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Takeaways from Health Live @ Seniors Today Webinar with Dr Pratit Samdani

On Saturday, December 19, Seniors Today hosted Leading Internal Medicine Specialist Dr Pratit Samdani. Dr. Samdani answered questions on the Covid vaccine. He also offered tips on pre- and post-Covid care for seniors.

Dr Samdani is an award winning 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 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.

 

 

Dr Samdani started the session by giving readers a little insight into his day – to – day routine as an Internal Medicine specialist at a Covid care facility hospital. “It’s been a roller – coaster ride ever since March 2020. We’ve had emotional disturbances, family isolations and splits. We’ve had all ages of patients come into the hospital and it’s been a difficult 10 months. But I think there is some bright light at the end of this harsh tunnel that we’ve passed through. India has done extremely well.”  Dr Samdani is optimistic that we will win over this pandemic. However, he said, this pandemic is here to stay so we need to make a couple of lifestyle modifications accordingly.

 

What is a virus?

Virus is a sub-microscopic infectious agent that multiplies only with the help of a living host, i.e it is a very small infectious germ that needs a host to multiply. It cannot multiply or grow within itself. It originated in a place called Wuhan in China. Wuhan is a famous seafood marketplace and is also famous for biological warfare. It originated from bats. Covid comes from ‘Co’ for corona, ‘Vi’ for virus and ‘D’ for disease. On March 11, 2020, we got a message from China’s President Xi Jinping, saying “no mingling”. And it was on the same day that our scientists, our medical fraternity, the industry started saying that they don’t want this message of no mingling. And it took off from there. 

 

Effects of coronavirus on the body
  • The throat, lung, circulatory system including the heart, kidneys and intestines –  all can be affected 

 

The transmissibility of some viral infections to draw a parallel:

  • MERS – CoV: 1 sick person can infect 3/4th of a person
  • Influenza: 1 sick person can infect about 1.5 people
  • Swine flu/H1N1: 1 sick person can infect 1.5 people
  • Ebola virus: 1 sick person can infect 2 people 
  • Covid-19: 1 sick person can infect 2.5 people

This value of infectivity is high for Covid as compared to the other viral infections as described above. But it is much lower as compared to mumps, smallpox, measles, rubella –  which can infect 10 – 15 people. So, the corona virus is an infective, virulent organism, but not as virulent as small pox or measles was. 

Covid-19 troubleshooters
  • Fatigue –  this can last for anywhere between three weeks to three months.  
  • Cough –  it can be a relenting cough. It can be a dry cough. It can be due to the infection of your lungs in which case the cough can be persistent. 
  • Low grade fever –  can last for a month. It is an inflammatory fever and not an infectious fever. You just need to rest it out. Keep yourself hydrated. Have a paracetamol, if required. 
  • Headaches and body aches can persist. And they can remain with any viral infection, especially if you’ve had a severe attack.
  • Breathlessness –  this can be due to your lung involvement or a cardiac involvement which can be seen up to one month after you’ve been infected with Covid. Monitor your oxygen saturation levels.
  • Joint pain and muscle pain involvement is very common. 
  • Insomnia or lack of sleep
  • Mental illness, trauma, anxiety, post – traumatic stress disorder (PTSD) –  not only to you but to your family members is common and it is imperative that you seek help from a counsellor. 
  • Gastrointestinal symptoms like diarrhoea
  • Cardiovascular symptoms 
What do you do?
  • Eat well. Get your caloric intake back 
  • Drink enough water. 
  • Avoid alcohol for at least one month post Covid infection 
  • Sleep well 
  • Exercise, but keep it under moderation. You may need to do some mental exercises, play Sudoku, paly cards or games with family, do the crossword. Resume your work slowly and steadily.
  • If you are an athletic or sports person –  if you recover from a mild disease, do one week of stretching and strengthening before you dive into your cardiovascular sessions.
  • If you had mild to moderate symptoms, limit your activity to slow walking or equivalent
  • If you have persistent symptoms or if they worsen –  wait, take a break. Do not exceed your exercise. Monitor your heart rate and pulse and do not let it shoot more than 60% of your normal heart rate. Wait for a few weeks to recover back. 

Lymphopenia (reduced/decreased amount of lymphocytes in your blood) which is seen in your complete blood count is a prognostic marker for Covid-19. If you have a low lymphocyte count, you’re more likely to get a more severe infection. 

Patients who require oxygenation at hospital or at home must have respiratory physiotherapists before they resume their activities. Patients with cardiac involvement need to be even slower –  build up their immunity, take cardiovascular fitness and only then resume their activities. 

We have all been eagerly waiting for the vaccine since March 11, 2020. The scientist, the laboratories, the industries have all been gearing up for this day. 

Vaccine is a biological preparation that provides active, acquired immunity to a particular infectious disease. It is a pathogenic imposter or a pathogenic barrier that prevents severe infections.

It is a substance which could be given orally, nasally or as an injection –  that prevents you and gives you immunity to fight an infection. If you have been given a vaccine, it is only for that particular disease. In 1796, on May 14, Sir Edward Jenner inoculated an eight – year – old boy with cowpox vaccine and months later, on July 1, 1796, he tested his new process by inoculating the same boy with a dose of smallpox virus to see if he was protected and this was the day vaccination was discovered. 

In Dr Samdani’s opinion with the exception of pure, clean and safe drinking water, there has been no human endeavour that rivals immunisation that combats infection and reduces mortality besides inoculation via vaccination. 

Antigen –  is a toxin or a foreign substance that causes an immune response. And you start fighting this infectious agent by producing antibodies. It is like a lock and key situation. 

Your battalion is your antibody that fights these infections which is the antigen. 

When you get an active infection, you get an antigen, you develop antibodies, and your body cells remember this infection and if you were to develop the same infection 5 – 10 – 15 years down the line, your memory cells remember this infection, they activate the immune system to combat thus infection thereby not giving you a very vivid form of the infection. And memory cells are an important component that helps in the concept of vaccination.

The vaccines don’t reach you right from the laboratory shelves. 

There are several stages before the drug is approved for usage by the population

  1. Pre – clinical stage –  here it is studied on mice, rabbits, monkeys and other animals
  2. Phase 1 –  where it is studied on a very small population of 20 – 50 people. 
  3. Phase  2 involves few hundreds of people 
  4. Phase 3 involves several thousand people. 
  • The aim of phase 3 is to establish safety. 
  • To identify rare side effects
  • Test its immunogenicity i.e the protection it can give us 
  • Efficacy 

Drawing some more parallels:

It took us 60 years to develop an effective vaccine for polio 

Ebola, 16 years down the line, we still don’t have a vaccine for it

SARS – CoV1 17 years and no vaccine 

MERS, 17 years down the line, no vaccine. 

Covid 19, 12 months and we have several vaccines

Types of vaccines 

– Live attenuated vaccine: it contains whole bacteria or virus which has been weakened so as to create a protective immune response. It is an old type of method of product delivery vaccine. It gives a very good immune response and stays in the memory of the cells. It is like getting an active infection. It gives an excellent immune response. 

Drawback is that you can’t give it to people who are immunocompromised for example –  autoimmune diseases, HIV, cancer, etc. It is also not suitable for pregnant women because there is a risk of flair of the disease. 

It can give you some sustained infection. For example, if you take a BCG vaccine, you can have some local pain.

Reconstitution (altering the concentration of the vial) and cold chain maintenance is required.  

Orogenic is a similar vaccine which is currently in Phase 2 for Covid-19 and we’ll hear about it in due course of time. 

– Inactivated vaccine –  also called killed vaccine. It is a vaccine containing the bacterial, viral or other antigenic particles that have been grown in a culture and lost their disease producing capacity. Covaxin is an inactivated vaccine for Covid-19. It has a good memory response. It has good stability. Runs no risk of inducing a disease because it is not live. 

Drawbacks –  it requires multiple doses, it’s inactive so you need to boost its activity hence the need for taking multiple shots. The response is, however, lesser than that of a live vaccine. 

Examples of common inactivated vaccines –  polio, pertussis and hepatitis. 

  1. Replication and non – replicating viral vectors –  it is a newer technology in this, you take a part of a virus, structure it in such a way that it behaves like an infection when it enters a body. For example, the Oxford AstraZeneca vaccine. 
  2. RNA and DNA vaccine –  Moderna, Pfizer work on this mechanism. This is not a time – tested mechanism so we don’t know how it’ll work 10 – 15 years down the line as compared to other methods of inoculation. You will require repeated boosters for this. It cannot be used with people who have an underlying chronic or immunocompromised state. There is a chance of an inflammatory reaction and we do not know its adverse/side effects. It requires a stringent cold chain. When the vaccine is not properly cold chained, it does not increase the side effects but decreases the efficacy. 

Most vaccines require two dosages. The first time we inject someone we get a primary immune response. This primary immune response is a good response but it doesn’t go and sit well in the memory cells. There is a slowing of the protection. The moment you give a second dose, 3 – 4 weeks apart, you get a huge spike in the immune response that sits in your memory cells and has a longer lasting immune response and protection. 

Side-effects –  

This is verbatim from Pfizer vaccine:

Overall, the Pfizer vaccine has more side effects than the flu vaccination but much less as compared to the shingles vaccination. 

The most common and solicited adverse effects include – 

  • Pain at the site of infection 
  • Mild fatigue, headache, Muscle pain, joint pain. 
  • Chills and only 15% of the patients documented having a fever. 
  • Chance of infection was very low, less than 0.5 %
  • Severe event is more likely in the second dose than in the first and were less frequent in the older adults than in the younger patients.  
  • Older patients who require the vaccine earlier are likely tio have lesser side effects from the preliminary data than in the younger patients. 

Unsolicited adverse events came up in the vaccine in the form of 

Swollen lymph nodes. It disappears within 3 – 4 weeks.  

Facial weakness, facial paralysis or bell’s palsy. Four people in the vaccine group presented with this, as compared to zero in the placebo group

6 people died during the trial. These were not related to the vaccine. 4 from the placebo and 2 from the vaccine group died from a heart attack, unrelated to the vaccine. 

Covishield s an Indian vaccine. A 40 – year – old man in Chennai on December 1 had some neurological problems like nausea, vomiting, drowsiness, he did not understand anything –  and this happened 10 days after the first shot . 

Covaxin –  we heard about Mr Vij which was negative for Covid-19 and about 10 – 14 days after his first shot (we are not sure if it was in the placebo arm or the vaccine arm) tested positive. Please understand the purpose of the vaccine is to prevent severe infection and not eliminate it altogether.

One person had viral pneumonia in the preliminary stages but this was not coronavirus – related or vaccine – related pneumonia.

The Russian vaccine –  here, we don’t have too much physical data –  14% had minor side-effects. In Russia, under Mr Putin, 60% of people who were surveys said that even if we get the vaccine free, we will not be willing to take it. 

What is an ideal vaccine? 
  • A vaccine which has a robust immune response
  • It should activate those memory cells. 
  • Easy to administer, preferably single dose. 
  • Should be easily stored 
  • Easy availability.
Will there be enough for everyone? 

We are right around the corner, where the healthcare workers will start getting their vaccine shots. At this moment it is voluntary, by the government, there is no compulsion. Dr. Samdani insists that “if you protect yourself, you will protect the others.” 

The highest priority will be given to nine categories:

  • Healthcare workers
  • Police officials
  • Sanitation department 
  • People above the age of 50 with comorbidities 
  • Elderly
  • People with conditions or comorbidities like diabetes, hypertension, cardiac issues, cancer

The first nine categories amounts to 30% of the population, that amounts to 400 million people.

Giving the vaccine to 1.3 billion people is a mammoth task, but India gives 20 million vaccines to the newborn every year. We have the largest universal vaccination programme in the world.

 

India and the Covid vaccine map – 

Indian drug companies are major manufacturers of vaccines that are distributed worldwide. 60% of vaccines in the lower income group come from India. Serum Institutes is one of the largest manufacturers and they will manufacture 1 billion doses of the corona virus vaccine –  the AstraZeneca vaccine. They have already manufactured 2 million vaccines for the ongoing trial. The Indian government has already reserved 1.6 billon dosages from different vaccine companies. The Serum Institute pledged to reserve and recruit 50% of the production for us, for domestic use.  

 Guidelines have already been set on 16th Nov’2020 to establish a say system and protocol. 

Will it be expensive?

The Russian vaccine is $15 a shot

Pfizer is priced about $19.5 

Moderna is around $32

The Indian vaccine is placed at a commercial value of approximately $3

We don’t know when the government will get the vaccine to us, but it surely will be more economical. 

All the vaccines have similar efficacy which is between 90 – 95% 

Will this end the pandemic?

90% of the population is susceptible to Covid-19. We must remember that when 60-70% of our population will be less susceptible to infection, as a result of one direct infection or vaccination, which will kind-of end the pandemic with what is called herd immunity. And that will not happen overnight. It will take a lot of time. In the world, 5.6 billion people will need to be vaccinated to end the pandemic. It may take years to achieve full population coverage with the help of vaccination. 

Hurdles that we may face once the vaccination is out:

  • Availability
  • Equitable distribution
  • Transportation and storage of the vaccination
  • Vaccine theft, vaccine weaponization 
  • Cost is always a concern

The masks are here to stay, regardless of when the vaccine hits the markets. 

If you’ve had contracted the corona virus in the past, there is a slim chance of you contracting it again, but again you also have memory cells to help you out in that situation. 

Even if you’ve had Covid in the past, you should still get the vaccine. It’s best to boost your immune. 

Dr Noor Gill
Dr Noor Gill, MBBS, deciphers the space between heartbeats, figuratively and literally. Powered by frequent long naps and caffeine, she believes that “knowledge without giving back to society is meaningless” and works to make caring cool again.

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