Living with the pandemic: Where we stand today
MUSCAT: Almost 2 years into the pandemic, mankind has never been blessed more. We could for the first time since the beginning of this once-in-a-century pandemic that has altered our lives beyond recognition managed to come up with the first vaccine for COVID-19 in less than a year. This will go down in history as one of science and medical research’s greatest achievements, perhaps the most impressive. We currently have about 8 peer-reviewed vaccines which can give reasonable protection against the severe form of COVID infection. We have two novel oral antivirals which are active against all variants assessed.
Two things that should be clearly understood are that no vaccine will make a PCR test turn positive and vaccines against contagious respiratory viruses, like Flu and now COVID, are supposed to keep people out of hospitals and away from ventilators. This is their historical barometer of success. They are not intended to prevent a positive test.
We live at a time where >65% of the world has encountered SARS CoV-2 antigens either through infection or vaccination. We have crossed more than halfway through the pandemic according to renowned epidemiologists and Infectious diseases specialists worldwide. By now we know the only way to win against this pandemic and its omicron variant is through a triple vaccine mandate, mask mandate and ensuring COVID appropriate behaviour always as responsible citizens. We as citizens should get vaccinated, wear masks, avoid overcrowded closed spaces as the spread of this viral infection is by droplets and aerosols which can be breathed in and even remain suspended in the air for a while after an infected person sneezes or coughs. Prior infection immunity may not protect well against Omicron. We must get vaccinated and boosted.
Omicron and triple vaccine mandate
Omicron is an infectious variant spreading in a non-immune population, with a much shorter incubation time, therefore, a much faster doubling time. It is more contagious than the delta variant. The biggest concern with omicron is that it contains >30 mutations in just the spike protein, the part which helps it enter human cells and the target for vaccines.
7 COVID variants of concern emerged in the past 14 months.
Alpha and Delta caused major damage. Others fizzled away. The 4 countries with the highest documented Omicron burden have each exceeded their pandemic record for new cases, and still ascending rapidly which being the major worry.
The data from South Africa and the United Kingdom shows that there are higher rates of reinfections and breakthrough infections with this new variant. Many people have got infected for a second and even a third time with this variant in SA. The risk of reinfection with the Omicron variant is 5.4 times greater than that of the Delta variant which was 2-4 times more severe than the original Wuhan 1.0 strain. As SARSCoV2 evolved to Omicron, transmission and immune escape reached new levels, fortunately, 3 independent studies from top labs, including one in a well-regarded in vivo model, all show reduced lung infectivity vs Delta virus infection.
Omicron’s immune evasiveness across all vaccines and prior Covid infectees is due to the marked decline in neutralising antibodies which is seen with all vaccines. Besides studies remarked a waning immunity and reduction in vaccine effectiveness with time after the second vaccine dose. Hence a booster shot is now advocated, and a third shot restores it to around 70%. It is given as early as 3 months for all above 18 years from the second shot to protect well against the Omicron variant. Protocols including the administration of booster doses within a reduced time frame that keep up with the latest evolving science should be implemented to win over this pandemic.
Though less severe illnesses related to Omicron are reported from the world over for now it doesn’t mean our hospitals and healthcare workforce will not be overrun. Despite the “omicron is milder” observation, hospital visitations and admissions for COVID-like
illnesses are on record pace in New York City currently. When case numbers go high suddenly, hospitals overburden and there will be a shortage of beds and that ultimately leads to an increase in mortality numbers especially with this Omicron variant which can double in 1.5 to 2 days.
We have a vaccine in abundance thanks to the MOH, so as citizens it is our collective responsibility to make sure the hospitals don’t get overburdened by ensuring triple vaccine mandate, mask mandate and ensuring COVID appropriate behaviour everywhere. As a parent or teachers, we can protect our unvaccinated children or students better if we ensure the above. We can further guide our loved ones to vaccinate if they are eligible for the third booster shot as a responsible citizen or help an unaffordable person to take the third shot.
Child vaccination& school
COVID-19 is also a childhood infection. About 6 million children had been infected in the United States before the Omicron wave. Almost 700 children have died from COVID-19 infection in the US to date making SARS COV-2 infection among the top 10 causes of death among US children. No child has died from vaccination. Vaccine-associated myocarditis in the young has been rare, relatively mild, and self-limited.
Pfizer has started vaccinating children aged 5-11 years with paediatric dose vials in the US. Adult vaccine stock cannot be used for this age group without tricky extra double dilution. It is colour coded with orange caps, to avoid mix-ups with purple-capped vials of adult vaccine.
The FDA examined more children, a total of 3,100 who were vaccinated, in concluding the shots are safe. The younger children experienced similar or fewer reactions -- such as sore arms, fever, or achiness. According to the data for Pfizer vaccination in the US for children aged 5-11 years dated December 20th, more than 6 million children got their first doses and >2.5 million with their 2nd dose and there are no major complications reported.
Children must go to school, meet their friends, actively play, and participate in extracurricular activities for their social and emotional development. This is their life. Cloth masks are not enough. Triple vaccine mandate for all school employees, vaccination for children, mandatory mask mandate using high-grade masks and Covid appropriate behaviour should be practised strictly in schools with proper distancing allowing classes like singing and eating lunch practised out in the open is the current trend among many European countries.
CDC released indoor air guidance for schools during COVID-19, which emphasises: “Opening windows, using portable air cleaners, improving building-wide filtration are ways to increase ventilation in school or childcare programme.”
If possible, there must be air filtration with Corsi-Rosenthal boxes and ventilation, at least of MERV-13 standard or even portable HEPA filter for larger classrooms or high-density rooms which is currently practised as a standard of care in many countries. Also important is CO2 sensors. We want CO2 levels as close to the fresh air as ~400 and it needs to be monitored. Such practices are common in many European schools and gyms and spike up over 1000–meaning poor indoor air. Or lastly if the above is not possible, practice common man’s resort- open windows and cross ventilate the room frequently.
Vaccinating all children against COVID-19 could be among the most impactful public health efforts. However, a choice not to get a vaccine is not a risk-free choice; rather it is a choice to take a different and more serious risk.
The way forward
Vaccinate and get boostered, avoid indoor crowded spaces as much as possible, use KN-95 or N95 masks at high-risk public indoor spaces if no choice, take air travel only, if necessary, use rapid tests before gatherings. If gatherings are unavoidable have them outdoors with a strict mask mandate and distancing. Wash your hands before touching your eyes or nose and before meals.
(Inspired Source - Articles, opinions, views and write-ups by Dr EricTopol, Dr Michael Mina, Dr Eric Feigl-Ding, Dr Vincent Rajkumar, Dr Faheem Younus, Dr Anthony J Leonardi and other profound Infectious disease specialists and epidemiologists worldwide, Newspaper articles from US & UK, CDC & NHS updates.)