Thread by @MPaiMD

Lots of AZ questions swirling. I can’t answer them all (1. Don’t actually have all the answers; 2. Need a Twitter break for my 🧠 health!) But @JHMustapha’s tweet resonated: yes, info on AZ and VITT changing DAILY. If this makes you anxious, you may elect not take AZ again. 1/n

https://twitter.com/jhmustapha/status/1396105084279402499

To give informed consent to AZ you must appreciate seriousness of these clots (they’re serious), risk of waiting for a different vaccine (moot, as mRNA supply ⬆️), and risk of getting VITT w 2nd dose. UK data is evolving so risk of 1:1mill has ⬇️ to 1:600thou and may ⬇️ more. 2/n

That’s not because scientists are jerks or governments are duplicitous or anything else shady! It’s bc as we do things over and over (eg. Give more shots), we will estimate a risk closer to the truth. I can’t guess what the “true” incidence of VITT w 2nd dose is. 3/n

Anyone who says they know what that true risk is, is either psychic or overconfident. It’s probably lower than 1st dose based on what we know about analogous diseases. But that’s as much as we know. 4/n

This is the same incomplete knowledge that informs the new “42 day window.” As we learn more about diseases we find exceptions to rules (eg. cases that present milder but later, cases that get better on their own, etc) I don’t know of a case that presented at 42 days! 5/n

But I understand NACI’s comment of “maybe just consider keeping your radar up longer.” Yes, it is anxiety inducing. It is also a conservative instruction that reduces the chance even a single exceptional case would be missed. 6/n

Similar uncertainty surrounds the mix and match strategy. Preliminary data looks great - and there’s precedent, and other countries are doing - but that’s not the same as saying “we are absolutely sure this is going to be fine.” 7/n

As a PERSON, I love certainty. My kids’ bedtime, my weekly grocery list, when we wash our darks and lights, my outfits for the week (yes... these days... all leggings 😊): everything is predictable and orderly. Certainty makes me feel safe and happy. 8/n

But as a physician & scientist, certainty is difficult to attain. Especially with a disease that was discovered in late March. It would be MUCH less scary if we could tell you exactly what will happen if you take AZ for your 2nd dose. And if what we say didn’t change weekly. 9/n

But we don’t currently have the certainty that you (or I!) would like. I know that doesn’t sit well. If you feel you can manage this decision, based on what we know now, then take your AZ 2nd shot. If you can’t, wait for more scientific clarity or take mRNA. 10/n

Understand that different people have different tolerances for certainty. Be okay with your tolerance. Be mad that we don’t know more - but realize it’s not anyone’s fault. It’s just the reality of evolving science. A little unfocused anger is okay. I have some of that too. 11/n

I’m going to spend the rest of my weekend with my little guys - who despite destroying order and certainty on a daily basis, are still the best parts of my life. Happy Victoria Day weekend. 12/12