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Menaka Pai, MSc MD FRCPC

Follow @MPaiMD

10 May, 10 tweets, 4 min read

@DrKateJMiller

Okay one more thread before bed! Lots of Qs asking "what IS VITT?" Before I get to that, if you'd like an AWESOME metaphor about vaccine choice, please read my buddy @DrKateJMiller's, then read on for some FACTS about VITT clots caused by AZ and J&J...

https://twitter.com/DrKateJMiller/status/1391173201623924737?s=20

@COVIDSciOntario

@COVIDSciOntario has published an evidence based brief on VITT (which includes a lay summary). All science, no spin. (Seriously, no spin.) @heysciencesam has helped us break the VITT facts down into tasty evidence bites. covid19-sciencetable.ca/sciencebrief/v…

These are the facts. 4-28 day window for symptoms to start (typical immune reaction... just like autoimmune HIT for the #hemetwitter nerds). Those incidence figures are referenced in the brief. covid19-sciencetable.ca/sciencebrief/v…

Can we predict who's likely to get VITT after an adenoviral vector COVID-19 vaccine? Unfortunately not well (or at least, not yet). We don't believe it's common in folks with lots of "classical" risk factors for blood clots.

Pregnant people likely aren't at increased risk of VITT - but NACI recommended they get mRNA vaccines because VITT is more challenging to treat if pregnant. Of course, like ANY vaccine choice, one must weigh risk of waiting for an mRNA vaccine with risk of VITT.

We think that the people with HIT and people with CSVT + low plts shouldn't get adenoviral vector vaccines - they MAY be at increased risk (no clear evidence) and may do worse. Women and younger people MAY be at slightly higher risk, but the jury is out.

I know this info may be scary. But even when science is alarming - it's still true. I would rather you know about VITT, so if you decide to get AZ or J&J, you know what to look for. Medical paternalism is an expedient but always bad choice. Demand transparency. Be empowered.

I empathize with the anxiety this evolving science brings. Please practice self care.

I am *very* alarmed at some of the rhetoric I've read around VITT. I implore you - seek trusted sources when you research this condition (not all MDs know about blood clots, just as not all MDs know about viruses or vaccines). Look for voices that are honest and kind.

@heysciencesam

And know that many of us are trying VERY hard to ensure VITT is on the radar of every HCP in Canada. As @heysciencesam says: be aware, not scared. Trust me when I say: we are getting through this pandemic, not without disappointments & grief... but we are getting through it. ❤️

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More from @MPaiMD

Menaka Pai, MSc MD FRCPC

@MPaiMD

10 May

@HamHealthSci

LONG week on call @HamHealthSci. Lots of calls about #VITT post AZ vaccine. I'm transparent w my patients - I believe empowerment leads to earlier detection, better outcomes, less stress. So I'm grateful to @heysciencesam for creating tools to help me be transparent with YOU! 🧵

If you've had AZ 4-28 days ago, be on the lookout for the following symptoms. If you have them, seek medical attention! (Sam, thx for making the doctor in this graphic look JUST LIKE ME 😜 #GenXZeneca #WomenInMedicine)

How do migraine sufferers know if this is a VITT headache? VITT headache often worse, more persistent, or has diff features than your usual headache. It might go with visual changes. When in doubt: seek care. We're educating clinicians about VITT here: covid19-sciencetable.ca/sciencebrief/v…

Read 10 tweets

Menaka Pai, MSc MD FRCPC

@MPaiMD

7 May

@COVIDSciOntario

⭐️ @COVIDSciOntario’s UPDATED guide to Vaccine-Induced Immune Thrombotic Thrombocytopenia #VITT Following Adenovirus Vector COVID-19 Vaccination! covid19-sciencetable.ca/sciencebrief/v…

If you’re NOT a healthcare professional, we have a lay summary for you here: covid19-sciencetable.ca/sciencebrief/v…

And targeted guides for outpatient and ED/inpatient settings are coming soon! (We’ve been working so hard on this our keyboards have caught 🔥. Need a quick breather.)

Read 6 tweets

Menaka Pai, MSc MD FRCPC

@MPaiMD

3 May

@ASPphysician

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

@COVIDSciOntario

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

Read 22 tweets

Menaka Pai, MSc MD FRCPC

@MPaiMD

23 Apr

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

Read 23 tweets

Menaka Pai, MSc MD FRCPC

@MPaiMD

17 Apr

I’ve spent my whole life being a rules follower. Imagine my surprise when one of my tweets from earlier today turned out, at 5 pm, to be a call for civil disobedience in Ontario, where unsafe nonessential work is okay but safer outdoor socializing isn’t. 1/n

As a WOC, my advocacy has had to be subtle, and my voice has had to be quiet. Burning it all down, leaving the table, throwing a tantrum and getting my way… these are privileges I actually don’t have if I want to have any impact. 2/n

BUT: I am aware that many other members of equity seeking groups don’t have a voice at all. And don’t have a seat at any table. I do. (Privilege is a relative thing.) So I’ll tell it to you straight: 3/n

Read 14 tweets

Menaka Pai, MSc MD FRCPC

@MPaiMD

16 Apr

Hey Ontario. Our healthcare system (and all the good things that flow from it, including the economy) is about to collapse. It's about powerful people not making hard choices that ultimately benefit everyone they are supposed to serve. What can YOU do? Empower YOURSELF. Read on:

1. Don’t spend time with people indoors if they're not in your household. If you have the privilege to follow this rule, follow it! Cosy up with your hunny bunny. Cuddle your kids. Facetime with all the people you love who are ?NOT in your household.

2. If you have to be indoors for essential tasks, keep 6 ft away + mask. Essential tasks = your job (though ask yourself... is it REALLY essential that you work indoors?) or life and death stuff. LCBO does curbside pickup, FYI.