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.

Low Carb diet for Diabetes: what is the scientific evidence?

Low Carb diet is often used for weight loss.

A recent “Study of Studies” published in BMJ shows that Low-Carb-diet is beneficial for diabetes control and remission.

The beneficial effects seem quite remarkable in the first six months but there is uncertainty about the long term effect.

Before you consider the Low-Carb-diet option, do discuss it with your doctor.

What replaces the Low-Carb-Diet is also important. Long term Low-Carb-Diet with animal protein seems to be bad for health.

Do consider plant based proteins instead .

References: Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data.
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4743 (Published 13 January 2021)
Cite this as: BMJ 2021;372:m4743

Seidelmann SB, Claggett B, Cheng S, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health2018;3:e419-28. doi:10.1016/S2468-2667(18)30135-X pmid:30122560

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.

Are spirits and beers more risky than wine?

Yes, according to a recent UK biobank study.

A large study of 309,123 participants found that Spirit drinking was associated with higher risk of early death compared to red wine drinking.

Beer/cider drinkers were also found to be at a higher risk of early death.

Alcohol consumption without food was associated with higher risk of early death compared to consumption with food.

Binge drinking with Alcohol consumption over 1–2 times/week was more risky compared to drinking spread out over 3–4 times/week.

But the study doesn’t seem to have looked at teetotallers. The study specifically excluded Abstainers and infrequent alcohol consumers. It is quite possible that avoiding alcohol altogether may be more beneficial but that might not be acceptable to many people !

As usual most of studies relating to food and drink need to be taken with a dose of healthy scepticism.

References:

Daily Mail. I Drinking wine instead of beer or spirits is healthier and could cut risk of death, study suggests. By Xantha Leatham For The Daily Mail 01:49, 12 Jan 2021 , updated 01:59, 12 Jan 2021

Association between patterns of alcohol consumption (beverage type, frequency and consumption with food) and risk of adverse health outcomes: a prospective cohort study. Bhautesh Dinesh Jani1* , Ross McQueenie1, Barbara I. Nicholl1, Ryan Field2, Peter Hanlon1, Katie I. Gallacher1, Frances S. Mair1 and Jim Lewsey2. Jani et al. BMC Medicine (2021) 19:8 https://doi.org/10.1186/s12916-020-01878-2

BBC. No alcohol safe to drink, global study confirms. By Laurel Ives. BBC Health. Published24 August 2018

Guardian. Study finds one small alcoholic drink a day raises risk of irregular heartbeat. Researchers examined heart health and drinking habits of 108,000 people aged 24 to 97 over 14 years
The report found people who consumed equivalent to a 330ml beer, a 120ml glass of wine, or 40mls of spirits were 16% more likely than teetotallers to develop atrial fibrillation.
Ian Sample Science editor
@iansample
Wed 13 Jan 2021 06.00 GMT

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.

Obesity kills but is losing weight in old age also risky ?

Losing weight is a New year resolution for many people. There is no doubt that having a normal weight is healthy overall.

But there is always some degree of uncertainty with any health advice and this BMJ paper certainly gives “food for thought”.

Before you read further , you have understand that there are varying degrees of being overweight. BMI ( Body mass index) is the scientific way of looking at body weight issues and it is calculated using height and weight.

Based on BMI, people are usually classified into three groups:

(a) underweight and normal weight (BMI<25)

b) overweight (BMI 25.0-29.9)

(c) obese (BMI ≥30.0)

There is no doubt that obesity is bad for health. The BMJ paper not supringly found obesity in adulthood increased the risk death.

But, intriguingly, just being overweight only without being obese does NOT seem to have MAJOR impact on risk of death in adults.

Paradoxically, the study found that “weight loss from middle to late adulthood was associated with increased risk of death”

It is large well designed study but nevertheless results of observational studies need to be interpreted with caution.

The message from this study is “do not gain excessive weight during early adulthood“. Losing the excessive weight later on might not undo the damage already done to the body.

References:

(1) Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study.

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5584 (Published 16 October 2019) Cite this as: BMJ 2019;367:l5584

(2) Free NHS calculator for BMI ( Body mass index calculation) and advice regarding Body mass index.

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.

Does smoking cause Body pain ?

Yes. Smoking can cause body pain and make you miserable.

Smoking is bad for various obvious reasons including the risk of developing of cancer. As smoking can make you miserable with pain, it’s time to make a new year resolution to stop smoking.

A large study done in UK shows that current and ex-smokers have a higher degree of bodily pain.

The study involved 223,537 people who were surveyed between 2009 and 2013 by the British Broadcasting Corporation (BBC) Lab UK Study.

As it is such a big study, the conclusions do need to be taken seriously.

Definitely another reason for quitting smoking this new year !

Reference:

Associations between smoking status and bodily pain in a cross-sectional survey of UK respondents. Addictive Behaviors 102:106229 · December 2019. DOI: 10.1016/j.addbeh.2019.106229

Smokers past and present ‘live in more pain’ – 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 views are not substitute for professional advice.

Can a Vegan diet help weight loss?

Yes, Vegan diet can help weight loss.

Lot of diets promoted by Magazines, Social Media Influencers and Celebrities do not have strong scientific evidence in favour of them.

A scientifically sound trial published by the medical journal JAMA ( Journal of American Medical Association) recently, found the Vegan Diet helped weight loss and promoted Good metabolism.

The trial involving 244 participants found that over 16 weeks, body weight decreased on average by 5.9 kg in those having a Vegan Diet. That’s very impressive!

References: Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial
Hana Kahleova et al. JAMA Netw Open. 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.

New oral medication approved for Prostate Cancer

Advanced Prostate cancer can be successfully controlled for many years by hormone therapy.

Until now, the hormone therapy, which is widely used widely used, involved either hormone injections or hormone implants.

The FDA in USA has recently approved a new novel oral medication for prostate cancer. It acts quickly and has been proven to be highly active. It is taken as a daily oral medication. It is reasonably well tolerated.

It is not known when the medication would be approved in UK and Europe.

References

(1) NEJM. Oral Relugolix for Androgen-Deprivation Therapy in Advanced Prostate Cancer

(2) FDA approval. FDA approves relugolix for advanced prostate cancer.

(3) Information about Relugolix. FDA: HIGHLIGHTS OF PRESCRIBING INFORMATION. and FULL PRESCRIBING INFORMATION.

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.

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 mandatory for everyone?

NO, it is not mandatory. The Government is NOT making it compulsory for everyone to have the vaccination. You have to give voluntary consent for Vaccination.

No one is being forced to have the COVID-19 vaccines.

In fact, there is a huge queue of people waiting to have the vaccine. The NHS capacity is limited at present and the NHS is trying the best to give vaccination to those people who are very keen to have it.

So, if you don’t want to have it, no one will force you to have it.

Once the waiting list for vaccination is cleared in early 2021, there might be some changes . If clinical trials show that vaccinated people do not carry virus and pass it to others, then the Government might change its guidelines.

For instance, health professionals working with sick and vulnerable people might be asked to have the vaccine so that they don’t pass the virus to vulnerable people under their care.

But it’s very unlikely vaccination would be made mandatory for General Public.

References

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

(2). Guidance. COVID-19 vaccination: guide for healthcare workers. Updated 15 December 2020

(3) Form. COVID-19 vaccination: consent form and letter for adults

(4). Coronavirus (COVID-19) vaccination consent forms.

(5). Guardian Newspaper. NHS doctors ‘scrabbling’ to get vaccine amid alarm at Covid variant. Many medics ‘frustrated’ about low priority given to frontline staff at high risk of infection. Denis Campbell Health policy editor
Sun 27 Dec 2020 20.46 GMT

(6). PHE. Guidance. Why you have to wait for your COVID-19 vaccine. Published 7 December 2020

(7). Guardian. Coronavirus. Spain will register people who refuse Covid vaccine, says health minister. Ashifa Kassam in Madrid. Tue 29 Dec 2020 14.33 GMT

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 the new variant of Coronavirus more dangerous?

Yes and No

The new mutant is more dangerous because it is more easily transmissible from person to person. The new variant is now spreading very rapidly in London and South East of England.

But, so far, the new variant has NOT been found to be more deadly than the original version. The new variant does NOT seem to have substantially increased the risk of hospitalisation and death anymore than the original version of coronavirus.

Emergence of this new mutant (called variant VUI-202012/01 fall) is a certainly a worrying development in this pandemic.

The mutations has made the new strain 70 per cent more transmissible but scientists do not expect these mutations to reduce the effectiveness of vaccines.

Tests are being carried out to confirm that the existing vaccines would still have a high degree of protective affect.

It is an evolving area and we have to hope that the new variant doesn’t make things worse than they are now !

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 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.

Should a patient avoid a surgeon on the surgeons’ birthday?

If you are going to have an emergency surgery, it may be worthwhile asking your surgeon whether it is their birthday on that day.

If you accept the findings of a recent study at face value, one should weigh up the pros and cons of seeking a different surgeon if one is available or request your surgeon to be extra careful.

An intriguing paper published in BMJ recently suggests so. The study looked at the outcome of Medicare patients who underwent emergency surgery in USA. It is a very large study in which 980876 procedures performed by 47489 surgeons were analyzed. Hence the study findings do need to be taken very seriously.

The study found that patients operated by surgeons on the surgeons’ birthday had a higher risk of death.

The study provocatively suggests, without any direct proof, that surgeons were possibly distracted on their birthdays and in their rush to go to their birthday celebration, they might have done “botched emergency surgeries” by not concentrating properly during surgery and by not providing good post-operative care.

The findings are entirely plausible from behavioural psychology point of view and the study authors seem to have done a thorough statistical analysis of various factors that could have spuriously affected the death rates.

Nevertheless, there remains a distinct possibility that the study findings are spurious. For instance, the scientific community is aware of the fact that if “any data is tortured enough”, the dataset will cough up spurious and unexpected results.

Apart from data dredging , one has to take findings from observational studies with a “pinch of salt”. That’s why we often see conflicting results about Nutrition published in Newspapers all the time.

Genuine Surgical errors can sometimes lead to death but much more commonly surgical errors can often lead to increase in rate of surgical complications. It is a bit of stretch for the study to suggest that surgeons all over the country are doing “ technically poor surgeries” everyday if that day happens to be their birthday and they are doing it in such a way to cause deaths without causing any surgical complications.

We don’t know whether the study inadvertently looked at male surgeons working on weekends at rural non-teaching hospitals as these factors could have a bearing on death rates.

Sad life events can adversely affect the work performance of any human being. But happy people are more productive at work. So the conclusion by the study that a happy event, such as a birthday, can adversely affect a surgeon’s performance deserves more scrutiny in a well designed study.

Read the full paper at BMJ website and share your views at the BMJ rapid response section.

References.(1). BMJ. Patient mortality after surgery on the surgeon’s birthday: observational study. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4381 (Published 10 December 2020)
Cite this as: BMJ 2020;371:m4381

(2) Conflicting healthy eating advice leaving public ‘clueless’, poll suggests. Rob Knight
Tuesday 16 July 2019 14:56

(3). Does Employee Happiness have an Impact on Productivity?. Saïd Business School WP 2019-13

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.

Can Pollution affect your heart?

Air pollution, particularly breathing toxic fumes whether it is from a cigarette or a diesel lorry is bad for the lungs.

Can pollution affect your heart as well ?

Yes, it can.

A large study involving more than 8 million people across 184 major cities in China studied the effect of pollution on heart diseases.

The study reports that “short term exposure to Pollutants in air is associated with increased risk of hospital admissions for major heart problems”.

May be everyone living or working close to major roads or high traffic areas should invest in a good mask !!!

Reference

Association between ambient fine particulate pollution and hospital admissions for cause specific cardiovascular disease: time series study in 184 major Chinese cities

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6572 (Published 30 December 2019)

Cite this as: BMJ 2019;367:l6572

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Is it worth stopping smoking after a diagnosis of lung cancer ?

Yes.

It is not too late to stop smoking even after a diagnosis of lung cancer.

A Study presented at the American Society of Clinical Oncology meeting earlier this year reports that ” No matter when smokers quit, their chance of survival increases following a lung cancer diagnosis”.

References

Quitting Smoking at Any Point, Even Close to a Lung Cancer Diagnosis, Improves Chances of Survival. Virtual scientific program of the 2020 American Society of Clinical Oncology (ASCO) Annual Meeting. 

https://www.asco.org/about-asco/press-center/news-releases/quitting-smoking-any-point-even-close-lung-cancer-diagnosis

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 red meat bad for heart?

Yes, red meat can increase the risk of developing heart disease.

A large study involving more than 43,000 men conducted at USA shows that “Red meat increased the risk of developing heart disease “.

In contrast , plant proteins such as nuts and lentils reduced the risk of developing heart disease.

References: Red meat intake and risk of coronary heart disease among US men: prospective cohort study.
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4141 (Published 02 December 2020)
Cite this as: BMJ 2020;371:m4141

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.

Cancer treatment delays during the pandemic

The Staff at National Health Service in UK are doing an admirable job during the pandemic. In the particular, the frontline staff (“patient-facing”) are showing great courage in face of great difficulties and are primarily driven by altruism.

But the pressures of pandemic means many routine scans and hospital clinic appointments have been cancelled particularly during the first wave. There is a great worry about delayed diagnosis of cancer and delayed treatment of cancer.

A paper in BMJ reports that cancer patients survival can be significantly compromised.

But, as with everything else in life, things are not always what they look like at first impression. Even things that are logical and common sense at first glance do not turn out to be simple and clear.

Firstly, delays and cancellations of scans paradoxically could have psychologically benefited some cancer patients . This might seem counterintuitive or even an outrageous statement.

But there are some cancers which are being over diagnosed. A Cancer diagnosis does not always mean a death sentence. Some cancers do not cause problems for a long time or never in the life time of a person. These cancers do not need to be diagnosed promptly. Not being diagnosed with these cancers prevents the psychological burden of a cancer diagnosis. This “over diagnosis” would be expectedly less during pandemic.

Secondly, treatment delays could be caused by a cancer that is advanced and the need for time consuming additional investigations and procedures. Sometimes delays are caused by patients needing to see many medical specialists for the treatment. So it’s the aggressive cancer and the complex patient care that would cause the delay and is responsible for poor outcome rather than the delay by itself.

Read the BMJ article and make your views known.

Mortality due to cancer treatment delay: systematic review and meta-analysis
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4087 (Published 04 November 2020)
Cite this as: BMJ 2020;371:m4087

Overdiagnosis in Cancer
H. Gilbert Welch, William C. Black
JNCI: Journal of the National Cancer Institute, Volume 102, Issue 9, 5 May 2010, Pages 605–613, https://doi.org/10.1093/jnci/djq099

Disparities in head and neck cancer: assessing delay in treatment initiation
Urjeet A Patel et al. Laryngoscope. 2012 Aug.

Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, Kalady MF, et al. (2019) . Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS ONE 14(4): e0215108. doi:10.1371/journal.pone.0215108

Has politics corrupted science during the COVID-19 pandemic?

The Coronavirus pandemic has brought out the best in many people. Acts of selflessness became the norm rather than an exception. Altruistic acts abound at all levels of Society.

Overall, Society has made and is still making sacrifices for the benefit of the Vulnerable.

Appearances do matter during an pandemic. Leaders and People in Power are obliged to show that things are under control (or atleast give the impression that things are under control ) so as to prevent mass panic.

But politics seems to have gone beyond that and seems to have corrupted the science.

BMJ has courageously published a strongly worded editorial.

Read it and make your views known through the rapid response section of the Journal.

Covid-19: politicisation, “corruption,” and suppression of science.
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4425 (Published 13 November 2020)
Cite this as: BMJ 2020;371:m4425

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.

Can Folic acid and Vitamin B12 Harm you ?

Yes , supplements can harm your health.

A study from Norway found that the combination can be harmful in certain people.

They report that “Treatment with folic acid plus vitamin B(12) was associated with increased cancer outcomes and deaths in patients with ischemic heart disease in Norway,”.

So avoid Vitamin supplementation if you have a well balanced healthy diet and no deficiency..

Reference

1. Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12. Marta Ebbing et al. JAMA. 2009.

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 publication 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.

Scientific evidence for a healthy diet and prevention of diabetes

Simple things in life can be the most difficult; For instance, Regular Exercise and a balanced Diet for a healthy life.

What constitutes a healthy diet is common knowledge. For example eating Whole grains, Fresh Fruit and Vegetables )

But what is accepted as common knowledge is not always backed up by robust scientific evidence .

So it is good to see two scientific papers in a recent issue of British Medical Journal with one paper exploring the role of fruit and vegetable consumption on type 2 diabetes and another paper exploring the role of whole grain foods on risk of type 2 diabetes.

1. One study found that Vitamin C and carotenoids have a protective effect against diabetes ( eg diet rich in citrus fruits, tomatoes , root vegetables such as carrots )

A word of caution to those rushing to buy vitamin supplements from the authors : “fruit and vegetable intake, rather than vitamin supplements, is potentially beneficial for the prevention of type 2 diabetes”.

2. Another study found that “whole grain foods, including whole grain breakfast cereal, oatmeal, dark bread, brown rice, added bran, and wheat germ, significantly reduced the risk of developing diabetes.

References

1. Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries.

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2194 (Published 08 July 2020)

2. Intake of whole grain foods and risk of type 2 diabetes: results from three prospective cohort studies .

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2206 (Published 08 July 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 publication 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.

Is high intensity exercise good for older people ?

Time is precious even for retired older people. People struggle to do longer duration of exercise every week.

Hence high intensity exercise – intense but short duration exercise- has become the favourite for busy individuals . ( See Mayo clinic Website and NHS website for Information about Exercise Intensity)

A Norwegian group compared high intensity exercise with medium intensity exercise in 1567 participants. The study involved a older population with an average age of 72.8 years.

People who did high intensity seem to have a trend towards longer life expectancy in the study.

Although study results are not definitive for all types of exercise, it’s terms of starting to do regular exercise , it’s never too late to start exercising !

References:

(1). Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3485 (Published 07 October 2020)
Cite this as: BMJ 2020;371:m3485.

(2). BMJ blogs. It’s never too late for older adults to start exercising. October 7, 2020

(3). Physical activity trajectories and mortality: population based cohort study. BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2323 (Published 26 June 2019)

(4) Mayo Clinic: Exercise intensity: How to measure it.

(5). NHS website: Physical activity guidelines for older adults.

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 outbreak ‘Hands. 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.

Does intensive follow benefit Bowel cancer patients?

Photo by rawpixel.com on Pexels.com

The old adage “prevention is better than cure” is mostly true with regards to cancer if you can do it.

If you can’t prevent it , at least catch it early, has been the prime motive behind screening tests for breast, cervical, bowel, lung and prostate cancers. (“early is better”). Cancers that are detected at an early stage can offer a better chance of curative treatment.

So one might logically expect that intensive monitoring and early diagnosis of a cancer relapse or a secondary cancer after initial treatment can be immensely helpful.

But the evidence for intensive hospital follow-up visits and investigations is weak for most cancers except for some cancers such as Testicular Cancers which are highly curable.

Intensive monitoring after bowel cancer treatment can detect treatable cancers. To confirm the benefit of early detection of relapse by intensive monitoring , a trial was conducted comparing intensive follow up versus routine follow up ( in France and Belgium).

Data presented at ESMO ( European Society of Medical Oncology) shows that the intensive follow with scans can detect cancer recurrences which can be treated by further surgery. But unfortunately the intensive follow up did NOT lead to longer life expectancy.

The results might be counterintuitive but after an average follow up more than six years, this trial demonstrates that intensive follow is NOT always best. Scans might be done for psychological reassurance but they could end up causing significant anxiety.

When there are resource constraints (e.g low economic countries) , one has to be careful about frequents routine scans for those without symptoms.

During COVID-19, even in rich countries such as UK where there might be huge waiting lists, one has to consider prioritising scans for those who need most.

References

1. ESMO Daily reporter: INTENSIVE FOLLOW-UP INCREASES FREQUENCY OF CURATIVE INTENT SECONDARY SURGERY IN COLORECTAL CANCER.

2. DRE is useless for follow up of prostate cancer patients. https://www.bmj.com/rapid-response/2011/11/03/dre-useless-follow-prostate-cancer-patients

3. Cancer patients follow up and a new role for GPs. https://www.bmj.com/rapid-response/2011/11/03/cancer-patients-follow-and-new-role-gps

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 should a doctor treat when evidence is uncertain?

Medicine is not always straight forward.

Photo by rawpixel.com on Pexels.com

Treatment of patients is often guided by evidence. Lot of medical treatments are logical and evidence for effectiveness is straightforward .

But sometimes evidence is patchy and uncertain. Sometimes doctors rely on experience and intuition.

From an ethical point, it might be helpful for doctors to think what would they do when they or their family are in the situation of their patient. Putting oneself in the shoes of the patient can sometimes help to deal with ethical dilemmas.

But some argue that doctors putting themselves in the shoes of patients is not ideal as emotions can cloud judgement.

What do you think?

Please read the BMJ article and my response.

“On emotions and clinical judgment” has now been published online by BMJ.
Access the article at: http://bmj.com/cgi/content/full/bmj.m3723
Toll-free link:
http://bmj.com/cgi/content/full/bmj.m3723?ijkey=kWmoDxrWgKLTjgp&keytype=ref

Morgan M. Matt Morgan: Standing in the shoes of a relative may complicate decision making. BMJ2020;370:m3344.doi:10.1136/bmj.m3344 pmid:32873585FREE Full TextGoogle Scholar

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.

Once a week chemotherapy is not superior to Chemotherapy given once every 3-weeks

Advanced ovarian cancer is treated by chemotherapy. A pre ious study of Japanese ovarian cancer patients RT showed significantly increased survival in those treated with dose-dense weekly paclitaxel compared to the standard three-weekly schedule.

Data from an international trial called ICON8 was presented at the ESMO Virtual Congress 2020, this week.

The final analysis of ICON8 “provides conclusive evidence that although weekly dose-dense chemotherapy can be successfully administered as first-line treatment for ovarian cancer, it has no survival advantage over the standard chemotherapy given once every 3 weeks.

ICON8: Overall survival results in a GCIG phase III randomised controlled trial of weekly dose-dense chemotherapy in first line epithelial ovarian, fallopian tube or primary peritoneal carcinoma treatment. Citation. Annals of Oncology (2020) 31 (suppl_4): S551-S589. 10.1016/annonc/annonc276

ESMO Daily Reporter: OVARIAN CANCER: FIRST-LINE DOSE-DENSE CHEMOTHERAPY IS NOT SUPERIOR TO STANDARD 3-WEEKLY CHEMOTHERAPY.

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.

Olaparib, as a 3rd line treatment, improves survival of a subset of prostate cancer patients with certain genetic changes .

Some prostate cancers are inherited. Some of these cancers have changes in a gene called BRCA.

Some prostate cancers which are not inherited can sometimes have these BRCA changes as well.

Data presented at ESMO ( European Society of Medical Oncology) shows that the prostate cancers with BRCA gene changes derive the most benefit from Olaparib. When administered as a third line treatment ( after failure hormone injection, novel hormonal tablets and chemotherapy) , Olaparib makes these patients live longer.

ESMO Daily Reporter. PROFOUND: OVERALL SURVIVAL DATA WITH OLAPARIB HERALD PRACTICE-CHANGING TREATMENT OF METASTATIC PROSTATE 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.

Immunotherapy not highly effective in Ovarian cancers

Immunotherapy has made a significant difference to the lives of many cancer patients with Skin, Kidney, Bladder and Lung cancers.

But in ovarian cancer patients, the results of trials have been disappointing .

Data presented at ESMO ( European Society of Medical Oncology) shows that the Immunotherapy agents Pembrolizumab and Nivolumab do not make significant difference over and above chemotherapy.

A caveat though, patients who responded to Nivolumab has longer duration of response and Nivolumab was well tolerated. So this indicates a subset of patients may benefit from chemotherapy.

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.

A highly effective treatment for secondary brain cancer in some Lung cancer patients

Brain secondaries from many primary cancer is always difficult to treat.

Particularly brain secondaries from Lung cancer patients can be quite difficult to treat.

Whole Brain Radiotherpy was widely used in past to treat brain secondaries in Lung cancer patients until 2016.

In 2016, QUARTZ study reported that Radiotherapy provided“ little additional clinically significant benefit for this patient group”.

So very few treatment options existed for this group of patients.

So it’s reassuring to see that a new drug was found to be highly active in lung cancer patients with brain secondaries.

Data presented at ESMO ( European Society of Medical Oncology) shows that the Lorlatinib showed a staggering 82% response rate in a small sub-group of patients.

References 1. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30825-X/fulltext

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.

A novel drug Osimertinib reduces risk of Brain cancer secondaries in lung cancer patients

Traditional intravenous Chemotherapy agents are often thought NOT to be highly effective in treating and preventing brain secondaries. This is because of the penal blood brain barrier.

Data presented at ESMO ( European Society of Medical Oncology) presidential symposium shows that the Osimertinib is highly active and significantly reduces risk of brain secondaries.

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.

New treatment combination for advanced Kidney cancers

The treatment of kidney cancer has dramatically changed in the last decade. More treatments are in pipeline and there was more exciting news this week.

Upfront immunotherapy in combination with other agents is very promising in 1st line treatment of advanced kidney cancers.

Data presented at ESMO ( European Society of Medical Oncology) shows that the combination of Nivolumab and Cabozantinib is better than Sunitinib alone.

“Nivolumab and Cabozantinib” combo joins the other combos “Nivolumab and Ipililumab” and “Pembrolizumab and Axitinib “ as 1st line options

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.