Thread by @mentorshipzim

Hi everyone ! This is @afromedwoman today I’ll be here to chat about keeping safe with this Delta and answering any burning questions you have on Covid-19 variants or vaccines. Please start to drop your questions below to get us started. More about me 👇🏾

https://twitter.com/mentorshipzim/status/1417811749051543555

I’m sharing from my perspective as a physician who has worked on the frontline caring for Covid-19 patient here in Singapore and is specialised in public health and pharmaceutical medicine and regulation. I’m also the daughter of a severe Covid-19 survivor in Zim before vaccines

Thanks for getting us started! A: Anything is possible w/ this novel virus but it is rare for people to be infected twice by same variant. Prev infxn w/ other variants does give you some protection but you may still be susceptible to infection with new variants.

https://twitter.com/frankkondie/status/1418156509872205826

Hence, we recommend that even those who have recovered from Covid should still proceed to get vaccinated if they have not yet been, 2 weeks after they recover. If you were infected after one dose you can get your second dose after recovery.

At least in Zim and SA, this drug has been allowed for import for human use to allow further research of potential benefits in Covid-19. So that’s giving it a fair look. So far though, there is no conclusive evidence that is has any benefit to prevent or treat Covid, tho (1/2)

https://twitter.com/khosiez/status/1418156095479103493

There are large, well powered (meaning study has enough people to be statistically reliable) studies underway includ at Oxford. Hope there is good news from those, but for now we should prioritise giving people EARLY access to already proven treatments. Delay costs lives (2/2).

Great Q! Actually I was planning to do some teaching about WTH these notorious variant come from so this is a good chance to do it. Viruses spread by infecting our human cells and using our cell’s machinery to replicate their RNA (Covid is an RNA virus) ….contd…

https://twitter.com/knightljn/status/1418162909209899012

…but the replication isn’t perfect everytime. Sometimes there are small changes (this happens more frequently in RNA viruses btw). The more the virus infects ppl tle more chances for an error to occur. Some changes don’t have any impact so these not that worrying…contd

…but some changes are worrying cos they enable the virus to infect our cells better and make them better at escaping *some* of the antibodies made from vaccination. These variants are called variants of concern (VOC) eg Alpha, Beta and Delta….

VOC can only come about if the virus is circulating and therefore replicating out of control. So that’s why we must rush to vaccinate people and prevent transmission using masks, social distancing and public health measures too….contd

There is also evidence that immunocompromised ppl can be infected by multiple strains and new variants can emerge. Not all of them can be vaccinated, so we have to reduce their chances of infection by getting vaccinated, and w/ masks and social distancing. scientificamerican.com/article/covid-…

Good Q. I know it’s been tough to mourn our loved ones in this weird time. But please trust that there are good public health reasons for the advice. The burial instructions actually vary by country, please follow local guidance but I’ll share a link on the WHO’s stance..contd

https://twitter.com/makoniadm/status/1418174649284825090

There are 3 main ways for Covid to spread droplet, surface (fomite) and airborne. The priority is allow dignity and respect but also minimise risk of spread. Droplet risk is greatest for those who come into close contact w/ the body eg mortuary and those preparing body for burial

Airborne spread is also greatest for those performing autopsy or embalming. The greatest risk for family members is probably from direct contact with the body by touching it or surface contact with coffin or other objects that may be contaminated by the body or funeral attendants

Although WHO doesn’t mandate closed caskets the local guidance may wish to reduce variables especially in settings where access to PPE and sanitation may be limited. And if there is risk of family members not wearing PPE correctly. More on WHO guidance 👇🏾 apps.who.int/iris/rest/bits…

Actually, my next bit of “teaching” was gonna be on the issue of what impact the variants have and will have on vaccines. Let me quickly have some dinner and we’ll be right back to pick up on this Q.

https://twitter.com/sunduzawekanyi/status/1418180920733995008

Okay, I’m back ! So to answer this question - No. Not all variants out there are variants of concern (VOC) some just scariants (hyped up by media). And among the VOC not all have significant impact on vaccine effectiveness….contd …

https://twitter.com/Sunduzawekanyi/status/1418180920733995008

Our immune system is really complicated but to simplify let’s think of it doing three things against Covid
1/ prev infection (stop virus before it enters our cells)
2/ prev severe disease ( the virus still manages to infect our cells but milder dx)
3/long-term protection …contd

Our current vaccines are not 100% effective at preventing any infection , but compared to being unvaccinated it does reduce your chances of infection. How much it reduces your risk depends on the vaccine and on the variant strain. Some variants are better at evading immune sys

None of the variant can escape all our immune defences from vaccines though, so even if prevention of infection is reduced , all vaccines will still be able to protect you from severe disease through other antibodies and cell immunity that variants hasn’t evolved to escape yet.

This study from Chile with Sinovac showed that even with Gamma variant circulating the vaccine was 66% effective at prev infection
88% effective at prev hospitalisation
90% at prev ICU admission
86% at prev death.

That’s pretty good even with variant
nejm.org/doi/full/10.10…

We don’t have any published studies looking at Sinovac and Delta variant. But we know from studies w/ Pfizer and AZ that while Delta significantly reduces vaccine eff of 1 dose with 2 doses, protection for severe disease is same as with other variants. nejm.org/doi/pdf/10.105…

So good news
1. All the vaccines still protect against severe disease vs variants
2. There are early studies in mRNA vaccines (hope more soon) showing germinal center B cells sugg that the protection is likely long lasting.

Unknowns
-We still need more published data on Sinovac and Beta and Delta but some protection vs severe dx likely
-We need to keep tracking data on death and hospitalisation among vaccinated over time to decide if any booster will be needed in the future.

Not all strains of Covid are equally transmissible even in places that had huge waves most ppl may have still not been infected. Also, we have evidence that some variants esp Beta and Delta are able to escape the immunity gained from natural infection hence boost w/ vaccine.

https://twitter.com/terrymatumba/status/1418188913366155270

Natural immunity is NOT the best way to get the wider population immune it comes at great cost of long term complications from Covid-19, deaths and the trauma of the experience. Rem when ppl declared India had herd immunity in Jan ? How did that pan out ? webmd.com/lung/news/2021…

Diabetes is a complicated disease that affects every organ in the body so simple answer is that ppl with diabetes (esp poorly controlled DM) have organ systems that are already weak when Covid-19 comes to wreak havoc. So many ppl are walking around w/ undiagnosed diabetes too.

https://twitter.com/roo_vim_bow/status/1418197078614941698

If you’d like to have a long read on all the factors that make diabetics more susceptible to severe Covid- Here is a reliable but not so textbook jargon piece on this statnews.com/2020/10/01/why…

This is a new vaccine that has only been used for a year or so. But from all other vaccines that have existed before we know that most severe side effects will manifest within a year. It’s extremely rare to have any vaccine side effects that first surface years after the vaccine.

https://twitter.com/terrymatumba/status/1418187933279047682

Given that millions have received these vaccines now, even the most rare side effects would have manifested by now. MCAZ is monitoring all vaccines for side effects for the long-term as other regulators are doing around the world. Report any side effect to MCAZ as below.

Agree it would be good to collect this data. We do collect such data here and I remember seeing that Namibia is also now doing this. The challenge is the capacity to collect the data. Even with Namibia one there was a lot of gaps ; I’ll share the link below

https://twitter.com/TerryMatumba/status/1418186898762342402

Here’s more on how Namibia is doing their reporting but as you can see they have a lot of missing data. It’s challenging in our setting sometimes to have very good records. I think it’s more feasible to do a study with HCWs who are easier to capture and follow over time.

https://twitter.com/RangaMberi/status/1417879643881885696

Sticking to those in Zim right now

1/ Inactivated (Sinovac/Sinopharm). This is one of the most traditional vaccine technologies. It basically takes a whole virus and weakens it so that it doesn’t cause sickness but our immune system is able to remember it if it sees it again.

https://twitter.com/TaPwiChi/status/1418214271792533517

If you’ve had a flu shot or vaccine for rabies, polio or hepatitis A then you’ve had an inactivated vaccine before and didn’t have the mark of the beast.

Technically there should not be any issue, IMO. They are both inactivated vaccines. However, clinics will follow protocols from Ministry. If Sinopharm supply is constrained think @MoHCCZim @MCAZofficial should have guidance to clinics on alternatives for those waiting 2nd dose.

https://twitter.com/madorotafadzwa/status/1418222298893488128

Going to bed now but rem that Delta be respected (Singapore is at 50% vaccinated and we have two huge clusters now and back in lockdown) this virus has humbled us again ! But it’s such a diff story now that last year before we had vaccines. Now, mostly unvaccinated are in ICU.

We must respect Delta but we do not have to fear it. The same controls apply to it as with any other variant. It transmits so fast so it means we must act faster
1/ Vaccinate (both doses, 1 dose is not enough)
2/ Mask
3/ Stay home if you can.

Stay safe. It’s been such a tough year and a half and it’s okay not to be okay. Please reach out if you need help. Sending prayers for everyone with a loved one with Covid right now at home or hospital, and for all of those who have lost someone.

https://twitter.com/friendshipbench/status/1417733141498929152