Dr Mark Holliday, a General Practitioner in a large group practice in South Africa, has shared some insight into some COVID conversations!
Johannesburg, South Africa (15 February 2021) – COVID vaccine options are finally here but which one works? Cures for animals might work on us but are we barking up the wrong tree? The next big wave will break this winter. Will natural herd immunity depend on vaccines? Fake news and fake medicine join forces. Where have all the denialists gone? Our children are safe.
Here’s what we know now.
The word on everyone’s lips: Covid vaccines.
Will they work? Vaccines have three main roles: First, to prevent you from catching the illness. Second, if you do catch COVID, they should make the illness milder. The third role is to prevent the spread of the illness; sadly, evidence of this in the current candidates is lacking.
With hopes dashed, the spin is now that instead of the vaccines protecting us from contracting the disease, they will instead protect us from dying or needing hospital ICU admission.
The launch of the Russian Sputnik vaccine came under a lot of criticism for its expedited approval, yet recent trials have shown it to be a good vaccine. An interesting aspect of this vaccine is that the second shot uses a different virus carrier from the first one, which makes its effect stronger. This principle of combining different vaccines in the second dose is now being trialed with the A-Z vaccine.
What about the SA variant? The SA virus variant has proven that some vaccines are less effective for us than others. The big three at the moment are all showing moderate effects, especially the Pfizer one. The imminent Johnson & Johnson one, despite its relatively low effectiveness, is appealing because it will require only one shot and can be stored at room temperature. J&J have donated 500 000 vaccines to SA, delivery starting this Tuesday.
100 000 of our stock of ‘useless, near expiry date’ Astra-Zeneca/Oxford (A-Z) vaccines are being deployed in a trial of SA health care workers to see if they can prevent hospitalisation and death. The A-Z vaccine interestingly seems to offer more protection if the second booster is given much later than after the recommended month.
When will the vaccines be available? South Africa will start vaccinating this week. We don’t need to over-worry, for we will have had the research benefits of 200 million doses administered to the rest of the world to prove safety. Criticisms of some candidates is already being voiced, e.g., the non-approval of A-Z in Switzerland and certain EU countries, the complete withdrawal of the Merck vaccine and the requirement for more data from Pfizer before being approved in India and Australia.
Cancer research helps vaccines: The new concept of messenger RNA vaccines (mRNA) has actually been used in the quest for cancer cures since 2013. Moderna and Pfizer have modified the technology for vaccine purposes, but the big spin-off in the future will hopefully be cures for cancer. This technology also means that rapid changes for new variants can be made within six weeks; Moderna has already started on a SA variant upgrade. Boosters of all vaccines are anticipated in the future.
Take the shot: Slow uptake of vaccines will give the virus more time to mutate and become resistant, so the quicker we all get vaccinated, the lower the likelihood of them losing their effectiveness. Even though the current vaccines may not be ideal, they will keep you out of hospital, and your symptoms should be milder. It also means that if you’re exposed to Covid, you won’t need to quarantine after the first dose.
Community immunity (The word ‘herd immunity’ is now frowned upon):
An interesting survey of antibodies in 4858 blood donors in SA released this week has suggested a much higher immune population (between 32% and 63%) than we previously thought. This bodes well for us reaching ‘herd immunity’ even without vaccines. The study may be an unreliable predictor because it did not include Gauteng & Western Cape. Also, blood donors are not representative of the general population.
The flu vaccine has a role to play:
We have not seen any flu this past year, but despite this, you should consider a flu shot soon as an important part of your COVID defence plan. A new flu vaccine to be released in March will keep your immune system stimulated, prevent confusion between Covid and flu and will free up hospital beds. Also, consider a pneumonia vaccine if you didn’t have one last year.
2020 was the year of fake news, is 2021 going to be the year of fake medicine?
Ivermectin: Public awareness of this veterinary drug has led to huge demand and fake versions of it seem to be circulating. This week, a laboratory released an analysis of five different tablets sold in the community, with four of the five being contaminated with other medications. Profiteers are importing large quantities from the Sub-continent, and we don’t know their origin, purity or expiry date. Reputable pharmaceutical manufacturers will have a SAHPRA, GMP and/or USP logo. If you have a stash, please go and check for these stamps of approval.
Rumours and photographs of fake vaccines coming in have already started to appear. Remember that all currently used vaccines have strict storage requirements and anything appearing on the street will either be fake or not effective as it is unlikely to have been stored at the correct temperature.
Denialists, where have you gone to?
The early phases of the epidemic quoted numbers of people sick or dying. Because the pandemic was invisible to most, conspiracy theorists and denialists had a field day with the statistics, confusing human responses to the threat. Today all of us can name friends or family who have either fallen seriously ill or succumbed – bringing the threat closer to home and making it all the more real. The denialists have vaporized since mid-December. Pseudo-intellectual, non-medical authorities have also silently disappeared into the woodwork. Let’s hope that they don’t reemerge to tout the same pseudo-science on vaccine technology, thereby endorsing a vaccine stay-away. Vaccination is the only way we can return to normal by year-end.
A few repurposed old drugs which have shown promise:
As mentioned before, Ivermectin, a veterinary drug for parasites, has been approved for treatment of Covid in several countries. A doctor’s lobby group based in Natal is strongly motivating for its use in South Africa. Colchicine, normally used for gout, has proven to reduce the number of ICU admissions and deaths, as has early nebulized Budesonide. Another drug to show promise is Aplidin, an extract from sea-squirts which is approved for the treatment of leukaemia in Australia.
A reason to wear clean underwear:
Testing has descended to a whole new level: Chinese researchers have found that virus presence in an anal swab two weeks after symptoms start is associated with worse outcomes. This is interesting because it confirms that seriously ill people shed viruses long beyond the tenth day that we have come to associate with non-infectivity.
The second wave, a dress rehearsal for next winter:
The first wave was small, the second wave, now diminishing, has been a dress rehearsal for what’s to come this winter. All authorities are warning of a big third wave, and we can again expect some kind of lockdown in our colder months. I don’t believe that vaccines will be administered to us in enough quantities to avert a big third wave, but I do think that come spring we will have been through the worst and can look forward to a fairly normal summer.
Children and school:
The under 19’s represent 37% of our population, yet are accountable for only 9% of tested cases and 3% of hospital admissions. Junior school kids are half as likely to transmit the virus, and their teachers are more likely to contract it from other adults. These are among the myriad compelling reasons to return to school.
Mental stress is the new normal.
This pandemic has produced a normal reflex of fear, worry and stress. The influence of social media has allowed fake information to take root in these anxious states and facilitated the pseudo-scientists to confuse people with half-truths. All this has been compounded by acquaintances dying, governmental restrictions, retrenchments and loneliness.
I urge you to resist ‘doom scrolling’ through the day, to question dubious claims and trust your sources before you passing on sensationalist information that may be fake. Reach out to those who you know to be lonely and if you are feeling excessively stressed don’t be afraid to ask for help.