Armand Dávila, a 49-year-old digital marketing strategist, takes extraordinary measures to avoid needles, even the mere sight of them.

Told by his doctor he was flirting with diabetes — a diagnosis that would necessitate insulin shots — Dávila took up marathon running. For routine medical procedures, including blood draws and vaccinations, Dávila has worn a sleep mask and headphones — that’s if he can even get himself to go in the first place.

“If I see the needle, I will hyperventilate,” said Dávila, who lives in the District. “If I hear the person coming with the needle, I will hyperventilate. Literally just looking at a needle makes my blood run cold.”

Now, with the coronavirus vaccine rollout, images of needles being jabbed into arms are inescapable on television and social media. For the millions of adults like Dávila who intensely fear needles, the eagerly awaited moment presents an existential dilemma: Many are deathly afraid of a needle that could save their lives.

And that raises a question some psychological experts say is being overlooked amid other inoculation concerns: How many of the needle averse will avoid the coronavirus vaccine and risk getting a disease that has claimed more than 330,000 American lives?

“I definitely think you’re going to see a group of people who will stay away and really maintain their fear,” said Bonnie Zucker, a Rockville psychologist who specializes in anxiety, including needle phobia. “It’s pretty powerful and scary.”

So scary, in fact, that studies show the needle averse routinely skip medical procedures — vaccines, tooth removal, blood tests — that they know are good for them.

Mary Rogers, a recently retired University of Michigan public health professor, says that between 20 and 30 percent of the population ages 20 to 40 fears needles. She co-authored a 2019 article in the Journal of Advanced Nursing reporting that 16 percent of adults avoid the flu vaccine because of it.

“I expect that this may occur with the covid-19 vaccine as well,” Rogers said. “If the same phenomenon occurs with covid-19 at half that rate, this would be a considerable number of adults avoiding the vaccine and may hinder our ability to reach herd immunity.”

In a recent survey of 788 American adults, the American Journal of Infection Control reported that fear of needles followed behind concern about side effects and the rushed development of the vaccine as the top reasons for those being unwilling to get vaccinated.

To people who can’t fathom why someone wouldn’t get a lifesaving vaccine because they fear a little needle, Zucker had this response: “Yeah, I agree with that, but I don’t have a needle phobia. For those who do, it’s just like people who are scared to step foot on a plane. They view it as just as terrifying.”

Jane Lyons, a 24-year-old affordable-housing advocate in Silver Spring who has suffered anxiety attacks around needles, took to social media with a plea to the news media: Stop showing pictures of needles because they are freaking out those, like her, with needle anxiety.

“It just sends a shiver down my spine when really I should be dancing with joy because the vaccine is coming soon,” said Lyons, who has skipped the flu shot and put off other medical procedures that involve needles.

Like Dávila and others who suffer from needle fears, Lyons cannot trace her angst back to any one event in her life. They say the worst part of the phobia — other than actually seeing needles — is needing to justify how they could be so afraid of needles to begin with.

“It’s hard to explain to somebody who doesn’t have this phobia,” Dávila said. “But it’s like realizing your worst fear happening — like if you’re afraid of heights and now you’re falling out of a plane. That’s as close as I can give you to the sensation that happens. It’s a trauma.”

It’s so traumatic that even explaining what it feels like is hair-raising.

“Just talking about this I’m breaking out into a cold sweat,” he said during a half-hour interview. “I hope you have all the information you need, but I’m traumatized talking about it. Oh my God.”

Dávila has never sought counseling for his needle anxiety, but psychologists say it is treatable, like other phobias, through cognitive behavioral therapy aimed at stopping a dangerous cycle in which avoiding an anxiety-inducing stimulus — in this case, needles — just makes the anxiety grow, like a snowball rolling down a hill.

“I tell all my patients with any kind of anxiety that avoidance is actually the fuel for anxiety,” said Kristin Kunkle, a psychologist at the Washington Anxiety Center of Capitol Hill. “The more you avoid something, the worse it gets.”

Kunkle and Zucker, the Rockville psychologist, treat needle anxiety with the gold standard method: exposure therapy.

Instead of avoiding pictures of needles, psychologists steadily expose patients to more and more images of needles. They progress to using fake but realistic needles to simulate the process of receiving an injection, even using real alcohol wipes.

“You’re getting them to face their fears in a gradual and more controlled way,” Kunkle said. “You gradually approach the thing that they are nervous about and begin to find ways to challenge the catastrophic beliefs that they have.”

It’s unlikely that exposure therapy can be ramped up to meet the challenges and timeline posed by the coronavirus vaccinations.

Exposure therapy isn’t a long process, but it’s also not quick, often taking several weeks. Also, many psychologists who use exposure therapy have long waiting lists for appointments and have opted out of insurance programs because of bureaucratic red tape and low reimbursements.

Experts and vaccine advocates say there are other, short-term solutions, including using pain-blocking gels, intentionally tensing and relaxing muscles repeatedly to induce relaxation, mindfulness, and flat-out distraction, as Dávila has done with his headphones and sleep masks.

Avoiding looking at the needle won’t help the long-term anxiety — it might even fuel it — but the coronavirus is deadly and highly transmissible, meaning the short-term trade-off is probably worth it, psychologists say, to save lives and protect the public.

The pressure on the needle phobic to get the vaccine will be intense.

“I think, for the first time ever, you’re going to see phobic, avoidant individuals really getting pressure from family members, from co-workers or employers, to get a vaccine and really face their fears,” Zucker said.

The rationalizations from the needle phobic will also be intense.

“It’s really hard to compete with a phobia,” Zucker said. “They’ll say to themselves, ‘Well, if I even get covid, I probably won’t even have the bad version of it.’ Or that we will get to a certain point where the numbers are so low that they won’t need to get vaccinated if they hadn’t already.”

But psychologists like Zucker and Kunkle also think (and hope) that those with extreme needle fears will engage in a different calculation with the coronavirus vaccine — that they are more scared of the virus (and dying) than they are of the needle.

As of right now, that mental arithmetic is pushing Dávila and Lyons toward the needle.

“At some point, you really do need to ask: What am I more afraid of? Covid or the needle?” Dávila said. “It’s covid.” And that means, “You have to put on your big boy pants, close your eyes and wear your headphones.”

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