Covid clot warning: Media blaming or sensible advice?
16 April 2021 · News
Health experts have warned the media to be cautious about reporting links between blood clots and the covid vaccines.
Is this a case of messenger shooting, or a valid note of caution to the media?...
You've reached our premium or archival content
To access this page, and more great content just like it, you need to become a paid subscriber.
If you already have an account, please login.
Otherwise, registration is quick and you'll have access instantly after payment.
Tags: COVID19 | News | pandemic | vaccination
This commentary is not legal advice nor medical advice. See your legal advisor and/or AHPRA (Australian Health Practitioners Regulatory Authority) - registered evidence-based medical practitioner, not a quack nor a person consuming and regurgitating US shock jocks, anti-vaxxers or conspiratorialists.
Rather this is a commentary on risk and at the end we ask whether the media could do more about asking more questions about whether the medical authorities, medical profession and pharmaceutical industry can do to determine whether a patient is a candidate for a particular treatment.
The information presented by the media is on evidence-based medicine. By presenting evidence-based information to the public means that the public is informed based on scientific evidence, not snake oil merchants and quacks.
People are not adverse to risk. We drive cars or cross the road as a pedestrian, knowing that there is a risk of an accident.
Similarly in medicine, there is a risk of an adverse reaction to medication or surgical intervention including death. For example, if one has an cholocystectomy, there is a 0.5% fatal outcome. If there is no surgical intervention, it could be death by sepsis.
In the famous "failure to warn" case of the High Court of Australia, Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479 (19 November 1992), ref http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/HCA/1992/58.html?context=1;query=rogers%20v%20whitaker;mask_path= the practitioner, despite conducting the procedure with due diligence and professionalism, failed to warn the patient of the risks of undergoing a procedure. In that case, the patient was not warned of the risk of undertaking an operation on eye, could lead to sympathetic ophthalmia, resulting in total blindness, paras 2, 3, 4, per MASON C.J., BRENNAN, DAWSON, TOOHEY AND McHUGH JJ.
Warning the patient of the adverse risk is part of the overall duty of the practitioner to inform the patient such that the patient makes the right decision.
Though the benefit of the treatment which was to restore eyesight was greater than the adverse risk of total blindness, the risk to the patient becoming blind was one in fourteen thousand, para 3, per MASON C.J., BRENNAN, DAWSON, TOOHEY AND McHUGH JJ.
Had the patient known of the 'minute' risk of one in fourteen thousand, the patient would not have undergone the procedure. The patient did not want to risk being the one in fourteen thousand.
Unfortunately. the patient became blind because of a lack of knowledge of the risk.
When it comes to the adverse risk of the covid-19 vaccine, according to the European Medicines Agency, data from the UK and European Economic Area (EEA) indicates that out of 20 million vaccinations, 7 had an adverse reaction, that's one chance in 2.9 million for disseminated intravascular coagulation (DIC) and 18 cases for cerebral venous sinus thrombosis (CVST), that's one chance in 1.1 million.
There has not been a proven link, sources https://www.ema.europa.eu/en/news/covid-19-vaccine-astrazeneca-benefits-still-outweigh-risks-despite-possible-link-rare-blood-clots and https://www.health.gov.au/news/atagi-statement-for-health-care-providers-on-suitability-of-covid-19-vaccination-in-people-with-history-of-clotting-conditions
Meanwhile, the Australian Technical Advisory Group on Immunisation (ATAGI), cautions by deferring administration of the vaccine on patients with a history with CVST and Human Induced Thrombocytopenia (HIT) where a blood thinner, heparin may risk causing clots, source, https://www.health.gov.au/news/atagi-statement-for-health-care-providers-on-suitability-of-covid-19-vaccination-in-people-with-history-of-clotting-conditions .
So, if people are informed about the risk, it's the patient's decision to not take the treatment as the patient in the High Court of Australia case of 1992 would have had the patient been informed. Alternatively, unlike the patient in the High Court case, the patient may well take a risk/benefit analysis.
But the argument posed by the medical adminstrators, accusing the media of adversely influencing public confidence in the vaccination program may well be true.
It may be that the benefits of the vaccine far outweigh the adverse risks which prima facie is between one chance in 1.1 to 2.9 million. The public may well be informed they don't want to be the one in 1.1 or 2.9 million in a similar way that the patient in the High Court Case did not want to be the one in fourteen thousand.
The news of the side effects of the Astra Zeneca side effects are on evidence based side effects as reported in the Daily Telegragh, https://www.dailytelegraph.com.au/coronavirus/why-under-50s-can-still-get-the-astrazeneca-vaccine/news-story/c1ac800d13d12b9028cd5496efe31445 - this is a rolling news item and it also publishes the statistics.
From the AusVaxSafety website, while 51.8% report an adverse reaction, 1.2% of patients attended their doctor or ED, source https://www.ausvaxsafety.org.au/safety-data/covid-19-vaccines.
People are well informed. The media are not sourcing their news from snake oil merchants and anti-vaxxers.
It is not as simple to assert that people are not taking the vaccine because of clots, even if the adverse effects provoke fear in the public. There are patients like the one in the High Court Case who would not have proceeded if the risks are known. There may well be situations where the patient knows the risks being minor yet proceed with the treatment.
For example, the risk of developing clots by consuming the contraceptive pill is 1 in 1000, which is a 1000 times higher risk than developing clots from the vaccine, https://www.abc.net.au/news/2021-04-15/covid-vaccines-answered-questions-blood-clots-astrazeneca/100072386. Of those 1 in 1000 clots, 6% of those who obtain clots by consuming the pill will die, source https://www.abc.net.au/news/2021-04-08/covid19-vaccine-blood-clotting-az-explainer/100055638 . Using mathematics, if 100 in 100000 patients develop clots from consuming the pill, 6 of those 100 will die.
That is there is a risk of consuming the pill for contraceptive or therapeutic purposes, reference for other purposes https://www.healthdirect.gov.au/contraception-options, https://endometriosis.org/treatments/oral-contraceptive-pill/
Again, the issue raised by the medical authorities about the media reporting adverse or alleged reactions to the vaccine may not explain the apprehension held my members of the public. People will use their own risk/benefit analysis from the information presented by the media and evidence-based articles. On the other hand, people may not approach the taking the vaccine as a risk/benefit but not prefer not being the person who is the 1 in a 1.1 million or the 1 in 14000 as the patient from the High Court case.
It is irrelevant whether the magnitude of the risk is 1 in a million, 1 in 14000 or even 1 in 1000. People will make their decision to take or not take a treatment based on risk/benefit or the patient being apprehensive of being unlucky.
In conclusion, the media should ask the questions and report the questions and answers to the medical authorities, the medical profession and pharmaceutical industry as well as university researchers as to what are the causes of the adverse reaction to a treatment and if there are diagnostic tests available to determine whether a patient is a suitable candidate to take a treatment.
Furthermore the other factor in people not taking the vaccine is not the risk/benefit analysis nor proceeding with the treatment knowing the risks, BUT patients being apprehensive of whether there will be a supply of the vaccine for the second shot in the recommended time after the first shot.
Another question the media should ask is whether the time difference between the first shot and the second affects the immune response.
Thus the issue of risk and the issue of vaccine supply should apply to all kinds of treatments and interventions.
Thank you,
Anbthony of thinking Belfield