The American article mentioned how Denmark and Austria had suspended the use of a certain batch of the AstraZeneca (Oxford) vaccine. The suspension came into effect after reports of patients presenting blood clots, just days following their shot. Since then, many other European and Eastern countries have either suspended or paused roll-out of the Oxford vaccine, as they wait for results of investigations into the unproven side effects.
‘Blood clots’ are not an unfamiliar medical concept to me. I was diagnosed with a Pulmonary Embolism (a potentially life-threatening blood clot in the arteries of the lungs) during my pregnancy just a year ago. In fact, I had been a perfectly, healthy 20-something year old, and found myself on daily blood thinning injections for over 6 months and attending regular hospital visits (alone), during a global pandemic. The symptoms, the fear and the recovery were not an easy journey.
The risk of developing blood clots is five-times higher during pregnancy and one of the leading causes of pregnancy-related deaths in the US. However, blood clots are not uncommon in the general population. In the UK alone, the prevalence of venous thromboembolisms (blood clots which form in the veins of the lower part of the body, travel around body and lodge in the lung) in the general population is two in 1,000.
Moreover, scientists in the UK and leading US virologist, Faheem Younas MD, have reassured the public that recent reports of blood clots after the Oxford vaccine are likely to be coincidental, especially when considering the prevalence of clotting in the general population. Furthermore, scientist Professor Stephen Evans of the London School of Hygiene and Tropical Medicine recently spoke to Sky News, emphasising that clotting was “strongly associated” with Covid-19.
Obesity, heart disease, pregnancy, smoking, immobility for long periods of time and age are all factors known to increase the risk of blood clots. Therefore, scientists are highlighting the importance of not assuming that correlation equals causation.
An example often given to explain that correlation does not equal causation is the conclusion that “ice cream causes drowning.” One would laugh at such a conclusion. However, interpreting data without context can lead these assumptions. In such a scenario, it would be more pertinent to first look at the fact that ice cream consumption increases in the summer. In the summer, people are also more likely to take part in swimming/visiting outdoor water locations. This may in turn may mean there are more cases of drowning. Although, ice-cream consumption and drowning cases both increase around the same time, ice cream does not cause drowning. This is what is meant by correlation not equating to causation. Scientists are urging us to remember this principle about the blood clots and Astra Zeneca vaccination.
It’s also interesting to note that in the UK, over 11 million vaccines have been administered without issue, according to the UK’s Medicines and Healthcare products Regulatory Agency.
Why am I still concerned?
Although, I have been eagerly awaiting the moment I am offered the vaccine, such reports lead to hesitancy, especially regarding the Oxford vaccine. This isn’t a case of being an anti-vaxxer, or anti-science, or unable to interpret and separate data. This is a case of a very personal and valid concern, given my health history. I have enthusiastically, anticipated getting the vaccine, to help those more vulnerable, to help be a part of the solution to this pandemic and to embrace how science has helped paved a way back to “normal life”, and to help prevent a real concern of clotting, should I contract Covid-19.
To me, the current reporting, though providing the public access to information they have a right to know, seems slightly irresponsible: the average person may not have a scientific background, or access to the information required to interpret the data that scientists are reassuring us are not a cause for concern.
As I await the results of the investigations into these unproven concerns, my hesitancy towards a vaccine which has been proven to be over 70% effective after the first dose and safely administered over 11 million times in the UK, remains so.
Cuba becomes first country to vaccinate children as young as two
Spencerbdavis, CC BY 4.0 https://creativecommons.org/licenses/by/4.0, via Wikimedia Commons
Cuba has become the first country in the world to offer Covid-19 vaccinations to children as young as two. The Caribbean Island with a population of 11.2 million people plans to vaccinate all children in an attempt to reopen schools which have been shut down since March 2020.
Cuba has decided to use two of its own vaccines to inoculate children and adolescents – Soberana-2 and Abdala. The World Health Organisation (WHO) has not yet approved the use of the two vaccines, however, Cuba’s Medicines Regulatory Agency (CECMED) gave the go-ahead for emergency use of the vaccines last week. Cuban officials said they will seek WHO’s approval in due time.
The reason behind the rush to vaccinate children is that schools have been closed for over a year. Most homes in Cuba do not have access to the internet, and so conducting classes online has not been a viable option. Instead, primary, junior, and high school levels have been taught via televised classes.
Since the start of the pandemic, Cuba has recorded at least 6,056 deaths due to Covid-19, but officials say the number could be higher.
The tourism industry in Cuba has also been heavily impacted by the coronavirus pandemic. The government is hopeful this new vaccine rollout will help mitigate the spread of the Delta variant before November 2021, which is peak tourism season in Cuba.
For some time, experts have questioned the need to vaccinate children as the virus has been seen to have less impact on children. Reports indicate children tend to show only mild symptoms or appear asymptomatic with Covid-19. However, children can still be carriers of the virus. Vaccination is being considered as the best way to protect the rest of the population and possibly facilitate herd immunity.
Meanwhile, WHO says children should not be prioritised to receive vaccinations over the more vulnerable. “Children and adolescents tend to have milder disease compared to adults, so unless they are part of a group at higher risk of severe Covid-19, it is less urgent to vaccinate them than older people, those with chronic health conditions and health workers,” says WHO in its COVID-19 Vaccines Advice page.
While several countries have begun vaccinating children over the age of 12, no country has administered the jab to children as young as two years old. China and Chile have approved the use of vaccines on children, but have not begun their use yet.
Covid booster shots – fact vs. fiction
As of June 2021, Covid-19 is one of the top 10 causes of death within the United States – it briefly became the top cause of death in early 2021. Thus, it emphasises the large risk that Covid presents, especially to those who are unvaccinated. Yet, the length of the efficacy of the vaccines is unknown, and the spread of the current Delta variant gives rise to the question: Is it effective to receive a third booster shot?
There are many myths that are circulating regarding the booster shots. Let us take a look at these myths.
Myth 1: I had Covid already, and am thus immune and do not need to receive another shot.
Although antibodies are produced by being exposed to a disease, the protection that is afforded by the natural immunity begins to decrease after approximately three to six months, and the risk of becoming reinfected begins to rise. To receive the third shot would be effective in increasing natural immunity against Covid, since the shot would function similar to a booster shot.
Myth 2: Children do not need to receive the shot since they are not prone to contracting Covid.
Although the rates of children being hospitalised or dying due to Covid are uncommon, it is encouraged by experts to have children receive shots to reduce the likelihood of transmitting the disease or becoming a carrier. In addition, as children are returning to school and other daily activities, approximately 1,000 schools in 31 states of the US have reported Covid cases and shut down – thereby reinforcing the fast spread of Covid, especially among children.
Myth 3: Receiving the booster shot would give you Covid.
The vaccine itself is made of messenger ribonucleic acid (mRNA), which is translated to genes that then produce a harmless protein called the “spike protein”. The spike protein is then displayed on the surface of cells, and is seen by the immune system as a foreign invader. The immune system then begins to build up defence mechanisms that allows it to attack the protein and remember it, thus allowing for a greater immune response should infection with Covid actually occur. Therefore, the vaccine does not transmit Covid – rather, it provides a safe copy of the spike protein, to help the immune system to recognise the protein and mount an adequate response.
Myth 4: The booster shot has not undergone stringent enough testing, and is therefore unsafe to use.
Pfizer, one of the Covid vaccines, was granted full approval by the Food and Drug Administration on 19th August 2021, after having been granted emergency authorization on 11th December 2020 for use in the United States. However, the Pfizer vaccine underwent Phase 1 and 2 trials (trials where the efficacy of the vaccine is tested on progressively larger and more varied populations), as well as Phase 3 with an overlapping schedule that allowed the vaccine to have its safety evaluated rigorously and in a timely manner.
Myth 5: The booster shot will alter my deoxyribonucleic acid (DNA).
mRNA is produced as a result of transcribing DNA at a molecular level, and therefore does not alter DNA. In addition, as DNA is housed within the protective nucleus of the cell, and the mRNA is translated outside of the nucleus, the mRNA does not come into contact with or modify DNA.
Myth 6: As soon as I receive the Covid booster shot, I no longer need to wear a mask.
In the United States, the Center for Disease Control (CDC) recommends to continue wearing a mask, as research shows that the Delta variant is causing deaths in both those who are unvaccinated and those who have been vaccinated, indicating that being vaccinated alone may not be sufficient to protect against Covid. Therefore, it is advised to wear a mask when indoors in a public place that is likely to have a high transmission rate of Covid.
Myth 7: If I receive the vaccine, I will test positive for Covid-19.
As the vaccine does not contain any live virus components, such as viral proteins, it would not transmit Covid. In addition, the viral tests that are performed look for the virus that causes Covid within the respiratory system; the vaccine would not transmit viral components that would cause a positive test result.
Myth 8: Receiving the Covid-19 vaccine would cause my arm to become magnetic.
The Covid booster shot does not contain metals or any magnetic materials, and would thus not exhibit magnetic properties, or create an electromagnetic field. Specifically, the Pfizer vaccine contains the following ingredients: mRNA, lipids (which allow the mRNA to cross the cell membrane to enter the cell and protect the mRNA), salts (including sodium chloride, potassium chloride, monobasic potassium phosphate, dibasic sodium phosphate dihydrate), and sugar (sucrose; it functions to assist in preserving the shape of molecules during very high or very low temperatures). The Moderna vaccine contains: mRNA, lipids, acetic acid (a very weak acid), acid stabilizers, sodium acetate (a salt), and sugar (sucrose). In addition, the Johnson & Johnson vaccine contains: an alternative and safe form of Adenovirus 26, citric acid monohydrate, trisodium citrate dihydrate, sugars, as well as ethanol.
Myth 9: Do the approved Covid vaccines within the US release their components?
The release of components from a vaccine, also known as vaccine shedding, occurs only when the vaccine contains a weakened version of the virus. However, the current vaccines approved for use do not contain a live version of the virus, and therefore vaccine shedding will not occur with these vaccines.
In light of the above points, there are many myths surrounding whether it is wise to receive a third booster shot. However, guidance from experts indicates that the booster shot assists in providing immunity against Covid, especially as cases arise amongst both vaccinated and unvaccinated citizens. Thus, it is advised to receive the third booster shot – not only to protect yourself, but your family and community as well.
Is the definition of medicine based on scientific parameters or human values?
Definitions of medicine, disease and health are some of the most complex and philosophically intriguing discussions one can have in a medical context. There seems to be no universal truth that can be applied to these terms, as each of them can be viewed subjectively through the viewpoint of value-based arguments or through objective, factual definitions.
The definition of disease through theories such as the biostatistical theory of health, health as well-being, etc. show that the definition of medicine is not entirely scientific, nor is it entirely value based. However, it is a complex and ever-changing mixture of the two, depending on the individual circumstances of how this argument is applied.
Firstly, the definition of medicine as the “curing people of diseases” can be scrutinised, which is often mentioned as the key defining point of medicine. It can be argued that this is not entirely correct, as there are fields of medicine where the aim of the practitioners is not necessarily to cure the patent of disease but mitigate and reduce the symptoms of that disease. For example, according to the WHO, palliative medicine “improves the quality of life of patients and that of their families.”. Furthermore, any form of symptomatic treatment for diseases, some which may be terminal and so deemed ‘incurable’, is proof that the sole aim of medicine cannot simply be to cure disease. In fact, we can redefine medicine as aiming to improve the quality of life of people with disease, and thus the practice of medicine takes on a more holistic approach. Therefore, we have already deconstructed the first assumption which is commonly stated with regards to the definition of medicine.
However, we have yet to define exactly what is meant by disease. For that we must take a closer look at two different theories of the definition of disease.
Firstly, we take the biostatistical theory of health, as put forward by Christopher Boorse who stated that “a disease is a dysfunction of a subsystem of the body.” Put simply, this theory states that disease is a failure (or dysfunction) of the parts of the body, to carry out functions to statistically ‘normal’ levels, dependent on the age, species, gender, and so on. On the face of it, this theory does make sense; for example, the parameters we use to diagnose high potassium/bilirubin/white blood cell levels in the blood, etc. are based on calculated ranges that are known to be accurately reflective of the statistical normal. However, a key weakness in this theory is that for certain recognised illnesses, a patient may have statistically normal biological indicators of health, for example: mental illnesses or phantom back pain. Therefore, this theory cannot be applied as a universal truth and we cannot define what a biological dysfunction is through scientific or statistical methods alone; hence, this seemingly supports the value-based argument.
The second theory is that of “health as well-being”, which has been aptly defined as “[bringing] values back into the assessment of health, without leaving facts behind.”. Here, well-being is dependent on an individual being able to achieve their ‘vital goals’, which are personalised for every person and are the conditions that must be achieved for a person’s minimal happiness. Therefore this theory seems to suggest that disease must be based on the values of a person, because the vital goals of a person are dependent on his/her values. And so we can argue that the definition of medicine must be more value-based. However, a key point is that although this theory relies heavily on the patient’s subjective view of their own health, that view can be heavily influenced by science, and how scientific methods are applied in the context of that disease. For example, a doctor must use scientific methods to diagnose and understand the cause of disease and decide on the treatment/s needed for that patient. This in turn will affect the patient’s vital goals, and how they predict the outcome of their illness; whether they presume they have a good prognosis is based on the advice of the doctor, which is in turn based on science. So even though the vital goals of a patient are entirely subjective, the way in which those vital goals are seen and adjusted are heavily influenced by science. Therefore, science is still a fundamental part of medicine, and we cannot say that medicine is not entirely scientific and based on values.
In conclusion, we can see how medicine cannot be defined as either completely scientific or completely value based and if we take either of these theories as absolute and try to apply them to all contexts of medicine, then, we will uncover a rabbit-hole of contradictions to these arguments. The key here is to view both theories as complementary, and not mutually exclusive. This allows us to understand that the value-laden definition of disease does not diminish the scientific aspect but instead serves as a way to support and make practical use of its scientific methods.
Medicine is thus based on the beautiful harmony between science that enables doctors to diagnose and treat physical illnesses, and the experiences and values of the patients that receive treatment for their illness, which may not have any outwardly physical manifestations, but cause distress and discomfort to the patient either way. Therefore, through whichever way you define disease, it is a complementary blend of scientific and ‘non-scientific’ that ultimately best fits the definition of medicine.
New treatment for Covid-19 approved in the UK
It was announced on 20th of August 2021 that the UK government’s Medicines and Healthcare products Regulatory Agency (MHRA) has approved a new Covid monoclonal antibody therapy for use in the UK. This drug, called Ronapreve has shown to prevent infection, as well as reduce the need for hospitalisation.
It is important to note though, that this is a very expensive drug, and it is very likely that it will only be used for people who are at a significant risk of becoming severely ill. It was previously used as one of the experimental medications given to US President Donald Trump in 2020.
Ronapreve is a combination of two antibodies that work together to prevent infection by stopping the virus from attaching to human cells, ending any further spread of infection in the body.
Research has shown that if given very quickly after the onset of the initial symptoms of the virus, this treatment can not only decrease the length of illness, but also reduce the need of hospital treatment as well as death from Covid-19.
Although how much the treatment has an effect will vary depending on the extent of use, it is estimated that it will reduce risk of hospitalisation, by about 70%. This is especially very important for people that are more vulnerable and are at a higher risk of becoming very sick from the disease, whether they have been vaccinated against the virus in the past or not.
In addition to this, prevention trials have also shown that the treatment will reduce the “viral load” that is produced by people that are infected, and this will subsequently reduce risk of transmission to other people.
Dr Samantha Atkinson from the MHRA said: “We are satisfied that this treatment is safe and effective.” The treatment is expected to be used by the NHS very soon, however due to being very expensive it is unclear who will receive it. The challenge now will be determining which patients should be prioritised for this treatment, as Covid-19 is not a rare disease at all.
The average cost of one course of treatment is £1,000-2,000, and as it is not a medicine that can just be bought over the counter, it is a monoclonal antibody treatment – these are complex and therefore very expensive to make.
Professor Myron Levin, who led the trial at the University of Colorado, said the results were “exciting” and could be “an important tool in our arsenal to help people who may need more than a vaccine to return to their normal lives”.
Health and Social Care Secretary Sajid Javid said:
“The UK is considered a world leader in identifying and rolling out life-saving treatments for Covid-19, once they have been proven safe and effective in our government-backed clinical trials.”
“This is fantastic news from the independent medicines regulator and means the UK has approved its first therapeutic designed specifically for Covid-19.”
“This treatment will be a significant addition to our armoury to tackle Covid-19 – in addition to our world-renowned vaccination programme and life-saving therapeutics dexamethasone and tocilizumab. We are now working at pace with the NHS and expert clinicians to ensure this treatment can be rolled out to NHS patients as soon as possible.”
US surpasses 40 million covid cases
20 months after the first Covid-19 case was reported in the United States, the total number of diagnosed cases has surpassed 40 million, with an approximate 161,000 new coronavirus cases a day.
Of the confirmed cases, this includes almost 650,000 patient deaths, according to data from John Hopkins University. The data also showed that more than four million of the total cases since the start of the pandemic were reported in the last four weeks. To put that into perspective, that means over 10% of the total number of cases reported have been in the space of under 5% of the duration since January 2020.
According to the Centre for Infectious Disease Research and Policy about 100,000 Americans are currently hospitalised because of Covid-19 infections. This increased rate of hospitalisation means at least six states including Florida and Texas have over 90% of intensive care unit (ICU) beds occupied.
Not only do surges related to the Delta variant continue to spread and schools reopening affect ICU capacity, but it also exacerbates a medical staffing shortage, as doctors, nurses, and other medical staff are exposed to and at risk of contracting the virus themselves.
According to the American Academy of Paediatrics (AAP), in the single week ending 2nd September 2021, 26.8% of reported weekly covid cases were in children, with this rate being only 15.1% across the entirety of pandemic.
While the data on child covid hospitalisations is limited, the AAP states, “It appears that severe illness due to COVID-19 is uncommon among children. However, there is an urgent need to collect more data on longer-term impacts of the pandemic on children, including ways the virus may harm the long-term physical health of infected children.”
As stated above, this rise in cases among children can be attributed to schools reopening after the summer break, as many children in the US returned in early August. The recent report from the AAP stated that cases amongst minors had decreased over the early summer period but have since increased exponentially.
Between 5thAugust and 2nd September over 750,000 covid cases were reported in children, with approximately 252,000 being in the past week alone. This is the highest number of child infections since the beginning of the pandemic.
The current statistics demonstrate how the Coronavirus pandemic is showing no signs of slowing down in the USA. As many states still struggle with the vaccine rollout and uptake, colder months and winter viruses are around the corner, it’s pretty safe to say even some of the wealthiest nations in the world aren’t out of the woods just yet.
Covid are we overreacting? – In Focus
The COVID pandemic is the largest public health issue of our lives. Changes to social interactions have impacted almost every aspect of life. But as the vaccine continues to be rolled out a number of questions are being raised about our response and approach. In this episode we bring you a fresh perspective and help bring things back ‘In focus’.
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