Here’s a message I receive almost every day: “I have the opportunity to get the J&J vaccine but I’m considering holding out for Pfizer/Moderna. Thoughts?”
My advice: Take the J&J vaccine now. 1/
There is still a very high level of #coronavirus transmission in the United States and the J&J vaccine provides rapid protection. (You’re fully-vaccinated two weeks after a single shot).
The overwhelming majority of #COVID19 patients I treat are people who have never been vaccinated. Occasionally, I’ll see a fully-vaccinated patient who has symptomatic COVID, but this is an exception, and I have never met a hospitalized COVID patient who received the J&J vaccine.
We don’t have to pretend the 3 #COVID19 vaccines are identical. They’re not. They were tested at different times in different groups when the prevalence of variants was different. But all 3 are incredibly effective. If you have the opportunity to get the J&J vaccine, take it.

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More from @DrMattMcCarthy

9 Apr
Fully-vaccinated people have been reaching out with questions about resuming normal life. (Yesterday: Is it safe to fly to a bachelorette party?).
Here's how I think about these questions: 1/
I'm occasionally asked to "clear" a patient for surgery. This might be an older person with heart disease who needs a massive operation and the surgeons want to make sure it's safe to move forward with the procedure. In practice, I don't ever "clear" the patient.
Instead, I provide a risk assessment. I also offer ways to limit that risk. Sometimes, the risks outweigh the potential benefits and the operation is cancelled. Most of the time, surgery moves forward as planned.
This analogy extends to post-vaccination life:
Read 4 tweets
10 Mar
UPDATE: The NIH-sponsored #COVID19 study, ACTIV-1, has now enrolled 470 patients at 31 medical centers in the United States. A data safety monitoring board will soon meet to evaluate preliminary results. This meeting could alter the way doctors treat #coronavirus. 1/
Hospitalized COVID patients who need oxygen are treated with two drugs: remdesivir (an antiviral) & dexamethasone (an anti-inflammatory). Patients in ACTIV-1 receive these drugs AND are randomized to one of 3 immunomodulators: abatacept, infliximab, or cenicriviroc (or placebo).
I lead this study at my hospital (we've enrolled 33). Clinicians occasionally stop me in the hall and ask if any one of the drugs seems to be working. The truth: I don't know. It's a double-blind study, so patients and doctors don't know if they're actually getting the real drug.
Read 4 tweets
1 Mar
New York confirmed its first case of coronavirus one year ago today. I went on @CNBC the next day to discuss what was coming: "Widespread disruption to daily life." 1/
I treated my first confirmed case on March 9, 2020. I prescribed hydroxychloroquine and azithromycin and did not use steroids. These decisions would later prove to be wrong.
I've spent most of the past year treating and studying #COVID. Surprises:
1) Patients may have oxygen levels that appear incompatible with life yet feel fine (silent hypoxia).
2) Some seem to have blood clots we can't find.
3) Others develop severe inflammation of blood vessels.
Read 6 tweets
10 Feb
NEW from CDC: "Fully vaccinated persons who meet criteria will no longer be required to quarantine following an exposure to someone with COVID-19." Here's what it means to "meet criteria": 1/…
1. Fully vaccinated (≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine).
2. Are within 3 months following receipt of the last dose in the series.
3. Have remained asymptomatic since the exposure.
Guidance does not appear to be based on new experimental data: "...individual and societal benefits of avoiding unnecessary quarantine may outweigh the potential but unknown risk of transmission."
Read 4 tweets
8 Feb
COVID Mystery: Why are some patients asymptomatic while others need to be hospitalized? We've known for a year that #COVID19 patients who have trouble breathing often have too much inflammation in the lungs (alveolitis). Now we know what's happening on a microscopic level: 1/
Within the lungs, an inflammatory cell called a macrophage becomes infected with #coronavirus, prompting the cell to release signals that attract T cells. These activated T cells then stimulate macrophages, forming a feedback loop that drives inflammation.…
This is a crucial insight with important implications for treatment. It suggests we might help the sickest #COVID patients by disrupting the inflammatory feedback loop with drugs that inhibit macrophages or activated T cells. There's an NIH-sponsored study trying to do just that.
Read 4 tweets
8 Feb
The FDA has updated its emergency authorization for convalescent plasma, narrowing its use to a smaller subset of #COVID patients. It was a necessary move, but I'm concerned the revision doesn't do enough to curb the emergence of viral variants. Here’s the problem: 1/
Plasma is still authorized for hospitalized #COVID19 patients who have impaired humoral immunity. These patients have trouble making antibodies and other proteins. At first glance, this makes sense: People who can’t make antibodies should be given some. But it’s not that simple.
Patients with immune impairment can serve as incubators that accelerate viral evolution, especially when they’re given plasma. Some won't clear the virus, allowing it to fester and mutate. If given at the wrong time, plasma could make things worse.…
Read 6 tweets

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