CMAAO Coronavirus Facts and Myth Buster: Country Experiences

Health Care Comments Off

With input from Dr Monica Vasudev

1397: Minutes of Virtual Meeting of CMAAONMAs on Corona Update: Country Experiences

20th February,Saturday, 9.30am-10.30am

Participants:Member NMAs: Dr KKAggarwal, President CMAAO; Dr Yeh Woei Chong, Singapore Chair CMAAO; Dr AlvinYee-Shing Chan, Hong Kong, Treasurer, CMAAO; Dr Ravi Naidu, Malaysia; DrMarthanda Pillai, India, Member World Medical Council; Dr Angelique Coetzee,President South African Medical Association; Dr Marie Uzawa Urabe, JapanMedical Association; Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association;Dr Qaiser Sajjad, Secretary General, Pakistan Medical Association; Dr DeboraCavalcanti, Brazil; Dr Prakash Budhathoky, Treasurer, Nepal Medical Association

Invitees:DrAkhtar Husain, Dr S Sharma, Editor IJCP Group

Keypoints from the discussion

· MalaysiaUpdate: Malaysia has gone through the third wave of coronavirusinfection. The total lockdown called the “movement control order” has beenreduced in some states as the total number of cases is now declining. Therewere 14 deaths yesterday. The vaccine (Pfizer) rollout will begin from 26th February.One million doses will be received today. The frontline workers will receivethe vaccine first. Malaysia expects to vaccinate 80% of population by April2022. The total lockdown has made a difference to the number of cases.

· BrazilUpdate: The cases are increasing, hospitals are full and there are nobeds for new cases. People do not use masks. Vaccination has started withOxford/AstraZeneca vaccine and the CoronaVac vaccine.

· SouthAfrica Update: Vaccination has started in all provinces 2 days back. Totaldaily cases are around 2000 cases per day. Cases are now reducing because oflockdown measures. Some restrictions have been relaxed; schools have beenreopened this week.

· HongKong Update: The lockdown in Hong Kong has limited public gatheringsto less than 4; lunch time just two people andonly yesterday dining at restaurants has resumed. Gyms, cinemas, gamingarcades, beauty parlors, sports centers have now reopened. Vaccination has beenlaunched with Sinovac vaccine. The Pfizer-BioNTech vaccine will arrive at theend of February and is expected to be administered in March. Many people areapprehensive about the Pfizer vaccine because of reports of deaths in Norwayand Bell’s palsy in Israel.

· JapanUpdate: Japan has started to vaccinate the medical staff. The numbersare under control. Although a mild lockdown is still in place to controlinfection during the vaccination process.

· NepalUpdate: Numbers are reducing, serious disease is also reducing. Thereis; however, a risk of rise in cases because of political gatherings,processions, etc. Vaccination has started 3 weeks before for frontline workers.After two weeks, mass vaccination will start for persons above 60 years.

· SingaporeUpdate: There are around 0-1 case per day. People are not allowed tovisit each other except 8 family members a day are allowed to visit twohouseholds. 250,000 people have been vaccinated till date and around 110,000having received their second dose; one person aged 72 years developed MI afterthe first dose of vaccine (Pfizer). However, according to the initialassessment, this was not caused by the vaccine. The Moderna vaccine has alsoarrived in the country. Singapore aims to vaccinate the whole population byAugust this year.

· BangladeshUpdate: The infection rate is coming down to around 400 new cases perday, detection rate is <3%. There are political gatherings although therehas been no increase in infection rates. More than one percent has beenvaccinated; initially there was fear about the vaccine, but the situation hasimproved. Now there is a very good response.

· PakistanUpdate: The number of cases and deaths are decreasing. No seriouscases; hospitalized cases have also reduced. However, people do not followSOPs. The vaccination process (Sinopharm vaccine) has started for healthcareworkers; although there is hesitancy among them. The Oxford-AstraZeneca vaccineis awaited.

· IndiaUpdate: The situation is optimistic with numbers reducing. Threestates are contributing around 60% of cases. Serosurveillance has shown that21% people have developed antibodies. The healthcare workers have beenaccepting of the vaccine. There is a debate whether to delay the second dose by8-12 weeks. Side effects have been very minor. Deaths that have occurred aftervaccination are not directly related to the vaccine.

· Everycountry is worried about resurgence in cases.

· Factorssuch as mutations, COVID inappropriate behavior and superspreader event, actingin combination, will lead to surge in cases.

· Twotypes of mutation: Substitution and deletion.

· Deletionmutation is permanent, while substitution mutation can be autocorrected byproof reading unless associated with deletion.

· Mutationin the state of Maharashtra in India is a substitution type of mutation andtherefore is localized to that region. The UK strain has three deletions.Hence, it is of concern. South Africa and Brazil strains do not have deletionsand therefore are not spreading globally.

· Newermutations mean longer period of isolation.

· Ithas been suggested that humidity from masks may lessen severity of COVID-19.Face masks substantially increase the humidity in the airthat the mask-wearer breathes in. This higher level of humidity ininhaled air may be why wearing masks has been linked to lowerdisease severity as hydration of the respiratory tract is known tobenefit the immune system.

· Itis important to shift from single gene testing to minimum three gene testing tobe able to detect mutations.

· Reactivationof the disease has been reported in an immunocompromised patient 4 months afterinitial infection, documented by genomic sequencing.

· Allergicmanifestations are same in all types of vaccines; reactogenicity is least inkilled virus vaccine and maximum in RNA vaccines, while immunogenicity islowest in killed vaccine and same in other vaccines. Killed vaccines are saferbut less effective, so require more doses.

· InIndia, 744 doctors have died due to COVID, Pakistan 191, Bangladesh 130, SouthAfrica 300, Nepal 6 and Brazil 440.

· Multipledoses of vaccine may precipitate multisystemic inflammatory disease.

· Swiftand prompt policy is needed to determine the timing of the second dose.

Dr KK Aggarwal

President CMAAO, HCFI and Past NationalPresident IMA

CMAAO Coronavirus Facts And Myth Buster – UK Strain: Longer duration of infection

Health Care Comments Off
With input from Dr Monica Vasudev
It was believed that B.1.1.7 variants increased infectiousness is due to higher viral load. New data suggest that it is related to delayed clearance, and longer duration of infection.
Infection duration appears to be longer for B.1.1.7, with a mean of 13.3 days (90% CI 10.1, 16.5), compared to 8.2 days for non-B.1.1.7.
A study evaluated if acute infection with B.1.1.7 is associated with higher or more sustained nasopharyngeal viral concentrations. Longitudinal PCR tests conducted in a cohort of 65 individuals with SARS-CoV-2 undergoing daily surveillance testing were evaluated.
These included seven infected with B.1.1.7.
For patients with B.1.1.7 variant, the mean duration of proliferation phase, clearance phase, and overall duration of infection was 5.3 days, 8.0 days, and 13.3 days, respectively. The corresponding figures for non-B.1.1.7 virus were mean proliferation phase of 2.0 days, a mean clearance phase of 6.2 days, and a mean duration of infection of 8.2 days.
The peak viral concentration for B.1.1.7 was 19.0 Ct vs. 20.2 Ct [19.0, 21.4] for non-B.1.1.7. This represents 8.5 log10 RNA copies/ml [7.6, 9.4] for B.1.1.7 and 8.2 log10 RNA copies/ml [7.8, 8.5] for non-B.1.1.7.
The variant B.1.1.7 thus appears to result in longer infections with similar peak viral concentration compared to non-B.1.1.7.
The longer duration may result in increased transmissibility of the variant.
1.      These variants probably carry non-spike mutations that affect their sensitivities to type I (or III) interferon.
2.       Not related to higher viral load as higher load is consistent with worse outcomes. Mitigation efforts should be just as effective.
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

CMAAO CORONAVIRUS FACTS AND MYTH BUSTER: Second dose reactogenic; Variant strain in UK more severe

Health Care Comments Off

Withinput from Dr Monica Vasudev

1384: Are COVIDvaccines too risky for some people?

1. The second dose of the vaccine appears to be more reactogenic than thefirst dose. Most symptoms occur within the first three days of receiving the doseand often resolve within a couple of days. The most common side effects appearto be pain, fatigue, headache and myalgias.

2. It appears to be associated with the antibody response. With the firstdose, most people dont have much of a reaction. There might just be a littlebit of soreness at the injection site. Most people develop more side effectsafter the second dose. Probably after the first dose, the body startsdeveloping an antibody response or an immune response. When the second dose isgiven, the body is ready to act against the antigen provided by the vaccine. Thisleads to an inflammatory response from the body.

3. The side effects like pain or fatigue are not allergies. Theyrenormal side effects of the vaccine.

4. Most allergic reactions will occur within 30 minutes of vaccineadministration. They present with urticaria or hives, angioedema and wheezing. Oneor two of these symptoms along with a low blood pressure or fast heart rate isanaphylaxis.

5. The new data shows that anaphylaxis appears to be not as common aspreviously thought.

6. The frequency of anaphylaxis is around five cases per milliondoses of the Pfizer vaccine and nearly 2.8 cases per million doses of theModerna vaccine.

7. People have allergies to several allergens. Food products, petdander, venom to bees, or even latex, none are contraindicated. Even if one hasanaphylaxis to these products, he can safely get the mRNA vaccines.

8. The only major contraindication to the mRNA vaccines is if one hashad an immediate allergic reaction to the first dose of the vaccine or if onehas had such a response to a component of the vaccine previously. This includespolyethylene glycol. This is a component of both the vaccines and some people mayreact to it.

9. Another contraindication is if one has had anaphylaxis topolysorbate. Polysorbate can cross-react with polyethylene glycol.


1385: The U.K. variant of coronavirusis probably more fatal and leads to more hospitalizations compared tonon-variant coronavirus cases, suggest data published on a British governmentwebsite. The report stated that therewas increased severity of COVID-19 cases caused by the B.1.1.7 variant comparedto non-variants of concern. The B.1.1.7 cases have been reported to be 30% to70% deadlier than the actual wild-type strain.

The concerns were first raised inJanuary, when the initial data suggested that cases with B.1.1.7 were deadlierthan non-variant cases.

The London School of Hygiene &Tropical Medicine noted a relative hazard of death within 28 days of 1.58 forvariant cases compared to non-variant cases. The Imperial College London statedthat the mean ratio of case fatality for variant cases was 1.36.

Public Health England conducted amatched cohort analysis to note a death risk ratio of 1.65 for variant versusnon-variant infected people.

Public Health Scotland employedthe S-gene target failure as a proxy to ascertain variant cases. The risk of hospitalization was foundto be higher among S-gene target failure cases versus S-gene positive cases.

Intensive Care National Audit andResearch Centre (ICNARC) and QRESEARCH also noted that there was a greater risk of ICU admission forvariant cases.

Evidence thus suggest that B.1.1.7 istied to an increased risk of hospitalization and mortality compared toinfection with non-variant virus.

CDC modeling in January estimatedthat the U.K. variant would dominate in the U.S. by the end of March. A new modeling study indicatesthat the incidence of variant cases is increasing two-fold every 10 days in this country.

(Medpage Today)

Dr KK Aggarwal

President CMAAO, HCFI and Past NationalPresident IMA

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