U.S. Calls for Pause on Johnson & Johnson Vaccine After Blood Clotting Cases

From The New York Times:

Injections of Johnson & Johnson’s coronavirus vaccine came to a sudden halt across the country on Tuesday after federal health agencies called for a pause in the vaccine’s use as they examine a rare blood-clotting disorder that emerged in six recipients.

Which has led to some very bad hot takes:

One death after 7 million J&J vaccinations for these blood clots (which they don’t even know are attributable to the vaccine), versus over 50,000 dead per 7 million cases of COVID in Americans. That’s a ratio of 1 : 50,000. You can fairly argue those mortality numbers are skewed by the fact that COVID has already ripped through our nursing homes, killing a lot of our most vulnerable people, but still, the risk numbers aren’t even in the same ballpark. And mortality numbers don’t include the millions of Americans who suffered or are suffering from severe cases that require hospitalization.

This is criminal innumeracy.

No, it’s not.

And this:

Given a bit of time to process the information, this seems the be the right take. From @craig_a_spencer, a New York City ER doc:

The many hot takes on here that the complications from J&J are so rare we shouldn’t have paused it’s use are persuasive at face value. The pandemic IS still raging. We NEED shots in arms. And the risk is SO low! This is all true.

But that argument is missing something critical.

If my loved one was among the 6 with a complication AND the FDA/CDC/US govt knew there was a signal but didn’t act, I’d be furious.

I really appreciate the transparency here.

They could’ve easily argued this away…”this is the background rate of clots” etc. But they didn’t.

Will this mean it’ll be harder to convince many, especially younger women, to get the J&J vaccine if/when we start using it widely again? Yes.

…even if the risk is shown to be much lower than Covid, getting struck by lighting, or dying from a vending machine crushing you? Yes.

But the practical importance of this pause – and how it was messaged, with a focus on informing providers – was huge. And really responsible.

I was in the ER today. One of the first patients I saw after getting briefed on the J&J decision was a young woman in her 30s.

She got the J&J vaccine a week ago. She had symptoms that overlap with those we were told to look out for. Today’s announcement changed my differential diagnosis & impacted my clinical management.

That’s exactly what it was meant to do. It’s also how we’ll get the data we need.

Look, let’s stop pretending that people don’t know the difference between vaccines. Or that potential issues with one vaccine means they won’t get the others if they’re available to them.

Will today’s announcement impact vaccine hesitancy? Perhaps. Maybe a bit. At most.

But more importantly, it should drastically improve our faith in the public health institutions tasked with protecting us. With how they had been politicized & over-ruled by the previous admin, this is critical.

And that’s exactly why I think today’s decision was the right one.

Link to tweet thread.

This pandemic isn’t an episode of House, MD. The principle of “first, do no harm” doesn’t mean the CDC and other government (science-focused) agencies should make a game theory-informed calculation about whether announcing the J&J vaccine pause will cause folks to go unvaccinated. The point was to raise awareness among care providers and better inform them. The public masses have been misinterpreting the science and the messaging for a long while now. This latest round of it is just that – the latest round of it. And around we’ll continue to go.

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