Thread by @MPaiMD

There have been a lot of… thoughts about NACI’s statement on “preferred vaccines” today. Many feel angry/bewildered/tricked/confused/all of the above. I get it. I still stand by this thread. As my friend @ASPphysician has said, not much has changed. Let me elaborate... 1/n

https://twitter.com/MPaiMD/status/1385741537221480449

FIRST, I must emphasize the clotting issue. Clots associated with the adenovirus vector COVID-19 vaccines (“VITT”) are SERIOUS. If you have weird symptoms that start 4-28 days post shot, seek medical care. A doc can order a complete blood count to see if you could have VITT. 2/n

In the next day or two @COVIDSciOntario will be posting an updated symptom list. For now, our existing version will do. I’ll post it as soon as it’s ready. Please don’t second guess symptoms post-vaccine. Early detection matters. 3/n

Okay - back to NACI. The content of NACI’s statement is actually STABLE, and NOT WRONG. The word choice (“preferred”) would not have been mine. But I've spoken to lots of patients today about this, so I will break down how I presented it to them. 4/n

Standard disclaimer applies: I’m a blood clot doctor. I talk about blood clot risks and engage in shared decision making all the live long day. I am not an ID specialist, epidemiologist, nor a public health expert. I do not envy NACI, PHAC, or HC their very hard jobs. 5/n

One of the hard truths about life, and medicine, is: nothing in life is free. Or as a wise bone marrow transplant doc told me, way back in residency training: “There are no good choices, Dr. Pai. Only hard decisions.” This truism applies to COVID-19 vaccination. 6/n

Let’s do some thought experiments and see how NACI’s statement works, in real life. I encourage you to do this with me, and maybe you will see why I support of the spirit of NACI’s statement. 7/n

Let’s think of an ideal (dare I say “preferred”) state: our country’s supply chain just got AWESOME. You can have ANY vaccine you want! Right now! Of COURSE you want a vaccine that doesn’t cause blood clots, right? 1/50,000 - 1/100,000 risk of VITT is low. But what's better? 8/n

Yeah, 0/100,000 is better! But this ideal state is not ours right now. NB: mRNA vaccines are coming in hot… so maybe it will be soon. 9/n

TAKEAWAY FROM THIS EXPERIMENT: It’s important to know about the expected time of mRNA vaccine arrival, if you decide to wait for an mRNA vaccine and not get one now. 10/n

Next ideal state: There’s no COVID-19 anywhere! Viva Auckland! Our government pursued a #ZeroCOVID strategy! You can WAIT for that “preferred” vaccine! Some parts of the country (and some Canadians who can avoid outside contacts) live in this state. Some don’t. 11/n

TAKEAWAY FROM THIS EXPERIMENT: It’s important to know how much virus is in your community, and your exposure to it, if you decide to wait for an mRNA vaccine and not get one now. (Also: can you reduce your exposures? ALWAYS reduce your exposures.) 12/n

Final ideal state: You are young (well below age 50), with zero health problems, and nobody you could pass the virus on to! Come and get me, SARS-CoV-2! I don’t need a “non-preferred” vaccine! Some Canadians can say this. Others can’t. 13/n

TAKEAWAY FROM THIS EXPERIMENT: It’s important to understand what bad things could happen to you while you wait, if you get COVID-19 while waiting for an mRNA vaccine instead of getting one now. 14/n

End of the thought experiments. Read my disclaimer, and note that I am on the outside looking in, like all of you. I’m also a doctor trying to guide not just my patients - but my loved ones - through these hard decisions. I'm not NACI! But from what I can gather… 15/n

NACI is trying to say that in an ideal state, mRNA vaccines are preferred. Because they have no risk of blood clots beyond what we see in the general population. But when the pandemic is raging, there are no good choices - only hard decisions. 16/n

And right now, NACI's asking us to think about the expected wait time for mRNA vaccines, our risk of getting COVID, and our risk of bad COVID outcomes. Then it’s asking us to weigh it against the risk of VITT, which is 1/50K-1/100K according to the data I've seen. 17/n

I will reiterate: VITT is a SERIOUS blood clotting condition. You do not need to be sleepless if you got your AZ shot 4-28 days ago (I bet you’re thinking “easy for her to say, right?” But people I love deeply have received AZ, so you and I can be a little worried together.) 18/n

You can be alert for symptoms and seek care IMMEDIATELY if you experience them. Stay tuned for more from @COVIDSciOntario. And please, liaise with your own doctor to help interpret your own risks if you're contemplating vaccination. 19/n

Finally, talking about risks & getting informed consent is the HARDEST (and best) thing I do in my job. It took yrs to get it right, and I still sometimes botch it (TY to my kind patients for helping me get better). There has been a lot of anger sent NACI’s way. 20/n

It’s okay to be frustrated. But perhaps redirect some of the anger to the truly bad policy decisions (paltry paid sick leave, unsafe work conditions), and personal decisions (maskless rallies, coordinated misinformation around vaccinations) that are ⬆️ the pandemic. 21/n

Inequity, callousness, and science-denial are driving the rampant spread of COVID-19 in this country. Not NACI. We should ALL get to live in the ideal state. 22/22