If you have to choose between killing one person to save the lives of 5 others, and doing nothing even though you knew that 5 people would die as a result of you doing nothing – what would you do? What would be the right thing to do? That is the hypothetical scenario that is becoming more relevant in today’s society and is a moral & ethical dilemma that most nations are facing when deciding on what policies to implement in the COVID world.

Side-line observation tells me that the pandemic strategies our government has been employing since our first lockdown a year ago were a mixture of Utilitarian and non-utilitarian approaches. In the case of a pandemic, utilitarian policies focus on looking after younger, healthy people as it’s most likely to produce the best outcomes. Non-utilitarian approaches focus on protecting everyone equally, it’s not just about the consequences but rights, duties and obligations. Now, the reason that I’m exploring this is so that I can make some sense of the decisions that the government is making and why there is an ever-increasing division within the society. It is not intending to criticise the government’s approach to pandemic management, however, what I’m trying to achieve is to figure out which option will do the best overall not just for individuals but also for society as a whole.

As much as we would like to believe we are living in a society, where all people are equal and deserve equal rights and opportunities, there seem to be no egalitarians in a pandemic. The scale of the challenge the pandemic created for our healthcare system means that there is an ineluctable need to prioritise the needs of many due to the lack of resources.  Take the capacity of our ICUs and the availability of ventilators for an example of a moral dilemma that the frontline staff in the hospital are facing. What if, knowing that there are only 10 ventilators available but there are 11 patients admitted who require its use. How would you decide who should get the treatment?

In a situation where money and resources are abundantly available, the argument is simple – everyone has an equal right to access ventilators, and therefore it is wrong to prioritise some over others. We cannot simply abandon our most vulnerable to save more lives, right? Yes, that is very true and should always be our goal to strive towards. However, does the ‘non-utilitarian approach still apply when resources are scarce? At some point, people will have to think about how they can do the best with the limited resources they have, and that means prioritising those people who have the best chance of recovering and living a long and healthy life. Although we are lucky enough to not need to make such dire decisions of who gets a ventilator or not, our government is very well aware that we do not have the necessary resource to cope if a widespread pandemic occurs. This explains the adaptation of a more or less ‘utilitarian’ approach when distributing medical resources like medicines and PPE. However, when it comes to deploying the lockdown strategy, a non-utilitarian approach was at the forefront. The logic to this approach is rather easy to understand: The decision of going into lockdown was purely based on the fact that not only do we need to prevent the number of infection cases and mortality rates from rising but also our healthcare system cannot cope if a widespread community transmission is present. At the initial phase of the pandemic, such strategy makes a lot of sense and it did serve its purpose in controlling the transmission rate within the community while preventing our already stretched healthcare system from overloading.

Some of you might ask, considering that the case-fatality rates of COVID-19 are sitting globally at around 2% (in comparison to 1% of the influenza virus), and the hospitalisation rate and death rates heavily skewed towards those 85 years and older  Then why do policymakers still believe reducing and suppressing the number of cases and case-fatality rates should be the end game we all strive towards? Even at the expense of 5 million people’s freedom and putting the economy on the line for a virus that can be detrimental to a smaller group of the population? Not to mention the repercussions of the lockdown on our mental health and wellbeing. One of the reasons being is that we do not have enough information to know how the virus behaves over time. And time has proven that virus mutation does exist and hence a more contagious delta strain emerged earlier this year. The second reason is that we did not have the vaccination available to us for protection. We all know that there is nothing utilitarian in the lockdown approach at all. However, it is the best strategy available at the time to cope with the pandemic. Hence, the need to sacrifice the many to protect the minority.

So how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID-19 with causing deaths and reductions in well-being from the cause of lockdowns? I have to reiterate that I’m not trying to argue that utilitarianism is the only relevant ethical theory, or in favour of a non-utilitarian approach. What I do believe in is that each approach has its place in time and the government should be fluid enough about the approaches they use depending on the given situation.

One of the determinant factors on deciding on the type of approach that policymakers consider when making decisions that affect the nation is a cost-effective analysis. It is extremely likely the government has run their numbers in terms of the cost of letting the virus spread freely in the community versus the cost of implementing strict lockdowns hoping to stomp out the virus. At the initial phase of the pandemic, it makes so much sense that a short burst of lockdown may be the answer that we are looking for before a mass vaccination to protect the population becomes available. It does not cause a significant impact on our economy while at the same time stamping out the virus to reduce the burden on our already stretched healthcare system and reducing the ongoing cost involved with managing and treating patients with COVID. The strategy did prove its success where we did enjoy a fair bit of time in level 1 last year after the success of the initial level 4 lockdown.  However, is this still relevant when the virus can no longer be contained or stomped out?

Unfortunately, the amount of money spent on maintaining our economy during the lockdowns, while not forward-thinking to revamp our healthcare system with the necessary resources to cope with the pandemic– really, this leaves us with not much of an option but to carry on lockdown until the majority of us are vaccinated.

Ever since the government announced the rollout of the COVID-19 vaccination program, I’ve been pondering this question – could we have done this more efficiently? Have we missed the crucial window to vaccinate that would have allowed us to avoid the lockdown we are in at the moment?  Being a front-line healthcare professional, seeing first-hand how our healthcare system operated during the pandemic, and the kind of resistance and bureaucracy that I’m seeing in action, yes, we could have done a lot better. However, in hindsight, being a small country at the bottom of the world and with limited financial capability in comparison to mega countries, maybe that is the reason why we are still in lockdown, maybe we have already done the best we can. Who knows?

Hindsight is 20/20. What makes it powerful is that it allows us to make better decisions for the future. There is no doubt that minimising the loss of lives due to COVID-19 is important. Equally, if not, more important, is the well-being of all people – both with and without COVID-19 – which must be balanced and should not be dismissed. There is huge attention to quantifying the number of cases of COVID-19 infection and the number of consequent deaths. However, our government should also place more attention to the possible consequences of lockdown measures for everyone. There is no doubt that lockdown measures themselves will have a direct effect on morbidity and mortality due to the denial and delay of medical treatments. The tremendous amount of pressure and stress generated by the lockdown will have a long-term effect on people’s mental health the many years to come. Besides the direct implication on our health and wellbeing, lockdown measures also have indirect effects through an economic recession. We simply do not know the number of job losses with associated loss of well-being and death.

Policy is often driven by politics or popular options, not ethics. Choosing an appropriate approach is not an easy task regardless of whether it is utilitarian or non-utilitarian. It requires that we choose the best course of action that will benefit the majority of the population to the greatest degree. There is no doubt that there will be a minority of people who would rather bear the consequences of their own decisions than to comply. However, those in the minority must be safeguarded by the policy that protects them as much as possible with full transparency so that they can be as autonomous as possible. I agree that no matter what approach the government takes, there is no win in the court of public opinion. However, what the pandemic has taught us in the last 20 months is that successive governments have neglected our healthcare and hospital systems for decades, sequentially explaining why our health system cannot cope with the burden that the pandemic has created. We have also observed significant mismanagement, injustice, and infringements of rights over the past 12 months which resulted in a divided nation.  Sometimes is easy to put our own agenda forward while neglecting people’s wellbeing and their right to autonomy. That is why it is more important than ever that our government must fill the gap of effective management that was missing throughout the pandemic and start making decisions by not only taking into consideration the pandemic itself but also the wellbeing and livelihood of its people.

The post What is the right thing to do? [Weekly Dose Of Wisdom] appeared first on Eastmed Pharmacy.

This is fantastic news, right? Of course, it is. Who would have thought that we would have a promising COVID-19 vaccine in just under a year of discovering the virus? Plus, developing and manufacturing the vaccine is one thing, but getting our hands on a vaccine is itself a process that alone is difficult enough since every country wants it. Credit has to be given to our government, as we now have an adequate buffer for our fight against COVID-19.

So, we’ve got the vaccine, now what? Indeed, that’s the million-dollar question and is one that should not be taken lightly. The next hurdle that the government must overcome is how to vaccinate the whole population within a short period of time. Vaccinating the population is a key priority of the government because it could end the pandemic and give us the power to open our borders and steer our economy back on the trajectory of economic recovery. It is an exercise that needs to be done as swiftly as possible. Not to mention that new variants of the virus are emerging, potentially making the vaccine ineffective. We are definitely in a race against time for sure.

Let’s put this into perspective: if the government’s goal is to vaccinate everyone within a year, this means that we would need to perform approximately 14,000 vaccinations each day for us to achieve that goal. This is the minimum speed the country needs to reach to achieve herd immunity before next winter approaches.  It is possible but it’s not an easy task. Let’s say if we have the manpower, facilities and resources to do all this, how can we guarantee that every one of the population would be willing to get vaccinated. In the second half of 2021, we could reach a point when we have more COVID-19 vaccines than people to vaccinate, and getting them to take it will be the primary issue.

This is a very valid question and is one that’s going to affect our pandemic strategy and possibly the one that could give our government significant headaches.

New Zealand has a hesitancy problem

To clarify, herd immunity is when enough people are protected against the virus to stop its spread. To achieve herd immunity and end this pandemic, experts estimate that we’ll need to vaccinate at least 70% to 80% of the population. Yet according to a recent survey by global company Ipsos, 51% of New Zealanders say they are likely to get the jab once it’s available to them. While 18% say they are not likely and a further 24% are sitting on the fence.  If that holds true and the herd immunity estimates are correct, it would make ending this pandemic impossible. Compounding that is the uncertainty of whether the vaccine is safe for children as currently it is not approved for use in children. Although several clinical trials are going on at the moment, sufficient data might not be available until the end of this year or early 2022. Given that 20% of the population is under 16, it might further hammer our goal of reaching herd immunity when such a large part of the population is excluded.

I believe the government has a huge task ahead of them when they roll out the COIVID-19 vaccination campaign. In order to launch a successful vaccination programme, the government should be completely transparent with the information they obtain with regards to monitoring the safety of the vaccine; but also, they need to understand why there is a hesitancy in getting the jab in the first place and strategically address the issues. Other than individuals with a strong anti-vaccine view, which tend to make up a very small minority of the public, hesitancy is often brewed by miscommunication and misinformation.

Misinformation about the short & long term safety of the vaccine

Those I know that are sceptical about the vaccine are mainly concerned about the short term and long-term safety of the vaccine being compromised due to the fast-tracked development process. A lot of these concerns are valid but are misinformed. This is because even though the vaccine development was fast-tracked, it still went through the three-phase clinical trial process required by the FDA, testing for safety and efficacy. Furthermore, the vaccines have already been tested in the real world since the mid-2020, meaning most of the short-term side effects would have been identified by now. Millions of people have already been vaccinated in the northern hemisphere with no major safety concerns detected for serious side effects. Not to mention that by the time a wider spread vaccination rollout happens here, there will be more than a year’s worth of safety data available, meaning that we would have a high level of confidence about the safety of the vaccine by then.

In terms of the long-term side effects, concerns are being raised on the internet that the mRNA technology used in the development of the Pfizer/BioNTech vaccine can affect our DNA or change our genetic code. This information is misleading. First of all, as discussed in my previous article, mRNA (messenger RNA) is found in all living cells and it sends signals to the cell and teaches them how to produce certain proteins that trigger the immune response inside the body. It is not the same as DNA (your genes), and it does not affect or in any way interact with your DNA. Hence, we can be assured that it will not cause DNA damage or alteration in both the short or long term.

In my opinion, the way COVID-19 played out in New Zealand has contributed to creating vaccination hesitation. On one side, a well-handled pandemic with minimal transmission and death rates was praised around the world. However, on the flip side, our success can hinder the government’s effort when it comes to encouraging people to get vaccinated to reach herd immunity. This is because there was never a widespread community transmission compared to the rest of the world. Hence, people simply don’t see the urgency to get vaccinated because there isn’t a threatening problem in the first place. But if the pandemic should have taught us anything in 2020, it’s that it’s better to be proactive and be on the offence than reactive and be on the defence. We must understand that it is important to get ahead of the pandemic before it becomes out of control.

Annual vaccination might eventually become the norm in our post COVID world. Of course, getting vaccinated is a personal choice and is one that everyone must consider with all the available evidence and information. What makes the vaccination decision so unique and important is that the decision we make could potentially affect the lives of everyone surrounding us.

To a successful vaccination rollout.

The post COVID-19 vaccination hurdle: How to convince Kiwis to get vaccinated? appeared first on Eastmed Pharmacy.

The NZ government has secured 4 different COVID-19 vaccines. They all use different vaccine technology and have different strengths and weaknesses. One of the stand-out candidates which has gained significant media coverage is the Pfizer/BioNTech vaccine. It was put in the spotlight partly because it was the first COVID-19 vaccine granted emergency use authorisation in the US. Also, it shattered previous records for vaccine development going from the development phase to clinical trials and being granted approval for use in less than a year. I have talked about how development speed can be made possible in my previous article (you can access it here). In summary, besides the global effort and billions of dollars that were pumped into speeding the developmental process up, another reason that we can achieve so much in such a short period of time is because of a ground-breaking vaccine technology that allows the long development timeline to be shrunk significantly. This technology is called mRNA and many more vaccines will be developed in the future using this method.

Let me explain why. Traditionally, there are 4 ways to develop a vaccine. The 2 most common methods are by exposing you to either a weakened (measles vaccine) or a dead (flu vaccine) virus or bacteria so that your body can develop the necessary antibodies to fight off the pathogens if you ever come across it in the future. The third way is by introducing a toxin (tetanus shot) of a virus rather than the virus itself. The fourth type is developed by exposing a small fragment (hepatitis B vaccine) of the virus instead of the entire virus.

Some of the COVID-19 vaccines use the more traditional method such as Novavax which uses a part of the SARs_CoV2 virus known as the spike protein. When injecting the spike protein into your body, it will not result in an infection. However, it’s enough to trigger your immune system to produce antigens that can recognise and launch an assault on the virus if it ever comes across it again.

The problem with such technology is that the production and isolation of the spike protein in a lab environment takes a tremendous amount of time and resources. It requires a large amount of live virus which is practically impossible to achieve in a short timeline, especially when mass vaccination of the population is required. As mentioned in my previous article, one of the reasons the COVID-19 vaccine can be created in such a short period of time is due to overlapping different phases during the development process and initiating the manufacturing process early, before approval of use has been granted.

The scientists are also able to speed up the development timeline by focusing on a different technology for the vaccine – the mRNA method. We all heard of the phrase “give a man a fish and it’ll feed him for a day. But teach a man how to fish and it will feed him a lifetime”. This is exactly what the mRNA method is about. It is to shift some of the work that is traditionally performed in a lab to your body.

To understand this concept, we need to be aware that our body cells are like mini-factories that are constantly producing proteins for our body to function properly. Our cells do this by producing a single strand of DNA (also called mRNA). Each strand of mRNA in a way acts like an instruction manual where it holds the information on how to make one type of protein. The cell then follows the instructions provided by the mRNA and makes the protein. If our body already has the hardware to produce proteins in a more efficient manner, why not teach our body to produce spike proteins of the SARs_CoV2 virus and sequentially allow our body to develop the necessary antibodies to combat the virus?

This is how the Pfizer vaccine is being produced – by identifying the genetic sequence in a COVID-9 virus that is responsible for producing the spike protein. By identifying the specific DNA sequence, a scientist can synthesise an instruction manual (mRNA) to teach our cells to produce the harmless spike proteins, allowing our body’s immune system to recognise the threat and produce the necessary antibodies to combat it.
Doesn’t this sound like the perfect vaccine that can speed up the development and production process? Yes, it does. However, it is not without drawbacks. The problem with isolating mRNA material is that it is relatively unstable and can be broken down easily. In order to main the vaccine in a stabilised state, it needs to be encapsulated inside a fatty layer and kept in sub-zero temperature. This has created some challenges logistically because it cannot simply be transported across the globe without a super-freezer and it is relatively costly to do.

The pandemic has created an opportunity for all the brains and resources in the world to come together to use ground-breaking technology to create a vaccine in an extremely short timeframe. We are all hoping this is the key turning point in the pandemic. However, what many of us don’t realise is that the COVID-19 pandemic gave vaccine development a whole new chapter and a perfect vantage point that we needed in shaping how we prepare, manage and contain any future virus outbreaks of any kind.

To a successful vaccination rollout.

The post The Pfizer/BioNTech vaccine explained appeared first on Eastmed Pharmacy.

The general feeling was that many people are not entirely happy with the government’s decision on Saturday night. One of the reasons was that some people were training hard and looking forward to the once-a-year “Round the Bays” event. The other reason was the strategy of going into a lockdown every time a new case of community transmission is found or suspected. The thoughts were that it’s probably not the best strategy when balancing stomping on the virus and stomping on our economy. Especially, the fact that the whole population and the economy of Auckland had to be punished when a few could not follow simple rules.

Don’t get me wrong, I’m not here to share my thoughts of how the situation should have been handled or how we should move forward as a team of 5 million. Quite frankly, I feel that the government has handled the situation to the best of its ability given the rapidly changing nature of the virus. However, as always, there are lessons the government could learn systematically to not jeopardise the effort of locking down a city of 1.5 million.

What I wanted to discuss instead today was why many people are feeling resentful and anxious and it all points to the result of what lockdown can do to us mentally.

There is no doubt that 2021 will be another interesting year given what we are seeing so far. There’ll definitely be challenging times ahead of us for both our mental and emotional well-being. The stress and uncertainty of the pandemic, the financial repercussions from it, and the anxiety of whether our lives could ever go back to some form of normality have been difficult. Now, faced with the potential of multiple short bursts of lockdowns, profound changes in our daily routines have arisen. Many of us, including yourself, could be feeling the strain already. Personally, the last lockdown had already placed significant stress and disruption to my daily work and personal routine. Things that should be done are not getting done. It’s really hard to find your equilibrium when everything feels like it’s going through a phase of a trough.

Everyone is being affected in some way or another. Every life situation during this time is bringing unprecedented challenges. Workers, if they are lucky, can work remotely. However, many can not and are unemployed until the lockdown finishes. Businesses are forced to operate with maximum restrictions. Parents do their best to home-school their kids while working from home themselves. Single people struggle to maintain a connection with their friends and family.

All of us are collectively facing problems of our own. It is extremely important to be aware of this and it is of paramount importance to not be judgemental. Everyone is fighting a battle that you are not aware of. In times like this, we must not get personal and realise that the is a valid reason why people are behaving this way. A little bit of understanding goes a long way during a pandemic of a lifetime.

People with depression and bipolar disorder are particularly vulnerable to the effects of the lockdown because of the disruption in routines and their usual patterns of daily life. Routines, regularity, and social interaction are important for people with depression to be able to manage their mood symptoms, and disruption in these can precipitate a relapse. During these challenging times, we must protect our mental health and the mental wellbeing of people who suffer from clinical depression. There are lots of things you can do to boost your mental wellbeing:

1)      Maintain your routine as much as possible

Establishing a routine allows you to get through the day with less stress and anxiety.

2)      Find moments for yourself.

Try to regularly set aside time for yourself in the absence of social media, news, or other technology. Trust me, this will help you to relax and have a positive impact on your thoughts.

3)      Stay connected with your loved ones

We must keep connections and close ties to our loved ones and friends. By staying connected, it’ll make us feel safer and less stressed and anxious.

4)      Share the love

At times of stress, it’s easy to neglect our relationships, especially to the people we see every day. It is important to spend and treasure the time with the people who love you and who will be with you no matter what the future holds.

5)      Find ways to forgive

Always look for an opportunity to give people the benefit of the doubt and see the good in people. Being quick to forgive not only is good for your relationships but also for your mental well-being as you embrace their good character and let go of their shortcomings.

6)      Improve someone’s life

Finding ways to be of service to others not only lightens their burden but also, most importantly, it will liberate yourself from a preoccupation with your own struggles (something I still have to remind myself regularly).

7)      Practice gratitude

It is important to be able to recognise the things that are right in front of us when we are in the middle of a storm. Dwell less on what’s wrong or missing and be thankful for what you already have is the most reliable way to maintain sanity and be mentally healthy.

We don’t know exactly how many more lockdowns we’ll have in the foreseeable future. It would be wise to start giving your emotional well-being the attention it needs and prioritise it. It’s alright to give yourself a break as you navigate through stressful times and adjust to a new situation or normality. There is no need to be harsh on yourself, you are doing the best you can, and that’s all matters.

To a happier and more optimistic you.

The post Looking after your mental wellbeing during the COIVD-19 Lockdown appeared first on Eastmed Pharmacy.

The recent community case a week ago that lead Auckland to a level 3 lockdown has been confirmed to be related to one of the more transmissive strains of the virus. For the past months and especially the past weeks, we have been bombarded with news and information about the emergence of several worrying variants of COVID-19 that happened in the UK, South Africa, and Brazil. We’ve heard a lot about the term “variants” but not many of us fully understand what it actually means, how these new variants came about, and how can they change the entire pandemic landscape in relation to the strategy in fighting the virus.

I decided to focus this week’s article on giving you all a deeper understanding of why we are seeing these worrisome variants now. And it boils down to the process of evolution.

1)  Increasing genetic diversity over time

In a nutshell, evolution is a continuous process where changes accumulate over time and the environment helps decide which characteristics or traits of the virus get to stick around and which ones should be eliminated. As a matter of fact, since the start of the pandemic, the COVID-19 virus has been mutating where its genetic codes have been changing slowly as it continues to spread from person to person. At the beginning of the pandemic, the transmissibility of the virus was not much different from the original virus that started more than a year ago. However, the extent of the mutation became substantial as the virus branched out further into different countries around the world. A simple analogy to describe this is like playing a game where your friend draws a picture of an object on a piece of paper on your back and you try to guess what they are drawing based on the strokes you feel from your back. Then you do the same on someone else’s back and the cycle keeps repeating for a further 3 people. Everyone would have a different interpretation of the image they are trying to tell to the next person at each subsequent time and by the end of the exercise, you are more likely to end up with a different image than what you’ve started with.
What we know is that the mutation of genetic material is considered normal and, in most cases, such mutations may even result in a weaker virus over time. However, what we are seeing today with how the virus is behaving is posing a great concern. Instead of seeing a weaker virus, the strain appears to be more aggressive and transmissible than past versions of the COVID-19 virus. What scientists are beginning to speculate is that the new variants might have evolved to dodge our immune system.

2)  Evolution due to increasing human immunity

Genetic diversity can be partly responsible for the emergence of new variants. However, it is not the only reason. It is also possible that the mutation is a response to the development of human immunity to the virus. At the beginning of the pandemic, everyone’s immune systems would be equally bad at recognising the virus. However, as time goes by, as individuals recover from the infection, a new variant may emerge that can somehow evade the immune system. For instance, both the South Africa and Brazil variants consist of a mutation in the virus that allows it to attach to human cells in a way that may allow reinfection in people who have already been infected with COVID-19.

3)  Mutation due to the infection of a certain group of individuals

The scientists also suspect the new variants could be a result of the infection of people who are immunocompromised. Under a normal situation, when our immune system is exposed to the virus, it will launch an immediate assault to try to neutralise the virus. However, in the case of a compromised immune system, the virus could be present in the person for a much longer period which could potentially allow the virus more time to mutate and evolve.

Final thoughts:

Many countries have started to vaccinate against COVID-19 since the beginning of 2021. There is a pressing urge for vaccination to happen quickly and to vaccinate as many people as possible (ideally 80% of the population to achieve herd immunity). This is because if vaccination does not happen fast enough, in the foreseeable future, the virus will be hammered by another big selection pressure to evolve and mutate and this time the new variant could be slightly better at evading the immunity provided by the vaccines. When this occurs, another widespread transmission can happen and the pandemic could reach another peak.
So many factors play into the creation of COVID-19 variants and discovery administration of a COVID-19 vaccine is not the end of the story, unfortunately, there are many more chapters that are yet to be written.

To a quick and efficient vaccination rollout,

The post Why the new variants of COVID-19 should not be taken lightly appeared first on Eastmed Pharmacy.

So why is maintaining a healthy level of calcium important?  It’s simply because having adequate levels of calcium may prevent us from bone diseases (rickets and osteomalacia) that can soften and weaken our bones.

One of the fascinating things about our body is that whenever our body feels as though we are not getting enough calcium from our diet because of low vitamin D levels, it will trigger a cascade of responses from a small gland in your neck called the parathyroid gland to release a hormone called PTH (Parathyroid Hormone). This hormone is responsible for assisting our body to source sufficient calcium for the body to function properly. PTH mainly achieves this by promoting the release of calcium from the most abundant source – our bones. This triggering response can reduce our bone density gradually over time and increasing our risk of osteoporosis.

There is no doubt about the importance of vitamin D in keeping our bones healthy. In fact, several studies link low vitamin D levels with an increased risk of fractures in the elderly, and they suggest that high dose vitamin D supplementation may prevent such fractures from happening. However, the role of vitamin D in disease prevention and the benefit of taking doses beyond the recommended daily allowance is not conclusive.

How does vitamin D help with our immune system?

There have been numerous studies looking at the association between vitamin D deficiency and autoimmune diseases such as multiple sclerosis and type 1 diabetes. There is also emerging evidence showing vitamin D could assist our immunity and help boost our body’s defenses to fight infectious diseases such as colds and the flu. Vitamin D does this by tempering the damaging inflammatory response of some white blood cells, activating and proliferating certain microbe fighting proteins.

A randomised controlled trial in Japanese schoolchildren involving 340 children found that the influenza rates in children who were given a daily dose of vitamin D (1,200 IU) during the height of the winter flu season were about 40% lower than children not taking any.
So, now the important question is:

Does vitamin D deficiency increase the severity of COVID-19?

To answer this question, we must first look at the population most impacted by COVID-19 and also how this school of thought came about. Based on all the available information, ever since the start of the COVID-19 pandemic, we know that groups such as the elderly and rest-home residents are disproportionally impacted by COVID-19. Traditionally, people in these groups are usually vitamin D deficient. Hence, suggesting a possible link between vitamin D deficiency and COVID-19 severity.

What we also know is that the severity of COVID-19 infection is determined by the presence of conditions such as pneumonia, severe acute respiratory distress syndrome, all of which involve underlying inflammation. One of the major defense mechanisms in our immune system to control inflammation and combat against viral infection is through the works of a T-lymphocytes. It has been consistently reported that COVID-19 patients have low T-lymphocyte levels and are markedly lower in severe cases. It can be postulated that if the levels of T-lymphocytes can be somehow increased, it might have a beneficial effect in reducing the severity of COVID-19.

Now the interesting thing is that T-lymphocyte levels can be increased by vitamin D supplementation. In other words, if vitamin D does increase T-lymphocytes and sequentially reduce the severity of COVID-19, then the next question is would vitamin D supplementation be the panacea to decreasing the impact of the pandemic?

In reality, however, it might not be as straightforward as we think. According to The Lancet’s findings from the D-Health randomised clinical trial, more than 20 000 Australian adults were recruited from the general population. It suggested that monthly doses of vitamin D did not reduce the risk or severity of acute respiratory tract infections. Although the trial indicated a statistically significant effect on the overall duration of symptoms, the reduction was deemed to be small (half a day) and unlikely to be clinically relevant.

Final thoughts

When looking at COVID-19 specifically, there is at this stage insufficient evidence; or the evidence available is not conclusive to suggest whether vitamin D supplementation offers a relatively safe option to decrease the impact of the pandemic. Further studies are necessary to determine if vitamin D plays an important role in preventing or reducing the severity of COVID-19.

However, in saying so, as we approaching the end of summer in the coming months, the amount of time spent outdoors will be reduced as the weather gets colder. Hence, I think it would be wise for those who are at high risk of vitamin D deficiency (e.g elderly) to discuss with their doctor and get their vitamin D levels checked and corrected accordingly.

Low-dose vitamin D can be purchased from pharmacies. It is important to bear in mind that there is a potential for vitamin D toxicity if you take it more than the usual daily dose. It is important to talk to your pharmacist or doctor first before you start taking vitamin D to prevent unnecessary supplementation.

Stay safe everyone.

The post Does vitamin D reduce the severity of COVID-19? (Part 2) appeared first on Eastmed Pharmacy.

What is Vitamin D?

There is no doubt that many of you have heard of “Vitamin D” and you may also be aware that we can get it from exposure to the sun. However, not many of us understand exactly what Vitamin D is and why it is so important.  To set the scene and understand the role of vitamin D deficiency in COVID-19, we must first understand what Vitamin D is.
Vitamin D as the word itself suggests is a type of vitamin that our body needs to function properly. It is made up of fat-soluble vitamins that exist in two forms: Vitamin D2 and D3. Vitamin D, in general, is produced, stored, and released into the circulation by a chemical reaction that occurs in our skin. It’s triggered by and is dependent on UVB radiation from sunlight, hence its nickname, “the sunshine vitamin”.

What is the difference between vitamin D 2 and D3?

In general, vitamin D2 (ergoclciferol or pre-vitaminD) is extracted from plants and can be found in fortified food and supplements. Vitamin D3 (colecalciferol) on the contrary is naturally produced in our body or found in animal food sources. Vitamin D3 is usually the preferred form as it tends to increase blood concentration and last longer compared to D2.

What is the best way to obtain vitamin D?

Only a small amount of food contains vitamin D and because of its small role in assisting us to replenish vitamin D, exposing our skin to sunlight is still our best way of getting it naturally. Although the production of vitamin D from our skin is the natural source for us to obtain vitamin D, many people have insufficient levels particularly during the winter months where we spend most of our time indoors to avoid the cold. People with darker skin tones also tend to have lower vitamin D levels due to the skin pigment (melanin) acting as a shade in reducing the production of vitamin D.

Although the sun plays a crucial role in helping us produce vitamin D, there is little information available about exactly how much sunlight is necessary to make enough vitamin D3 to maintain a healthy body and promote strong bones. But what we do know is the danger of overexposure to sunlight and the risk of skin cancer. It should come as no surprise that Vitamin D deficiency only affects 5% of adults in New Zealand because of how much we love our beaches and the outdoors during the summer months. On the contrary, we have the highest incidence of melanoma (the most serious kind of skin cancer) in the world. Because of the intensity of the sun we have in New Zealand, we must achieve a balance between exposing ourselves to enough sunlight to maintain adequate vitamin D levels while still avoiding the risk of skin cancer.

According to the Ministry of Health, optimal vitamin D levels can be produced in a few minutes if at least the face, arms, and legs are exposed. This information prevents us from turning into burnt toast! Hence, there is no additional benefit in spending longer in the sun. The current recommendation for people who burn easily in the sun is only 5 minutes of sun exposure each day before 11 am and after 4 pm. While people with a darker skin tone may require up to 20 minutes instead.

Is there a thing with too much vitamin D?

Sourcing vitamin D through prolonged sun exposure is more likely to cause skin damage than vitamin D toxicity because our skin can produce a compound that protects the body from producing excessive amounts of vitamin D. In saying so, vitamin D toxicity can occur from overdosing on vitamin D supplements. Too much vitamin D may result in abnormally high levels of calcium circulating in our bloodstream, leading to confusion and arrhythmias.

Stay tuned next week for a look at the evidence of whether vitamin D could help fight COVID-19.

To smart sun exposure,

The post Does vitamin D reduce the severity of COVID-19? (Part 1) appeared first on Eastmed Pharmacy.

My last article discussed my concerns about the COVID-19 vaccine that Pfizer currently has undergoing phase 3 clinical trials. Many of you may wonder how can a COVID-19 vaccine be developed, clinically tested, manufactured, and projected to be available for distribution as early as the first quarter of 2021? How can we develop vaccines so quickly without compromising on safety?

These indeed are very good questions and to answer them, it helps to look at the bigger picture of how a vaccine typically gets developed.

Vaccine development can generally be split into three phases.

The first phase in the process is developing several potentially viable vaccine candidates in the lab where they will be vetted by testing in animals or human cells to first see if they are capable of suppressing the virus without causing significant harm – which is called the pre-clinical phase.

If one of the candidates passes this phase, it enters human clinical trials where it’ll be tested extensively for safety, efficacy, and side effects before it’ll be given a green light for licensing, manufacturing, and distribution to the public. This phase is usually the longest and the most time-consuming where a normal process would take years if not a decade to complete.

Human trials usually consist of three phases and each phase is responsible for testing a larger group of people than the previous phase. Phase 1 usually involves a small group of people (less than 100) and is responsible to test if the vaccine is safe. Phase 2 usually involves several hundreds of people and usually is the time where we will find out if the vaccine is effective or not. The last phase is Phase 3 and it is the most time-consuming, expensive, and most diverse part of the human trial where factors such as age, sex, ethnicity, comorbidities will be considered.

During a phase 3 trial, researchers will have to give tens of thousands of participants either the testing vaccine or a placebo. Then what follows is the process of waiting for months and even traditionally for years (if it was not because of the Emergency Use Authorisation fast-tracking the COVID-19 vaccine) to see how many participants from both groups eventually get the disease while they go about living their normal lives.

The entire clinical trial process of developing a vaccine usually takes 10 to 15 years. However, what we are seeing today with the Pfizer COVID-19 trial is that they are racing to compress this entire process into just 1.5 years.

The way they are doing it is by overlapping the different phases of the human trials so that they are conducting several different trials at the same time. Also, the manufacturing process is initiated while the vaccine is still being tested so that the distribution process can occur immediately after proving the vaccine works. To allow the potential vaccine to be available as quickly as possible, FDA is granting authorisation to allow the approval of any COVID-19 vaccines that can demonstrate a good short-term safety profile under an Emergency Use Authorisation. This bypasses the need to demonstrate safety for more than one year after vaccination as with the standard approval process.

Besides the speed in getting the vaccine into the market, another biggest problem with conducting clinical trials in such a short time frame during the peak of a pandemic is that the results can be affected by public health decisions.

For instance, researchers at Oxford University back in April had started planning to perform a large-scale Phase 3 trial of their COIVD-19 vaccine in the UK due to the surging number of new cases confirmed around the time. However, the number of confirmed cases has dropped significantly in July due to lockdown measures and COVID-19 restrictions like wearing masks and maintaining social distance.  Normally it would be fantastic news. However, in terms of testing the efficacy of a vaccine, it meant that the UK would no longer a good place for it. This is because there’s simply not enough exposure for participants to get sick to know whether the vaccine is working, which is particularly a crucial part of the process of conducting a phase 3 human trial.

Based on those challenges surrounding phase 3 clinical trials, some researchers are starting to advocate a different and unorthodox way of obtaining meaningful data as fast as possible. Instead of waiting for the COVID-19 virus to eventually infect some of the tested population in the phase 3 trial, researchers deliberately infect a group of willing volunteers with the virus on purpose to test the safety and efficacy of the vaccine. This kind of study is called the human challenge trial. The human challenge trial can replace the phase 3 trial by incorporating a large-scale safety study afterward. This study can significantly shrink down the timeline of vaccine development and could potentially save thousands of lives due to the speed at which it can be conducted.

Although the human challenge study has been used successfully replicated in the past for the development of cholera, typhoid, malaria and influenza, there is a huge difference that makes it challenging for COVID-19. For all those aforementioned conditions, there is an effective treatment available when things go wrong.

The problem with COVID-19 is that there is currently no treatment available and hence limiting only healthy young adults and people with no long-term health conditions to participate in the trial. In other words, instead of having the luxury of recruiting a broad spectrum of people like in a typical phase 3 trial, a COVID-19 human challenge trial does not give us enough data to show its efficacy in a population outside the studied age group. Above all, the most important issue with a COVID-19 challenge study is the ethical validity of purposefully infecting a healthy individual. Even if ethical approval was granted, the safety of participants cannot be a guarantee as we do not know the full extent of damage COVID-19 may have on each individual’s health.

When it comes to developing the most important vaccine in the recent history of humankind, a balance must be maintained. It is the balance between patient safety and how desperate we are to have an effective vaccine. There is no doubt that we need a vaccine as soon as possible. A huge emphasis is placed on the speed at which an effective vaccine can be developed in creating a widespread immunity with minimal loss of life. However, it is also crucial not to lose sight of the importance of patient safety as it should above all else be defended against the political agenda or our ambitious goal.

To a fast and safe vaccine development,

The post The Unorthodox Way Of Testing A COVID-19 Vaccine appeared first on Eastmed Pharmacy.

According to Pfizer, preliminary data suggested their COVID-19 vaccine is more than 90% effective at protecting people from the infection compared to people in the trial who received a placebo of saltwater.

To truly appreciate and get the sense of how extraordinary these findings are, let’s put things into perspective. One of the criteria that FDA officials laid out was that the COVID-19 vaccine must be at least 50% effective to consider approval. In comparison to other licensed influenza vaccines that are available in the market, most are sitting somewhere between 40% to 60% effective on a year with good predictions. This is because the influenza virus keeps evolving into forms year after year. If these preliminary results hold true to the end of the trial, this COVID-19 vaccine could outperform a regular flu vaccine and hence could seriously flatten the curve of this pandemic.

The excitement and enthusiasm for such promising results created a huge ripple effect around the world as there could finally be a light at the end of the tunnel. This could put an end to the outbreak which resulted in more than 51 million people infected and caused 1.2 million deaths and counting across all continents.  Not to mention the amount of fear, anxiety, and massive financial implications created from the numerous lockdowns of major financial centres around the world for most of 2020.

According to our government, the promising vaccine could be made available to New Zealand as early as in the first quarter of 2021 as the Government signed a deal with Pfizer and partner company BioNTech back in October to purchase 1.5 million doses of the vaccine, enough for 750,000 vulnerable New Zealanders.

Being healthcare professional, we are trained to foster scepticism when interpreting scientific findings. Our ears and eyes are fine-tuned to details that the general public might not have otherwise placed their focus on. Although the press release boasted about the efficacy of the promising vaccine, the information released at this early stage does not answer several key questions that are necessary before we can truly understand whether the vaccine could stamp out the COVID-19 pandemic.

Does the vaccine protect against mild, moderate, and severe infections?

A piece of crucial information that was missing from the announcement is about the spectrum of the infection the vaccine can protect against. We are not sure at the moment whether the vaccine can protect people from only mild infection of COVID-19 or from moderate to severe infections as well.

Also, there is no mention of whether the vaccine could protect against cases with no symptoms because the study only considered people to have contracted COVID-19 if they both tested positive and experienced symptoms.

How effective is the vaccine in protecting the elderly population?

In regards to how well the vaccine will perform in different age groups, there is no information about the efficacy of the vaccine in the elderly population (over 65s) and also people with pre-existing health conditions. Based on the available evidence from the pandemic, these are the most susceptible groups of people to likely experience severe infections and complications. In other words, the overall 90% efficacy of the vaccine may not extends to those in the most venerable groups.

Can the vaccine stop virus transmission?

While the preliminary data suggest the extraordinary efficacy of the vaccine in reducing the risk of contracting COVID-19, we do not know whether it has a role in suppressing the virulent effect of the virus or eliminating it to reduce the risk of spreading the virus – which is crucial in flattening the pandemic curve. Imagine how effective the vaccine would be if it only suppresses the symptoms and virus but is not able to prevent the spread to vulnerable groups.

Is telescoping the clinical trials timelines safe? 

Another big question lies in the time frame in which the clinical trials were conducted. To speed up controlling the pandemic as fast as possible and to put a halt to the number of deaths, the FDA is granting authorisation to allow the approval of any COVID-19 vaccines that can demonstrate a good short-term safety profile under an Emergency Use Authorisation. This bypasses the need to demonstrate safety for more than one year after vaccination as with the standard approval process. Telescoping the clinical trials timelines may not be sufficient enough to answer the question of how safe the vaccine could be and sequentially expose all of us to the unknown potential long-term side effects of the vaccine. Also, without a decent surveillance period, we would not be able to determine how long the immunity lasts – would it be a few months like the flu vaccine? Or a lifelong immunity like smallpox or measles?

After what everyone been through for the past year, there is no doubt that there is an immediate need to put an end to the pandemic. Economies around the world are entering a recession phase that could possibly be one of the worse periods in the history of humankind. Governments are stacking up billions in debts and millions of job losses are happening right before our eyes. All attention has been placed on rushing a COVID-19 vaccine to the market. However, we need to ask ourselves what are the costs that come with a fast-tracked vaccine. Are we risking the potential life lost as a result of a rushed development? Is the risk too great in comparison to the public health solutions we have in hand already that have proven to be effective in controlling the virus?

Despite many unanswered questions around the COVID-19 vaccine, that still hasn’t damped my enthusiasm for the achievements and the extraordinary efficacy of the promising vaccine. Let’s all hope this is the panacea that we all been looking for in 2020.

The post COVID-19 Vaccine – Hope or Concern? appeared first on Eastmed Pharmacy.

One of the questions that many of us might be pondering ever since our first lockdown is how can we plan and prepare for something that cannot be seen. Well, it turns out there is a way to see coronavirus indirectly, to see its transmitting behaviour, to see how fast it spreads. It is the method used by many data journalists or epidemiologists to collect as much relevant data as possible.

Mapping an invisible killer like the coronavirus is just the same as catching a serial killer. You always need to be ahead of the killer, understanding their behaviour, studying their every move so that you can catch them before they strike again. It also requires both patience and dedication and a robust data collection and reporting system. It is considered both a science and an art form.

The birth of virus mapping has its root in London in the mid-1800s. Back then, people genuinely lived a hard life where medical knowledge and interventions were not as advanced as today’s world. Multiple new diseases were emerging where people had no idea of their whereabouts, let alone how to treat and eradicate them. Many people were contracting and dying from diseases that they had no knowledge of despite the fact that those diseases and viruses are not considered deadly in modern-day terms. One of them is cholera. As a result, people came up with a bunch of weird theories and potential remedies for the disease that lead to inaccurate health advice from wrapping up in hot blankets to taking a teaspoonful of hot water. The advice was not evidence-based and people were generally ill-informed, hence they continued to get sick and die.

The situation took a drastic change when an English physician, John Snow showed up. (By the way, he’s not the Jon Snow from the Game of Thrones). His proposition was simple: tracking every single sick person by talking to them, asking them where they’ve been, what they did, what they touched, and who they came in contact with.

The data he collected all clustered and pointed to a water pump in Broad Street. It turned out that from this data collection exercise, they found out the water supply from the pump was polluted by sewage from a nearby cesspit where a baby’s nappy contaminated with cholera had been dumped. This was a huge revelation because people at the time believed that cholera was transmitted through the air rather than through bodily fluid.

What John produced was not just a simple map of a killer disease, but a detailed statistical analysis. Medicines back then were predicated on each doctor’s knowledge and experience rather than incorporating data science in their daily practice. His work changed the way we practice medicine and also the way we see, visualise and analyse data.

Now fast track to 2020, we are in the midst of a global pandemic. Although, the coronavirus today is very different from the cholera outbreak in the 1850s. (For starters, it is a virus and not a bacteria like cholera). However, what is common between the two is that they both were fast-spreading and infectious. The technique and method required to map coronavirus is virtually the same but on a much greater scale. Rather than trying to map out the virus in a small city, we now need to extend the mapping to countries and even the entire world.

What’s different in today’s world is that people move a lot faster and can travel further compare to back in the 1850s. With that being said, technology these days enables us to track and trace coronavirus in ways we could never imagine and to an extent that can be quite disturbing to comprehend. However, it comes at a cost.

Take South Korea and Singapore for an example. If you were to tested positive for coronavirus, you’ll be interviewed by the police and health officials, and your phone’s GPS signal and credit card transactions will be accessed cross-referenced to retrace your every step. This is to reconstruct a trail of everyone that you have close contact or interaction. Even any objects that you’ve touched will be traced and isolated. Once you are in isolation, all your movements will be monitored and tracked to ensure you do not breach the isolation period. This is the way these countries map out coronavirus to stay ahead of the game. Despite the meticulous, labour, and resource-intensive work involved with this method of mapping, it is possibly the only possible way to truly track the virus and stay ahead of it.

Now a plausible question to ask is why aren’t all countries in the western civilisation utilising this strategy to stamp out the coronavirus?  There are several reasons for this. One of the important reasons is that many people in the western world are not comfortable with the idea that their every move is being tracked. We are more sensitive in regards to our privacy being breached compared to some parts of the world. Secondly, this level of tracking requires the government to pour in a large amount of money and funding for it to be possible, and to be frank, many countries do not have the necessary financial resource to do so. Lastly, and is probably the real reason, is that some countries like the United States are simply too late to implement any tracking and mapping of the virus. Many countries did not act or respond quickly enough when there were only a few hundred cases. When it gets over thousands of cases and without a responsive government plan and strategy, it is virtually impossible to map the virus accurately for us to stay ahead of it.

In a way, we all should be extremely grateful for how responsive our government was when handling the pandemic. Obviously, there are things we could have done a lot better but overall, I believe the government has done a tremendous job in preventing NZ from following the footsteps of some other less responsive governments.

Even though we are at alert level 1, there is still a risk of COVID-19 returning to the community. So it is crucial to continue good habits with a face covering, maintaining good hygiene, maintaining social distancing, staying at home if you are sick, and getting a COVID-19 test if you present with COVID-19 symptoms. I also encourage everyone to continue tracking where they’ve been and who they’ve seen to help with the contact tracing app.

It is possible for NZ to continue on level 1 for the long term but it requires all of our input – don’t be complacent!

To a COVID-19 free NZ,

The post Mapping our way to COVID-19 free appeared first on Eastmed Pharmacy.