Post-vaccine risk

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    ‘The vital questions today are whether the new strains are more deadly and whether our currently available vaccines and monoclonal antibody treatment are also effective against them.’

    BACTERIA react and develop resistance to drugs against them in order to survive. The Multi-Drug Resistant Tuberculosis (MDRTB) and the Methicillin-Resistant Staphylococcus Aureus (MRSA) are examples. Viruses, which are protein molecules, mutate more efficiently to various strains to be more virulent to propagate themselves. The SARS-CoV2 virus of COVID-19 has mutated to various strains; two popular ones are the UK and the South African variants. Viral mutation is natural and expected and their occurrence was no surprise.

    Currently, there are 101 million cases of COVID-19 in 219 countries, with about 2.2 million deaths, a daily average case of 800,000 and death toll of 18,000 per day, globally…and counting. In the United States, there are more than 26 million cases with about 432,000 deaths, following the first case involving a Washington man who fell ill on January 19, 2020 after returning from Wuhan, China, four days earlier. The average daily death toll since that first case was 1,073.6. Johns Hopkins reported 235,000 new cases and nearly 4500 deaths in one day, a new record high, on Tuesday, January 12, 2021.

    The vital questions today are whether the new strains are more deadly and whether our currently available vaccines and monoclonal antibody treatment are also effective against them.

    Clinical observation
    So far, the clinical evidence shows the new strains are multiple times more virulent (more contagious, 7-10 times more rapidly transmissible). While some reports say the UK strains are not any more serious, UK Prime Minister Boris Johnson stated that in UK the new strains “are 30 percent more deadly” compared to the original SARS-Cov2 virus. The vaccines appear to be also effective against them. The South African variant is likewise more contagious, and appears to be more severe. The vaccine efficacy against it is slightly less but still enough to provide immunity. For all these new strains, the pharmaceutical companies may have to tweak their vaccines to achieve at least 95 percent effectivity against all of them and future mutations.

    Much behind schedule
    More than 68 million doses of the vaccines have been distributed to 56 countries around the world, a daily average of 3.44 million a day. Vaccinating 7.8 billion people globally is the greatest dilemma humankind has ever faced. Since the campaign started in the USA (population: 330.9 million) on December 14, 2020, about 43 million doses of the two vaccines have been distributed, nearly 24 million (about 56 percent) have been administered, an average of 1.25 million per day. The goal today is to administer 1.5 million doses a day. This could be achieved in about 8 months, certainly before the end of 2021, provided supply and administration are both 99-100 percent adequate. The two most efficient on top of the list are South Dakota and Puerto Rico, each having administered 87.6 percent of their allocation, with California having given only 2.5 million doses for 16 percent of its almost 40 million people. The formidable dilemma is logistics, a variety of red tapes in the administration of the vaccine, more than a supply issue, because many states still have some vaccines left but quite slow in putting the shots in the arms of their constituents. This is not to minimize the magnitude of the need for more vaccines for the remaining 80-85 percent of unvaccinated people in the United States.

    Dangerous option
    The ill-advised idea floating around about using the vaccines reserved for second dose in order to vaccinate more people is scientifically flawed and could lead to disaster for those who are waiting for their second shot, because there is now a shortage of vaccines. The demand is greater than the supply, with the two overwhelmed drug firms unable to manufacture enough and faster to meet the present need. Without the second dose, the vaccination (protective immunity) is incomplete, and as the delay goes further, the antibodies already formed could wane. These individuals could get COVID-19, likely the new strains, while waiting for their second shot, wasting the first shot they received.

    Incomplete immunity
    The first dose confers only about 52 percent protection, with 48 percent residual risk. After the second dose, the immunity level gradually goes up to around 95 percent after a few months, not immediately! Exactly how long, we still do not know for certain. Clinical observation in the next 8 months or more could provide us the answer. Currently, about 5 percent of those who got their first shot became infected with COVID-19 when they allowed their guard down and ceased donning mask, stopped social distancing and crowd avoidance. If more of those who received the first dose become careless and reckless, the rate of new infection (most likely a variant strain) and its faster transmission to others and death rate among the “first-dosers” would be more devastating as a new, more deadly pandemic in itself.

    If we want to survive
    After receiving the second dose, we must continue to follow the CDC anti-COVID 19 guidelines, masking-up, doing social distancing and avoiding crowds until herd immunity is reached. Otherwise, COVID-19 could still get us, even after our second dose, unless and until country-wide immunity has been achieved and COVID-19 eradicated.
    Behavioral modification helps. After receiving the first or second dose of the vaccine, let us behave as if we have not had the vaccines, and resume wearing mask, doing social distancing and avoiding crowds. It’s for our own safety and the protection of others around us. And the scary reality is that the new strains of the virus are becoming more dominant than the original SARS-CoV2 virus and some other mutations could still evolve. We have sacrificed and suffered from the isolation of self-quarantine and successfully evaded the invisible enemy for the past 12 months. Let us extend our patience and continue to follow the CDC guidelines religiously for at least another 6 months, since we are now able to see the light at the end of the tunnel. We must not derail this hope.

    Only We, The People
    This strategy is the security insurance we all need to end this vicious killer pandemic sooner. The government cannot do this for us. It is up to us, We, the People, to discipline ourselves and behave properly, a pre-requisite for us, our loved ones, and all our fellowmen to survive one of the greatest human tragedy in modern history.
    Once again, I challenge everyone to join this crusade to save lives, or, if you don’t give a damn, to get out of the way!
    ***

    Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, a Health Public Advocate, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian and anti-graft foundation in the United States. Visit our websites: philipSchua.com and FUN8888.com Email: scalpelpen@gmail.com

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