Brian Cirone of Windham had an appointment to get the Johnson & Johnson vaccine Tuesday morning but got a call about 45 minutes before his scheduled time telling him it was canceled. Cirone now has an appointment next week to get the Pfizer or Moderna vaccine, but says he’d take the J&J shot if the federal government allowed it. Brianna Soukup/Staff Photographer

The pause in Johnson & Johnson vaccinations in Maine on Tuesday caused many providers and patients to review and in some cases adjust their efforts to inoculate against COVID-19.

It also raised concern that an extremely rare blood clotting complication with the J&J shot might increase vaccine hesitancy, although health officials said it’s too soon to know the long-term impact on inoculation programs happening in school gyms, nursing homes and pharmacies across the state.

Brian Cirone of Windham was unfazed when his appointment was canceled for a J&J shot at the Windham Veterans Center on Tuesday. He had a backup appointment for the first of two Pfizer or Moderna shots next week at MaineHealth’s Scarborough Downs clinic.

But Cirone, 45, said he’d still take the J&J shot if the federal government allowed it, and he worries that the vaccine’s rare clotting problem will make others reluctant to get inoculated and embolden people who oppose it.

“I still trust science,” Cirone said. “Hopefully, this is a temporary bump.”

Health officials share Cirone’s apprehension that problems with the J&J vaccine will increase public resistance to inoculation.

“We’re already running into vaccine hesitancy, especially in rural areas of Maine, so it is a concern,” said Dr. Dora Anne Mills, the chief health improvement officer at MaineHealth, the state’s largest health care network. She’s also a former head of the Maine Center for Disease Control and Prevention, and sister of Gov. Janet Mills.

The Maine CDC paused use of J&J doses Tuesday as recommended by federal agencies concerned about complications with the one-shot vaccine. Maine has received 34,400 J&J doses for the state vaccination program since it became available for use five weeks ago. An estimated 30,000 additional J&J doses have been allocated to the retail pharmacy program in Maine, which includes Walmart/Sam’s Club, Walgreens, Hannaford, Shaw’s and others.

Barbara Gilchrist of Brunswick got the Johnson & Johnson vaccine last Thursday. She said it seemed like the pause on its use was probably just an overabundance of caution, but it is “still scary to think about” the reported clotting problem. Brianna Soukup/Staff Photographer

The U.S. Centers for Disease Control and Prevention is scheduled to meet Wednesday to investigate six reported cases of cerebral venous sinus thrombosis among more than 7 million J&J shots given nationwide.

All six cases were among women ages 18 to 48 and symptoms occurred six to 13 days after vaccination, federal authorities said. One woman died, three were hospitalized, including one in critical condition, and two have been discharged.

None of the cases was in Maine, where Barbara Gilchrist, 35, got the J&J vaccine on Thursday at the Gorham Fire Department.

She treated herself to a milkshake afterward to celebrate, and she experienced some body aches and soreness at the injection site. But she was feeling better by Tuesday, when she learned about the clotting problem.

“My brain immediately lit up red flares,” said Gilchrist, who lives in Brunswick. But that moment of anxiety didn’t last. She thought about the extremely small number of women who were affected, resolved to watch out for any adverse effects and relaxed.

“I don’t think it would deter me from getting (the vaccine) if I hadn’t gotten it already,” she said.

Federal officials also halted J&J vaccine use to make sure health care providers know that blood clots arising from J&J doses should not be treated with typical methods, such as blood thinners.

However, blood clots are far more common among people who have fallen ill from COVID-19 – up to 20 percent of all cases – according to a review of 42 studies published in November by the University of California San Diego.

“The risks posed by COVID-19 far, far exceed any associated with the vaccines,” said Dr. Joan Boomsma, chief medical officer of the MaineHealth network, which includes Maine Medical Center in Portland.

The majority of the more than 200,000 doses of COVID-19 vaccine administered at MaineHealth clinics over the past three months have been Pflizer and Moderna, neither of which is connected to any reports of serious health conditions.

MaineHealth has received small amounts of the J&J vaccine for homebound and hospitalized patients, as well as about 2,000 doses that were administered last week at a vaccination clinic operated by Pen Bay Medical Center in Rockland.

“Given how extremely rare the blood clotting condition is, (MaineHealth) clinicians do not expect to see any adverse incidents among those vaccinated, but nonetheless are asking patients to be vigilant and to contact their healthcare provider with any questions,” Boomsma said in a written statement.

The pause in J&J vaccinations prompted the Old Orchard Beach Fire Department to postpone an inoculation clinic that was scheduled to vaccinate more than 300 people on Wednesday at the town’s high school gym.

A sign at the Windham Veterans Center let people know that Tuesday’s vaccine clinic there was canceled because of a pause in use of the Johnson & Johnson vaccine. Brianna Soukup/Staff Photographer

The department sent an email to scheduled recipients on Tuesday morning, notifying them that the clinic has been postponed one week to April 21, with appointments at the same times. Recipients were asked to respond if they needed to cancel their appointments, but few had done so by noontime Tuesday.

“I think most people are waiting for more information,” OOB Fire Chief Fred LaMontagne said. “The majority of people are in wait-and-see mode.”

Northern Light Health, a hospital and provider network that includes Eastern Maine Medical Center in Bangor, had 735 J&J doses remaining in stock of about 4,100 doses received as of Monday. Spokeswoman Karen Cashman didn’t respond to questions about the impact J&J vaccine concerns might have on the network’s inoculation efforts or vaccine hesitancy.

“Northern Light Health is eager to hear the results of the (federal) inquiry,” Cashman said in a written statement. “To date, we are not aware of any similar events with any patients to whom we have administered the J&J vaccine. We have paused the administration of J&J vaccine in compliance with the CDC and FDA’s request as a precaution.”

Pausing the J&J vaccine also worries the Maine Health Care Association, which represents 92 nursing homes and 105 assisted-living facilities. The one-shot vaccine has made it easier to vaccinate residents and staff members in the wake of the federal pharmacy partnership that provided clinics in long-term care facilities.

The J&J vaccine was especially effective in solving the problem of hospital patients being discharged to skilled nursing facilities without being inoculated because they couldn’t schedule a second dose, said Rick Erb, the association’s president and CEO.

“We weren’t using J&J exclusively, but there certainly was a benefit for our residents and staff,” Erb said. “We’ve been making steady progress and we’ve been finding that people who were reluctant initially are now more willing. Any decline in available options is concerning. We don’t want to see anything that impedes progress.”

On Tuesday, the national group that represents Erb’s members called on the Biden administration to allocate more Pfizer and Moderna vaccines to long-term care facilities to fill the gap caused by the J&J pause.

“The federal government was primarily allocating the Johnson & Johnson vaccine to nursing homes and assisted-living communities,” said Dr. David Gifford, chief medical officer for the American Health Care Association and the National Center for Assisted Living. “Without swift action to replace (the J&J) vaccines, we could see tragic consequences.”

For those concerned about the safety of COVID-19 vaccines, MaineHealth’s Mills emphasized the effectiveness of the three-layered monitoring system that flagged the J&J clotting problem to federal authorities.

Mills also praised vaccination as “our ticket back to normal,” along with continued masking and social distancing. With the rise of COVID-19 variants, she said, health experts now believe 80 to 90 percent of Mainers must be vaccinated to reach herd immunity. As of Monday, about 29 percent of Maine’s 1.3 million residents were fully vaccinated.

“Protect yourself and your loved ones,” Mills said. “Get vaccinated.”

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