Saturday, 9 January 2021

Is the COVID-19 Vaccine safe for me?

More frequent tests, additional requirements likely for those who do not take COVID-19 vaccine: Lawrence Wong
By Ang Hwee Min, Channel NewsAsia, 8 Jan 2021

Individuals who choose not to take the COVID-19 vaccine may need to go through “more frequent testing”, said Minister for Education Lawrence Wong on Thursday (Jan 7). 

In an interview on CNA’s Talking Point, the co-chair of the COVID-19 multi-ministry task force spoke of "tangible benefits" for those who choose to get vaccine shots.

“It may well be, if the data validates all the hypotheses, that transmission risk can be significantly reduced. It may well be that travellers coming back need not serve SHN (stay-home notice) or will serve a shorter SHN. So those will be the benefits of getting a vaccination besides the fact that you are protecting yourself and your loved ones,” he added. 

“There will be these tangible benefits and those who choose not to be vaccinated, well, then you have to live with more frequent tests, you have to live with quarantine, you have to live with all of these other additional requirements.”


EARLY BETS TO SECURE VACCINES

Mr Wong also explained why the vaccine made by the Chinese biopharmaceutical company Sinovac was picked as one of the three vaccines to be used in Singapore.

The vaccine is 78 per cent effective in protecting against the coronavirus, according to the results of a study announced on Thursday by Brazilian state health officials. More than 12,000 health workers in Brazil participated in the study.

The Government convened an expert panel to look at making early purchases of vaccines “as early as April”, Mr Wong said.

“We have to make early bets in order for Singapore to be near the front of the queue for vaccines. And that's what is happening today.”

At the time, there was no clinical data or “full-fledged information” available from any vaccine company, said Mr Wong.


With only "very early stage clinical information" available, the committee and experts narrowed down the selections to 35 vaccine candidates. They eventually decided on the three vaccines - Moderna, Pfizer-BioNTech and Sinovac - based on safety and effectiveness based on the preliminary data that was available then, he added.

“And that's the three that we have made advanced purchases for, with the aim of building a diversified portfolio of vaccines that will be safe and effective for use in Singapore,” said Mr Wong.

When asked by Talking Point host Steve Chia if this approach by Singapore could be characterised as "hedging (its) chances", Mr Wong replied: "Very much so."

According to the Economic Development Board (EDB), the vaccine panel made its first advance purchase agreement with Moderna in June, securing it with a downpayment. In August, it bought the Sinovac vaccine and was in advance talks with Pfizer-BioNTech.

Singapore’s Health Sciences Authority (HSA) eventually approved the Pfizer-BioNTech vaccine first. Prime Minister Lee Hsien Loong announced in a televised address on Dec 15, 2020 that the first shipment would arrive by the end of December, with other vaccines expected in the coming months. 


The panel intends to continue to see whether it can make further purchases to add to the vaccine portfolio, said Mr Wong.

“That's our overall approach. It's not to make a single bet, we know that we've made some early bets, some may turn out positive as I think Pfizer has now been authorised, Moderna looks like it's going to be, it has been approved in America,” he added.

“We are looking at the data, we will await that data full data from Sinovac and then the process will continue for other vaccine candidates.”


VACCINE SAFETY

The Moderna and Pfizer-BioNTech vaccines use the new messenger RNA (mRNA) technology, while Sinovac is a traditional inactivated virus vaccine.

mRNA vaccines teach our cells to make a protein that triggers an immune response inside our bodies, said director of communicable diseases at the Ministry of Health (MOH) Associate Professor Vernon Lee. This is different from traditional vaccines that put a weakened or inactivated germ into our bodies.


“This is basically the key - the actual mRNA degrades very quickly in the body, so body temperature will only remain for about 48 hours. And thereafter, there's no additional component of the vaccine that remains in the individual,” added Assoc Prof Lee, who was also speaking on Talking Point.

Although the Pfizer-BioNTech vaccine is the only one approved so far, as additional vaccines come onboard, there will be some vaccines that can or cannot be used in certain subpopulations, he added.

For example, the Pfizer-BioNTech vaccine cannot be used in people who have severe allergic reactions or a history of anaphylaxis, said Assoc Prof Lee. For now, children under 16, pregnant women and individuals who are severely immunocompromised are also excluded from using the Pfizer-BioNTech vaccine.

“Other vaccines might be able to be used in different populations. So we need to wait for more information, and it is which vaccine is more ... applicable or relevant to that particular population if it's offered, we will encourage people to get that vaccine,” he added.

The third guest on Talking Point, Associate Professor Benjamin Ong, senior vice president (Health Education & Resources) at the National University of Singapore (NUS), said the data for the Pfizer-BioNTech vaccine is “most complete”, and experts are “confident enough” to recommend its use in Singapore’s setting.


CHOICE OF VACCINE

On the subject of whether people would be allowed to choose their vaccine, Mr Wong said that the Pfizer-BioNTech and Moderna vaccines worked similarly, and efficacy rates from evidence around the world were “all about the same”.

“So really, there's not much to differentiate between these two vaccines. I think at this point in time, we have Pfizer only, there's nothing to choose from. So let's go with Pfizer, get people vaccinated on the Pfizer vaccine,” he added.

“If later on other vaccines are authorised, be it Moderna or Sinovac, then we have to think about whether choice may be extended. Or perhaps some vaccines work better for certain sub-segments of the population, and then we might allocate vaccines differently as well.”

VIRUS MUTATIONS

When asked about the new strain of COVID-19 that surfaced after the Pfizer-BioNTech and Moderna vaccines were approved around the world, Assoc Profs Ong and Lee said mutations occur “all the time”, and are part of "natural evolution”.

Prof Lee likened the mutations to a car getting a different licence plate or colour.

“The same make, same model, different licence plate, we see many of them all around the time. And sometimes you might have a car with new tires, it might be a bit more efficient, move faster, and so on, but it's still the same make,” he added.

“At this point, there's no evidence that it (the virus) has changed to another make, another model, another brand. And we, of course, will be looking out for different strains, different variants that occur all the time.”

From the mutations that have been studied so far, it seems like the vaccines “probably would still work”, said Assoc Prof Ong, adding that this is being actively tested.

“The areas that pertain to the spike protein, for example, are conserved. So from the basic scientific principles, it should still work. And we will know very soon because more than two, three million people now in the UK in the US have received a vaccine. And if it is not going to work, in the next few weeks to months, we will know,” he said.

The variants that have been reported are only those that have been detected, and there may be others that have yet to surface, said Assoc Prof Lee.

“Actually what's important is in addition to the vaccine, we have a very strong border, you know, control regime, plus all the same management measures wearing of masks or contact tracing,” he added.


UNVACCINATED INDIVIDUALS STILL SUSCEPTIBLE

Acknowledging that many people hope to return to a pre-pandemic normal, Mr Wong said that even in a post-COVID-19 world, there would be pandemics with more virulent diseases that arise in the future. 

“I think rather than thinking about let’s go back to life before COVID, I think we should be thinking now about what are the things that we have done during this period that really ought to be permanently part of our new daily routines,” he added.

“And how can we raise our levels of defences, our levels of protection, our levels of hygiene so that we can be more prepared and more resilient in the future?”


Assoc Prof Lee also stressed that individuals who do not get vaccinated are “still susceptible” to being infected with COVID-19.

“Even if we reach that sort of herd immunity or collective protection level, it does not mean that there will be no cases and that’s the same for all other infectious diseases. And the risk of cases occurring in Singapore is not just what we do here but what’s happening in the rest of the world,” he said, adding that an open economy, travel and trade would result in imported cases.

“If we are not vaccinated, every single individual who is not vaccinated, is another naive susceptible individual who then can get infected by those diseases. To protect yourself, you should get vaccinated and then there’s the other benefit of protecting your loved ones and those around you,” said Assoc Prof Lee.

“It is very important for that reason because even if we have a high vaccination coverage, it does not mean no disease. It is not possible to wipe COVID-19 from the face of the earth. We’re going to see this recurring from time to time, so it is important for that personal protection reason.”










COVID-19 vaccine could mean shorter stay-home notice for those who take it: Lawrence Wong
Govt will consider it if data shows vaccination significantly reduces the transmission risks
By Rei Kurohi, The Straits Times, 9 Jan 2021

Travellers who have been vaccinated against Covid-19 may avoid having to serve a lengthy stay-home notice (SHN) when they return to Singapore in the future, Education Minister Lawrence Wong has suggested.

Mr Wong, who co-chairs the multi-ministry coronavirus task force, said the Government would consider drastically reducing or even doing away with the two-week quarantine requirement if data shows vaccination significantly reduces transmission risks.

He said this was one of the potential "tangible benefits" for those choosing to be vaccinated, besides protection against the virus. "Those who choose not to be vaccinated, you have to live with more frequent tests, you have to live with quarantine, you have to live with all of these other additional requirements," he said on Thursday in an interview on CNA's Talking Point.

"If you have the vaccination, you travel to a high-risk place, you come back, can that SHN be shortened, or even done away with completely? That is the big question," said Mr Wong. "We still don't know the extent to which a vaccination can completely - or how significantly - help reduce transmission risk. So, those studies are still pending. If indeed the data shows that transmission risks can come down significantly with vaccination, then certainly, we will consider reducing drastically the SHN or even doing away with it."

Being vaccinated may also make it possible to travel abroad more freely, depending on the requirements in other countries, Mr Wong noted. "Even without a vaccine today, many Singaporeans can already travel freely to other countries without a quarantine there because they regard Singaporeans as coming from a low-risk jurisdiction," said the minister.

"I think with a vaccination, it will certainly help, but those are regulations that are outside of our control."


The discussion, hosted by CNA presenter Steven Chia, also featured Associate Professor Vernon Lee, director of the communicable diseases division at the Ministry of Health, and Associate Professor Benjamin Ong, who chairs the expert committee on Covid-19 vaccination convened by the MOH.

Prof Lee debunked a number of rumours about the vaccine, including one that it can cause cancer.

"At this point, there is no evidence that this vaccine will result in such a side effect," he said in response to a question from a viewer. He added that most of the known side effects are mild, but the vaccine can cause severe allergic reactions in some people. The messenger RNA used in the Pfizer-BioNTech vaccine, currently the only one being administered here, also does not incorporate itself into human DNA, Prof Lee noted. "In fact, after about 48 hours, it just dissipates in the body and it disintegrates, so there is no evidence at this point that there is any such concern," he said of the cancer rumour.

There is also no evidence that a patient who receives the vaccine will have difficulty getting pregnant, Prof Lee said in response to another question.

Prof Ong said the likelihood that the vaccine will cause long-term issues is "very remote". Nonetheless, he said the expert committee decided to play it safe and has recommended pregnant women should wait until after they have given birth before being vaccinated.

Asked about the new strain of the virus that has emerged in Britain and spread to various countries, including Singapore, Prof Ong said mutations occur all the time, adding that the vaccine is likely to still work on the new strain. This is because the mutated virus features the same spike protein as the earlier strain.


Singapore has also purchased a vaccine developed by US pharmaceutical firm Moderna, which similarly uses mRNA technology to introduce the genetic code to the body to produce a piece of the coronavirus known as a spike protein, thereby helping the patient's cells recognise and develop an immune response to Covid-19. The Republic has also bought stocks of a more traditional inactivated virus vaccine produced by China's Sinovac.

Mr Wong said Singapore had to make "early bets" on these vaccines as long ago as last April, before there was extensive clinical data on their efficacy, to ensure Singapore would be near the front of the queue.


































Coronavirus After-effects: 3 in 4 COVID-19 patients suffer from at least one symptom six months after infection
Research shows fatigue was most common post-infection problem among 1,733 patients
By Salma Khalik, Senior Health Correspondent, The Straits Times, 13 Jan 2021

Three out of four patients still suffered from at least one symptom six months after falling sick with Covid-19, with the most common problem being fatigue or muscle weakness, a study has found.

Other common post-infection problems were sleep difficulties, and anxiety or depression. More women than men were affected.

These results from the study of 1,733 patients with a mean age of 57 from Jin Yin-tan Hospital in Wuhan, China - the largest such study carried out to date - were published in The Lancet journal last week.

The cohort comes from the 2,469 Covid-19 patients discharged from the hospital between January and May last year. The follow-up was done from June to September, with 736 patients excluded because they did not attend follow-up appointments for various reasons, including dementia.

There were also 33 people who "died after discharge mainly due to exacerbation of underlying pulmonary, heart and kidney disease".

The study found that more than half the patients had "residual chest imaging abnormalities" six months after their illness, with greater impairment in those who had been more severely sick.

About one in four was not able to walk the same distance in six minutes that they were able to before getting Covid-19.

The study said a limitation to this finding is that it was self-reported.

It added that some patients had persistent problems with their kidney function.

In the six months since getting infected, some developed diabetes, or had blood clots that affected their heart or brain.

It noted that some of the continuing problems reflect those suffered by patients who survived Sars, or severe acute respiratory syndrome, in 2003 - which was also caused by a coronavirus.


Researchers in Canada - which had 250 Sars infections and 38 deaths - found that a third of Sars survivors complained of poorer mental health a year after infection, and 40 per cent had chronic fatigue for a mean period of 41.3 months.

A commentary in The Lancet on the China study said: "Evidence from previous coronavirus outbreaks suggests that some degree of lung damage could persist, as shown in patients who recovered from Sars, 38 per cent of whom had reduced lung diffusion capacity 15 years after infection."

Dr Asok Kurup, who chairs the Academy of Medicine's Chapter of Infectious Disease Physicians, said such a long "tail" following severe infection is known to occur - although it is not common.

He said: "Severe influenza, especially in those who end up with respiratory failure, can be followed by respiratory issues that can take a long time to recover from.

"Some types of adenoviruses can occasionally cause both respiratory and even kidney failure, and we have seen some cases needing years to recover."

He added that doctors in Singapore "are seeing some patients who have recovered from Covid-19, but are having respiratory issues".


Professor Dale Fisher, a senior infectious diseases consultant at the National University Hospital, said: "I believe that 'long Covid' exists but it's hard to accredit the symptoms fully to Covid-19 specifically without more research."

He said that anxiety and depression, as well as sleep disturbance, are more common today even in people without Covid-19, but "objective features such as radiological changes in the chest and a deterioration in kidney function are hard to dispute. But what they mean in the longer term is still unknown".

He added: "I don't know why people worry more about the vaccine compared to worrying about Covid-19 itself and the risk of long-term effects; fatigue, breathlessness, sleep disturbance, anxiety, depression, kidney impairment and scarred lungs."








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