Working out the Kinks

To my Patients and Friends,

Here’s the latest COVID-19 update… I hope you find it helpful.

Clearing up some clotting questions

You most certainly have heard about the recent Johnson & Johnson Covid vaccine pause as a result of reports of a rare clotting disorder called Cerebral Venous Sinus Thrombosis (CVST).  First of all, it’s important to know that less than 1 per million vaccine recipients have experienced CVST, whereas in the general population, the incidence of CVST is actually higher, at 3-4 per million.

Based on data to date, symptoms of CVST have arisen within two weeks after administration of the vaccine.  Symptoms to be aware of include:

  • Severe headache
  • Backache
  • New neurologic symptoms (ex: weakness, change in mentation, slurring of speech, visual change)
  • Severe abdominal pain
  • Shortness of breath
  • Leg swelling
  • New or easy bruising
  • A red spotty rash called petechiae

Although there is great concern that this pause will lead to increased vaccine hesitancy and mistrust among potential vaccine recipients, pauses like this are not uncommon, and it should really be seen as an indication that the system is working and that the FDA and CDC are doing their jobs: to diligently monitor the effects of vaccines in order to keep us safe and protected.  An important consideration is also that, because of the unique nature of this type of clotting disorder, it is treated differently than a much more common type of clot, i.e., deep vein thrombosis (or DVT)- a type of blood clot that can arise in the limbs.  Therefore, this appropriate pause allows time to ensure that medical personnel are educated to be aware of this phenomenon in order to act appropriately when there is suspicion of CVST.  It’s also important to be aware that this type of vaccine will be critical in ensuring that disadvantaged populations around the world will have easy access to vaccinations in order to more effectively bring an end to the pandemic… so we need it!

The pause is expected to continue for at least another week (final return-to-market date TBD), and we are not sure at this stage whether or not the vaccine will be re-labeled to exclude certain categories of recipients (ex: younger women)… stay tuned.

Be one who is aware of B.1.1.7.

As I’ve discussed in previous installments, the B.1.1.7 (or U.K. variant) has now become the dominant strain in the United States (and here in Connecticut).  Studies have been mixed as to whether or not this variant causes more severe disease, although the preponderance of evidence seems to suggest that it does. Additionally, evidence suggests that it can cause a more prolonged illness and is more transmissible, most likely because those who contract this virus have a higher viral load than is the case with the “original” strain.  Most importantly, it has an increased affinity for younger people.  And in fact, we have seen more young people hospitalized since this strain has become more predominant.  Although current vaccines seem to offer adequate protection against the strain, the majority of young people (i.e., under age 30) have not been fully vaccinated and are therefore vulnerable.  This represents a meaningful chink in the armor, particularly as related to schools and colleges, the expectation being that we will continue to see increased spread of the virus among these populations in the coming weeks, particularly after students return from spring break travel and resume participating in extracurricular activities such as youth sports.  Unfortunately, school administrators need to be on the alert for this.  In other countries including Canada, and in many areas here in the US, including Michigan, Minnesota and the Northeast region, this variant has caused huge problems and has resulted in numerous shutdowns.  And the incidence is currently high in Fairfield County.  The esteemed Dr. Mike Osterholm has much more to say about this in his most recent podcast.

Vaccines for kids

Pfizer has requested approval to allow their COVID-19 vaccine to be administered to children ages 12 through 15.  Hopefully, Emergency Use Authorization (EUA) will be granted within the month… stay tuned!

Vaccine boosters on the horizon

Many experts believe that boosters will be required, perhaps within a year after an initial vaccination series.  For instance, Moderna is planning on having a COVID-19 booster vaccine available by this coming fall… and boosters are being designed to protect against emerging variants of the virus.  These boosters will likely be essential in our ongoing battle against the pandemic, as viral mutations leading to new variants are expected to continue occurring over the course of time.  I encourage you to have faith in the system… it continues to work hard and well on behalf of us all.

That’s all for now… be safe and don’t be afraid of vaccines!  I hope you all have a nice weekend.