I got the J&J vaccine, and I’d do it again

Side effects make people skittish, but you know what’s definitely bad? Covid-19

Just like that, the wait was over. I had just finished writing about the unevenly distributed challenge of waiting (for a Covid vaccine, a vote, a legal process, whatever) and was fruitlessly checking my email once again for a vaccine invitation from the DC government. But then, plot twist! According to a neighbor, a church down the street was holding a city vaccine clinic the very next day. The rumor seemed almost too good to be true—it involved registering via a dubious-looking telehealth site, which sent no confirmation. But when I showed up, I waited my turn, walked into a dark tent, and was duly stuck with a Johnson & Johnson shot. Then I emerged into a bright array of spring flowers, feeling shocked, blessed, and relieved after more than a year of worry. (Also a bit chastened. Sorry to have doubted you, government.)

The shot felt like a gift, and as I left I received another one. It was a printout with the address for V-Safe, an opt-in smartphone system developed by the CDC and Oracle to trace side effects from the various Covid vaccines. The system is simple: it asks you a few basic questions, and then every day (and eventually every week) your phone pings with a text from Uncle Sam, just seeing how you’re doing. “Hi Amanda, it’s time for your daily v-safe check in,” the message says. A menu of three little emoji faces lets you tell the system if you feel good, fair, or poor. Then you can check off boxes indicating whether you’re experiencing such symptoms as chills, fever, fatigue, swelling or redness at the injection site, and whether those symptoms are mild or interfering with your daily life. Depending on your answers, the system says, you may receive a follow-up call from the CDC.

I like to think of myself as not a side effects person. But when I started shaking with chills that night, I was glad to recall the V-Safe pamphlet and plug the address into my phone. In the days that followed, as my fever and swollen upper arm waxed and waned, the daily pings from V-Safe seemed sweet and solicitous, attention from a government that cared. Was I feeling good? Hell no, United States government, I was not, thanks for asking! I mashed the red “sad face” button marked “poor.” How cathartic. The next day, it checked on me again, and I was glad to be able to report I felt much better. Short of bringing me soup, the app could not have seemed more attentive to my welfare.

Of course, this automated emotional labor is neither the primary nor the secondary purpose of the system. The main point is to gather data on side effects for what is, after all, a government-sponsored program to vaccinate as much of the country’s population as possible. (Check out this informative March 1 CDC report from the first month of Pfizer/BioNTech and Moderna vaccinations, which shows that symptoms like fatigue, fever, and pain at the injection site really are very common.) But V-Safe’s second purpose—its own side effect, if you will—is to teach millions of people to recognize these ordinary and largely harmless side effects for what they are. I felt crappy enough for a few days that I might have been a little worried—except that every adverse reaction I was having was right there on the app’s short checklist of symptoms, showing that it was just my immune system doing its job.

V-Safe’s list seemed especially benign in light of another possible Johnson & Johnson vaccine side effect that emerged this week, causing the FDA to temporarily “pause” any more Americans receiving the shot I had been so grateful for. (The Pfizer and Moderna shots, which work through a different mechanism, are unaffected, and the White House reassured Americans this week that there will be enough of those two vaccines to go around.) Six women ages 18-48, out of 6.8 million Americans who have received the Johnson & Johnson vaccine, were diagnosed with a rare but serious blood clotting condition; one has died, and another was reported to be in critical condition. The FDA told people who had received the Johnson & Johnson shot in the last three weeks to watch for symptoms of blood clots, which include severe headaches, abdominal pain, leg pain, and shortness of breath. Unlike V-Safe’s list of mostly low-level side effects, these are symptoms that merit a call to a doctor and likely a visit to the emergency room.

Most experts seem to believe that temporarily halting distribution of the J&J vaccine was the right thing to do, “out of an abundance of caution,” as National Institute of Allergy and Infectious Diseases director Anthony Fauci said. I hope that their cost-benefit analysis is right, and that this news doesn’t lead to people becoming more wary about this vaccine or Covid vaccines in general. Because based on what we currently know, I have no regrets about taking that shot and would do so again tomorrow if that’s the one I could get. What I really do not want is Covid-19.

My math looks like this. Let’s say the Johnson & Johnson shot causes fewer than one in a million recipients to suffer the rare condition known as cerebral venous sinus thrombosis—a clot in the veins that drain blood from the brain. That condition is often treatable, as long as it is quickly diagnosed and doctors know to use a different anticoagulant than the most common one, heparin, which paradoxically can actually cause clots of this kind. If you can get the Pfizer or Moderna vaccines instead of Johnson & Johnson, fine. But if Johnson & Johnson is available first, from a clotting perspective it seems way safer to take it than risk a few extra weeks of exposure to Covid-19. One analysis found that around one in five Covid-19 patients suffered a blood clotting event, and that these patients were particularly likely to die—the risk of death for such patients was 74% higher than if they did not suffer a clot. (In fact, another paper last year noted that the clotting issues with Covid were so severe that doctors needed to be on the watch for unusual heparin-induced clots anyway, since thousands of patients might be put on heparin as part of their treatment.) Essentially, a one in a million chance of a usually treatable clotting condition is far preferable to catching a disease that has killed close to 600,000 Americans, in part by giving them blood clots.

In taking on the responsibility of vaccinating the whole American population, the US government is having to teach us about medical risk, which can be complicated to absorb, and in this case involves new emergency-authorized treatments whose full effects are not yet entirely known. Sometimes that involves a kindly little public health tool like V-Safe. Other times, it may mean temporarily pulling a vaccine out of circulation while trying to encourage people not to lose faith in it entirely.

Given our often scientifically confused population, I’m concerned that any discussion of side effects will be discouraging to those who are already nervous about the vaccine. But having fallen down a rabbit hole of research papers on clotting risk this week, I can tell you I feel extremely lucky to have those J&J antibodies in my system right now. I’m no doctor, but based on extensive consultation with Dr. Google: please get vaccinated as soon as you can with whatever vaccine is available to you, sign up for V-Safe if you are recently vaccinated, and join me in hoping for the best while keeping your eyes peeled for any symptoms out of the ordinary.

What to read

It’s not just for vaccines: For a look at how rating experiences with happy or sad faces helps improve customer satisfaction, see David Owen’s delightful 2018 New Yorker piece about HappyOrNot, a Finnish startup responsible for the rating terminals you may have seen in airports. It has allowed companies to quickly see where customer service is falling short, while also allowing customers to feel heard. “HappyOrNot is satisfying because you can use it effortlessly and anonymously, without condemning yourself to a lifetime of targeted ads, and without adding still more monetizable information about yourself and your family to the world’s exponentially growing online hoard of permanently lost privacy,” Owen writes.

What to consume

At this time of year, no Twitter account is more full of real-life drama than that of farmer and author James Rebanks, who is trying to help his flock of sheep deliver dozens of adorable lambs in the gorgeous green fields of England’s Lake District. Warning: some don’t make it, but most of them thrive.

Good health and good spirits to all of you, and hope you are taking time to soak up the beauties of spring. See you next week.