Covid Vaccine Update 

(1st November 2020)

So it’s time for my monthly researched Covid Update: This time it’s the hot topic of the Covid vaccine which everyone is keen to know.
Disclaimer: Information gathered is from authentic sites /colleagues but is an evolving situation wherein we will get more answers and clarity as time goes by.
 
Covishield vaccine: Oxford university-led, marketed by AstraZeneca is in lead currently and ready for first batch implementation in the UK shortly. Human trials are on and the UK may apply for an emergency license soon. A lot will depend on this trial”s result for India as “Serum Institute of India” ( who has collaborated for the same to manufacture it ) may also get a go-ahead on the vaccine production here under emergency licensure.
 
Other top runners:
Covaxin :Bharat Biotech starts phase 3 trial / moderna and Pfizer in ph 3 claim to be ready by first quarter 2021/ others : NVX-CoV2373 by Novavax-ph 3/ zydus Cadila ph 3/ Russian :Sputnik V vaccine -bypassing ph 3 and approved for trial injections / cansino biologics- ph 3/ sinovac – ph 3/ China : cansino biologics ph 3 etc
According to WHO, more than 150 Covid-19 vaccines are presently in development, with around 44 candidates in clinical trials and 11 undergoing late-stage testing. But a disclaimer of the first generation of vaccines being rolled out has already been made- it may need modifications based on initial results.
Covishield vaccine has shown both T cell and antibody immunity in initial trials and only time will tell about how long the immunity will last and also the safety of the vaccine. Most likely there would be a need for vaccine booster dose,thus requiring 2 doses at an interval of a month.
Indian Scenario: The vaccine industry is quite robust in India as we have been into it for decades for national and global demand.
Let’s break this down into headers –
Manufacturing: Labs claim to be prepared for this which may take 6 to 9 months after getting license clearance from the government.
 
Cold chain: Requires planes, trucks, and cold storage warehouses. There are already around 28000 Cold storages for vaccines in India connected thru an electronic vaccine intelligence network…but again the situation may evolve depending on the type of vaccine which comes out first for public use. Covishield/ Novavax require 2 to 8 degree Celsius and can be managed in current cold storage’s but if it’s a frozen variety like Moderna comes out, then -80 degree storage required will need very different infrastructure ( and hence much more investment and time needed ) then current existing cold storages.
 
Distribution: Vaccine distribution probably would be done by digital health ID like that of voter ID or aadhar card registration … if we can conduct voting for such a large democracy, we can surely vaccinate all . We have eradicated smallpox and polio in past so, with our network channels and huge manpower, the Ministry of Health can surely do this. The existing Universal Immunisation Programme (UIP) is a vaccination program launched by the Government of India in 1985 and the Covid vaccine would probably be augmented under that.
 
Price of the vaccine in India: Would be very affordable as it will be hugely supported by MOH and the central government
FUTURE VACCINES to follow: nasal spray vaccine against Covid-19 is being worked on. These are less invasive than injection, rapidly absorbed thru nasal mucosa, easier to mass-produce and distribute. The intranasal spray is being co-developed by Beijing Wantai Biological Pharmacy Enterprise with researchers from Xiamen University and Hong Kong University. The Phase I clinical trial is expected to begin in November 2020 and probably reach phase 3 by end of 2021.
So let’s look forward to a more positive 2021 and till then use the current vaccine available to all which are Mask, Social Distancing and Handwashing/Sanitization.
 
Dear Doctor Colleague friends, there may be gaps in this info, so please feel free to add your perspective/info in the comments
 

COVID-19 UPDATE

(28th September 2020)

 
It’s time for my monthly update on COVID, so here goes. Addressing common questions based on science, research, and common sense.
 

Q: WHAT’S THE STATUS OF THE VACCINE?

A: There are many labs working on this across the world with the top 8 to 10 in lead. Phase 3 trials on humans are happening as we speak. At least 3 or 4 may get approvals this year or early next year. Many countries including India have preordered. The efficacy of the best vaccines in this scenario will be 60to 75%. But the time of manufacturing and distribution across 1.4 billion of us will take time … optimistic mid next year / realistic end next year ( just a sensible guess)

Q: IS THE WORST BEHIND US AND HOW LONG WILL THE PANDEMIC LAST?

A: We don’t know. Different countries will have different timelines depending on the preventive measures the public takes. Mid next year will be able to give a fair idea on these questions as our treatment protocols will mature and the status of the vaccine will be clear.

Q: WHEN CAN A PERSON RETURN SAFELY TO WORK OR BE WITH FAMILY AFTER BEING COVID POSITIVE?

A: COVID patient is noncontagious after 12 to 14 days of first symptoms. Some people may be positive on RTPCR even after this duration but that is mostly due to the debris/ protein wall of the dead virus. That is why an exit test is now not mandatory to end the isolation period.

Q: CAN A PERSON GET REINFECTED?

A: The chances of reinfection as of now are rare. We will get to know more as time goes by. We still do not know how long the antibodies last post-infection ( also there is T cell immunity working which we don’t measure as it’s a complex process). This question is best left to us clinicians and researchers to debate in our academic sessions. The general public should not be concerned with this and carry on with standard precautions even after recovering from COVID.
 

Q: WILL WE ACHIEVE HERD IMMUNITY BEFORE THE VACCINE?

A: No, for this, at least 60 to 65% of people need to be infected. This is a humongous number given our population. We don’t have enough serosurvey data but at best we must be around 10% infected as of now.

Q: IS IT TRUE THAT INDIANS HAVE A LESS FATALITY RATE BY COVID?

A: Yes that’s true as per serosurvey. If you do not have comorbidities, your chances of being asymptomatic or mild COVID illness with a high survival rate are very very high. In India, there are many many more deaths with tuberculosis and cancer every day than COVID. But that doesn’t mean we become complacent… precautions are must. Even if we have a low mortality rate, the sheer number of deaths would be largely due to our large population and we definitely do not have a healthcare infrastructure to handle that.

Q. SHOULD CHILDREN BE ALLOWED TO GO TO SCHOOL?

A: In India, only 11% of kids have access to digital platforms. Going forward they will need to go to school with all due precautions. Children’s resilience is much better than adults and there have been very very few cases of hospitalization with COVID and even lesser deaths. Ultimately it’s a government policy decision based on many local pandemic factors of an area. For eg. perhaps Kerala can open school earlier as compared to Maharashtra or Delhi NCR.
 

Q. SHOULD I WEAR A MASK WHILE WALKING/ JOGGING/CYCLING?

A: If you are in an open space and not with many people around, you don’t need to wear a mask

 

Q: IS FLYING SAFE?

A: I have taken four flights after the lockdown lifted and with due precautions, it is not considered high risk. Planes have HEPA filtration for air. Mainly one has to safeguard the route of entry of the virus which means the nose, mouth, and to some extent eyes. Keep your mask and some glasses on throughout the journey till you reach home and shower. Do not take off your mask to eat in domestic short flights but if it’s international you may take a quick bite ( request your next seat passenger to not have food at the same time so that both of you are not without a mask at the same time )

Q: IS GOING TO THE GYM SAFE?

A: This may hurt a few people and business owners, but it comes under risk area due to closed space and sharing of equipment. Also, masks and social distancing become a challenge during workouts in the gym.

Q: SHOULD I KEEP HAVING IMMUNE BOOSTERS LIKE KADHA, HALDI ETC.?

A: There is nothing like immunity boosters. It’s a well-wisher generated hype. We are all born with certain innate immunity and then depending on our lifestyle we gradually develop various levels of immunity over years. You can have kadha or haldi … no harm but don’t overdo it. People have reported liver problems due to excessive indulgence in these. Adequate sleep, daily exercise, balanced meals, and a stress-free life are the best immunity mantras.

Q. ARE PEOPLE STILL TAKING HYDROXYCHLOROQUINE AS PREVENTION FOR COVID … WHAT DOES THE RESEARCH SAY?

A: So we now have many studies from various countries including India ( Max hospitals too has done a large sample study on this) and it’s proven that HCQS has no role.
 

Q. WHERE DO WE STAND WITH VARIOUS TREATMENT OPTIONS LIKE REMDESIVIR, FAVIPIRAVIR, BLOOD THINNERS, DEXAMETHASONE, PLASMA TRANSPLANT ETC?

A. Leave this for the doctors to discuss amongst themselves. Most people will become ok with symptomatic treatment at home. Do not self medicate in case of symptoms and seek medical attention. TRUST YOUR DOCTOR.

Q. SO HOW DO WE MOVE FORWARD?

A. We have to stay away from both panic and denial. MASK up always when stepping out ( this is the biggest game-changer in controlling the pandemic), keep social distance even at work, and with friends while socializing, and sanitize/wash hands frequently. Stay optimistic, spread positive energy….. Do not watch the news every day and have digital sunset time 
 
PS: This info is to the best of my knowledge only and may change over a period of time as we keep learning about this pandemic.

Corona Update: The Second Wave

(7th September 2020)
 
THERE IS NOTHING LIKE A SECOND WAVE. WE HAVE BEEN AND WILL BE IN A BIG LONG WAVE as Virus is pretty much out there. When people move more freely, the cases will spike up… it’s natural till most are infected and cured (herd immunity concept).
Given the circumstances of the Indian economy and the long haul of Covid we are in, we will have to move on … so move on with adequate precautions. Have said it earlier too that the mortality and morbidity rate of Covid is very very low as compared to many other diseases. But it appears frightening for the following reasons :
 
1. Even a small morbidity or death rate in India appears large due to the sheer large denominator 1.3 billion population For eg. 0.1% mortality of 1.3 billion is 13 lakhs ( we have had around 71 k so far ).
2. No other disease ever got such close attention by media. If u look at stats there have been many more fatal diseases and exist even now
3.Government hasn’t done much to create a state of art healthcare facility so that people feel assured that they will be taken care of when sick
4.Unpredictability & uncertainty of pandemic creates fear too
5. Vaccines take long and are no guarantee to work for all strains. Viruses love to mutate. So one can’t really bank on vaccines.
But In reality, there is NO NEED TO PANIC AGAIN ( we are in for a long haul, cases will increase as people movement increases but the virulence of the virus does decrease over a period of time )Good news is that 90% of cases have been asymptomatic or mild. The bad news is that we are a humongous population so the road to the end of the pandemic is long.
 
Be cautious, avoid crowds, take precautions, stay away from the news, and keep a positive outlook.
 

LIVELIHOOD or LIFE ?

(Ist May 2020)

Tough call! The virus doesn’t understand the exit strategy of a lockdown or sealed borders. If anyone in authority is listening… please use this extended lockdown time to make state of art isolation facilities in every city that people are not scared to go to. There is a huge task force required to run isolation and Covid hospitals … we need to gear that up. Another two weeks or months of lockdown will achieve nothing except tanking the economy and increasing mental health issues.
 
So what are logical solutions to this illogical bizarre pandemic? No straight solutions but maybe :
 
  • Keep the elderly and immunocompromised at home, rest to gradually & cautiously move out with adequate precautions.
  • The virus is here to stay for some time so efforts to Destigmatize Covid 
  • Applaud & support people braving and treating it.
  • Plan a road map ahead to prepare & brace yourself to coexist with Mr corona till it decides to go away on its own as natural evolution ( we can stay optimistic about a safe & effective vaccine but don’t know when ) .
  • The best way to prevent spread of #COVID19:
     STAY HOME WHEN YOU ARE SICK.
    Wash your hands often
    Avoid touching your face and eyes
    Avoid contact with people who are sick
    Cover your cough/sneeze with a tissue, put in the bin
    Clean/disinfect frequently touched surfaces

We have had much higher mortality in India due to road traffic accidents ( >1.5 lacs/yr) tuberculosis (>2.2lacs / yr)other infectious diseases, cancers( > 7.84 lacs), cardiac d”s, congenital diseases in infants, poverty, malnourishment, etc etc etc … life still went on. People in a larger part of our country chose LIVELIHOOD over LIFE … not the best choice but that is how India with its burgeoning population survived till now.So let’s think again

 

This has been authored by 

Dr. Parul Sharma 

Director- Ophthalmology

Max Hospitals & Viaan Eye Centre

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