Is The Second Covid19 Wave Here || Doctors Roundtable || Covid19 update

But our big story today is the COVID19 alarm, which has once again been sounded in the country. This on a day when the number of active cases have risen to the highest level of 2021. Remember, these are the numbers that we are now getting in the country active cases one lakh 97 to 37 deaths, one lakh 50 360 recoveries, as you can see there at the moment, the COVID19 surge that's taking place in India at the moment, if you look at weekly cases, this is the surge that's taken place, the lowest was from the February eight to 14 period, when they were just 77,002 84 cases, then it went up to 88,008 90, February 15 to 21st. Then it went up over a lakh between the 22nd and 28th of February, March one to seven, one lakh 17.

But in the latest week, now, they've climbed the one lakh 55,019 month, that's the worst in four months. Now, this is very focused because there are certain states that are worst affected. So if you look at the states that are worst affected, it's clear that Maharashtra has the largest number, so almost 70% of the cases at the moment one lakh 31,812 are in Maharashtra alone. So, Maharashtra remains the worst at the moment the other states Kerala where there is a gradual sign of recovery, but the number of cases 27,005 37 at the moment are the active cases, active cases number three is Punjab 11,009 42. The fourth case where state which is a worry for the government at the moment is Karnataka 8008 79. cases are beginning to rise in Bengaluru in particular, and the fifth is Tamil Nadu active cases 5001 49 remember, this is a state that's going to the election. So clearly, there are pockets of the country, Gujarat, another state where there are worries being expressed. Now, that's not the only concern because night curfew is now being imposed in several parts of the country.

The big question also is on the vaccines because after blood clots were reported in some countries among those who took AstraZeneca has Oxford vaccine which is COVID shield in this country. Many nations especially across Europe have suspended the use of Astra Zeneca. India, as I said, uses Oxford vaccine made by the serum Institute of India. How worried should we be what does this mean for the vaccination Dr. Mullen Sharma gets you this report before we go to our special doctors table.

It started with the death of a 49 year old nurse in Austria due to blood clots days after receiving a dose of anti COVID vaccine. While Austria suspended administration of vaccine from a particular batch from Astra Zeneca. Denmark stopped giving the vaccine altogether. Since then, many European nations have decided to err on the side of caution. Germany, France, Italy, Spain are the latest to join the long list of nations that have suspended the vaccine developed by Oxford University and produced by AstraZeneca AstraZeneca has released a statement assuring safety the firm says that a review of 17 million people showed no evidence of any increased pulmonary embolism, deep vein thrombosis or thrombocytopenia in any defined age group, gender badge or in any particular country. The World Health Organisation has also said there is no evidence of side effects and that the Advisory Committee on vaccine safety will be reviewing the data.

The European medicine agency says there is no indication that vaccination has caused these conditions. It says the number of reports of blood clots and people who receive the AstraZeneca vaccine was no higher than for those who haven't caught the shot.

There is no indication that vaccination has caused these conditions. They have not come up in the clinical trials and they're not listed as known or expected side events with this vaccine.

Meanwhile, Australia, the United Kingdom and Canada are continuing with the AstraZeneca vaccine.

Several more countries have suspended the use of AstraZeneca vaccines as a precautionary measure. This does not necessarily mean these events are linked to vaccination, who Advisory Committee on vaccine safety has been reviewing the available data is in close contact with the European Medicines Agency and will meet tomorrow.

The Oxford vaccine is key to India's vaccination drive against COVID COVID shield the Indian version of the Oxford vaccine produced by serum Institute of India accounts for the bulk of the shots being given in India.

In India, the government has said that no serious event related to a blood clot has been reported post vaccination. And in India, about two crore doses of COVID Shield have already been administered, at least as far short of the vaccine. With concerns being raised across the nation, Will people now become hesitant to take the Oxford AstraZeneca and serum Institute of India's vaccine Here is the question we need to ask today with the show Benoit, Milan Sharma for India today.

Let's then go straight to our doctors roundtable where I'm going to ask the most frequently asked questions as the country possibly heads for a second Coronavirus wave Dr. Arun Kumar Chairman Institute of chest surgery at Vedanta joining us also with us Dr. Haman Tucker consultant physician in Mumbai at several hospitals on a Mumbai is leading doctors Dr. Shai Jamil is one of the country's leading virologists internationally acclaimed and Dr. Raj parekh is director of medical research at just low hospitals written a book also on the corona vaccine. So I'm going to come to you gentlemen, with sharp, quick questions and hopefully sharp answers to all our frequently asked questions at the moment. The first one, is it time to review the Oxford vaccine? Why don't you take it Dr. Jamil because you're a biologist. You've been tracking this? Is it time to review the Oxford vaccine as some countries in the West? You muted yourself Dr. Jamil, you'll have to you'll have to remove the unmute button, sir.

Yes, I'm sorry. So I don't think so. If you look at what the European Medicines Agency was just saying in your clip, 17 million people have taken the Oxford AstraZeneca vaccine. There are 44 zero cases of blood clots that have been seen in people who have taken the vaccine, there is no causality. If you simply look at the random event of blood clots, the rate is about one every one in 1000 people per year. If you translate the 17 million number, that translates to just random about 150 per week, we are talking about 40 cases, not significant. No causality. Simply alarmist. There is no reason for us to suspend anything.

Is The Second Covid19 Wave Here

So you're saying what the European countries have done? We do do not need to follow that. Am I very clear, sir. You're saying not the alarm. alarmism is completely unwarranted. Am I right? It is. Okay. Good. It is. Given that you've already almost answered my second question which I wanted to pose are the fears of post vaccine blood clots real Dr. Tucker, have you had any case or anyone come to you complaining after the vaccine of anything mildly resembling blood clotting?

Not at all, not even remotely resembling blood clotting. And I completely compliment Dr. Jamil for the statistics that He has given, which will not interest to many, but this is absolutely miniscule. I must add that the incidence of thromboembolism in the routine population is even higher than that has been than that what has been reported in these 40 cases. And it was these very concrete, Scandinavian ones that flagged off the Pfizer flag, when there were some deaths following Pfizer. And then the clouds moved on and the skies became blue for Pfizer. I think as far as India is concerned, our skies are always blue and will continue to remain blue. This is only a storm in a teacup

storm in a teacup.

Okay, that's, again, very reassuring to hear the next question that I have which is coming is should any precautions needed? Are there any precautions specifically needed to avoid blood clots or any After Effects after taking the vaccine? Dr. Arvind Kumar, any precautions that you've been advising your patients to take when they go in for a vaccination?

Right, they thank you very much for having me on the show. First, I would complement both the CO panellists and totally again a co what they have said number one, the incidence is extremely low. Number two as it is if you analyse the population, their population has a higher incidence of these problems from gambling, because of various reasons.

One of them being the old age where this problem is known to occur, the other being people in the bed. Those who are nursing homes confined to bed because that is the population elderly person confined to bed most of the time is the population which has a highest chance of getting thromboembolism. We don't know how many of these people who have gone after taking vaccine they went and lied down in the bed for next couple of days, which actually led to this plot rather than the vaccine be in our country have administered close to three crore dosages majority nearly 85 90% of which is COVID19 shield and we are yet to see a single case of thrombo embolism which can be which has been reported in this population. Okay, and this is a huge number. So I don't think other than carefully looking at the data which will emanate from these countries I don't think we need to take we advise all our patients to drink plenty of fluids to take analgesic, anti pyretic Crossan and tablet when they have fever, to take good food and be active. If they have fever, they should rest. Elderly people should be advised to keep moving their legs because if they are bedridden, not moving legs, they are more prone to have thromboembolism or otherwise more specific precaution. And we must continue vaccination. Please,

I'll come to that in a moment because I think all of you are giving very reassuring signals at the outset. Dr. Potter, you want to add your word is there any precaution needed at all on this entire issue of blood clots Do you believe is grossly exaggerated? We've got countries like France, Italy, Spain, the big European countries, all pausing the rollout.

Well, I concur with my panellists up to a point. I am not 100% reassured, and I'll tell you why. In a moment, I was hoping to look at the data comparing different vaccines in terms of blood clots. I'm also waiting to look at age matched data, a lot of young people are getting blood clots. But having said that, the data that I have looked at so far is reassuring. I do not disagree with the figures presented by my co panellists. But keep in mind rajdeep that the scientific bodies of several countries have scrutinised this data. And while they should have been more transparent, in giving their reasons, they have positive vaccination.

That clearly is no indication for us to pause our drive. But I think there is a cause not for alarm. But for some concern. When, you know, scientific bodies have advised against it. The CDC hasn't in our country we go on, but some of us who are involved in medical research, need to keep monitoring this data and also slicing it in a different way to do a inter vaccine comparison.

Okay, let's then come to I think overall, the sense we're getting in this is for our viewers, don't worry. This is not let's not be alarmist because some countries have suspended their vaccine roll out of Oxford AstraZeneca. There is no evidence on the ground as of now at least in India to suspend the rollout. Let's turn to my next question or the next focus I want to do as to what whether people should take anticoagulants when they take the vaccine. Why don't you take this Dr. Tucker because you're a physician. You can explain? Should we be taking anticoagulants? A lot of viewers are asking this while taking the vaccine.

All of my patients who have been on anti platelet agents what people misconstrue as blood thinners, we have continued them on it. And those who are on anticoagulants also, within limited reason we have continued them on it. But there is absolutely no indication to say that if you are going for the Oxford vaccine, you need to take a blood thinner, not in the least there is no prophylaxis of this nature required at all. Okay,

that's that's again, reassuring, in a way and let me come to you Dr. Jamil as a virologist on the panel, the serious side effects to look out of for after vaccination. We are seeing several vaccines now being used across the world, both the MMR vaccines and and the vaccines that we're using in this country. Is there any pattern that you've detected in terms of serious side effects that should be looked out for after the vaccinations are taken.

But the most serious side effect after any vaccination is something called anaphylaxis, which happens within minutes. And that's why you are asked to stay at the vaccination site for 30 minutes. Beyond that, is the regular fever, fatigue, headache, redness at the site. That's it. I mean, nothing serious has really been reported. If you look at India's data In India, 234 people out of 3.3 crore who have received the vaccine have been admitted to a hospital. And coming back to the earlier problem about blood clots, not a single one of them have shown blood clots. So this is really a miniscule number. No, no vaccine, no drug is 100% safe or 100% effective. We all look at risk versus benefit. And today, the risk versus benefit is much in favour of taking the vaccine because we are going still in the middle of a crisis.

Okay. So in a sense, again, I'm glad to see the reassurance coming in from your doctor because I think a number of people panic when they heard the news that's come in from the west. An interesting question that Dr. Arvind Kumar I want to take to you because I'm told a couple of doctors in your hospital also have suffered because Can somebody get infected? despite taking both dose of the vaccine is an important question.

Can somebody get infected despite taking both doses of the vaccine? I'm told a couple of doctors have been infected at Vedanta. But in general, do you believe people are safe after taking both doc doses? Or should they still be cautious?

So two things like the one is that just taking first and second dose doesn't mean that you are protected as per the advisory given by the Ministry and also from the vaccine manufacturers. The real immunity is supposed to come about two weeks after the second dose that is when the the antibody levels speak. So I think you have to wait up to second week after the second dose. That's one number two, if you look at the efficacy figures, whether it is reported as 90% or 80%, or 70%, or some code as 60%, let's take a round figure of 75%. So 75% people are getting protection 25% may still get the disease. And therefore, as doctors we have been saying regularly, just one dose of vaccine means nothing. second dose of vaccine also you have to wait for two weeks, then you are in that 75 80% protected category, but 20 25% or 10 or 40, whatever the rancour is there is a figure where people may still not develop antibodies and therefore may get the disease and end till we reach IRD. immunity level, we all need to continue to have what is called COVID19 appropriate behaviour,

you know that? It? Does anyone want to jump in there? Does anyone have a different view on this entire issue of getting affected after taking both doses?

Not on the issue of getting in the record, because I think that has been not on the issue of being infected. That has been explained very clearly that getting two doses doesn't necessarily insulate one. Just a bit. I'd like to add here that some of the mutations in the virus, particularly the Brazilian, and the South African variants are known to dodge the antibodies produced by some of the vaccines. And that's the thing to keep in mind, because there are nutrients going around and we won't know which mutant it is, unless a whole genome sequencing is done. replicate

those mutants in India, according to you. Are those mutants already here other strains already here? No, no,

absolutely. There was one reported in Delhi today. But rusty, there's something else I'd like to add. And I'd like my co panellists to correct me if either my observation or my conclusion is incorrect. As I was watching your show, something caught my eye in the visuals that you showed.

Is The Second Covid19 Wave Here Doctore Roundtable

And that was the technique of vaccination. You know, we were taught that the right way to get the vaccine is once the needle is inserted in the muscle to aspirate, that is to pull out of it to see if there is any blood drawn to ensure that the vaccine is going in the muscle and not in a blood vessel in two of the visuals, which I'm sure you all got from somewhere else, one of them in India and one abroad. In both of them through the corner of my eye. I was astonished to see that no aspiration was done. And the vaccine was injected directly into the muscle that I believe poses a slight risk of the vaccine going into a blood vessel, other than the muscle but I I am open to correction.

Dr. Tucker, you I heard you say no. Do you want to respond? Was there something that troubled you at the moment about your own fracture?

No. No, when when you mentioned about mutants, theoretically, is right. Absolutely. That mutants can partially dodge the antibodies that have been created, but we don't have those mutants in large numbers. Don't want to throw a scare amongst my population and my patients that we have mutants, but your question which you asked, answered both the problems that we are facing that there is a false sense of security amongst people who have taken the vaccine right that is the problem that is occurring. And your second infection which you test is because you have as he rightly said 75% efficacy, so, you can get the infection again, but it will be such a mild infection, because your antibodies will tame it, you will not need to be hospitalised and you will not need to have serious problems. So, I am not worried so much currently about mutations theoretically what Dr. Perry says is right. Okay, let

me come to the next big question. And this is a question which is now being debated across the world at the moment in the medical fraternity and Dr. Jamelia, perhaps best place to answer this is a virologist should the gap between the two COVID Shield or Oxford AstraZeneca vaccines be 28 days or eight to 12 weeks? A report in Lancet suggests that it should be eight to 12 weeks. In India, it's being done at at I think, at 28 days across hospitals between the first and second dose is immunity greater The longer the spread between the first and the second dose doctor.

It's it's a little more nuanced than that. The report in Lancet is a meta analysis of for Oxford AstraZeneca vaccine clinical trials, one of which was the low dose high dose trial, which should never have happened should never have been taken into account. It was a mistake. Secondly, if you look at the results in that paper, which is really an observational analysis, it's observation of four different clinical trials. The confidence intervals are very wide. The data if you analyse it carefully, looks very strange. So on the basis of that, in a country like India, where vaccine supply is not a problem, I am not willing to, you know, say that delayed to eight to 12 weeks.

So you're given 28 days, you believe 28 days? Well,

I'm okay with 28 days. But let me just highlight one point that at this point, we don't even know what the best protection means. No one knows this. The vaccines have not been tested for efficacy long enough. So if if I'm asking people for best to be the enemy of good, that's not the right approach. No, sir. Eric vaccine into as many people as possible.

We are on an upswing right now.

Now, the reason I'm asking you this is that does that mean dr Jamil that we still don't know that even after taking my two doses? How long will I be immune for?

No one knows this? Who knows this post vaccination data is just not available. Clinical, you know, efficacy of clinical trials have been determined over a two month period.

So you're not willing to even tell me? So am I am I being told that even after taking my second vaccine, I am not reassured that I will not get COVID-19 for three months, six months, no timeframe can be put.

No one knows this. No one knows this. And that's why it's important for us to keep wearing masks. And that's why everyone keeps saying please, even after you take the vaccine, wear a mask.

You know, that was my question, Dr. Tucker, should people continue to wear masks and follow social distancing even after taking the vaccine? We've just seen an end about two days ago, an entire Cricket Stadium was chock a block, if any VIPs were not wearing masks, I was in Mahabalipuram. Two days ago shooting a story there were about 1000 there were over 1000 people on the beach, very few of them with masks. Are you saying that even after taking your two doses, you must wear your mask and follow social distancing?

Absolutely, because if you don't wear the mask, those esoteric bugs which might come and get you will produce some kind of infection drew Like I said before, after two doses you will get my mother

Okay, well

then if you get infected, so you have to as a mask.

Okay, so so the COVID protocol, continue that Dr. Kumar, you want to jump in on that? Do you believe that is what you know, a sense of COVID fatigue has crept into this country. And I know a number of shopkeepers I spoke to in Mahabalipuram said COVID is a rich man's disease they say You people are talking about COVID I want to protect my livelihood. And many of them said we are okay. We are, you know, we don't have mass and we haven't got COVID What would you say?

I would just give three four very clear messages, because this programme has to give a very clear reassuring message to people.

Number one, as of today, the two vaccines that are available in the country are our best option to fight COVID. So whenever indicated who's ever turn is coming, they must go and take the vaccine as per the should, you will recommend it number one. Number two, taking one doors or two doors of vaccine does not mean that you've got 100% protection two weeks after the second dose, you're likely to have about 70% protection and the rest of the people the data shows that even if they get infection, it is likely to be a mild infection without requiring admission.

Nonetheless, that does not mean that we become complacent. Our best protection for this for several months will continue to be wearing mask maintaining social distancing, hand ID and four but most important, not accumulating in large numbers in closed spaces. Recently, I have seen people organising birthday parties, marriage functions, other functions where hundreds of people accumulate in one closed all right AC that is a short short invitation to disaster and must be resisted if we have to control Corona

given that Dr. Perry can we you know given what all of you have been saying putting up certain warning signals while not being alarmist Can we really see a second wave is here, because linked to this, the fact is the fatality rate is down in the new infection. So is this a milder strain that we are seeing? Is this a second wave as is as it is being described? Because the number of positivity, the positivity rate has increased in the last few weeks?

Yes. To your second question, Is this the second wave? I believe Indeed it is. This has happened across the world. It has happened across history, even as we speak. Now, there is an incipient third wave in Italy and Germany, which might sweep across the European continent. So it isn't the nature of the virus. It is an intrinsic feature of the pandemic, that it does come in multiple ways. But isn't

it milder, we have infections, and and many of them asymptomatic.

Let's not be too certain of this rajdeep I just want to take you back to exactly a year. And one week ago, your channel has been at the forefront of reporting on the pandemic. And you may recollect that I did an interview with you, you're in a week ago. And there was a lot of reassurance in that. And at that time, they were just 84 cases in India and zero deaths. And I did pull out some data and graphs and mathematical models to indicate that the picture was not that roasting. You agreed with me or some of the panellists did not. And I believe it's time for us to look at the data again, it's time for us to be cautious. optimism is a great thing. It makes us feel wonderful Mutt optimism in an overdose can have toxic side effects.

Let me take that to a doctor Jamil. Dr. Jamil, do you see a second wave or a very different kind of wave? If at all, there is one much more localised in certain states? And in very, very hyper localised areas, even within those states? Are we seeing a hyper localised, weaker second wave?

Well, there is there are certainly increase in cases in many parts of the country, especially six or seven states over the over the last maybe four weeks, the number of cases there have increased by anywhere from about 150 to 500%. To say that it is weaker, I don't think there is enough evidence, certainly the case fatality rate has not increased the case fatality rate, if at all has gone down a little bit. There is also no evidence to suggest that it is a new strain of the virus because you know, the genome sequencing data that is coming out has not really been linked epidemiological Lee either to the to the spurt in infections more the fatality so as far as we know at this time is the same virus right. But you know, we need to be cautious. We need to be careful. And all the half measures of having night curfew and or really make no sense.

So you don't go back to the lockdown. Are you saying doctor we should go back home.

I'm not saying that. All I'm saying Is that everyone is making an emotional response. People are not thinking through this, there are only two tools available to us to protect ourselves. One is COVID appropriate behaviour and the second is vaccine. We are worrying ourselves to death over, you know, these blood clots this and that. But at the same time, we are not wearing masks.

So this is not logical at all. Very, very interesting. It's very interesting the way you're putting it COVID appropriate behaviour is much more important than having night curfews or temporary lock downs in a few places. Dr. Arvind Kumar, just a couple of minutes. The next question is to you, which is, interestingly be asked by a number of people, should the general population also now be allowed to take the vaccine? Is the is our vaccine drive too restrictive at the moment? Why can't I as a 55 year old with no call comorbidities also take the vaccine has the time come to push faster?

I totally agree with this observation. But the I have myself been saying that now time has come where more and more centres should be allowed to dispense this vaccine at this jurisdiction to over 60 or 45 to 60 with comorbidities should actually be removed and a free availability of vaccine and all efforts by all agencies to inoculate as many people as fast as possible will probably be our best response to the second rising wave of Corona.

In a very interesting question. Dr. Tucker has come from Mr. Ganapati. in Chennai, he says a hospital that gave AstraZeneca the Kobe shield vaccine as a first dose is now offering the only borrowed bio that is co vaccine. What should a patient do? Interesting question. Can I take a Kobe shield first dose and co vaccine second? Surely not.

So this is a theory which a lot of scientists have been trying to propound where you combine two vaccines to get better efficacy. But we don't have scientific data. I want to question that hospital why they are not giving the second dose of COVID shield. I hope they're not fallen prey to this propaganda coming from the west. Because one swallow does not make a summer and the hospital should not be more Catholic than the Pope and give up the COVID Shield vaccine. I think the evidence currently today is both vaccines from the same family should be used. There are experiments going on about mixing one with the other, but we don't have data and when we are looking through a microscope at fried effects. I don't want to try anything unwarranted.

Okay, I think all of you typically like quality doctors have given so many clear messages that I think our viewers will be enriched by listening to y'all you made it clear blood clotting is not an issue. Don't worry about it. Go ahead, get yourself vaccinated. But even after vaccination, follow COVID appropriate protocol, keep the mass the social distancing on the battle is still on. We don't know whether it's a second wave as yet or not. But vaccination is an important step forward. And we still don't know how long the immunity will last. But it is certainly better than not getting vaccinated. To all four of you doctors. I appreciate you joining us on our doctors roundtable this evening. Thank You