Before and after taking my Covid-19 vaccine

On Friday the 19th of February, I had my first shot of the Covishield Covid-19 vaccine. Earlier, I had decided to take the vaccine whenever it was available. But then I felt the need to give some time to see the possible side effects of the vaccines available.

In my last blog, I indicated that I would indicate who should not take the vaccine. Unfortunately, I do not have full information on who should not take the vaccines. Early on, I got the impression that those who are on blood thinners after coronary bypass surgery, should not take the vaccines as some patients had blood clotting problem.

I checked with my cardiac surgeon. He said that it is not contraindicated. He advised two precautions. First, the injection should be administered using a very fine bore needle. Second, after the injection, that site must be kept under pressure for about 10 minutes.

I spoke to a senior citizen friend of mine. He said that he had the vaccine and that he did not have any side effects after the vaccine.

I cross-checked with my physician. He advised me to go ahead and have the vaccine. He said that there were no major problems with the large numbers vaccinated in his centre.

So, without much delay, I arranged for the vaccine and had it over with last Friday. Fortunately, I had it at a centre where there were no crowds during the time of the injection

I am preparing this blog over five days after the vaccine was administered. By God’s grace, I had no complications of pain or fever. 

Yesterday, while taking a class for online students, many of who were doctors were asked a question on whether they had the Covid-19 vaccine and if so any complications. Many said that they did not have any complications. A few said that they experienced fever, pain and malaise. One mentioned diarrhoea.   

There was one interesting feedback. This person had taken the Sinovac or China made vaccine about three months back. Now he tested positive for Covid-19.          

Surprisingly many throughout the world are passing up the opportunity to take the vaccine. What are some of the possible reasons that people are not willing to take up the vaccine?

There is first of all some apprehension that there is not enough information published or reported relating to complications of the vaccine trials at different phases. There is conflicting information on the level of efficacy or % of protection of each of the major vaccines in use. The third point is there is uncertainty as to how long the immunity of the vaccines would last.

When I had completed the first dose of the vaccine, I was told that when I take the second dose 28 days later, I would get a ‘Vaccine Passport.’ It is creating an impression that soon without this type of ‘passport’ people would not be able to travel freely. I would be happy to be corrected on this.

Even as I was writing this blog, I came across the following information relating to the expansion of the Covid-19 vaccine programme.

“People aged more than 60 years and those who are 45 plus and have comorbidities will be able to get a vaccine against Covid-19 at a government centre or a private hospital from March 1.

Announcing this, the central government on Wednesday said people above 45 years of age will have to show a certificate stating they have comorbidities.”

I am sure more information regarding will become available in due course of time.

New information on Covoid-19 has been continuously coming forward as new interventions are being introduced. Updating this type of information continuously is necessary. I am happy to share this information through these blogs. I would value it if many readers raise questions and make additional feedback and comments as that would add value to the whole knowledge building process.

At a personal level, I was able to update some information that emerged regarding Covid-19 in my book COVID-19. The updated eBook is currently available at the following link. Readers may utilise as needed and convenient. I hope to bring out the print version soon.

Book COVID-19

Global eBook COVID-19 http://tiny.cc/gb01tz 

Indian eBook COVID-19 http://tiny.cc/bb01tz

I hope to share some information on Covid mutants or variants in my next blog.

Rajaratnam Abel

Processing…
Success! You're on the list.

Vaccine preparation and clinical trials

In my last blog, I mentioned that I will present various aspects of clinical trails in the preparation of vaccines. So, here it is.

Peter Piot who played a key role in the HIV epidemic and then the Ebola crisis has made this statement. “Let us be clear: without a corona vaccine we will never be able to live normally again. The only real exit strategy from this crisis is a vaccine that can be rolled out worldwide.” If a vaccine is so important, then you may be interested in knowing as well as find it useful to know how we reached this stage where we have a number of vaccines available.

Research centres and companies throughout the world worked at breakneck speed to develop a vaccine for this disease. There are certain biases that come in such haste. If the disease attacked only the developing world, there normally would not have been such a big hurry. Since this has hit the developed countries far out of proportion to the developing world, there is a certain urgency in this process. In this blog, I would like to explain the steps or phases involved in developing and making a vaccine available for wider use public use.

Phases of vaccine research

There are at least six steps in carrying out research on developing a vaccine. I’ll take you through these six steps briefly for your understanding.

Step 1. Identifying the antigen or the substance that would be administered to an individual that would produce the desired response of generating the antibodies to these antigens. In some vaccines, live but half-killed or attenuated organisms are used as the antigen. The Covishield or the Oxford vaccine belongs to this category, using chimpanzee adenoviruses. The Covaxin of Bharat Biotech uses inactivated or killed SARS CoV2 virus. In other vaccines such as the Pfizer vaccine, parts of the organism are used as the antigen using a technology called mRNA. This explains the three broad types of vaccines available today.

Step 2. In this step, the selected antigen is tried out in test tubes in laboratories and then on animals. Effectiveness and safety are looked at this stage.

Step3. – Phase 1 clinical trials. In this phase what has been developed in the laboratory is now tested on actual human volunteers. Again, effectiveness and safety in the humans are looked at this stage. Very few individuals are used at this stage.

Step 4 – Phase 2 clinical trials. In this phase, a small number of volunteers get the vaccine and then they are challenged with the disease. The immunised volunteers actually receive the disease germs and then they determine whether the vaccine actually prevents the disease or not. Safety is an important consideration here.

The difficulty with COVID-19 is that there are no one hundred percent effective medicines for the disease. What if the vaccine fails and the volunteer gets the disease and even dies? These considerations have always slowed the pace at which these early phases have gone through.

Step 5. – Phase 3 clinical trials. In this phase, the vaccine is made available to a larger population but still under research supervision and based on the written consent given by those in the trial. Over forty years ago, I had the privilege of being an administrator for a major research on injectable polio vaccine, a killed polio vaccine, under the Head of Virology Department, Dr Jacob T John. At the end of phase 3 trials, we were able to prove that the injectable polio vaccine was effective and safe in a rural Tamilnadu population in India.

The issue with COVID-19 vaccines has been that different vaccines had their phase 3 trials completed at different points in time. In India this has become an issue, that the Covaxin of Bharat Biotech has not completed the phase 3 trial and it has been given emergency use license. This is why, those who receive this vaccine have to sign a consent form agreeing to be part of the phase 3 trails, till the number to be involved in the phase 3 is completed. Many experts are questioning the reason for this hurry without phase 3 trials. Even a case has been initiated in the Supreme Court.

Step 6. – Phase 4 clinical trials. In this phase, it is carried out as a marketing exercise. It is freely used in the ongoing health care delivery system. The administering of Covishield comes under phase 4 as they have completed the phase 3 trials. Generally, after phase 3 trials, it is expected that the results of the trial must be published in a reputed medical journal refereed and reviewed by subject experts before phase 4 is started. In India both Covishield and Covaxin have not published their Indian experience. This is another drawback of the Indian vaccination programme.

In my experience mentioned earlier, after the phase 3 trials with injectable polio, it went on to phase 4. Phase 3 was in a small geographic area of one development block or county. In phase 4 it covered the whole district consisting of nearly forty such blocks or units. I was not directly responsible at this stage, but I was involved with the team. There were certain design issues which resulted in not showing the same level of effectiveness of the injectable vaccine seen in phase 3. Therefore, this injectable vaccine was rejected then. Only after repeated difficulties faced with the oral polio programme using live attenuated polio virus drops was the injectable vaccine brought back in the final assault on polio.

Before I go further on vaccine trials, I must highlight handling some of the ethical issues involved in such type of research. The first is recruiting volunteers for such trials. There are clear international guidelines that state how volunteers could be brought into the research and their rights and protection.

In such research, the participants have the right to comply or not comply with the research protocols at any stage. Always a signed written consent statement is obtained from anyone who participates in such research.

One last ethical decision concern is the need to have a comparable group. One group will have the vaccine and the other may not get anything or they get what is called a placebo. In this case it being water or saline which is an inert or inactive substance that is harmless. Again, there are strict guidelines followed by research institutions when control groups are used.

Now you can understand the complexity of developing a new vaccine for COVID-19. There are strict protocols to be followed, although there are temptations to shortcut the steps because of the suddenness of the disease and the rapidity of its spread. By the time a vaccine goes through these phases, it was predicted that it could be a year or more before it was available for immunisation. But then the vaccines arrived much earlier than expected.

There is then always the question, whether there were short cuts in this vaccine race. Very clearly the phase 3 trials have not been completed in all vaccines. Not all vaccine trials have been published in journals. The manner in which reactions to the vaccines have been handled have also raised questions and doubts. There have been a number of deaths associated with the vaccines. It is not clear that these have been reviewed by competent neutral experts to determine if there is any relationship with the vaccines.

I am going back to the statement made Dr Peter Piot indicating the need for a vaccine before we can go back to the type of normal living of the pre COVID-19 era. Even with a number of vaccines available today, there are certain issues associated with it discussed below.

The companies which have invested in vaccine research have the primary purpose of making profits. The initial indications are that they are not going to be cheap. Richer countries may be able to afford them. Even there the poor in those countries may not get it easily unless the governments intervene in an equitable manner. WHO has called this vaccine nationalism.

The next issue to be addressed is to produce millions or even billions of vaccines if it has to be effective. Whether these large quantities could be produced so quickly is one important consideration. The price fixed by the companies would determine how freely these large quantities are available for those who need.

We are witnessing around this time a community backlash against any vaccines to be given. The anti-vaccine lobby is very powerful in some of the countries. The US which had successfully controlled measles as a disease has seen it come back in epidemics, because parents have refused to give the measles vaccines to their children. Similar objections to this vaccine could also create problems in controlling the disease. A large number of potential recipients are refusing to take the vaccine in different countries.

Only now after the initial round of experience with the different vaccines, for those whom it is contraindicated is beginning to emerge. In my next blog, I’ll share a list of those who should not take this vaccine.

Processing…
Success! You're on the list.

Karan Thapar Interview with Dr Gagandeep Kang of Christian Medical College Vellore COVID Vaccines in India

This interview is based on the situation that two vaccines are now available in India for administering to the general population. Certain questions have been raised which are addressed in this interview. While this may be relevant for India, even readers from other countries may find this useful.

New Delhi: In an interview where she addresses in detail the concerns raised by both Bharat Biotech’s vaccine Covaxin and the Oxford-AstraZeneca vaccine made by the Serum Institute, called ‘Covishield’, India’s top vaccine scientist has said that whilst she is willing to participate in clinical trials of any vaccine she will not take Bharat Biotech’s Covaxin as a vaccine until its required efficacy data is made public.

Professor Gagandeep Kang said that without efficacy data no vaccine should be cleared and agreed that this means the clearance given to Bharat Biotech’s Covaxin without efficacy data has been done on the wrong basis. She said she found the limited approval given to the Bharat Biotech vaccine without Phase 3 trial efficacy “extremely confusing”.

In a 48-minute comprehensive interview to Karan Thapar for The Wire, Gagandeep Kang, who works at The Wellcome Trust Research Laboratory at the Christian Medical College in Vellore, said the precedent set by the Ebola and Nipah vaccines, both of which were cleared without completing their Phase 3 trials and obtaining their efficacy data, does not apply to COVID-19.

She said this is both because of the differences in the disease and its mortality as well as the fact that we have other licenced products to tackle COVID-19. “I would ask why would you want to give a vaccine without efficacy emergency use authorisation in these circumstances?” she said.

Commenting on the claim made by Dr. Krishna Ella, the chairman of Bharat Biotech, that the 2019 Clinical Trial Rules permit in an emergency the clearance of an untested vaccine on the grounds that its Phase 2 data, which establish safety and immune response, are acceptable, Kang made it clear that she did not agree. She said whilst the rules allow the bypassing of all clinical trials this was, she believed, to avoid bridging studies in the case of foreign vaccines that have undergone trials abroad.

In her belief the rules do not permit authorising the use of a vaccine without completing the Phase 3 trial. That is what has happened in the case of the Bharat Biotech vaccine.

Questioned by The Wire about the head of the ICMR Dr. Balram Bhargava’s claim that Bharat Biotech’s efficacy has been established by animal trials and Phase 1 and Phase 2 trials, Kang once again made her disagreement very clear. She said whilst animal trials are used in America to clear drugs its only when you can properly mimic the human disease in the animal. She said that is not the case with COVID-19. Secondly, she said Bharat Biotech’s Phase 1 and Phase 2 trials involved a total of 800 participants and that is far too small a number to rely on for efficacy data.

Speaking to The Wire about a claim made by both Dr. Balram Bhargava and Dr. Vinod Paul that the Bharat Biotech vaccine has been cleared because it could be better at tackling new strains of the virus and, in particular, the British mutation, Prof. Kang said “I wish we had data to establish this”. She added: “At the moment we don’t”. She said the Bhargava-Paul claim is simply “a hypothesis”.

Kang told The Wire she is “really confused” by the language that the Bharat Biotech vaccine has been cleared for use “in clinical trial mode”. She said she’s “not sure what that means”. In the interview she seemed to accept that this could mean that people who get the vaccine will actually end up being part of the continuing clinical trials.

Asked if the international community will conclude that India has cleared the Bharat Biotech vaccine in a way that is similar to how the Russians and Chinese cleared their vaccines her reply was short, sharp and simple: “absolutely”. She said there’s “very little difference between the way the Chinese and Russian vaccines have been cleared and this one”.

Speaking to The Wire about the Oxford-AstraZeneca vaccine, Kang said the fact it ended up with two outcomes from its trials – 60% efficacy from two full doses and 90% efficacy from a half dose followed by a full dose – is “really messy”. She said if she had been the regulator she would have set aside and disregarded the serendipitous 90% outcome because that was not the procedure Oxford AstraZeneca initially intended to follow. She would have been gone by the efficacy result that emerges out of the procedure they had originally said they were going to pursue i.e. the 60% outcome.

However, Kang said that if it is true that Oxford AstraZeneca gave paracetamol to suppress side effects this would not be “a deal breaker for licensure”. She also pointed out that baby aspirins are often given to children when they are vaccinated to suppress side effects such as a fever or a pain in the arm.

Kang told The Wire that the two or three cases of neurological problems after the Oxford-AstraZeneca vaccine are a different matter. However, she added there have only been two or three such cases out of the thousands of people who were part of the trials. Therefore, you cannot say they are because of the vaccine. She added it would be a different matter if many more cases emerge when the vaccine is administered for regular use. That is not the case at the moment.

Kang also said she disagreed with Professor T. Jacob John’s view that the Special Expert Committee has bent over backwards to accept the Oxford vaccine data. She does not believe Oxford has been shown special favours.

In The Wire interview Kang was also questioned the way both COVID-19 vaccines have been cleared in India. She said: “We have got a real communication problem. We need to do a lot more to convince people we have done the right thing. The pandemic no doubt creates urgency but if we are to use vaccines we need to build trust.”

Asked whether the DCGI, when he cleared the vaccines, should have followed the practice of the MHRA in Britain and the FDA in America and answered questions Kang said: “All government authorities should be more available to answer questions”. She added that “the more open and transparent we are will make all the difference in building trust.”

Finally, asked whether the names of members of the Subject Expert Committee and the National Expert Group on COVID-19 should be made public, Kang said: “I can’t think of reasons why their names are not in public”. She added one possible reason could be to protect them from pressure and questioning. When it was pointed out that experts should be willing to be questioned and to defend their decisions, Kang said she hoped, “One day questions would be welcome.”

Those of you who want to take the time to listen to the actual interview, can click on the link below to see and hear the interview in the youtube.

https://www.youtube.com/watch?v=YCm68olXnAk&ab_channel=TheWire

I will share the steps of an ideal vaccine trial in my next blog. This may give you an idea of the stages through which a vaccine is carried through before it is made available for the public. In 1980-1988 I was part of a team that carried out phase 3 trials of injectable polio vaccine.

Some of you may be interested in getting a copy of my book COVID-19. The eBook is availablle in the following links.

Global eBook in US $ http://tiny.cc/gb01tz

Indian eBook in http://tiny.cc/bb01tz

Rajaratnam Abel

<script id="mcjs">!function(c,h,i,m,p){m=c.createElement(h),p=c.getElementsByTagName(h)[0],m.async=1,m.src=i,p.parentNode.insertBefore(m,p)}(document,"script","https://chimpstatic.com/mcjs-connected/js/users/94f4df985b4de7cadc30a1669/423ef4b1e2c9ae885523cacba.js");</script>

Happy New Year 2021

I just did not want to miss this opportunity of wishing you all a very happy new year in 2021.

Everyone would like to forget 2020 and hope for the best in the coming year.

I had hoped to send each one of you updated ebooks during the holiday season. Covid death within the family upset all my plans. What I missed, I will catch up during the new year.

Only God can give us that rich blessing we all desire. It is my sincere prayer that God would richly bless each one of you during the coming year.

Expect new blogs during the coming months. I will share the forthcoming books during the coming year.

Hope to keep in touch during the coming year.

Rajaratnam Abel

The mental dimension of COVID-19

The mental dimension of COVID-19 was not realised early in the onset of the pandemic. The prevalence of mental difficulties associated with this disease cannot be ignored. A few salient problems are briefly described below.

When a person was diagnosed with COVID-19, no relative would visit such a family as would have been done in other disease settings. It created mental tensions on both sides. Fortunately, many of the families having such patients did not expect relatives to visit them. It was worst when such people died, with most relatives keeping away from the funerals.

Stigma was the other problem identified. Because of the ease of spread among the general population, doctors and nurses who worked with COVID care were shunned and some house owners asked such tenants to vacate their homes.

Fear of the disease and the associated admissions into intensive care units with loss of contact with loved ones was one of the major problems faced. This fear made many to hide their suspected diseased state and refused to seek early diagnosis and treatment, resulting in deaths.

Managing COVID-19 deaths was another frightening experience. The number of persons who could participate in such a funeral was limited. Relatives had to stand far away from the actual funeral site. This caused severe mental trauma as the usual closure associated with a normal funeral could not take place.

Schools were closed and children had online classes conducted. While it appeared to be like an extended holiday like situation, over time it brought in tensions within homes. Children were becoming addicted to online activities beyond just classes. Conflicts, abuse including sexual abuse began to occur.

More than online classes it was work from home that created the major mental problems. Along with work from home, many lost their jobs. Prolonged loss of jobs meant anxiety and tension in paying mortgage, house rent and over time even obtaining food. Unable to bear the tension, some families committed suicide as a whole.

The lock down in many countries resulted in loss of small businesses. They found it difficult to get back even after the lock down was lifted. They went through similar problems as those who lost jobs above. The images of migrant workers walking long distances have been etched in our memory.

Even in villages where the disease was not widely prevalent, the economic downturn affected them as well as much of the labour was lost. They struggled for food as many others, being anxious about from where their next meal would come from.

The last point was brought out forcefully, when the organisation I work with was able to arrange food and essential supplies to some of the poor tribal families we served. What a sense of relief and satisfaction in their faces as they received twenty kilos of rice besides other food stuffs!

I want to share my own experience. One of my close relatives, much younger than me contracted the disease. He was very careful in not taking any risks. Probably he let down the guard only once and the disease attacked him. His son and some other family members provided all the support. Because of seeking delayed treatment, he died. I never visited him even once, not even for the funeral. Even his only sister and family never visited throughout.

I appeared to be bearing it well. I provided all the professional support over the telephone. But I could not carry out the routine tasks I was used to carrying out. This was a subtle but definite mental affect of the COVID-19 disease. However, as a family we were a source of mental support to the family during the disease, funeral and afterwards. There was always a question, whether we did the right thing.

The COVID-19 pandemic has disrupted the lives of people in a number of ways. Although the mental effects are not clearly visible, they have caused untold hardships to individuals and families worldwide. Such families need mental support and counsel as they get back to their normal life.

Processing…
Success! You're on the list.

The Side effects of COVID Vaccines

In my last blog, I had looked at the vaccines that are either available or will be available soon. I had indicated that I would touch on the side effects of the vaccines in this blog.

Earlier, in my book on COVID-19, I had indicated there are 4 phases of clinical trials on the suitability of a vaccine. In the first phase, the testing on humans is carried out to determine the optimum dose that is both effective as a vaccine and without serious side effects.

Moderna vaccine

In the first phase of the Moderna vaccine trial, one recipient had severe side effects. His arm became more painful during the second dose. After about eight to ten hours, he had chills and the temperature went up to 103.2 degrees. His fingertips felt cold. He was nauseous and his muscles hurt.

He went back to the urgent care where he was followed up. His temperature had come down and was given Tylenol. Instead of getting admitted as advised, he went home. His fever had risen to 101.5. When he got up to go to the bathroom, he felt nauseous again and vomited and fainted on his way back from the bathroom. He was asked to come back to the urgent care, but he chose to stay at home and by the evening of the second day, his fever came down and in a few days’ time he had no side effects.

The most common side effects were fever and pain in the injected arm. Other severe side effects included fatigue in 9.7% of participants, muscle pain in 8.9%, joint pain in 5.2%, and headache in 4.5%. Let us now go to the Oxford vaccine.

Oxford vaccine

In the race to come out with the first effective vaccine, Oxford was the leader. It already had a tested vaccine for another corona virus. They were held up a bit to identify a manufacturing partner, which later was Astra Zenca. The study was carried out primarily in four countries, namely the UK, Brazil, South Africa and the US and additionally in India.

The Oxford trial also faced an additional problem. There was a mix up of the doses provided by the manufacturer. While they thought that they were injecting the full dose vaccine, later they found out that the dose was only half. Interestingly when they analysed the results, they found that the half dose patients had less side effects and the efficacy was also over 90%. This mix up had to be studied in detail before proceeding further.

As the race continued, the Oxford study faced one major side effect in one individual. He had transverse myelitis a neurological condition. Until independent experts assessed the cause of the side effect, the study had to be stopped for a few days. As a result of this delay, they could not start their phase three trial in the US as planned and it is not over yet. In the meantime, Pfizer and Moderna completed their research and made their products available for use and so Pfizer received the first approval in the US.

Across all four studies, the Oxford vaccine had a good safety profile with serious adverse events and adverse events of special interest balanced across the study arms. The findings of their research were published in the Lancet, world’s leading scientific journal from the UK.

Serious adverse events occurred in 168 participants, with 175 events, three of which were considered possibly related to either the experimental or a control vaccine. A case of haemolytic anaemia was observed in the control group in the UK phase 1/2 study occurring 10 days after control vaccine was considered possibly related to the intervention. Three cases of transverse myelitis a disease related to the spinal cord were reported. An independent team of experts decided that one of the three could be related to the vaccine with the other two not being related to the vaccine. All trial participants have recovered, or are in a stable or improving condition.

There were four non-COVID-19 deaths reported across the studies (three in the control arm and one in the covid vaccine group that were all considered unrelated to the vaccine, with cause of death assessed as road traffic accident, blunt force trauma, homicide, and fungal pneumonia.

Pfizer Vaccine

Pain and associated swelling and redness at the site of the injection were the most common side effects. It was less among participants older than 55 years of age than among younger participants. It was also less after the second dose than the first. Less than 1% of participants across all age groups reported severe pain. Compared to pain, injection-site redness or swelling were reported by lesser percentage of participants and not increasing after the second dose. In general, local reactions were mostly mild-to-moderate in severity and not severe, resolving within 1 to 2 days.

The most commonly reported systemic side effects were fatigue and headache (59% and 52%, respectively), after the second dose, among younger vaccine recipients; being slightly lesser among older recipients. Fatigue and headache were also reported by many placebo recipients (23% and 24%, respectively), after the second dose, among younger vaccine recipients and less among older recipients. Slightly more fatigue (in 3.8%) and headache (in 2.0%) were reported after the second dose.

Fever (temperature, ≥38°C) was the third reported side effect after the second dose by 16% of younger vaccine recipients and by 11% of older recipients. More participants reported fever after the second dose than the first and it was quite low. Two participants each in the vaccine and placebo groups reported temperatures above 40.0°C. Younger vaccine recipients were more likely to use antipyretic or pain medication than older vaccine recipients more after the second dose than the first. Fever and chills were observed within the first 1 to 2 days after vaccination and resolved shortly thereafter.

Lymphadenopathy or swelling of the lymph nodes in the arm pit was the other side effect reported by 64 vaccine recipients (0.3%) and 6 placebo recipients (<0.1%). Four related serious adverse events were reported among vaccine recipients (shoulder injury related to vaccine administration, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paraesthesia). Two vaccine recipients died (one from arteriosclerosis, one from cardiac arrest). Four placebo recipients (two from unknown causes, one from haemorrhagic stroke, and one from myocardial infarction) also died. No deaths were considered by the investigators to be related to the vaccine or placebo.  

There were four cases of Bell’s palsy—a facial paralysis that is often temporary—were observed among 18,000 volunteers over two months in the Pfizer/BioNTech trial. It is unclear whether the cases were provoked by the vaccine or whether it is similar to what occurs in the general population.

Pregnant women were not included in the vaccine trials. Therefore, they are not in the first group of those participants prioritised for the vaccine. However, there are probable pregnant volunteers who want to go through the trials and obtain the vaccine if suitable.

The Russian vaccine, Sputnik, is in the trial stages in India, and only after the results in India would it be available for use based on the results.

There are three issues besides the side effects that would contribute towards the final decision on the vaccines to be chosen. The first is that most vaccines require two doses. This makes vaccination logistics difficult as invariably some will miss the second dose. Only Johnson and Johnson vaccine, still behind in phase trials, requires one dose.

The second issue is the need for storing some of the vaccines at very low temperatures. This issue alone may force India not to skip the Pfizer vaccine. The Oxford vaccine does not require such low temperatures.

The third issue is cost. Pfizer and some vaccine manufacturers have indicated that they would like to make profits out of the vaccine, while others have indicated a willingness to keep costs low for larger populations. The Oxford vaccine is available at lower cost as well as the Johnson and Johnson vaccine when available.

What is my final message? The ones who suffered severe side effects have said that the side effects are nothing compared to severity of the COVID disease itself. It is anticipated that most people will escape “severe” side effects, defined as those that prevent daily activity. When the vaccine is made available to you, take the vaccine. Anticipate some side effects. Consider it a bonus, if you have no side effects. Be prepared to take paracetamol tablets as others have taken similar medications in other countries.                     

Writing this in simple language was not easy. It is possible that there are some who have questions relating to the side effects. Please feel free to ask them in the comment section of my blog or LinkedIn or Face Book. Experts reading this may have more current information regarding the side effects. Please feel free to add them. It would be useful if those who are reading this can share their vaccine experience, if they do get the first and second doses of the vaccine.

My blog; www.rajaratnamabel.blog

Should you take the Covid-19 vaccine when available?

As a public health physician, recently I was asked for my opinion on whether people should take the COVID-19 vaccine when it is made available.

When I first published the book on COVID-19, there was no vaccine. Then I shared the manner in which vaccine trials are conducted. Now many of you are aware of the different phases of trials for the vaccines. Now the vaccines are beginning to be available in different countries. It is likely to be available shortly in India.

I am using the term ‘when made available,’ because the government of India at least is planning to start with high priority groups first, starting with health care workers, frontline workers and then senior citizens and then come down the line.

One of the purposes of doing phased trials is to determine the effectiveness of the vaccine as well as identifying the side effects. With the vaccines being now approved for use, the recorded side effects are being made public.

Before I attempt to answer the question, we need to understand that the community is already divided into two broad categories of people with two groups in each. The first category is those who advise people to take or not to take the vaccine. The second category is the group where already some have decided that they will not take the vaccine and the opposite are those who have chosen to take the vaccine.

The whole world has put so much hope on a vaccine to get out of the COVID-19 problem, it may not meet all our expectations.

Having said this, now let us look at the issues involved in understanding the vaccine and its use with COVID-19. I have looked at the three leading vaccines namely the Oxford-Zenca, The Pfizer and the Moderna vaccines.

The first issue is what is called efficacy. That means, what percentage of protection does the different vaccines provide. The WHO has indicated that any vaccine that is more than 50% is acceptable.

The Oxford Zenca vaccine has displayed protection from 70 to 90%, with Pfizer 95% and Moderna 94%.

We are not sure how long the immunity produced by the vaccine would last. Would there be a need for repeat vaccines and how often? We do not have complete answers for these.

One of the logistic issues relating to some of the vaccines is the need for very low temperatures. It may not be easy and in such situations, those that require lesser temperature requirement may be more acceptable.

Whatever be the situation, just because you have taken the vaccine, do not become complacent and become careless. We still do not know enough of the disease, much less the value of the vaccines being promoted now.

Someone has indicated that it would be better to be cautious of any rushed vaccine. “Would you take the Pfizer vaccine tomorrow?” That was the question asked of nurses and support staff in a cancer centre. Their immediate answer was, “No. We are not required to take it.”

So, what would my advice be? If the vaccine is made available to you, by all means take it. We do not know how much rush there would be in the initial phases, and whether we will be forced into crowds to get the vaccine. I hope soon you have more information to make an informed decision on the vaccine to be taken when available.

Just a figure below to show how people in different countries are looking at the vaccines coming in for COVID-19.

Don’t take chances with COVID virus: It will attack you.

I am writing this post after burying one of my close contacts, another victim of Covid 19. He was healthy and strong. He was young for his age. He was very careful in taking precautions for preventing the disease. He hardly went out of his house. He only went to his office and returned home. 

But once he had to attend work outside his office. He was probably careless on this day and the Covid virus attacked him. He just never got out of it, dying after a month of struggle. What a wasted life! Just with one risk in six long months of careful control, he was gone.

In recent posts, I have been posting different aspects of Covid disease. Without any hesitation I would like to emphasise the importance of consistent actions of wearing masks, keeping safe distances and maintain hygiene with washing hands with soap and water or sanitising. These are the only actions that can help in preventing this disease.

In India I see so many people being careless with these practices. Don’t stop wearing masks. If others don’t wear masks, you maintain safe distances.

I feel sorry for the people of the US. Even after so many people dying, still people are debating about the usefulness of masks and safe distances. Some are even demanding the right to not wear masks as it infringes on their rights.

Consistent correct mask use, safe distances and sanitized hands are the best methods of preventing this disease.

My close contact gave that virus one chance and it took him away.

Don’t give a chance to the Covid virus. It will attack you. It may cost you your life.

You may want to read more from my book COVID 19 or share it with friends and contacts.

Book COVID-19

Global eBook COVID-19 http://tiny.cc/gb01tz 

Indian eBook COVID-19 http://tiny.cc/bb01tz 

Rajaratnam Abel

Providing supportive oxygen to COVID-19 patients

When a patient gets admitted into a ward for care following a COVID-19 infection, besides specific medicines that need to be administered, providing oxygen depending on its saturation level and the need to respond to the level of breathing difficulty is the major medical intervention.

When a patient is inside an ICU, relatives outside often do not know how to interpret the oxygen support that is being provided to the patients. This blog is an attempt to explain the different devices through which oxygen is administered.

There are four broad methods or devices by which oxygen is administered to a patient admitted for COVID treatment. The following are the common oxygen delivery devices.

1.    Nasal cannula, adult and paediatric (single use).

 They are connected to a lip support and a fully adjustable harness (one tube right/left side). It is a cannula with twin nasal prongs designed for easy administration of medicinal oxygen through the patient’s nostrils

This is the first level of providing oxygen to COIVID-19 patients who need oxygen support. It can deliver 1–6 Litres of oxygen per minute and deliver about 24–44% of oxygen. Humidification may be necessary especially for children. It is easy to use and the patient can eat and talk.

2.     Mask with a reservoir bag; adult type. 

This is a non-rebreather mask with a reservoir bag. It is used to deliver medical oxygen directly to the upper airway of the patient. It includes two unidirectional valves, one that closes during inspiration to prevent room air mixing with oxygen in a reservoir bag; and one that closes during exhalation to prevent exhaled respiratory gases from entering the reservoir bag.

This is the next level of providing oxygen support. It delivers > 10 Litres per minute and delivers 80–95% oxygen at a higher level of concentration. To be effective the flow should be maintained at > 10 L/min as lesser concentration can cause the bag to collapse during inspiration.

3.    Venturi mask; adult and paediatric types.

It is also known as pressure mask or an air-entrainment mask. It delivers oxygen, with a specific concentration from 24–60% minimum. It has an adjustable nose clip.

This is third and highest level of oxygen support without connecting to a ventilator. It can deliver from 2–15 Litres per minute/min and meet 24–60% oxygen need according to the type of mask. It allows precisely measured amount of oxygen to be delivered. It comes in different colours to indicate the flow rate. It confines some patients and it interferes with talking and eating.

Today, many patients are managed with the above three different levels of masks without taking the patient on to a ventilator. If a patient is taken from the first level to the second or third level, it indicates that the patient is not doing well. On the reverse if a patient moves from level three to level two or one it indicates that the patient is improving. This is called non-invasive intervention.

4.    Ventilator

A ventilator is a bedside machine with tubes that are inserted inside your airways. The air flows through a tube that goes in your mouth and down your windpipe. It mechanically helps pump oxygen into your body. The ventilator also may breathe out for you, if you can’t do it on your own. The breathing tube may be uncomfortable. While it’s hooked up, the patient can’t eat or talk. This is called invasive intervention.

The following are the indicators for starting a patient on ventilators, rapid progression over hours, lack of improvement with noninvasive methods, hypercapnia or when there is retention or too much carbon dioxide (CO2) in the blood, normally caused by reduced air flow into the lungs, haemo-dynamic changes indicated by low blood pressure and or signs of heart failure, or multi-organ dysfunction indicated by failure of different organs, and altered neutrophil-lymphocyte ratio among white blood cells.

There is a fear in the minds of people that when patients are put on ventilators, that many will die. While in the early days of COVID-19, many who were put on ventilators died, as we did not have proper medicines. Today, many patients who are connected to a ventilator survive, because we know more about the disease and how to manage it.

I hope to cover and share other information about COVID-19 in other areas where we have a better understanding of the disease and how to treat such patients. But prevention is the best and safest as we do not know who will die.

Don’t take chances with the COVID virus. If you give it a chance it will attack you. Wearing mask, keeping safe distance and frequent washing of hands with soap and water or sanitizing is the surest way of preventing the disease.

If you are interested in knowing the full COVID story, you can access the book on the disease available in the following link.

COVID-19

Global eBook http://tiny.cc/gb01tz

Indian eBook http://tiny.cc/bb01tz

Rajaratnam Abel

My author manifesto: Why do I write?

Well, why do I write at this age of seventy-five years? It all started as a young physician when I started out on my medical career. From my experience I wanted to contribute something to society beyond just treating patients day in and day out.

I knew writing was one of the ways I could contribute. In my first ten years I published two articles in a church magazine. One was about forgiving a person who tried to steal something from my backyard. The other was my understanding of how small pox was eradicated from India.

But in the last 25 years of my professional career, I got into a project involved in plenty of health-based research as well as valuable experiences in overcoming poverty and improving the health of the people, especially the poor.

So, plenty of scientific articles flowed out of my pen. I did not write them alone. I was almost always part of a team of authors who did the work together. In a way, my desire to contribute got fulfilled. God gave me the privilege of writing over 75 scientific articles.

My first book came out just three years before I retired. I had taken a sabbatical of three years, when I completed my PhD as well as the book. Unfortunately, I did not publish it through regular publishers. I had enough official money to print the book. I just printed and distributed it freely as it was an official book.

Only when I retired, did I find out the value of formally publishing through publishing companies. Again, God has enabled me to publish 4 books over the past five years, through online publishing.

So, why am I publishing. The basic purpose is the original one of contributing. In principle it means sharing my experiences of a life time serving the poor in their health and economic needs. What a rich experience God gave me!

An author is supposed to make plenty of money. When sharing experience and knowledge was my goal, money took a back seat. Oh yes, I could do with more money. That was not my goal. So, I make my book freely available especially the eBooks for readers to download it free.

More people have downloaded free than purchased my book. I wish even more had downloaded free. I will continue to make them free whenever Amazon gives me the privilege.

What I have learnt from experienced authors is that an author should never ask people to buy his book. So, always my request is that those who read the announcement of my books, forward to someone whom they think would benefit from that book. Some may buy, others may not.

Therefore, I am sharing information about the books that are in the online market place. I intend to share information about my books online in every blog I write.

My web site

www.rajaratnamabel.blog

Businessmen for the poor

Global Paperback  http://tiny.cc/q901tz

Global eBook http://tiny.cc/f801tz

Indian eBook http://tiny.cc/k901tz

Paperback Indian http://tiny.cc/6f71tz

COVID-19

Global eBook http://tiny.cc/gb01tz

Indian eBook http://tiny.cc/bb01tz

Dr John Scudder

Global eBook http://tiny.cc/ob01tz

Indian eBook http://tiny.cc/wb01tz

In one of my subsequent blogs, I’ll write about the rich and varied experience that God gave me in my life time of service. Besides writing, God has given me the privilege of teaching students in two different institutions.

The first and major one is teaching MBA students of a leading university on introduction to health and environment. The other one is to teach community health management to development practitioners.

However, I look forward to an ongoing dialogue on different topics where it was possible to bring about changes in the community, especially in the development of the poor. I would value critical comments and pointed questions challenging some of the thoughts I present.

I look forward to your kind criticisms and feedback.

Rajaratnam Abel

Processing…
Success! You're on the list.
%d bloggers like this: