A-The distribution of the COVID-19 vaccine is continuing in the goal of reaching a herd immunity or at least a protective level. It is believed that the vaccines may prevent people from getting the disease. We are not too sure if people who benefited from the vaccine become less likely to spread the disease if they become infected. Nobody for sure knows the answer but it is possible that the vaccination may also help in the transmission of the disease. If all continue well, we can reach the Herd Immunity by April 2021.

Studies in Spain and Israel have demonstrated that the viral load is lessened in a person who has benefited from the vaccination compared to somebody who become infected but has never received the vaccine. This is encouraging and people should know the protective effect of the vaccination. The higher the viral load, the easier you become infected vice versa, the lower your viral load, the less chances you can become infected.

We have already discussed the fact that the vaccination does not stop you from wearing your mask, avoid crowded place, wash your hand as often as you can or practicing the social distancing. These will be precautions you will have to submit you to until this pandemic goes away. Recent reports have demonstrated more than 20% decline in COVID-related admissions in hospitals but the number of cases has even increased. It does not appear that the drop in these hospitalization has anything to do with the vaccination because only less than 10% of people has received both doses. Around the world, the infection rate to the COVID-19 has also shown a decline as well. Poor countries have no resources to effectively respond to the exigencies of such a pandemic. There is little plan for vaccination. Many of those countries are like Haiti and the wear of masks and the social distancing are almost inexistent.

Schools have opened their doors and vaccination has been extended to kids as young as 12 years old. It was suggested that teachers will need to be incorporated in the group at risk and like for the underserved populations especially the one living in the homeless shelters, they should benefit also from the protective effect of the vaccine. Testing supplies were also provided to the schools. In the meantime, genomic testing has allowed our experts to track down cases with the new strains (United Kingdom and South Africa) in more than 35 states.

B-  Anal testing for COVID-19 virus in now implemented in China, it is not replacing completely the standard swabbing through the nose or the throat but only selected cases more likely te high risk patients. Passengers arriving in Beijing and some schoolteachers with their students have been part of the experience. The swabbing is invasive and inconvenient but can be obtained through a stool specimen or in using a saline soaked 2 inches’ cotton swab, inserted through the anus, to allow one to take specimen for the search of the virus. It seems that the accuracy rate is higher when using this technique. The virus lives longer in the excrements or in the gastrointestinal system than the respiratory tract.

An article was published by the Chinese scientists and published in the Future Medicine, claiming finding few cases where the throat and nasal swabs test were found negative while they tested positive with the anal swabs. They proposed rectal swabbing for any patient ready to be discharge after treatment from the hospital. Unfortunately, not all support the practice of using anal swabs because the virus is contracted through the respiratory system and not the digestive system.

Finally, we may report that cases of Ebola were reported in Guinea, Sierra Leone and Liberia to complicate the actual picture of the COVID-19 pandemic.

C- Nursing Home deaths have fallen down by more than 60% between Dec 2020 and February 2021. One explanation is that the nursing home population has been on the priority list to receive the vaccination and they did receive it. An epidemiologist at Yale University, Sunil Parikh explained the decline in deaths happened surprisingly fast even through most of the residents are still being vaccinated. Another study in Israel has made the same conclusions while residents did not receive both shots.

The Johnson and Johnson vaccine has finally been approved by the FDA (Food and Drug Administration). So far data are very positive. It will appear immediately on the market. with the Moderna and the Pfizer vaccines. It is expected that the Johnson and Johnson vaccine will eliminate death and admission in patient contacting COVID-19. On the 20,000 volunteers who received the Johnson and Johnson shots, not one has been hospitalized with signs of the disease. The sharper the reduction of severe cases, the more we will cry victory on this pandemic. Soon the three vaccines will do their impact and the Johnson and Johnson may show it advantages in the fact that only one injection is needed. One has to remember that the pandemic is far from being over. We can always expect new outbreaks especially when non-vaccinated people continue to disregard the social distancing and the wear of masks. Let us be sure that we continue the actual distribution of the vaccines because more and more people realize the benefits of being vaccinated. 1.4 million to three million vaccine to 3 million per day appears to be the actual challenge. With the new vaccine Johnson and Johnson out this weekend, the new administration will be able to vaccinate more than 4 million per day.

Meanwhile, a new variant is spreading in the New York City area. Unfortunately, Ghana and other West African countries may not benefit from the advantages of the industrialized countries but there is hope that Covax, a global vaccine initiative will correct some of the inequalities. The development of those mRNA “vaccine” has been a success story with no serious concerns. Minor local side effects with redness and pain or swelling, with systemic signs like fever, malaise, muscle ache and joint pain are somewhat expected. Recently, a country vaccination reported a mild decline in the number of vaccinated because of the severe weather in the Midwest and south western of the country. Efforts to catch up is on the way and federal officials are correcting the situation. A problem remains that one third (1/3) of our National Guard members mainly the young personnel in active duty, are refusing to follow the recommendations for them to take the vaccine. We hope this will not stop us from reaching the desired immunity we are thriving to reach

D- Recently we realized the way the public showed confusion about terms being used like “Vaccinate” or “Inoculate” or “Immunize”.

Let us start with a basic definition of a vaccine. A vaccine is a preparation allowing a preventive inoculation to confer immunity against a specific disease. Generally, a form of the disease agent (killed or weakened bacteria or viruses) is inoculated to stimulate antibody production. It is generally a shot that introduce a disease to an organism for the immune system to recognize it. The white blood cells defend the body against this weakened form of the disease and prepare some specific cells to be ready to fight the real pathogen. Vaccines have been around since the end of the 16th century and have significantly help in the fight against disease like smallpox. The term vaccine derives from the word cow.

Vaccines are making the headlines every day in the treatment of the COVID-19 and the further we go in this pandemic, the more you will hear about distribution and the injection of the vaccine in order to reach a herd immunity. People are waiting for to be vaccinated or inoculated. Other are hesitating but still get a certain contact with the virus to help their immune system to react and fight the virus. As of mid-February 2021, 190 million COVID-19 vaccines have been administered and day by day the numbers increase. Vaccines are given in all age group while babies receive polio or rotary virus vaccines, school-age children receive chickenpox, mumps, measles, rubella, tetanus, influenza and adults also use vaccines especially with the flu season

Vaccinate means to give a vaccine to someone. Through a sterilized needle into muscle is generally the best way to administer it but it can also be given orally or through the nose. Some vaccines may require more than one dose. Inoculate mean to implant a pathogen or a micro-organism to a person or an animal or even a plant to confer resistance. The term “Inoculate” come from the 15th century the Latin ‘inoculare’ means graft by budding, implant. Inoculate also refer to vaccine but in microbiology the word is used for the instance when a scientist introduces a microorganism into a new environment in the hope it survives and thrives. By example an algae bacterium in a petri dish to evaluate its grows.

Immunize means to render harmless or ineffective or neutralize or to become immune. One someone is immune to something; it is because he enjoys a certain protection against. You acquire Immunity. Someone can be immune to a disease or to a person. This means that the body is able to recognize quickly a disease or a pathogen and react to it quickly with antibodies. Those antibodies are the bodyguards responsible for the defense. Vaccination is directly related to immunization which can last for longtime but can also be temporary like in Tetanus until the body forgets how to make the antibodies. So a booster shot is needed to reactivate the antibodies.  This is why we get a temporary immunity against certain diseases.

In conclusion. we can use those 3 words in different contexts like: I want to help the nurses vaccinate the patients this morning or my mother got vaccinated earlier this week. In the context of a laboratory, I would say that I inoculated the rats this morning with a small dose of thyroid hormone, meanwhile the bacteria recently injected in the Petri dish has grown rapidly. Finally, I can easily say that I realized that I become immunized to Typhoid disease or Malaria. The more he flew to New-York city, the more he got immunized to the crowd. This is the way those 3 words Vaccinate, Inoculate and Immunize can be used in a conversation but in fact, they represent the same concept of ideas in vaccinating someone or in giving m him/her a vaccine but you inoculate an animal when in a laboratory setting you implant a virus to his body and more generally you get immunize when you receive immunity to something to someone. These 3 terms can be interchanged in a context of a medical discussion or in a friendly conversation.

E- Athletes with COVID-19 with no signs or with mild symptoms need to stay away from exercises. A quarantine may allow them to recover fully and return to a gradual sport participation. If symptomatic, they should get tested with still a delay in the return to activities. Athletes have differences with the regular population in the way that their heart may be enlarged because of their training activities. Screening test may allow us to triage the one in need and they may have no symptoms or only mild symptoms. A return to play guideline is necessary considering that the virus may cause myocarditis in many of the one showing signs of infection. One has to remember that myocarditis is an important cause of sudden death during exercises especially in competitive athletes.

Cardiac injuries are also investigated with a troponin level especially among patients hospitalized. MRI may also evaluate myocarditis which can be found as well in other viral diseases, very often not associated with chest pain or abnormal EKG. Cardiologists do not know yet if cardiac imaging after COVID-19 carry the same risks of a sudden cardiac death or if these criteria represent the same signs found in myocarditis, but a resolution of the symptoms can take up to 6 months. Athletes need to take their precautions to prevent exposure to the SARS-C0V-2 virus. The heart issues are relevant to anyone in the general population looking for a progressive return to sport activities. One should refrain from strenuous exertions. Even if the cardiovascular system is not directly impacted by the virus, it may be affected by inflammatory process and thrombotic episodes which can be seen in the development of the disease. Risk of sudden death, arrhythmia remain during exercise can be unexpected events. This is why it is recommended to take period of rest during the quarantine while recuperating from COVID-19 and resume gradually the exercises. For patients recovering from COVID-19 after a hospitalization, who still have chest pain or shortness of breath, they should keep the activities light until the symptoms resolve.

After their acute illness, post collegiate athletes should resume gradually their activities. Cardiac testing, ECG, blood troponin and Echocardiogram are part of the evaluation of a competitive athlete. Any new symptoms during this recovery period should be reported and dealt with. Sport medicine physicians and cardiologists are looking for a way to define the prevalence of myocarditis for the National Collegiate Athletic Association.in refining protocols for cardiac testing able to predict sudden cardiac arrest or other cardiovascular complications in the athletes who have been victims of COVID19..

Maxime Coles MD

Ste Croix, VI.  (2-28-21)

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