Tag: Covid-19

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The harsh truth: Children are getting COVID

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Breaking down the Delta Variant

Breaking down the Delta Variant

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It seems we hear of a news report of a newly discovered Delta COVID19 case in Sri Lanka almost on a daily basis. Resulting in the question, what is the delta variant and what does that mean for us?

For our more in-depth blog on variants, please click here. 

Short read: It is highly transmissible and has caused more hospitalisations than the Alpha variant in the UK (and India, though the data isn’t as neatly available), especially in young people and the unvaccinated. It is found to be more resistant to the Pfizer and AstraZeneca vaccine responses especially after only one dose but continues to provide 80-90% protection after two doses against symptomatic disease. A widespread of this variant in Sri Lanka could overburden an already overwhelmed medical system. Until vaccines can be rolled out to the majority of the population, adhering to strict COVID19 protocols by businesses and individuals is our only avenue for protection. 

Want more details? Read on!

The Delta variant (B.1617.2) was first sequenced in India post its recent COVID wave of March 2021. The variant was classified as a variant of concern by the WHO alongside the Alpha variant (B.1.1.7) first discovered in Britain, the Beta variant (South Africa) and the Gamme variant (Brazil). Variants of concern are those that are considered highly transmissible, highly infectious and/or deadly.

So what do we know about this newest variant on the block?

Image source: Dr. Eric Topol

How transmissible is it?

WHO’s Dr Mike Ryan described the Delta variant as “faster, fitter and will pick off the more vulnerable more efficiently than the previous variants”. The variant is the fastest spreading one in the UK and has prompted medical professionals to estimate that it is around 60-70% more transmissible than the Alpha variant. 

Tracked data shows that COVID cases have grown 75% week over week in May in the UK (mostly amongst young people and the unvaccinated). 

Why is more transmissible more dangerous?

To quote Zeynep Tufecki on a New York Times op-ed:

“Increased transmissibility is an exponential threat. If a virus that could previously infect three people on average can now infect four, it looks like a small increase. Yet if you start with just two infected people in both scenarios, just 10 iterations later, the former will have caused about 40,000 cases while the latter will be more than 524,000, a nearly 13-fold difference.”

What are its symptoms?

Even in the early throes of the Indian third wave, reports of different COVID19 symptoms began to circulate amongst social media. 

Updated COVID19 symptoms as per the CDC now include:

  • Fatigue
  • Muscle or body aches
  • தலைவலி
  • வறண்ட தொண்டை
  • Congestion or runny nose
  • Diarrhoea
  • Nausea and vomiting

How does it affect hospitalisations and the death rate?

A Public Health Scotland study found that the risk of hospital admissions was almost doubled with Delta vs. Alpha. 

Amongst those vaccinated with Pfizer or AstraZeneca, the Public Health England study reported that those with one dose of vaccine were 75% less likely to be hospitalised and those with both doses are 94% less likely to be hospitalised when compared to the unvaccinated population.

How does it respond to vaccines? 

A report published by Public Health England indicated that the variant is moderately resistant to vaccines, especially just the first dose. A single dose of AZ or Pfizer reduced a person’s risk of developing symptomatic illness by 30% (vs. 50% for the Alpha variant). A second dose of AZ increased protection to 60% (compared to 66% for Alpha). Two doses of Pfizer were 88% protective against the variant (compared to 93% against Alpha). 

No studies are available about the Sputnik or Sinopharm response to the new variant.

How can we stay safe?

Whilst richer countries look to rapid deployment of vaccines to counteract the rising Delta cases, Sri Lanka – with limited access to vaccines – must rely on the tried and tested COVID19 safety precautions:

  • Limiting physical gatherings (especially, AC & indoors)
  • Masking indoors & outdoors (over nose & mouth, when around those that are not of the same household)
  • Washing hands with soap
  • Sanitising high touch surfaces

As the third wave has taken us to the brink of medical capacity, any spread of the Delta variant in Sri Lanka could have serious ramifications to public health, but also to the overburdened medical system.

We encourage all Sri Lankans to get vaccinated, to stay home and follow COVID19 protocols to the utmost of your abilities. 

If you are experiencing any COVID19 symptoms or would like to speak with a doctor about your general health, download the oDoc app here. 

If the uptick of cases and variants are causing your mental health to suffer, speak to a psychologist on the oDoc app safely from your home.

Sources

  1. Stowe, J. et al. Effectiveness of COVID-19 vaccines against hospital admission with the Delta (B.1.617.2) variant., Preprint at https://go.nature.com/3gnqwxr (2021)
  2. Sheik, Z et al. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness., The Lancet: 397: 2461-262 (2021)
  3. WHO says delta is the fastest and fittest Covid variant and will ‘pick off’ most vulnerable, CNBC (2021)
  4. UK reports 6,238 daily Covid cases amid fears over Delta variant infectiousness, The Guardian (2021)
  5. Tufecki, Z., Covid’s Deadliest Phase May Be Here Soon, The New York Times (2021)
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Understanding the dynamics – breastfeeding, pregnancy and COVID vaccines

Understanding the dynamics - breastfeeding, pregnancy and COVID vaccines

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As Sri Lanka rolls out its vaccination program, the questions have shifted from “Which vaccine should I get?” to “Should pregnant and breastfeeding women get vaccinated?” 

The answer in short: Yes, everyone should get vaccinated when offered the chance.

For a more detailed answer on how the vaccine affects pregnant and lactating women, read more below.

Breastfeeding and vaccinations 🤱🏾

Women who have recently given birth or are still breastfeeding should get the vaccine. 

Initially, the clinical trials for the COVID-19 vaccines currently in use did not include women who were breastfeeding. So, there was no clinical data on the safety of vaccines in lactating women, effects of the vaccine in breastmilk production and the consequences on the baby. However, now according to the WHO and new research, lactating women can receive a COVID-19 vaccine.

Recent reports have shown that breastfeeding women who have received COVID-19 vaccines have antibodies that pass on to the baby via breast milk, helping in protecting the baby. 

 A study conducted in Israel with thePfizer-BioNTech vaccine, with 84 breastfeeding women, showed that IgA antibody (the first line of defence when exposed to an infection) secretion was present as early as 2 weeks after vaccination in the breast milk. This was followed by a spike in IgG antibody (important for remembering the virus to prevent future infections) 1 week after the second dose in the breast milk. This suggests a potential protective effect against infection in the infant as these antibodies are passed on to them via the milk. No mother or infant experienced any serious adverse event during the study period.

More data is needed to understand what protection these antibodies provide to the baby. Even though the studies on breastfeeding and vaccinations are not advanced, the present data shows no indication of harm to the mother or child.

Pregnancy and vaccinations 🤰🏾

As with many other vaccines, the effects of the COVID-19 vaccines on pregnant women have not been studied extensively yet. However, health professionals assess the risks of COVID19 vs. the COVID vaccine when deciding whether pregnant women should receive the vaccine. 

Pregnant women with any of the following conditions are at a higher risk of contracting severe COVID than women who are not pregnant: 

  • have underlying health conditions (for example diabetes, high blood pressure or asthma)
  • are overweight
  • are aged 35 years or over

Preliminary findings in a study conducted in the US on the effects of mRNA vaccine in pregnant women did not show obvious safety signals among pregnant women who received mRNA Covid-19 vaccines compared to the control group.

It must be noted that injection-site pain was reported more frequently among pregnant women than among non-pregnant women, whereas other side effects such as headache, chills, and fever were reported less frequently. However, a more detailed and longitudinal study is needed to understand the full impact of vaccination on pregnant women. 

We already know pregnant women are at a higher risk of getting severe COVID and also at a higher risk of delivering a baby prematurely. So in a country like Sri Lanka, where the transmission rate is high, the benefits of getting the vaccine far outweigh the risks. 

Fertility and vaccinations 🌸

Women who are planning to get pregnant in the near future can absolutely take the vaccine. There is no evidence of COVID vaccines affecting fertility or the chances of getting pregnant. So get your vaccine when it becomes available to you. 

If you want more detailed information on getting vaccinated you can speak to one of our on-demand GPs at any time via the oDoc app. If you or your loved ones are showing any COVID symptoms please consult a doctor via oDoc immediately or use the oDoc COVID symptom checker to understand what you should do next.

Sources

  1. Perl, S. H., Uzan-Yulzari, A., Klainer, H., Asiskovich, L., Youngster, M., Rinott, E., & Youngster, I. (2021). SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women.
  2. Vaccination Considerations for People Pregnant or Breastfeeding. (2021, June 16). Centers for Disease Control and Prevention. 
  3. Public Health Scotland. (2021, June 18). Pregnancy, breastfeeding and the coronavirus vaccine. The Coronavirus (COVID-19) Vaccine. 
  4. WHO. (2021, June 4). Episode #41 – Vaccines, pregnancy, menstruation, lactation and fertility. World Health Organisation.
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So, can we mix and match vaccines?

So, can we mix and match vaccines?

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As the first dose recipients of the AstraZeneca vaccine started to reach the 12-week mark in May, a lot of people were dismayed that they wouldn’t be able to receive the second jab in a timely manner. A lot of conversations began to revolve around “well, what happens to my immunity?” or “can’t we use another vaccine as a second dose?” and at the time, there weren’t much scientifically sound answers to ease people’s nerves. 

The dearth of the second jab of AstraZeneca vaccine for over 500,000 in Colombo was largely due to the Indian COVID surge shutting down Serum Institute exports in late March. As India hurried to absorb all its domestic production to stop a calamitous third wave, a large number of developing countries, including ours, were left without a way forward. 

In December, Russia & the UK began a study of the safety & efficacy of following up a first AstraZeneca dose with a Sputnik booster and in the UK & Spain, researchers started studying the effects of a follow-up Pfizer booster.

Short answer: The jury is still out on exact findings but some preliminary data is available: side effects were more pronounced in intensity (however not severe and no hospitalisations) and higher antibody levels were seen after a Pfizer booster. 

Want more details? Read on: 

What do we know about safety?

In a UK trial, of the ca. 460 people (median age of 50+ years) that received the AZ jab and then a Pfizer booster 28 days later saw greater intensity in post-second jab side effects than those that received a second AZ dose (“control group”). 

More people felt feverish, had chills, felt fatigued, had joint pain and muscle aches in the study group than in the control group. Most of these effects were felt in the first 48 hours after. Efficacy data has not yet been made available. 

Safety and efficacy data of a booster shot being administered after 84 days is expected in June.

What do we know about efficacy?

A study by the Carlos III Health Institute in Madrid enrolled 663 people who had received the AstraZeneca first dose to receive the Pfizer second dose after eight weeks. The control group did not receive any booster shots. 

The results showed a much stronger immune reaction producing a higher level of antibodies in the Pfizer group than they did with the first dose of AstraZeneca. No severe side effects were reported.

What about a Sputnik booster? 🇷🇺

In December 2020, the UK & Russia began to partner on a study to test safety and efficacy of mixing these two vaccines. On May 28th, Russia announced a hold on it’s mix and match trial with Sputnik as the national ethics committee awaited further data.

What about a Sinopharm booster? 🇨🇳

No data is available at the time of publication however Bahrain has allowed mixing with a second dose of SinoPharm. 

What are other countries doing?

Some countries have already begun allowing a second dose of mRNA to supplement the first dose of another brand. On 1st June, Canada’s National Advisory Committee of Immunization announced it would allow second doses of mRNA to be administered to those that received the first dose of another brand of vaccine. 

Bahrain, Finland, France and Norway had begun allowing second doses of mRNA to be administered to those with AstraZeneca first doses.

What about us in Sri Lanka? 🇱🇰 

The health authorities have not approved the mixing of vaccines in Sri Lanka at the time of publication. The government is attempting to procure the shortfall of AstraZeneca doses by any means possible and has signed an agreement with Pfizer for 900,000 doses for delivery in July. 

The recent crowdings and altercations at AstraZeneca vaccination drives serve to be more harmful than helpful when limiting the spread of COVID19. Until sufficient data is available and vaccines are approved & available for mixing, we believe it’s most prudent for those that received the first AZ dose to adhere to strict COVID19 protocols, limit travel as much as possible and avoid crowded gatherings. 

If you or a loved one have been diagnosed with COVID19 and are awaiting transfer to an intermediate care centre or government facility, oDoc Home Care is available for you. 

With oDoc Home Care, you receive daily calls from a medical doctor for symptom monitoring & medical advice, a wellness bundle including gloves & masks, a pulse oximeter and blood pressure monitors. Click here for more details. 

Sources

  1. Shaw, R., et al (2021) Heterologous prime-boost COVID-19 vaccination: initial reactogenicity data., The Lancet., 397:2043-2046. 
  2. Callaway, E (2021) Mix-and-match COVID vaccines trigger potent immune response, Nature Magazine
  3. Miller, A (2021) Canada recommends mixing and matching AstraZeneca, Pfizer and Moderna COVID-19 vaccines, CBC
  4. Explained: Which are the countries allowing you to mix Covid-19 vaccines?, Indian Express (2021)
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You test positive for COVID-19. What Now?

covid positive

You test positive for COVID-19. What now?

Updated August 12th, 2021.

Medically Reviewed by Dr. Rashmira Balasuriya BSc (Hons) MBBS PGCert (MedEd)

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With the number of COVID-19 cases rising across the country, it is more likely than ever that we have either interacted with or know of a person who has been tested positive for COVID-19. And if we’re feeling a little temperature or a sore throat, our next thought tends to be “Should I take a PCR test?”. With the amount of ambiguity and daily change of regulations, we, at oDoc, want to keep you informed and updated with the latest news regarding COVID-19 processes in Sri Lanka.

What should you do after finding out you’ve been tested positive for COVID-19?

Contacting your local PHI

You can find out who your local PHI is from this website (On the navigation bar at the top, click ‘Find PHI’ and fill in your area details) The lab or hospital where you were tested for COVID-19 will also inform your local PHI and Ministry of Health.

Things you should keep in mind for your conversation with the PHI officer:

  • COVID-19 symptoms
  • How long you’ve been having these symptoms
  • Any known medical illnesses (i.e. asthma, diabetes, etc)
  • Any medications taken for known illnesses or after becoming COVID positive
  • Any allergies
  • Any previous surgeries
  • If you’re a smoker or not
  • People you have been in contact with over the last few days
  • Have an emergency contact number of a family member/friend
pcr test

Home Isolation 

To reduce the burden on hospitals and COVID-19 care centers, the Ministry of Health has introduced the option of low risk COVID-19 patients isolating in their homes. Here are a few things to keep in mind when quarantining at home:

  • REST.
  • Remain in a separated well-ventilated room.
  • Avoid contact with others as much as possible. Identify one family member who is low risk to be in contact with you. Wear a surgical mask and wash hands before coming into contact with anyone else.
  • Do not share washrooms if possible. If sharing, you should disinfect the washroom after each use.
  • Eat a healthy diet.
  • Stop smoking.
  • Do not routinely take antibiotics or steroid medication. Only take medication prescribed by a licensed medical practitioner.
  • Have warm fluids frequently such as tea, kothamalli, jeewani
  • Steam inhalation – only for symptomatic relief and always ensure safety
  • Keep track of any new or worsening symptoms – If possible, keep a check on your basic vitals – temperature, pulse rate, respiratory rate (count the number of breaths per minute), blood pressure and oxygen saturation.
  • You should use separate cutlery, plates, dishes and bedding from the rest of the household members.
  • Clean frequently touched surfaces often.
  • Keep your bed linen and clothes in a laundry bag separate from others.
  • All household members should remain at home and avoid any contact with people who don’t live in the same household.
  • No visitors should be allowed during the home isolation period.
  • Call 1990 if you have any difficulty breathing, chest pain or loss of speech/mobility.
  • Keep emergency contact numbers close by.

How will you be accessed during home isolation?

The area MOH will be responsible for triaging COVID positive individuals who need home-based care and who need hospitalized care.  Taking care of your mental health during this period of isolation is also important and can help in making you feel better, so consider speaking to a mental health professional during this time as well.

During your home isolation period, you can purchase Home Care with oDoc. You will need to inform your local PHI if you choose to use this service.Here’s what you have access to:

  • A dedicated doctor assigned to you to virtually monitor your symptoms everyday 
  • A Pulse Oximeter and Blood Pressure Meter (both NMRA approved) to be sent to your home
  • A Wellness Package of masks, gloves, sanitizer, and a box of Panadol to be sent to your home.

Click here to find out more about Home Care with oDoc.

A minimum of 14 days is required for the home isolation period. The Ministry of Health and your doctor will make the decision on when you should stop the home isolation period. This will depend on your symptoms and how many days have passed since the onset of symptoms. If the MoH decides you can remove yourself from isolation, it is still recommended that you quarantine at home for a further 14 days.

Government/Private Care Centers

If the PHI/MoH decides that you need to be treated at a hospital or care center, there are options to stay in a government care center for free or a private care center for a fee. If you choose to quarantine at a private care center, you can find all the information on space availability, rates and medical support here.

You may have to remain at home before a bed becomes available at a COVID care center. If you need to remain at home for a few days, please follow the above guidelines. Your local PHI will transfer you to an Intermediate COVID care center when a bed becomes available to you.

How do you know when to seek immediate medical attention?

  • Progressive worsening of persistent symptoms
  • Difficulty in breathing at rest or after mild exertion
  • Oxygen levels at rest is below 96% or less than 94% after mild exertion (check with Pulse Oximeter)

If any of the above occurs, please go to the hospital immediately or call 1990 for an ambulance.

How long after you’ve recovered from COVID-19 can you take the vaccine?

If you’ve had a mild/moderate version of COVID-19, you can take the vaccine 2 weeks after recovery. If you’ve had a severe form of the disease AND received monoclonal antibody/plasma therapy as part of your treatment, you will have to wait at least 1 month before vaccination.

We will continue to update this article if and when regulations change so keep checking this space for any COVID-19 related news in Sri Lanka.

Watch our short video explaining everything you need to know about the highly contagious and transmissible Delta Variant here.

If you would like to read more about the SinoPharm and Sputnik vaccines, read more here. 

If you or a loved one would like further advice on COVID-19 symptoms, consult with our on-demand GPs who are available 24/7.  You can download oDoc here.

References:

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