#BTColumn- BIM and COVID vaccines (Part 1)

Disclaimer: The views and opinions expressed by this author are their own and do not represent the official position of the Barbados Today Inc.

by Dr. Colin Alert

The COVID-19 pandemic has been with us almost for 18 months, and shows no signs of going anywhere in a hurry. In that case, it may be reasonable that we learn to live with it.

The Ministry of Health and Wellness has proposed many measures designed to help mitigate the viral onslaught. The COVID-19 vaccine – and we are being offered either the Oxford Astra Zeneca or Sinopharm varieties – is one tool that we have to fight the virus.

Some characteristics of the Oxford Astra Zeneca and the Sinopharm vaccines will be covered in the Part 2 of this article.
Meanwhile, I hope this article stimulates some consideration of getting the vaccine in those eligible to receive it that have not gotten it yet.

The decision to take, or not take, the vaccine has many components, including medical, legal, financial, religious, and even conspiracy theory components, but this article only deals with a few medical considerations.

Persons may choose to discuss at least the medical aspects with their personal physicians.
What does (either) vaccine do?
• The vaccine provides over 85 per cent protection against becoming seriously ill, needing to be hospitalised, or at risk of dying if you contract the virus. 18 months ago, at the start of this pandemic, the virus was killing about seven per cent of persons infected – case fatality rate.

Over time this has dropped to under one per cent (in Barbados we have had 49 deaths in over 4000 infected persons), but because of the large numbers of persons affected by the virus, over 195 million worldwide, over four million persons have died to date.
• The virus has certainly changed over time. The original strain of virus changed into an alpha-strain (UK variant), which was estimated to be about 2.5 times (but estimates vary greatly) more infective than the original strain.

The delta-strain (Indian variant), just in time for the Olympics because it is ‘stronger, fitter and trying to set new records’, is about 3 times more infective than the alpha-strain (again, estimates vary greatly, especially when the virus invades crowded city areas, as we have seen in Brazil and India).

This delta variant is currently touring the world. This means that, if one person had the original strain and unfortunately spread it to 2.5 persons, if he/she contracted the delta variant and there was no change in personal behaviour then he/she could spread it to a minimum of 7.5 persons. If the other persons are unvaccinated then they are at risk of getting seriously ill or even dying, as well as causing further spread.
• It is possible for a fully vaccinated person to test positive for the delta (or perhaps other) variant of COVID-19 because no vaccine is 100 per cent effective in preventing infection.

These cases, known as “breakthrough cases”, seem just to cause mild illness in the short term, but whether there will be long term consequences is not known at this time.
• Even though the delta virus seems to be less deadly than the strains that came before, this virus may still cause serious illness in those with co-morbidities, perhaps even if they are vaccinated. Less deadly does not mean it is not deadly. It is causing severe illness in children, for whom no vaccine has currently been approved.

It is also not clear at this time how many persons develop slight (non life-threatening) illness, how long these illnesses may last, and what happens over a longer period of time.

Some of these persons may develop the ‘long haul syndrome’, a series of covid-related illness that, at this time, we have no experience in what may happen in the long term. Medical researchers are currently following some of these individuals to see what happens to them over time.

• The delta strain is touring the world like a global traveller. It has long been said “if America sneezes, then the Caribbean catches a cold”. The delta virus is well on its way to cause sneezing fits in America: Caribbean countries (especially if their borders are not closely monitored) may be at risk for really bad colds, e.g. pneumonia.
• When the early surge(s) of the virus seemed to target the elderly and those with co-morbidities, an appropriate public health response was to try to protect these individuals by offering them protection, and the vaccine, when it became available, was part of this.

Now that younger persons seem to be more vulnerable to the virus, even though the case fatality rate has slowed, it is still one of the most appropriate public health responses to attempt to protect as many persons as possible, and this now includes younger persons.

Benefits to an individual of getting (either) vaccine.
• When fully vaccinated, an individual is much less likely to become seriously ill, or in danger of death.
• A fully vaccinated individual is ‘less likely’ to serve as a reservoir for large quantities of the virus. This ‘less likely’ cannot easily be quantified, but two possible consequences of this: 1. He/she is less likely to spread covid to unvaccinated individuals, including family members and un-vaccinated co-workers and 2. He/she is less likely to serve as a reservoir from which mutant COVID strains arise.
• The more covid virus there is around, the more possible it is for mutations to develop.
At the moment the current dominant mutant strain, the delta mutant, seems to be more infective but less deadly than the initial COVID strain.
And our current vaccines at least seem to keep the current mutant strain in check. But future mutants may be more deadly, more infective, and may not be restrained by our current vaccines. It is important that we try to stop further mutations, if possible.
• The more individuals that receive the vaccine the better chance of keeping the virus at arm’s length, as we approach what is called ‘herd immunity’.

However, herd immunity depends on how contagious the virus in circulation is: herd immunity was estimated to be about 70 per cent for the original strains, but rises for more contagious strains. For the delta strain, some epidemiologists suggest that 85 per cent population coverage may be needed.

• Some persons believe that, if they get the virus and suffer only mild symptoms, then their bodies will build up some immunity to the virus, and perhaps some mutant strains.
Unfortunately, in this approach, many more persons would die.

Most of the vaccines available to date seem to provide more protection – an increased immune response – than one develops from getting the disease naturally. Vaccinated persons would then be in a better position to ward off some future virus attacks, as well as reduce the number of deaths.

Benefits to a community of having vaccinated individuals.
• A vaccinated individual is less likely to spread the virus to unvaccinated family members. This may be a young child, for whom vaccines are unavailable at the moment, or an elderly relative with a co-morbidity like obesity, diabetes and/or hypertension. In either case it can disrupt whole families.
• A vaccinated individual is less likely to spread the virus to unvaccinated co-workers.
We have seen how one infected person can cause work places to shut down – bad news for everyone. While we may or may not have a national lockdown in the future, the more persons that get the vaccine the less likely this will happen.
• We have seen scenarios where positive COVID-19 tests have shut down countries, stopped major sporting events like the Olympics or the IPL, stop national cultural events like Crop Over, cause economies to collapse and put people on the unemployment line.
If we can get large enough numbers of persons to be vaccinated, to reach the point of community or herd immunity, this can significantly interrupt the spread of the disease, and slow or stop the generation of mutant strains.
• Even when the virus does not cause major medical illness or even death, it has still caused major financial disruption all over, in persons who do not even contract the disease.

It is disrupting schools and universities. It is disrupting our artists and our sports persons.
It has generated a large number of psychological issues, which potentially may have long-term effects in our communities.

A large number of individuals in a community who are vaccinated can slow down the rate at which the psychological health of the community deteriorates.
• If, or perhaps when, based on what we are seeing in the rest of the world, the delta variant arrives on our shores and manages to evade our border defences, then a large vaccinated population will provide a second line of defence, as far as deaths are concerned.

The COVID vaccines can provide much more than medical benefits, to individuals and a community. As countries around us collapse, vaccines, and a variety of other protective measures, may help us stay afloat, and help us get back on our feet. Both individually and as a community, we can benefit from COVID protective measures, including the vaccines.

Dr. Colin V. Alert, MB BS, DM. is a family physician and associate UWI family medicine lecturer