Alright, a tweet series on what I currently think about the AZ vaccine. This is NOT medical advice, I am not an expert by any means, I don't have the same access to data that the public health guys do, I'm just a geriatrician trying to figure this out too in an info vacuum.
So before you get stuck into me about being a murderer/playing god/being Bill Gates drone...just don't. I'm not here to shame anyone, I'm here to discuss. Whatever you choose, based on your own personal circumstances, is just fine.
In 800 AD smallpox had wiped out millions. Chinese doctors discovered that by taking scrapings of smallpox and pipetting it up peoples noses, they could prevent smallpox. The fatality rate of this was a whopping 1%. People still took it; the smallpox death rate was 35%.
In time better options came along and this was abandoned for the obvious reasons.
All of the following information comes from the UK MHRA Yellow Card report - the UK has a huge rate of AZ use so I thought it would be a good start, with thanks to @mckaty for the link.
The estimated number of AZ first doses delivered in the UK by the 12th of May was 23.9 million and the estimated number of second doses was 9.0 million. I'm not sure why this is an estimate, surely this number is known but I don't know how they record this.
By the 12th of may, there have been 309 cases of major thromboembolic events with thrombocytopenia (blood clots), and 56 deaths (18% case fatality rate). CVST (brain clots) reported in 116 cases (average age 46 years) and 193 had other major events (average age 55 years).
Number of UK suspected thrombo-embolic events with concurrent thrombocytopenia ADR reports received for the COVID-19 Vaccine AstraZeneca by patient age up to and including 12 May 2021. 
By sex:
"At the time of this report, over 127,500 people across the UK have died within 28 days of a positive test for coronavirus."
The case fatality rate of COVID is 1-3% based on the numbers I've looked at. So if you get it, you have a >97% chance of survival BUT it may be worse or better than that based on your age, that's a very blunt number and incorrect if you're older or comorbid.
What does this all mean? First of all I think that saying "you can choose to risk death from covid which is a greater risk, vs death from clots from AZ which is a far lesser risk", is a false dichotomy. Pfizer is/will be available.
Currently the options are for people over 50:
1. Wait for Pfizer and ride out winter. This is probably the risk-getting-covid scenario which needs to take into account your baseline health and fitness - and age.
1. Wait for Pfizer and ride out winter. This is probably the risk-getting-covid scenario which needs to take into account your baseline health and fitness - and age.
As you can see, mortality from COVID starts rising substantially around age 50. Unfortunately, so does clotting risk from the AZ vaccine.
2. Get the AZ vaccine and risk getting dangerous blood clots. You have a 99.9998% chance of not getting clots, BUT if you're that extremely unlucky person, you have a 20% chance of dying which is high (this may improve now that we know what we're dealing with.
What about which one is more effective?
1. Pfizer appears effective at preventing *transmission* of SA variant, and at preventing severe disease and death.
2. AZ is effective at preventing severe disease and death for SA variant, but not *transmission*.
1. Pfizer appears effective at preventing *transmission* of SA variant, and at preventing severe disease and death.
2. AZ is effective at preventing severe disease and death for SA variant, but not *transmission*.
Some of the medical are community argue that the risk of this happening is so remote, and in a pandemic we should just vaccine up and get on with it. Others are vehemently opposed. Everyone is arguing.
This is an ethical dilemma. There is no definitively right or wrong answer, the only right answer, is the one that is right, for YOU. If you look at all the numbers above and think, I'm going to wait for Pfizer because this level of risk is unacceptable to me, that's ok.
Asking people to take on this kind of risk for a vaccine is something we haven't asked the community to do for a very, very long time. Decades at least.
Conversely if you say nope, I've looked at these numbers, I'm getting AZ because the risk that covid poses to me is much more unacceptable - then that is just fine too.
And frankly, if we had no other choice but AZ, I am certain the community would have rolled up their sleeves and worn the risk, en masse. But that is not where we are. We have one on the horizon that does not require this ask of the community and it is close.
What do I think should happen? I think that the age for AZ needs to rise based on the new data we have about TTS in the 50-59 age group.
What should you do? Mull it over. Talk to loved ones. Talk to your GP. Read everything (sensible) that you can. Weigh up your options, and make the decision that is right for you. I trust you. And no shame either way.
Finally, far more knowledgeable and cleverer people than me will likely weigh in here (be kind, I'm not an expert). Please read their replies because they will add considerations I have not. Thank you.
I should add though, that there is a high chance that COVID will escape hotel quarantine in winter and we will find ourselves in a different scenario: large numbers of unvaccinated at risk of hospitalisation/death. Consider this in your decision too.
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