Help me rationalize my fears of the Astrazeneca vaccine
April 24, 2021 9:04 AM   Subscribe

I'm scheduled to get my first Astrazeneca shot here in BC, Canada on monday. I'm as pro-vaccine as anyone else here on Metafilter, but all the talk about the blot clot risk is freaking me out. Thanks media. Are there other things I do on a day to day basis that are just as likely to kill me that I'm not worried about?

As a 42-year woman in Canada, I'm eligible for the Astrazeneca shot now. Because of supply issues in Canada it's unlikely I cant get one of the mRNA shots until late June.

The numbers being discussed in the media right now are the chances of a clot due to the Astrazeneca vaccine are 1 in 100,000, and the chances of dying from said clot are about 20-40%. However, the chances of a life altering stroke are much higher!

Here in my high-transmission neighbourhood, there are 275 / 100,000 cases of covid per week, and lets say a fatality rate of 1%. Which means 2-3 deaths per 100,000. Obviously worse than 1 in 100,000. I get that. But I live alone and rarely leave my house, so my chances are much much lower than that - those numbers are skewed by higher risk populations. What are the chances of me getting covid if i literally only spend 30min a week grocery shopping and visit one friend who lives their life similarly?

I hear others say there's a 1 in 1600 chance of a blood clot with the Pill (number taken from memory, may not be accurate). Um.. did that, got one 15 years ago, my doctors wont allow me to take the pill any more. That argument does not bode well for my brain, literally.

I've heard you're more likely to die in a car accident on the way to get the shot! That appears to be crap by my calculations. Canada has 5.1 deaths per billion kms. I'm driving no more than 20km round trip to get my shot, which means a 5 in 50mil chance, or 1 in 10mil chance. A lot lower than the shot.

I do have a high stroke risk (see mention of previous clots a couple paragraphs above), and anxiety, and have talked to my doc. He said there's nothing that says that high-stroke risk people are more likely to be affected by the Astrazeneca clots (it's a completely different type of clot apparently) than the normal population, and that me having my vaccine will almost certainly help with my anxiety.

I like to think I have a very rational brain, anxiety not withstanding. Are there any other rational, ideally backed by number arguments out there that will help me? I drink an obscene amount of caffeine - how likely is that going to kill me?

For example - Lets say I have a 10% chance of having a stroke in the next 10 years, and a 25% chance that'll kill me - what are my chances of dying per week from stroke? My math says the chances are 0.25% chance death per year, or about 5 in 100,000 per week... yikes. I shouldn't have done that math! (Can any one double check my math?) But I live with those numbers every day, and am not obsessing about that. At least, not any more. Is there anything else similar that can help put things in perspective? Maybe I just answered my own question!

So am I really just weighing the risk of having a 4 in a million chance the shot I'm booked for on monday will kill me? Worded that way, it sounds way less scary than 1 in 100,000 for the clot...

And wow, this has got to be my most morbid ask-mefi question to date after 16 years on the site... thanks covid.
posted by cgg to Health & Fitness (24 answers total) 3 users marked this as a favorite
 
Check out the Micromort table on Wikipedia.

You have a 20 in 1,000,000 chance of dying a day from all causes in Canada. The shot increases your chance of death by about 3 in 1,000,000. 1 in 100,000 get clots so that's 10 in 1,000,000. If 30% die from the shot that's 3 in 1,000,000.

Based on the Micromort table I think you'd need to drive more like 2,300 miles to have a 1 in 100,000 chance of dying.
posted by gregr at 9:25 AM on April 24, 2021 [1 favorite]


Best answer: From what you write, it doesn't seem as if you are truly disputing the science or data that the vaccine is necessary for Covid-immunity both for your own and your community's safety. This isn't coming across as a mathematical risk-management concern either.

Rather, it seems like your worry is a manifestation of anxiety about... (imagine me waving my hand at the whole damn world), exacerbated by this pandemic. You're channeling all these anxiety chemicals flooding your brain into furious intellectual activity in order to alleviate the anxiety.

As coping mechanisms go, this is a pretty good one, on balance! It's not actually harmful to yourself to keep your brain extra busy as a way to alleviate your anxiety, unlike, say, coping with with alcohol or dissociation or yelling at your loved ones.

But the trouble with intellectualized coping mechanisms is that they can end up paradoxically INCREASING your anxiety rather than alleviating it, like, if you work yourself up into ever greater worry by coming up with more and more facts and what-ifs. This might be the trap you've fallen into right now.

So what can you do? I think it would help you a lot to accept your anxiety just as it is. It's really painful to try to beat your feelings into submission using reasoning and facts and research and hypotheticals. Your feelings are what they are. They don't have to be rational. It can be freeing to accept that it's okay to feel whatever anxiety you feel even as you take the actions you know you need to take for the wellbeing of yourself and your community.

I like to think of my anxiety like it's a toddler having a meltdown, and I am its parent. I can empathize with the way a toddler's brain simply can't process the moment when in meltdown mode, and, like, if I were to offer rationalizations and facts, they won't help at all. I would speak to the toddler gently, in a calm voice, letting them know it will be ok, they can get through this scary thing. I can promise them that I will be right there to help them and take care of them even if the worst that they are fearing actually happens. I'd give the poor kid a hug, bribe them with the promise of ice cream afterwards, hell I might even bribe them with the offer of candy for putting on shoes and getting into the car. And then I would totally distract the toddler with fun! shiny! or soothing activities until the appointed hour arrives, rather than allow them to obsess and fixate on impending doom.

It will be ok for you, too, cgg. You can do this scary thing. You can trust yourself and your loved ones to be there for you and take care of you even if the worst happens. You'll cross that bridge when you get to it. For now, be gentle with yourself, accept that your brain and body are flooded with anxiety and that's allowed!, promise yourself a real treat right after you get your vaccine, and distract yourself with a candle, or flowers, or a walk in the woods, or a favorite book while you wait for what feels like impending doom, but the adult part of you knows it isn't.
posted by MiraK at 9:26 AM on April 24, 2021 [33 favorites]




Buy a lottery ticket on your way to the appointment.
posted by Huffy Puffy at 9:30 AM on April 24, 2021 [8 favorites]


Best answer: I don't think I can help with this math -- and in a way, it doesn't matter. You're scared and that's okay and valid, whether or not it's "rational."

But I'll tell you that what really, really helped me when I got my AstraZeneca shot (which was about two days before most European countries stopped using it in people of my demographic!) was, perhaps counterintuitively, reading a ton about this type of blood clotting issue -- vaccine-induced prothrombotic immune thrombocytopenia.

I am the kind of person who likes to know what's going on in my body and how medications work. If you're at all like me, I'd suggest reading some of the scientific literature on the clots, who is susceptible, and what the symptoms are. Try this one on treatment of VIPIT ...

and this one, from the German doctors who were among the first to identify this side effect

Also check out this Q&A.

The tl;dr is -- yes, this is a dangerous (albeit extremely rare!) side effect, but it is treatable. Now that doctors are aware of it, they are more likely to be able to treat it effectively. One reason for some of the early deaths was that doctors treated VIPIT like any other blood clotting disorder and gave the patients heparin, which is the wrong thing to do with this types of clots (which form when antibodies attack platelets and make them clump up), and seems to make it worse.

Learning all this really helped me feel in control of the situation. Instead of worrying that unknown scary things were happening inside me, I was able to say, "I'm producing antibodies. There is a tiny, tiny chance that something might go wrong with these antibodies, but if it does, I am armed with the information to get myself to a doctor, tell them about my symptoms in a clear and coherent way, and get appropriate treatment."
posted by artisthatithaca at 9:30 AM on April 24, 2021 [37 favorites]


You're forgetting point prevalence vs. lifetime prevalence. You only get the shot once. You're taking a 1 in 250,000 chance once. (Yes, we may eventually need boosters, but presumably by then the risk profile or available shots will have changed.) You drive every day. Your risk of ever dying or being permanently disabled in a car accident are dramatically higher than your risk of same from this one shot. And yet you don't avoid driving to reduce your accident risk budget, do you?

It's more or less the difference in odds between buying one lottery ticket for a drawing versus buying thousands.
posted by shadygrove at 9:57 AM on April 24, 2021 [3 favorites]


AZ is 100% preventive of serious illness and death. Picture someone getting prepped for intubation, and thinking "maybe I should have gotten that vaccine."

It might not matter right now though; since BC is running low on AZ.
posted by dum spiro spero at 10:00 AM on April 24, 2021 [2 favorites]


Best answer: There was a good Twitter thread about this by a blood clot doctor - I found this helpful.
posted by SoftRain at 10:03 AM on April 24, 2021 [1 favorite]


I got my first shot of AZ last week, and had similar thoughts to you. I knew that getting the first vaccine available was the right thing to do, but I could not shake the feeling that AZ was somehow more dangerous, and that my friends who might get--or have already gotten--one of the MRNA vaccines were getting a more "premium" experience. I was quite ashamed of myself for this thinking, but like you, I had a hard time shaking it.

The points above about comparable other risks that we take without thinking helped, but what really resonated with me was the idea that the AZ is a "traditional" vaccine, while the MRNA ones are newer technology. My brain calmed down at the idea that I was getting a better-known quantity and that perhaps any risks were simply being identified more easily and earlier on.

[Note that this should not be taken to imply that there are any greater risks with the other vaccines, which have been scrupulously researched and tested etc.. This is just a thought that helped my lizard-brain get into line with my rational one.]
posted by rpfields at 10:11 AM on April 24, 2021 [1 favorite]


But I live alone and rarely leave my house, so my chances are much much lower than that - those numbers are skewed by higher risk populations. What are the chances of me getting covid if i literally only spend 30min a week grocery shopping and visit one friend who lives their life similarly?

Probably quite low if your lifestyle doesn't change. However, things happen -- people fall, break their leg, and spend a week in the hospital followed by six months of shared rides to physical therapy and doctor's appointments; friends get covid and don't realize it until after you have hung out; etc. The vaccine is your insurance in case you have to take on more risk, as well as lowering the risk of the things you already do.

I live in a place where the AZ vaccine isn't available, but if they had offered it to me I would have taken it without hesitation. It's a tiny risk that lowers your overall risk tremendously. That is a great bargain in my eyes.
posted by Dip Flash at 10:24 AM on April 24, 2021 [7 favorites]


I don't have much to say but that I understand your anxiety. I got the AZ shot on Thursday and it felt like the right thing to do at the time, but now I'm second-guessing it, wondering if I should have waited given that I work from home and only go out to do the grocery shopping once a week.

I know rationally that the risk of a clot is small but it's very difficult to conceptualize what those numbers mean in actual fact. Strangely, I feel more in control because at least when I go grocery shopping I feel some semblance of control over the circumstances. None of this is rational, but that doesn't make the feeling any less real.
posted by synecdoche at 10:47 AM on April 24, 2021 [2 favorites]


Some good advice above, especially about being gentle with yourself about being anxious and understanding that it's not necessarily a matter of rational persuasion.

But I live alone and rarely leave my house, so my chances are much much lower than that - those numbers are skewed by higher risk populations. What are the chances of me getting covid if i literally only spend 30min a week grocery shopping and visit one friend who lives their life similarly?

Since we're not going to actually eradicate COVID, how does the thought of doing that forever make you feel? Which are you more frightened of? That's not actually a rhetorical or gotcha question. If you find that you are quite happy with the idea of spending the rest of your life essentially never leaving your home (will your one "safe" friend continue to live like that indefinitely?), that would be important information for you. But sometimes I overcome anxiety about change with a visceral sense that the current situation just can't continue.
posted by praemunire at 10:50 AM on April 24, 2021 [5 favorites]


there's a 1 in 1600 chance of a blood clot with the Pill (number taken from memory, may not be accurate). Um.. did that, got one 15 years ago, my doctors wont allow me to take the pill any more. That argument does not bode well for my brain, literally.

I know it's the weekend, but maybe you could still get a second opinion from a medical professional about whether the AZ vaccine is safe for you to take given your specific history. I think that would boost my confidence in my ultimate decision.
posted by trig at 10:54 AM on April 24, 2021 [5 favorites]


(The poster mentions discussing getting the shot with their doctor wrt to their previous clot experience, FYI)
posted by MadamM at 11:17 AM on April 24, 2021 [3 favorites]




(Right - this would be a second opinion for confirmation)
posted by trig at 11:35 AM on April 24, 2021 [1 favorite]


Just to add to artisthatithaca, my sense from following the news is that in addition to making sure doctors know how to treat it, the pause was to develop messaging for patients. They should tell you what symptoms to look out for when you get your shot.
posted by coffeecat at 11:51 AM on April 24, 2021


To be clear the OP has stated that they would be willing to take an mRNA vaccine which might happen in June. So this question is not asking about never getting vaccinated.

While I generally agree with what others have said here, the truth is this is about your own anxieties. Read the twitter thread linked above. She actually states that if you are not in a high risk area and you are a safe person then yes. waiting is reasonable.
posted by vacapinta at 11:52 AM on April 24, 2021 [2 favorites]


I've just recd my AZ appointment for Tuesday tea-time. My brother and sister in the UK are one shot ahead of me and they're fine. In contrast to Gertrude Stein's a rose is a rose is a rose, I don't think all clots are equivalent. Dr Marie Scully, [Guardian] the consult haematologist in London, recognised the similarity between the AZ clotees and HIT [heparin inducted thrombocytopaenia] which made it clear that heparin treatment was throwing gasoline on a fire. Your pill-induced clots were a different mechanism and so shouldn't inform the outcome for you this week. But I see your doc said that already.
God bless Team AZ and all who sail in her.
posted by BobTheScientist at 11:52 AM on April 24, 2021


Male, early 40s. I got the AZ shot last week. I'll tell people it made me feel sicker than I have in a year, because I don't think I got sick last year at all. I felt mildly feverish and achy for about 24 hours, then it was gone.

Here's the thing, though. I went grocery shopping yesterday, and I felt a distinct lack of the anxiety that's been there for so long I'd stopped noticing it. I know the first shot probably won't provide its maximum protection for another week or two and I'm not bulletproof even after the second shot, but it was kind of remarkable. I'd expected to feel a catharsis at the vaccination center that didn't come, but pausing beside the cereal and realizing that I wasn't slightly wary of everyone in the store was a unique sensation.

You know the odds of problems with AZ, and if you can hold out for an mRNA vaccine there's probably no harm in it, but it feels like such a relief to have it out of the way.
posted by figurant at 12:24 PM on April 24, 2021 [2 favorites]


I'll link the article from ScienceBasedMedicine, but here's a bit of TL;DR

Initial observations show "total number of reported blood clots was within expected range", and thus, any benefit of the vaccine would vastly outweigh any additional risk of blood clots.

Now there is a focus on a SPECIFIC TYPE of blood clot, as a pre-print paper (that has NOT been peer-reviewed) claimed 9 cases of CVST (clot in vessel that drains blood from the brain) probably vaccine-induced. Expert reactions to this paper is mostly negative, indicating there is simply NOT ENOUGH DATA to form any conclusions, much less blame it on vaccine.

CVST cases are so rare, experts simply don't know what the background rate is overall, muchless in any segment of population to estimate risks. The ESTIMATED rate is 2-16 per million people.

Also keep in mind that it is also possible for COVID to increase the risk of blood clots, rather than the vaccine. In fact, 2 out of 9 patients have been previously diagnosed of pre-existing blood coagulation disorders, according to one reaction from experts. Thus, the link to AZ vaccine is "insecure". Another doctor called the study "not of high quality and completely unable to say whether or not vaccine causes clotting"
posted by kschang at 1:07 PM on April 24, 2021


Response by poster: Thats all for chiming in, for all the extra information (really helpful!) and being gentle with my poor anxious brain. Definitely going to get a vaccine, and assuming they don't run out before my appointment monday, probably soon. There's definitely some truth the idea i'm reacting to yet another thing to be anxious about in all the things that already exist, especially since this one thing is also supposed to be the thing that helps end this nightmare. Take care ya'll... you are awesome people.
posted by cgg at 2:23 PM on April 24, 2021 [5 favorites]


Covid deaths would be 2 per 100,000 per week - not a fixed number, of course, but even if that rate remains true only for a few weeks then the ultimate risk is much higher. Shot would be whatever it is much less frequently (twice ever, or perhaps every year if we have boosters, and also requiring that they never fix the problem).
posted by How much is that froggie in the window at 8:56 PM on April 24, 2021 [1 favorite]


I wasn't going to really say anything in this thread because I couldn't really think of any way to lessen your anxiety (I would be freaking if I had a history of blood clots too) on the topic.

BUT I went out in public today and had a multi-store, multi-town shopping spree for my birthday and ended the day by eating inside in a restaurant (too cold to eat outside, unfortunately) and I hugged relatives and it was GLORIOUS. It was so normal (other than the masks in public). I wasn't worrying about being near other humans. God, it was worth it.
posted by jenfullmoon at 9:09 PM on April 24, 2021 [3 favorites]


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