On Tues, I had the same reaction to NACI's latest AZ advice as the rest of you but after reflection and reaction I have to say-NACI is right. We must help our pts balance risk & make an INFORMED decision. Too many docs are messaging "NACI is wrong, AZ is safe" It's not that easy

This is not binary. AZ is effective and for almost everyone who gets it, they will be fine. But VITT is also real, likely more common than originally though (1/50,000-1/100,000) and it is really bad (fatality up to 40%, serious illness and disability for others).

COVID risk is not binary either-where you live, who you live with, where you work, what options you have to keep yourself safe all matter. It is complicated and really impossible to calculate a number but it isn't hard to think help pts think of the ways in which they have risk

It's not all about numbers either. People all have difference tolerance for risk and tolerance for waiting. The emotional harm of waiting 3 weeks may be enough for someone who is in a community with almost no COVID accept the risk of VITT.

And Pfizer is coming. A LOT of Pfizer. There is enough for everybody and waits are not what the used to be. For many that wait might be worth it to reduce their risk of VITT. For others even 3 days is too long.

So we have to TALK about this
- how can we communicate about risk so people can make individualized choices that are truly informed but accurate advice not fear tactics or oversell
- how do we pivot our messaging to be more nuanced, less of the of "first vaccine is best"

As health care providers also are responsible to inform ourselves
- have WE tried to understand the risk, to be nuanced not binary
- do you understand VITT? How it presents, how to investigate, how to treat? Sadly, many cases so far were not recognize quickly with worse outcomes

Was AZ the wrong choice 3 weeks ago - probably not for almost everyone
Is it the wrong choice today - depends on who you are
Will it be the wrong choice 3 weeks from now - maybe, depends on how well that wave of Pfizer is rolling out /fin