AGE, UNDERLYING MEDICAL ILLNESS AND COVID-19
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WHY ARE OUR MOST VULNERABLE UNVACCINATED?

Dr. Shivani Samlall. MBBS, Specialist in Obstetrics and Gynaecology with a sub-specialty in Gynaecology Oncology, with over 10 years of practice. She also holds a Post Graduate Diploma in Clinical Trials and Research. Dr Samlall can be contacted at drshivanisamlall26@gmail.com

COVID-19 GUYANA’S SITUATION
AS we have seen in Guyana over the past few months, there has been an increase, not only in the number of COVID-19 cases (over 3,300 active cases!), but in the number of COVID-19 hospitalisations, ICU admissions and deaths (over 50 deaths in two weeks!) most likely due to the Delta variant. Our situation is concerning and indeed tragic, especially since the science has shown that most of these deaths could have been prevented through vaccination and other preventative measures.
Recent figures for COVID- 19 deaths for the month of July and August have shown that most of these persons were unvaccinated. A breakdown of these stats shows that in July, there were 65 COVID-19 deaths, of which 61 (93.8 per cent) were unvaccinated, two were partially vaccinated and two were fully vaccinated. And in August, there were 76 COVID-19 deaths, of which 62 (81.5 per cent) were unvaccinated, 12 partially vaccinated and two fully vaccinated. These stats are being mirrored not only in our neighbouring Caribbean countries but also the rest of the world, whereby the unvaccinated are mainly the victims of COVID-19.

WHY IS COVID-19 MOSTLY AFFECTING PERSONS OVER AGE 45?
Looking at the daily releases of COVID-19 deaths, the majority are occurring in persons above age 45. This corresponds with current Centre for Disease Control (CDC) data which shows that more than 95 per cent of COVID-19 deaths occur in people over age 45. The reason being that most persons above this age group have underlying medical illness(es) or what we term co-morbidities.

This makes them more vulnerable than the general population of getting severely ill and dying from COVID-19. Additionally, the older you are, the more health conditions you have and the more severe your conditions are, the more at risk you are. Yet, there seems to be major reluctance among this population to get vaccinated.

Based on what I have seen on social media, I can only assume that this is because of issues surrounding safety and efficacy of the vaccines in this group of people (persons with underlying medical conditions). This week’s column therefore addresses the current international recommendations for COVID-19 vaccination in persons with underlying medical illness and lists most (but not all) of the medical conditions which increases a person’s risk of getting severely ill and dying from COVID-19. It also discusses why there are breakthrough infections in persons who are vaccinated and why the vaccines do not offer the same level of protection in all persons.

WHAT ARE THE CURRENT RECOMMENDATIONS FOR VACCINATION IN PATIENTS WITH COMORBIDITIES?
Health organisations in the USA, UK and WHO, namely “The Advisory Committee on Immunisation Practices” (ACIP), “The Joint Committee on Vaccination and Immunisation” (JCVI) and the “WHO Strategic Advisory Group of Experts on Immunisation” (SAGE) respectively have all recommended COVID-19 vaccination for patients with comorbidities, including immunocompromised individuals.

Although there is limited data on the efficacy of the vaccines in immunosuppressed patients, it is still recommended that these persons be vaccinated, considering that there are one of the most vulnerable groups, i.e., they are at an extremely high risk of progression to severe illness and death.

These strong across-the-board recommendations by the various health organisations are made because many studies would have demonstrated that the COVID-19 vaccines save lives in persons with underlying medical conditions. As discussed in last week’s column, all vaccines have side effects; however the benefits of the vaccines outweigh the potential risk of side effects.

WHO ARE MORE AT RISK OF BECOMING SEVERLY ILL FROM COVID-19?
According to the CDC, older adults, persons with disabilities and adults of any age with any of the following conditions are more likely to get severely ill from COVID-19:
1. Cancer — treatments for many types of cancer can weaken your body’s ability to fight off the infection.
2. Chronic kidney disease (of any stage)
3. Chronic lung diseases such as: COPD (chronic obstructive pulmonary disease), asthma, interstitial lung disease, cystic fibrosis, and pulmonary hypertension
4. Dementia or other neurological conditions
5. Diabetes: type 1 or type 2
6. Down syndrome
7. Heart conditions such as: heart failure, coronary artery disease, cardiomyopathies or hypertension
8. HIV infection
9. Liver disease such as: alcohol-related liver disease, nonalcoholic fatty liver disease, and especially cirrhosis
10. Overweight or Obese. The risk of severe COVID-19 illness increases sharply with elevated BMI.
11. Pregnancy: Pregnant and recently pregnant people (for at least 42 days following end of pregnancy)
12. Sickle cell disease or thalassemia
13. Smoking (current or former smoker)
14. Solid organ or blood stem cell transplant
15. Stroke or cerebrovascular disease
16. Substance use disorders
17. Immunocompromised state (weakened immune system).
Of Note: People who have a condition or are taking medications that weaken their immune system may not be fully protected even if they are fully vaccinated.
18. Children and teens with underlying medical conditions are at increased risk for severe illness compared to children without underlying medical conditions. According to the CDC, one way to protect the health of your children, especially those who cannot be vaccinated (less than 12 years) is to ensure that all adults in a household are vaccinated against COVID-19.

BREAKTHROUGH INFECTIONS AFTER VACCINATION
The vaccines against COVID-19 show your natural defences what the virus look like, so you are primed and ready and can respond quickly and strongly if exposed to the virus. However, as I would have conveyed in my previous column, no vaccine is 100 per cent effective in preventing a disease. This means that occasionally these viruses can break through these defences (breakthrough infection). When this happens, you get a milder case of the disease, with less risk of serious harm.

IMPORTANCE OF MANAGING UNDERLYING MEDICAL CONDITIONS
It must be noted that in some persons such as those of advanced age, or with many underlying illnesses, and severe medical conditions, the vaccines do not offer the same level of protection as compared to someone who is younger or who does not have complicated underlying heath issues.

It is therefore very important for these persons to manage and maintain control of their underlying medical illness. This means that they must take their medications as prescribed, that they continue to monitor their blood pressures, blood sugars, etc. regularly and that they maintain their diet and exercise recommendations. Additionally, they should continue their regular medical follow-up and if they get sick or think that may have COVID-19, they “SHOULD NOT” hesitate to seek medical attention.

IN CONCLUSION:
What remains clear is that the older you are, the more health conditions you have, and the more severe the conditions, the higher your risk of getting severely ill and dying from COVID-19. It is for this reason that current international guidelines strongly recommend vaccination in this group. Additionally, because of the contagiousness of the Delta variant, and the subsequent risk of break-through infections, it is recommended that you not only control your underlying medical condition but also continue to wear your masks, and sanitise/wash your hands and practise physical distance.

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