Health Live @ Seniors Today with Dr Pratit Samdani

Seniors Today hosted Dr Pratit Samdani, leading doctor with a specialisation in internal medicine, for the March 27, 2021 edition of Health Live at Seniors Today. Dr Samdani addressed questions on the need to take the vaccine, appropriate time gap between the two doses and other such frequently asked questions. Dr Noor Gill captured the takeaways.

Dr Pratit Samdani is an awardwinning doctor with specialisation in Internal Medicine. He has experience in General Medicine Ward, Emergency, Casualty, HIV, Isotope, Diabetes, Nephrology, Neurology, Infectious Diseases and OPD. He has vast experience in training and teaching graduate and postgraduate students. He is Honorary Professor of Medicine and Head of the Medicine unit at the GT and Sir JJ Hospitals in Mumbai. He is Consultant Physician, Intensivist and Head of the Department of Intensive Care at the Breach Candy Hospital. He is also Consultant Physician at the Jaslok, Saifee and Bhatia Hospitals in Mumbai.

Here are the takeaways from the Q&A with him

• After taking the vaccine it is common to have a day or two of some body pain, fever, headache- which is nothing out of the ordinary or unusual. The side effects can be easily managed by taking a paracetamol and by resting for a day or two after taking your vaccine. Dr Samdani recommends that you take paracetamol for your pain as opposed to Combiflam which is a stronger painkiller but has more side-effects such as gastrointestinal effects and is also harmful for the kidney. He says that he would rather take a paracetamol than take Combiflam, ibuprofen, diclophenac for any pain.
• The response of the vaccine in the elderly is much slower, delayed and less than younger people.
• When we were vaccinated as children or when we got our children vaccinated, they were not being vaccinated for a newer disease or with a new vaccine; we did not have much research back in the day. With the advent of technology, television, media and reading, there is much more awareness. So when there is more awareness there are more noses that are poking and thus many questions.
• A vaccine is essentially a protective thing that fights against a particular disease for which you were inoculated. When you take the shot of your first vaccine, after 13-15 days your body may start developing some antibodies.

Antibodies are y-shaped proteins that fight against the foreign invaders or the infection (SARS CoV2  in this case) that fights against Covid-19 and builds/ regulates/ up streams a strong immune system by doing so.

• After you take the first shot of the vaccine, within 13-15 days, you start developing some antibodies and your antibodies start peaking and at the end of around four weeks you get the “first dose response” or the “primary immune response”. The first dose response is not adequate enough if you’ve not had Covid in the past. So, you need to give a secondary boost to your system which happens after you take the second dose of the vaccine which is typically, as we debate (Dr. Samdani uses the word debate because there is no correct answer at the moment) four to eight to 12 weeks after taking your first dose. If you’ve had Covid in the past, you can delay your second shot, the first shot however is still mandatory and can be administered.
• In the western world, if we divide it into two parts, the US and the Europe or the UK-USA has two vaccines, one is the Pfizer vaccine and the other is the Moderna vaccine, which are both mRNA vaccines. Both of them are to be given at a space of 21 and 28 days respectively after the first shot and there is absolutely no debate about this. In the UK, they predominantly have the Oxford AstraZeneca or the Serum institute’s or the co-locally known as the Covishield vaccine. The debate has been that the second vaccine should be taken after 4 weeks probably best after 8-12 weeks.

In Dr Samdani’s opinion, for a person or a patient who has never had Covid, it may be late to have an adequate response after 8-12 weeks so it will be good if one takes the vaccine after 4 weeks.

• The efficacy of the vaccine is less than 55% if taken after less than 6 weeks, 58% within 6-8 weeks, 70% within 9-11 weeks and up to 12 weeks it was 81%. So in Dr Samdani’s view, it would be good to take your second shot after four weeks and not later than eight weeks.
• In order to politically correct, Dr Samdani’s answer to whether you should get an antibody test before getting vaccinated is a no. He says it is not economically viable; the interpretation and the standardisation needs to be kept in mind. However, if you do want to get your antibodies tested, there are two types of antibody testing:
  • Total antibody
  • IgG antibody
  • Neutralising antibodies
• Anything in the past, whether it is a vaccine or an infection, the IgG values will be reflective of some amount of protection. A value of or above 5 will give you some protection ­– this is for people who have probably had infection in the past and were either asymptomatic or mildly symptomatic. Yes, you can get your antibodies tested but it is not important or compulsory to do so.
• There are two parts of protein in the Covid-19 vaccine — one is the neutralising protein and the other is the more complex binding protein. The neutralising protein binds a particular protein on the virus and prevents the virus from getting inside. The binding protein does not prevent you from getting infection. If you’ve taken the first dose and want to wait for the second, you should get your neutralising antibody tested and if the neutralising antibodies are well above the limits (anything above 60-70%) it is decent protection and you can wait for longer than four weeks.
• No vaccine can give you 100% protection unless the disease is eradicated. The Pfizer and Moderna vaccine give you 94-95% protection up to 2 jabs, 21 to 28 days away. The Covishield and Covaxin provide 70-80% protection. And that for the Johnson and Johnson vaccine is just 66%. This protection means that it will prevent you from severe Covid infection and will prevent you from entering the ICU or being hospitalised for long durations. It is protective in terms of protecting you against severe Covid infection; it is not 100% protective in saving you from Covid-19.
• If you have an ongoing infection or if you have a fever, you may want to wait before getting your first or second shot. But don’t stop or delay on the account of your D-dimer levels. D-dimer is a non-specific marker which goes up in several conditions including inflammatory diseases and conditions. But if you have skyrocketing D-dimers, you need to be investigated further. You can get your vaccine even if your CRP (C reactive proteins) is high. You do however need to find the underlying cause for the rise in the CRP, which is a marker for acute infection.
• If you’re allergic to aspirin, or sulpha drugs you can still take your shot. The vaccines that we have out for Covid-19 have absolutely no chemical material inside the vaccines. More importantly they have no preservatives. In the past most of the people who had allergic reactions to the vaccine was because of the preservatives.
• The vaccines that we have in India, both Covishield and Covaxin can be stored easily in the refrigerator. The Pfizer vaccine requires -74*C temperature for storage and 2-8*C for Moderna.
• If you’re on chemotherapy and are on rituximab or are taking it for other conditions, it is advisable that you take your rituximab at least four weeks before you take the shot or if you have to take the drug at least keep a gap of two weeks minimum.
• Samdani feels like at this point we will require a booster dose at some point of time even after taking the 2 doses.
• There is no way to find out if an individual is a carrier.
• There is no solid data that tells us if you can or cannot consume alcohol after getting vaccinated. But alcohol in the long run does hamper your immune system if you consume large amounts of it.