25 million people in the Philippines are at great risk of dying from COVID

Vaccination of healthcare workers is proceeding at a rapid clip, but an alarming surge of cases in the Philippines is threatening to overwhelm the healthcare system anew. Questions about the pandemic still abound. When will this end? Will it end? How will vaccines make this happen?

Data coming out of Israel is very encouraging. Israel has fully vaccinated more than 50 percent of its citizens. Vaccination prevented an estimated 98.9 percent of deaths from COVID-19, a figure better than the clinical trials.

Vaccination resulting in a major decrease in deaths is the main reason for rolling out the first-generation vaccines under emergency use authorization. If the highest risk populations can be vaccinated as soon as possible, deaths can potentially drop by over 90 percent. The highest risk populations include healthcare workers, senior citizens, and those with chronic illnesses. 

 Protecting the most vulnerable

Early in the pandemic, it became clear that elderly patients were the most likely to die. The latest numbers show that 10 percent of elderly Filipinos who contracted COVID-19 died. Out of the nearly 13,000 COVID-19 confirmed deaths, 60 percent were in those older than 60 years old.

The senior citizens made up only 13 percent of all confirmed cases, so the percentage of deaths was out of proportion. In addition to the elderly, patients with chronic health conditions such as heart disease, hypertension, and chronic lung illness had similarly high rates of death. Frontline healthcare workers with a high risk of exposure to critically ill COVID-19 patients were in constant danger of contracting COVID-19, and a similar disproportionate number of healthcare workers have died.

There are approximately 1.7 million Filipino healthcare workers, 10 to 12 million senior citizens, and another 10 to 12 million people who have some sort of comorbid illness. This comes out to nearly 25 million people in excessive danger of mortality from COVID-19. A vaccine that prevents nearly 100 percent of deaths can very quickly decrease the risk of dying for these vulnerable groups.

To illustrate the significance of the effect of vaccination, if currently available vaccines were deployed a year earlier at the start of the epidemic, there would have been less than 1,000 deaths instead of over 12,000. If the global community had these vaccines at the start of the pandemic, more than 90 percent of the 2.7 million deaths would have been prevented. So even if none of these vaccines eliminated COVID-19, the majority of the people who died would have instead experienced illness akin to the common cold. A major decrease in rates of severe disease and death could be expected even at just 25 percent vaccination coverage of the population, as long as the people at highest risk are vaccinated first.

Achieving herd immunity

More data out of Israel suggest that there is a major effect on transmission from the vaccines. Decreased symptoms mean decreased infection. People who sneeze and cough are more likely to spread infection. Vaccination does seem to have an effect on preventing asymptomatic disease. If confirmed, then herd immunity may be achievable for some of the currently available vaccines. It will still entail vaccinating a large proportion of the population. Clinical trials in children are just beginning, and there is no guarantee the vaccines will work as well in kids compared with adults. While children have been largely unscathed by COVID-19, they can still be infected. Children can also transmit infection to more vulnerable populations.

What to expect after vaccination

It takes two to three weeks from the first dose of a COVID-19 vaccine to get some protection from disease. The full measure of protection as shown in the clinical trials will not be attained until two weeks after the second dose. In the Israel experience, some people still got infected between the first and second doses, although very few had severe disease. Therefore, it is necessary to continue minimum public health standards at least until full vaccination has been achieved. Even after getting full protection, mask and face shields should continue to be worn in the presence of unvaccinated people. Once most people are vaccinated, these prevention measures may be gradually relaxed. In the meantime, fully vaccinated individuals have a much lower chance of developing severe disease or dying from COVID-19.

If a vaccinee develops a cough, colds, or a sore throat shortly after vaccination, a SARS-CoV-2 RT-PCR test should be done as soon as possible. This may be a sign that he or she was incubating COVID-19 at the time of inoculation. If the symptoms occur more than a week after the first dose, the other possibility is that an infection was acquired anyway because of incomplete vaccine protection prior to the second dose.

Vaccines prevent severe disease but some infections can still occur

There have been recent reports of people testing positive for COVID-19 after vaccinations. These should be treated as real, naturally-acquired COVID-19 infections. None of the current COVID-19 vaccines cause COVID-19. None of the current vaccines can elicit a positive RT-PCR for SARS-CoV-2 on a swab test, since none of them carry any viable SARS-CoV-2 virus.

The only type of vaccine that can potentially cause a mild form of COVID-19 is a live-attenuated SARS CoV-2 virus vaccine. This vaccine platform is not yet available, but it is due to undergo clinical testing. The current platforms using inactivated virus, mRNA, viral vector or spike protein vaccines will not cause a false positive on an RT-PCR SARS-CoV-2 or COVID-19 antigen test. These vaccines may cause a positive IgM or IgG on an antibody test, but results may not be consistent across different antibody test kits.

No testing with a SARS-CoV-2 RT-PCR, antigen or antibody test is needed before or after vaccination. As long as there is no history of any COVID-19 symptoms or recent close contact with a confirmed case in the last 14 days, vaccination can proceed. It is not harmful for someone to get a COVID-19 vaccine even if he or she is incubating the virus. There is no reason to expect that it will cause more severe disease. The main drawback is that the vaccination may not work.

There is no need to check antibody levels after vaccination because there is no consensus on what level of antibodies is protective. There is no consensus either whether these titers represent neutralizing antibodies. Neutralizing antibodies are the antibodies that can actively remove circulating virus particles.

There are no commercially available tests that measure cell-mediated immunity. Cell-mediated immunity is the body’s way of detecting and destroying viruses that are hiding in infected cells. It is thought to play a major role in preventing the development of severe COVID-19.

Getting high risk groups vaccinated is urgent. The recent surge raises the stakes even more. A day can make a difference, because it takes time for the immune response to kick in.  Healthcare workers are exposed every single day, and each delay can mean loss of lives. Though uncertainties remain, one thing remains certain. Vaccination saves lives.