Can unauthorised treatments cause harm?

Yes, there is a risk of serious harm from “unauthorised” COVID treatments that are not officially authorised by competent regulatory authorities such as MHRA in UK or FDA in USA.

If a treatment is not authorised, it should have at least have good clinical trial evidence.

India is going to a rough patch. People with COVID are desperate for treatment. There is shortage of oxygen which is a commonly used treatment.

Apart from oxygen for respiratory support, only Two treatments have been proven to be of significant help in COVID-19 pneumonia. (1) Steroids (2) An arthritis drug called Tocilizumab

Many antivirals drugs have not shown any meaningful benefit. Various other drugs are still in trials.

It is rapidly evolving area and the BMJ has a COVID guideline which is being frequently updated during this pandemic.

This is significant risk of harm from drugs which are NOT properly assessed in clinical trials.

Anecdotally there has been lot of sudden deaths in India. Lot of unproven treatments such as Azithromycin, ivermectin, antivirals agents, chloroquine, and other agents widely used in india.

Although there is no definitive proof, One cannot help wondering whether poor outcome in at least some Indian patients is related to combinations of unproven drugs that are used widely in unregulated private healthcare sector.

BMJ. Drug treatments for covid-19: living systematic review and network meta-analysis
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2980 (Published 30 July 2020)
Cite this as: BMJ 2020;370:m2980

BMJ. A living WHO guideline on drugs for covid-19 BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3379 (Published 04 September 2020).

BMJ COVID-19 Treatment algorithm.

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

Would COVID-19 vaccination be made compulsory for people in some jobs !

New Zealand recently fired customs and border officials after they refused vaccines.

Compulsory COVID vaccination -for people in some jobs- is not official policy in UK or USA yet.

“Italy has become the first country in Europe to make COVID vaccination compulsory for healthcare workers”

It does look like that COVID-19 vaccination would be made compulsory for people in some jobs !

Any third wave, later year, in UK may push the government in making COVID vaccination mandatory for health workers and some other key workers.

References

Guardian. New Zealand fires nine border workers who refused Covid vaccine.
Tess McClure in Christchurch
@tessairini
Mon 3 May 2021 02.32 BST

BMJ. News Analysis. Covid-19: Is the UK heading towards mandatory vaccination of healthcare workers?
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1056 (Published 21 April 2021)
Cite this as: BMJ 2021;373:n1056

BMJ News. Covid-19: Italy makes vaccination mandatory for healthcare workers
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n905 (Published 06 April 2021)
Cite this as: BMJ 2021;373:n905

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

Is it the beginning of the end ?

COVID-19 is still raging like wild fire in various parts of world particularly in India now.

But, in U.K, it does look like the “beginning of the end” for the COVID pandemic. Vaccines seem to have greatly aided this end.

On Tuesday, UK reported 1,946 new infections and only four deaths within 28 days of a positive test.

So unless there is a new variant which overcomes the protective shield of the Vaccines, there may be no more lockdowns and life may go back to some sort of normality.

References

BBC news. Another Covid lockdown unlikely, says scientist. By Hazel Shearing
BBC News

The official UK government website for data and insights on coronavirus (COVID-19).

BBC news. What is the India Covid variant and will vaccines work?
Soutik Biswas
India correspondent
Published22 April

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

Outdoor face masks: is it helpful or an hindrance?

In the indoor settings, wearing masks can help to reduce the risk of getting COVID-19 infection.

But in the outdoor setting, masks may not be very helpful as the risk of getting COVID-19 infection from others, in outdoor settings, is considerably smaller.

Two teams discuss the pros and cons of outdoor mask wearing in a BMJ debate.

Apart from infection prevention, I can see some additional benefits for voluntarily wearing masks in the streets.

The streets of major cities have significant air-pollution. So facial masks can help to reduce inhalation of toxic chemicals.

More and more surveillance street-cameras are now deploying facial-recognition software to deter criminals. But the cameras may also track movements of ordinary law-abiding people for marketing and advertising reasons. So face-masks may also be helpful to those with privacy concerns.

Read the article and submit your views through BMJ rapid response section.

BMJ . Coronavirus Transmission
Should masks be worn outdoors?

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1036 (Published 28 April 2021)
Cite this as: BMJ 2021;373:n1036

Sundar S. Voluntary outdoor mask-wearing can have incidental benefits in cities. BMJ rapid response. 2nd May 2021.

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

COVID-19 pandemic: India vs Israel

The contrast between India and Israel over this weekend is astonishing. (Gloom vs Cheer).

Israel reports “no new daily Covid-19 deaths for the first time in 10 months”.

India, on the other hand, reports, a record 2,624 deaths in the 24 hours and about one million infections in last three days alone.

The new wave in India seems to have been caused by emergence of new variants, as well as mass gatherings.

It maybe that the mass rapid vaccination drive in Israel helped.

Let’s hope that UK, Europe and USA are firmly on the path towards normality in the summer as the vaccination rates go up.

References

BBC news. Covid-19: Israel records no daily deaths for the first time in 10 months.

BBC news. India Covid surge: Hospitals send SOS as record deaths registered.

Guardian. CoronavirusWhat do we know about the Indian coronavirus variant?
Ian Sample Science editor
@iansample. Mon 19 Apr 2021 16.50 BST

BBC news. Covid vaccine: How many people in the UK have been vaccinated so far?
By The Visual and Data Journalism Team
BBC News

New York Times. Tracking Coronavirus Vaccinations Around the World.
By Josh HolderUpdated April 23, 2021.

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

Can someone die due to COVID-19 infection even after having the full course of protective vaccination?

Yes, rarely it can happen.

COVID vaccines are very highly effective in preventing serious infections that would result in hospitalisation. Even a single dose of the vaccine has very good efficacy.

But vaccines are not 100% effective.

So until the pandemic is under full control, older adults, particularly those over 60 years, should be cautious even after full vaccination.

It also has to be said that the risk is dramatically small after full vaccination. Only a tiny minority of people get serious COVID-19 infection after full vaccination.

In USA, about 5800 “breakthrough” COVID-19 infections has been reported so far among the roughly 77 million people who had been fully vaccinated. That’s less than 0.008% cases.

A much more smaller minority among this minority group had serious infections. Among the 5800 cases, 396 patients were admitted to hospital and 74 patients died from COVID-19. That’s less than 0.0001% deaths.

So unless new viral mutations dramatically reduce vaccine efficacy, it looks very promising.

References:

1. BMJ News. Covid-19: Infections fell by 65% after first dose of AstraZeneca or Pfizer vaccine, data show BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1068 (Published 23 April 2021)
Cite this as: BMJ 2021;373:n1068

2. BMJ news. Covid-19: US reports low rate of new infections in people already vaccinated
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1000 (Published 16 April 2021)
Cite this as: BMJ 2021;373:n1000

3. Sun News. DOUBLE TROUBLE ‘Concerning’ Indian Covid variant now in UK has two ‘escape mutations’ that could dodge antibodies
Vanessa Chalmers, Digital Health Reporter
12:22, 16 Apr 2021Updated: 12:25, 16 Apr 2021

4. BBC news. Coronavirus: ‘Double mutant’ Covid variant found in India. Published 25 March

5. Daily Mail. Could the Indian ‘double mutant’ coronavirus derail Britain’s roadmap out of lockdown? Experts warn variant could ‘scupper our escape plan’ and urge Boris to put country on red list. By James Robinson for MailOnline
01:49, 17 Apr 2021 , updated 11:08, 17 Apr 2021

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

Are COVID-19 vaccines necessary for someone who has recovered from a COVID-19 infection ?

Yes !

If someone has recovered from a COVID-19 infection, they would have some protection against getting another COVID-19 infection.

But, even if someone has recovered very well from a previous infection, vaccination is necessary because there is still a significant risk of getting COVID-19 infection again.

A recent study published in the medical journal Lancet reports that people who had a previous infection have about one-fifth risk of getting an infection again compared to those without a previous infection.

So while there is some protection against future infections, there is still a risk and hence it is prudent get the Vaccine when it is offered.

Reference:

Lancet. SARS-CoV-2 seropositivity and subsequent infection risk in healthy young adults: a prospective cohort study. DOI: https://doi.org/10.1016/S2213-2600(21)00158-2

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Should young adults avoid Astra Zeneca COVID-19 vaccine ?

Probably Yes, because of the reports of rare cases of brain clots following vaccination.

Like everything else in medicine, risks and benefits needs to be assessed in each individual case.

For instance, a doctor won’t give toxic treatments for a self limiting flu. But, on the other hand, a doctor will try toxic chemotherapy to control advanced lung cancer.

It’s always going to be a balance between risks from a disease versus risks and benefits of a particular treatment.

No vaccine or medicine is ever going to be 100% safe.

For that matter, Life is full of risks. Getting out of bed can be risky. Not getting out of bed everyday is also risky.

Older adults who are at high of COVID related death and COVID related complications should have the vaccine during this pandemic and not worry too much about rare serious side effects.

But young adults, who are a low risk, can avoid Astra Zeneca vaccine based on the available data, if alternatives are available.

References

Official UK data. MHRA. Research and analysis. Coronavirus vaccine – weekly summary of Yellow Card reporting. Updated 8 April 2021.

BBC news. Covid-19: Seven UK blood clot deaths after AstraZeneca vaccine. By James Gallagher.
Health and science correspondent.

BBC news. AstraZeneca vaccine: How do you weigh up the risks and benefits? By Robert Cuffe. Head of statistics

BBC news. Covid: Under-30s offered alternative to Oxford-AstraZeneca jab. By Nick Triggle. Health correspondent

BMJ news. AstraZeneca vaccine: Blood clots are “extremely rare” and benefits outweigh risks, regulators conclude. BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n931 (Published 08 April 2021). Cite this as: BMJ 2021;373:n931

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

COVID-19 infection affects brain and mental health

A recent paper published in Lancet Psychiatry reports that at least 1 in 3 patients , who have recovered from severe COVID, have substantial neurological and psychiatric problems during the next six months .

This report is very worrying .

If study findings are confirmed by other studies, this would be yet another substantial reason to consider getting the vaccine as soon as it is offered.

References

Guardian. One in three survivors of severe Covid diagnosed with mental health condition
Study finds 34% developed psychiatric or neurological conditions after six months
.
Sarah Marsh
@sloumarsh
Wed 7 Apr 2021 06.00 BST

BMJ. Covid-19: One in three has neurological or psychiatric condition diagnosed after covid infection, study finds
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n908 (Published 07 April 2021)
Cite this as: BMJ 2021;373:n908

Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry 2021 (published online 6 Apr). doi:10.1016/S2215-0366(21)00084-5. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext.

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Are COVID-19 vaccines safe in cancer patients having immunotherapy?

Yes, Pfizer vaccine is safe.

A recent study published in the esteemed Lancet Oncology Journal shows that the vaccine is well tolerated in patients having immunotherapy.

Unlike cancer chemotherapy, immunotherapy works differently. It works by releasing the in-built brakes holding down the immune system thereby boosting the body’s immune system against cancer.

There has been some theoretical concerns whether this might lead to COVID vaccine causing more side effects.

Reassuringly, the Vaccine side effects were NO different from those seen in people not having immunotherapy. The Vaccine also did NOT increase the immunotherapy side effects.

Immunotherapy is increasingly used widely in treatment of cancer are often better tolerated than chemotherapy.

So the study is good news for tens of thousands of patients on immunotherapy and any cancer patient who has hesitated before, should seriously consider having the vaccine now

COVID infection could be very nasty in cancer patients and all evidence points to the benefits of vaccine far outweighing any risks from the Vaccine.

References

Short-term safety of the BNT162b2 mRNA COVID-19 vaccine in patients with cancer treated with immune checkpoint inhibitors
The Lancet Oncology. Published: April 1, 2021
Barliz Waissengrin et al. DOI:https://doi.org/10.1016/S1470-2045(21)00155-8

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Are COVID-19 vaccines safe in Children ?

Yes, Israel has vaccinated vulnerable children and there have been NO reports of unusual or unexpected reactions.

Pfizer has just released positive results of a study which looked at safety and efficacy of the Vaccine in 12 to 15 year olds.

Pfizer-BioNTech covid-19 vaccine has shown 100% efficacy against SARS-CoV-2 in 12 to 15 year olds.

The Vaccine reassuringly was well tolerated, and the side effects were no different from those observed in the group aged 16 to 25.

What about much more younger children?

A vaccine trial in the children aged 6 months to 11 years has been started recently and results should be available later this year.

References

SKY news. Wednesday 31 March 2021 14:35, UK

The Guardian. Wed 31 Mar 2021 14.20 BST

BMJ News. Covid-19: Pfizer reports 100% vaccine efficacy in children aged 12 to 15
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n881 (Published 01 April 2021)
Cite this as: BMJ 2021;373:n881

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

How long do the COVID-19 vaccines offer protection?

Many millions of people have now been vaccinated against COVID-19.

The COVID-19 vaccines are highly effective but the next important question is how long would the vaccines continue to protect.

Some vaccines for other viral diseases offer life long protection but others like flu vaccines need annual boosters. COVID-19 Studies are still ongoing.

A recently released Pfizer vaccine study data indicates that protection with Pfizer vaccine lasts for many months as a minimum. To be precise, so far, Pfizer vaccine was found to have 91% efficacy for up to six months. Ongoing studies would clarify whether booster vaccines are needed in future.

Guardian. Pfizer vaccine has 91% efficacy for up to six months, trial shows. Ian Sample Science editor
@iansample
Thu 1 Apr 2021 17.27 BST

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

COVID-19 is risky even after a patient recovers from it initially

COVID-19 is not a self limiting illness particularly if you have been poorly enough to be hospitalised the first time around.

Even after recovering from a COVID-19 infection, many people remain at high risk of death.

A recent UK study published in the BMJ found that “ Nearly a third of people who have been in hospital before were readmitted after discharge for further treatment in the following four months”.

“And worryingly one in ten patients died during the follow up period after hospital discharge”.

The increase in risk was not confined to the elderly. So everyone still needs to be careful as the lockdown is being gradually eased.

References:

1. BMJ. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ 2021; 372 doi: httpst://doi.org/10.1136/bmj.n693 (Published 31 March 2021)
Cite this as: BMJ 2021;372:n693

2. Guardian. Almost third of UK Covid hospital patients readmitted within four months. Ian Sample Science editor
@iansample
Thu 1 Apr 2021 06.00 BST

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Is the new variant of COVID-19 Coronavirus more deadly ?

Yes !

The new variant in UK, led to the second National Lockdown. Previously, it was reported that the new UK variant spreads more easily but it was NOT known whether it was more deadly.

Now, new evidence published in BMJ (British Medical Journal) indicates that the new UK variant of Coronavirus is more deadly and causes more deaths.

References for further information.

1.BMJ. Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study. BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n579 (Published 10 March 2021)
Cite this as: BMJ 2021;372:n579

2. Blog. Is the new variant of Coronavirus more dangerous? 20 Dec 2020

3. Daily Mail. UK’s dominant Kent Covid variant is up to TWICE as deadly as older versions of the virus, study claims. By Stephen Matthews Health Editor and Sam Blanchard Deputy Health Editor For Mailonline 12:11, 10 Mar 2021 , updated 18:34, 10 Mar 2021

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Delays to the 2nd dose of COVID Vaccine can be harmful in cancer patients.

The Pfizer vaccine was tested in clinical trials with two doses given at 3 to 4 week interval.

But during Vaccination of the General population, the UK has taken a pragmatic view and delayed the 2nd Vaccine dose by up to 12 weeks.

A recent study suggests that this delay in administering 2nd Vaccine dose might put cancer patients at risk.

References

1. Guardian. Delaying second Pfizer dose leaves cancer patients at risk, say researchers
Covid vaccination policy review urged after study finds 12-week gap leaves patients vulnerable
.
PA Media
Thu 11 Mar 2021 16.40 GMT

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Should Heath care workers be compelled to have the COVID vaccine ?

The health care workers often deal with the people who are most vulnerable to COVID.

Studies have shown that hospital transmission of COVID played a significant role during first and subsequent wave of the pandemic.

So healthcare workers have a moral and ethical duty to protect their patients by vaccinating themselves.

But this needs to be balanced against the personal choices and beliefs of the healthcare worker.

It is possible that Hospitals and Care homes would make vaccination mandatory for healthcare staff in the near future.

References

Guardian. Healthcare professionals in the UK have a moral duty to get the Covid jab
Frances Ryan.

Daily Mail on Line. Nearly 80% of health care workers in Illinois and half of staff in Texas and North Carolina REFUSE coronavirus vaccines – and it’s holding up the rollout of shots across the US. By Associated Press and Natalie Rahhal U.S. Health Editor 15:37, 08 Jan 2021 , updated 21:21, 08 Jan 2021

Daily Mail. NHS staff could be forced to have Covid jab: Radical plan is being considered for thousands of medical staff who turn down the vaccine… but what if they STILL refuse? By Jason Groves Political Editor For The Daily Mail
22:14, 02 Mar 2021 , updated 22:52, 02 Mar 2021

Gov.UK. SARS-CoV-2 in the hospital environment and risk of COVID-19 nosocomial transmission, 31 May 2020. Paper prepared by the Environmental and Modelling Group (EMG). From:
Scientific Advisory Group for Emergencies
Published: 26 June 2020

Guardian. Fifth of patients with Covid-19 may have caught it in hospital, study finds
This article is more than 9 months old
PHE research chimes with concerns that asymptomatic healthcare workers may have played role in spread Coronavirus

Nicola Davis
@NicolaKSDavis
Tue 19 May 2020 18.56 BST

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Can companies force you to have the COVID vaccine and say ‘no jab, no job’ ?

Possibly yes, if it is important for your job.

A BBC report discusses the legality of it .

Vast majority of people are desperate to have vaccination and some people are even queue jumping. So this issue is of relevance to some people only and that too when vaccines are freely available to all.

If you are a plumber, who may be visiting the homes of Vulnerable people or a Care Home worker looking after very elderly people, it may be justifiable to say ‘no jab, no job’.

Balancing individual Liberty versus the benefit of others would be a legal minefield particularly when existing workers are concerned.

Furthermore, there are still lot of things we do not know how vaccines. We do not know how long they will protect somebody. We do not know whether all vaccines have similar efficacy. We do not know about the extent to which vaccines would be effective against any variants.

So “Vaccine passport” for ALL types of jobs is a unlikely now.

BBC News. Coronavirus: ‘No jab, no job’ policies may be legal for new staff. 18 Feb 2021.

BBC news. Covid vaccine passports could discriminate, experts warn
By Rachel Schraer
Health reporter

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Does Hand Washing help to prevent COVID-19 ?

Yes,

But the extent to which Hand washing helps is uncertain.

Masks, Social distancing and Vaccination seem to be more highly important than Hand Washing.

Read the very good Guardian newspaper piece on the topic of hand washing.

References

Guardian: Q&A: Does handwashing stem the transmission of Covid-19?
James Tapper
Sun 14 Feb 2021 10.00 GMT

Daily Mail: So which Covid vaccines is Britain getting – and which one is the best? How two companies’ jabs are already being used, another is coming in March and two more could be approved within weeks. By Connor Boyd Assistant Health Editor For Mailonline
11:58, 29 Jan 2021 , updated 02:00, 30 Jan 2021

Daily Mail. Pfizer’s Covid vaccine COULD stop people spreading the virus as well as preventing serious illness, Israeli doctor claims after finding antibody levels surged after second dose. By Emily Webber and Sam Blanchard Deputy Health Editor For Mailonline
12:05, 19 Jan 2021 , updated 14:06, 19 Jan 2021

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

COVID pandemic: finally, the end is in sight !

The latest good news about Oxford vaccine is hugely encouraging and denotes the end of pandemic is in sight.

The latest positive results show that even a single dose of the vaccine is highly effective.

The vaccine offered 76% effective protection from a single dose for three months”. This validates the UK decision to prioritise first dose of the vaccine and delay the second dose of booster vaccine.

Most importantly the Vaccine was shown to reduce spread of the virus causing the COVID.

It is the first time a vaccine has been shown to reduce transmission of the virus

If all the vaccines now in use continue to be safe and highly effective in real world population, then it is only a matter of months before the pandemic comes to an end and normal life returns in 2021 !

A separate study also reports very positive news. The study reports that 9 out of 10 people who had an actual COVID infection will have protective antibodies for at least six months.

Vaccines work by tricking the body into thinking that there is a real infection and hence the body produces antibodies. So this study indirectly indicates the protection from vaccines will also last longer and yet another reason to be hopeful about the end of pandemic in 2021.

BBC news. Covid-19: Study showing Oxford vaccine slows virus spread ‘superb’ – Hancock.

BBC news: Covid: Antibodies last at least six months in most.
By Rachel Schraer
BBC Health reporter

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Two New Vaccines against COVID-19

More good news on the vaccine front in the fight against the coronavirus.

Two new vaccines have reported positive results.

The NOVAVAX vaccine is first Vaccine to report efficacy against the new variants. It is 95.6% effective against the original strain of coronavirus.

NOVAVAX is 86% effective at protecting against the new UK variant, which is very reassuring. But the Vaccine is only, 60% effective against South African variant of the virus. The efficacy against Brazilian variant is unknown.

The Janssen vaccine, produced by the US giant Johnson & Johnson, is a single-dose vaccine and has proved 66% effective against Covid-19. The vaccine was just 57% effective in the South African part of the trial.

The reduction in efficacy of both vaccines against new variants is a bit worrying and indicates that if further new variants emerge in future, existing vaccines could be less effective and vaccines would need to be updated.

The Janssen vaccine uses a common cold virus and uses a approach similar to the Oxford Astra Zeneca Vaccine.

Novavax vaccine differs from existing vaccines and it uses a artificially produced COVID-19 spike protein, which is then assembled into nanoparticles to make them look like coronavirus.

Bloomberg: Covid Mutations Undercut Optimism Even as More Vaccines Near
By Robert Langreth
30 January 2021, 00:04 GMT
Updated on 30 January 2021, 12:02 GMT

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Spit test for COVID

Anyone who had the COVID test would know that the swab up the nose and throat is unpleasant.

Life would be much more easier if you can just spit in a test tube and the saliva could be tested for COVID.

Early results are promising and tests so far has shown that saliva testing is as good as nose swab testing

References

BBC. Covid-19: No-swab saliva test finds symptomless cases.
By Michelle Roberts
Health editor, BBC News online.

JAMA January 15, 2021. Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing for Detection of SARS-CoV-2
A Systematic Review and Meta-analysis

Guillaume Butler-Laporte, MD1; Alexander Lawandi, MD, MSc2; Ian Schiller, MSc3; et al. JAMA Intern Med. Published online January 15, 2021. doi:10.1001/jamainternmed.2020.8876

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The authors views are not in way intended to be a substitute for professional advice.

Can you get COVID-19 infection just by “Talking” to an infected person for a few minutes?

Yes, you can.

You don’t need to be exposed to an infected person who is coughing, sneezing and spluttering to get the infection.

Merely talking to an infected person can make you catch the coronavirus infection particularly if you are very close to the person with infection and not wearing a mask in an indoor setting with poor ventilation.

Remember, Even Vaccines don’t have 100% protection.

Remember to maintain Space and Wear a Face Mask

References

Guardian. Talking can spread Covid as much as coughing, says research.
Tiny aerosols of the virus emitted when speaking linger in air for longer than larger droplets from a cough.
Nicola Davis Science correspondent
@NicolaKSDavis
Wed 20 Jan 2021 00.01 GMT

Journal Proceedings of the Royal Society A. Evolution of spray and aerosol from respiratory releases: theoretical estimates for insight on viral transmission. P. M. de Oliveira , L. C. C. Mesquita , S. Gkantonas , A. Giusti and E. Mastorakos. Published:20 January 2021. https://doi.org/10.1098/rspa.2020.0584

Guardian. Single Covid vaccine dose in Israel ‘less effective than we thought’.
Peter Beaumont
Tue 19 Jan 2021 16.53 GMT

Telegraph: UK to ‘look carefully’ at claims vaccine efficacy in Israel has dropped to 33 per cent with one dose.
Israel’s vaccine tsar says single Pfizer dose appears ‘less effective than we had thought’ as scientists demand evidence is published
By
Sarah Knapton,
SCIENCE EDITOR
20 January 2021 • 1:46pm

Daily Mail: Israel is STILL waiting for its world-beating vaccination drive to kick in as cases and hospitalisations soar higher than ever despite vaccine stopping 50% of new Covid infections. By Chris Jewers For Mailonline11:20, 14 Jan 2021 , updated 18:04, 14 Jan 2021

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Where can you find official data and statistics on Coronavirus infection?

The official UK Government website for data and insights on Coronavirus (COVID-19).

WHO Dashboard

Worldwide data – John Hopkins university dashboard is perhaps more widely used and quoted.

https://covid19.who.int

https://coronavirus.data.gov.uk

https://coronavirus.jhu.edu/map.html

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Why are some people falsely sceptical of COVID Vaccines?

Disclaimer: A personal view point !

“Vaccines hesitancy” is a problem in some sections of society.

A significant minority of people have an unhealthy scepticism about all vaccines in general fuelled by misinformation on social media. Some people in western world, who haven’t seen the horrors that can be wrecked by infectious diseases, have an ill-informed view about all Vaccines.

Vaccines have played a significant role in protection against various deadly infections diseases in the past century. The infectious diseases of childhood have become less prevalent even in developing countries now. But there is a risk of Vaccine Hesitancy spreading to these third world developing countries .

That is not to say that all vaccines are free of side effects. Lot of people do have mild side effects after any vaccination. But very serious side effects are rare.

The concerns of people with Vaccine Hesitancy particularly relating to COVID Vaccine is genuine. The COVID vaccines have been rapidly developed and there are no long term efficacy or toxicity data. Because it is a global emergency, countries are forced to begin COVID vaccination based on the available excellent short term efficacy and safety data. Only time can tell whether the Governments got it right over long term.

But there is no evidence to suggest secrecy or conspiracy surrounding development of various vaccines including COVID vaccines. For instance, two reports of severe allergies due to COVID vaccine was immediately brought to the attention of everyone by Regulatory authorities in UK.

It is now reported that Norway is investigating deaths after coronavirus vaccination in very frail elderly people. Any adverse report on vaccines will be investigated and made public.

Rare individual stories of serious side effects is understandably shocking. It is human nature not to risk when one personally feels well at a particular point in time.

It is very important to remember that life is full of risks. People make decisions every day based on benefits versus risks ( eg driving a car). People need to understand that the benefits from most vaccines against infections diseases significantly outweighs the risks of various vaccine side effects. While a handful have serious side effects, many millions do benefit from the all vaccines.

“Vaccines hesitancy” is also not helped Historic mistrust of government in sections of population which regrettably can make things difficult in terms of achieving good vaccine coverage at population level.

If you have concerns about vaccines –

“Do read information about Vaccines with an open mind and pay attention to high quality population level studies assessing risks versus benefits and ignore individual unsubstantiated stories”.

“Do speak to your doctor about your concerns with an open mind”.

“Do NOT always seek information that affirms your views and Worries. Do seek reliable information that challenges your views on vaccines before you make your choice”.

References

JAMA Insights Clinical Update
January 21, 2021
Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine
Tom Shimabukuro, MD, MPH, MBA1; Narayan Nair, MD2
Author Affiliations
JAMA. Published online January 21, 2021. doi:10.1001/jama.2021.0600

BMJ. Covid-19: Norway investigates 23 deaths in frail elderly patients after vaccination
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n149 (Published 15 January 2021)
Cite this as: BMJ 2021;372:n149.

Guillain-Barré syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005)
Nizar Souayah et al. J Clin Neuromuscul Dis. 2009 Sep.

The Atlantic. Anti-vaxxers Think This Is Their Moment. Society’s well-being depends on how well public-health officials and average internet users combat misinformation. DECEMBER 20, 2020
Renée DiResta.
Technical research manager at the Stanford Internet Observatory.

Countering Vaccine Hesitancy. Kathryn M. Edwards, Jesse M. Hackell and THE COMMITTEE ON INFECTIOUS DISEASES, THE COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE
Pediatrics September 2016, 138 (3) e20162146; DOI: https://doi.org/10.1542/peds.2016-2146

Guardian. Covid vaccine: 72% of black people unlikely to have jab, UK survey finds.
Linda Geddes
Sat 16 Jan 2021 07.00 GMT

Lazarus JV, Ratzan SC, Palayew A, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med 2020 doi: 10.1038/s41591-020-1124-9

BBC. Royal Marsden’s leading cancer expert Martin Gore dies.
Published 11 January 2019

Times. Cancer pioneer Martin Gore’s sudden death from routine jab.
David Brown
Friday January 11 2019, 12.01am, The Times

The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations
Emilie Karafillakis et al. Vaccine. 2017.

BMJ. The rush to create a covid-19 vaccine may do more harm than good. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3209 (Published 18 August 2020)Cite this as: BMJ 2020;370:m3209

MHRA: Confirmation of guidance to vaccination centres on managing allergic reactions following COVID-19 vaccination with the Pfizer/BioNTech vaccine

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Can Vaccines get us back to normal life again during autumn?

Possibly Yes, but not sooner than that.

Perhaps in later part of 2021, life can just approach some sort of normality in western countries with high uptake of vaccination.

There are many hurdles along the way.

The first problem is supply of Vaccines. There are limited initial supplies globally. It will take many months even for richer countries to get their full supply.

Secondly, Vaccines take many weeks to become very effective. In clinical trials, more than 90% effectiveness was noted for some Vaccines a few weeks after the second dose.

Millions in the UK are yet to receive the first dose. Lots of people would not get the second dose until 10-12 weeks after first dose. A UK minister predicts a September vaccination target for all adults.

So it will take time for the full Vaccine effect to kick in at both individual as well as society level.

Thirdly, there is a potential problem of “Vaccines hesitancy” in sections of the society. A significant minority of people have a unhealthy scepticism about Vaccines fuelled by misinformation on social media.

Fourthly, it has to be pointed out that “No Vaccine works perfectly”. A Vaccine does not offer 100% protection. The high efficacy rates noted in young healthy volunteers participating in various trials might not be observed in real world population, and efficacy rates might be lower in elderly people.

Finally, the most serious potential risk and hurdle would be loss of Vaccine efficacy if new variants of Coronavirus are not protected by existing Vaccines.

Keep the mask; a Vaccine won’t end the COVID-19 crisis right away !

References.

BBC. Will a vaccine give us our old lives back?
By the Visual Journalism Team.
14 January 2021

WSJ. Vaccines Are Coming but They Won’t End Covid-19 Anytime Soon. By Feliz Solomon
Dec. 13, 2020 8:00 am ET

Guardian. All adults in UK will be offered coronavirus vaccine by September.
Dominic Raab sets timescale and says ministers hope to ease lockdown restrictions in March.
Heather Stewart
Sun 17 Jan 2021 13.17 GMT

Guillain-Barré syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005)
Nizar Souayah et al. J Clin Neuromuscul Dis. 2009 Sep.

Countering Vaccine Hesitancy. Kathryn M. Edwards, Jesse M. Hackell and THE COMMITTEE ON INFECTIOUS DISEASES, THE COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE
Pediatrics September 2016, 138 (3) e20162146; DOI: https://doi.org/10.1542/peds.2016-2146

Guardian. Covid vaccine: 72% of black people unlikely to have jab, UK survey finds.
Linda Geddes
Sat 16 Jan 2021 07.00 GMT

CDC. New COVID-19 Variants.
Updated Jan. 15, 2021

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Covid-19: Can you catch the coronavirus while exercising outdoors?

Yes, you can.

But the risk depends on how long and how close you have been in touch with an infected person.

Momentarily passing someone while jogging is extremely unlikely to lead to an infection.

But face to face contact lasting many minutes with a friend or someone who is infected can lead to an infection.

There is a good article on how BBC website.

References:

BBC. Covid-19: Can you catch the virus outside?https://www.bbc.com/news/explainers-55680305
By David Shukman. Science editor.

Mayo Clinic. Safe outdoor activities during the COVID-19 pandemic. By Mayo Clinic Staff.

Imperial. Airborne transmission of COVID-19 carrier particles during exercise.

UK. Ministry of Housing, Communities &
Local Government. Guidance. COVID-19: Guidance for managing playgrounds and outdoor gyms. Updated 6 January 2021

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Should you avoid the Hospitals during this third wave of COVID pandemic?

Yes and No. It depends on how important your hospital visit is.

Recent news reports say that a significant number of patients acquired COVID during their hospital stay. Hospital acquired infections are a serious concern.

Yes, avoid, if you are trying to visit a family member admitted for a routine or elective medical procedure and is doing well.

Yes, avoid, if you can have a satisfactory phone or video consultation with medical team.

No, you should NOT avoid if you have any serious illness like heart attacks, stroke or cancer.

Everything in medicine depends on an assessment of risks versus benefits. For many patients with serious illness, on the whole, the benefits of proper treatment are likely to outweigh the risks of serious problems from COVID and risks can be managed.

If in doubt, ask your doctors or nurse about it. Do not take any action without discussing your concerns with your medical team.

References

Telegraph. Exclusive: Almost as many caught Covid in hospital in past month as in previous four. More than 11,000 people who went into England’s hospitals with unrelated issues contracted virus in December and early January
By Katherine Rushton and Sophie Barnes
14 January 2021 • 9:54pm

BMJ: Views And Reviews. Acute Perspective.
David Oliver: Could we do better on hospital acquired covid-19 in a future wave?
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n70 (Published 13 January 2021)
Cite this as: BMJ 2021;372:n70. davidoliver372@googlemail.com
Follow David on Twitter @mancunianmedic

JAMA: Richterman A, Meyerowitz EA, Cevik M. Hospital-acquired SARS-CoV-2 infection: lessons for public health. JAMA2020;324:2155-6. doi:10.1001/jama.2020.21399. https://jamanetwork.com/journals/jama/fullarticle/2773128. pmid:33185657

JAMA: Rhee C, Baker M, Vaidya V, et al., CDC Prevention Epicenters Program. CDC Prevention Epicenters Program. Incidence of nosocomial covid-19 in patients hospitalized at a large US academic medical center. JAMA Netw Open2020;3:e2020498. doi:10.1001/jamanetworkopen.2020.20498. pmid:32902653

HSJ. Hospital acquired covid infections hit record high. By Matt Discombe11 December 2020

Healthcare Safety Investigation Branch. National report charts challenges of managing COVID-19 transmission in hospitals. 29 Oct 2020. https://www.hsib.org.uk/news/national-report-charts-challenges-managing-covid-19-transmission-hospitals/.

David Oliver: Heed HSIB on covid transmission in hospital. BMJ2020;371:m4306. doi:10.1136/bmj.m4306. pmid:33177046

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice

Anything potentially good from this COVID-19 pandemic?

It might seem foolish to ask the question “Anything good from this COVID-19 pandemic?” when so many people across the world has been so badly affected by the coronavirus pandemic.

There is some truth in the proverb that “every dark cloud has a silver lining” and no matter how bad the current pandemic is now, human spirit and endeavour would get something positive out of it.

One possible good thing that has come out of the pandemic is the “mRNA technology”.

Of the three vaccines so far, two of them the Pfizer vaccine and the Moderna vaccine are based on RNA technology.

The successful use of RNA technology for Coronavirus Vaccines would hopefully enable the versatile RNA technology to be further developed and successfully used a cancer treatment in near future.

Further clinical trials in cancer patients would be done to provide proof of their potential.

References:

Bloomberg. Technology & Ideas. mRNA Vaccines Could Vanquish Covid Today, Cancer Tomorrow.
The best news about the mRNA shots from BioNTech and Moderna is that the same technique could also defeat many other diseases.

MSKCC. In a Twist, Scientists Find Cancer Drivers Hiding in RNA, Not DNA.

Jerusalem Post Health & Science. Israeli scientists use mRNA COVID-19 vaccine technology to fight cancer. By MAAYAN JAFFE-HOFFMAN NOVEMBER 24, 2020 20:08

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

A first COVID infection can make the body resistant to second infection for atleast five months

If someone had a COVID-19 Coronavirus infection and has recovered from it, then their body develops resistance to a further second infection

The protection is similar to that provided by vaccination. The UK study found that the protection lasts for atleast five months.

Caveats: It is not known how long the protection will last and the study is ongoing.

While a previously infected is protected against 2nd infection, that person can still carry and transmit virus to others. PHE reports that “early evidence from the next stage of the study suggests that some of these individuals carry high levels of virus and could continue to transmit the virus to others”. So the usual COVID-19 precautions are still needed.

The study involved healthcare workers from hospitals across the UK. The study recruited mainly Young and Middle age people ; it is not known whether the study findings would apply to older age people who are the most vulnerable.

The protection is not 100%. The protective effect was noted for only 83% . So there is still a chance someone who has recovered from the 1st infection might still get a 2nd infection.

The other big concern is “the risk of reinfection from the new Covid variants spotted in the UK, South Africa and Brazil”.

The study continues and more information would be available later this year ”

References:

PHE. Press release. Past COVID-19 infection provides some immunity but people may still carry and transmit virus
Study finds past coronavirus (COVID-19) infection provides some immunity for at least 5 months, but people may still carry and transmit the virus. Published 14 January 2021. Public Health England

Guardian Newspaper. Recovering from Covid gives similar level of protection to vaccine
PHE found immunity from earlier infection provided 83% protection against reinfection for at least 20 weeks.
Ian Sample Science editor. @iansample
Thu 14 Jan 2021 06.00

Daily Mail. Previous coronavirus infection gives people immunity for five months – MORE than the Oxford vaccine, PHE study finds. By Joe Pinkstone For Mailonline
00:01, 14 Jan 2021 , updated 11:54, 14 Jan 2021

Telegraph: Brazilian Covid variant may infect people who have recovered from virus
Scientists find new coronavirus strain has mutated to be more infectious and has changes that help it evade immune system
By Sarah Knapton,
SCIENCE EDITOR
14 January 2021 • 3:00pm

SIREN – SARS-COV2 immunity and reinfection evaluation; The impact of detectable anti SARS-COV2 antibody on the incidence of COVID-19 in healthcare workers.

SIREN protocol: Impact of detectable anti-SARS-CoV-2 on the subsequent incidence of COVID-19 in 100,000 healthcare workers: do antibody positive healthcare workers have less reinfection than antibody negative healthcare workers?

BMJ: Covid-19: Past infection provides 83% protection for five months but may not stop transmission, study finds.
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n124 (Published 14 January 2021)
Cite this as: BMJ 2021;372:n124

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Where can I find official detailed information about the three COVID vaccines (Pfizer, Astra Zeneca and Moderna)

You might have read information about the COVID vaccines on various news outlets and social media messages.

If you want complete summary information about vaccines approved by the regulatory authorities, click on the links below.

Two types of information leaflets accompany all licensed medicines.
– One is meant for health professionals and has lot of clinical information. (called SPC)
– The other is meant for patients and public and provides a summary of facts using lay terms.(called PIL).

The leaflets provide information about all common side effects observed in the trials.

Oxford Astra Zeneca: Professionals Version .

Oxford Astra Zeneca: Patient Version

Pfizer. Professionals Version

Pfizer. Patient Version

Moderna. Professionals Version

Moderna. Patient Version

FDA USA: Pfizer-BioNTech COVID-19 vaccine prescribing informationexternal

FDA USA: Moderna COVID-19 vaccine prescribing informationexternal

The above links reproduced below with longer titles and date of publication.

Please note when new significant information comes to light, the company and regulatory authorities are likely to update the information leaflets.

Oxford Vaccine : Information for Healthcare Professionals on COVID-19 Vaccine AstraZeneca
Updated 7 January 2021.

Oxford Vaccine: MHRA. Information for UK recipients on COVID 19 Vaccine AstraZeneca
Updated 7 January 2021.

Pfizer Vaccine. MHRA. Information for Healthcare Professionals on Pfizer/BioNTech COVID-19 vaccine
Updated 31 December 2020

Pfizer Vaccine. MHRA. Information for UK recipients on Pfizer/BioNTech COVID-19 vaccine
Updated 31 December 2020

Moderna. MHRA. Information for Healthcare Professionals on COVID-19 Vaccine Moderna
Updated 8 January 2021.

Moderna. MHRA. Information for UK recipients on COVID-19 Vaccine Moderna
Updated 8 January 2021.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Some Good news for those who have recovered from a COVID-19 infection !

People who have recovered from a COVID-19 infection are expected to have some protection against another repeat infection by the COVID-19 Coronavirus.

The protection comes from patients own antibodies present in their blood.

Previously, there was a concern that this protection might not last very long and that the levels of protective antibody may drop off quickly and this in turn can lead to repeat infections.

Now a study from Oxford indicates that protection against repeat infection (re-infection) can last atleast 6 months.

This news indirectly might also be good news for COVID-19 vaccines .

Vaccines work by tricking the body into thinking that there is a virus infection and the body then produces the protective antibodies and cells.

Based on this study, one can logically hope that the protection by vaccines can be long lasting as well. Of course, nothing is certain and further vaccine data is awaited to confirm this.

References: (1) Lumley SF, O’Donnell D, Stoesser NE, et al., Oxford University Hospitals Staff Testing Group. Antibody status and incidence of SARS-CoV-2 infection in health care workers. N Engl J Med2020. doi:10.1056/NEJMoa2034545. pmid:33369366

(2) BMJ news: Covid-19: Antibodies protect against reinfection for at least six months, study finds. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4961 (Published 30 December 2020)
Cite this as: BMJ 2020;371:m4961

(3). BBC news: Covid reinfection: Man gets Covid twice and second hit ‘more severe’
By James Gallagher
Health and science correspondent

(4). Lancet Infectious diseases. Genomic evidence for reinfection with SARS-CoV-2: a case study. Richard L Tillett, PhD, Joel R Sevinsky, PhD, Paul D Hartley, PhD, Heather Kerwin, MPH, Natalie Crawford, MD, Andrew Gorzalski, PhD, et al. Published:October 12, 2020. DOI: https://doi.org/10.1016/S1473-3099(20)30764-7

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

A third Vaccine approved for protection against COVID-19 Coronavirus infection

Pfizer Vaccine and Astra Zeneca/Oxford Vaccine were approved last month by the UK regulatory authorities.

Now the regulatory authorities have approved a third vaccine. The third vaccine from Moderna along with two other vaccines should help to bring the pandemic to an end.

The Moderna vaccine is a new technology like the Pfizer Vaccine. (based on mRNA technology).

Like the two vaccines, the short term data for Moderna vaccine is very encouraging.

Over long term, one hopes that the protective effect of all the three vaccines is long lasting and that they remain effective against any new variants of coronavirus that might emerge in the coming months.

Overall, there is certainly ‘light at end of the tunnel’ and the world can emerge out of this horrific pandemic in a short period.

BBC. Moderna becomes third Covid vaccine approved in the UK
By Michelle Roberts
Health editor, BBC News online

BBC.Covid-19: Pfizer/BioNTech vaccine judged safe for use in UK
By Michelle Roberts
Health editor, BBC News online
Published2 December 2020

BBC. Covid-19: Oxford-AstraZeneca vaccine approved for use in UK
By James Gallagher and Nick Triggle
BBC News
Published30 December 2020

MHRA. Oxford University/AstraZeneca COVID-19 vaccine approved.

MHRA. Moderna vaccine becomes third COVID-19 vaccine approved by UK regulator.

MHRA. UK medicines regulator gives approval for first UK COVID-19 vaccine.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Are takeaway deliveries risky during Coronavirus pandemic?

Possibly yes, if food is not properly handled during preparation, packaging and delivery.

It is likely the risks from properly prepared food and food packaging itself are minimal. There is more risk from interaction with the delivery person.

If you are shielding or a very old person, there is a chance the food delivery person might pass on the infection to you. Stay at safe distance, use gloves and masks, and advice the delivery to be left at door for collection. Wipe Clean outside packaging and transfer contents to your own containers.

But for young adults the risk is likely to be very small.

Most importantly, it has to pointed out that everything in life has some risks. If you are not buying a takeaway, you might have to go shops or supermarkets to buy food for cooking and eating. There is a risk of catching cornovirus from other people while shopping !

There is a good article in BBC titled “ Coronavirus: How safe are takeaways and supermarket deliveries?

A previous blog post also gives information about survival of coronavirus in artificial surfaces

References: Can you catch Coronavirus infection from Soft drink cans, Sandwich wrapper and Amazon Parcels?

Coronavirus: How safe are takeaways and supermarket deliveries? By Victoria Gill
Science correspondent, BBC News

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

New drug treatments for COVID-19

More good news in fight against COVID-19 pandemic !

Steroids were previously proven to be effective against severe Coronavirus (COVID-19) infection. The steroids are believed to work by dampening the inflammation caused by coronavirus.

Dexamethasone and Prednisolone are the commonly used steroids.

Now two other drugs have been reported to work in COVID-19 infection. (yet to be published).

Both the anti-inflammatory drugs are not entirely new drugs as they are already routinely used for treatment of various arthritis.

The BBC reports: “The anti-inflammatory medications, given via a drip, save an extra life for every 12 treated, say researchers who have carried out a trial in NHS intensive care units”.

The two drugs “tocilizumab and sarilumab” may become available for treatment of severe COVID-19 shortly.

All these additional drug treatments are needed ONLY for severe Coronavirus (COVID-19) infection. Mild COVID-19 infections do NOT need these drug treatments.

References . BBC news. Two more life-saving Covid drugs discovered. By Michelle Roberts. Health editor, BBC News online. Published 7 Jan 2021.

BBC news. Coronavirus: Dexamethasone proves first life-saving drug. By Michelle Roberts. Health editor, BBC News online. Published 16 June 2020

BBC News. Tocilizumab: Arthritis drug may treat severe Covid. By James Gallagher. Health and science correspondent. Published 19 November 2020

BMJ. Dexamethasone in management of covid -19. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2648 (Published 03 July 2020)
Cite this as: BMJ 2020;370:m2648

BMJ. Rapid Recommendations. A living WHO guideline on drugs for covid-19. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3379 (Published 04 September 2020). Cite this as: BMJ 2020;370:m3379

BMJ. Covid-19: Arthritis drugs improve survival in intensive care patients, shows study
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n61 (Published 08 January 2021)
Cite this as: BMJ 2021;372:n61

eMC. Sarilumab is a human monoclonal antibody selective for the interleukin-6 (IL-6) receptor, produced in Chinese Hamster Ovary cells by recombinant DNA technology. (Sarilumab, administered as a subcutaneous injection is routinely used for treatment of arthritis and is not an entirely new drug).

eMC. Tocilizumab is a recombinant humanized, anti-human monoclonal antibody of the immunoglobulin G1 (IgG1) sub-class directed against soluble and membrane-bound interleukin 6 receptors. (Tocilizumab, as a intravenous or subcutaneous formulation, is routinely used for treatment of various arthritis and is also not an entirely new drug).

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Can you get Coronavirus infection even after getting the Vaccine ?

Yes, you can get the COVID-19 infection even after the vaccines.

This is because no vaccine is 100% effective. ( Eg Pfizer 95%, Oxford 70%)

The distressing story of a Nurse in Wales getting the infection after vaccination is an example.

There is also a theoretical chance that protective effect of vaccine is affected by new variants of Coronavirus.

But it is reassuring to learn that the Pfizer vaccine could be effective against UK and South Africa coronavirus strains (but the study is unpublished study and yet to be not peer reviewed ).

Be safe. Be aware !

References: BBC news. Covid: Nurse ‘angry’ over positive test despite vaccination. By Rachael Garside. BBC Wales News.

Covid-19: Pfizer/BioNTech vaccine judged safe for use in UK. By Michelle Roberts. Health editor, BBC News online. Published2 December 2020

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. List of authors.
Fernando P. Polack, M.D., Stephen J. Thomas, M.D., Nicholas Kitchin, M.D., Judith Absalon, M.D., et al., for the C4591001 Clinical Trial Group*
December 31, 2020
N Engl J Med 2020; 383:2603-2615
DOI: 10.1056/NEJMoa2034577

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Merryn Voysey, DPhil *Sue Ann Costa Clemens, PhD *Shabir A Madhi, PhD *Lily Y Weckx, PhD *Pedro M Folegatti, MD *Parvinder K Aley, PhD
et al.
Published:December 08, 2020DOI:https://doi.org/10.1016/S0140-6736(20)32661-1

CNN. Genetics experts worry coronavirus vaccines might not work quite as well against UK variant. By Elizabeth Cohen, CNN Senior Medical Correspondent. Updated 0328 GMT (1128 HKT) December 24, 2020

Telegraph: Coronavirus latest news: Pfizer vaccine could be effective against UK and South Africa strains, study says. Gareth Davies, breaking news editor. 8 JANUARY 2021 • 9:41AM (“Pfizer Inc and BioNTech’s Covid-19 vaccine appeared to work against a key mutation in the highly transmissible new variants of the coronavirus discovered in the UK and South Africa, according to a laboratory study conducted by the US drugmaker. The not-yet peer reviewed study by Pfizer and scientists from the University of Texas Medical Branch indicated the vaccine was effective in neutralizing virus with the so-called N501Y mutation of the spike protein.”)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

What is evidence for delaying the 2nd dose of COVID-19 ?

The UK has made a pragmatic decision based on limited available evidence to delay the second dose so that more people can get the vaccine.

While there is some evidence for the Oxford vaccine, there is scant public evidence in support of delaying the Pfizer vaccine.

A BMJ news article provides an excellent summary of the current evidence.

Only time will whether there are any major risks to this approach.

Reference: Covid-19 vaccination: What’s the evidence for extending the dosing interval? BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n18 (Published 06 January 2021). Cite this as: BMJ 2021;372:n18

Covid-19: Order to reschedule and delay second vaccine dose is “totally unfair,” says BMA
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4978 (Published 31 December 2020)
Cite this as: BMJ 2020;371:m4978

NHS. Letter to chief executives of all NHS trusts and foundation trusts. 30 Dec 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/12/C0994-System-letter-COVID-19-vaccination-deployment-planning-30-December-2020.pdf.

NHS. Coronavirus (COVID-19) vaccine. When the 2nd dose will be given.

Daily Mail. Pfizer warns there is NO proof its Covid jab works when doses are taken 12 weeks apart as UK regulator scraps 21-day rule in desperate attempt to get millions more vaccinated. By Connor Boyd Assistant Health Editor For Mailonline
14:52, 30 Dec 2020 , updated 16:58, 30 Dec 2020

Statement from the UK Chief Medical Officers on the prioritisation of first doses of COVID-19 vaccines. Joint clinical advice from the 4 UK Chief Medical Officers on the prioritisation of first doses of the coronavirus (COVID-19) vaccines. Published 30 December 2020.

Priority groups for coronavirus (COVID-19) vaccination: advice from the JCVI, 30 December 2020. Advice from the Joint Committee on Vaccination and Immunisation (JCVI) on the groups that should be prioritised for vaccination.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Why do some people falsely believe COVID-19 is a hoax ?

It is quite difficult to give a single reason why some people believe COVID-19 is a hoax.

Since the coronavirus pandemic started, there has been so much anxiety, stress and severe disruption to the everyday life.

Most people like certainty with everyday life. Most people do not wake up and think that there is very very tiny chance I might die today (even though that’s true).

Thinking about bad things all the time can make you feel very stressed and exhausted . In a way, it is healthy NOT to focus on all the bad things that can happen everyday.

The daily bad news about Coronavirus pandemic can be very upsetting to some people, particularly if you cannot mentally switch off.

So some people mentally cope by believing the COVID-19 is fake news. Believing COVID-19 is a hoax helps some people to get on with their lives without being very fearful and worried everyday. It is a coping mechanism.

Unfortunately social media doesn’t help and lot of fake news sites tell people that it is no worse than a simple flu. (which is not true, COVID-19 is certainly much worse than simple flu).

It is true that only about 1% of people with COVID-19 die due to the disease. But if ten million people get infected in a country that means an extra 100,000 deaths. If the whole population of UK were to get the infection, theoretically it could mean at least an extra 500,000 deaths.

COVID-19 is particularly bad for old people . The risk of death is <1 per 10 000 for someone aged less than 30 but the risk is much higher for older age groups. For example, in men aged 80 or older, the risk of dying from COVID-19 is just over 1 in 10.

Be safe. Be aware.

Do trust the NHS website rather than a “friend of a friend” on social media.

References:

Guardian Newspaper. Doctors are our frontline against Covid. Now they lead the fight against its deniers, too
Gaby Hinsliff. Mon 4 Jan 2021 14.36 GMT

Newspaper headlines: ‘Lockdown 3′ and ‘race to vaccinate vulnerable’
By BBC News. 5 Jan 2021.

“Normal” risk and dangers of covid-19
Awareness of normal risk is not normal
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4121 (Published 29 October 2020)
Cite this as: BMJ 2020;371:m4121 https://www.bmj.com/content/bmj/371/bmj.m4121.full.pdf

Spiegelhalter D. Use of “normal” risk to improve understanding of dangers of covid-19. BMJ2020;370:m3259. doi:10.1136/bmj.m3259. pmid:32907857

Comparative evaluation of clinical manifestations and risk of death in patients admitted to hospital with covid-19 and seasonal influenza: cohort study. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4677 (Published 15 December 2020)
Cite this as: BMJ 2020;371:m4677

Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4509 (Published 27 November 2020)
Cite this as: BMJ 2020;371:m4509. https://www.bmj.com/content/371/bmj.m4509

Office for National statistics. Population estimates for the UK, England and Wales, Scotland and Northern Ireland: mid-2019.

NHS Coronavirus (COVID-19). Get the latest NHS information and advice about coronavirus (COVID-19).

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Will the existing COVID vaccines work against the new Coronavirus variant spreading in England ?

A new variant of Corona virus is spreading fast in England.

Some Hospitals in England are reportedly being swamped with COVID patients.

The whole world is placing their bets on vaccines to defeat the Coronavirus and emerge out of this dreadful pandemic.

Studies are ongoing about the effectiveness of vaccines against this new variant coronavirus. There is a risk that changes seen in the variant virus (mutations) might make it evade the vaccine shield.

So far, there has been no conclusive evidence that the variant virus will definitely escape the vaccines. Even if they do, the good news is that current vaccines can be adapted to deal with the changes in the virus.

Reference

(1) BBC News. New coronavirus variant: What do we know?. By James Gallagher
Health and science correspondent. Published 20 December 2020.

(2) BBC News. Newspaper headlines: ‘Vacc to the future’ and village hall jabs.

(3) Preliminary genomic characterisation of an emergent SARS-CoV-2 lineage in the UK defined by a novel set of spike mutations.

(4) Neutralising antibodies drive Spike mediated SARS-CoV-2 evasion.

(5). Covid-19: New coronavirus variant is identified in UK. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4857 (Published 16 December 2020)
Cite this as: BMJ 2020;371:m4857

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Is the COVID-19 Coronavirus vaccine safe for use in patients having chemotherapy and immunotherapy?

Yes, the available indirect evidence indicates that the anticipated benefits overweigh the potential risks.

Cancer patients, particularly those on chemotherapy have compromised immune systems and hence more vulnerable to COVID-19 Coronavirus complications.

The guidelines indicate that anticipated benefits of vaccine are greater than unknown risks from the Coronavirus vaccines.

The Vaccine trials deliberately included lot of healthy people. Very few people with cancer, particularly cancer patients on active treatment, were included in the COVID-19 trials. So there is not much direct evidence regarding efficacy and safety of Vaccines in cancer patients. But indirect evidence significantly favours Coronavirus vaccination in cancer patients.

Flu vaccines are regularly used in cancer patients without any major side effects specific to cancer patients. No increase in incidence or severity of drug side effects were seen in immunotherapy patients having flu vaccines.

On balance, Vaccination is most likely to be of utmost benefit for most advanced cancer patients on active treatment.

References:

ESMO STATEMENTS FOR VACCINATION AGAINST COVID-19 IN PATIENTS WITH CANCER.

Guidance: COVID-19: the green book, chapter 14a
Coronavirus (COVID-19) vaccination information
for public health professionals. (UK),

Cochrane: Influenza (flu) vaccination for preventing influenza in adults with cancer

Safety of Inactivated Influenza Vaccine in Cancer Patients Receiving Immune Checkpoint Inhibitors
Curtis R Chong et al. Clin Infect Dis. 2020.

ESMO: CANCER PATIENT MANAGEMENT DURING THE COVID-19 PANDEMIC.

Kuderer NM Choueiri TK Shah DP et al.
Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020; 395: 1907-1918

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.
The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Is the new vaccine against COVID-19 causing CoronaVirus safe and effective ?

Yes, the available short term data indicates the vaccine is safe and effective in vast majority of people.

The big unknown is the long term efficacy and side effects.

Normally medicine progresses slowly and carefully like a big train turning slowly on sharp uphill bend .

But due to pandemic emergency, the vaccines are being introduced to the the general public more more earlier than it would have done, well before availability of more mature data.

Long term, there are some uncertainties. For instance, there is a possibility of loss of efficacy if vaccine effect is not long lasting. But there is no evidence to suggest at present this would happen. As regards long term side effects, once more data is collected and more patients are followed up after vaccination, there will more mature data on side effects.

The available data suggests that very high groups who are a high risk of death from COVID , have good odds of benefitting from vaccine.

The trial data published so far, UK Medicine regulator conclusions , Pfizer data sheet and UK govt Guidelines has been positive so far.

It may be that low risk groups such as people in 20s, who have less chance of dying from COVID, may opt for more long term data before having the vaccination.

References:

NHS Coronavirus (COVID-19) vaccine

MHRA Regulatory approval of Pfizer / BioNTech vaccine for COVID-19

Information for UK recipients on Pfizer/BioNTech COVID-19 vaccine. Updated 16 December 2020.

Information for Healthcare Professionals on Pfizer/BioNTech COVID-19 vaccine. Updated 16 December 2020.

Public Health England. COVID-19 vaccination programme. Information for healthcare practitioners. Published December 2020. Version 2.1

The Green book chapter 14a COVID-19-SARS-Cov-2.

PHE. Confirmation of guidance to vaccination centres on managing allergic reactions following COVID-19 vaccination with the Pfizer/BioNTech vaccine. 9/12/2020.

British Society for Rheumatology. Guidance for COVID-19 vaccinations.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.


The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Is this the beginning of the end for COVID-19 ?

The superstitious might say “don’t jinx it by calling the end early”……..

So the answer is “may be”.

The good news from two Vaccine trials indicates that this might be “beginning of the end” for COVID-19.

Two recent press reports give rise to lot of optimism to the population that is getting weary with the lockdown. It is good to have a ray of hope among all the doom and gloom.

The covid-19 vaccine (mRNA-1273) from US biotech company Moderna was found to be 94.5% effective.

Another mRNA vaccine developed by Pfizer and BioNTech was reported to be 90% effective.

Now the caveats…. these are interim trial results and the trial results have not been subject to scrutiny by the wider scientific community as the full results are yet to be published.

Clinical Trials usually recruit motivated people without too many other medical problems. So one has to hope that these interim trial results can be replicated in the wider elderly population with lot of medical problems.

Update: Now a third Vaccine, the “Oxford Vaccine” has been found to be 90% effective when given as “a half and then full” schedule.

Update: summary so far at BMJ website.

Let’s hope that all the vaccines are very safe and highly effective when used in the real world population.

References: (1). Covid-19: Vaccine candidate may be more than 90% effective, interim results indicate. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4347 (Published 09 November 2020). Cite this as: BMJ 2020;371:m4347.

(2). Covid-19: Moderna vaccine is nearly 95% effective, trial involving high risk and elderly people shows. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4471 (Published 17 November 2020). Cite this as: BMJ 2020;371:m4471

(3). Covid-19: Oxford vaccine is up to 90% effective, interim analysis indicates
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4564 (Published 23 November 2020)
Cite this as: BMJ 2020;371:m4564

Covid-19: What do we know about the late stage vaccine candidates?. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4576 (Published 24 November 2020)
Cite this as: BMJ 2020;371:m4576

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Some good news amid the doom and gloom: People have Longer immunity to Coronavirus infection after recovering from it.

After someone has recovered from a Coronavirus infection, the body remembers how to fight the virus in future. This is called immunity and it is not known how long this immunity will last.

If the immunity is not long lasting, people can get coronavirus infection again during the second and even third wave.

The body’s immunity is made up of two types of cells: B cells and T cells. T cells and B cells are central to the human immune system.

B cells produce antibodies and previously in various studies , they were found to decline rapidly give rise to fear that people would get Coronavirus infection again and again.

Now a study has reported that T cell immunity can last more than 6 months in patients who have recovered from an infection.

This news is also good from a vaccine point of view. It gives us hope that sooner or later an effective vaccine would become available.

BMJ News.
Covid-19: T cell response lasts for at least six months after infection, study shows
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4257 (Published 02 November 2020)
Cite this as: BMJ 2020;371:m4257

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Are families of Healthcare workers at increased risk of hospital admission due to COVID-19 ?

Yes !

“Patient Facing” healthcare workers do admirably put them at harms way during this Coronavirus pandemic .

So health workers are at increased risk of getting admitted to hospital due to COVID-19.

But a recent Paper in BMJ says that families of healthcare workers are also at increased risk of hospital admission. In very few other lines of work, does the occupational hazard affect the families of workers as well.

The authors report “ …. patient facing healthcare workers and members of their households were, respectively, threefold and twofold more likely to be admitted to hospital. Healthcare workers and their households accounted for one in six of all admissions with covid-19 in the working age population (18-65 years).”

The paper says “Among admitted healthcare workers, one in eight were admitted into critical care and six (2.5%) died; in admitted household members, one in five were admitted to critical care and 18 (12.9%) died.”

Routine testing of healthcare workers and early testing of families as well as better access to effective PPE is urgently needed.

References : 1. Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3582 (Published 28 October 2020)Cite this as: BMJ 2020;371:m3582

2. Covid-19: risks to healthcare workers and their families. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3944 (Published 28 October 2020)Cite this as: BMJ 2020;371:m3944

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Coronavirus re-infection and immunity

Many Viral infections give some sort of immunity to the person infected. For example, if a child has chicken pox, then the child develops immunity to further chicken pox. This immunity can even be life long for many children.

But some viral infections don’t result in significant immunity to further infection. For example, Flu and Common Cold viruses infections do not result in effective long immunity. That’s why flu vaccines are given yearly to vulnerable people.

It was hoped that a Coronavirus infection could result in at least some sort of long immunity to further infections.

A recent report of man who developed Coronavirus/ COVID-19 for the second time is worrying. If this is a widespread phenomenon and not an isolated case, then it has significant implications for the current pandemic.

Herd immunity, whereby many people are immune to further Coronavirus infection either through previous infection or Vaccination, was suggested as the way of ending the current pandemic.

This report, if confirmed to be true across significant sections of population, would indicate a much more longer duration of COVID-19 pandemic.

References:

1. BBC news: Covid reinfection: Man gets Covid twice and second hit ‘more severe’
By James Gallagher
Health and science correspondent

2. Lancet Infectious diseases. Genomic evidence for reinfection with SARS-CoV-2: a case study. Richard L Tillett, PhD, Joel R Sevinsky, PhD, Paul D Hartley, PhD, Heather Kerwin, MPH, Natalie Crawford, MD, Andrew Gorzalski, PhD, et al.
Published:October 12, 2020. DOI: https://doi.org/10.1016/S1473-3099(20)30764-7

3. Lancet Infectious diseases. What reinfections mean for COVID-19. Akiko Iwasaki
Published:October 12, 2020. DOI:https://doi.org/10.1016/S1473-3099(20)30783-0Edridge AWD

4. Edridge AWD, Kaczorowska et al.Seasonal coronavirus protective immunity is short-lasting.Nat Med. 2020; (published online Sept 14.)https://doi.org/10.1038/s41591-020-1083-1View in Article

5. Tillett RL et al. Genomic evidence for reinfection with SARS-CoV-2: a case study.Lancet Infect Dis. 2020; (published online Oct 12.)https://doi.org/10.1016/S1473-3099(20)30764-7View in Article

6. To KK-W et al. COVID-19 re-infection by a phylogenetically distinct SARS-coronavirus-2 strain confirmed by whole genome sequencing.Clin Infect Dis. 2020; (published online Aug 25.)https://doi.org/10.1093/cid/ciaa1275View in Article

7. Van Elslande J et al.Symptomatic SARS-CoV-2 reinfection by a phylogenetically distinct strain.Clin Infect Dis. 2020; (published online Sept 5.)https://doi.org/10.1093/cid/ciaa1330View in Article

8. Prado-Vivar B et al.COVID-19 re-infection by a phylogenetically distinct SARS-CoV-2 variant, first confirmed event in South America.SSRN. 2020; (published online Sept 8.) (preprint)https://doi.org/10.2139/ssrn.3686174View in Article

9. Dearlove B et al. A SARS-CoV-2 vaccine candidate would likely match all currently circulating variants.Proc Natl Acad Sci USA. 2020; 117: 23652-23662View in Article

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

How long can Coronavirus Virus Survive on doors, handles, furniture and fittings?

Coronavirus was previously known to survive for about 3 days at room temperatures. (On certain surfaces made of plastic and stainless steel).

Now an Australian team has found that Coronavirus can survive upto 28 days in Cold conditions. The results need to be interpreted with great caution as it tested virus under unusual artificial conditions and hence might not be relevant for real life situations

On the other hand , if the study is right, then it might indicate that the Pandemic can get worse during cold Winter before it gets better in Spring and Summer.

What can we do? In addition to Social distancing measures and Mask wearing, Frequent hand washing would stop the Virus from Spreading.

Every Week , we are learning more about the Virus. Let’s hope it comes to an end soon.

1. BBC news: Covid-19 virus ‘survives on some surfaces for 28 days’. https://www.bbc.co.uk/news/health-54500673

2. Daily Mail. https://www.dailymail.co.uk/news/article-8828459/Coronavirus-survive-MONTH-surfaces-including-banknotes-mobile-phone-screens.html

3. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
April 16, 2020
N Engl J Med 2020; 382:1564-1567
DOI: 10.1056/NEJMc2004973

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Risk of Death from COVID-19: does ethnicity matter?

Yes, people from different ethnicities are affected in different ways by Coronavirus.

People of white ethnicity seems to be at lower risk.

People of black ethnicity seem to have higher risk of severe disease but seem to survive better than South Asians in UK.

South Asians who are hospitalised in UK due to severe disease seem to have the highest risk of death.

More work needs to be done to identify underlying the biological factors responsible for the increased risk of death in South Asians in UK.

BBC News. Covid: South Asian hospital patients ‘at greater risk of dying’

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.


The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Coronavirus : Why Hand hygiene is also important in addition to Face mask ?

The UK government’s slogan for controlling COVID-19 pandemic is “ ‘Hands. Face. Space

The reason hands are emphasised is because the Virus can stay alive on Human skin for many hours. So touching others by hugging or hand shaking can spread the virus.

A recent Japanese study found that Coronavirus can stay alive on skin surfaces for about 9 hours. They also found that alcohol gel can inactivate the virus in about 15 seconds !

References:

1. Survival of SARS-CoV-2 and influenza virus on the human skin: Importance of hand hygiene in COVID-19 Ryohei Hirose, Hiroshi Ikegaya, Yuji Naito, Naoto Watanabe, Takuma Yoshida, Risa Bandou, Tomo Daidoji, Yoshito Itoh, Takaaki NakayaClinical Infectious Diseases, ciaa1517, https://doi.org/10.1093/cid/ciaa1517 Published: 03 October 2020

2. Guardian: Coronavirus outbreakHands. Face. Space’: UK government to relaunch Covid-19 slogan.

3. Fox News: The coronavirus can survive on skin for this many hours, study suggests
Researchers found that SARS-CoV-2 outlived the influenza A virus on human skin
. Madeline Farber By Madeline Farber | Fox News

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.
The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Which is better for COVID-19 protection : face masks or face shields.

Various type of masks are used by public for protection against COVID-19.

Some wear cloth masks. Some use medical disposable masks. Some wear face shields particularly those working in shops.

Are they all the same?.

No

Recent evidence indicates that standard light-blue disposable surgical masks are the most effective at containing the Cornovirus.

Face shields were found to be failing when compared with standard ( triple layer) medical grade masks.

References

1. Face shields ineffective at trapping aerosols, says Japanese supercomputer. Guardian Newspaper. Justin McCurry in Tokyo. Tue 22 Sep 2020 07.19 BST. https://www.theguardian.com/world/2020/sep/22/face-shields-ineffective-trapping-aerosols-japanese-supercomputer-coronavirus

2. Do cloth masks work? Supercomputer Fugaku says yes.World’s fastest computer calculates that nonwoven fabric is best. YUKI MISUMI, Nikkei staff writer. August 25, 2020 00:34 JST. https://asia.nikkei.com/Business/Technology/Do-cloth-masks-work-Supercomputer-Fugaku-says-yes

3. Visualizing droplet dispersal for face shields and masks with exhalation valves. Physics of Fluids 32, 091701 (2020); https://doi.org/10.1063/5.0022968

4. Visualizing the effectiveness of face masks in obstructing respiratory jets. Siddhartha Verma, Manhar Dhanak, and John Frankenfield. https://aip.scitation.org/doi/10.1063/5.0022968
Phys Fluids (1994). 2020.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Cancer and COVID-19

Cancer patients, as expected, did badly during the 1st wave of the COVID-19 pandemic

Data presented at ESMO ( European Society of Medical Oncology) shows that Cancers had – higher rates of Hospitalisation, higher risk of Complications and increased risk of Death.

Elderly cancer patients on the whole did very badly but surprisingly cancer patients under age of 50 did far worse than their peers without cancer.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

COVID-19 risk assessment of NHS members : is it an opportunity missed?

The National Health Service had recently embarked on a Risk assessment exercise of its staff to assess the Vulnerability of individual members to Coronavirus infection ( COVID-19).

The exercise is being done with good intentions. Given the unprecedented situation of the pandemic and lack of concrete data , the exercise seemed to have steered away from firm “one size fits all” type of recommendations.

Given the uncertainties with the currently available data on various forms of protection ( from simple surgical masks to shielding) , the exercise could have been a starting point for an nationwide intervention study .

An opportunity seems to have been missed and if there is a second wave, NHS might regret not learning from the first wave.

Please do add your opinion at the rapid response section of the BMJ.

References

1. Covid-19 risk assessment in BAME staff

Covid-19 risk assessment: a futile metaphorical strip search

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3251 (Published 26 August 2020)

Cite this as: BMJ 2020;370:m3251

2. Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2743 (Published 15 July 2020)

Cite this as: BMJ 2020;370:m2743

3. Complete protection from covid-19 is possible for health workers

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2641 (Published 07 July 2020)

Cite this as: BMJ 2020;370:m2641

4. Two metres or one: what is the evidence for physical distancing in covid-19?

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3223 (Published 25 August 2020)

Cite this as: BMJ 2020;370:m3223