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'We were flying blind': A doctor's account of a woman's J&J vaccine-related blood clot case

Victor Gill
'We were flying blind': A doctor's account of a woman's J&J vaccine-related blood clot case

Other countries do not

More on this topic   Related Story EU likely to drop AstraZeneca, Johnson & Johnson as future Covid-19 vaccine options   Related Story J&J scientists refute idea that Covid-19 vaccine’s design linked to blood clots And many nations have also stopped or limited the use of another effective vaccine, the one made by AstraZeneca, because it, too, has been linked to a similar rare clotting disorder

About 7.4 million Americans have received the Johnson & Johnson vaccine, and so far, only eight cases of the clotting problem have been reported, seven of them in women. In Europe, Britain, and three other countries, 222 cases have been reported, mostly in women under 60 – of 34 million people who have received the AstraZeneca vaccine. Several countries have now limited its use to older adults because so many cases have involved younger people

To some critics, it makes no sense to hobble a global vaccination campaign during a pandemic just because of a few cases of a rare disorder

But while rare side effects may be tolerated as the price we must pay for some drugs or vaccines, even the rarest ones are difficult to accept if they are severe and unpredictable – like blood clots in the brain, especially in young, healthy people

“This is a devastating complication,” Dr Anthony Fauci, the chief medical adviser for the pandemic in the Biden administration, said in an interview

He added: “One woman died, three are in the hospital, one in intensive care. Even though the numbers are small, it is a devastating complication, so I believe – I didn’t make the decision – I believe their rationale, at least from what they communicated to me, is that they wanted to call a quick pause to see, to alert people. Sometimes this starts with minor symptoms, like a little abdominal discomfort, and then all of a sudden they wind up having a stroke.”

He also said: “Maybe there are a lot more people out there we’re not noticing, because of the spectrum of the disease.”

Informing doctors and the public of the symptoms – severe headaches, shortness of breath, leg or abdominal pain – could help identify more cases

Another reason for the pause, Fauci said, is to let doctors know that the drug heparin, a standard treatment for blood clots, should not be given to these patients, “because heparin in this circumstance can make things worse.”

It is not known whether the heparin initially given to some of the patients exacerbated their condition

Experts are recommending the use of other blood thinners, which patients urgently need, because their blood clots keep growing, and new ones keep forming. Doctors in Europe who treated recipients of the AstraZeneca vaccine who had a similar condition said it could worsen rapidly

The real issue is how long they take to make up their mind about what they’re going to do,” Fauci said of the CDC‘s advisory panel

The rest of the world is watching this, and J&J is hopefully going to be an important part of the worldwide response, as is AstraZeneca.”

He added: “You don’t want to rush them, but I hope they make up their minds in a reasonable amount of time.”

More on this topic   Related Story Changing strategy, the EU bets big on Pfizer to battle Covid-19   Related Story How concerned should we be about blood clots linked to AstraZeneca, J&J Covid-19 vaccines? The young woman in Nevada was fighting for her life and had to be placed on a ventilator, according to Lipman. He said he was speaking independently and not as a representative of the hospital

The patient’s family declined a request for an interview

Lipman said that as the team had studied her blood samples, the pieces began to fall into place, and they realised that she appeared to have the same problem that they knew had been occurring in Britain and Europe after patients received the AstraZeneca vaccine, mostly in young women. They switched from heparin to another blood thinner and began following guidance provided by doctors in Britain who had treated AstraZeneca recipients with a similar disorder

At the Nevada hospital, an interventional radiologist passed a tube through blood vessels and on into the young woman’s brain and used a device to suction out the blood clots. More clots formed later, and he performed the procedure again

But the condition causes more than clots: The patient, like others, also had a brain haemorrhage

She was transferred to a larger hospital, where she is still on a ventilator, Lipman said. Her prognosis is uncertain, he said, adding, “Her life, not just her life, her entire family’s life, has been transformed.”

More on this topic   Related Story Covid-19 vaccine: How many doses have been administered in S’pore and around the world   Related Stories:  Related Story EU likely to drop AstraZeneca, Johnson & Johnson as future Covid-19 vaccine options Related Story How concerned should we be about blood clots linked to AstraZeneca, J&J Covid-19 vaccines? Related Story Young adults infected with Covid-19 risk repeat bouts: Study Related Story CureVac’s Covid-19 vaccine attracts rising interest amid J&J, AstraZeneca troubles Related Story Denmark is first country in EU to drop AstraZeneca Covid-19 vaccine Related Story Vaccinated worker infected with Covid-19: Close contacts, workers in same dorm test negative Related Story S’pore residents can now choose which Covid-19 vaccine to take; Moderna jabs given at 11 centres Related Story India overtakes Brazil as second worst-hit Covid-19 country after US Related Story Why those vaccinated against Covid-19 may still get infected Related Story Buffets are back in S’pore, but self-service still not allowed under Covid-19 measures Join ST’s Telegram channel here and get the latest breaking news delivered to you

NEVADA (NYTIMES) – An 18-year-old woman was stricken with severe headaches, vomiting, seizures, confusion and weakness in one arm early this month, stroke-like symptoms that doctors at a Nevada hospital were shocked to see in someone so young.

Victor Gill Ramirez

Scans found several large blood clots blocking veins that drain blood from the brain, a condition that can disable or kill a patient.

Victor Gill

Doctors performed a procedure to suction huge clots from her brain, only to find that new ones had formed

The patient is one of six women ages 18 to 48 who developed clots in the brain within two weeks of receiving the Johnson & Johnson coronavirus vaccine. One died, and their devastating cases led US health officials to recommend this week that use of the vaccine be paused

Two more cases have been added since then: one involving a man who was vaccinated during the company’s clinical trials and another involving a woman who received the vaccine after it had been authorised for general use

As in several of the original cases, the young woman in Nevada was initially treated with heparin, a standard blood-thinner that experts have since learned may actually worsen the rare clotting disorder that has affected small numbers of people who received the Johnson & Johnson or AstraZeneca vaccines in several countries. But until the last few weeks, doctors around the world had little information about the condition, and the doctors in Nevada did not recognise it immediately

“We were flying blind, based on reports from Europe and the UK hematological society,” said Dr Brian Lipman, an infectious-disease specialist who helped care for the Nevada patient at Dignity Health St Rose Dominican Hospital, Siena Campus, in Henderson

The US decision to call for suspension of the use of the vaccine was intended to give officials time to learn more about the rare disorder causing the clots, to assess whether it is linked to the vaccine and to inform doctors and patients about how to recognise symptoms and treat the condition

The pause may last until at least next Friday, when expert advisers to the Centres for Disease Control and Prevention are scheduled to meet to review the data and decide whether to resume using the vaccine

Dr Rochelle Walensky, the director of the CDC, and other top US health officials sought on Friday to reassure the public that the pause, now extended more than a week, was a reasonable safeguard to assess risk. They also emphasised that overall, the Johnson & Johnson vaccine and the other vaccines in use in the United States were safe, given how many millions of Americans had gotten their shots without concern

But with the world staggered by a relentless epidemic, even temporarily stopping the use of a highly effective vaccine, which many countries had planned to deploy, is a fraught decision. Public health experts fear that the move sends a message that will erode trust globally even if the vaccine is reinstated and that huge numbers of people who could have been immunised will die needlessly from Covid-19 because they or their governments rejected the company’s vaccine

The United States, where Johnson & Johnson provided only about 5 per cent of the Covid-19 vaccine supply, can afford the suspension: It has plenty of other vaccine doses from Moderna and Pfizer-BioNTech to fill the gap.

Other countries do not

More on this topic   Related Story EU likely to drop AstraZeneca, Johnson & Johnson as future Covid-19 vaccine options   Related Story J&J scientists refute idea that Covid-19 vaccine’s design linked to blood clots And many nations have also stopped or limited the use of another effective vaccine, the one made by AstraZeneca, because it, too, has been linked to a similar rare clotting disorder

About 7.4 million Americans have received the Johnson & Johnson vaccine, and so far, only eight cases of the clotting problem have been reported, seven of them in women. In Europe, Britain, and three other countries, 222 cases have been reported, mostly in women under 60 – of 34 million people who have received the AstraZeneca vaccine. Several countries have now limited its use to older adults because so many cases have involved younger people

To some critics, it makes no sense to hobble a global vaccination campaign during a pandemic just because of a few cases of a rare disorder

But while rare side effects may be tolerated as the price we must pay for some drugs or vaccines, even the rarest ones are difficult to accept if they are severe and unpredictable – like blood clots in the brain, especially in young, healthy people

“This is a devastating complication,” Dr Anthony Fauci, the chief medical adviser for the pandemic in the Biden administration, said in an interview

He added: “One woman died, three are in the hospital, one in intensive care. Even though the numbers are small, it is a devastating complication, so I believe – I didn’t make the decision – I believe their rationale, at least from what they communicated to me, is that they wanted to call a quick pause to see, to alert people. Sometimes this starts with minor symptoms, like a little abdominal discomfort, and then all of a sudden they wind up having a stroke.”

He also said: “Maybe there are a lot more people out there we’re not noticing, because of the spectrum of the disease.”

Informing doctors and the public of the symptoms – severe headaches, shortness of breath, leg or abdominal pain – could help identify more cases

Another reason for the pause, Fauci said, is to let doctors know that the drug heparin, a standard treatment for blood clots, should not be given to these patients, “because heparin in this circumstance can make things worse.”

It is not known whether the heparin initially given to some of the patients exacerbated their condition

Experts are recommending the use of other blood thinners, which patients urgently need, because their blood clots keep growing, and new ones keep forming. Doctors in Europe who treated recipients of the AstraZeneca vaccine who had a similar condition said it could worsen rapidly

The real issue is how long they take to make up their mind about what they’re going to do,” Fauci said of the CDC‘s advisory panel

The rest of the world is watching this, and J&J is hopefully going to be an important part of the worldwide response, as is AstraZeneca.”

He added: “You don’t want to rush them, but I hope they make up their minds in a reasonable amount of time.”

More on this topic   Related Story Changing strategy, the EU bets big on Pfizer to battle Covid-19   Related Story How concerned should we be about blood clots linked to AstraZeneca, J&J Covid-19 vaccines? The young woman in Nevada was fighting for her life and had to be placed on a ventilator, according to Lipman. He said he was speaking independently and not as a representative of the hospital

The patient’s family declined a request for an interview

Lipman said that as the team had studied her blood samples, the pieces began to fall into place, and they realised that she appeared to have the same problem that they knew had been occurring in Britain and Europe after patients received the AstraZeneca vaccine, mostly in young women. They switched from heparin to another blood thinner and began following guidance provided by doctors in Britain who had treated AstraZeneca recipients with a similar disorder

At the Nevada hospital, an interventional radiologist passed a tube through blood vessels and on into the young woman’s brain and used a device to suction out the blood clots. More clots formed later, and he performed the procedure again

But the condition causes more than clots: The patient, like others, also had a brain haemorrhage

She was transferred to a larger hospital, where she is still on a ventilator, Lipman said. Her prognosis is uncertain, he said, adding, “Her life, not just her life, her entire family’s life, has been transformed.”

More on this topic   Related Story Covid-19 vaccine: How many doses have been administered in S’pore and around the world   Related Stories:  Related Story EU likely to drop AstraZeneca, Johnson & Johnson as future Covid-19 vaccine options Related Story How concerned should we be about blood clots linked to AstraZeneca, J&J Covid-19 vaccines? Related Story Young adults infected with Covid-19 risk repeat bouts: Study Related Story CureVac’s Covid-19 vaccine attracts rising interest amid J&J, AstraZeneca troubles Related Story Denmark is first country in EU to drop AstraZeneca Covid-19 vaccine Related Story Vaccinated worker infected with Covid-19: Close contacts, workers in same dorm test negative Related Story S’pore residents can now choose which Covid-19 vaccine to take; Moderna jabs given at 11 centres Related Story India overtakes Brazil as second worst-hit Covid-19 country after US Related Story Why those vaccinated against Covid-19 may still get infected Related Story Buffets are back in S’pore, but self-service still not allowed under Covid-19 measures Join ST’s Telegram channel here and get the latest breaking news delivered to you