CMAAO CORONA FACTS and MYTH 25th : CMAAO minutes dated 17th April

Author :Dr K Aggarwal President CMAAO, HCFI, With input from Dr Monica Vasudev

Minutes of Virtual Meeting of CMAAO NMAs on “CMAAO Uptodate Covid-19 sutras”

17^th April, 2021, Saturday, 9.30am-10.30am

India

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Participants: Member NMAs

Dr KK Aggarwal, President CMAAO

Dr Yeh Woei Chong, Singapore Chair CMAAO

Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO

Dr Angelique Coetzee, President South African Medical Association

Dr Debora Cavalcanti, Brazil

Dr Marthanda Pillai, India, Member World Medical Council

Dr Marie Uzawa Urabe, Japan Medical Association

Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association

Dr Qaiser Sajjad, Secretary General, Pakistan Medical Association

Dr Akhtar Husain, South African Medical Association

Invitees : Dr S Sharma, Editor IJCP Group

Key points from the discussion

In Brazil, the vaccination is moving very slowly as doses are not sufficient. The mortality is very high.
In South Africa, 275,000 J&J vaccines have been administered. So far, only 20 minor side effects have been reported; one allergic reaction in a recipient who was hospitalized for 24 hours but recovered. No reports of clots with the vaccine or breakthrough infection. It is an easy vaccine, effective against the South Africa variant and effective against severe disease. The J&J vaccine has been temporarily suspended. Number of daily cases are 1300+ and deaths around 70.
In Bangladesh, around 5.6 million people have taken the first dose and 1.4 million have received the second dose. Covid infection after the first dose of the vaccine is being reported. Infections are spreading and more than 100 deaths are being recorded daily. South Africa variant has been identified and presents with fever with no cough. Complications are now occurring earlier.
There is a third Covid wave in Pakistan. UK, South Africa and Brazil variants have been found in the country. The cases and deaths are increasing. People are reluctant to follow SOPs. 10 lakh were vaccinated till Thursday. No reported cases of Covid after the first dose of vaccine as yet.
Japan is facing the fourth wave of the infection. UK and South Africa variants have been detected. Around 4000 tests are done every day; 30-40 deaths are reported daily. One percent of population has been vaccinated.
In Hong Kong, the fourth wave is well-controlled now. There are 1-2 local cases daily and more than 10 imported cases. The danger is that 1-2 cases have no known origin, which means that there are hidden cases in the community, which could spread.
Singapore has administered 2 million doses so far; 40,000 daily. Presently the age group 45-60 years is being vaccinated. The next group to receive the vaccine will be younger than 45 years. In last 7 days, cases have been in single digits.
In India, there has been a spurt in the number of Covid-positive cases after the 1^st or the 2^nd dose of the vaccine, predominantly in the first week after the vaccine. Many Covid-positive persons have significantly low Ct value indicative of high rate of transmission. Post-vaccine Covid can be either the person is already carrying the virus, infection acquired at the vaccination center or the infection is acquired after taking the vaccination. India is in midst of the second wave. UK strain is predominant in the state of Punjab; there are few cases of South Africa and Brazil variants in the country. Double mutation has been detected; one variant that is causing e gene target failure. Now patients are presenting with very high fever, systemic inflammation with no pulmonary involvement. Transient ear deafness is one symptom in this new wave; children are more affected now. Mortality is much less than in the first wave.
Post-vaccine Covid is of two types: Primary Covid (occurring within 14 days of the first vaccine) and breakthrough Covid (occurring after 14 days; look for systemic inflammation evident as high fever and very high CRP but lungs are spared; occurs due to inadequate binding non-neutralizing antibodies before the second vaccine dose).
Women in the reproductive age group or those who are on HRT are more likely to develop clots after the vaccine. Consider prophylactic aspirin 75 mg before vaccination to prevent clot, if not contraindicated.
Aspirin has to be continued for at least 15 days after the second vaccine dose to prevent thrombotic clot.
Day 3 is the day of inflammation and Day 5 is the day of thromboinflammation.
Assessment of risk vs benefit should be done on case to case basis.
Consider aspirin in comorbid persons before during and after Covid or Covid vaccine, if no contraindications.
If CRP is high on day 1, d-dimer will start rising on day 3 and on day 5, platelet reduction occurs. This is the time for clot formation.
Vaccine induced thrombocytopenia: Rising d-dimer and reduced platelet count.
Do CRP first and then PCR to prevent CPR.
Post-vaccine Covid presents with cough and throat pain (anecdotal observation).