With input from Dr Monica Vasudev

1558: Minutes of Virtual Meeting of CMAAO NMAs on “Will surge in cases in India affect the neighboring countries?”

10^th April, 2021, Saturday, 9.30am-10.30am

Participants: Member NMAs: Dr KK Aggarwal, President CMAAO; Dr Yeh Woei Chong, Singapore Chair CMAAO; Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO; Dr Angelique Coetzee, President South African Medical Association: Dr Marthanda Pillai, India, Member World Medical Council: Dr Marie Uzawa Urabe, Japan Medical Association: Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association: Dr Qaiser Sajjad, Secretary General, Pakistan Medical Association: Dr Akhtar Hussain, South African Medical Association: Dr Tashi Tenzin, Bhutan Medical Association

Invitees: Dr Russell D’Souza, Australia UNESCO Chair in Bioethics; Dr S Sharma, Editor IJCP Group

Key points from the discussion

• India has crossed the first peak and is experiencing the second wave, which is larger than the first wave. A significantly high number of persons are testing positive for COVID-19 even after full vaccination.
• India has high vaccination rate (more than 3 million vaccines per day) and very high infection rate (more than 8%). India is recording around 1,50,000 new cases every day.
• Israel has controlled infection rate by intensifying vaccination, while in Michigan, the infection rate is still rising despite more than 30% vaccination rate.
• Vaccine failure is inevitable; AstraZeneca vaccine has 70% efficacy, so has 30% failure rate; Pfizer vaccine has 5% failure rate.
• We do not know if the post-vaccine COVID is due to a new strain or is it the wild virus infection.
• The AstraZeneca-Oxford vaccine is effective against the UK variant of the coronavirus; hence, these could be cases of re-infection with the Brazil or South Africa strain, against whom the AstraZeneca vaccine is ineffective.
• More than 100 doctors at four different hospitals have tested positive after taking the vaccine. Majority are mild infections. Could these be a result of a superspreading event precipitated by the vaccine? We do not know.
• A large number of patients are presenting with classical symptoms of COVID but negative RT PCR; but this could be due to the redefining of Ct cut-off threshold from 40 to 35 or E-gene target failure. In children, the viral load is low, hence may be false negative.
• It is unlikely that the vaccine is causing disease enhancement.
• Could inadequate antibodies (non/partially neutralizing) be the answer? Systemic inflammation is seen without pulmonary involvement. No COVID pneumonia in most patients.
• The question arises if vaccine should be given to post-COVID patients.
• Mutations occur with high virus transmission and high infection rate.
• In India, although a large number of people are vaccinated, the percentage of people vaccinated is not very high. The herd immunity is not yet achieved. In the state of Punjab, 80% cases are of UK variant. We do not know if the double mutant identified in India causes superspreading events.
• COVID precautions are still very important after the vaccine. This message needs to be re-emphasized.
• It remains to be seen if the surge in cases in India will affect the neighboring countries.
• South Africa is using the J&J vaccine. So far, 300,000 doctors and healthcare workers have been immunized. People have been informed that the immunity starts only after 28 days of the vaccine, so there is still a risk of getting COVID-19.
• These clusters of infection show that a person can still spread the infection even after the vaccine. If no antibodies were developed after taking the vaccine, one can become a superspreader. Two doses may not be adequate. The genetic variant needs to be studied. Genomic testing is very important.
• Anecdotal cases cannot be dismissed and need to be considered seriously.
• Clotting is a real “preventable” event. If after the fourth day of the vaccine, there is more than 30% fall in platelets and rise in D-dimer, immediately start anticoagulant (rivaroxaban).
• In Hong Kong, community cases are zero to single digit.

 Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA