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COVID-19 Vaccine Updates
With input from Dr Monica Vasudev
1397: Minutes of Virtual Meeting of CMAAONMAs on Corona Update: Country Experiences
20th February,Saturday, 9.30am-10.30am
Participants:Member NMAs: Dr KKAggarwal, President CMAAO; Dr Yeh Woei Chong, Singapore Chair CMAAO; Dr AlvinYee-Shing Chan, Hong Kong, Treasurer, CMAAO; Dr Ravi Naidu, Malaysia; DrMarthanda Pillai, India, Member World Medical Council; Dr Angelique Coetzee,President South African Medical Association; Dr Marie Uzawa Urabe, JapanMedical Association; Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association;Dr Qaiser Sajjad, Secretary General, Pakistan Medical Association; Dr DeboraCavalcanti, Brazil; Dr Prakash Budhathoky, Treasurer, Nepal Medical Association
Invitees:DrAkhtar Husain, Dr S Sharma, Editor IJCP Group
Keypoints from the discussion
· MalaysiaUpdate: Malaysia has gone through the third wave of coronavirusinfection. The total lockdown called the “movement control order” has beenreduced in some states as the total number of cases is now declining. Therewere 14 deaths yesterday. The vaccine (Pfizer) rollout will begin from 26th February.One million doses will be received today. The frontline workers will receivethe vaccine first. Malaysia expects to vaccinate 80% of population by April2022. The total lockdown has made a difference to the number of cases.
· BrazilUpdate: The cases are increasing, hospitals are full and there are nobeds for new cases. People do not use masks. Vaccination has started withOxford/AstraZeneca vaccine and the CoronaVac vaccine.
· SouthAfrica Update: Vaccination has started in all provinces 2 days back. Totaldaily cases are around 2000 cases per day. Cases are now reducing because oflockdown measures. Some restrictions have been relaxed; schools have beenreopened this week.
· HongKong Update: The lockdown in Hong Kong has limited public gatheringsto less than 4; lunch time just two people andonly yesterday dining at restaurants has resumed. Gyms, cinemas, gamingarcades, beauty parlors, sports centers have now reopened. Vaccination has beenlaunched with Sinovac vaccine. The Pfizer-BioNTech vaccine will arrive at theend of February and is expected to be administered in March. Many people areapprehensive about the Pfizer vaccine because of reports of deaths in Norwayand Bell’s palsy in Israel.
· JapanUpdate: Japan has started to vaccinate the medical staff. The numbersare under control. Although a mild lockdown is still in place to controlinfection during the vaccination process.
· NepalUpdate: Numbers are reducing, serious disease is also reducing. Thereis; however, a risk of rise in cases because of political gatherings,processions, etc. Vaccination has started 3 weeks before for frontline workers.After two weeks, mass vaccination will start for persons above 60 years.
· SingaporeUpdate: There are around 0-1 case per day. People are not allowed tovisit each other except 8 family members a day are allowed to visit twohouseholds. 250,000 people have been vaccinated till date and around 110,000having received their second dose; one person aged 72 years developed MI afterthe first dose of vaccine (Pfizer). However, according to the initialassessment, this was not caused by the vaccine. The Moderna vaccine has alsoarrived in the country. Singapore aims to vaccinate the whole population byAugust this year.
· BangladeshUpdate: The infection rate is coming down to around 400 new cases perday, detection rate is <3%. There are political gatherings although therehas been no increase in infection rates. More than one percent has beenvaccinated; initially there was fear about the vaccine, but the situation hasimproved. Now there is a very good response.
· PakistanUpdate: The number of cases and deaths are decreasing. No seriouscases; hospitalized cases have also reduced. However, people do not followSOPs. The vaccination process (Sinopharm vaccine) has started for healthcareworkers; although there is hesitancy among them. The Oxford-AstraZeneca vaccineis awaited.
· IndiaUpdate: The situation is optimistic with numbers reducing. Threestates are contributing around 60% of cases. Serosurveillance has shown that21% people have developed antibodies. The healthcare workers have beenaccepting of the vaccine. There is a debate whether to delay the second dose by8-12 weeks. Side effects have been very minor. Deaths that have occurred aftervaccination are not directly related to the vaccine.
· Everycountry is worried about resurgence in cases.
· Factorssuch as mutations, COVID inappropriate behavior and superspreader event, actingin combination, will lead to surge in cases.
· Twotypes of mutation: Substitution and deletion.
· Deletionmutation is permanent, while substitution mutation can be autocorrected byproof reading unless associated with deletion.
· Mutationin the state of Maharashtra in India is a substitution type of mutation andtherefore is localized to that region. The UK strain has three deletions.Hence, it is of concern. South Africa and Brazil strains do not have deletionsand therefore are not spreading globally.
· Newermutations mean longer period of isolation.
· Ithas been suggested that humidity from masks may lessen severity of COVID-19.Face masks substantially increase the humidity in the airthat the mask-wearer breathes in. This higher level of humidity ininhaled air may be why wearing masks has been linked to lowerdisease severity as hydration of the respiratory tract is known tobenefit the immune system.
· Itis important to shift from single gene testing to minimum three gene testing tobe able to detect mutations.
· Reactivationof the disease has been reported in an immunocompromised patient 4 months afterinitial infection, documented by genomic sequencing.
· Allergicmanifestations are same in all types of vaccines; reactogenicity is least inkilled virus vaccine and maximum in RNA vaccines, while immunogenicity islowest in killed vaccine and same in other vaccines. Killed vaccines are saferbut less effective, so require more doses.
· InIndia, 744 doctors have died due to COVID, Pakistan 191, Bangladesh 130, SouthAfrica 300, Nepal 6 and Brazil 440.
· Multipledoses of vaccine may precipitate multisystemic inflammatory disease.
· Swiftand prompt policy is needed to determine the timing of the second dose.
Dr KK Aggarwal
President CMAAO, HCFI and Past NationalPresident IMA