Hacker News Reader

> I just don't understand how come the same reaction hasn't been seen in the millions of people vaccinated with AZ outside Norway.

Dude, it has been seen outside Norway, and the observations are exactly the same, at least here in Germany. A certain group of people, maybe in combination with a certain type of drug they are taking, seem to be at risk for a very specific thrombosis in combination with a very low blood platelet count. There is some detective work necessary now to identify this group, so they can be excluded from AZ vaccinations, and then go on with the vaccination. That's what needs to be done now, and as fast as possible.

Thanks you, that's very helpful. None of the articles I've come across on this have explained the context outside Norway, including the one linked in this thread.

> railcar switch dilemma

In case you tried to remember, this is generally referred to as the trolley problem.

Your options are not just A) take the AZ vaccine right now, and B) never take any vaccine.

You can also wait until more data becomes available, or until another vaccine becomes available. Doing so does carry some incremental risk, but this risk is smaller than the risk of not getting vaccinated ever.

> until another vaccine becomes available

Well yeah, other vaccines (Biontech/Pfizer and Moderna) with far fewer side effects and apparently higher effectivity are already available, and that's part of the problem. It's not that the potentially fatal blood clots are the only side effect of the AstraZeneca vaccine, people also pretty often get infection symptoms (fever etc.), which is of course not that bad, but still unpleasant. So you can't really blame people for wanting to get the better vaccine...

I specifically talked about the risks of delayed vaccination and did not frame the choice in the extreme terms you described.

Looks like it was a pretty short delay:

https://www.dw.com/en/astrazeneca-german-team-discovers-thro...

> This is a real-life example of the runaway railcar switch dilemma. The train car is heading towards a crowd of millions of people and will plough through the middle of them killing many hundreds, or you can throw the switch and divert the railcar so it hits a handful of people prone to the blood clot reaction.

In this situation it's not that much of a dilemma, though. It's not as if those prone to blood clots are not at risk until they're given the vaccine, everyone is at risk from COVID and the blood clot prone maybe even more so. And the sheer number of people it will benefit means the choice is simple.

> very concerning if it's true

Little known fact: women's birth control pills also have a higher risk of blood clot. Always have. If that risk is considered to be acceptable then I don't see any reason why this isn't either.

Yes, but, there are close to 200 vaccines. It isn't as if all vaccinations have stopped, there are other options, and panic and fear on the side of omg must vaccinate now, now,now!?

Any hint, even the slightest, that complications may be ignored, could result in untold masses refusing vaccination out of fear. So let's pause one vaccine for a few days, and see if moving ahead, or more research is required.

Several European countries are already finding that millions of people are refusing the AZ vaccine due to unfounded and disproven aspersions made against it by political leaders in Europe. So either way vaccine deployment gets hurt. If you suspend usage vaccinations get delayed and people wonder if there are real problems, otherwise why is it's use being suspended? If you push ahead people complain concerns aren't being taken seriously. It's lose/lose all round.

Meanwhile Britain has got on with the job and vaccinated 25 million people (including me on Monday, with AZ), and avoided the fresh waves of infections crippling Europe and flooding their hospitals at the moment.

> there are other options

Not with sufficient supply there isn’t. That’s the issue almost every country is facing, and AZ production plants can’t just flip a switch and start making Moderna vaccines instead.

No matter what if you stop using the AZ you’re going to have a sharp drop in the number of vaccinations you’re able to do. That would almost certainly result in more deaths than the side effect of the vaccine.

> Any hint, even the slightest, that complications may be ignored, could result in untold masses refusing vaccination out of fear.

Only if people (and the media especially) hype up a very small danger to be more than it is. The larger danger is and always was COVID itself, especially with the new strains spreading.

The US will have >600 million doses from Moderna and Pfizer delivered by July, and currently even has 30 (soon 60) million AZ doses in storage that won't get approval before these 600 million other doses are delivered.

There's certainly countries where this will be a difficult ethical consideration, but it's far from clear-cut everywhere with the data and timelines that are currently available.

AstraZeneca isn't even approved in the US yet so the delay will most likely have no effect there.

I'm sorry, but anti-vaxxer nutjobs do that hype all on their own. And people are already sensibly worried about rushed testing, and approval processes.

(It is sensible to be worried, and to keep a sharp eye.)

Now there appears to be a complication with one vaccine. No hype is required, for people to become enraged if there is no investigation. Most jurisdictions have said 'pause for a few days, until we look into this'.

This is very, very sensible. Logical. Calm and cool, as a reaction.

Let me put this another way.

By your response, you're suggestion that we should not have even bothered with clinical trials? Just inject anything we thought might work, right away, just in case?

Because, if you're advocating against pausing, for something that would get a second look in a clinical trial... ?

> By your response, you're suggestion that we should not have even bothered with clinical trials? Just inject anything we thought might work, right away, just in case?

That's very clearly not my suggestion. You're being absurd. You're talking as if the AZ vaccine had no clinical trial. It did. It's been proven safe for the vast, vast majority of the population.

At no point did I say that this shouldn't be investigated. It should be. But there is no need to pause the rollout of the vaccine while that happens. A reminder: 40 cases in 17 million. Very few of those 40 cases have been fatal. "Pause for a few days" is very generous. How many days? We all know investigations like this can go on for weeks. Months, even. All the while the much more dangerous thread, COVID, is allowed to spread further.

The mouse brain derived Japanese Encephalitis caused death, often 2 years after vaccination. It too went through clinical trials, and seemed perfectly safe at first. It was pulled as a result.

Yet, those clinical trials were not rushed, nor the government approvals, nor did it have the sort of pressure you are applying right now.

Further, you have no idea how wide spread, or severe this may be. You cite numbers from the media, yet reject pausing, without even knowing the precise number of people unable to get vaccinated as a result, or if more cases of clotting may appear as time passes.

You have no real data.

Let's get some.

FYI, we are not far apart ideologically here. I get what you are saying, but imagine this..

2 weeks pass, and it is shown that the problem is quite severe. The vaccine is tossed.

Next the anti-vaxxers, the media, start spewing words of distrust. Helpfully, the media shows a grandmother crying, for days, over and over, about her dead son.

How many may refuse vaccination, and die then?

I believe it makes more sense to demonstrate caution, due to the sad politics of humanity.

>> there are other options

> Not with sufficient supply there isn’t.

Depends. If AZ is not removed entirely from use but instead only from the most affected group (women under 50), then this can be achieved by shuffling around which group gets which vaccine. So the same number of people will be vaccinated, and vaccination deaths are avoided.

> Only if people (and the media especially) hype up a very small danger to be more than it is.

At least here in Germany, it was mainly the healthcare workers who specifically rejected AZ. Police, fire brigade, kindergarten teachers, etc. were eager to get any vaccine. So simply blaming it on the media is maybe short-sighted, there are other dynamics at play here.

Who is to say that other vaccines don't have the same side-effect? That could especially be assumed of the other viral vector vaccines, so Johnson & Johnson, Sputnik and CanSino, none of which have received much scrutiny so far.

Even if the mRNA vaccines are safe, we depend on J&J and AZ doses for our reopening plans in Europe. We can expect economic damage from any wait for alternative vaccine doses.

J&J uses a different adenovirus than AZ (and human rather than chimpanzee). Of course, this is now demonstrated as a potential side effect to be on the lookout for.

> there are close to 200 vaccines.

That number is at best vaccine candidates, and I suspect even that is a very charitable term.

The actual number of vaccines approved by any health agency is 12, most of which are not approved by any EU health agency. Including the number of vaccines in Phase III trials that might be approved in the next several months would get you maybe another dozen at most.

I say both risks are totally related.

Covid itself causes blood clots.

The solution here has been to administer aspirin to Covid patients.

So the solution for the AstraZeneca vaccine should be the same. Vaccinate people, give them some aspirin over two weeks, just in case.

There are two semi-independent clotting systems.

Broadly, aspirin works on the one associated with heart attacks. Most strokes are caused by the other. So taking aspirin for strokes doesn't usually help. (Source: had a mild stroke, was told this by multiple neurologists.)

Covid seems related to both.

You need non-trivial blood thinners - Warfarin, rivaroxaban, apixaban - to affect DVT etc, and those are high-maintenance meds with side effects of their own.

But there is some evidence that aspirin does help with Covid clotting, and low doses for short periods seem pretty safe.

So the worst you'll do is improve your odds of avoiding problems from something that's already not much of an issue.

It reminds me of the blood clotting scare tactic sometimes used to discourage women from taking birth control. I remember raising it once with my OB/GYN who quickly told me that the risk of blood clots from the pill is very low for a non-smoker like me while the risk of getting blood clots if I became pregnant is much higher.

It really complicates the operations though, which is already proving to be difficult for many countries: You have to add aspirin distribution & storage to the vaccine, which might be an issue for costs if not for the logistics of it.

More importantly, you have to manage whether the vaccinated people can take aspirin. You don't want this to be how you find out you have a different blood coagulation issue, or anything else that aspirin can affect adversely (I'm not a medical professional).

I wonder is the aspirin won't bring higher risk than the vaccine.

The numbers people are passing around are way too low. Low enough that it's difficult to understand why somebody is taking any action at all instead of reading it as a minuscule statistical fluctuation.