COVID-19 Precaution Dose – How politics overrule scientific approach

All citizens were made guinea pigs by political leaders who perhaps felt the need for a major gamble to win elections! We are fortunate that we are no worse as by using homologous vaccines one’s body had already tolerated the vaccine.

By RK Nimai

As done by some developed countries, India also started providing a booster dose called precaution dose for COVID-19 to those who had two doses of vaccines with a gap of nine months after the second dose, which was subsequently reduced to six months. In other countries, it was heterologous vaccination, while in India it was homologous, as it is claimed that heterologous vaccine provides better immune response, though it is still not very clear. Heterologous means different vaccines while homologous means the same vaccine.

Politics overrule scientific approach

WHO do not recommend booster dose as they are more concerned with the large population left out in the poorer countries that can continue harbouring the virus to be spread all across the globe! Despite this, all countries which can afford it have started the booster dose, with some even administering the fourth dose.

The Central Drug Standards Control Organisation, the country’s nodal drug regulator and an independent body under the Government of India had not approved the precaution dose.

No data on the efficacy of the precaution dose using homologous vaccination, that is those who received Covishield continue with it and those who got Covaxin also got the same, or heterologous vaccines were then available in India. In other words, politics overruled scientific approach, and the manufacturers did not submit any data on the efficacy.

The decision, ,perhaps was related to the election to the states, including Manipur and UP held in February-March.

Preprint papers relating to the efficacy of the precaution doses started appearing in June, six months after mass administration.

All citizens were made guinea pigs by political leaders who perhaps felt the need for a major gamble to win elections! We are fortunate that we are no worse as by using homologous vaccines one’s body had already tolerated the vaccine.

It is only recently that Corbevax of Bharat Biotech was approved for use as a booster dose from 12 August.

Covovax, the Indian version of Novavax manufactured by Serum Institute of India still does not figure among those approved for booster dose.

The importance is that the third and the fourth wave were driven by Omicron variants and its sub-lineages and most of the studies then were against Delta variant, the driver of the second wave, which unfortunately led to high mortality.

Even now the data on the efficacy of the various vaccines against omicron and its sub-lineages are still limited, though there are claims of developing vaccines specific for omicron variants.

Fourth wave in Manipur

In Manipur the fourth wave can be said to have tapered by now as the number of people tested positive has gone down considerably. Fortunately, the number of mortality is also small, those succumbing being mostly among those with comorbidities.

From July 1 till August 22, the number of positive cases was 2,350 and the number of deaths stood at 25. Of the 25, 22 had comorbidities while 3 are free from co-morbidities; eight were unvaccinated, five vaccinated with the first dose, 11 with the second dose, one with precaution dose while seven were unvaccinated.

From the data it is clear that comorbidities drive mortality and those with comorbidities need to be cautious; even those with second dose of vaccination.

Which sub-lineages are driving the fourth wave?

As there is no announcement in the public domain as to which sub-lineage of Omicron variant is driving the infection in Manipur and perhaps genome sequencing, which is a costly and time consuming affair perhaps not undertaken, one is still in the dark which sub-lineages BA.1, or BA.2, or BA.4 or BA.5 are driving the fourth wave.

In Delhi, it was reported that majority of the cases were by BA.2.75 sub lineage and with physical communication normal there is every possibility of this sub-lineage already spreading in Manipur.

In the United States and Europe, BA.5 is the main driver. No distinct symptoms have been reported for BA.2.75 sub-lineage but reports in the middle of July indicate scratchiness, dryness and pain causing sore throat which is usually mild, particularly among vaccinated persons and lasts for about four-five days.

Sore throat can be followed by other symptoms like loss of smell or taste, chills, fatigue, body aches, diarrhoea, nausea and vomiting. But most of the cases do not proceed to the more serious symptoms.

Many cases go undetected
As the symptoms are mild in the fourth wave of the pandemic, many just do not feel the need to get tested, as a result many cases perhaps go undetected spreading the infection.

Recently in the middle of August another report indicated that the symptoms are mild with low grade fever while many are asymptomatic. Even though the fourth wave is mild, it can still kill as we have cases who had precaution doses succumbing to the disease as well as persons who have no co-morbidities and had the second dose of vaccination.

Sub-lineage BA.2.75

The WHO on July 6, 2022 declared sub-lineage BA.2.75 as a variant of concern. Other sub-variants circulating in the globe are BA.4, BA.5, BA.2.38, and BA.2.12.1 with their unique mutations.

Efficacy of diabetes drug
Since the last part of 2021 reports are appearing about the efficacy of Metformin, a diabetes drug towards the management of COVID-19. It has now been reported that early use of this drug could reduce hospitalisation and mortality.

Proper management of blood glucose levels reduced disease severity, incidence of acute respiratory distress syndrome, requirement of ICU admissions and mortality among COVID-19 patients.

It has been theorised that Metformin reduces blood glucose levels and increases insulin sensitivity and could, possibly inhibit viral infection, multiplication, maturation, inhibit translation of viral proteins, regulate viral protein-host protein interactions and the immune response in COVID-19 patients.

However, it must be understood that no medicine should be taken without the advice of medical professionals as taking Metformin can lead to hypoglycemia.

Good News – Antibody fragment VH Ab6
One positive report appeared in Nature Communications recently that an antibody fragment VH Ab6 can attach to a site in the spike protein which was conveniently called “weak spot” and this neutralises the ability of SARS-Cov-2 to enter human cells. The good news is that this weak spot is present in all variants thereby indicating that mutation in this region is rare. Pharma companies can develop both prophylactic and therapeutic medicine to combat COVID-19, irrespective of the variant.

Controversy over DOLO-650
With the controversy over the prescription of DOLO-650 manufactured by Micro Labs, instead of 500 mg of paracetamol due to alleged inducement, one needs to be careful and even question any doctor prescribing paracetamol tablets which have more than 500 mg.

Micro Labs has been alleged to have spent about Rs 1,000 crore on freebies which were strenuously contested by the company claiming that IT sleuths had collated all the marketing expenditure for the past many years to arrive at this figure and its sale of DOLO-650 during COVID-19 years come to about Rs. 350 crore.

The matter is now with the Supreme Court but, if true, it confirms the strong nexus between doctors and pharma companies. Any drug has side effects and the doctor weighs the benefits and the side effects and prescribes medicine.

Paracetamol is contraindicated to those who are hypersensitive to acetaminophen, the active ingredient, and has severe hepatic impairment and severe hepatic disease. Although it is a well tolerated medicine it has side effects some of which are nausea, vomiting, constipation, etc for administration through oral route.

Some rare side effects are bloody or black tarry stools, bloody or cloudy urine, pinpoint red spots on the skin, skin rash, hives or itching, sudden decrease in the amount of urine, etc and if such symptoms are observed you must consult medical professionals immediately.

Most Important Preventive Measures
Since the symptoms during the fourth wave are mild, many are not tested, making one never sure who is suffering from COVID-19 and who can spread the infection. Thus one ought to be careful.

Some of the preventive measures are getting vaccines and those eligible for precaution doses to get it.

Masking in public spaces remains the most important preventive measure but hardly practiced.

Public spaces, especially schools, colleges and the bazaar area must insist on masks so that the disease spread is minimised.

Those who had symptoms need to immediately contact the healthcare system and get treated immediately.

Proper hand hygiene must be observed and rooms where multiple persons sit together or people visiting must have the doors and windows open.

SARS-Cov-2 mutates rapidly and one never knows the behaviour of future variants, and any one of them could be more severe and more contagious, thus basic precautions are the need of the hour.

(The view expressed are personal)

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