A Pause on the J&J COVID Vaccine

There has been some news about one of the COVID vaccines today, and I wanted to put it into context for you. Based on advice from the CDC and the FDA, the US has paused the distribution of the Johnson and Johnson vaccine after six people developed a rare condition within three weeks of the shot, and one of them has died.

Cerebral venous sinus thrombosis (CVST) is a blood clot that forms in the large veins that drain blood from the brain. It's important to realize that CVST is a different condition from the much more common type of blood clots that may form in the legs, and can be related to smoking, birth control pills or COVID itself. Keep that in mind when reading articles about this.

My initial impression was that this was an overreaction - this is six out of nearly 7 million vaccine recipients, less than one in a million. If you look at how common CVST is in general, estimates are 2-5 cases per million per year, although more recent studies suggests that it could be even higher than that. So that means that in any random group of 7 million people who weren’t vaccinated, you might expect at least 14-35 cases of this condition. And withholding the vaccine, especially if there weren't others to fill the need, means less people vaccinated. Which of course means more infections and more variants. It also means more COVID deaths, since that’s what the vaccines are really proven to prevent. Many more people could die for lack of a vaccine than would have gotten this rare blood clot, even if it was related to the vaccine (which hasn’t even been proven yet).

But then I realized something. The CDC and the FDA made the right call here.

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Vaccination Documentation

On Tuesday, April 6th, New York state will eliminate the last government restriction on COVID vaccine eligibility. On that date, the shot will be available to anyone over 16 (the lower age limit of the Pfizer vaccine’s emergency use  authorization). Hooray, and a big THANK YOU to the scientists who got us here!

Now the #1 reason to get the shot is to keep you from dying of COVID, and the #2 reason is to reduce spread, limit cases, and stop the evolution of new variants. Also, the CDC says that getting vaccinated is a big part of our safe return towards normalcy - being with other people outside of your household, indoors, and without masks (even if they aren't vaccinated, as long as they are healthy). And you don’t need a piece of paper to get those benefits. Nevertheless, it seems like more and more companies, schools, venues and other organizations are going to be asking for evidence of vaccination. This might be in the form of your completed vaccine card or something more high-tech.


When I’m vaccinating people, I got a lot of questions about this, so I figured I would write a something about it. Here are a few of those questions.

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Vaccinated Parents, Unvaccinated Kids

A month ago, COVID vaccines were this hot ticket item that you got with some combination of priority status, luck, connections and a lot of web page refreshing. Yesterday, New York State opened them up to everyone over age 30, and on Saturday, they will be available to all New Yorkers over age 16 (the lower age limit of the FDA’s emergency use authorization for the Pfizer vaccine). Production has ramped up significantly, and with three vaccines approved for emergency use, even with the expanded priority groups it's getting easier to get an appointment. And in other good news, vaccine hesitancy is dropping, and the United States as a country is doing well in terms of vaccine distribution. This week, we have about 16% of our population fully vaccinated (which means 2 weeks after the last shot).

Furthermore, it looks like in addition to preventing you from dying of COVID-19 (which is good!), the vaccines have been shown to significantly slow the spread of the virus in the real world, which is a critical victory. Even asymptomatic cases of SARS-CoV-2 infection turn your body into a factory for producing mutant strains, also known as variants. The more variants that are created, the greater the chance that one of them will get an evolutionary advantage and become more lethal, more spreadable, or resistant to the vaccines. It’s an arms race that we can’t afford to lose.

So I’m writing today about the situation that a lot of families - mine included - are suddenly finding themselves in. How do we act when the adults are fully vaccinated and the kids aren’t?

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New CDC Guidance on Schools and Social Distancing

There is some new guidance from the CDC on social distancing in schools! As the husband of a lower school principal, I have been lucky enough to have a front row seat to the incredibly complex and vital process of keeping kids safe in the era of COVID-19. This was especially difficult last Spring, when school administrators were tasked with “building the airplane while it was in flight” - switching instantly to remote learning, something that had never been done before at this kind of scale. As the year wore on, the work pivoted to building processes and systems that let the kids return to school in person, while reserving the ability to provide Zoom school to those families who wanted it, or in situations where a COVID exposure required quickly quarantining a group of kids. Read more

Useful Links for Scheduling Your COVID Vaccine

I have been vaccinating people at some of our Mt. Sinai facilities (in Manhattan and Brooklyn), and lots of people have been asking me for help with this. So I tried to organize my list of vaccine scheduling sites in a way that makes them easy to reach.

These sites mainly cover New York City and State. That’s the nature of appointment scheduling - the best resources tend to be local, since there is no good nationwide site at this point. I don't have as much experience with scheduling in New Jersey (where I also see patients), but this is the NJ state central hub.

I put many of these on my Instagram link page:

https://www.flowcode.com/page/snotdoctor.

This makes it easy to try them all, especially if you are reading this on a smartphone. But I'll go into a bit more detail on blog post below.

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