The latest COVID-19 guideline from Directorate General of Health Services at Ministry of Health & Family Welfare @MoHFW_INDIA, are pristine no-nonsense science.
1. Bold and clear statement about asymptomatic infection:
“NO MEDICINES REQUIRED”
2. No antibiotics
3. No place for HCQ, Zinc, Vitamins, Ivermectin on the document
4. Clear instructions on steroid dose. One dose, fixed duration.
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5. No steam inhalation advised (people sometimes do this in excess).
6. Hydration, diet and positive mindset/social connections get attention.
7. Clear instructions on Remdesivir and Tocilizumab, these are to be carefully used - only in highly selected patients.
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8. Bold instructions to
“ACTIVATE HOSPITAL INFECTION CONTROL COMMITTEE” (HICC)
👆This is an absolutely important & assertive step that will change the way medicine is practiced in hospitals. Antibiotic stewardship / infection control practises are part of it.
(See pic)
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On a personal note, as an advocate of rational prescribing and no-nonsense evidence-based medicine, I am relieved that our voices have been heard by those who are formulating these guidelines.
Thanks to @spkalantri for the alert. The link to PDF is on the thread above.
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Adding the thread by Dr @spkalantri on this with my regards. The updated COVID guidelines by DGHS, MOHFW India. The PDF document was dated 27 May 2021. Link on thread above.
Antibody titre 115 AU/ml for Covishield and 51 for covaxin.
27 breakthrough infections occurred (4.9%) after both doses: 25 were mild, 2 were moderate, no deaths.
Risk of breakthrough infection:
5.5% with covishield
2.2% with covaxin
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Listing some facts which will help understand the context of the study:
1. Anti Spike antibody is not the same as neutralising antibody. Its level is not known to reliably correlate with NAb, which is typically measured only in research labs. See my earlier tweet on this.
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The neutralizing ability of vaccine drops with time, and age. The variants of concern B.1.617.2, B.1.351
and B.1.1.7, have a 5.8, 4.6 and 2.6 - fold reduction respectively when compared with the original Wild type strain. Study from UK comparing variants against vaccines.
The study measured neutralizing ability of post-vaccine serum against variants. Theoretically, it means VOC are more likely to get past vaccine protection, esp. those who had only 1 dose.
However, such lab studies are best interpreted along with clinical observations.
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The reason for seeking clinical correlation is that immunity is multi-pronged, and we are not measuring T cell protection in such studies.
While neutralizing antibodies stop the virus from infecting our cells, what happens AFTER the infection is largely decided by T cells.
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Among 506 healthcare worker infections from a cohort of 12,248 at PGI Chandigarh, 64% were unvaccinated, 9.5% were fully vaccinated (>2 weeks past II dose)
However, the shorter follow up post 2nd dose (time bias) means the real % could be higher.
The graph does not factor in the duration of follow up. During an ongoing vaccination process, those who are unvaccinated “get longer time” (compared to the vaccinated healthcare workers) to pick up the infection.
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Cont’d
Since vaccination takes time, those who were 2 weeks past second dose in the pie chart would have had fewer days of observation, than others.
This means that the odds of picking up infection will be smaller by default. This also gets reflected in the pie chart.