COVID update by experts

 *Covid Update-216*

*Vaccine Variants and Third Wave*:

A meeting was held on the Aegis of East Delhi Physicians Association in 10 July 2021. *Padam Shree Prof Raman Gangakhedkar from ICMR enlightened the audience with his original ideas, Dr Moorjhani Infectious Diseases Specialist also shared his experiences*. Meeting was chaired by Dr SK Gupta, Dr Pankaj Chaudhary Dr Anupam and Moderated by Dr Ruby

*Sharing some Key issues discussed  in meeting*.  

🔰Dr SK Gupta: *Should HCW esp Doctors opt for  3rd dose Booster of  Covid Vaccine* as it is already six months since they received last dose as antibody levels might have waned significantly?  

🌹Dr Gangakhedkar:  *No need of third Dose (Booster) even to Health Care Workers* in current scenario because :

1️⃣.Data is showing that current covid *vaccines (including Covaxin  and Covishield) provide at least a year long good protection*.

2️⃣. Sensitisation of *memory T cells is likely to give longer protection* even if antibody titres wane off. 

3️⃣In India vaccination started  on Jan 16 so it just bit too early to talk about Booster vaccination even for HCW. Though antibody levels continue to decrease in absence of fresh challenges by the antigen *(it is also possible that HCW keep getting some exposure to virus by nature of their job)*

4️⃣. *Covid appropriate behaviour Mask Hand Sanitizer can protect upto 85% of covid infections*. 

5️⃣.Currently there are no variants of Public health concern in sight which could be totally evading the vaccine driven  immunity. *Available vaccines have shown to provide significant immunity against variants of concern*.

6️⃣ *_In case immune escape variant takes over  in near future_* 

-- *HCW will be the first to be offered the vaccine*

-- Vaccines can be tweaked to newer variants.

7️⃣ Though some breakthrough infection have occurred in HCW despite two doses of vaccine. Most of such cases have been mild.

🌹Dr Moorjhani: Lately mortality among cases of breakthrough infection has been 0.1% in NewYork

🌹Dr Gangakhedkar: mortality after breakthrough infection is mainly has occurred  in very old age  people having comorbidities, so such *HCW who are old infirm and have serious co morbidities can be considered by Booster dose* .

🌹Dr Moorjhani: *In USA third Booster dose is being planned for patients 1. Dialysis patients 2. Transplant recipients 3. Immunocompromised*.

🔰Dr SK Gupta: UAE *(Dubai) is offering a third dose* as the graph of cases contained to remain high despite very high coverage of population. In UAE more than 50% people received China's Sinopharm Vaccine

🌹Dr Gangakhedkar: *Sinopharm vaccine from China had shown varied efficacy of ~51 % to 80% in different countries which  remains unexplained*. There could be doubts about transparency of data (regarding vaccine) from China. Such a question does not arise for vaccines used in India. 

🔰🔰Dr Ruby : *What about the revaccination of those with poor anti body titres on antibody testing*.🔰🔰

🌹Dr Gangakhedkar: *Antibody testing is not recommended for such a purpose*.

 ◆Different vaccines  produce different antibodies like anti Spike, Anti Nucleocapsid IgG Etc and 

◆various antibody  kits would measure the differently 

◆Protection cut off levels have not been defined 

◆ T cell responses can't  be measured and are not likely to be commercially available in near future.

◆Anti body levels may vary with time interval of  vaccination 

*If a properly timed antibody test is conducted using a standardised kit and results show poor response then Revaccination using a vaccine from different platform (√Vector √mRNA √inactivated etc)  should be considered* in old,  immunocompromised and people with comorbidities..