‘We were flying blind’: A doctor recounts a woman’s Johnson & Johnson vaccine-related blood clot case
An 18-year-old woman was stricken with severe headaches, vomiting, seizures, confusion and weakness in one arm early this month, strokelike symptoms that doctors at a Nevada hospital were shocked to see in someone so young.
Scans found several large blood clots blocking veins that drain blood from the brain, a condition that can disable or kill a patient.
Doctors performed a procedure to suction huge clots from her brain, only to find that new ones had formed.
The patient is one of six women ages 18 to 48 who developed clots in the brain within two weeks of receiving the Johnson & Johnson coronavirus vaccine. One died, and their devastating cases led U.S. health officials to recommend Tuesday that use of the vaccine be paused.
Two more cases have been added since then: one involving a man who was vaccinated during the company’s clinical trials and another involving a woman who received the vaccine after it had been authorized for general use.
As in several of the original cases, the young woman in Nevada was initially treated with heparin, a standard blood-thinner that experts have since learned may actually worsen the rare clotting disorder that has affected small numbers of people who received the Johnson & Johnson or AstraZeneca vaccines in several countries. But until the last few weeks, doctors around the world had little information about the condition, and the doctors in Nevada did not recognize it immediately.
“We were flying blind, based on reports from Europe and the U.K. hematological society,” said Dr. Brian Lipman, an infectious-disease specialist who helped care for the Nevada patient at Dignity Health St. Rose Dominican Hospital, Siena Campus, in Henderson.
The U.S. decision to call for suspension of the use of the vaccine was intended to give officials time to learn more about the rare disorder causing the clots, to assess whether it is linked to the vaccine and to inform doctors and patients about how to recognize symptoms and treat the condition.
The pause may last until at least next Friday, when expert advisers to the Centers for Disease Control and Prevention are scheduled to meet to review the data and decide whether to resume using the vaccine. Dr. Rochelle Walensky, the director of the CDC, and other top U.S. health officials sought Friday to reassure the public that the pause, now extended more than a week, was a reasonable safeguard to assess risk. They also emphasized that overall, the Johnson & Johnson vaccine and the other vaccines in use in the United States were safe, given how many millions of Americans had gotten their shots without concern.
But with the world staggered by a relentless epidemic, even temporarily stopping the use of a highly effective vaccine, which many countries had planned to deploy, is a fraught decision. Public health experts fear that the move sends a message that will erode trust globally even if the vaccine is reinstated and that huge numbers of people who could have been immunized will die needlessly from COVID-19 because they or their governments rejected the company’s vaccine.
The United States, where Johnson & Johnson provided only about 5% of the COVID vaccine supply, can afford the suspension: It has plenty of other vaccine doses from Moderna and Pfizer-BioNTech to fill the gap. Other countries do not. And many nations have also stopped or limited the use of another effective vaccine, the one made by AstraZeneca, because it, too, has been linked to a similar rare clotting disorder.
About 7.4 million Americans have received the Johnson & Johnson vaccine, and so far, only eight cases of the clotting problem have been reported, seven of them in women. In Europe, Britain, and three other countries, 222 cases have been reported, mostly in women under 60 — of 34 million people who have received the AstraZeneca vaccine. Several countries have now limited its use to older adults because so many cases have involved younger people.
Researchers suspect that in these rare cases, the vaccine causes an intense reaction by the patient’s immune system, which churns out antibodies that activate platelets, a blood component needed for clotting. An unusual syndrome results, with extensive clotting that leaves the patient with low platelet levels and a tendency to bleed at the same time. Why this occurs in some people, many of them younger women, is not known, and experts say that they have so far been unable to identify traits or underlying conditions that may make some people susceptible.
In a statement issued Wednesday, Johnson & Johnson said: “The safety and well-being of the people who use our products is our number one priority, and we strongly support awareness of the signs and symptoms of this extremely rare event to ensure the correct diagnosis, appropriate treatment and expedited reporting by health care professionals. We continue to believe in the positive benefit-risk profile of our vaccine.”
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