Recent resurgence of SARS COV 2 – Covid 19 disease in our country, led by second tier cities in Maharashtra, closely following the global upward trend of new virus variants such as B.1.1.7, B. 1.351 and P.1 representing the United Kingdom, South Origin Africa and Brazil. These variants suggest critical mutations that have the potential to change the course of the disease. These shapes also suggest the origin of the second wave of chaos that is predicted in our country. He has started to sound the alarm bells and must therefore once again stress the value of vaccination as the only definitive answer to limit the impact of this scourge. Fortunately, in our country we only have a very limited impact of the South African variant which is the most sinister of the three.
The human body is inhabited and surrounded by billions of microbes and some of them are useful but can become harmful if our immune system is weakened and the microbes facilitate its entry mainly through respiration and food or water.
Comorbidities (common associated diseases) such as diabetes, high blood pressure, hypothyroidism and especially obesity, or even natural aging, can weaken our intrinsic immunity.
Some of these microbes are viruses that jumped from animals, are grouped together as zoonotic viruses, such as SARS COV 2, a new corona virus leading to Covid 19, which has been totally foreign to our immune system and therefore unable to mount a trained attack against thwarting its entry into our body in the absence of natural adaptive immunity specific to the organism. The only way to prevent it from entering our body is to vaccinate against this new potentially deadly virus with a suitable vaccine that we only started using since January 16.
The history of vaccine immunization is a proven science without a doubt. It started in modern times with Edward Jenner who found vaccination against the deadly smallpox virus in the nineteenth century as a definitive answer. Currently we have very potent vaccines for a number of very serious diseases with unqualified success like polio, rabies, mumps, measles etc. The reluctance to vaccinate must go away once and for all, and we must volunteer for vaccination at the earliest, as we become eligible.
It is worth periodically reviewing the current status of vaccination against SARS VOC 2 disease.
Here are a few things to note.
1. All should be vaccinated without delay or doubt in order to protect themselves and society as a whole to achieve personal safety and a much desired “ herd immunity ” – the desired level of protective immunity for society in general, at the earliest. It is the only effective solution as preventive therapy and nothing else!
2. Covishield (Oxford -AstraZenica) and Covaxin (ICMR-Bharat biotech) are good enough to produce adequate immunity. The controversy surrounding Covishield has gradually subsided and people should feel reassured.
3. Both vaccines require two doses. Covaxin should be repeated after four weeks, while field coverage may need to be delayed up to twelve weeks for better immunity, as recently suggested. However, the advice of the Indian government must be given priority at a given time and in a given situation.
4. Some pain is expected after vaccination at the injection site. However, this pain decreases considerably within a few days. Only a few have systemic reactions such as fever, malaise or loss of well-being that are probably less felt with covaxine.
5. Those with a disease requiring anticoagulants (warfarin-type drugs) should consult their doctor before being vaccinated. Anti-platelets such as aspirin and clopidogrel are not contraindications to vaccination. However, when in doubt, it is always best to consult your doctor or the vaccine manufacturers.
6. These reactions usually resolve within a few days, but sometimes there may be a manifestation of an acquired covid infection acquired a few days before vaccination or in the first days after vaccination, especially if a history of patient exposure are available. This is unrelated to the administration of the vaccine. .
7. This fever, although associated with RTPCR positivity for the SARS COV 2 virus, suggesting covid disease, is not a sign of ineffective vaccination because the minimum effective neutralizing antibodies take time to reach a level. minimum protection, ie three to four weeks after administration of the “covishield” vaccine and probably longer for “Covaxin”. Long-term protection is provided by adaptive immunity derived from T cells which, as suggested, may take longer but such immunity is much more effective in countering such attack by the virus.
8. Since the cases of infection have been increasing steadily in recent weeks across our country, setting a higher number every day, serious attention and continued practice in the use of a mask, preferably a double mask, once you are away from home and therefore no longer in public places. We must also maintain as much distance as possible between people, and meet as few people as possible and this too only in open and fully ventilated places, are standard protective measures. Washing hands frequently is a long-standing good practice and should be adopted permanently into our future routine and social behavior, as it reduces several other common infections in daily life. There are reports that many of these diseases associated with fecal-oral entry like gastroenteritis, typhoid fever etc. , have simultaneously decreased significantly over the past year, possibly due to regular hand washing and increased cleaning practices.
9. Two or more fully vaccinated single people can meet without a mask and without a distance, but only if there are no unvaccinated people in the group. Care should be taken when unvaccinated people are part of the group, even if there are few unvaccinated people.
10. It should be remembered that the vaccines available in India only succeed in vaccinating 60-80% of the vaccinated, which is a clear indication that 20-40% will remain unvaccinated and therefore remain susceptible to infection even after completion. of vaccination.
11. Most studies indicate that even after two weeks after two doses of the vaccine, you are only protected against severe forms of covid-19 disease and possible death. Covaxin may be better at fighting emerging mutants because it is a whole virus in a killed form.
12. Mild and moderate infections with the SARS COV 2 virus can persist even in vaccinated individuals and, therefore, full protective measures should be maintained longer until collective immunity of the population is achieved and that people are being vaccinated globally (in this highly connected world) in greater numbers and therefore will take longer to achieve!
13. Those who have recovered from SARS VOC 2 virus disease should also take at least one shot of the vaccine without delay. In case of doubt, one can measure the value of the titer of neutralizing antibody which is a guide for the level of protection.
14. The story of new mutant forms such as those emerging from South Africa or Brazil seems to be even more frightening and therefore strict monitoring of international travel is extremely important. please never leave your guards as the pandemic is far from over !!
15. The impact of vaccination is already visible in countries where vaccination campaigns are at an advanced stage such as Israel, South Korea. We need to speed up the process to the speed of the breaking neck to get the desired result at the earliest
16. The relaxation of the eligibility criteria for vaccination up to 45 years from April 1 is very good news. Very soon we are going to have some additional vaccines such as the Russian vaccine “Sputnik by Reddy lab” and one from Johnson and Johnson available in our country, which will speed up the process of obtaining the much desired collective immunity.
The author is a former professor and head of the department of medicine, RIMS, Ranchi, Jharkhand.