Since last April, The Center for Health Journalism has been publishing a special newsletter geared to journalists as they report on one of the biggest and most complex stories of our times. Each Monday, while the pandemic runs its course, The Coronavirus Files will provide tips and resources and highlight exemplary work to help you with your coverage. This week, the Center for Health Journalism’s Coronavirus Files Monday newsletter is curated and reported by science writer Amber Dance, PhD. Have a suggestion or a request? Write us at editor@centerforhealthjournalism.org.
No ID, no vaccine?
Today’s the day: Every adult in the U.S. should be able to get a coronavirus vaccine as of April 19. That’s “equality,” explains Akilah Johnson in The Washington Post, but not “equity.” Equity, she writes, “takes into account people’s varying circumstances and allocates resources based on need to reach an equal outcome.” In her piece, Johnson zeroes in on the challenges faced by immigrants trying to get vaccinated. The federal government says everyone is allowed to get vaccinated, including legal and undocumented immigrants. But some vaccination sites have been asking for identification, such as driver’s licenses or Social Security numbers. “The idea of having to be ID’d is a major source of stress for immigrants,” Natalícia Tracy of Boston’s Brazilian Worker Center told Johnson. Authorities may also fail to communicate about eligibility and vaccine sites in languages immigrants can understand. One solution, Johnson writes, is to provide vaccines at places where immigrants already feel safe, such as job centers.
Johnson & Johnson vaccine in limbo
After concerns were raised about blood clots among a half-dozen women who received the Johnson & Johnson shot, last week the CDC’s vaccine committee decided it lacked enough information to let the vaccinations continue, for now. Another vote may come later this week or early next. The situation parallels what happened in Europe in recent weeks, when similar clotting concerns arose over the AstraZeneca vaccine. Both vaccines are based on genetic material carried by harmless viruses.
The clots in question are an unusual type, called cerebral venous sinus thrombosis or CVST. They trap blood in the brain, causing a brain bleed. In the cases potentially related to these two vaccines, this has been coupled with low numbers of platelets, which normally promote clotting, resulting in internal bleeding that can be deadly. The pause in vaccination is partly to give doctors time to learn how to treat these events. A common treatment for clotting, heparin, can make things worse by further reducing platelets, but alternative treatments are available. It’s not clear why the vaccines from Johnson & Johnson and AstraZeneca might cause this to happen in rare cases.
It’s also not clear how often CVST happens normally, though it’s quite uncommon, and the handful of cases so far associated with the more than 7 million J&J vaccinations do seem to be at a rate higher than the baseline rate for such clots. That said, if CVST is indeed a side effect from these vaccines, it’s still extremely rare. People are more likely to get struck by lightning or a meteorite, bowl a perfect 300, or get audited by the IRS. (The Washington Post has a nice graphic illustrating the risk.) In a new study from Oxford University, not yet vetted by other scientists, researchers find that if you get COVID-19, the odds of a different kind of clotting — CVT — are 39 in a million. Many reporters have been tempted to compare the vaccine-clotting risk to the clotting risk posed by birth control, but others say it’s problematic to compare different types of clots.
With Johnson & Johnson immunizations on hold, what does that mean for the U.S.’s vaccination rate? Perhaps just a dent; vaccines from Pfizer and from Moderna, made using a different technology based on mRNA, make up more than 90% of the doses administered so far. The Biden administration says there will be enough of those shots for everyone in the nation, and Pfizer has promised to deliver its next 300 million doses two weeks early. But the pain from the J&J pause will likely be felt most acutely in underserved communities, such as the homeless, where the convenience of its one-and-done dosing is hugely beneficial. Nursing homes and assisted living communities were also relying heavily on the Johnson & Johnson vaccine, reports McKnight’s Long-Term Care News.
Several writers have considered whether the FDA and CDC made the right choice in pausing the J&J administrations. “If highlighting the clotting heightens vaccine hesitancy and helps conspiracy theorists, the ‘pause’ could ultimately sicken — and even kill — more people than it saves,” write Sharyl Gay Stolberg and Jan Hoffman in The New York Times. But many experts have also praised the transparency shown by these federal health agencies. “Trying to hide bad news from the public not only doesn’t work but is seriously counterproductive,” writes Kiera Butler, a senior editor at Mother Jones, who concluded that federal regulators made the right choice when confronted with two lousy options.
What happens next? When the vaccine committee is ready to vote, it has several options, explains Katherine J. Wu in The Atlantic. They could stop using the vaccine entirely, but this seems unlikely. Experts told her “they’d need to see many, many more clotting events to even consider pulling an otherwise highly successful and effective vaccine from the global market.” The committee could allow Johnson & Johnson vaccinations to start again for everyone. Or, they could restrict Johnson & Johnson vaccines to groups deemed at lower risk for CVST. (This is the approach that has been taken with the AstraZeneca vaccine in many European nations.)
U.K. variant not quite so bad?
Two new studies in Lancet journals suggest that the B.1.1.7 variant, now dominating the U.S., might not be as deadly as initially reported. While it does still seem more infectious than the original coronavirus, it doesn’t appear to cause more severe disease or higher death rates after all, reports Molly Walker at MedPage Today. But these papers hardly close the book on the question, writes Alice Park at TIME, and more study is needed. Current vaccines all offer strong protection against the variant, all the more reason to get that shot.
From the Center for Health Journalism
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What we're reading
- “CDC Studies confirm racial, ethnic disparities in COVID-19 hospitalizations and visits,” by Rachel Treisman, NPR
- “Black women are fighting to be recognized as long COVID patients,” by Jamie Ducharme, TIME
- “Incarcerated and infected: How the virus tore through the U.S. prison system,” by The New York Times
- “A vaccine study in college students will help determine when it’s safe to take masks off,” by Carolyn Y. Johnson, The Washington Post
Events and Resources
