[Funny]

Anyone has any idea about 3rd dose of vaccine? I read a few articles mentioning a booster dose, I am not sure of the terminology here. Does it mean that the booster dose is a different dose compared to 1st and 2nd? For Covishield at-least, the 1st and 2nd doses are the same and if the 3rd booster dose is also the same then can/should we take it?

[drrajasaravanan]

Originally Posted by anand253

)
- As per Cowin, he is allowed to take second does post 31 May. Should I get second dose vaccination complete for peace of mind prior as there will be some exposure during travel
- Give his medical background any tests to be done prior to getting second dose of Covishield for additional safety prior to vaccination
- Or is it recommended to check for antibodies and if sufficient level postpone vaccination to when I reach the other city
Thanks in advance for guidance.

Hi,
Post CABG he should be only on antiplatelets, if he is on blood thinners there should be another reason which you have not detailed. The answers to your questions
1. The 2nd dose is preferably taken 30 to 60 days after recovery from the infection. I would say June first or second week should be fine.
2. No medical test is required prior to 2nd dose. Ensure he is continuing his antiplatelets ( I don't think its blood thinners) appropriately.
3. No need to check for antibody titers for vaccination. Not relevant as far as I know.
Do remember post 2nd dose there is a 10 to 14 day period before the body builds up its defences to fight reinfection so plan your travel accordingly.

Originally Posted by Funny

Anyone has any idea about 3rd dose of vaccine?

Hi,
3rd dose or booster will be part of recommendation at some point. Right now it has not been detailed. Expect a yearly or twice a year doses for the vaccine. Pfizer is considering a 3rd dose after a interval of 6 to 8 months.
We will have more data, more access and cross over choices by the end of this year, so let's wait and see.

[Engine_Roars]

We need a bed with oxygen and ventilator for one of my relatives in Jaipur, Rajasthan. Preferably at a government hospital. They are facing financial difficulties and have already paid in lacs for the treatment so far at a private hospital. Family has pitched in where ever it could however this has been too big a hole to fill.

Stay safe guys. This virus is a curse.

[PhantomLord]

Had COVID? You’ll probably make antibodies for a lifetime

https://www.nature.com/articles/d41586-021-01442-9
https://www.reuters.com/article/us-h...-idUSKBN2BM3BZ

[atnyia]

Originally Posted by atnyia

No one I know who got even a single dose, got hospitalized.

Question to doctors and others. How many hospital admissions do you see/know for people who had a single dose and catch infection after 15 days (supposed time for antibody generation). How many of them end up in critical care?

I am trying to asses how safe it's going to be for people like me who got vaccinated recently and who will need to step out after two three weeks.

[amit_2025]

Question to Doctors that has may be been asked and answered already but asking again here to get a politically incorrect and clear answer

It goes without saying that one should not choose to wait for a particular vaccine and should try and get vaccinated at the earliest

The question is that if someone has access to all 3 vaccines as an option, which one should he/she pick basis the scientific evidence available so far both in terms of trial data and more recently post vaccination exposure data?

The internet is full of "all vaccines are good and get whichever you can" but most of these articles/videos are from bloggers and youtubers more than qualified medical professionals

[drrajasaravanan]

Originally Posted by PhantomLord

Had COVID? You’ll probably make antibodies for a lifetime
[/url]

Hi,
It's too early to say the antibodies protect you for lifetime. No data available till now. I had got infected twice and the 2nd time was after vaccination too. This should tell you that antibodies don't last but I do believe the memory cells can limit the seriousness of infection either natural or by vaccination.

Originally Posted by atnyia

Question to doctors and others. How many hospital admissions do you see/know for people who had a single dose and catch infection after 15 days (supposed time for antibody generation). How many of them end up in critical care?

Hi,
I am yet to see a patient who is less than 60 who got vaccinated with two doses and critically ill. We did see few cases who received single dose but did not lose any of them and we are able to deescalate treatment very fast. We did see few patients more than 70, post two doses of vaccination getting infected and dying in ICU. I think they did not seroconvert. Having said that I have seen more 80Y old who were treated with home isolation and support after infection post 2 doses of vaccination. This is a generalization and by July end I will have the exact data from my centre.
IMHO, even getting a single dose helps but do practice COVID appropriate behaviour. I think the latter is as important as the former.

Originally Posted by amit_2025

The question is that if someone has access to all 3 vaccines as an option, which one should he/she pick basis the scientific evidence available so far both in terms of trial data and more recently post vaccination exposure data?

Hi,
Short of flooding this site with lot of information I am biased towards Pfizer as supported by the data I have access too. By December end we will have more information and data to support further scientific decision.

[amit_2025]

Originally Posted by drrajasaravanan

Hi,
Short of flooding this site with lot of information I am biased towards Pfizer as supported by the data I have access too. By December end we will have more information and data to support further scientific decision.

Doctor, Thank you for your prompt response and the invaluable information and guidance you have been providing to fellow BHPians

Which would you pick between Covishield, Covaxin and Sputnik if all three were available simultaneously?

[vivek95]

Originally Posted by drrajasaravanan

Hi,
Short of flooding this site with lot of information I am biased towards Pfizer as supported by the data I have access too. By December end we will have more information and data to support further scientific decision.

Hello Doc

Even I would anyday prefer/am biased towards Pfizer--BioNtech (USA--Germany) Covid-19 vaccine over others. Srilanka Govt has already approved that some 10 days ago, wonder what is preventing us to do so.

I second your observations regarding people contracting Covid post vaccination. Same experiences at my end in Mumbai here, have come across couple of patients becoming hypoxic and requiring 15L NRBM (non rebreather mask) O2, but none has succumbed and expired so far, touchwood.

By the way, I had mentioned about getting myself tested for Antibody to Sars-Cov2 Spike protein RBD ( receptor binding domain) last week. As you know this test is more specific to Sars-Cov2 virus. Forgot to update that, by God's grace, my titre values are >250. The cut off value is 0.8 Ever ready to face this virus head on and serve more patients, bring it on.

--Dr. Vivek

P.S - expanded abbreviations only for the convenience of non-medicos.

[drrajasaravanan]

Originally Posted by amit_2025

Which would you pick between Covishield, Covaxin and Sputnik if all three were available simultaneously?

Hi,
The following is my opinion based on The data I have access to and had the opportunity to discuss with fellow colleagues whose opinion I value.
1st choice will be Pfizer. Reason is the data available and predictable efficacy. 2nd choice is Covishield for the same reason. But for people younger than 40Y without comorbids illness and for people who are at risk of clotting we have to be careful. In the absence of access to Pfizer will still advice to go ahead with Covishield with appropriate precautions.

Originally Posted by vivek95

Ever ready to face this virus head on and serve more patients, bring it on.
.

Hi,
I salute your spirit and positivity. Your titers are shockingly high, could it be due to repeated low threshold exposure to several variants. Asymptomatic health care workers don't show such high tiger levels. Did you get infected too or am I missing something.

[vivek95]

Originally Posted by drrajasaravanan

I salute your spirit and positivity. Your titers are shockingly high, could it be due to repeated low threshold exposure to several variants. Asymptomatic health care workers don't show such high tiger levels. Did you get infected too or am I missing something.

Thanks for your encouraging words Doc. As I had mentioned earlier on this thread, since the last 1 year 3 months that I have been working in Covid ICU, there hasn't been a single day of any sort of mild sickness. This is purely because of God's grace and my parents blessings I would say that I have remained asymptomatic all through. I got my RTPCR test done twice - first one on arrival at Mumbai international airport as I flew down from Jaipur, Rajasthan, that was in end Nov 2020. Result was negative. Second RTPCR was done on April 1st 2021 that turned out Negative again. Needed this mandatory test report because I did a solo drive from Mumbai to Gulbarga, Karnataka via Pune--Solapur on April 2nd, returned on April 4th.

--Dr. Vivek

[CCRider]

I've also been trying to see if there is anything at all to choose between the two available vaccines. Data on the web is very limited and sketchy
and with what I was able to find I could not conclude anything. In the end it does seems like "the best vaccine is the one that you can take asap".

Posting the consolidated data that I picked up from various random sources here which may give a sense of real world efficacy

Max Hospitals
---------------
13,965 staff who received both shots
837 got infected - 6%
84 got hospitalized (10% of infections)
1 death
No mention of which vaccine was given

Apollo
------
3235 healthcare workers (article doesn't clearly say if all were vaccinated but assuming all got at least 1 dose)
85 infected (2%) (65 were fully vaccinated and 20 got 1 dose)
2 hospitalized ( 0.06%)
No ICU admission / death
All got Covishield


Fortis Centre of Excellence for Diabetes in Delhi
--------------------------------------------------
107 received second dose and 5 more got 1 st dose
19 people infected in all
15 members (14%) got infected 2 weeks post the second dose
1 hospitalization case

of the 113 - 28 got Covaxin and 85 got Covishield but no mention of breakup for the infected group

Fortis group
------------
1600 were vaccinated
105 ( 6%) developed Covid-19 infections
1 was admitted to the hospital with mild infection.
No mention of which vaccine was used



Personal anecdotal evidence
-------------------------
Covishield
- an elderly couple > 60 who took 1st dose Covishield got infected after a month and unfortunately passed away (both of them)
- I know quite a few people in my friends / colleague's family members > 60 who took first dose and escaped with mild infection without needing hospitalization

Covaxin
- My father's cousin recently passed away a month afte taking 1st dose
- two couples (both > 65) who took covaxin both doses caught the infection but did not need oxygen. They had a 102 fever and infection was present for a week.

How do the two compare on Variants
-Lab studies conducted show that vaccines neutralize both the Indian and UK variants (B.1.617 and B.1.1.7) but at a reduced efficacy (around 50% for both vaccines)


Theoritical comparison
Covishield
- Rare Risk of the blood clot issue
- Vaccine only based on spike protein. So if that mutates it may not work
+ Tested across large populations all over the world

Covaxin
- Read somewhere that real world efficacy may vary per vial as the amount of immunity inducing material may be non uniform resulting in indeterministic efficacy
+ Since its based on whole virus, it may work against variants which change the spike protein
- Concerns around not following meet the "Good Manufacturing Practice"

My take away: The 0.04% symptomatic infection rate post vaccination as published by ICMR is definitely incorrect. But the oft repeated statement that Vaccine protects against sever illness seems to be true. However there are no guarantees.


References

Max
https://www.facebook.com/93226131833...9436991761834/

Fortis Centre for Diabetes
https://theprint.in/health/delhi-hos...erious/652277/

Fortis group
https://www.outlookindia.com/website...-deaths/382819

Apollo
https://www.biospectrumindia.com/new...-covid-19.html

[PhantomLord]

Originally Posted by drrajasaravanan

Hi,
It's too early to say the antibodies protect you for lifetime. No data available till now. I had got infected twice and the 2nd time was after vaccination too. This should tell you that antibodies don't last but I do believe the memory cells can limit the seriousness of infection either natural or by vaccination.

Thank you for input, quoted statement is from the study in that link. I am more concerned about people being blind about vaccines, its like you(immune system) finish a race(Covid variant infection) and then ask when should I start my learners course(Emergency use vaccine simulating original virus), my point is you(immune system) already know driving. I can understand if infected person is asking advise about approved vaccine which is built to cover all variants.

About Fizer & Indian variant - I read Indian variant has acquired partial resistance to antibodies.
See - https://www.scmp.com/news/world/euro...otects-against

[Sran]

Originally Posted by atnyia

Question to doctors and others. How many hospital admissions do you see/know for people who had a single dose and catch infection after 15 days (supposed time for antibody generation). How many of them end up in critical care?

Not a doctor but I have seen more than 10 cases where people have been critical after taking the first shot, all covishield, 2 in patna and 7 in Jaipur.
My mausi was one of the unfortunate one who contracted covid after first dose on april 12. She got tested on april 21 with HRCT value 19. We did everything that was possible. Remdesivir, Lmwh, steroids and other medicines with High flow oxygen, Bi-pap, all at home as beds were not available plus 2 senior doctors in our knowledge were monitoring her, with 24 hours nurse. Once her oxygen level dropped it never went up even with high flow and bi pap, her spo2 never breached 88 and without that it hovered between 45-55. She passed away on 4th of may, 2021, she was 60. She had no ailments like b.p or sugar, nothing at all. For a whole year from march 5, 2020 she never went out from the house for anything neither the house workers nor any visitor was allowed inside and strict rules were in place for others who went out for work. I miss her.

One of our known person's father passed away a week back at age 70 even after taking both doses of covishield in January.

My bade papa contracted the virus after first dose of covaxin but the effect was minimal, he is 80+ but he had a bad case of UTI post covid.

[drrajasaravanan]

Originally Posted by CCRider

My take away: The 0.04% symptomatic infection rate post vaccination as published by ICMR is definitely incorrect. But the oft repeated statement that Vaccine protects against sever illness seems to be true. However there are no guarantees.

Hi,
Thank you for sharing such data. ICMR data will recorrect gradually as they incorporate more data with time. They only thing aimed by vaccination is to avoid severe illness in majority. For reasons yet unknown elderly patients do not generate necessary response post vaccination and succumb to the illness. Still majority will benefit.

Originally Posted by PhantomLord

About Fizer & Indian variant - I read Indian variant has acquired partial resistance to antibodies.

Hi,
Studies have already showed reduced response to Indian variant by both Pfizer and Covishield but still its efficacious in preventing critical illness in most. I expect they will be reworked over time to cover most if not all variants. In the present situation it's not sustainable but will happen over time.

Originally Posted by Sran

My mausi was one of the unfortunate one who contracted covid after first dose on april 12. She got tested on april 21 with HRCT value 19.
.

Hi,
May her soul rest in peace. Thank you for sharing such a painful experience. Hope you will not mistake me for citing a few things here.
Steroids, blood thinners, antibiotic are appropriate treatments but for people who are not following the trajectory towards improvement there is escalation which is individualized for each patient. For limitations due to resources a lot of our doctors follow a template for care which may fail in 2 % of patients. This is more true in younger patients who wait till the have exhausted all the physical reserve. There is more to patient management than a template and getting such care at appropriate time can make a difference.
The point I would like to insist is to please access medical care when you are close to the threshold before exhausting your physiological reserve.