Tag: Vaccines

Another drug to fight severe COVID

More good news !

The new drug for COVID is called baricitinib.

The drug Baricitinib is not a brand new drug. It is normally used to treat a type of joint problem called rheumatoid arthritis. Now, this drug has been found to be very beneficial in patients suffering from severe COVID.

The drug was evaluated as part of the renowned RECOVERY trial.

RECOVERY ( Randomised Evaluation of Covid-19 Therapy) trial is led by investigators in U.K.

The trial found that Baricitinib reduces the risk of death by around one fifth in patients with severe covid-19.

On the other hand, Some bad news about a drug who was thought to be promising before. Questions have been raised about the actual benefit , if any, from a previously approved drug called Molnupiravir.

Overall, at present, we have lot more drugs to tackle COVID in addition to the Vaccines.

References

BMJ. Covid-19: Anti-inflammatory treatment baricitinib reduces deaths in patients admitted to hospital, finds trial
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o573 (Published 03 March 2022)
Cite this as: BMJ 2022;376:o573

BBC news. Another life-saving Covid drug identified
By Michelle Roberts
Digital health editor

Guardian. Arthritis drug could help save Covid patients – study
Rheumatoid arthritis drug baricitinib can reduce risk of death from severe Covid by about a fifth
Nicola Davis Science correspondent
@NicolaKSDavis
Thu 3 Mar 2022 18.07 GMT

Daily Mail. Arthritis drug cuts risk of severely-ill Covid patients dying by up to a fifth, major trial reveals. By Luke Andrews Health Reporter For Mailonline
15:00, 03 Mar 2022 , updated 16:42, 03 Mar 2022

BMJ. Molnupiravir’s authorisation was premature
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o443 (Published 03 March 2022)
Cite this as: BMJ 2022;376:o443

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Why did so many vaccinated people catch the omicron variant recently ?

Many people report that they have seen many of their friends and family and work colleagues have caught the COVID virus during the recent wave.

Why did so many vaccinated people catch the infection?

It’s because of two reasons. (1) the vaccines are not 100% effective and (2) there is substantial reduction in vaccines effectiveness over time.

A large U.K. study looked at vaccine effectiveness against symptomatic disease caused by the omicron and delta variants in England.

Frighteningly, No effect against the omicron variant was noted from 20 weeks after two Astra Zeneca vaccine doses, and the effectiveness of two Pfizer vaccine was only marginally better with 8.8% protection at 25 or more weeks after two Vaccine doses.

Vaccine effectiveness improved to about 65% protection at 2 to 4 weeks after a third Pfizer booster but this was not long lasting and the effectiveness decreased to about before decreasing to 44% at 10 or more weeks after Vaccination.

In summary, Vaccination with two doses of AstraZeneca or Pfizer vaccine provided limited protection against symptomatic disease caused by the omicron variant.

A third booster with Pfizer or Moderna vaccine substantially increased the protection, but even that protection gradually decreased over time.

This study, published in the Prestigious NEJM journal, was Funded by the U.K. Health Security Agency and hence highly reliable.

One has to hope that any new variants do not bypass the vaccine protection and cause much more severe disease than omicron!

References

Daily Mail. US Omicron surge is close to reaching its peak with infections ‘coming down as fast as they went up as variant runs out of people to infect’: Deaths remain low, rising just 10% in two weeks as daily cases rise 184%. By Mansur Shaheen U.S. Deputy Health Editor For Dailymail.Com
14:53, 12 Jan 2022 , updated 22:18, 12 Jan 2022

NEJM. Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant.

Nature magazine. Iketani, S., Liu, L., Guo, Y. et al. Antibody evasion properties of SARS-CoV-2 Omicron sublineages. Nature (2022). https://doi.org/10.1038/s41586-022-04594-4 ( substantial loss in neutralizing activity against omicron variant)

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, partic

Are COVID vaccines less effective in people with low-immunity?

Yes, the COVID vaccines struggle to boost the immunity against COVID in people who have a defective or suppressed immune system.

A recent study published in BMJ looked at all relevant publications and confirms this. Cancer patients and patients who have received organ transplants are at risk of inadequate protection from the vaccines.

It is important that people who have low immunity get boosters as recommended by the guidelines ( third or fourth dose).

References

BMJ. Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-068632 (Published 02 March 2022)
Cite this as: BMJ 2022;376:e068632

U.K. govt. COVID-19 vaccination: a guide to booster vaccination for individuals aged 18 years and over and those aged 16 years and over who are at risk. Updated 2 February 2022.

NHS. Coronavirus (COVID-19) vaccine for people with a severely weakened immune system. Page last reviewed: 24 February 2022

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

How quickly do COVID vaccines lose their effectiveness?

The rapid development and deployment of COVID vaccines has played a critical role in bringing the Pandemic under control (at least in early 2022).

But there is a disappointing factor with the current vaccines. The disappointing factor is NOT the side effects !

The disappointing factor is the loss of efficacy (protection) within a matter of months, particularly against new variants.

How quickly do the vaccines lose their effectiveness?

An Italian study published in BMJ provides some insight.

In this study involving more than 33 million people, the long term protection of Pfizer-BioNTech and Moderna vaccines was assessed.

Vaccine effectiveness against any SARS-CoV-2 infection significantly decreased from 82% to 33% at about 7 months after the second dose.

Vaccine effectiveness against severe covid-19 (admission to hospital or death) was much better though. The effectiveness decreased but to a much lesser extent, from 96% to 80%.

This Italian study confirms that a booster dose of vaccine six months after the primary vaccination cycle is the best way forward.

Reference: Effectiveness of mRNA vaccines and waning of protection against SARS-CoV-2 infection and severe covid-19 during predominant circulation of the delta variant in Italy: retrospective cohort study
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-069052 (Published 10 February 2022)
Cite this as: BMJ 2022;376:e069052

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light

Why is the COVID booster needed ?

Two reasons

One, immunity levels decrease after about six months . The extra shot boosts the immune system.

Two, the end of pandemic once again is pushed away as a new omicron variant has now come on the scene

References

Will Britain need a £1billion Covid booster vaccine roll-out for EVERYONE every winter? Two doses of Pfizer’s vaccine wane after six months no matter what age you are, major Israeli study finds. By Joe Davies For Mailonline
13:32, 17 Nov 2021 , updated 15:55, 17 Nov 2021.

Daily UK Covid cases breach 50,000 for first time in a month after rising 13% in a week and deaths creep up 2% to 160 but hospital admissions fall for 10th day in a row. By Luke Andrews Health Reporter and Rory Tingle, Home Affairs Correspondent For Mailonline
16:37, 26 Nov 2021 , updated 18:39, 26 Nov 2021

Boris ‘plans travel bans on MORE countries over Christmas’ amid fears of new Covid super-variant Omicron as health chiefs call for calm and say there is ‘no plausible scenario’ strain will take UK back to ‘square one’. By Shaun Wooller and Eleanor Hayward and Claire Ellicot For The Daily Mail and Tom Pyman For Mailonline
22:00, 26 Nov 2021 , updated 01:58, 27 Nov 2021

BBC Covid: Face masks re-introduced as UK Omicron cases found

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light

A new COVID variant !

A new variant of Coronavirus has emerged in Africa and it is causing significant concern.

The variant seems to have “changed its coat”. The scientists worry that these changes ( mutations) can make it more transmissible and potentially evade vaccines.

U.K government has put six African countries on the Red List. All flights from South Africa, Namibia, Zimbabwe, Botswana, Lesotho and Eswatini are being suspended now.

References

BBC news. Covid: New heavily mutated variant B.1.1.529 in South Africa raises concern. James Gallagher
Health and science correspondent.

BBC News. Covid: Africa travel restrictions over variant fear.

Guardian. South Africa to be put on England’s travel red list over new Covid variant.
Hannah Devlin, Ian Sample and Jessica Elgot
Thu 25 Nov 2021 21.22 GMT

Daily Mail. Scientists sound alarm over new ‘worst-ever’ super-mutant Covid variant that will make vaccines at least 40 per cent less effective as flights are BANNED from South Africa and five other African countries. By Tom Pyman and Connor Boyd Deputy Health Editor For Mail online
20:32, 25 Nov 2021 , updated 22:07, 25 Nov 2

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

Two new anti-viral drugs for COVID

Two new viral drugs promise to reduce the health burden from COVID.

So far, Covid vaccines have played a pivotal role in reducing Cases, Hospitalisations and Deaths from Covid.

Two new drugs, one from Pfizer and another from Merck promise to provide a new way to fight the virus in vulnerable people.

The oral pills from Pfizer is called Paxlovid. Paxlovid is a combination of two drugs. One drug is a new antiviral drug developed by Pfizer and is called PF-07321332. Another drug is called ritonavir, and ritonavir is already being used to treat HIV/Aids.

The Merck drug is known by the brand name Lagevrio [chemical name is molnupiravir]. This drug is approved by U.K. regulators and is ready to be used in the NHS. The Pfizer drug is yet to be evaluated by authorities for approval.

References

Lagevrio 200 mg hard capsules. eMC SPC

Ritonavir Mylan 100 mg film coated tablets. eMC SPC

Wiki. Paxlovid.

Guardian. Pfizer Covid pill ‘can cut hospitalisations and deaths by nearly 90%’
Experimental antiviral pill taken at home is highly effective at preventing deaths, trial suggests
Ian Sample Science editor
@iansample
Fri 5 Nov 2021 14.10 GMT

Guardian. UK first to approve oral antiviral molnupiravir to treat Covid
Pill can be taken twice daily at home and priority will be given to elderly patients and those with health vulnerabilities
Ian Sample Science editor
@iansample
Thu 4 Nov 2021 12.38 GMT

Daily Mail. Daily Covid cases fall again… by a FIFTH: Infections drop 22% in a week to 34,029 while deaths and admissions creep up just 3% – as ONS finds third wave has ‘likely peaked’ and EU’s crisis starts to overtake UK. By Connor Boyd Deputy Health Editor For Mailonline
16:45, 05 Nov 2021 , updated 23:06, 05 Nov 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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Is it safe to combine Flu Vaccines and COVID vaccines?

Yes, according to a recent U.K. study which assessed the combination of Flu vaccines and COVID vaccines.

The well designed study found the combination to be safe. The study also found “the side effects of giving both vaccines together were generally well tolerated and acceptable”

There is a worry that Flu might cause severe problems this year compared to last year.

Everyone’s attention has been focused on COVID booster and many old people have not been thinking much about their yearly Flu shots.

It is important that elderly have the flu shots this year.

It is important to note that it is not unusual to combine vaccines. Lot of childhood vaccines are combined safely for many decades.

References

Guardian. Flu and Covid jabs safe to be given at same time, study finds

Safe for people to get flu and Covid jabs at same time, says study
Clinical trial finds reported side effects mainly mild to moderate.
ByNina Massey, PANick WoodMax Channon
00:15, 1 OCT 2021

ComFluCOV vaccine study

Study Summary slides

The Safety and Immunogenicity of Concomitant Administration of COVID-19 Vaccines (ChAdOx1 or BNT162b2) with Seasonal Influenza Vaccines in Adults: A Phase IV, Multicentre Randomised Controlled Trial with Blinding (ComFluCOV)

CDC. Combination Vaccines. Fewer shots, but same protection

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

New Pill for COVID

A new antiviral pill for COVID is very promising. It may be used widely to control the infection in people suffering from early stages of illness.

But the pill does NOT seem to work very well in people with severe illness.

It is important to note that “Prevention is better than cure”. That’s why using COVID vaccines to prevent the disease in first place is a better option.

COVID Vaccines will continue to play the lead role in controlling the COVID pandemic.

The antiviral pill by the made by the company Merck is likely to become the first approved oral medication effective against coronavirus. But other companies, including Pfizer, are also developing new oral antiviral medications.

Dexamethasone and other steroid pills, which can help COVID illness, do NOT have direct antiviral activity.

Overall, this antiviral pill is another promising step towards complete normality.

References

BBC Covid antiviral pill can halve risk of hospitalisation
By Jim Reed
Health reporter

Guardian. Covid antiviral pill halves hospitalisations and deaths.
Merck’s antiviral drug, molnupiravir.
Hannah Devlin Science correspondent
Fri 1 Oct 2021 15.56 BST

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

To Boost or not to boost ?

U.K. has started offering booster vaccines.

People aged 50 years and over, health and social care workers and younger people at risk are being offered a booster dose of coronavirus (COVID-19) vaccine.

Firstly, it has to be pointed out that it is not uncommon to offer booster vaccines with various other viral illnesses.

Secondly, the Data from Israel does support a role for COVID booster vaccines.

On the other hand, some people feel the case for booster is overstated.

The decision by U.K. Govt seems to be a reasonable and pragmatic one considering that the rate of new COVID infections is still high.

References

Guardian Opinion
The message from Israel is clear: Covid booster shots should be standard
David O’Connor
Mon 27 Sep 2021 11.47 BST

NEJM. Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel
Yinon M. Bar-On, M.Sc., Yair Goldberg, Ph.D., Micha Mandel, Ph.D., Omri Bodenheimer, M.Sc., et al.
September 15, 2021
DOI: 10.1056/NEJMoa2114255

U.K. Govt Guidance
COVID-19 vaccination: a guide to booster vaccination
Published 16 September 2021

BMJ. Editorials
Covid-19 vaccination: evidence of waning immunity is overstated
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2320 (Published 23 September 2021)
Cite this as: BMJ 2021;374:n2320

Daily Mail. UK’s daily Covid cases rise 5% in a week to 37,960 as hospital admissions and deaths continue to fall – amid fears FOURTH wave may have already began with cases starting to spill over from children to their parents. By Emily Craig Health Reporter For Mailonline and Luke Andrews Health Reporter For Mailonline
12:35, 27 Sep 2021 , updated 16:44, 27 Sep 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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Risks and benefits of COVID vaccines in 12 to 15 year olds

Previously, the UK vaccine expert committee (JCVI) decided that would NOT advice COVID vaccines to healthy 12 to 15-year-olds because the “direct individual benefit” to their health was only marginal.

But the Chief Medical officers have decided the other way now. The UK Government is now offering 12-15 year olds COVID vaccination and believes that this is the way out of the pandemic.

This is a very finely balanced decision. Decision seem to have been made on “public health grounds” rather than “individual” benefit.

In England, children aged 12 to 15 will be offered one dose of the Pfizer and BioNTech vaccine ( one dose instead of the usual two doses so as to minimise risks).

Lot of Vaccines offered for many other childhood illnesses have much greater benefit than COVID vaccines.

A nice article in Guardian by a Paediatrician discusses the benefits and risks of COVID vaccines in the 12 to 15 year olds. Boys seem to be more at risk of Heart side effects compared to Girls.

It would be difficult decision for lot of parents with healthy children.

References

Guardian. As a paediatrician, I believe it’s right to vaccinate young people aged 12 to 15
Russell Viner
There are no simple solutions to Covid, but children themselves will, on balance, benefit from being vaccinated. Russell Viner is a paediatrician and professor at the UCL Great Ormond Street Institute of Child Health
Tue 14 Sep 2021 14.31 BST

BMJ. Covid-19: Vaccinating children will help end pandemic, says minister
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2254 (Published 14 September 2021)
Cite this as: BMJ 2021;374:n2254

Daily Mail. It makes you think…’ Holly Willoughby finds herself conflicted about son Harry, 12, getting the COVID-19 vaccine as she’s caught between debating doctors on This Morning. By Andrew Bullock For Mailonline
13:19, 14 Sep 2021 , updated 14:28, 14 Sep 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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

COVID vaccination of 12-15 year olds: benefits vs risks

Should young teenagers have the COVID vaccine?

At present, this is a difficult question to give a straightforward answer.

For most of “middle to old age” people, the benefits of COVID vaccines are far greater than potential side effects from vaccines.

On the other hand, in case of 12-15 year olds, the benefits are marginally better than risks and individual circumstances need to be taken into account.

UK’s vaccine advisory body is called JCVI. ( Joint Committee on Vaccination and Immunisation ).

JCVI on Friday declined to recommend universal vaccination of all 12-15 year olds. This is because the chances of children becoming seriously ill from COVID-19 is very small. This needs to be balanced against a tiny risk of myocarditis, or inflammation of the heart in young people due to the vaccines. It is a matter of weighing up disease versus vaccine.

But, this does not mean COVID vaccines are not being given to 12-15 year olds.

USA, France, Italy, Israel and Ireland are offering vaccines to this group.

In U.K., vulnerable children with heart and lung problems, blood disorders, diabetes and various other diseases are eligible for the COVID vaccine. Children living with extremely vulnerable adults are also eligible.

Parents with healthy 12-15 year olds have a difficult choice to make in the coming weeks.

References

BMJ news. Covid-19: JCVI opts not to recommend universal vaccination of 12-15 year olds
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2180 (Published 03 September 2021)
Cite this as: BMJ 2021;374:n2180

BBC news. Covid: What do parents think about vaccinating children?
By Jennifer Meierhans & Kris Bramwell
BBC News

BBC news. Scientists not backing Covid jabs for 12 to 15-year-olds
By Philippa Roxby and Nick Triggle
BBC News

BBC news. Why vaccinating all teens is a difficult decision
By Philippa Roxby
Health reporter

Gov.U.K. Guidance
Coronavirus (COVID-19): antibody testing
Updated 22 August 2021

NHS. Antibody testing to check if you’ve had coronavirus (COVID-19)

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Is Moderna COVID vaccine better than Pfizer Vaccine?

Are all COVID Vaccines equally effective ?

Probably not.

But until recently there has been hardly any direct clinical studies comparing different vaccines.

A recent study conducted in Belgium compared the Moderna and Pfizer COVID vaccines.

The study looked at antibody responses following vaccination in Health care workers. Antibody levels were measured prior to vaccination as well as 6 to 10 weeks after the second dose.

Higher antibody levels were observed in people vaccinated with Moderna vaccine compared with those vaccinated with Pfizer vaccine.

Future research is needed to see how these differences affect the general population.

Both Moderna and Pfizer vaccines are based on same technology (mRNA based vaccines).

If significant differences exist between between vaccines of same technology, then it is likely that differences would exist between vaccines of different technology (eg Pfizer vs Astra Zeneca).

The public health authorities would need to decide whether booster vaccinations should be done with a different vaccine.

References

Bloomberg. Moderna Creates Twice as Many Antibodies as Pfizer, Study Shows
By Jason Gale
31 August 2021, 03:54 BST

JAMA Research Letter
August 30, 2021
Comparison of SARS-CoV-2 Antibody Response Following Vaccination With BNT162b2 and mRNA-1273
Deborah Steensels, PharmD, PhD1; Noella Pierlet, MSc1; Joris Penders, MD, PhD1; et al . JAMA. Published online August 30, 2021. doi:10.1001/jama.2021.15125

(mRNA-1273 is Moderna Vaccine and BNT162b2 is Pfizer vaccine).

Daily Mail. ALL over-50s will get Covid booster shots by autumn: People who got AstraZeneca ‘are set to be offered a Pfizer jab’ in new vaccine drive because it is more effective against Indian variant. By Katie Feehan For Mailonline and Glen Owen for The Mail on Sunday
10:12, 01 Aug 2021 , updated 18:02, 01 Aug 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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Are booster vaccines the way out of this pandemic?

Vaccination promised a straightforward way out of the pandemic. Protection from TWO doses of vaccine initially promised to end the pandemic.

Israel led the way in mass vaccination. Infection rates plummeted and life seemed to be returning to normal.

But infection rates then started rising in Israel and Israel was forced to use booster vaccines for high risk population.

It is now hoped that the THIRD booster vaccines would provide a way of keeping COVID infections at a manageable level.

Only time will tell whether this strategy would be successful!

References

BBC Covid: What Israel tells us about the way out of the pandemic
By Rachel Schraer
Health reporter

Sky News. COVID-19: Scientists say vaccines could control pandemic … After two doses of Pfizer, there was a 70% reduction in all cases and a 90% drop in symptomatic cases, new data shows. Friday 23 April 2021 09:08, UK

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Are teachers at higher risk of catching COVID ?

No.

Generally, Children are known to spread viral infections easily among themselves due to close contact in confined environments.

Most children in schools are not vaccinated against COVID.

Opening of schools in Scotland has recently increased COVID infections.

So there is an understandable worry that teachers may get more COVID infections.

A recent study published in BMJ is reassuring.

Compared to other adults, teachers were NOT found to be at increased risk of severe COVID or at increased risk of hospital admission with COVID-19

References

BMJ Research.
Risk of hospital admission with covid-19 among teachers compared with healthcare workers and other adults of working age in Scotland, March 2020 to July 2021: population based case-control study
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2060 (Published 02 September 2021)
Cite this as: BMJ 2021;374:n2060

BBC News. Covid in Scotland: Return of schools ‘fuelling’ record case numbers

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

COVID-19: Disease versus Vaccine

Two contrasting news about COVID vaccine and disease recently.

First, a New Zealand woman dies after COVID vaccine. Death was attributed to heart inflammation caused by the vaccine.

Second, a 40 year vaccine-sceptic dies of COVID disease and sadly, leaves behind a pregnant wife.

How to interpret this information?

Remember everyday life is full of risks. Almost nothing is risk free. People balance risks and benefits everyday for most things in life. The same approach should be used for COVID vaccines.

It is understandable that some people are worried about side effects of vaccines. These concerns are REAL There is still lot unknown about long term efficacy and side effects of COVID vaccines.

If you are worried about vaccines and yet to have the vaccine, do note that the available evidence indicates that it is in your interests to have the vaccine.

If you are a vaccine sceptic, do NOT believe everything that is said on social media. Sometimes people put wrong information on social media. Sometimes people post information that is out of context.

What to do?

Ignore information that is not directly relevant to COVID vaccines.

Do NOT mix politics with Vaccines.

Beware that social media can make you paranoid about COVID vaccines.

Read official information. Available scientific evidence now indicates that the benefits of COVID-19 vaccine far outweighs the risks for vast majority of adults.

In particular, if you are above 50 years, do consider having the vaccine as a matter of urgency without further delay.

This is because in England, the Schools and Universities are going to open this month. Data from Scotland shows that COVID cases will spike after schools and Universities open.

Be selfish and do what is right for you and your family. Do not worry about “loss of face” on social media because you have changed your mind about vaccines.

Live to post another day !

Stay safe and be careful even after vaccination. No vaccine give you 100% protection.

References

BBC News. New Zealand woman dies after receiving Pfizer vaccine.

BBC News. Staffordshire Covid sceptic Marcus Birks dies in hospital.

Daily Mail. BBC presenter Lisa Shaw, 44, died due to incredibly rare blood clot complications caused by AstraZeneca covid vaccine three weeks after she had first jab, coroner rules. By Katie Weston and Joe Davies For Mailonline.
11:29, 26 Aug 2021 , updated 13:46, 26 Aug 2021

Daily Mail. Hillsong member, 34, who tweeted ‘got 99 problems but a vax ain’t one’ dies after month-long battle with COVID-19 and final ‘pray for me’ message. By Emily Crane For Dailymail.com
14:17, 23 Jul 2021 , updated 18:41, 23 Jul 2021

Daily Record. Mum-of-three dies after suffering rare reaction to AstraZeneca vaccine
The 47-year-old developed blood clots on her brain – causing a catastrophic stroke – and her fiance Mark Tomlin has now spoken of the devastating impact her death has had on him and five-year-old son Orson.
By Dan Martin Kaitlin Easton
17:46, 27 JUN 2021

MHRA. COVID-19 vaccines: updates for August 2021.

GOV. UK Coronavirus: how to stay safe and help prevent the spread . Last updated
27 August 2021

CDC. Vaccines for COVID-19.

BBC News. Covid in Scotland: Return of schools ‘fuelling’ record case numbers

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Can Vaccinated people spread the disease to others if they get a COVID infection?

Yes.

Normally Vaccines that are highly effective (for various other diseases) prevent most vaccinated people from getting the infection completely.

But that does not seem to be the case with COVID vaccines.

The COVID vaccines are highly successful in preventing severe COVID, hospitalisations and deaths. But they seem to be a bit less effective in preventing people from catching mild COVID infections.

So if a vaccinated person gets a mild COVID infection, can they pass it onto others?

Yes, they can.

This is an important fact for people with vulnerable family members and friends.

If you have mild symptoms, do get tested and be extremely careful when you are with your vulnerable family members ( elderly parents, grandparents etc).

You can pass COVID to them even if you do not have much symptoms.

As vaccines lose some effectiveness over a period of time, do NOT assume that double vaccination would protect your vulnerable family members.

A recent Public Health England report indicates that both vaccinated and unvaccinated people with COVID infection are equally infectious and capable of spreading to others.

A similar report was also published from USA recently.

The end is not in sight yet. Be careful when you are with vulnerable family members !

References

Nature. COVID vaccines slash viral spread – but Delta is an unknown.
Smriti Mallapaty

CDC. How Vaccines work.

CDC. Diseases that Vaccines prevent.

U.K. Public Health England. SARS-CoV-2 variants of concern and variants under investigation in England: technical briefing 20. Ref: PHE publications gateway number: GOV-9220. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1009243/Technical_Briefing_20.pdf

USA. BMJ. Covid-19: Delta infections threaten herd immunity vaccine strategyBMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1933 (Published 02 August 2021)Cite this as: BMJ 2021;374:n1933

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

When will the COVID Virus go away?

The bad news is that it looks like that the virus is NOT going away any time soon.

COVID Vaccination has been tremendously successful in preventing people from getting severe disease.

A couple of months back, it was hoped that “Herd immunity” (Wide spread protection) caused by Vaccination would make the virus go away.

But recent news from Massachusetts, USA indicates that Vaccination is NOT going to produce herd immunity and make the virus go away.

Lot of Vaccinated people do get infected and the only good news is that “the vaccines offer strong protection against severe disease”

China fights to contain a new outbreak in Wuhan now. There is a possibility of further outbreaks elsewhere as well. That can create favourable conditions for new variants to emerge .

So don’t be surprised if new variants emerge in winter and COVID is still the headline news early next year !

References

BMJ. Covid-19: Delta infections threaten herd immunity vaccine strategy
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1933 (Published 02 August 2021)
Cite this as: BMJ 2021;374:n1933

BBC news. 3Aug 2021. Wuhan: Chinese city to test entire population after virus resurfaces
By Yvette Tan

BBC. Covid: ‘Israel may be reaching herd immunity’
By Rachel Schraer
Health reporter
Published14 April

BMJ News
Covid-19: What new variants are emerging and how are they being investigated?
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n158 (Published 18 January 2021)
Cite this as: BMJ 2021;372:n158

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Pfizer COVID Vaccine: How much efficacy is lost every month?

COVID vaccines lose some efficacy over time.

How much ?

Pfizer vaccine has been reported to lose, on average, about 3% efficacy every month.

An updated trial report of the Pfizer vaccine says that “ Pfizer vaccine efficacy decreased from 96% to about 84% over 4 months.

The results of this study certainly indicates that booster vaccines are needed for the winter months to prevent another wave of deaths.

References

BMJ News. Covid-19: Pfizer vaccine’s efficacy declined from 96% to 84% four months after second dose, company reports
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1920 (Published 30 July 2021)Cite this as: BMJ 2021;374:n1920

BMJ News. Covid-19: Millions could be offered booster vaccinations from September
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1686 (Published 02 July 2021)
Cite this as: BMJ 2021;374:n1686

Thomas SJ, Moreira ED Jr., Kitchin N, et al. Six month safety and efficacy of the BNT162b2 mRNA covid-19 vaccine.medRxiv2021 [Preprint].

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

Why COVID Vaccine boosters may be necessary during winter ?

Vaccine boosters may be offered to adults, particularly vulnerable adults, during this winter.

Why?

Two reasons.

1. The amount of protective antibodies produced by a person’s body after vaccination seem to fall after a few months. This may mean that that some protection is lost and that some vaccinated people may become more vulnerable to COVID infection during the winter wave. A booster would benefit.

2. The COVID vaccines may also have reduced protection against new variants. A booster using an updated vaccine may give better protection.

References

Guardian. Vaccines and immunisation.
UK scientists back Covid boosters as study finds post-jab falls in antibodies
Exclusive: Waning antibody levels are possible warning sign of lower protection in months after vaccination.
Ian Sample Science editor
@iansample
Thu 22 Jul 2021 12.45 BST

Guardian. Rates of double-jabbed people in hospital will grow – but that does not mean Covid vaccines are failing.
Ian Sample Science editor
@iansample
Thu 22 Jul 2021 16.34 BST

Daily Mail. Pfizer says booster shot of its COVID-19 vaccine extends protection and is being updated to target Indian ‘Delta’ variant. By Mary Kekatos Acting U.S. Health Editor For Dailymail.Com
22:23, 08 Jul 2021 , updated 23:32, 08 Jul 2021

Daily Mail. Are these the numbers scaring Boris? Study shows 29% of the 42 people who have died after catching the new strain had BOTH vaccinations as cases soar another 40%. By James Robinson for MailOnline
14:08, 13 Jun 2021 , updated 12:22, 14 Jun 2021

How long does covid-19 immunity last?
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1605 (Published 30 June 2021)
Cite this as: BMJ 2021;373:n1605

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

Vaccine for the obesity pandemic !

As the world battles the COVID-19 pandemic , there is another pandemic that been going on for decades without any end in sight.

The other pandemic is obesity !

Obesity has caused far more deaths than the COVID-19 pandemic.

The Vaccines promise to end the COVID-19 pandemic.

Wouldn’t it be wonderful if a vaccine can sort the obesity pandemic ? It does not need to be rhetorical question or wishful thinking.

An article in Science magazine reports an association between obesity and a type of body immune cell called macrophages. This raises the possibility of using immunotherapy for obesity.

There is also another tantalising possibility. Behaviours, emotions and eating wrong type of food are often blamed for obesity. What if the entire scientific thinking about obesity is wrong?

In the past, another widespread condition used to be blamed on wrong food and stress. Stomach ulcers used to be very common and very distressing. Modern stressful life, emotions and wrong type of food were universally blamed for stomach ulcers. Then an Australian team proved stomach ulcers were due to an infection. Now stomach ulcers are routinely treated by antibiotics!

Obesity is common among the disadvantaged people in society. All types of infections are common in disadvantaged people. So it is not beyond the realms of plausiblity to hypothesise (suggest) that obesity could be caused by an infectious agent that affects food intake in some way, by possibly affecting sense of taste or smell of smell or feeling of fullness after eating (satiety).

If an infectious agent (e.g bacteria, virus or prion) is indeed found to be responsible for development of obesity, then the vaccines would provide a very easy way to prevent obesity.

Please note: The science magazine article on immunotherapy is based on excellent, high quality scientific work. But the possibility of an infection being responsible for obesity is merely a scientific hypothesis or scientific suggestion. It is based on a personal hunch. It is NOT based on any direct high quality scientific data at this stage !

References

Science Magazine. An anti-obesity immunotherapy? https://science.sciencemag.org/content/373/6550/24

BBC. Over a million hospital admissions for obesity
By Sophie Hutchinson
BBC News

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

Do COVID vaccines cause heart inflammation?

Yes

COVID Vaccines have caused heart inflammation in a small minority of people.

But that does NOT mean Vaccines have to be avoided.

The benefits of vaccines are far higher than risk of side effects for vast majority of adult population.

People have not stopped traveling by car because of risk of road accidents. This is because benefits considerably outweigh the risks !

References

BBC news. Heart inflammation link to Pfizer and Moderna jabs
By James Gallagher
Health and science correspondent

BMJ. News Analysis.
Covid-19: Should we be worried about reports of myocarditis and pericarditis after mRNA vaccines?
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1635 (Published 24 June 2021)
Cite this as: BMJ 2021;373:n1635

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

Would COVID Vaccination become mandatory for all adults ?

It is unlikely to become mandatory in most western countries. It almost certainly would not become mandatory in USA, where Vaccination seems to become tangled with highly divisive politics.

But it is not an impossible scenario in European countries.

It is possible that more countries would follow the example of Turkmenistan, which has a policy of “no jab, no job”

Also, it does not have to a direct government policy.

If the governments change the law to allow businesses to demand vaccination proof, then indirectly vaccination becomes mandatory for most people.

Private Businesses and Travel industry may decide to make vaccination mandatory for their employees and customers so as to avoid further disruption to their business.

In countries, such as Israel and U.K., where there is already high uptake of vaccination, a change in Law may not be needed at present.

But if the present surge in infections continue, and variants emerge, Governments may change their approach.

References

BMJ. Covid-19: Turkmenistan becomes first country to make vaccination mandatory for all adults
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1766 (Published 12 July 2021)
Cite this as: BMJ 2021;374:n1766

Daily Mail. Get ready for Covid jab passports at busy pubs that don’t do enough to tackle infections, warns Boris Johnson. By Daniel Martin Policy Editor For The Daily Mail
23:54, 12 Jul 2021 , updated 01:47, 13 Jul 2021

Daily Mail. Pingdemic pandemonium! Chaos at airports and on the railways as key workers are ordered to go into self-isolation by controversial app. By David Churchill, Transport Correspondent For The Daily Mail
23:51, 12 Jul 2021 , updated 23:59, 12 Jul 2021

Daily Mail. It IS full steam ahead on freedom day: Boris Johnson puts faith in the public’s common sense on July 19 – even though some doctors and scientists want to delay it. By Glen Owen and Anna Mikhailova For The Mail On Sunday
22:00, 10 Jul 2021 , updated 01:52, 11 Jul 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 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 personal views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is NOT previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice.

Would we be having a third dose of COVID-19 Vaccine as a Booster ?

Yes, it is a possibility that a third booster dose of COVID vaccine would be offered later this year.

Vaccination has been tremendously successful so far. But it is too early to declare victory against the virus.

Data from Israel indicates that the current Pfizer vaccine, although still highly active, offers less protection against delta variant.

In June, the vaccine was found to be just 64 percent effective in preventing coronavirus infection whereas during May, when the delta strain was less prevalent, the vaccine was 94.3% effective.

So if more variants emerge, then vaccine boosters may be particularly needed for the vulnerable people.

References

Ministry data said to show Pfizer shot blocks majority of serious Delta cases. Figures reportedly indicate vaccine less effective against contagion from variant, but hospitalizations remain low; officials said weighing use of Moderna for 2nd dose for over 18s. By AMY SPIRO
Today, 10:23 am

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Should you elect to wear masks when restrictions are lifted ?

U.K. is on course to lift almost all COVID restrictions in mid July 2021.

A U.K. minister has said that “wearing masks” would become a personal choice.

Just because there is a choice, it does not mean it is always good for you.

Government decisions are often made not only with scientific facts but also with economic and political considerations. Compulsory masks may not be liked by a section of society and Government has to take that into account in a democratic society.

Personally electing to wear masks in crowded public places could be sensible for the following reasons.

– There is some debate about the extent of protection a person gets wearing masks following the Danish mask study. But no robust scientific study has shown significant harm from wearing masks. So it is better to be safe and wear masks even if the extent of protection is debatable.

– Infections are rising now and luckily, vaccines seem to have protected most people from getting severe COVID. But Vaccines are not 100% effective. Moreover, when infection rates go up further and society opens up more, there is a risk of variants emerging that may be partially vaccine resistant. So wearing masks may provide some protection.

– Not all people get poorly when they get COVID. But these people with COVID can still pass infection to other vulnerable family members and people who don’t have the protection from vaccines. So wearing a mask can stop people with mild COVID from spreading the infection to others.

– Some people do not want to wear masks because they think they are not at risk of death or hospitalisation. Remember, COVID related problems affect different people in different ways. Lot of people do recover from COVID without major problems. But some people do develop long-term symptoms from COVID. So it is better to wear masks for COVID protection.

References

1. BBC news. Covid-19: Masks will become personal choice, says Robert Jenrick
By Emma Harrison & Kathryn Snowdon
BBC News

2. Bloomberg. Face Masks in England to Become ‘Matter of Personal Choice’
By Andrew Atkinson
4 July 2021, 09:47 BST
Updated on 4 July 2021, 11:14 BST

3. Daily Mail. SAJID JAVID: The economic arguments for opening up Britain are well known. But, for me, the health case is equally compelling. By Sajid Javid For The Mail On Sunday 22:02, 03 Jul 2021 , updated 23:13, 03 Jul 2021

4. BBC news. Covid-19 in the UK: How many coronavirus cases are there in my area?
By The Visual and Data Journalism Team
BBC News

5. Daily Mail. Face masks do NOT protect the wearer from coronavirus, but will stop them from infecting other people, Danish study finds. By Mary Kekatos Senior Health Reporter For Dailymail.com and Reuters
15:26, 18 Nov 2020 , updated 18:02, 20 Nov 2020

6. BMJ. Danish mask study: masks, media, fact checkers, and the interpretation of scientific evidence. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4919 (Published 23 December 2020)
Cite this as: BMJ 2020;371:m4919

7. NICE. COVID-19 rapid guideline: managing the long-term effects of COVID-19
NICE guideline [NG188] Published: 18 December 2020

8. Coronavirus: When can we stop wearing face masks or coverings?
By Michelle Roberts
Health editor, BBC News online

9. Science. Implications of defective immune responses in SARS-CoV-2 vaccinated organ transplant recipients. Peter S. Heeger, Christian P. Larsen, Dorry L. Segev

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Should we continue to wear masks and be cautious in public places after July 19th ?

Yes, we should be cautious after the freedom day on July 19th and this is for the following reasons.

1. Vaccines are highly effective but they are NOT 100% effective.

2. Two doses are needed for full protection. Even though, more than two third of adults have had atleast one vaccine, only about half the U.K. population had double vaccination so far.

3. Vaccine Protection against New COVID variants may NOT be as good as it is now. For instance , vaccines are slightly less effective against the delta variant particularly after first dose.

4. Vaccine protection may decrease over time and Vaccines may not give the same level of protection as months pass by.

4. Being cautious now, may helps us to avoid lockdowns during Autumn and would help to save Christmas !

Of course, some people may feel strongly against any compulsory restrictions and hence it should not be made compulsory.

People, who are comfortable at being cautious, can try to wear masks and practice as much social distancing as possible in public places.

References

BBC News. Covid-19: End of England’s Covid rules still set for 19 July
By Hazel Shearing
BBC News

Daily Mail. Freedom Day ‘will see virtually ALL Covid curbs axed’: Ministers prepare full unlocking on July 19 with masks, social distancing and work from home advice dropped to save shattered businesses – but date will NOT be brought forward. By James Tapsfield, Political Editor For Mailonline
08:29, 23 Jun 2021 , updated 14:52, 23 Jun 2021

Daily Mail. Now Jacob Rees-Mogg joins the calls to DITCH masks as soon as restrictions are lifted: Three Cabinet members break ranks to urge PM to ditch face coverings amid calls for clarity. By Jack Maidment, Deputy Political Editor For Mailonline and James Tapsfield Political Editor For Mailonline
17:40, 24 Jun 2021 , updated 19:56, 24 Jun 2021

Guardian. Vaccines are not magic bullets – we’ll still have to take precautions
Zania Stamataki
To make the most of England’s vaccination rollout we may need to keep wearing masks even after restrictions are lifted
Dr Zania Sta. Tue 22 Jun 2021 06.00 BST

Public Health England. Press release
Vaccines highly effective against hospitalisation from Delta variant
New analysis by PHE shows for the first time that 2 doses of COVID-19 vaccines are highly effective against hospitalisation from the Delta (B.1.617.2) variant. Published 14 June 2021

Public Health England (page 39).
Investigation of SARS-CoV-2 variants of concern: technical briefings
Technical briefing documents on novel SARS-CoV-2 variants.
Last updated
25 June 2021

European Centre for Disease Prevention and Control. Immune responses and immunity to SARS-CoV-2.
(last update 18 May 2021)

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

Can someone who had both COVID vaccines still die from COVID-19?

Yes, even after having both the vaccines, there is still a small risk of dying from COVID-19

Why?

This is because the vaccines are not 100% effective.

People who had both the vaccines can still get COVID-19 infection. A unlucky few of those who get an infection can still die from COVID-19.

Recent reports indicate that about half of deaths in U.K. are in people who had at least one dose of COVID vaccine.

The good thing is that the overall number of deaths is VERY LOW compared to the high number of deaths at the peak of pandemic when vaccines were not available.

Vast majority of infections do still occur in the unvaccinated individuals. ( PHE document- page 13 & 14)

The Guardian newspaper has got a good article on this topic.

One has to hope that vaccines do NOT lose their effectiveness over time.

We have to hope that more new variants do NOT emerge as there is a possibility that Vaccines may be less effective against new variants emerging in future.

References

Guardian.
Why most people who now die with Covid in England have been vaccinated
David Spiegelhalter and Anthony Masters
Sun 27 Jun 2021 08.00 BST

Daily Mail. Are these the numbers scaring Boris? Study shows 29% of the 42 people who have died after catching the new strain had BOTH vaccinations as cases soar another 40%. By James Robinson for MailOnline
14:08, 13 Jun 2021 , updated 12:22, 14 Jun 2021

Public Health England. Research and analysis
Investigation of SARS-CoV-2 variants of concern: technical briefings.
Technical briefing documents on novel SARS-CoV-2 variants.
Last updated 25 June 2021. (page 13 and 14)

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Was the Kent variant more dangerous than the original Wuhan variant ?

Yes, the Kent variant who got a foothold in December was far more dangerous.

A recent study in BMJ reports that “the risk of hospital admission is higher” for people infected with the Kent variant compared with the original wild-type Wuhan variant of Coronavirus.

This higher severity seems to be specific to adults older than 30 years.

The current variant spreading in U.K. (delta a.k.a Indian variant) may not cause widespread havoc, like the Kent variant, due to the lock down and wide spread vaccination.

One has to hope that we do not get any variants that breaks the protective shield of COVID vaccines.

BMJ Risk of hospital admission for patients with SARS-CoV-2 variant B.1.1.7: cohort analysis
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1412 (Published 15 June 2021)
Cite this as: BMJ 2021;373:n1412

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Do people in U.K. trust the COVID vaccines?

Yes, a very high percentage of U.K. people trust the COVID-19 vaccines.

A recent report in BBC says that U.K. is the most trusting nation with regards to COVID-19 vaccines.

The survey found that 87% of survey respondents in U.K. had faith in the COVID jab.

This survey involved more than 68,000 people and hence the results are highly reliable.

This high level of faith is certainly helping the U.K. Government as it rolls out vaccines for most of adult population.

The U.K. Government, in particular, the “Public Health England” deserves credit for keeping the U.K. people well informed.

References :

BBC News. UK ‘most trusting’ country on Covid vaccines

BBC News. Covid-19: More than half of UK adults have had second jab. By Dulcie Lee

NATURE Journal. News.
Trust in COVID vaccines is growing. 10 February 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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Are many NHS staff reluctant to have COVID-19 vaccines?

No !

Vast majority of health care workers already had the COVID vaccine. Only a small minority have vaccine hestitancy.

A recent study found that about 90% of staff had at least one dose of the vaccine within 2 months of vaccine roll out. That is very impressive.

This study ( published in Lancet Journal) found that vaccines are very effective in reducing infections.

But the study also showed what we know already. Vaccination does not give 100% protection.

Everyone, in particular, health care staff need to continue with other COVID precautions such as masks, distancing and regular washing as advised by Government.

Reference: COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. Published:April 23, 2021 DOI: https://doi.org/10.1016/S0140-6736(21)00790-X

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Should NHS staff be forced to have COVID-19 vaccines?

U.K. Government vaccine minister announced over weekend that compulsory COVID vaccinations are being considered for NHS staff.

Majority of NHS staff believe in the vaccine and so it is not an issue for most NHS staff. But a small minority of staff are either sceptical or they have some other reasons why they were not able to have the vaccine.

Should those NHS staff be forced to have COVID-19 vaccines?

It is a tough question. Compulsory vaccines have caused huge backlash in past among the general population as well as among some in medical profession.

On the other hand, Vaccination against Hepatitis is already mandatory for NHS surgeons and this is not a new thing.

The vaccination of staff is not only for personal protection but also to prevent NHS staff spreading infection to vulnerable patients.

For instance, many patients recently caught COVID in hospitals. Both Guardian and Daily Mail report that up to 8,700 patients died after catching Covid in English hospitals.

Usually, NHS workers as individuals are allowed to make their own choice particularly with regards to annual flu vaccines.

But during this pandemic, NHS has to balance individual choice against the greater good to the population.

There are no easy answers !

References

Metro. Covid vaccine could become compulsory for NHS staff.

Daily Mail. Jabs for jobs: NHS workers will be legally required to have Covid vaccinations under new plans with up to one in five health staff in some areas still unvaccinated. By William Cole For Mailonline
15:36, 30 May 2021 , updated 17:38, 30 May 2021

RCN. RCN position on mandating vaccination for health and social care staff. 15 April 2021.

BBC news. The anti-vaccination movement that gripped Victorian England
By Greig Watson
BBC News
Published 28 December 2019.

Anti-compulsory vaccination league. Br Med J 1867;1:264–73. doi: https://10.1136/bmj.1.323.264

BMJ. COMPULSORY VACCINATION
Association Medical Journal 1853; s3-1 doi: https://doi.org/10.1136/bmj.s3-1.10.224-a (Published 11 March 1853)
Cite this as: Association Medical Journal 1853;s3-1:224

Guardian. Up to 8,700 patients died after catching Covid in English hospitals.
Denis Campbell and Anna Bawden
Mon 24 May 2021 17.50 BST

Daily Mail. Nearly 9,000 patients died after catching Covid on English hospital wards while being treated for something else. By Connor Boyd Assistant Health Editor For Mailonline
19:00, 24 May 2021 , updated 19:06, 24 May 2021

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

Have People died after COVID-19 vaccines ?

Yes, people have died after having COVID-19 vaccines.

Recently, a BBC Radio Newcastle presenter, Lisa Shaw was reported to have died after the Astra Zeneca COVID vaccine. Her family is blaming the COVID vaccine for causing clots and ultimately her death.

In India, a Popular Tamil actor and comedian died within 48 hours of receiving a COVID vaccine. His vaccination was broadcast live on TV to encourage public uptake of vaccination but his unfortunate death after vaccination probably ended up causing vaccine hesitancy in some people.

A news article in BMJ reports that the “Pfizer-covid-19 vaccine is “likely” to have been responsible for at least 10 deaths of frail elderly people in nursing homes in Norway”.

But, the most important thing to remember is that deaths are rare after COVID-19 vaccines.

Yes, there are true distressing accounts of vaccine side effects. But what you do not hear is the benefit most people have from vaccines.

Millions of people received vaccines so far with vast majority having no major side effects.

Consider this for context. Think about plane accidents. Millions of people travel by plane without any problems. If People fly safely and reach their destination, it is not headline news. People do not go around saying that they have traveled safely by plane and that they are alive !

But a aeroplane accident which happens rarely is front page news. It would be all over the 24 hour TV news channels across the world. Plane accidents are utterly and unimaginably devastating for those individuals and families involved. But the rare plane accidents do not make most other people avoid flying. The accidents do not mean that no one should travel by plane. The travel by planes has far more benefits than risks for majority of population.

Same with COVID vaccines. Serous Side effects are headline news even if they are very uncommon and rare. The available data indicate benefits are much greater than risks.

So think carefully before you refuse a vaccine.

References

Guardian. Lisa Shaw death: BBC presenter had blood clots after AstraZeneca jab, family says
(Radio Newcastle broadcaster had severe headaches a week after vaccine and fell seriously ill days later, relatives say).
Lisa Shaw
Lucy Campbell
Thu 27 May 2021 18.36 BST

BMJ. News. Covid-19: Pfizer-BioNTech vaccine is “likely” responsible for deaths of some elderly patients, Norwegian review finds
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1372 (Published 27 May 2021)
Cite this as: BMJ 2021;373:n1372

BMJ. Research. Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1088 (Published 13 May 2021)
Cite this as: BMJ 2021;373:n1088

BMJ. News. Covid-19: Risk of cerebral blood clots from disease is 10 times that from vaccination, study finds
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1005 (Published 16 April 2021)
Cite this as: BMJ 2021;373:n1005

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Vaccine Hesitancy

Worries about vaccines are nothing new. Anti_vaccination groups were formed in 1860s when small pox vaccination was made compulsory. Even when small pox was causing untold devastation, some people were opposed to it.

The Vaccine hesitancy of 19th century is somewhat excusable. Some of the worries were real, and not much was known about the safety of small pox vaccine at that time. Lot of people were ill-informed and did not have access to good sources of information. They didn’t know the immense potential of the vaccination to eliminate distressing diseases.

Vaccines have now successfully eradicated small pox. Many other devastating infectious diseases such as polio have been controlled in many countries across the globe due to the vaccines.

Some of the vaccine hesitancy in west is because western people are not fully aware of the devastating power of infectious diseases (at least until COVID-19 came to the world in 2020).

Vaccine hesitancy is also sustained by “confirmation bias” . Confirmation bias is the tendency of human beings to seek information that confirms what they believe in. If you distrust vaccines, you go looking for information that confirms you beliefs and you disregard information that proves vaccines are hugely beneficial.

Some people wish for a 100% safe vaccine. But there is no such thing as completely risk free vaccine. It is true Vaccines can cause serious side effects. It is true that Vaccines can cause long term side effects. It is true that Vaccines can rarely cause life threatening side effects and even deaths.

It is normal to worry about side effects of vaccines. But the potential for side effects should not be the reason to decline vaccination.

One has to look at benefits as well as risks. Some people focus on everything bad that can happen as a result of vaccines.

COVID-19 vaccines had an unusually short development period. This is because of the pandemic. The available evidence indicate that the benefits of the vaccines are far greater than risks. It is true that there is no long term safety data. But in the middle of a pandemic, which has caused untold misery to millions, waiting for perfect long term data is not an option.

If you are sceptical about vaccines, please do focus on benefits as well as risks. Do not focus on risks only.

References

BMJ. Practice Pointer. Covid-19 vaccination hesitancy. BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1138 (Published 20 May 2021)
Cite this as: BMJ 2021;373:n1138

BMJ. News. Covid-19: Pfizer-BioNTech vaccine is “likely” responsible for deaths of some elderly patients, Norwegian review finds.
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1372 (Published 27 May 2021)
Cite this as: BMJ 2021;373:n1372

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

U.K. approach to vaccination proven to be the right one. Is it Luck or Foresight?

UK government wanted as many people have “some” degree of protection against the COVID-19 rather a only few people having “full” protection against COVID-19.

A recent paper published in BMJ validates the U.K. approach even though it was initially criticised by WHO ( world health organisation)..

Is it Luck or Foresight that U.K. Govt got it right? Probably both but more foresight than luck. Perhaps a cappuccino cup of foresight sprinkled with chocolate of luck.

Guardian. No data to support UK delay of vaccines’ second dose, says WHO.
Sarah Boseley Health editor
Tue 5 Jan 2021 19.48 GMT

Daily Mail. UK should feel ‘vindicated’ over its ‘brave’ decision to delay second doses of Covid vaccines, World Health Organization official says. By Sam Blanchard Deputy Health Editor For Mailonline. 13:29, 08 Feb 2021 , updated 15:03, 08 Feb 2021

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

How effective are the COVID vaccines against the new Indian variant?

Everyone in U.K. hoped that we have turned the corner with this pandemic after the recent spike in infection from the Kent Variant,

But now comes the Variant from India. (the scientific name is B1.617.2 variant of concern).

The Indian variant appears to be more transmissible but no evidence yet that the Indian variant is inherently more deadly than the Kent variant.

Naturally, we are in a better place now than last year because of the vaccination.

But there is some evidence that spontaneous changes (mutations) in the B.1.617.2 variant virus may make it partially resistant to antibodies produced by vaccines.

So how effective are the current vaccines against this Variant from India?

Lab testing shows that the current vaccines can be still effective against the Indian variant but may not be highly effective as it is against the Kent/U.K. variant.

PHE data shows that after two doses, Pfizer vaccine is 88% effective against Indian variant compared to 93% effectiveness against the Kent strain.

After two doses, AstraZeneca jab is 60% effective against Indian variant compared to 66% effectiveness against the Kent variant.

But after the first dose, both vaccines were only 33% effective against Indian variant compared to around 50% efficacy against the Kent strain.

The vaccine protection is better with two doses of vaccine and that’s why the Govt is speeding up second vaccine dose in affected areas.

Fingers crossed, hope this strategy works !

References

BMJ. Covid-19: Caution urged while lockdown eases in England because of vaccine success
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1203 (Published 11 May 2021)
Cite this as: BMJ 2021;373:n1203

BMJ News Covid-19: UK cases of variant from India rise by 160% in a week
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1315 (Published 21 May 2021)
Cite this as: BMJ 2021;373:n1315

U.K. Govt. Most vulnerable offered second dose of COVID-19 vaccine earlier to help protect against variants. From: Department of Health and Social Care. Published 14 May 2021

Telegraph: Two doses of AstraZeneca vaccine provide over 80 per cent protection against Indian variant, PHE study finds.

Guardian. India Covid variant: is it a threat to the UK’s reopening plans?
Ian Sample Science editor
@iansample
Fri 14 May 2021 11.19 BST

Daily Mail. UK is in a ‘very good position’ against Covid variants as Pfizer says there is NO proof current jab needs updating to fight mutant strains. By Luke Andrews Health Reporter For Mailonline
16:30, 10 May 2021 , updated 18:12, 10 May 2021

Daily Mail. How deadly is India’s Covid variant and is it REALLY behind explosion of cases? Scientists say ‘perfect storm’ fuelled nation’s crisis and mutant strain just had a ‘head-start’ – as study shows vaccines DO work against it. By Connor Boyd Assistant Health Editor For Mailonline
16:26, 27 Apr 2021 , updated 08:17, 28 Apr 2021

Collier, DA et al. SARS-CoV-2 B.1.1.7 sensitivity to mRNA vaccine-elicited antibodies. Nature; 11 March 2021; DOI: 10.1038/s41586-021-03412-7

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

BBC. Covid: Increasing confidence jabs work against Indian variant
By Doug Faulkner
BBC News

ONS. Coronavirus (COVID-19) Infection Survey, UK: 21 May 2021 (“early signs of a potential increase in the week ending 15 May 2021”)

BBC. Covid: Pfizer and AstraZeneca jabs effective against Indian variant – study
By Dulcie Lee
BBC News

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

How effective is a single dose of Pfizer and AstraZeneca vaccine?

UK government wanted as many people have “some” degree of protection against the COVID-19 rather a only few people having “full” protection against COVID-19.

So the U.K. government delayed the second dose of Covid vaccine for 12 weeks.

Some people have now been offered two vaccines but still there are many people who were yet to have the second dose. They would be wondering how effective a single dose of the vaccine is. How much protection they have now.

A recent paper published in BMJ provides very encouraging news .

With Pfizer vaccine, vaccine effectiveness reached 61% after 4 to 5 weeks of the first dose.

With AstraZeneca vaccine, vaccine effectiveness reached 73% after 5 weeks of first dose.

This data is very reassuring

But the data also stresses the importance of having the second dose for further protection.

Please do make a note that (a) vaccines do take a few weeks to be become effective after the first dose (b) no vaccine is 100% effective and (c) we also do not know how long this protection from vaccine will last.

BMJ. Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1088 (Published 13 May 2021)
Cite this as: BMJ 2021;373:n1088

BMJ. Public health impact of delaying second dose of BNT162b2 or mRNA-1273 covid-19 vaccine: simulation agent based modeling study
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1087 (Published 12 May 2021)
Cite this as: BMJ 2021;373:n1087

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 sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

Delaying second vaccine dose leaves cancer patients vulnerable to coronavirus

How effective is a single dose of Pfizer Vaccine in cancer patients?

Single dose is not very effective in cancer patients.

An UK study has now been peer reviewed and published in the esteemed Lancet oncology journal. The study showed inadequate protection after first dose.

More than half of the cancer patients receiving a single dose of the Pfizer COVID-19 vaccine have been left with little protection against the virus.

Two doses are critical and the second booster ideally need to be given on time at 21days.

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

Here we go again – another new variant that can derail the plans to return to normality in U.K.

The UK is coming out of lockdown and the infection rates, hospital admissions and deaths are reassuringly low.

The vaccination rates are rapidly going up and understandably many people are hoping for some sort of normality very soon.

But a new variant has been detected across the country. The scientists are worried about this new variant of coronavirus- called India variant. This variant can derail government plans in UK.

The current vaccines seem to offer somewhat less protection against this new variant . If this variant takes a strong foothold in UK , then we have to wait a bit longer for normality.

References:

Guardian: India Covid variant: is it a threat to the UK’s reopening plans?
Ian Sample Science editor
@iansample
Thu 13 May 2021 15.35 BST

BBC. Covid: Three cases of Indian variant found in Leicester
Published 28 April.

BBC. Covid: Targeted testing in Nottingham after Indian variant rise. 11 May.

BBC. Covid: Boris Johnson ‘anxious’ about Indian variant
By Hazel Shearing & Joseph Lee
BBC News. 13 May.

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

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

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

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

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

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

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

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

References

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

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

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

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

Is it the beginning of the end ?

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

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

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

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

References

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

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

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

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

COVID-19 pandemic: India vs Israel

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

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

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

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

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

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

References

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

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

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

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

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

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

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

Yes, rarely it can happen.

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

But vaccines are not 100% effective.

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

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

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

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

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

References:

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

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

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

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

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

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

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

Yes !

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

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

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

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

Reference:

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

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

Should young adults avoid Astra Zeneca COVID-19 vaccine ?

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

COVID-19 infection affects brain and mental health

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

This report is very worrying .

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

References

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

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

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

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

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

Yes, Pfizer vaccine is safe.

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

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

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

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

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

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

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

References

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

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

Are COVID-19 vaccines safe in Children ?

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

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

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

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

What about much more younger children?

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

References

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

The Guardian. Wed 31 Mar 2021 14.20 BST

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

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

How long do the COVID-19 vaccines offer protection?

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

Guardian. Fifth of patients with Covid-19 may have caught it in hospital, study finds
This article is more than 9 months old
PHE research chimes with concerns that asymptomatic healthcare workers may have played role in spread Coronavirus –
Nicola Davis
@NicolaKSDavis
Tue 19 May 2020 18.56 BST

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

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

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

Possibly yes, if it is important for your job.

A BBC report discusses the legality of it .

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

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

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

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

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

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

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

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

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