Q&A Event 17.11.21

Dr Ian Blyth – Consultant in Infectious diseases and Microbiology, Public Health Wales

The current best understanding is that this Coronavirus lived within bats and then moved into another animal, probably the pangolin, and after altering itself within the secondary host became a virus that could infect humans.

Covid-19 is not too dissimilar from the original SARS virus that we saw nearly two decades ago, but they are two discreet viruses within the same class.

Dr Ian Blyth – Consultant in Infectious diseases and Microbiology, Public Health Wales​– Consultant in Infectious diseases and Microbiology, Public Health Wales

For the great majority of individuals, the symptoms are mild, usually mild flu like symptoms with fever, loss or change in sense of taste or smell and a cough.  Some individuals will experience constipation or diarrhea, and they'll feel hot, sweaty, and achy all over.

But it can develop into something much more serious.  Those that are most at risk are the more elderly, especially those over the age of 75, and those especially who are immune suppressed. 

The virus replicates within the cells of the lungs and can result in damaging the lungs and inflammation. 

Inflammation within the lungs makes them inefficient and this can lead to more coughing and shortness of breath, often requiring hospitalisation and the support of oxygen. 

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB

Most people get well fairly quickly from Covid, but there's growing evidence that some, maybe about one in four or five people, have symptoms which lasts about five or six weeks, and that's not uncommon.

Long COVID is when people have symptoms up to three months after the initial infection. They experience a variety of symptoms, including ongoing breathlessness, muscle pain, and a cough. 

A much smaller group are having what's called “Post Covid Syndrome” where the symptoms are not resolving and there are ongoing medical problems, particularly fatigue, breathlessness on exertion and pain, and “brain fog”.  These symptoms can last quite a long time.

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB

We’re now in a third wave of infections in West Glamorgan.  At present we're seeing just over 2000 positive test results a week.   These are identified cases where we've got a positive PCR test –  that's just a proportion of the cases, but it's a consistent measure throughout.

At the peak (Christmas 2020), we were seeing nearly 4,500 positive test results each week.

The reduction in cases is partly due to:

• vaccination
• acquired immunity through previous infection; and
• Effectiveness of the control measures that have been put in place.

To date (17.11.21), we've recorded 65,334 cases.  That's about 1 in 7 of all the cases in Wales. 

In terms of hospitalisations, we've seen about 50 hospitalisations a week.

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB

There is a reluctance in the younger age.  Younger people are more reluctant to have any vaccination. 

In the youngest age group (aged 12 to 15) only about 35% are coming forward for a first jab. 

With regards to the booster programme, we're not getting through people as quickly as we would like; but people are coming forward when invited for a booster. 

We've not seen much drop off between first and second vaccinations.

If we compare Black Asian and Minority Ethnic against the rest of the population, there's a gap across all age groups and that gap gets bigger at younger groups. 

The difference is about

• 4% or 5% for those aged 50 or over
• 7% for the 40 – 49 age group; and
• 12% – 14% for those under age 39

Dr Ian Blyth – Consultant in Infectious diseases and Microbiology, Public Health Wales

There are two types of vaccine available in the UK.  Both utilise the vaccine’s messenger RNA.

The Pfizer and the Moderna vaccines were used quite heavily in the first wave of infections in Wales. 

How they operate is that they use a type of genetic code similar to that of the novel coronavirus, SARS, which blocks the spike protein that allows the virus to connect to cells. 

It doesn't stop us becoming infected, but it does stop the virus from taking hold by preventing the virus's ability to replicate itself, which then further diminishes the severity of infection.

The vaccine also appears to reduce our chances of acquiring the infection.  Certainly, it reduces our chances of becoming severely unwell from the infection.

The second set of vaccines that are available are the Johnson & Johnson and the Oxford AstraZeneca.        They work in a slightly different way but again prevent the virus from replicating itself. 

Dr Ian Blyth – Consultant in Infectious diseases and Microbiology, Public Health Wales

Both vaccines and natural infection will produce antibodies, but over time the protection becomes weaker. 

What is required for a long-term protective immune response is further stimulus and that's why we deliver      second and booster vaccines.

So, yes, having an infection does give some protection, but it only protects you for a certain length of time. 

There’re also some early studies that suggests that natural immunity is shorter-lived than the vaccines given.

So, even individuals that have had Covid should have the vaccine as it means you're better protected and for longer.

Dr Ian Blyth – Consultant in Infectious diseases and Microbiology, Public Health Wales

We need to be led by the scientific evidence as to whether additional vaccines are necessary. 

Clearly, we're not going to provide vaccines that individuals don't need.  That would only be a waste given that there are people around the world that need vaccinations.

It is likely that further boosters will be required for those individuals who are immunosuppressed or lose their immunity quicker than the general population.  

Whether the population as a whole requires multiple vaccinations/boosters will depend on how this pandemic develops, and how long immunity lasts after sequential exposure.  

Dr Amer Hamed Bilal – Consultant Cardiologist and BIMA Founding Member

It’s fair to say that most vaccines can take a long time to produce.  However, given that this virus has taken pandemic proportions affecting the whole world, it has had the benefit of global resources. 

We have been informed by what we learnt from previous coronaviruses such as Sars over 20 years ago.

Normally the clinical process for developing vaccines has three sequential phases.  With the Coronavirus, much of the work has been carried out all the same time which has quickened the process. 

This has all helped shortened the time of production of the vaccine. Certainly, there was no cutting of corners. 

Dr Ian Blyth – Consultant in Infectious diseases and Microbiology, Public Health Wales

These studies have been completed and probably interrogated more than any other clinical study in the world.  Indeed, the scientists producing data in this field have been under the scrutiny of the whole world. 

As Dr Amer said, it's because of the goodwill, generosity, hard work and pulling together of the whole of society that has got us to this point so quickly.  I have no concerns about the work that's been done.

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB

I think it's happened quickly, but it's not been rushed.  I think there's a distinction between those two things.

Dr Ian Blyth – Consultant in Infectious diseases and Microbiology, Public Health Wales

We know that pregnant women, especially late in their pregnancy, who contract COVID-19 are at higher risk of complications in their pregnancy and a higher risk of severe disease. 

We now have sufficient data to safely advocate pregnant women to be vaccinated and that is endorsed by the Royal colleges of pediatricians and obstetricians. 

I advocate all pregnant women to get themselves vaccinated. 

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB

There are risks with all vaccines, and each of them has slightly different risks.

AstraZeneca is one which we know has a risk of blood clots; it is a very rare condition which can cause blood clots in the brain.  About one in 250,000 to one in 300,000 were affected on average with this condition. 

There are some complications with other vaccines also.  It is always a balance between the risk of getting the disease and severe consequences and complications from that disease (which are much more common) against the vaccine risk complications (which are comparatively rare).

So, I'm not saying there are no risks to the vaccine, rather they are small and in comparison to the known and greater risks of getting Covid the vaccines are recommended.

Dr Amer Hamed Bilal – Consultant Cardiologist and BIMA Founding Member

Just to clarify, you are more likely to have a clot with Covid than from the vaccine. That is, the infection is more likely to give a blood clot than the vaccine itself. 

Vaccination is a very safe way of treating a disorder; without it we don't really have any effective treatment. 

Statistically, you are more likely to die from a plane falling on your house than from the vaccine.

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB 

The decision to recommend vaccination for those aged 12 to 15 in the UK was based on a large amount of data generated, particularly from the USA where vaccines have been administered to that age group for a while. 

The concern with this age group has been mainly around the mild side effects, which are rare. 

The recommendation for this age group has also been because of the wider impact in terms of potentially reducing transmission in a household setting and reducing transmission to other more vulnerable individuals.

Dr Amer Hamed Bilal – Consultant Cardiologist and BIMA Founding Member

In general, it appears that the Covid infection seems to be affecting slightly more the BAME communities and although mortality within the young is not so common, it can happen.

With regards to the vaccine, there is no evidence to suggest that it is less safe for ethnic children.

There are a lot of studies going on all over the world now to understand better this disease.

Dr Amer Hamed Bilal – Consultant Cardiologist and BIMA Founding Member

In the past, previous vaccines used fetal cells, but that's not the situation with recent vaccines. 

The current vaccine doesn't use any animal products. 

From the Muslim perspective, most Muslim scholars have issued a statement to say that this vaccine has nothing to contradict the Halaal considerations. 

Regarding the vegetarian and vegan aspects, we understand that there is no animal product in the vaccine and that the ingredients are synthetic, and lab produced.

Alfred Oyekoya – Founder and Director BAME Mental Health Support

Frankly, I was one of those who was skeptical about the vaccine.  In essence, my fears were largely attributed to the historical injustice against many Africans in the past when drugs were first trialed. 

What I did to overcome that anxiety was not to rely on social media conspiracy theory, but to educate myself using the right information. I would encourage anyone who is hesitant, as I was, to seek the correct information from trusted sources. 

I did experience some mild side effects.  I had fever symptoms at night, but paracetamol helped.

Farida Patel – Chair of Neath Port Talbot BME Community Association

I had no doubt at all about the vaccine because I worked in a GP surgery and therefore use to asking people to have their vaccinations.  There’s always been hesitation from many patients about vaccines and often I would persuade them from telling them that I was having it.  

People said to me “Oh, you'll have side effects”, but luckily, I had no side effects.

Prof. Uzo Iwabi OBE – Specialist Policy Adviser on Equalities to Welsh Government / Founder Race Council Cymru

For a lot of our community the concerns have been historical, or because the vaccine is so new. 

Some people wrongly belief that it would be better to catch the disease and build up natural immunity.  

In terms of side effects, different people have different experiences.

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB

No, it’s unlikely with the current picture.

If things start to get much worse during the winter, then we may have some more restrictions – but that's not to say that we will never have a lockdown, it’s just probably not.

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB

The recommendation for booster vaccine is the Pfizer vaccine or perhaps the Moderna. 

The AstraZeneca vaccine can be used as a booster but it's not the preferred one. 

However, if there's been a very bad reaction in the 1st or 2nd  vaccinations, there is a possibility to have a review and potentially get a different type of vaccine as a booster.

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB

At the moment (17.11.21), you can get a Covid pass on the basis of having a first and a second vaccination.  Therefore, a booster is not required to get a Covid pass at this time, but that might change.

That said, if you're traveling internationally, then the policies dictated by the host country you're going to might insist on a booster.  So, you may find that your travel ability is restricted without the third/booster vaccination.

Dr Amer Hamed Bilal – Consultant Cardiologist and BIMA Founding Member

As a hospital doctor, I find it difficult that someone in the health sector will refuse to have a vaccine that makes them safer in approaching their patients and the people around them. However, I think the best approach is to persuade them. We might need to spend more time doing this, but I prefer not to force anybody to take something against their wish, but I know it's a very difficult situation.

Farida Patel – Chair of Neath Port Talbot BME Community Association

It is difficult.  If they feel that they don't want to have it, no matter what, then you can't force anybody, it's their choice.  So, if they decide in preference to leave their job, that's up to them.  My view is that it would be wrong to stay without being vaccinated and possibly compromise someone else who may be vulnerable. 

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB 

I agree with both Dr. Amer and Farida.  We have a long and noble tradition of respecting autonomy and the individual’s right to choose what happens to their body, and I wouldn't like to see that impacted.  However, people must understand that choices have consequences. 

So, if it's requirement of having a vaccine to undertake particular activities and you choose not to take the vaccine, then you live with consequences of that.  We're not talking here about enforced or compulsory vaccination.  I would agree with Dr. Amer that we should be looking to persuade people that this is a safe and effective vaccine.

Dr Ian Blyth – Consultant in Infectious diseases and Microbiology, Public Health Wales

Throughout this discussion we have been talking about taking the approach of balancing risks. 

If you are in one of those higher risk populations, you may need to be more conscious of the precautions that mitigate the risk of infection – such as face masks, washing hands, keeping a distance from people.

Where you can, it may be best to avoid interactions with others and areas where you're at higher risk of acquiring the disease – areas where you are enclosed with poor ventilation and with large number of people. 

I wouldn’t want to try and stop individuals from getting out and seeing their families and enjoying their life.  But there's lots of things, including regular lateral flow testing, that you can do to mitigate the risks.

Dr Amer Hamed Bilal – Consultant Cardiologist and BIMA Founding Member

The answer is, yes, they can have the second vaccination if they can provide evidence of the first.  Although, current policy is that it's preferable to have the second dose in the same vaccine that you have previously. 

Dr Ian Blyth – Consultant in Infectious diseases and Microbiology, Public Health Wales

That said, there's no evidence of any risk from mixing vaccines.  So don't be put off from having further vaccines, because you had a slightly different formulation outside the UK.  Let the people know at the time and they will work out what is the best strategy for you.

Dr Keith Reid – Executive Director of Public Health, Swansea Bay UHB

There is one slight complication that sometimes people who've had a mixed program have difficulty getting a vaccine passport and, unfortunately, that's not resolved yet.

Prof. Uzo Iwabi OBE – Specialist Policy Adviser on Equalities to Welsh Government / Founder Race Council Cymru

The reasons for the hesitation within the BAME communities not to take up the vaccinations are varied.

Most were really frightened because they felt the vaccine was very new. Fear ripples through people and communities quickly. 

In countries where we have sent vaccines there is hesitation and mistrust due to the feeling that the Western world has exploited black people in the past and will send them faulty and flawed vaccines.  That is, the offer for help is not genuine and, sadly, there's truth in a lot of the concerns from the past.

Despite all evidence to the contrary, some are resolute not to have the vaccine.  Possibly, the biggest challenge for us are the Windrush elders. They are elderly, very frightened and many don't have family here.

There is still a long road ahead. Most of ‘refusers’ believe that if they contract COVID it will be mild.  Therefore, it is important to put out more educational information in diverse languages.  So, our work must carry on!

Dr Amer Hamed Bilal – Consultant Cardiologist and BIMA Founding Member

I totally agree with Professor Uzo, and, as a man of faith, I think that we also need to be addressed by good education and through good public health awareness campaign.

In the end, it is your decision whether to have the vaccine.  But at the end of the day, you may be putting at risk the life of your friends and elderly relatives.  You may be fit enough, but maybe they're not.