I cleared my schedule to watch ACIP discuss the J&J vaccine.
I'll try to live tweet important portions for those who didn't take the day off.
Interesting comparison slide between AZ and J&J clot epidemiology and symptoms
Good question about age difference between AZ and J&J clots.
Could the difference in mean age be related to the timing and rollout of J&J vaccine and not be a function of age. Older ppl got mRNA vaccines bc the came out first.
Answer- more to come on that later today.
I kept asking people to stop saying "only 6 cases" we all knew more were coming.
More cases are under review. Some of those under review are cases in males.
Data source- VAERS (which is subject to underreporting)
Cases in Females broken down by age (N=15).
0 were pregnant/post partum
2 on oral contraception
7 obese
All heparin treatment was before the notice went out to Healthcare providers.
None of the 3 deaths recieved heparin.
10 under review as potential cases using the restrictive case definition.

Well expand case def and they expect more cases that need to be underreview.
I don't like verbal public comment periods!
Risk benefit of J&J present by Janssen researchers.
Supports a warning on label
Proposed warning
More on proposed warning
J&J wants awareness, enhanced labeling, and education, and wants the paused lifted because of variants and impacts that a pause in America could have on global vaccine uptake, hesitancy, and goal of herd immunity.
I'm excited about this current talk. Here's what she plans to address
7 day average of Covid cases, just in case you haven't seen data in a while
Epi of Covid-19 since March 1
Faster growing covid rates in adults, females 18-29
Mortality 3 per 100,000
26 cases of TTS will occur but 2200 hospitalizations and 1400 deaths prevented if J&J resumed for all adults.
Lost confidence in J&J over the last month, but this doesn't extend to the mRNA vaccines
Populations most likely to be impacted by pulling J&J vaccine
listening to the 4 policy options. Here's the 2 I prefer.
either restrict access to those 50 and over, or provide really detail education to females under 50.

My problem with education for females under 50 is the implementation of this.
This is the option currently being discussed. (4th option, educate women under 50)
If it was a warning, how would it be implemented?
Response- we'll educate providers and general public through infographics.
Q's from members
Q- why not just give J&J to males only?
Q- why would it be challenging for sites to carry two vaccines? Lots are doing this already?
Q- BIPOC communities feel targeted & don't like that bc of J&J lower efficacy and now safety concerns. Any look into this?
Here's all 4 options
Better picture of the 4 options. Male only is not an option mainly bc there was 1 case in phase 3 trials in a male and there's some males being examined in the potential case data.
Member questions
Q- Is it harder to keep multiple types of vaccines on site or educators all providers and the public on the risks of TTS?

Q- could sites publicize which vaccines they have so the public could decide where to go to get the vaccine that's best for them?
I should have been keeping track, but so far, most are leaning towards option 4, a couple has expressed interest in option 3. Options 1 and 2 aren't being discussed at this time.
Discussion, is there a differences between #2 and 4?
And how will the "may choose another vaccine" be implemented if sites only have 1 vaccine available?
A- ACIP would reinforce that a certain group has a small risk of a serious adverse event.
2nd for #2, keep it simple.
Here's my concern...
people are pushing for J&J for ease of vaccinating incarcerated, homeless, transient population.
But, how well will we be able to identify TTS in these groups? Healthcare access will be an issue, How well will we intervene in these groups when TTS occurs?
I'm getting tired, but I want to hang in to see the final vote. Send energy my way.

Options 1 and 3 have been taken off the table. Voting will be for options 2 or 4.
Proposed language that will be made into a fact sheet and infographics if ACIP moves forward with option 2 or 4.
I hope they change the word "remote". That wouldn't resonate with all people.
Great discussion going on
Q- Will J&J let people know that there are other vaccine options?
A- very vague response
Q- Will people recieve the fact sheet right before their appointment? like after they already traveled there and are awaiting their vaccination?
A- vague response
Vote occurring on this
10 in favor, 4 oppose, 1 abstained

JJ so continue to be offered for those 18 in over.

There's no informed consent requirement.

A person who voted yes said it will be up to local health departments to ensure people understand risk.

I'll have my job cut out for me.

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More from @Theresa_Chapple

16 Mar
My college's motto is "I'll find a way or make one." @ClarkAtlanta
This motto has allowed me to think outside the box in all aspects of my life. But this has been most useful during the pandemic.
I have a nothing is impossible take.
How does this stance help?
Well 3ft v 6 ft debate. Why are are debating this? To get more kids in in-person learning. What else could achieve this goal? Maybe utilize all the empty buildings we drive past everyday. My work building is green and healthy building designated with amazing ventilation.
It's sitting empty. Why not host schools in these buildings? Vaccination- could we vaccinate at places people already go? Pop up clinics at grocery store parking lots? Mobile clinics in hard to reach areas? mass Vaccination sites in large housing complexes?
Read 4 tweets
4 Mar
Okay, I'm about to start listening.
Thanks @AmyBaugher for bringing this podcast to my attention, and thanks @statsepi for preparing me for the offenses I'm about to hear.

And to think, this was released during #BlackHistoryMonth

🧵 live tweeting this podcast
Title: #StructuralRacism for Doctors- What is it?
1st the title is distressing. Why are we still asking what is it? Why aren't we focused on addressing it? Still defining something that is clear, noted in research, & pervasive is problematic & stalls progress.
Pressing play now
"We discussed structural racism. Going into this interview I didn't understand the concept." I'm confused, who are you? There's no introduction of the narrator. What field is he from? What work does he do? Does he interact with patients & not understand this life & death concept?
Read 27 tweets
3 Mar
Logistics matter when planning a vaccine clinic, especially for high risk populations. Today, one of "my seniors" that I've been helping secure vaccination spots, drove over an hour for an appointment. They waited in line at the drive through vaccinated site.
Here's the problem-
Older people often have to use the bathroom frequently. That was the case here. However, this person was not allowed to get out of the car. They were terrified to break the rules because of the police presence & didn't want to leave because it took months to get a appointment.
This elderly person wet themselves all while waiting to get vaccinated.

Yesterday I was told about a disabled elderly person at a walk up clinic who left instead of getting vaccinated because their health condition didn't allow for them to wait hours in the cold.
Read 4 tweets
26 Feb
@Epi_D_Nique and I collaborated to provide a user-friendly review of the CDC’s study on #Covid_19 spread in elementary #schools in one Georgia district. This study is important because of its focus on young children and community spread. Happy🧵reading! cdc.gov/mmwr/volumes/7…
Data were collected over 24 school days (Dec 1-Jan 22, 2021) on Covid-19 spread in and outside of elementary schools, from Cobb County, GA. What’s interesting about this study? It focuses solely on elementary schools. Why is that important?
These schools serve the youngest group of school age kids, and some believe their contribution to Covid spread is negligible. We know that young kids have less extreme symptoms and lower risk of death compared to older children and adults.
Read 26 tweets
20 Feb
my concern about the CDC operational report on reopening schools
new classification of low, moderate, substantial, and high.
Low is 0-9 cases per 100,000 with a test positivity rate of less than 5%.
moderate combined 2 previous levels and includes up to 8% + rates
I get that the thought is younger children are less likely to contract the virus, but at the same time we believe that pregnant ppl are at increased risk of contracting the virus. It is not a leap to believe elementary age children may live with a pregnant parent.
This is actually highly common for the 40% of families with 3 or more children. Yet, in moderate/low areas, there's no recommendation for virtual school for elementary age kids.
This is a concern for anyone that has any health condition making in-person school particularly risky
Read 20 tweets
17 Feb
3rd grade homework assignment was to discuss with the family why we live where we live. I tried to broadly answer, but my daughter kept probing. Qualitative researcher in the making?
The conversation I didn't want to have, that I ended up having, was about the racism we endured.
I tried to focus on us moving from ATL to MD because of my job. But she's old enough to remember that this is not our 1st home in MD.
Why did we move from our 1st MD home, she askes?
Crap, truth or lie? Think quick. Truth won out.
Our neighbors kept calling the police on us.
She wanted details, why? which ones? how often? was she happy or scared to see the police? She had all the probes.
I explained, everytime we'd enter the home through the front door instead of the garage, the neighbors would report a burglary in progress.
Read 6 tweets

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