'We Were Flying Blind': A Doctor's Account of a Woman's J&J Vaccine-Related Blood Clot Case

📆 19/4/2021 10:58 pm
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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. Sign up for The Morning newsletter from the New York Times 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

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, addresses a news conference about the pause in the Johnson & Johnson COVID-19 vaccine, at the White House in Washington on Tuesday, April 13, 2021.

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. 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.

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.

“This is a devastating complication,” Dr. Anthony Fauci, the chief medical adviser for the pandemic in the Biden administration, said in an interview. Another reason for the pause, Fauci said, is to let doctors know that the drug heparin, a standard treatment for blood clots, should not be given to these patients, “because heparin in this circumstance can make things worse.”

Another of the first six patients with the clotting condition was a healthy 48-year-old woman who went to an emergency room in Nebraska because she had felt ill with abdominal pain for three days. Her case was described in a letter to the editor of The New England Journal of Medicine published Wednesday. Her platelet count was low, and other blood tests were also abnormal. A CT scan found extensive blood clots in veins in her abdomen.

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