke, which is a blockage of blood flow to the brain.
In her case, however, the quicker passing of symptoms made Bieber’s a transient ischemic attack (TIA), which many people call a ministroke.
Fillmore said a TIA is generally more short-lived than a full-blown stroke.
“When symptoms last more than 24 hours, at that point, you would be considered to have had a stroke,” Fillmore said. “The other key difference is, on findings on brain imaging, in a stroke, you would have permanent brain damage.”
It also turns out that Bieber’s risk factors for having a TIA were actually came out fairly quickly in her medical workup. About a month and a half ago, Hailey Bieber posted this video to YouTube, which mentions some of them:
You don’t have to watch the video, as I can summarize from this article:
In her video, Bieber describes how doctors found several factors that likely led to her condition, including a hole in her heart, a recent COVID-19 infection, long airplane travel during which she did not move much, and birth control.
“I had just recently started birth control pills, which I should have never been on because I am somebody who suffers from migraines,” Bieber said, noting that she never discussed that point with a doctor before going on the medication.
Fillmore said, in some cases, migraines can point to a clotting condition, and birth control and immobility on a flight can both increase the risk of clots on their own, particularly those in the legs.
“If you have a hole in your heart, then you have an abnormal connection between the veins and arteries of your body,” Fillmore said. “So, if there is a clot in your leg in the veins, that can travel up to the heart and go through that abnormal hole in the heart, and subsequently travel to the brain and cause your strokes and ministrokes.”
It turns out that that “hole in the heart” was a patent foramen ovale:
More tests revealed that Hailey had a patent foramen ovale (PFO), a small opening between the upper heart chambers, the right and the left atrium.
Hailey’s PFO was grade 5, the highest grade, and it was between 12 (.47 inch) and 13 (.51 inch) millimeters, she said.
The blood clot inside Hailey allegedly escaped through the opening and traveled to her brain, which is what caused her TIA.
Hailey underwent a PFO closure operation to plug the gap inside her heart and she was able “to move on from this really scary situation.”
Normally, this hole between the two atria closes shortly before birth, and it’s a fairly common condition, particularly given that people with a PFO and no other heart abnormalities are generally asymptomatic. Apparently this was the case for Hailey Bieber; that is, until she had her TIA, after which the PFO was diagnosed (as it’s in the differential diagnosis for stroke in a young person) and fixed.
The bottom line is that, not only was Hailey Barber’s TIA not caused by the COVID-19 vaccine, very likely her having had COVID-19 contributed to the clotting that led to her TIA. However, first, foremost, and always, any health issue suffered by a celebrity must have been due to vaccines, because that’s how antivaxxers roll. It doesn’t matter if there’s a plausible link or not. It doesn’t matter that explanations for what happened exist all over the mainstream media. What matters is the narrative, and it doesn’t matter how often it is pointed out that the COVID-19 vaccine doesn’t cause Ramsay Hunt syndrome or other people who suffer from it are reported.
To antivaxxers, it’s always about the vaccines, which is why antivaxxers are promoting the false narrative that Justin Bieber is “vaccine injured.”