Several years ago, the coronavirus became a powerful factor affecting our lives. It is not surprising that vaccination against COVID-19 is the most discussed topic today, both in private conversations and in the official news. In the modern information environment, it quickly becomes overgrown with conjectures, guesses and myths.
What is really going on? We decided to ask Fedir Lapii, a pediatric infectious disease specialist with 23 years of experience, author of more than 40 scientific papers, associate professor and the head of the technical group of Shupak’s Department of Pediatric Infectious Diseases and Pediatric Immunology.
Lana Synychkyna, a lawyer and a partner of JSC Arzinger, conducted a conversation with the hero.
NEW WAVE OF THE EPIDEMIC: EVERYTHING IS MUCH MORE SERIOUS
Modern humanity lives in a changing reality, to which it is necessary to constantly adapt. This also applies to our response to the pandemic, such as a lockdown.
Over the past year and a half, a certain amount of experience has been accumulated, which allows us to say that the “nationwide lockdown” is no longer relevant. We now use the term “adaptive quarantine”.
Its essence is that radical restrictions apply only to those regions in which a certain level of morbidity has been reached. Lockdown is one of the most effective ways to contain the growth in the number of patients requiring hospitalization.
When we try to describe the spread of COVID-19, we must understand that “wave” is a very conditional concept. But, if you learn the statistics of morbidity, it will become obvious that the rise is indeed followed by a decline, and then an upturn again… The current conditional wave differs from the previous ones.
Firstly, the number of daily deaths has increased significantly. Secondly, the number of patients, including those who are seriously ill, is growing faster. Thirdly, the condition of patients in hospitals is characterized as more severe.
Fourthly, the good news is that we now have a vaccine. Without vaccination at this generally more difficult stage, it would be very difficult for us to fight COVID-19.
Moreover, the delta variant of the virus is more easily transmitted from person to person, therefore, many more people get sick with it. It should be understood that over the course of several years, many people are psychologically tired of “keeping their distance”, they often ignore the threat of infection, and this also contributes to an increase in the number of patients.
A distinctive feature of this wave is that the number of sick children has increased significantly. But this may be due not so much to the peculiarities of the “delta” as to the increase in the number of social contacts — the summer period is over, the children have gone to schools and kindergartens.
VACCINATION: TIME TO DISCOVER MYTHS
There are many myths about vaccination. I want to dispel some of them. A vaccinated person can also become infected and get sick with COVID-19. Therefore, he must continue to abide by the generally accepted rules: wear a mask, keep his distance, wash his hands and ventilate the room.
The advantage of vaccination is that if a vaccinated person gets sick, he allocates the virus in a much smaller amount. And the period during which this happens is much shorter. It would seem that medical science has established this unequivocally.
But, unfortunately, scientific articles that set out the results of vaccination research are now available to a huge mass of non-specialists. And they draw the wrong conclusions from scientific evidence.
For example, there is evidence that the respiratory tract of both vaccinated and unvaccinated sick people secrete RNA (ribonucleic acid), and this is fixed by PCR tests.
The layman does not see the difference and on this basis speaks of the ineffectiveness of the vaccine. In fact, the real picture is different and there is still a difference. RNA is not a full-fledged virus, but, roughly speaking, a part of it, to which the test reacts.
That is why a PCR test can be positive even if a person does not present a threat to others at the moment, but presented it two days ago.
You can only become infected with the whole virus, not its RNA. Therefore, having become ill, a vaccinated person is in any case less dangerous to others. For the simple reason that the “whole” virus is provided in smaller quantities and the provision process ends much faster.
In any case, if a patient has a positive PCR test, doctors will prefer to treat him as infected with a virus. I’ll try to explain why in the current conditions it is better to play it safe…
Yes, laboratory methods, due to a number of circumstances, can make some mistakes. They can give false positive or false negative results. Physicians should take this into account.
But in a situation where intensive care units are overcrowded with people who are in a critical condition, it is much more prudent to neglect this error. Laboratory research is important and testing methods need to be improved.
But, fighting the epidemic, attention should still be focused not on them, but on the effect that vaccination gives. The example of the UK shows that with 80% of the vaccinated population, the number of people who require hospitalization is reduced by 4 or more times.
IS THE VACCINE INEFFECTIVE? THIS IS NOT TRUE!
Yes, there are social groups (for example, elderly people with serious concominant diseases) for which the vaccine is less effective. The same Pfizer BioNTech, on average, 95% effectively protects the body from COVID-19 and helps to avoid hospitalization.
But if you take separately vaccinated cancer patients or elderly people, the effectiveness of two doses drops to 75%. Famous example: US Secretary of Defense Powers, who died of COVID-19 after being vaccinated with two doses.
This case has been widely discussed… However, before arguing that vaccinations are ineffective, let’s consider that the 85-year-old minister was a very elderly and sick man: he had stage 4 cancer.
Even with a general decrease in morbidity and mortality from COVID-19 in the population, seriously ill people, unfortunately, are not protected from such cases. But with a high percentage of vaccinated people, the healthcare system is coping much better with the pandemic.
It means that the chances of avoiding death becomes greater, including for those people who are at risk. It can be seen not only in Britain, but also in Israel, where 70% of the population is vaccinated.
In Denmark, Norway, Finland, Portugal — there are already more than 90%. In these countries, deaths and serious cases have become so rare that they have even launched a program to reduce beds, dedicated to covid patients.
IMMUNE RESPONSE: IT’S ALL ABOUT GENETICS
Precedents, when a person at a young age, vaccinated with two doses, without serious pathologies, dies from COVID-19, are observed. But they are isolated cases. It’s difficult to understand why it happens, it’s needed to understand each specific case in detail.
It is possible that the conditions for storing and transporting the vaccine were violated — for each type of vaccine, there are specially developed conditions. For example, CoronaVac, AstraZeneca cannot be frozen.
Pfizer and Moderna are frozen only during the long-term storage phase, but they cannot be re-frozen after defrosting once. If the storage conditions have been violated, the vaccine may not work and not form an immune response, that is, a person at risk may remain unprotected.
In addition, it must be borne in mind that genetically we are not the same. We are very different. There are people who are outwardly healthy, without obviously serious diseases, but the peculiarity of their body, for some reason, does not allow them to develop an immune response. From an evolutionary point of view, there is nothing strange in the fact that such people end up in intensive care. Evolution is generally a cruel thing.
But medicine is precisely what makes a person survive, contrary to the laws of evolution, the laws of nature. For the sake of this, doctors actively intervene in the process of natural selection. But we cannot take into account all the genetic characteristics of people that affect the consequences of vaccination or COVID-19 disease.
However, we can safely say that the current standard two-dose vaccination guarantees a good level of protection for most people. At the same time, medical science does not stand still. Research in this area is ongoing.
The possibility of increasing the interval between the first and second doses of the vaccine is being discussed. It is likely that if it is longer than 21 or 28 days, the protection will be much more effective. Also, for better protection, a booster dose will be recommended, 6 months after the second dose of the vaccine.
Now let’s look at the cases when a person gets sick after the first or second dose of the vaccine. Why is this happening? The fact is that the COVID-19 vaccine does not work for emergency prevention, that is, when the infection has already occurred, but symptoms have not yet developed. Here, too, doctors are gradually accumulating statistics, on the basis of which certain recommendations will be developed.
WHEN WILL THE PANDEMIC END?
There are various theories about how life originated on our planet. But we know for sure about viruses — these are very ancient inhabitants of the Earth. They stood at the very beginning of the evolution of all life on the planet. For millions of years, they mutate, adapting to changes.
The most susceptible to mutations are the most stable ones. For example, RNA viruses, which include SARS-COV-2. Mutations can both enhance the negative impact of the virus on our body and weaken it.
Virologists cannot always predict this, if only because the history of the existence and mutations of viruses is millions of times longer than the time it takes scientists to observe them. People learned about them a little over 100 years ago.
Based on our knowledge of past epidemics, we can predict that the acute phase of the pandemic in the European region will end in 2022. If there are no surprises. But even if the pandemic subsides, COVID-19 will not go away, we will most likely have to learn to live with it for many years.
In other regions of the planet, the situation may turn out differently. Because different countries have different levels of vaccination. And let’s not forget that it does not stop the spread of the virus, but only reduces, prevents severe cases of COVID-19.
DOES VACCINE INCREASE VIRUS MUTATION?
Definitely not. This is another myth. A vaccine, on the other hand, allows us to prevent the virus from mutating. The virus changes only inside our body, it cannot mutate outside of it. The vaccine reduces the residence time of the virus in the body, therefore, reduces the likelihood of mutations.
Viruses are constantly mutating, regardless of whether we use a vaccine or not. This is a natural selection, this is how they survive, adapting to environmental conditions. For example, they can live in the body of an animal, and then at some point adapt to the human body.
Cycles of mutation for SARS-Cov-2, the causative agent of COVID-19, are also quite natural. Rumors that this is an artificially bred virus in the laboratory, which behaves in some unnatural way, is not supported by scientific data. SARS-Cov-2, like other viruses, was created by nature.
Although, of course, a person can cause certain mutations by laboratory methods and put them at his service. As an example, we can cite the created poliomyelitis virus — the “Sabin strain”. At one time, Albert Sabin took the polio virus and began to multiply it in cell culture.
As a result of mutations, many different strains have turned out. Of these, Sabin chose the weakest, which did not pose a threat to humans, but formed an immune response that protects against paralytic poliomyelitis.
Yes, the “Sabin strain” was artificially bred, but it is still a living, nature created, albeit greatly weakened, virus. If we talk about such “artificially derived” viruses, then they, of course, have their own specific features. SARS-Cov-2 does not show such features, that is, no one has specifically bred it as a biological weapon.
WHAT ARE THE BEST VACCINES?
All vaccines go through certain stages of clinical trials in humans. The first stage is the study of the most common side effects (about 100 study participants). The second is the selection of the vaccination scheme, the number and volume of doses, the interval between them (several hundred – 1.5 thousand people are involved).
The third stage is the study of the effectiveness of the vaccine (40-60 thousand participants, some of whom receive the vaccine, and some receive a placebo). In addition, there are also so-called intermediate points, corresponding to the research protocol.
For such vaccines as Pfizer, Moderna, AstraZeneca, CoronaVac, the third stage of research has been completed, their results have been published. These vaccines are approved by WHO for emergency use.
Some are approved by the European Medicines Agency (EMA) and national agencies. But the developers of the Russian “Sputnik V” did not provide the requests of experts with necessary information, therefore the vaccine did not receive approval from either the WHO or the EMA. Apparently, Sputnik V’s third stage failed.
Strictly speaking, there is also a fourth stage — the so-called post-marketing research. They start when the vaccine has already begun to be used in large quantities, and will never end.
The safety of the vaccine, its effectiveness in real conditions, is constantly monitored. We remember that clinical research began when the virus first manifested itself in Wuhan, China.
But later, alpha and delta variants appeared. Vaccines continued to be tested for them as well. So far, we have confirmation that in these cases, Pfizer, Moderna, AstraZeneca, CoronaVac also provide reliable protection against the severe course of COVID-19.
VACCINE SIDE EFFECTS
By the way, post-marketing studies compared the risk of thrombosis from COVID-19 and the risk of thrombosis from vaccines. There was no convincing evidence that vaccines can cause thrombosis. Even if we take the notorious case of a BBC journalist who died of thrombosis after being vaccinated with AstraZeneca. It qualifies as probably — likely, but not confirmed.
That is, thrombosis that occurs after vaccination does not mean “due to vaccination”. There is also no evidence that vaccination is dangerous for children, as it was said by studies in the United States and Israel, where over 30% of adolescents are already vaccinated. It does not negatively affect a woman’s ability to get pregnant, this is also a myth. There is post-marketing data for 30% of pregnant women who were vaccinated in September 2021 in the United States.
So, statistics on spontaneous abortions, premature births, congenital malformations, etc. is exactly the same as it was in the period before covid. Vaccination for pregnant women is safe, although pregnancy itself is a risk factor, against its background, COVID-19 disease can be quite difficult.
Therefore, WHO is not in vain insisting on the vaccination of pregnant women and other people at risk. To date, the only “side effect” has been found in vaccination: in the USA, herpes zoster recurred more often in vaccinated compared with unvaccinated. Here, the statistics are even higher than among patients with COVID-19, but why this is happening, we have not known yet.
HOW TO TREAT COVID-19?
If a person’s disease is not severe, then no emergency measures are required. The patient is not hospitalized if the blood oxygen saturation is more than 92%. If this number is less, then the patient can be transfered in the outpatient clinic and used to maintain saturation at an acceptable level with a portable oxygen concentrator.
Artificial ventilation of the lungs is used only in the most severe cases. There are other methods of resuscitation… Especially for fans of the popular vitamin therapy (vitamins A, C, D and zinc), I would like to note that its effectiveness has not yet been proven. But I can say for sure that antiviral drugs that affect the development of COVID-19 really already exist.
The only thing is that you need to use them carefully. Because there is a nuance: for its reproduction, the virus exploits our cell, and the antiviral drug, in order to be effective, it has to interfere with the processes taking place in the cell. These drugs are now produced in Britain and are certified.
Well, they cost a lot — from $ 500 per course. There are other types of drugs — they contain antibodies to neutralize the virus. The cost of such drugs is more than $ 1000 per dose. The vaccine currently costs about 3-4 dollars. So here, too, the benefits of vaccination are quite obvious.
