Explained: Why you shouldn’t ditch the mask after Covid-19 vaccination

While all of the COVID-19 vaccines are spectacularly good at shielding people from severe illness and death, the research is unclear on exactly how well they stop the virus from taking root in an immunized person's nose and then spreading to others.

With 50 million Americans immunized against the coronavirus, and millions more joining the ranks every day, the urgent question on many minds is: When can I throw away my mask?

It’s a deeper question than it seems — about a return to normalcy, about how soon vaccinated Americans can hug loved ones, get together with friends, and go to concerts, shopping malls and restaurants without feeling threatened by the coronavirus.

It seems clear that small groups of vaccinated people can get together without much worry about infecting one another. The Centers for Disease Control and Prevention is expected shortly to issue new guidelines that will touch on small gatherings of vaccinated Americans.

But when vaccinated people can ditch the masks in public spaces will depend on how quickly the rates of disease drop and what percentage of people remain unvaccinated in the surrounding community.

Why? Scientists do not know whether vaccinated people spread the virus to those who are unvaccinated. While all of the COVID-19 vaccines are spectacularly good at shielding people from severe illness and death, the research is unclear on exactly how well they stop the virus from taking root in an immunized person’s nose and then spreading to others.

It’s not uncommon for a vaccine to forestall severe disease but not infection. Inoculations against the flu, rotavirus, polio and pertussis are all imperfect in this way.

And now coronavirus variants that dodge the immune system are changing the calculus. Some vaccines are less effective at preventing infections with certain variants, and in theory could allow more virus to spread.

At the moment, many experts believe that what’s permissible will depend to a large extent on the number of cases in the surrounding community.

The higher the number of cases, the greater the likelihood of transmission — and the more effective vaccines must be in order to stop the spread.

“If the case numbers are zero, it doesn’t matter whether it’s 70% or 100%,” said Zoe McLaren, a health policy expert at the University of Maryland, referring to vaccine effectiveness.

https://indianexpress.com/article/explained/covid-19-vaccination-use-of-face-masks-7213480/

Kidney care: Some dietary dos and don’ts that cancer patients need to follow

If you are suffering from a kidney condition, even cancer, be mindful of what you put on your plate.

The kidneys are vital organs, flushing out toxins from the system. They are key to keeping the body healthy and clean. As such, if something happens to them, the rest of the body suffers, too.

While there are many conditions that could affect the normal functioning of kidneys, kidney cancer and treatment requires special attention. “Many cancer treatments cause nausea or gastrointestinal problems, eventually interfering with one’s ability to eat and process food normally. In many cases, patients lose their appetite entirely, or get mouth sores that can make it difficult to eat anything,” says Apeksha Ekbote, chief dietician, NephroPlus.

 

She adds that because of cancer cachexia symptoms, the dietary needs and nutritional importance should be enhanced. Meals should contain immune-enhancing foods.

She suggests some dietary dos and don’ts.                                                         

Do’s

Eat healthy: It will help restore normal tissues, prevent infection, and maintain strength and energy. Well-balanced diets include lots of fruits and veggies, whole grains, high biological value protein sources like lean chicken or fish or soya products.

Watch out for protein intake: Kidney cancer patients need to be aware of how much protein they eat. Generally, the kidneys filter the waste out of the body, but that waste can build up in one’s bloodstream when the kidneys aren’t functioning normally. Hence, depending on whether or not one is on dialysis, the protein intake may increase or decrease.

Monitor the phosphorus: While seeds, nuts, and beans that are high in phosphorus can be enjoyed, one should watch out for the quantity of consumption. Phosphorus, which is a chemical element, can build up in one’s bloodstream, especially when the kidneys don’t work at full capacity. Limiting dairy products to 300ml/day will help one keep a check on the phosphorus levels.

Limit your meal quantity during the day: Kidney cancer patients normally feel nausea, diarrhea, and constipation during treatments. Hence, they need to adjust how and when they eat. Instead of large meals during the day, consume smaller portions every few hours.

 

Don’ts

Avoid drinking too much fluids: Since the kidney isn’t functioning at optimum levels, the body may not be able to make urine. Excess fluid can cause swelling, high blood pressure, and shortness of breath.

Avoid too much salt consumption: Sodium can cause high blood pressure, which deepens kidney problems. One should find alternative seasonings like herbs or lemon juice. Also, stay away from processed snacks and meats, canned foods, and fast food, all of which contain a high amount of sodium. Also, read food labels to keep a check on the sodium content.

Do not assume all diseases come with the same recommendations: Do not presume that all cancer diseases have the same diet plan. Diet suggestions can be different for every cancer, so make sure you relook at nutrition information specified for kidney cancer.

Do not stop exercising: Exercise is an important factor for any person who has a specific disease or has undergone surgery. It is mandatory to consult your doctor about the type of workout that is best for you.

 

https://indianexpress.com/article/lifestyle/health/kidney-care-some-dietary-dos-and-donts-that-cancer-patients-need-to-follow-7210982/

WHO: "Premature," "unrealistic" COVID-19 will end soon

 A senior World Health Organization official said Monday it was “premature” and “unrealistic” to think the pandemic might be stopped by the end of the year, but that the recent arrival of effective vaccines could at least help dramatically reduce hospitalisations and death.

The world's singular focus right now should be to keep transmission of COVID-19 as low as possible, said Dr. Michael Ryan, director of WHO's emergencies program.

“If we're smart, we can finish with the hospitalisations and the deaths and the tragedy associated with this pandemic” by the end of the year, he said at media briefing.

Ryan said WHO was reassured by emerging data that many of the licensed vaccines appear to be helping curb the virus' explosive spread.

“If the vaccines begin to impact not only on death and not only on hospitalisation, but have a significant impact on transmission dynamics and transmission risk, then I believe we will accelerate toward controlling this pandemic.”

But Ryan warned against complacency, saying that nothing was guaranteed in an evolving epidemic.

“Right now the virus is very much in control," he said.

WHO's director-general, meanwhile, said it was “regrettable” that younger and healthier adults in some rich countries are being vaccinated against the coronavirus before at-risk health workers in developing countries.

Tedros Adhanom Ghebreyesus said immunizations provided by the U.N.-backed effort COVAX began this week in Ghana and the Ivory Coast, but lamented that this was happening only three months after countries such as Britain, the U.S. And Canada began vaccinating their own populations.

“Countries are not in a race with each other,” he said. “This is a common race against the virus. We are not asking countries to put their own people at risk. We are asking all countries to be part of a global effort to suppress the virus everywhere.”

But WHO stopped short of criticising countries who are moving to vaccinate younger and healthier populations instead of donating their doses to countries that haven't yet been able to protect their most vulnerable people.

“We can't tell individual countries what to do,” said Dr. Bruce Aylward, a senior WHO adviser.

Tedros also noted that for the first time in seven weeks, the number of COVID-19 cases increased last week, after six consecutive weeks of declining numbers. He described the increase as “disappointing,” but said it wasn't surprising.

Tedros said WHO was working to better understand why cases increased, but that part of that spike appeared to be due to the “relaxing of public health measures.”

http://www.indiapress.org/gen/news.php/The_Pioneer/400x60/0

Lesson from the pandemic – the value of large-scale clinical trials

The speed and scale of the Covid-19 pandemic was surprising, Dr Gagandeep Kang, the

country’s foremost vaccine expert and professor of microbiology at the Christian Medical

College-Vellore, told Anonna Dutt. She said India needs to invest in creating clinical trial
networks to prepare for future pandemics.
 
Did you imagine the emergency would be this big when we started seeing the first few
cases?
 
All through March (last year), I was getting increasingly worried that it wasn’t something that
was being taken seriously. What surprised me was the speed and scale of the spread. It moved
much faster than I anticipated. And that I think is reflection of the reproductive number. We
probably underestimated it early on because we were relying on Chinese data. We got a better
handle on it when we started getting data from Europe.
 
Was it also because we were looking at data from the SARS outbreak?
 
The difference between SARS and Sars-CoV-2 – the good thing is it does not kill as much as
SARS does. The SARS case fatality rate was close to 10%. Only 8,000 people got infected but
almost 800 of them died. Whereas with Covid-19, we are having trouble what the case fatality
rate is. It looks like among the symptomatic, it is one in 100. But there are so many people
without symptoms that the infection fatality rate is lower than 1%. Sars-CoV-2, however, is
more transmissible because of asymptomatic infections.
 
What are the policy implications of this difference between Covid-19 and SARS?
 
In January (last year), we saw that they (the viruses) were similar. Initially, theWHO and China
were saying that there was no person-to-person transmission, which was quickly discounted by
the third week of January. Then, they were also saying that there were no asymptomatic
infections. And, that was something I was waiting for. Because, once you have a disease that
can spread asymptomatically, your methods for controlling the disease need to change
completely.
 
Towards the end of February, it became clear that this was happening and it could not be
handled the same way as SARS had been. All of the initial recommendations of hand-washing
and social distancing came from our understanding of SARS. But, asymptomatic infection is
when masks enter the picture and become even more important. Now we also know that it is
not just a droplet infection, you produce aerosols as well.
 
Was the lockdown necessary?
 
If we had a situation where everybody followed government instructions, then there would
have been no need for a lockdown. Countries such as Vietnam, Thailand, and Japan have all
shown that it is possible to manage without the lockdown as long as you have the resources,
the ability and the commitment. I think the lockdown was necessary because it conveyed to the
people that it is a serious issue and it stopped the movement of people. It also had many
unintended consequences like what happened to livelihoods, what happened to migrant
workers. It also created a fear in the minds of people, leading to stigmatisation.
 
I was really worried about the government-controlled testing of Sars-Cov-2. When they set up
testing in January, it was only NIV doing the testing, only NIV confirming it. And, that is
impossible for a country the size of India. Private labs were not even allowed to establish testing
until the end of March with the lockdown. So, you say you can start the testing now and you
lock the country down when all the kits are imported. Fortunately, testing has opened up.
All kinds of things were done which were a waste of effort and a divergence from the critical
issues like ramping up testing as quickly as possible. If the lockdown had been a lockdown
where imports were still allowed, it would have been better. I think now the government is
clear that it does not want to be caught in that situation. Diversification of the supply chain is
definitely something we should be thinking about.
 
What do we need to do to prepare for a future pandemic?
 
The one thing that we should learn from this pandemic is the value of large clinical trials. If
you go to the clinical trials registry of India, currently, there are hundreds of trials for different
drugs registered. All of them are recruiting just about 100 patients. If you take a tiny number
of people, you have a bad study design, you know what you what to prove, and guess what,
your study actually proves what you want it to.
 
We need to create clinical trial networks for drugs, vaccines, and procedures not just for
infectious diseases, but cancer, orthopaedics, cardiology and so on. We should fund one large
study rather than 30 smaller studies.
 
Then, there is surveillance. We need “one health” surveillance looking at both animals and
humans. It can be done separately but the data needs to be shared. There is a need for an
integrated data system.
https://epaper.hindustantimes.com/Home/ArticleView?newspaper=hindustan+times+(a
mritsar)&issue=87782013043000000000001001

Comorbidities list for vaccine eligibility seen as too narrow

India, as part of the second phase of vaccination, made people aged over 60 years and those

above 45 years with comorbidities eligible to get a vaccine from March 1
Focus on severe ailments, combination of diseases excluding many: experts
 
The Union Health Ministry’s list of 20 comorbidities that make people in the 45-59 year age
group eligible for a COVID-19 vaccine is seen by some medical professionals as too narrow.
“The list of comorbidities provided by the Health Ministry is overly restrictive and
complicated. Many conditions, including obesity, have been left out,” said Dr. Gagandeep
Kang, Professor of Microbiology at CMC Vellore.               
 
“The focus seems to be on people with severe diseases and combination of comorbidities,” Dr.
Anant Bhan, a researcher in global health and bioethics based in Bhopal said.
 
Hypertension is one of the common conditions that increases the risk of progressing to severe
COVID-19 disease and even death. However, people with hypertension alone are not eligible
unless it is accompanied by other diseases such as diabetes or conditions such as angina. “The
initial focus has been on severe forms of a disease or condition. In a month or two, we may see
less severe forms of diseases included,” says Dr. D. Prabhakaran from the Public Health
Foundation of India (PHFI), Delhi and one of the two members who prepared the list for
cardiovascular diseases. There were two members for each thematic disease who prepared a
list, and the final list was prepared based on suggestions from each group, he said.
 
Across the world, people with comorbidities have been identified as a high-risk group wherein
the person infected with SARS-CoV-2 virus has a greater chance of becoming critically ill and
even dying. The risk is higher in older people with comorbidities. India, as part of the second
phase of vaccination, made people aged over 60 years and those above 45 years with
comorbidities eligible to get a vaccine from March 1.
 
Besides being restrictive, the focus is on people with more than one comorbidity. With each
comorbidity increasing the chances of severe disease and death, focusing on people with more
than one comorbidity would have been acceptable in case of vaccine shortage. But with
millions of doses of both vaccines already available in India, it is not clear why the focus is on
diseases at an advanced stage, said Dr. Giridhara Babu, epidemiologist at PHFI, Bengaluru.
Many unaware
 
“Large sections of the population don’t even know if they have comorbidities. It would have
been better had we followed the U.K example, which has gone with age bands instead of
comorbidities,” Dr. Kang added. “It would have been easier to cover more people at risk with
age cut-offs.”
 
Diabetes is one of the major comorbidities resulting even in death in COVID-19 patients.
However, only those with over 10 years of diabetes plus hypertension are eligible for
vaccination. Similarly, only those with end-stage kidney disease and on haemodialysis are
included. People with stroke are eligible only if they also have hypertension or diabetes.
However, many suffer from stroke caused by aneurysm or haemorrhage caused by arterial
block in the brain even in the absence of hypertension or diabetes.
 
While asthma and chronic obstructive pulmonary disease (COPD) have not been specified, the
list includes those using corticosteroids for a “prolonged period” as being eligible. How long
is “prolonged ” is not defined.
 
Dr. Prabhakaran said there is evidence that people with more severe forms of disease are at a
greater risk of dying or becoming critically ill with COVID-19 disease and hence the focus has
been on vaccinating these people on priority. Dr. Bhan said when vaccinating people with
severe disease, there should be greater vigilance for serious adverse events and safety.
Unlike other diseases, more conditions of cardiovascular disease have been included.
“Cardiovascular disease is a spectrum, which may not be the case for other diseases,” Dr.
Prabhakaran explained.
 
“They should have ideally included people in institutional care, like people with mental health
conditions or those accessing healthcare facilities often as these people are at higher risk,” says
Dr. Bhan.
https://www.thehindu.com/sci-tech/health/coronavirus-comorbidities-list-for-vaccineeligibility-
seen-as-too-narrow/article33965547.ece

Pfizer, Oxford vaccines reduce severe COVID-19 in elderly, study finds

The Pfizer and Oxford-AstraZeneca vaccines for COVID-19 are highly effective in reducing severe coronavirus infection among people aged 70 years and above, according to a study.

The research, posted as a pre-print and yet to be peer-reviewed, estimated the effect of both the COVID-19 vaccines on laboratory confirmed symptomatic disease in individuals aged 70 years or older in England.

The researchers, including those from Public Health England (PHE), compared the rate of hospitalisation and deaths in confirmed COVID-19 patients aged over 80 who were vaccinated more than 14 days before testing positive, with unvaccinated cases.

Data suggests that in the over 80s, a single dose of either vaccine is more than 80 per cent effective at preventing hospitalisation, around 3 to 4 weeks after the jab, PHE said in a statement.

Evidence for the Pfizer vaccine suggests that it leads to 83 per cent reduction in deaths from COVID-19, it said.

The data also shows symptomatic infections in over 70s decreased from around three weeks after one dose of both vaccines.

"Vaccination with either a single dose of Pfizer or Oxford-AstraZeneca COVID-19 vaccination was associated with a significant reduction in symptomatic SARS-CoV2 positive cases in older adults with even greater protection against severe disease," said the authors of the study, adding both the vaccines show similar effects.

They said the protection was maintained for the duration of over six weeks of follow-up, and there is a clear effect of both the vaccines against the UK variant of concern.

Experts say the new analysis adds to growing evidence that the vaccines are working, and are highly effective in protecting people against severe illness, hospitalisation and death.

"This adds to growing evidence showing that the vaccines are working to reduce infections and save lives," Mary Ramsay, PHE Head of Immunisation, said in the statement.

"While there remains much more data to follow, this is encouraging and we are increasingly confident that vaccines are making a real difference," Ramsay said.

However, she cautioned that the protection is not complete and it is not known yet how much these vaccines will reduce the risk of  someone passing the coronavirus onto others.

"Even if you have been vaccinated, it is really important that you continue to act like you have the virus, practise good hand hygiene and stay at home," Ramsay added.

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