Thread by @MPaiMD

So you read today’s NACI advice - AZ ok if you’re 30+! Unless you can wait for mRNA 💉! And then you read the MANY hot takes from experts, non-experts, and para-experts. And you are SCARED. Let’s work through it. (The required reading is below). 1/n ema.europa.eu/en/documents/c…

Disclaimer: I’m a blood clot doctor. I am not a public health expert. Or an ID doc. But you wouldn’t believe how much I talk to people about weighing their risk of clots. (So much.) I can help you make good choices for you (and be less petrified if you just got AZ yesterday.) 2/n

Here’s the real UP TO DATE (as of now) risk of getting VITT (the bad AZ clots). If you’re under 50 it’s between 1/50K and 1/100K. Wish I could be more precise. But when the science is moving fast and the event is rare, you can’t make better predictions than that. 3/n

We don’t really think gender impacts that risk. Or: history of clots (except HIT and maybe CSVT according to Health Canada), birth control, pregnancy, autoimmune disease, low or high platelets, family history of clots, taking blood thinners or aspirin. 4/n

Let’s hold onto that 1/50-100K risk. That is the risk of GETTING A BAD BLOOD CLOT WITH AZ. You can be somewhat reassured by this fact: healthcare providers across Canada know how to spot and treat these clots. They are treatable. 5/n

Risks don’t matter unless you weigh them. Put the 1/50-100K risk of taking AZ on one side of the scale. What’s going on the other side? The risk of not taking AZ. Are you scared of dying of COVID? Being hospitalized? (That one scared me - I have 2 little kids). 6/n

You might be scared of being in the ICU (esp as we are running out of beds). Maybe even catching it and spreading it to a vulnerable loved one scares you. How do we figure THIS out? 7/n

Here’s where the required reading comes in. Scroll through it. It will tell you how to weigh your AZ risk. Because you’re under 50... or 40... if there’s not a lot of COVID around, your risk of all that bad stuff is low. 8/n

You don’t need to run for a COVID vaccine NOW if you’re literally seeing nobody. Or if you live in New Zealand (like my dear and lucky friend, @CWLBloodDoc!) But what if you live in Ontario? 9/n

There are some communities that have really high infection rates. Check out page 3, 6, 9. Notice how the scale tips? AZ benefits outweigh risks. No contest.
10/n. ema.europa.eu/en/documents/c…

If you live in the GTA, and in many other hot areas of ON, you could ignore the scales and wait for Pfizer or Moderna. That is your right. But with community transmission being so high, you are taking on a large amount of risk. Patients in our ICUs right now were waiting... 11/n

for a vaccine (often, desperately hoping for any vaccine!) Many will not survive that wait. Most who survive will have longstanding health problems. 12/n

If you’re in a moderate risk area (page 4,7,10) the scale still tips towards getting AZ instead of waiting. A lot of places in ON are moderate risk. Some people with “public facing” or “essential work” in those areas are actually at high risk. 13/n

Talk to your doc if the ⚖️ look wobbly when you do your own personal math. Other reasons to tip that scale: you have health problems, are older, are really worried about COVID, or COVID has attained your healthcare (eg. 🇮🇳, many parts of 🇨🇦) 14/n

What if you’re in a LOW infection risk situation? Man. I’d love to live there. Please be honest with yourself about your risk of catching COVID. I’m being honest with you about your risk of blood clots with AZ, based on all I know as a blood clot doctor now, on Friday night. 15/n

I know this pandemic has put us on edge. 🇨🇦’s blood clot specialists - and our friends worldwide - are working 24/7 to ensure we can care for you if you get a blood clot (and you’re more likely to get one of you catch COVID than if you get AZ). 16/n

But as we consult in - or are redeployed to - ICUs, we see people (often younger and healthier than us!) dying because they couldn’t get a vaccine. We see the costs on all sides. 17/n

I will not tell YOU what to do, because your life circumstances and health situation are not mine. But I will not let you be misinformed about blood clots. I will not let your fears be dismissed or minimized. I will be transparent about what I know. 18/n

I think doctors should be honest, supportive guides. We should help you make healthy choices. This is my effort to do that around the 2 parts of medicine that I am passionate about: blood clots, and empowering patients. 19/n

I can’t keep up with the many individual questions I’m getting but for trustworthy references, check out @ThrombosisCan @PDSA_ITP and @COVIDSciOntario. 20/n

Here’s that required reading. It’s put out by the European regulator, EMA_News: ema.europa.eu/en/documents/c… 21/n

And I have to take a nap first, but my amazing coauthors and I will soon be updating the layperson’s guide to VIPIT/VITT. For now, this few weeks’ old version will still help you make sense of this and feel better about what you decide. covid19-sciencetable.ca/sciencebrief/v… /fin.

Tweet 14: STRAINED not attained. Even my autocorrect is exhausted today.