Treatment of First Clot Cases May Have Made Things Worse

The Johnson & Johnson vaccine will remain on pause in the US until at least Friday, when a CDC advisory panel is scheduled to meet. In the meantime, more details are emerging about the rationale behind the pause and the rare clotting cases in question. Coverage:

• Backfiring: The feds acted after six women between the ages of 18 and 48 developed a particularly rare type of blood clot, and the Wall Street Journal reports that four of the six received the blood thinner heparin. While the drug is a standard treatment for clots, it might actually make things worse in these cases. The story details the case of a 48-year-old who improved after the heparin was replaced by a different blood thinner. Part of the rationale for the pause was the concern that doctors needed more information on treatment.
• 'Flying blind': One of the women who received heparin was an 18-year-old in Nevada, reports the New York Times. Doctors were surprised that someone so young developed such serious clots, then more surprised when they kept returning after standard treatment. "We were flying blind, based on reports from Europe and the UK hematological society," says Dr. Brian Lipman, who helped care for the woman at Dignity Health St. Rose Dominican Hospital in Henderson. The reference is to clots that emerged overseas in recipients of the AstraZeneca vaccine, developed with a similar technology as the J&J vaccine.

• Possibilities: The J&J vaccine is expected to be made available to the public again perhaps in a week or sooner, though health officials may restrict its use to men and women over 50, per the Journal. Or it may be made available to all, but with a stronger warning about the risks.
• 8 cases: The Times notes that since the pause went into place, two more cases have been added to the six—a man who developed clots during the vaccine's clinical trials and a woman who received a shot after it was authorized for use. One woman in this group has died.
• One view: In an op-ed at the Washington Post, two writers with specialties in medical ethics argue that the decision to continue the pause for another week is a "deadly mistake." The justification for a short pause to educate doctors and the public is valid, but "there is no evidence the vaccine's risks universally, or even typically, outweigh its benefits in preventing a pandemic disease with serious and unknown consequences," write Govind Persad and Dr. William F. Parker. The CDC and FDA "should end the pause, keep sharing information, and let patients decide."
• Criticism: J&J responded to the pause by saying that clots also have been linked to the Pfizer and Moderna vaccines, but a slew of experts interviewed by CNN say that isn't true. "That is a really irresponsible thing to say," says Dr. Paul Offit, a vaccine expert at the University of Pennsylvania. He's a member of the FDA advisory panel that reviewed all three vaccines.

(More Johnson & Johnson stories.)