Article: COVID-19 Vaccines – What the Scientific Experts Say

By Katey Watson

26 February 2021

Image: Gerd Altmann (Pixabay)

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Introduction

The COVID-19 pandemic has impacted greatly on our lives for over a year. There is finally “a light at the end of the tunnel”, with approval of several vaccines. However, a “Misinformation pandemic” has caused confusion. Therefore, I decided it would be helpful to share what I have learnt from attending the following recent online expert scientific panels about the vaccines approved within the UK:

1. The Royal Society[1]: The Race for a Vaccine[2] (28 January 2021).
2. ZOE Symptom Study[3]: COVID-19 Vaccines: What we know so far[4] (3 February 2021).
3. University of Southampton[5]: Beating COVID-19 – Vaccines, Trials and Prevention[6] (9 February 2021).

What are COVID-19 and SARS-CoV-2?

COVID-19 is the disease that develops from exposure to the coronavirus, SARS-CoV-2.

Viruses comprise either ribonucleic acid (RNA) or deoxyribonucleic acid (DNA). COVID-19 is caused by a coronavirus that is RNA based. Coronaviruses are typically respiratory viruses, replicating in the airways. Four coronaviruses circulate yearly, resulting in cold-like symptoms, whereas SARS, MERS and COVID-19 can cause serious illness[2]. SARS-CoV-2 uses its spike proteins (as a key) to enter our cells through ACE-2 receptors (a doorway). It then hijacks our cells’ machinery to replicate and spreads to other cells in our body. COVID-19 develops if there is a high enough viral load within the body.

COVID-19 is a biphasic disease – it has two main phases:

1. Viral replication: Initial illness for about a week, before the patient starts feeling better[2].
2.  Inflammatory response: Severity depends upon how successfully the immune system halted viral replication – the lower the viral load, the milder the symptoms[2].

Graphic of SARS-CoV-2 viral particle. Image: Joseph Mucira (Pixabay)

Why vaccinate against COVID-19?

Vaccination programmes are a means to safely attaining herd (community) immunity. They suppress or eliminate the infection by reducing its opportunity to spread. These population-wide initiatives protect everyone by shielding those who have not yet or cannot be vaccinated, as well as protecting the individual[2]. The proportion of the population required to obtain herd immunity depends upon the transmissibility of the specific infection. The higher the R0, the more contagious the infection and the more likely mutations will arise. Therefore, where infections have a high R0, it is important to develop a vaccine to reduce or eradicate disease[6].

Vaccines produce stronger and longer-lasting immunity than naturally acquired immunity from previous infection[2, 6]. Incurring both types of immunity provides a cumulative effect, offering greater protection[6].The vaccines approved so far should prevent hospitalisations and death in most cases[6].

COVID-19 has caused long-lasting problems in some patients’ organs, especially the brain and lungs. The long-term health costs from COVID-19 outweigh any potential vaccine long-term risks[4].

The immune system

The two main parts of the immune system are:

1) Innate immune defence:

This first-line (non-specific) defence is constantly alert for invaders. If a threat is identified, the innate immune system cells search for and kill infected host cells and protect others from infection[7]. In viruses, the lower the viral load, the milder the symptoms. But SARS-CoV-2 suppresses the innate response resulting in an increased viral load[2].

2) Adaptive immune defence:

This secondary response is very specific to the invader (e.g. SARS-CoV-2). The major players are:

  • B cells: Antibodies attach to the virus and label it for destruction[7].
  • T cells: Kill infected cells, activate other immune cells and support the antibody response[7].

These cells have a subgroup of memory cells tasked with remembering the specific virus and learning to combat it better next time the virus is encountered[7]. It is expected that COVID-19 vaccines should lengthen the immune response to about a year instead of a few months[2, 4, 6].

Types of vaccine

At time of attending the expert panels, vaccines in use within the UK were Pfizer-BioNTech[8] and Oxford-Astra-Zeneca[9] which teach the immune system to target the SARS-CoV-2 spike protein – the key to entering host cells. The immune system recognises the spike protein and uses it to train antibodies and T cells to inactivate this particular protein. With this spike protein inactivated, the virus cannot enter the cell and replicate, rendering it harmless. These vaccines do not contain the actual SARS-CoV-2 virus and, importantly, do not suppress the innate immune response, unlike the virus[2]. Many other COVID-19 vaccines are under development with potential for future use worldwide[2].

The main types of COVID-19 vaccines are:

  1. Replication-incompetent vector (Astra-Zeneca, Janssen): An inactivated cold virus producing a spike protein. An immune response is mounted against the spike protein and cold virus[6]. (Used against SARS and MERS[4]).
  2. RNA (Pfizer, Moderna): RNA (in this case mRNA or messenger RNA) produces a spike protein from the genetic material carried inside a “lipid particle”. The lipid particle aids the immune response. (Used previously in anti-cancer vaccine research[6].
  3. Recombinant spike protein base (Novavax, Medicago GSK): The spike protein is created in a lab and transported in an “adjuvant” (immune enhancer) to create a stronger immune response. (Fairly traditional method)[6].
  4. Inactivated virus (Valneva): The virus is grown in a lab, killed and inactivated. This method might be useful against spike protein mutations. (Traditional method)[6].

Efficacy:

Vaccine efficacy (efficiency) percentages indicate the ability of the vaccine to protect against developing COVID-19. It is difficult to compare efficacy between COVID-19 vaccine studies, because researchers use different groups of people and measurements to assess their particular vaccine[4, 6].

Image: Belova59 (Pixabay)

Fast vaccine development

Expert scientists were already aware that a viral pandemic posed a serious threat to humanity. Therefore, new vaccine technologies (including mRNA vaccines) had already been in development for many years[2].

At first sight, ten months to develop, test and approve vaccines seems remarkably quick when compared to previous vaccine development. However, this timeframe seems reasonable when it is considered:

  • There was huge worldwide government investment (billions of US dollars) – usually there are long delays waiting for funding to trickle through[2].
  • The three trial phases ran in parallel – usually they take place one after the other[2].

The World Health Organization was integral in coordinating the development of new COVID-19 treatments and vaccines[10]. The UK’s “Medicines and Healthcare Products Regulatory Agency” (MHRA) is the global expert, previously ensuring vaccine safety for the whole of the European Union. Any uncertainty about vaccine approval is not about safety, it is about how well the vaccines will work and for how long[6].

How vaccines work

1. First dose: Primes the immune system to recognise the SARS-CoV-2 spike protein. Specific antibodies are created, and remembered by memory cells[2]. There is some protection against COVID-19 after two to three weeks (depending on the vaccine)[4]. Partial protection should prevent severe disease, keeping most people out of hospital[2, 4].

2. Second dose: Boosts the immune response, making it stronger and longer lasting. Memory cells recognise the SARS-CoV2 spike protein, produce improved antibodies and memorises them for next time they are needed[2].

12-weeks between vaccine doses

Some were concerned when the advised three weeks gap between vaccine doses was changed to twelve weeks. The timeframe changed after Astra-Zeneca analysed their data from people who had received their second dose at twelve weeks – results indicated better efficacy with a longer gap. They are now analysing data from those who had their second booster later than twelve weeks – the data suggests even higher efficacy[4].

There was no medical reason for Pfizer choosing three weeks between doses – presumably, it was to enable faster turnaround for their vaccine release[6]. It was thought Pfizer vaccines would likely perform comparably to Astra-Zeneca, because they elicit a similar immune response[4].On the 18 February 2021, evidence from Israel’s Pfizer vaccinations reported the second dose could potentially be delayed, because the first dose provides adequate interim protection, but advised more long-term follow-up was needed[11]

Image: mohamed Hassan (Pixabay)

Transmissibility

People who have had the vaccine can still carry the virus (SARS-CoV-2) without succumbing to the disease (COVID-19). Hypothetically, it could be spread to someone else, although this is not yet known for sure. But, there is probably reduced risk of transmitting enough virus to cause severe disease, because it cannot replicate as easily in a vaccinated person[2]. The UK’s recent fall in new COVID-19 cases and hospitalisations, suggests the vaccines offer some protection against transmitting the infection to others – we are awaiting further data to confirm whether this is the case.

Vaccine suitability

Questions were raised about whether the vaccine was suitable for all adults:

Previous infection with SARS-CoV-2:

It is likely the first vaccine dose would improve the immune response in those recently infected with the virus (up to six months ago) compared to those who have not been exposed[4]. COVID “long-haulers” should be safe to take the vaccine, because ongoing symptoms are an inflammatory response, not the virus itself[4].

Autoimmune diseases and immune suppressants:

People with autoimmune diseases or prescribed immune suppressants are not usually included in vaccine trials, because they skew the study results, rather than concerns over their safety. Therefore, according to Professor Tim Spector, the vaccines should be safe for this group[4].

Astra-Zeneca and the over 65’s:

Astra-Zeneca was tested on a limited number of over 65’s, because many in this group were advised to shield at the time trials were commencing. Therefore, it seemed inappropriate to ask most of this group to attend research centres[4]. On 15 February 2021, the World Health Organization recommended Astra-Zeneca for adults of all ages based on the available study results[12].

Vaccine side effects

No steps were missed in testing the vaccines before approval[6]. Phase three trials (the biggest phase, testing for efficacy) included ten times more volunteers than usual – sometimes over 30,000 people, compared to the usual 2,000 – 3,000[2, 6].

The UK’s Joint Committee on Vaccination and Immunisation (JCVI) assessed the Astra-Zeneca vaccine based on millions of doses – their results showed exceptionally good safety. Up to 1,000 reactions are considered normal, but for the Astra-Zeneca trials, there were only the usual immediate minor side effects (e.g. sore arm, fever) and no hospital admissions[6]. Any vaccine side effects of concern are expected to occur fairly immediately; therefore, people usually wait fifteen minutes after vaccination before leaving the vaccination centre[2].

Common side effects:

As with most vaccines, common minor side effects can occur soon after vaccination and may last a few days. The most common is a sore or slightly swollen arm near site of injection. A smaller proportion, experience systemic effects, including headache, fever and/or fatigue. Systemic effects are more likely after the second (booster) dose, because the immune system is already primed to recognise viral proteins[4]. These symptoms indicate the immune system is developing protection. People are more likely to experience side effects if they are anxious about them, even with the placebo saline injection (placebo effect). Symptoms are eased with paracetamol[4].

Side effects due to previous COVID-19 exposure:

Individuals who had previously experienced Covid-19 were twice as likely to experience systemic side effects after the first vaccine. This suggests in these circumstances, the primer (first dose) acts like a booster (second dose), as the immune system was already primed by prior natural exposure to SARS-CoV-2. Consequently, these individuals could have more protection, closer to that experienced after the second dose. It is still safe to have the second booster dose[4].

Image: Wilfried Pohnke (Pixabay)

Mixing vaccines

It has long been known, mixing different classes of vaccines between doses can provide a more efficient immune response[4, 6]. Currently the UK does not plan to mix doses, because this has not been tested on SARS-CoV-2 vaccines yet (this is the next research step)[6]. In the future, a range of vaccine boosters could become available to provide better protection against specific variants[4].

New variants

New SARS-CoV-2 variants were always expected – it is part of natural evolution[2, 4]. Viral replication is not perfect – copying errors result in random mutations. Changes that enable the virus to spread more easily are more likely to become dominant over those that spread slowly, as this increases the virus’s survival chances[2]. Regardless, it is extremely unlikely a variant would completely resist a vaccine – there may be more susceptibility for mild infection, with most avoiding severe illness[6].

If enough people are vaccinated, variant concerns will be less relevant, because the infection will be forced to die out. The key is to work together (worldwide) and focus on vaccination to drive down R0 and levels of virus circulation[4]. With less virus circulating, there is less opportunity for the virus to mutate into new variants.

RNA viruses, such as SARS-CoV-2, evolve slowly. Therefore, it is thought current vaccines should remain effective against COVID-19 for at least a year. Research scientists are working on vaccine tweaks to protect against new variants – a much quicker process than creating vaccines from scratch, as only minor changes to the existing vaccines are required[2, 4, 6]. Also, less volunteers are needed in these trials, further speeding up the process[4].

Image: memyselfaneye (Pixabay)

The Misinformation pandemic

There is major concern about the spread of misinformation by people in a position of trust and those in algorithm-led social media bubbles. The whole of society needs to tackle this issue, including:

  • Public citizens/peers,
  • Government,
  • Scientists[6].

A common misconception by many people is that mRNA vaccines are “gene therapy” and not actually vaccines, because they think the injected mRNA alters human DNA. This does not happen – after the mRNA has passed on its message, it just breaks down and degrades in a harmless manner[6].

The future

It has almost been a year since the UK (and many other countries) first went into lockdown. So what does the future hold for us? This is what the scientific experts predict:

Yearly vaccine boosters:

It is unlikely COVID-19 will completely disappear – instead, it is expected to become a background infection (endemic). We will probably need an annual booster for the immediate future, particularly to protect the vulnerable[4, 6].

Changed behaviour:

There is likely to be an improved attitude towards infection – changing behaviour to prevent infection risk – similar to attitude/behaviour changes towards accidents. Historically, accidents were a common cause of death, but this gradually changed over the years with improved preventative measures[6]. The public are now more aware about the importance of handwashing and ventilation, but other bad habits still need to be addressed, including the UK culture of going into work when unwell[6].

Targeted strategies: Identifying the spreaders:

It is unclear whether spreaders are adults returning home from work, and/or children returning from school. When this has been identified, better targeted health strategies can be introduced to protect the community[2]. Governments are expected to prepare improved response systems to mitigate pandemic spread of emerging future viruses[6].

Utilising technology:

The latest generation vaccines (mRNA and replication-incompetent vector) are as good as, if not better than traditional vaccines. There is very promising potential to use this technology to protect us against other prevalent diseases, including cancer[2].

Future research initiatives:

  • Preventing long-haul COVID[6].
  • Investigating the impact of the vaccines in long-haul COVID patients[6].
  • Research into vaccinating children to protect the community[6].

Lessons learnt:

  • The countries suffering least from this pandemic were those with a quick and decisive response: Taiwan learnt from the SARS epidemic in 2003 and reacted quickly. The UK (and other countries) need a quicker and more decisive response the next time an infectious disease emerges[2].
  • This pandemic has highlighted some serious inequalities within society needing to be addressed[2].
  • Global vaccination is needed to control this pandemic[2].
Image: Aksh Kinjawadekar (Pixabay)

Returning to ‘normal’

The big question is “Will the Covid-19 vaccines bring back normality?” Currently in the UK, we cannot change our cautious behaviour, because the virus is still widely circulating and we need to protect the whole population[4]. A more normal situation is expected in a year or so, but we need to embrace a new normal to protect humanity. Humans have taken away too much from the planet, affecting the climate and environment – the new normal needs to be a more sustainable way of life[2].

Conclusion

The COVID-19 pandemic is a global health concern, with scientists working around the clock to develop treatments and preventative vaccines to counteract this threat. However, the “Misinformation pandemic” has led to public confusion about the safety and effectiveness of approved vaccines. Therefore, scientists led expert panel discussions to address concerns and answer questions (some of which I have shared with you here). Vaccination programmes are imperative to control the spread of fast spreading infectious diseases with high mortality, such as COVID-19. Vaccines provide stronger and longer-lasting immunity than naturally acquired immunity. Fast vaccine development and approval was enabled by massive government investment and parallel-running trials. The long-term adverse health effects from COVID-19 outweigh any potential vaccine long-term risks. Vaccination programmes are a community initiative, aimed at protecting everyone, including those who cannot be vaccinated. The future of humanity requires a more sustainable lifestyle to protect our planet from new and re-emerging infectious diseases.

Image: Gerd Altmann (Pixabay)

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References

1. The Royal Society, 2021. The Royal Society.
2. Prof. Brian Cox, Prof. Melinda Mills, Prof. Charles Bangham and Dr Rino Rappuoli: The Royal Society, 2021. The Race for a Vaccine.
3. ZOE Symptom Study, 2021. ZOE Symptom Study.
4. Dr Anna Goodman and Prof. Tim Spector: ZOE Symptom Study, 2021. Covid-19 Vaccines: What we know so far.
5. University of Southampton, 2021.University of Southampton.
6. Prof. John Holloway, Prof. Rob Read, Prof. Saul Faust and Prof. Lucy Yardley OBE: University of Southampton, 2021. Beating COVID-19 – Vaccines, Trials and Prevention.
7. The Open University, 2014. SK320 Infectious Disease and Public Health: Block 1.
8. GOV.UK, 2021. Information for UK recipients on Pfizer/BioNTech COVID-19 vaccine.
9. GOV.UK, 2021. Regulatory approval of COVID-19 Vaccine AstraZeneca.
10. World Health Organization, 2021. COVID-19 Vaccines.
11. Amit, S., Regev-Yochay, G., Afek, A., Kreiss, Y. and Leshem, E.: The Lancet, 2021. Early rate reductions of SARS-CoV-2 infection and COVID-19 in BNT162b2 vaccine recipients.
12. World Health Organization, 2021. WHO lists two additional COVID-19 vaccines for emergency use and COVAX roll-out.

More from What’s on Watson’s Plate

Guest Blog: Mythbusting the Coronavirus Vaccine

By Alice Taylor

9th October 2020 (updated 13th November 2020)

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Introduction

Hello! I’m Katey’s cousin Alice and I’ve spent 10 years working in the clinical trials industry. As you can imagine, over the past few months I’ve been following the news of coronavirus vaccine development closely, both from a personal and professional point of view. More recently, I’ve also seen alarming claims about the rollout of a coronavirus vaccine go viral on social media and am concerned that these claims may harm efforts to stop the spread of COVID-19.

A misleading message about the vaccine that was shared on my road’s coronavirus support WhatsApp group. I have seen many similar messages posted on other social media platforms.

I’ve written this article to explain more about the changes the UK government are proposing to make to existing vaccine legislation, and how these changes would apply to a coronavirus vaccine specifically, to try and combat misinformation.

To clarify, the organisation I work for now doesn’t have a potential coronavirus vaccine in development.

What is a vaccine?

A vaccine is a type of drug which is designed to prevent someone from getting a disease, rather than treating a disease once someone has already caught it. Vaccines work by teaching the immune system to fight against a weakened version of a disease, which is unable to cause the disease itself. This means that if the actual disease ever shows up in the body, the immune system will recognise it and can defeat it quickly before it causes any problems. Watch this video[1] for more information.

The World Health Organisation estimates that vaccines prevent 2 – 3 million deaths globally each year from diseases like diptheria, tetanus and pertussis[2].

How is the UK government proposing to change the law with regards to a coronavirus vaccine?

The British government published a consultation paper on the 28th August 2020[3], which lists changes they are proposing to make to the Human Medicines Regulations 2012[4]. This law governs the licensing, manufacture, wholesale dealing and sale or supply of medicines for human use. The consultation paper was addressed to key people and organisations with specialist knowledge of public health and the existing law, although anyone was welcome to comment on it.

The 2012 Regulations already state that exemptions to certain aspects of this law can be made for medicines used to treat a pandemic disease, like COVID-19. However, the law doesn’t currently allow any exemptions for medicines used to prevent pandemic disease, so a coronavirus vaccine would not be covered by the existing legislation. As the government believes an effective COVID-19 vaccine will be the best way to deal with the pandemic[5], they are proposing to change the law in several ways to make widespread rollout as easy as possible.

Frequently Asked Questions

Here are some Frequently Asked Questions about the proposal, based on comments I have seen on social media. Note, these questions and answers only cover this particular proposal – I haven’t tried to predict any further changes the UK government may consider, or how other countries may choose to roll out a vaccine.

If the coronavirus vaccine is unlicensed, does that mean it hasn’t been tested?

No, ‘unlicensed’ doesn’t mean ‘untested’. All drugs in the UK have to go through three phases of clinical trial testing to prove the drug is safe and effective before they can be rolled out more widely, and this is true of every potential coronavirus vaccine too. There are currently over 40 different coronavirus vaccines being developed by scientists all over the world, in various stages of the testing process[6].

It usually takes a really long time, sometimes up to 10 years, for all three clinical trial phases to be completed. As the COVID-19 pandemic is an urgent, global threat, the testing process is being sped up by overlapping some of these phases. (Check out a really useful diagram which illustrates this here[7].) This is a much more difficult and expensive way of conducting clinical trials, which is why this isn’t the normal process. Although the trial phases for potential coronavirus vaccines are being accelerated, in the UK the testing itself within each phase is no less strict than it would be under normal circumstances. At each phase, if there isn’t enough data to show a coronavirus vaccine is sufficiently safe or effective to move on to the next phase, that vaccine will be abandoned.

Licensing is the stage that takes place after these three trial phases have been completed, where the licensing authority (the Medicines and Healthcare Products Regulatory Agency [MHRA] in the UK) reviews all the trial data. It then decides whether the drug should be granted a license, and what patient population, disease indication and dosage that license covers. If a safe and effective coronavirus vaccine is available, as proven by clinical trial data, the manufacturer will still have to apply for a license from the MHRA. However, given the circumstances, the Joint Committee on Vaccination and Immunisation (who advises UK health departments on immunisation)[8] will advise the UK government to proceed with coronavirus vaccine rollout before a license has been granted if they believe there is strong enough evidence to do so.

Could I sue the drug company or the person administering the coronavirus vaccine if I had a bad reaction after receiving it?

Generally speaking, no. The law already protects drug manufacturers from being sued in the civil courts when the licensing authority recommends that an unlicensed product is used in response to a public health threat. The government is proposing to expand this legal protection slightly to include drug companies who want to put an unlicensed product on the market, where that drug company is not the manufacturer of the drug – as is the case with several of the potential coronavirus vaccines, which are being developed by universities rather than drug companies.

You couldn’t sue the person administering the vaccine either. The law already protects people administering licensed vaccines from being sued, on the understanding that it isn’t their fault if someone has a bad reaction after vaccination (provided they administered the vaccine correctly). The government wants to amend this part of the law to include people administering unlicensed vaccines too, for the same reason.

You could still sue the drug company if the vaccine is defective, with defective defined as not as safe as you are entitled to expect. Likewise, you could still sue the person who gave you the vaccine if you could prove it was administered incorrectly.

Could I claim compensation from the government if I had a bad reaction after receiving the coronavirus vaccine?

This isn’t yet clear. The government does currently operate a compensation scheme called the Vaccine Damage Payment[9] for people who are severely disabled as a result of vaccination. Individuals are only eligible for this payment, given as a one-off tax-free sum of up to £120,000, if their severe disability was caused by vaccination against certain specific diseases. The government hasn’t yet clarified if coronavirus will be added to this list of diseases. 

Will the people administering the coronavirus vaccine be unqualified or non-medical?

No, the people administering the vaccine will be qualified. Given the huge number of people who would have to be vaccinated in as short a timeframe as possible, the government wants to amend the law to allow healthcare professionals who do not normally vaccinate, e.g. midwifes, physiotherapists and paramedics, to be able to administer a coronavirus vaccine. The group of people allowed to administer a coronavirus vaccine may be expanded further to also include those who are not registered healthcare professionals. In all cases, there would be a detailed protocol to follow to ensure all of these people are appropriately trained via an NHS approved training programme before they may start vaccinating.

The people administering the coronavirus vaccine most likely will be non-medical – just as they are now when it comes to other vaccines. ‘Non-medical’ means anyone except doctors or dentists, so that includes pharmacists and nurses, who administer most vaccines like the flu jab already[10].

Will the coronavirus vaccine be mandatory or mass promoted?

No, the proposed changes to the law do not include plans to make a coronavirus vaccine, or any vaccine, mandatory in the UK.

The government is planning mass promotion of the coronavirus vaccine in a similar way to how they promote the flu vaccine. It is already legal for vaccination campaigns to be advertised to the public, but the vaccines in these campaigns currently have to be licensed. The proposed changes would allow the promotion of an unlicensed, temporarily authorised COVID-19 vaccine.

Will the coronavirus vaccine be 100% safe?

No, no vaccine is 100% safe. The underlying principle behind a coronavirus vaccine, same as any other vaccine, will be that vaccinating is safer than not vaccinating[11]. People can and do suffer bad reactions from vaccines and this is unquestionably terrible for those affected. However, this is a very, very small proportion of the total number of people who receive vaccines, the vast majority of whom experience no significant side effects. Given the potentially fatal consequences of COVID-19[12] – as well as serious long-term effects aka ‘long covid’[13] – and provided that there is very robust scientific evidence to support it, the government would deem the benefits of taking a coronavirus vaccine to far outweigh the risks. It is up to individuals to decide if they agree.

Update: Consultation Outcome (added 13-Nov-20)

The government published the outcome to their public consultation on proposed changes to the Human Medicines Regulations on the 16th October[14]. Based on the 191,740 responses received, the government will go ahead with drafting legislation to amend the existing law as they had outlined, and as summarised above, with 3 key changes:

1. Attaching conditions to a temporarily authorised vaccine

The consultation outcome emphasises that although the existing law contains a provision that enables the temporary authorisation of an unlicensed medicine in response to a public health emergency, this provision should only be used in truly exceptional circumstances. The decision to use this provision will only be used at the request of the Secretary of State for Health and Social Care, if the MHRA advises that there is robust evidence to demonstrate that the vaccine is sufficiently safe and effective. The government has amended the proposed changes to say that a review must be done within a year of the first use of this provision in order to evaluate the whole process, but they note that they expect any temporary authorisation to be short-term anyway as it would cease as soon as a full license is granted.

2. Extending immunity from civil liability

Many people responding to the consultation were concerned that pharmaceutical companies would not be held accountable for any problems with the vaccine (e.g. serious side effects). The consultation outcome explains that the existing law already recognises that it is unreasonable to ask drug companies to take on the liability for consequences of the government’s decision to authorise the supply of an unlicensed drug. However, the outcome stresses that you would still be able to sue the drug company who make the vaccine in the event of a ‘sufficiently serious breach’ of the approval conditions set by the government. Where the original consultation proposed that the courts would judge the seriousness of any breaches of the approval conditions from the perspective of a pharmaceutical company, the outcome states that the courts must instead make this judgement from the point of view of a person who has ‘relevant expertise in the subject matter of the breach’.

3. Expansion of the workforce

The consultation outcome makes it clear that new vaccinators must undergo comprehensive training and pass a competency assessment, under the clinical supervision of a healthcare professional, before they can administer vaccines to patients. Based on the consultation feedback, the government has added a requirement for new vaccinators to receive continued supervision by an experienced vaccinator, where appropriate, once this training is complete.

The outcome also clarifies that vaccinators must obtain informed consent from each person receiving the coronavirus vaccine before it is administered, as is standard practice now for all other vaccines or indeed any kind of medical treatment, test or examination[15]. This underlines that the coronavirus vaccine will not be mandatory – it will only be administered to people who voluntarily consent to receive it, after they have been fully informed of all potential benefits and risks.

Vaccine Information Resources

If you’re looking for further information on vaccines and the coronavirus vaccine in particular, try the following links:

  • The Oxford University Vaccine Knowledge Project[16] – an excellent resource recommended by the NHS for all kinds of clear, general information about vaccines, with detail on those which make up the UK immunisation schedule.
  • Full Fact: Coronavirus Treatment[17] – Full Fact is a charity based in the UK which addresses a wide range of viral misinformation. Their expansive coronavirus coverage includes responses to claims that RNA vaccines change your DNA, and that Bill Gates is planning to put microchips in COVID-19 vaccines.
  • Johns Hopkins University Coronavirus Resource Center: Vaccines FAQ[18] Johns Hopkins University in the US has been a brilliant source of coronavirus information from the start of the pandemic. Some common questions about the coronavirus vaccine are answered here, while elsewhere on their vaccines hub they go into detail about COVID-19 vaccine trial design, regulatory integrity of vaccine studies and more.
  • CDC: Busting Myths and Misconceptions about COVID-19 Vaccination[19] – a short but useful piece from the American Centers for Disease Control tackling common COVID-19 vaccine myths.
  • WHO: Coronavirus Disease (COVID-19) Advice for the Public: Mythbusters[20] – a very handy page that pools together a large number of myths about the coronavirus, including the claim that vaccines against pneumonia offer protection against the coronavirus.

I’ve found it a lot harder than I thought it would be to find good resources debunking coronavirus vaccine myths specifically, so I’m not surprised that misinformation about it has been able to spread and take hold among the general public so stubbornly. Speculation, unconfirmed reports and outright lies have filled the hole where reliable information should be. Experts are well aware of this issue and know that it’s essential that it’s dealt with in order for the vaccine to be rolled out successfully[21]. Now the first effective coronavirus vaccine is on the horizon (albeit with many questions still to be answered[22]), hopefully a comprehensive, nationwide myth-busting campaign will follow shortly. In the meantime, if you do see or read something alarming about the coronavirus vaccine, remember to follow advice on how to spot misinformation[23] before you get tricked into believing (and worse, sharing) something untrue.

References

1. https://youtu.be/-muIoWofsCE
2. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
3. https://www.gov.uk/government/consultations/distributing-vaccines-and-treatments-for-covid-19-and-flu
4. https://www.legislation.gov.uk/uksi/2012/1916/contents/made
5. https://www.gov.uk/government/consultations/distributing-vaccines-and-treatments-for-covid-19-and-flu/consultation-document-changes-to-human-medicine-regulations-to-support-the-rollout-of-covid-19-vaccines
6. https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html
7. https://www.bbc.co.uk/news/health-54027269
8. https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation
9. https://www.gov.uk/vaccine-damage-payment
10. https://www.independentnurse.co.uk/news/health-secretary-draws-ire-of-practice-nurses-over-flu-jab-remarks-1/229985/
11. https://vk.ovg.ox.ac.uk/vk/vaccine-safety
12. https://ourworldindata.org/mortality-risk-covid
13. https://www.bmj.com/content/370/bmj.m3489
14. https://www.gov.uk/government/consultations/distributing-vaccines-and-treatments-for-covid-19-and-flu/outcome/government-response-consultation-on-changes-to-the-human-medicines-regulations-to-support-the-rollout-of-covid-19-vaccines
15. https://www.nhs.uk/conditions/consent-to-treatment/
16. http://vk.ovg.ox.ac.uk/vk/faqs-about-vaccines
17. https://fullfact.org/health/coronavirus/?utm_source=homepage&utm_medium=trending#treatment
18. https://coronavirus.jhu.edu/vaccines/vaccines-faq
19. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/about-vaccines/vaccine-myths.html
20. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
21. https://www.ox.ac.uk/news/2020-11-10-covid-19-vaccine-reliable-communications-needed-beat-infodemic-misinformation
22. https://www.bbc.co.uk/news/explainers-54880084
23. https://fullfact.org/health/how-to-fact-check-coronavirus/

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Article: Probably ‘That’ Coronavirus: My Symptoms

By Katey Watson, July 2020

Image: Clker-Free-Vector-Images, Pixabay

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Disclaimer: I wasn’t tested for COVID-19, so I don’t know for sure if it was ‘That’ virus; however, I strongly suspect it was – I’ll update this article accordingly if I find out for sure.

Introduction

I thought I’d share my symptoms of ‘probably’ COVID-19 for anyone who’s curious, as I’m interested in peoples’ varied experiences, so I thought you might be too.

Pre-Virus

During the 14 days leading up to my first symptoms (13 March 2020), I had several social contacts: On the 14th day before my symptoms occurred (only 19 total UK COVID-19 cases had been reported in the UK, none in my area) I hosted my open house Birthday party with a total of 20 guests, some travelling from further afield, including London. Over the following days, I went to circuit training, a Jobs Fair in the city centre (I used public transport), local busy pub night, dentist appointments and met two friends from outside my city of residence (two of us used public transport). In hindsight, I’m annoyed with myself for not being more cautious, but then, very few people were at the end of February/early March.

Image: Chris und Alisia Alpinger, Pixabay

Symptoms Summary

Officially recognised symptoms were initially fever and persistent cough. However, more recently, 19 symptoms were identified[1, 2].

I had a wide variety of symptoms, some fading and later re-emerging – some days I felt awful, followed by others when I thought I was recovering, only to relapse a day or so later. I wasn’t ever aware of having a fever and I didn’t realise until day 72 of symptoms that I’d partially lost my sense of smell – my Mum apologised for the overly ripe fruit stink, something that would usually bother me, but I hadn’t noticed it at all. I haven’t included the smell loss below, as I have no idea when it started.

My main symptoms spanned over 67 days. I went through a symptom-free phase between Day 29 and Day 35. At time of writing, it’s Day 112, and I’m still experiencing insomnia and fatigue, although lessening. It’s been an odd and interesting illness, COVID or not!

My Symptoms in Order of Appearance

Headache: Days 1 – 4, 6 – 8 & 10
(Image: mohamed Hassan, Pixabay)
Sore throat: Days 1 – 4, 6 – 8, 12 & 38 – 47
(Image: Ary setyobudi, Pixabay)
Cough (mostly dry): Days 2 – 21, 23 & 36 – 67
(Image: mohamed Hassan, Pixabay)
Breathlessness: Days 4 & 21
(Image: Clker-Free-Vector-Images, Pixabay)
Insomnia: Started after waking in the middle of the night unable to breathe. Resultant fatigue & brain fog: Day 4 onwards
(Image by Stephanie Ghesquier from Pixabay)
Gut discomfort: Days 4 – 5, 7 & 9 – 11
(Image: Christian Dorn, Pixabay)
Light-headedness/dizziness: Days 5 & 7
(Image by Stephanie Ghesquier, Pixabay)
Chest tightness/heart pains: Day 7 & Day 21
(Image: mohamed Hassan, Pixabay)
Body aches (mainly back, ribs & kidneys): Days 10 – 27 & 36
(Image by mohamed Hassan from Pixabay)
Impaired hearing: Day 21
(Image: Clker-Free-Vector-Images, Pixabay)
Skin burning sensations (right hip, waist & right thigh): Days 27 – 28
(Image: Clker-Free-Vector-Images, Pixabay)

I was mostly symptom-free (except insomnia, fatigue and brain fog) on Days 29- 35 and from Day 68 onwards.

Table of My Symptoms in Order of Appearance

Table: Summary of my symptoms & their duration, in order of appearance.

I hope you found this article informative and helpful. For graphical representation and more detailed extracts from my health diary, please click on: Supplementary Information.

Please consider joining the ZOE COVID Symptom Study (endorsed by the NHS) to help track the virus, including emerging hotspots. All you need to do is download the app and report daily on whether or not you feel well – it only takes a minute to complete:

– Apple Store: https://apps.apple.com/gb/app/covid-symptom-study/id1503529611
– Google Play store: https://play.google.com/store/apps/details?id=com.joinzoe.covid_zoe&hl=en_US

I hope you found this article interesting and informative. Stay safe.

Image: Elsemargriet, Pixabay

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References

1. World Health Organization, 2020. Coronavirus: Symptoms [online]. Available from: www.who.int/health-topics/coronavirus#tab=tab_3.

2. COVID Symptom Study, 2020. 7 things you need to know about staying safe as lockdown measures begin to lift [online]. Available from: https://covid.joinzoe.com/post/tips-covid-safety.

Health Diary Week 28: Food, Exercise and a Positive Mind

Slipping

Image: Steve Buissinne, Pixabay

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<<<Week 27

Hi and welcome to another weekly instalment of what’s on my plate, health and nutrition updates and some positive smile-provoking experiences…

Weight, BMI and Fat Results

This is not a proud week – I’m slipping backwards on my weight and fat progression. I gained 0.8 lb (0.4 kg) taking me up to 167.2 lb (75.8 kg) – ouch! This really needs sorting asap!

Week 28 results: Slipping – Need to get back on track!

I don’t want to be too hard on myself in such unsettled times, BUT, I can’t help be concerned, because of potential health implications, more immediately related to ‘the virus’[1]. I’ve utilised COVID-19 information sharing by high impact scientific journals e.g. ‘The Lancet’[2]. It’s increasingly apparent that those classified with obesity are at higher risk of severe symptoms/complications from COVID-19[3, 4, 5, 6]. Clearly, I need to get back on track! So, let’s investigate where I went wrong this week…

Image: GraphicMama-team, Pixabay

Food and Nutrition

So, let’s have a look at what food was on my plate, the healthy and not so healthy choices and identify any tweaks I could make to improve my nutrition…

Snacks:

What went wrong?…It’s primarily my poor snacking again! I’ve made some good choices (e.g. fruit, seaweed thins), but I’ve also over-indulged on The Incredible Bakery food I’d ordered (hot cross buns, coffee cake  slice, brownie), coconut cream  and crisps/chips. So, I really need to be more mindful about snacking and making better choices.

Particularly high saturated fat & free sugar snacks: The Incredible Bakery Choco coffee slice & brownie (I ate the brownie over 2 days) with coconut cream.

Breakfast and Lunch:

So, what else did I eat? I had those heartier breakfasts again – still hungry!: Baked beans on toast (with coconut-based cheese sprinkle), bacon-ish sandwich (Quorn slices) and toast with Meridian yeast extract. I also had less conventional breakfasts of pitta with sweet chilli hummus, Incredible Bakery sausage roll and Mushroom stroganoff leftovers on toast.

For lunches, I had My Typical Salad five times this week, a bacon-ish sandwich and an Itsu chilli miso noodle pot. 

Oat bread-based breakfasts: Clockwise: Yeast extract, bacon-ish sandwich, mushroom stroganoff leftovers & baked beans with ‘cheese’ sprinkle.

Dinner:

Dinners included an experiment with cauliflower steak (tahini, lemon juice, garlic and cumin coating). It tasted great, but this first attempt was a little dry, so we repurposed leftovers into a curry. We had lots of mushrooms to use, so made a very tasty stroganoff following the ‘It Doesn’t Taste Like Chicken’ recipe using a milk and flour-based sauce instead of cream. Another evening, we had vegetable fajitas. On Friday, I had my much-loved Heck vegfurter hotdog with fried onion, gherkin, mustard and ketchup. My highlight was a Plant Pioneer ultimate burger with melted Applewood cheese in Incredible Bakery onion & seed bun with guac, salsa, iceberg, tomato and gherkin – I have a thing about gherkins at the moment!

Cauliflower dinners: Left: Cauliflower steak with shawarma kebab pieces & veg. Right: Cauliflower, pea & potato curry with brown rice.
Mushroom stroganoff with brown rice.
My highlight: Plant Pioneer burger with all the trimmings!

Exercise

Let’s move on to what I did right – I continued with physical activity: 3.5 hours (five sessions) on the exercise bike at the highest tension, 30 minutes (two sessions) jogging on the trampette, five Mr Motivator 5-minute workouts (BBC HealthCheck UK) and a 20 minute walk (my first in 45 days!).

I was uncomfortable with the walk – I’ve been aware for some time that I’m developing an aversion (since lockdown) to leaving the house and that I should address this before it becomes habit. So, when I awoke from a bad dream at 5am, I decided a short walk would help clear my mind. I’ll try to do a weekly one from now on.

Me after several days hiking on the Inca Trail Trek – the hardest trek I’ve ever completed! (2008, Machu Picchu Peru).

Positive Thinking: What Made Watson Smile

Okay, time now to move on to ‘What Made Watson Smile’ this week…

Incredible Bakery Delivery:
That delivery from The Incredible Bakery – I’d got excited and ordered more than I’d realised – thankfully the baked goods were freeze-able! We got stuck into the hot cross buns first.

M&S Little Garden Seeding Pots:
The M&S Little Garden seeding pots we’d collected pre-lockdown coming along well on the windowsill:

Garden beauty:
Noticing the garden beauty changes I might not have observed pre-lockdown:

Droplets on garden flowers after the rain.

Dyspraxic Adults Meet-Up:
My first Zoom meet-up with other adults with dyspraxia[7], many also with hypermobility[8]. The Occupational Therapist guest speaker provided some helpful strategies. I didn’t really talk but I still felt accepted and understood just from listening to other’s stories:

Superfoods Course:
Completion of Week 2 Superfoods: Myths and Truths via Future Learn before the weekend socials:

Quick WhatsApp video chat with my Aunty before ‘meeting’ with the ‘girls’:

Image: Alfredo Rivera, Pixabay

Girls’ Houseparty Meet-Up:
The ‘girls’ Houseparty catch up before meeting the pub crew. We may be physically distanced, but we’re fortunate to have modern technology to remain socially close:

Image: Jacquelynne Kosmicki, Pixabay

Pub replacement ‘Houseparty’ with friends:
I miss pubs, but I’m thankful we can still ‘see’ each other:

Week 29>>>
<<<Week 27
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I hope you enjoyed this week’s ‘What’s on Watson’s Plate’. Please feel free to follow my bite-sized updates on Instagram or Facebook. See you next Wednesday for another catch up.

References

1. Dietz, W. and Santos‐Burgoa, C., 2020. Obesity and its Implications for COVID‐19 Mortality. The Obesity Society [online]. Available from: https://doi.org/10.1002/oby.22818.
2. The Lancet, 2020. The Lancet COVID-19 Resource Centre. Available from: www.thelancet.com/coronavirus.
3. Cai, Q., Fengjuan, C., Luo, F., Liu, X., Wang, T., Wu, Q., He, Q., Wang, Z., Liu, Y., Chen, J., Liu, L. and Xu, L., 2020. Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China. The Lancet [online]. Available from: https://ssrn.com/abstract=3556658  or http://dx.doi.org/10.2139/ssrn.3556658.
4. Kass, D. A., Duggal, P. and Cingolani, O., 2020. Obesity could shift severe COVID-19 disease to younger ages. The Lancet. Available from: https://doi.org/10.1016/S0140-6736(20)31024-2.
5. Simonnet, A., Chetboun, M., Poissy, J., Raverdy, V., Noulette, J., Duhamel, A., Labreuche, J., Mathieu, D., Pattou, F., Jourdain, M. and The Lille Intensive Care COVID‐19 and Obesity study group, 2020. High prevalence of obesity in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) requiring invasive mechanical ventilation. The Obesity Society [online]. Available from: https://onlinelibrary.wiley.com/doi/10.1002/oby.22831.
6. Flint, S. W. and Tahrani, A., A., 2020. COVID-19 and obesity – lack of clarity, guidance, and implications for care. The Lancet [online]. Available from: www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30156-X/fulltext.
7. Dyspraxia Foundation, 2019. Dyspraxia in Adults [online]. Available from: https://dyspraxiafoundation.org.uk/dyspraxia-adults/.
8. Hypermobility Syndromes Association, 2017. What are hypermobility syndromes? [online]. Available from: www.hypermobility.org/what-are-hypermobility-syndromes.

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Article: Practical Tips to Reduce Risk from COVID-19

By Katey Watson, March 2020

Image: Natasha Spenser, Pixabay

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This week on Instagram, I listened to a helpful (non-scary) interview of Dr Jenna Macciochi (an established Immunologist) by doctors_kitchen. Dr Macciochi provided some practical tips to reduce the risk from coronaviruses (and many other infections). I’ve summarised her key advice below:

Hand Washing

Wash hands regularly, especially after touching commonly used surfaces – I know – we’ve all heard this, but it really is important!

Hand Gel

Hand gel needs to contain at least 60% alcohol to be effective. (Hand washing with soap and water is better).

Smoking

If possible quit (or at least reduce) smoking – the virus enters lung cells through a receptor called ACE-2. Smoking increases the number of these receptors, providing more doorways. (I don’t know if this includes vaping, but I’ll try to find out and update).

Sleep

Sleep is very important! – our 1st line of defence immune cells (Natural Killer cells) plummet without enough sleep making us more likely to succumb to infections.

Diet

Eat a diverse range of plant-based whole foods (e.g. vegetables, salads, fruits, legumes, grains) – they contain health-protective fibre, phytochemicals and flavonoids (includes coffee and good quality dark chocolate! – in moderation of course). But, keep sugar consumption minimal – it feeds gut microbes harmful to health. For more information about good and bad carbohydrates: Article: Carbs: The Good, The Bad and the Sometimes ‘Farty’!

Fasting

Be cautious about fasting – it is not yet known what type/level of fasting is beneficial or detrimental for fighting the COVID-19 virus.

Intensive Exercise

Avoid very intensive exercise – it puts a strain on the immune system.

Stress

Try to reduce stress (find some time for relaxation) – stress suppresses the immune system making us more likely to succumb to infections.

Face Masks

Face masks are only effective if they are regularly changed due to moisture build-up. Therefore, enable our health workers to have enough by not bulk buying their stocks, so that they can safely treat those of us potentially infected.

I hope you found these practical tips as useful as I did. More details can be found on the doctors_kitchen Instagram page at: https://www.instagram.com/p/B9Y-_vSh8L7/.

Take care all 😊

Article: Probably ‘That’ Coronavirus>>>
<<<Article: Carbs
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Pixabay images in order of appearance

1) jacqueline macou – hand washing
2) xaviervandeputte0 – hand gel
3) tookapic – smoking
4) Free-Photos – sleep
5) silviarita – diet
6) Welcome to all and thank you for your visit! ツ- diet
7) Mimzy – fasting
8) skeeze – intensive exercise
9) Gerd Altmann – stress
10) Juraj Varga – face mask

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