The health workers who became terminally ill – Norway

It is about half a year since AstraZeneca’s vaccine against corona was stopped in Norway.

Norwegian health authorities pulled the emergency brake when the Danish authorities put the vaccine on pause after reports of blood clots and deaths.

Not long after, similar cases appeared in Norway.

But why was Norway, with eight cases, apparently hit harder than other countries? Why was the connection between the side effects and the vaccine discovered in little Norway? And who was affected?

A special weekend in mid-March is central to the search for the answers.

And while the experts were trying to solve the riddle, many vaccinated health workers feared that they too could be affected by the serious side effects.

Weekend guard

On Friday 12 March this year, Pål André Holme prepared for the first shift through the weekend.

He is a professor and chief physician at the Department of Blood Diseases at Rikshospitalet, Oslo University Hospital, and had already received several calls from other hospitals about seriously ill patients with blood clots, low blood platelets and bleeding.

A life-threatening and very unusual course of the disease – now known as VITT (vaccine-induced immune thrombotic thrombocytopenia).

Chief physician Pål Andre Holme led the work to find out why more patients were admitted to Rikshospitalet with low blood platelets, internal bleeding and blood clots.

Photo: Jorunn Hatling / NRK

When he came to work, three of them were at Rikshospitalet.

– They were extremely ill, says Holme.

At the time, the doctors at the hospital did not quite know what they were facing, but they assumed that the serious course of the disease could have something to do with AstraZeneca’s coronary vaccine.

The day before, the vaccine had been put on pause after disturbing reports from Denmark. There, the health authorities investigated whether a death could be linked to the AstraZeneca vaccine.

In addition, there were reports that a woman in her mid-30s from Tynset had died. The woman was a health worker and died a few days earlier at another hospital in the country.

– Everyone was basically healthy and young. They had taken the vaccine 8-10 days earlier and all were health workers, says Holme.

Health workers

Because it was primarily health workers who received the AstraZeneca vaccine in Norway. They were a priority group that had to be protected against infection and disease in order for society to function in the best possible way in anticipation of more vaccines.

One of the health workers who was admitted to Rikshospitalet this weekend was a woman in her late 30s. She herself worked at a hospital and became very ill about a week after being vaccinated.

Before she arrived at Rikshospitalet, the platelet level was very low and a CT scan indicated a blood clot in her head.

In a short time, large resources were invested to find answers.

Was it possible to establish that the vaccine was the cause of the special course of the disease, and how should the terminally ill patients receive the best possible treatment?

– It was a huge activity here. Everyone who could contribute, let go of what they had in their hands and worked on through the weekend and the next few days, says Holme.

Department of Internal Medicine Research

At the Department of Internal Medicine Research at Rikshospitalet, there was full activity as the researchers looked for a connection between the AstraZeneca vaccine and serious side effects.

Photo: Jorunn Hatling / NRK

One of the really great strengths of the university hospital is that they can take clinical issues from the ward back to the laboratory and try to find the answers and vice versa, bench-to bedside research in good English.

– In addition, we merged several environments with different cutting-edge expertise. Not least, we had to bring in experts on antibodies from the University Hospital of Northern Norway. I have never experienced a similar team spirit before – everyone threw away what they had and went “all in”, says the professor.

At the same time as the researchers worked intensely to find out why someone became so seriously ill, the Norwegian health authorities encouraged health workers, who had been vaccinated, to report all forms of blood clots as soon as possible.

Chest pain

One of them was dental nurse Cathrine Thorvaldsen. The same day that the vaccine was paused in Norway, March 11, she was vaccinated with AstraZeneca.

Catrine Thorvaldsen.

Dental nurse Catrine Thorvaldsen got a blood clot in her lungs at the same time as there were reports of fatal side effects after the AstraZeneca vaccine.

Photo: Christian Zielger Remme / NRK

After a few days of flu-like symptoms, she thought everything had gone well and started working again.

– But exactly one week after vaccination, I got chest pain, and then a possible blood clot was found in the lungs, Thorvaldsen says.

She feared that she too could be affected by WHITE, and was very afraid of what might happen.

– When there were reports of more deaths after blood clots, I just had to shut it out. I could not bear to watch the news and was terrified.

Fortunately, Thorvaldsen did not get the rare combination of side effects, and was treated with blood-thinning drugs at Diakonhjemmet hospital, but the body was treated badly and the dentist, with his own practice, was on sick leave for several months.

The case has been reported as a possible side effect to the Norwegian Medicines Agency, and she has submitted a claim for compensation to the Norwegian Patient Injury Compensation (NPE).

It has not yet been determined that AstraZeneca’s vaccine caused the blood clots in the lungs, and the case is still being processed.

To date, the Norwegian Medicines Agency has registered 361 reports of blood clots after coronary vaccination started.

– This does not mean that there is any connection with the vaccine – but that the doctor or patient has reported a suspicion as we encourage. Then we systematize the numbers and do more research, says Steinar Madsen, director of the Norwegian Medicines Agency.

According to the Norwegian Medicines Agency’s latest adverse reaction report, 296 of the cases have been reported after the mRNA vaccines of Pfizer and Moderna. Per. On 14 October, 7.3 million doses of these vaccines were administered in Norway.

So far no connection has been proven with the vaccines and the risk of blood clots, writes the Norwegian Medicines Agency.

The press conference

The same day that Thorvaldsen was treated for a blood clot, and only a week after the vaccine was put on pause in Norway, things happen at Rikshospitalet.

At short notice, Oslo University Hospital and Pål Andre Holme call in for a press conference on the lawn outside the hospital.

The stunt takes place just hours before the European Medicines Agency EMA holds its announced press conference on AstraZeneca’s future, and before researchers from other countries have time to broadcast their findings.

– We have made findings that can explain our inpatients’ clinical course, Holme said on the lawn.

The finding had no consequence for EMA’s conclusion that day. They believed that the AstraZeneca vaccine was still safe.

The solution

But soon new reports appeared about possible VITT cases in several countries, and in April, the Norwegian researchers published a study in The New England Journal of Medicine.

There, they concluded that there was a connection between the vaccine and the serious side effects. A German group study corresponded to the Norwegian findings and was published the same day.

What exactly did you find out?

– What we saw was that the patients received an enormous immune response. It was almost as if there was an immunological storm in these people, says Holme.

Do you now know why someone gets this response?

– No, even though we have worked extremely hard with this, we still do not know why anyone is affected.

Why do you think that Norway was one of the countries that first discovered the connection?

– We knew exactly which vaccine was used and how many had been vaccinated. In addition, several of the cases ended up at Rikshospitalet. Thus, we got a very good overview early on and could see a connection, says Holme.

Why are there more cases in Norway than in other countries?

– I think it’s about cognition, you only count what you know what is, and here we were good at registration. In the beginning, extremely few cases were reported in other countries, but now we see that other countries are approaching our numbers.

What do you think about it being used in other countries?

– I think it’s unfortunate. At the same time, I am not a vaccine opponent, and the fight against covid is important. But I wish everyone had access to effective vaccines that do not provide this side effect profile that we have seen in Norway, says Holme.

Survivors are marked

A total of eight people received VITT in Norway after vaccination with AstraZeneca, NRK’s ​​review shows.

Four of them died.

One of them was a 37-year-old hospital employee.

The first to die.

NRK has been in contact with the woman’s cohabitant for almost 20 years. He does not want to be interviewed about the case, but says that the death still affects him and his immediate family strongly.

  • The other three who died were also women and worked in the health service
  • The youngest was 34 years old, while the oldest was 54 years old
  • Two of the women were mothers

Three who died.

In Norway, four people survived the life-threatening disease condition

  • Two of them are men
  • The youngest is in his mid-30s and the oldest is in his mid-50s
  • All four are health professionals

The four survivors

As far as NRK knows, some have done quite well, while others are struggling with significant repercussions.

After eight cases with VITT of about 140,000 vaccinated, AstraZeneca was permanently removed from the Norwegian vaccination program on 12 May.

Used in 170 countries

But the vaccine is still used in 170 countries, and AstraZeneca has so far released 1.2 billion

Kristin Løseth

Kristin Løseth, chief medical officer of AstraZeneca Norway, says that work is being done to find out why the very rare but serious side effects occur.

Photo: Jorunn Hatling / NRK

vaccines.

– It is also used in many EU countries and is a very important vaccine to fight the pandemic, says Kristin Løseth. She is the medical director of AstraZeneca Norway.

Løseth says that no VITT cases were detected in the large clinical studies that were done before the vaccine was approved.

– The figures we are sitting on show that this serious side effect occurs in one case per 100,000 on the first dose. We know that the incidence was higher in Norway, but we do not know why, she says.

Is this a safe vaccine?

– We are in a very serious pandemic where most people agree that the vaccine is the way out. This is an approved and effective vaccine, and we need all good and effective vaccines, says Løseth.

Compensation

In Norway, the Norwegian Patient Injury Compensation (NPE) deals with compensation claims from patients or relatives who believe they have been harmed after public vaccination.

Rolf Gunnar Jørstad, director of NPE

Director of Norwegian Patient Injury Compensation (NPE), Rolf Gunnar Jørstad, says that they have found a basis for compensation in three of the VITT cases so far.

Photo: NAME

After the mass vaccination started, NPE has received a total of 141 claims for compensation. Four of them are WHITE cases.

– We have decided three of the VITT cases, and for all three there is a basis for compensation, says director of NPE Rolf Gunnar Jørstad.

He says that they had a good medical professional background to decide on the connection between the vaccine and the condition of the injury.

The amount of compensation has not yet been determined.

No one has received the serious side effect combination (VITT) after the vaccines offered in Norway now, Pfizer and Moderna.

There have been some reports of cases of VITT after the Janssen vaccine in other countries. The vaccine is not part of the Norwegian vaccination program.

In April, NRK and several media outlets wrote that Pål Andre Holme and the co-authors of the study, which was published in The New England Journal of Medicine, had previously received fees from the pharmaceutical companies Pfizer and Bayer. Holme denied that it had affected the work, but said that he should have stated about it when the study was submitted.

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