Mostly because they don't actually KNOW. At least, not by an acceptable standard. I cannot use their level of so called knowledge in my practice or I would lose my license. I need to actually KNOW what I am doing, WHY I am doing it, What I expect to change by doing it, What side effects I expect to see, and what side effects are enough of a concern to stop the treatment. The guidance here is filled with a lot of "should help..." "might reduce..." "feel strongly..." and my personal favorite "think how bad it would have been..." None of those suggest knowledge. All of them suggest...uncertainty. I cannot practice with uncertainty.
For example: if John arrives in the ER with chest pain, I will ask him if he is allergic to ASA. If he isn't he will get either 160mg chewable or 320mg chewable (depends on the school of thought of the ER doctor treating him, or the protocol of the facility, regardless he gets ASA unless he is allergic or has a bleeding ulcer problem, or is already on anticoagulants). Then he gets an IV, preferably an 18 gauge with Normal Saline running, in case he needs more advanced cardiac meds (atropine, amiodarone, epinephrine, etc) We will do an ECG, to see what part of the heart is affected by the potential blood clot, and order a bunch of blood tests to confirm cardiac muscle involvement. Specifically looking for elevated troponin levels, which if present confirm cardiac damage. We will look at chemistry, to see if his calcium, sodium or potassium are off, and will adjust those according to what we find. IF his troponin is elevated we will do another troponin 6 hours later, rising levels means more damage, dropping levels means the peak of the event is over. SO he gets ASA, which is an antiplatelet aggregate, meaning any clot won't get bigger. IF there is no clot (angina, or panic attack, etc) then the ASA we gave him will do no damage. If he has a clot, confirmed via ecg changes, elevated troponin, etc, then we either give Tenecteplase IV ( highend clot buster) based on his weight, or even better, if we have access to a Cath lab, we send him for an angiogram and likely angioplasty (they open the affected artery with a balloon). The point here is this, the initial intervention of ASA, unless contra indicated, WILL help with a blood clot in the heart. IF there is no clot, the ASA will do no harm. We do not open with the Tenecteplase, because if there is no clot to breakup John has a much higher chance of having a hemorrhagic stroke now that we gave him the clotbuster. We don't open with an angiogram/angioplasty until we KNOW it is needed. At no point in this situation do I give John anything based on my "feeling strongly that it might help" "should help" "might reduce" or any of that uncertain crap. I need to own my practice, so I research the shit out of what I may encounter and might be required to do. So that when my patient asks what to expect, I KNOW the answer, and the statistics about likely outcomes. No part of my practice is based on guess work and someone else's research.
Yes the vaccine might help, it probably will. It might also cause an autoimmune disease in five years or less, or more. It might be 97% effective against all coronavirus diseases for the life of those vaccinated. Great! It might also result in a hyperinflammatory response to the next coronavirus they are exposed to and kill them in under 3 days. I do not know any of those answers. Neither do the manufacturers frankly. There is no data on the vaccine older than six months. Everything else is theory, and theory sometimes bites you in the ass, Hard. I consider this a global experiment, longitudinal study yet to come. I can not ask my patients to accept a vaccine that I will not take and that I know nothing about, other than that the trials were rushed, it has been approved under "emergency situation", not regular approval, and that, two days before it was available my government suddenly passed a "vaccine compensation" bill to compensate anyone who suffered as a result of vaccine administration. Again, not reassuring stuff.