CME INDIA Presentation by Admin.

More than a year after COVID-19 emerged, still many mysteries persist about the disease. We do not know why do some people get so much sicker than others? It is still a mystery – Why does lung damage sometimes continue to worsen well after the body seems to have cleared the SARS-CoV-2 virus? And what is behind the extended, multi-organ illness that lasts for months in people with ‘long COVID’? Nobody knows.

Now these questions are fading in physician’s mind. Now new avatar is COVISHIELD and COVAXIN in India. As per health ministry one million COVID-19 vaccine doses have been administered in India in just 6 days, a count which is higher than that of countries such as US and the UK. In addition, India continues on its steady trajectory of reporting a sustained downfall in the daily new cases.

Celebrating Vaccination in spite of all odds is now the NEW TREND.

When asked, how are you feeling after getting vaccinated with COVAXIN, my friend sent this:

ये इश्क नहीं  आसां , बस इतना  तो  समझ  लीजे ,

एक  आग  का  दरिया  है , और  डूब  के  जाना  है .

कागज  की  हवेली  है , बारिश  का  ज़माना  है ,

आवाज़  भी  जख्मी  है  और  गीत  भी  गाना  है .

CME INDIA members share their experiences:

Dr Basab Ghosh, Agartala:

• We from clinic took Covishield yesterday. Among all, I had a tough time. After eight hours, gradually I developed uneasiness, body ache, fever and headache. I didn’t take PCM, just wanted to experience how much dead Corona could irritate me. It was overall a bad night all together! In the morning took PCM and now feeling better 😊

Dr Ambrish Mithal, DM,Endo, Max Healthcare, Delhi:

• I have mild malaise and low-grade fever- 99.3. Started late night. Settling now. Feeling almost normal but not 100%. Have a busy day☺️ figuring out what to do. About 40 appointments, 2 lectures🤦‍♂️.my secretaries had suggested that we should do 50% today. But I overruled them 🤣. Checking with the team. I was vaccinated with Covishield around 11. 30 am yesterday. I was fine in the day.  Late last night/ early morning had low grade fever 99.4. with malaise but no body ache or chills. I woke up feeling lousy – popped in an antipyretic. By 10 am I was much better. By 1 pm had forgotten about it. All good. Saw patients from 9am to 6 pm. Then two webinars. Now going to eat and watch Crown. ☺️

Dr Ashish Gautam, Asso. Prof. Med., Agra:

• Mixed reactions post vaccination in Agra.
• Few hospitals claimed temperature rise 103 of their staff post vaccination requiring IV paracetamol.
• Most of staff in govt. hospital are absolutely fine. Those who were previously COVID positive develop more symptoms. Those who didn’t had COVID history are absolutely asymptomatic.

Dr Vasanth Kumar, President Elect RSSDI, Hyderabad:

• Just to inform our friends that 6 of my friends took Covaxin a week back. Youngest was 30 and the oldest 72. None of them had any complaints at all.

Dr Payal Jain, Prof GNIMS, Noida:

• I got COVID in November 1st week. Received Covishield on 22nd Jan. Only local injection site pain until now and also antibody titer done on 17th Jan was 1.26.

Dr Hem Shankar, Bhagalpur:

• You didn’t have sufficient antibody levels. Now the vaccine will take care.

Dr Arvind Gupta, Diabetologist, Jaipur:

• I am vaccinated with Covishield today. Feeling good and elated. Please do not get carried away by the reports of others. That way we can overcome the effects of vaccine. It’s my personal opinion.

Dr Meena Chhabra, Diabetologist, Delhi:

• It is not about getting carried away but it is about being aware that mild to moderate side effects are to be expected That is why I shared the elation but also the side effects I faced.

Dr Prabhat Agarwal, Agra:

• My observation is, who got COVID previously developed severe symptoms like fever and myalgia and joint pain after vaccines!

Dr Basab Ghosh, Agartala:

• I have the same feelings. But regarding my clinic experience. I was COVID positive and had severe symptoms like fever, body ache, headache. However, my clinic’s another female staff 46 yr. was COVID positive, but had no symptoms after vaccination. Another female staff 36 yr. obese didn’t have COVID, but had severe symptoms after vaccination.

What to do when?

• Initial COVID positive, High antibody levels, etc. are not contraindicated for COVID vaccine, rather all citizens are to be vaccinated as on date guideline – Dr Basab.

• My relative’s COVID antibody total is >10. Should she take COVID vaccine or not? She was COVID positive in October. Then fully recovered – Dr B K Sharma.

Dr prabhat Agarwal Agra: Yes, no confusion

• CAD, HTN, and on ECOSPRIN:

Anti-platelet drugs like aspirin and clopidogrel are not even considered as blood thinners and don’t show any contraindications.

• Post-COVID vaccination, how to detect if patient has active infection?

Dr Raghuraam, DNB ophthalmology, Dist. Hosp., Dharwad: Hi sir, post COVID vaccination, how to detect if patient has active infection. I have severe symptoms after vaccine, started next day. No co-morbidities, age-34 yr.

Started with:

1. Mild continuous fever with occasional severe chills.
2. Severe myalgia from da1 to day 6 today.
3. Severe cough with expectoration.

No relief on augmentin or azithro. Kindly advise… Took vaccine on Monday 18th Jan 4.34pm. Symptoms started on 19th Jan., Tuesday after 11.30am.

Dr Anu Jain, Ambala Cant:

• Should  get all relevant investigations including cxr done.

Dr Atri Gangopadhyay, Pulmonogist, Ranchi:

• The person may be having symptoms prior to vaccine too.
• Get RTPCR and COVID Antibody (IgM and IgG)

Dr Subrahmanyam Karuturi, Rajahmundry, AP:

• Vaccine stimulates your immune system. When your immune system gets activated you become sick. That’s natural. It’s called as vaccine reactions. Not side effects

Dr H D Sharan, Ranchi:

• Your symptoms could be due to
• Fresh infection with SARS CoV 2 so get RT PCR done  Also CRP, D DIMER and HRCT Chest .
• It does not look like a reaction as reaction should not persist for so long although much is not known about Covaxin

Dr Tapas Kumar Koley, New Delhi:

• Please get all investigations done asap related to COVID-19 as well as for nonCOVID conditions. Check your oxygen saturation. If RTPCR is positive, go for HRCT chest for early signs of pneumonia. Without much data about Covaxin, it is difficult to opine whether it is a vaccine reaction or something else. Regards and best wishes.

Dr Suresh Kubavat, Consultant Physician, Goraj Dist., Vadodara:

• Many colleagues were discussing about post vaccine symptoms
• Symptoms do suggest that the vaccine is really working.
• Interesting would be to do the titre of antibodies and correlate the severity of post vaccine symptoms. Severe the symptoms, higher should be the antibody titer after one month following second dose. Second , those having severe symptoms should take vaccine on working days and be ready for more symptoms, though may not be alarming.
• I got reply from another doctor colleague as follows – “As of now doing post vaccination titre of antibody is not useful as the antibodies developed by vaccines are different from the antibodies produced by natural COVID infection…..they are called spike antibodies. So the antibody test will show vaccine induced sero positivity (VISP) result….not specific.” Once we have antibody tests specifically to pick vaccine induced antibodies….then these titres will be useful.

Dr Shashank Joshi, DM Endo, Mumbai:

• Post 6 weeks one needs to do titres of Neutralizing antibodies if u need to know about immune status.

Dr Praveen Kulkarni, MD Medicine, Miraj, Maharashtra:

• I took Covishield  vaccine on Friday (22/1/2021). Had fatigue, headche after 12 hours. Then high grade fever (101) after 24 hours. Didn’t take any drug. All symptoms disappeared after 36 hours without any drug.

Dr Keyur Acharya, Intensivist, UK:

• Not sure about more symptoms and more efficacy here. These vaccines have been studied extensively and are being given all over world to millions of people and no major reactions are reported. This tells me it is safe.
• Efficacy – again trials have shown them to be effective. After 10 to 12 days of first dose( may have got exact days wrong) my chances of going to hospital with severe symptoms needing hospitals are minimal.
• As regards to doing antibody titres,  it is not cost effective and in absence of baseline data about levels of titres needed, at what time etc. I don’t think it will add any meaningful conclusions. We are still not in precision medicine era and not certainly in middle of pandemic.
• Pragmatically,  if I have symptoms persisting after 48 to 72 hours of vaccination,  I would personally be looking for another explanation- COVID or non COVID.

Dr Basab Ghosh, Agartala:

1. COVID antibody IgM and RT-PCR should be helpful to know whether he had active infection or not!
2. But, how to get relief of the situation? As he is beyond viral stage dt wise Methylprednisolone should be helpful for him?

Answer: Yes

CME INDIA Learning Points

• The race to develop safe, effective vaccines against severe acute respiratory syndrome coronavirus 2 has produced impressive results.
• Phase 3 data for two RNA vaccines, BNT162b2 (Pfizer/BioNTech) and mRNA-1273 (Moderna), and the adenovirus-vectored vaccine ChAdOx1 nCoV-19 (Oxford University/AstraZeneca) have been published in peer-reviewed journals.
• Further phase 3 reports are expected imminently. 
• Mass-vaccination programs should be celebrated.
• Many challenges lie ahead in reaching eligible recipients and protecting those at risk from COVID-19-related morbidity and mortality.
• On Jan 16, 2021, India launched its program with the goal of reaching 300 million people by August, 2021.
• The country has approved the use of ChAdOx1 nCoV-19 and the whole-virion inactivated vaccine BBV152 (Bharat Biotech); however, there are fears that the rapid approval of BBV152, phase 3 results for which are not expected until March, 2021, might undermine confidence and add to the growing problem of vaccine hesitancy in India-Lancet says.
• The hope is that vaccines will provide lasting benefits, but careful monitoring will be needed to establish the durability of protection.
• Emerging SARS-CoV-2 variants are a cause for concern. New variants also emphasise the ongoing need for public health mitigation strategies and add to the urgency of vaccine rollout across the globe.

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