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UPDATE ON COVID 19 VACCINES

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Dr. H. T, Wickremasinghe

It is commendable that the government of Sri Lanka has planned to get down nine million doses of Covishield Vaccine from Serum Institute of India, the world’s largest vaccine manufacturing company. This vaccine is actually none other than AstraZeneca –Oxford Vaccine manufactured by The Serum Institute of India, by the name of Covishield. To date, Sri Lanka has already administered about 200,000 doses to healthcare workers. The next consignment would be given to persons over 65 years and persons with co-morbid conditions such as diabetes, hypertension, heart disease and kidney disease.

With the rolling out of the vaccine globally, new observations have surfaced. The original schedule of the vaccine was to give two doses 28 days apart. This provided almost 70% immunity. However, new evidence has come out last month, suggesting that it would be better to increase the gap between two doses to 12 weeks (3 months) instead of four weeks. This would offer a more robust 84% immunity. The United Kingdom is already using the three months interval between two doses. This will provide greater flexibility for vaccine roll-out, and help the health authorities to deal with any possible supply disruptions, while consistently sustaining the maximum immunity to the public.

A study done by the independent COVID 19 Vaccine Research Group in UK had shown that until the time of conclusion of the study at three months, a single standard dose would provide 76% protection with no declining of immunity. How long this protection would last is not known yet. But time would tell us. As with any other vaccine, an introduction of a second dose at three months would certainly boost the immunity.

 

The second observation made during the roll out of this vaccine is that it appears to provide some form of protection to community spread of the disease. This study revealed that there was 67% reduction in community spread of the disease. This is in fact very good news, as when we go on vaccinating more and more people, there would be less and less community spread of the disease, reducing the burden on hospital medical services.

Another issue which surfaced while rolling out of the vaccine is the safety and efficacy of the vaccine in persons over 65-years of age. Unfortunately, all phase three trials done by AstraZeneca have not included many persons over 65 years of age. They primarily targeted the 18-55 year age group. According to the data from AstraZeneca’s phase three trials, only two out of 660 persons in the trial aged over 65 were infected with COVID 19. Such a small number of participants is grossly insufficient to make a global decision. It is obvious that AstraZeneca has failed to provide reasonable data of safety and efficacy of their vaccine in the elderly population. They are already paying the penalty as countries such as Germany, France, Austria, and South Africa have declined to use the vaccine for persons over 65 years, despite the recommendation made by the European Medicines Agency (The governing body of drug evaluation in EU countries) to use the vaccine for all ages. However, the United Kingdom decided to continue vaccination for all ages including persons of over 80. Their interim analysis during the early part of the vaccination programme shows that the vaccine is not only effective and provide the same immunity as for others but also has slightly less side effects.

Considering the seriousness of COVID 19 in the elderly and it’s very high mortality, it is my considered opinion that even if the vaccine is less effective or has more side effects, it is still worth giving it to old persons as it would save their lives.

With more and more new genetic variations of SARS CoV 2 virus emerging, a reasonable concern has transpired among scientists whether the vaccines would be able to provide immunity to the new emerging strains. Up to now globally there are more than 8,000 variants. Out of those, three variants, the South African variant, the Kent (UK) variant and the Brazilian variant are few rapidly gaining global spread. The UK variant has been identified in Colombo, Avissawella, Biyagama and Vavuniya.

Studies done in UK has shown that AstraZeneca vaccine would provide immunity to the UK variant. However, a similar study done on over 2,000 participants in South Africa has unfortunately revealed that this vaccine is not effective against the new South African strain.

There are more than 150 vaccines against COVID 19 in the production pipeline. Out of those a dozen are nearing completion and awaiting submission of their dossiers to World Health Organization for approval. With such a vast array of vaccines, it would be easy for WHO to distribute vaccines early to provide vaccination to all needy people in the world. But it would not be easy to have the same vaccine supply without disruptions with the expanding global demand. At the same time, some vaccines would show immunity to some new emerging variants, while another vaccine would show immunity to other variants. This brings us to another new strategy. What if we combine vaccines? Combined vaccines theoretically will provide greater flexibility for vaccine rollout and help to deal with any possible intermittent supply shortages of a particular brand.

However, the official guidance given by vaccine authorities in the world state that anyone who has already taken a vaccine should get the same brand of vaccine for both doses. The US Food and Drug Administration and the UK’s Joint Committee on Vaccination and Immunization (JCVI) recommend as much. It’s only in ‘very rare circumstances’ that vaccines of different brands may be used and only if one vaccine is available at a certain time, or it is not known which one was administered for the first dose. Nevertheless, the usefulness of a combined vaccine, in case of a short supply or with combating a new emergent variant, cannot be underestimated. New research is underway to find out the efficacy and safety of such combinations. The initial report with AstraZeneca-Pfizer vaccine combination will be available by mid-2021. Similar trials will be undertaken soon, so that the health authorities of countries would have a better and competitive option of choosing vaccines for their public.

Despite all this good news, we still have question for which we have to wait for an answer. How long the immunity will last is the question for with no answers are available yet. Many countries have already commenced their vaccination programme, even before the introduction of free vaccine programme by WHO sponsored COVAX. In the race of COVID 19 mass vaccination, Israel is well ahead of all the countries in the world already covering 43% of the total population. The number of new cases and deaths due to COVID 19 has come down. Even in the US, the initial wave of vaccination is slowly showing results of reduction of mortality from COVID 19 related complications.

The majority of the vaccines used so far may not provide the expected picture-perfect immunity and the world may continue to have COVID 19 infections, but based on evidence, speculations have already been made to claim that vaccination could provide almost 100% protection from death, This is what we all want.

With that positive note, let me conclude while emphasizing the need to continue our general public health measures such as wearing masks, social distancing and avoiding crowded gatherings to reduce the risk of contact with an infected person. There is no science to beat common sense.

 

(The writer, a Senior Consultant Paediatrician, is President of the Vaccine and Infectious Diseases Forum of Sri Lanka)



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Features

Strong on vocals

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The group Mirage is very much alive, and kicking, as one would say!

Their lineup did undergo a few changes and now they have decided to present themselves as an all male group – operating without a female vocalist.

At the helm is Donald Pieries (drums and vocals), Trevin Joseph (percussion and vocals), Dilipa Deshan (bass and vocals), Toosha Rajarathna (keyboards and vocals), and Sudam Nanayakkara (lead guitar and vocals).

The plus factor, where the new lineup is concerned, is that all five members sing.

However, leader Donald did mention that if it’s a function, where a female vocalist is required, they would then feature a guest performer.

Mirage is a very experience outfit and they now do the Friday night scene at the Irish Pub, in Colombo, as well as private gigs.

 

 

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Dichotomy of an urban-suburban New Year

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Ushered in by the ‘coo-ee’ of the Koel and the swaying of Erabadu bunches, the Sinhala and Tamil New Year will dawn in the wee hours of April 14. With houses to clean, preparation of sweetmeats and last-minute shopping, times are hectic…. and the streets congested.

It is believed that New Year traditions predated the advent of Buddhism in the 3rd century BC. But Buddhism resulted in a re-interpretation of the existing New Year activities in a Buddhist light. Hinduism has co-existed with Buddhism over millennia and no serious contradiction in New Year rituals are observed among Buddhists and Hindus.

The local New Year is a complex mix of Indigenous, Astrological, Hindu, and Buddhist traditions. Hindu literature provides the New Year with its mythological backdrop. The Prince of Peace called Indradeva is said to descend upon the earth to ensure peace and happiness, in a white carriage wearing on his head a white floral crown seven cubits high. He first plunges, into a sea of milk, breaking earth’s gravity.

The timing of the Sinhala New Year coincides with the New Year celebrations of many traditional calendars of South and Southeast Asia. Astrologically, the New Year begins when the sun moves from the House of Pisces (Meena Rashiya) to the House of Aries (Mesha Rashiya) in the celestial sphere.

The New Year marks the end of the harvest season and spring. Consequently, for farming communities, the traditional New Year doubles as a harvest as well. It also coincides with one of two instances when the sun is directly above Sri Lanka. The month of Bak, which coincides with April, according to the Gregorian calendar, represents prosperity. Astrologers decide the modern day rituals based on auspicious times, which coincides with the transit of the Sun between ‘House of Pisces’ and ‘House of Aries’.

Consequently, the ending of the old year, and the beginning of the new year occur several hours apart, during the time of transit. This period is considered Nonegathe, which roughly translates to ‘neutral period’ or a period in which there are no auspicious times. During the Nonegathe, traditionally, people are encouraged to engage themselves in meritorious and religious activities, refraining from material pursuits. This year the Nonegathe begin at 8.09 pm on Tuesday, April 13, and continues till 8.57 am on 14. New Year dawns at the halfway point of the transit, ushered in bythe sound of fire crackers, to the woe of many a dog and cat of the neighbourhood. Cracker related accidents are a common occurrence during new year celebrations. Environmental and safety concerns aside, lighting crackers remain an integral part of the celebrations throughout Sri Lanka.

This year the Sinhala and Tamil New Year dawns on Wednesday, April 14, at 2.33 am. But ‘spring cleaning’ starts days before the dawn of the new year. Before the new year the floor of houses are washed clean, polished, walls are lime-washed or painted, drapes are washed, dried and rehang. The well of the house is drained either manually or using an electric water pump and would not be used until such time the water is drawn for first transaction. Sweetmeats are prepared, often at homes, although commercialization of the new year has encouraged most urbanites to buy such food items. Shopping is a big part of the new year. Crowds throng to clothing retailers by the thousands. Relatives, specially the kids, are bought clothes as presents.

Bathing for the old year takes place before the dawn of the new year. This year this particular auspicious time falls on April 12, to bathe in the essence of wood apple leaves. Abiding by the relevant auspicious times the hearth and an oil lamp are lit and pot of milk is set to boil upon the hearth. Milk rice, the first meal of the year, is prepared separate. Entering into the first business transaction and partaking of the first meal are also observed according to the given auspicious times. This year, the auspicious time for preparing of meals, milk rice and sweets using mung beans, falls on Wednesday, April 14 at 6.17 am, and is to be carried out dressed in light green, while facing east. Commencement of work, transactions and consumption of the first meal falls on Wednesday, April 14 at 7.41 am, to be observed while wearing light green and facing east.

The first transaction was traditionally done with the well. The woman of the house would draw water from the well and in exchange drop a few pieces of charcoal, flowers, coins, salt and dried chillies into the well, in certain regions a handful of paddy or rice is also thrown in for good measure. But this ritual is also dying out as few urban homes have wells within their premises. This is not a mere ritual and was traditionally carried out with the purification properties of charcoal in mind. The first water is preferably collected into an airtight container, and kept till the dawn of the next new year. It is believed that if the water in the container does not go down it would be a prosperous year. The rituals vary slightly based on the region. However, the essence of the celebrations remains the same.

Anointing of oil is another major ritual of the New Year celebrations. It falls on Saturday, April 17 at 7.16 am, and is done wearing blue, facing south, with nuga leaves placed on the head and Karada leaves at the feet. Oil is to be applied mixed with extracts of Nuga leaves. The auspicious time for setting out for professional occupations falls on Monday, April 19 at 6.39 am, while dressed in white, by consuming a meal of milk rice mixed with ghee, while facing South.

Traditionally, women played Raban during this time, but such practices are slowly being weaned out by urbanization and commercialisation of the New Year. Neighbours are visited with platters of sweetmeats, bananas, Kevum (oil cake) and Kokis (a crispy sweetmeat) usually delivered by children. The dichotomy of the urban and village life is obvious here too, where in the suburbs and the village outdoor celebrations are preferred and the city opts for more private parties.

 

 

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New Year games: Integral part of New Year Celebrations

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Food, games and rituals make a better part of New Year celebrations. One major perk of Avurudu is the festivals that are organised in each neighbourhood in its celebration. Observing all the rituals, like boiling milk, partaking of the first meal, anointing of oil, setting off to work, are, no doubt exciting, but much looked-forward-to is the local Avurudu Uthsawaya.

Avurudu Krida or New Year games are categorised as indoor and outdoor games. All indoor games are played on the floor and outdoor games played during the Avurudu Uthsava or New Year festival, with the whole neighbourhood taking part. Some of the indoor games are Pancha Dameema, Olinda Keliya and Cadju Dameema. Outdoor games include Kotta pora, Onchili pedeema, Raban geseema, Kana mutti bindeema, Placing the eye on the elephant, Coconut grating competition, Bun-eating competition, Lime-on-spoon race, Kamba adeema (Tug-o-War) and Lissana gaha nageema (climbing the greased pole). And what’s an Avurudhu Uthsava sans an Avurudu Kumari pageant, minus the usual drama that high profile beauty pageants of the day entail, of course.

A salient point of New Year games is that there are no age categories. Although there are games reserved for children such as blowing of balloons, races and soft drinks drinking contests, most other games are not age based.

Kotta pora aka pillow fights are not the kind the average teenagers fight out with their siblings, on plush beds. This is a serious game, wherein players have to balance themselves on a horizontal log in a seated position. With one hand tied behind their back and wielding the pillow with the other, players have to knock the opponent off balance. Whoever knocks the opponent off the log first, wins. The game is usually played over a muddy pit, so the loser goes home with a mud bath.

Climbing the greased pole is fun to watch, but cannot be fun to take part in. A flag is tied to the end of a timber pole-fixed to the ground and greased along the whole length. The objective of the players is to climb the pole, referred to as the ‘tree’, and bring down the flag. Retrieving the flag is never achieved on the first climb. It takes multiple climbers removing some of the grease at a time, so someone could finally retrieve the flag.

Who knew that scraping coconut could be made into an interesting game? During the Avurudu coconut scraping competition, women sit on coconut scraper stools and try to scrape a coconut as fast as possible. The one who finishes first wins. These maybe Avurudu games, but they are taken quite seriously. The grated coconut is inspected for clumps and those with ungrated clumps are disqualified.

Coconut palm weaving is another interesting contest that is exclusive to women. However men are by no means discouraged from entering such contests and, in fact, few men do. Participants are given equally measured coconut fronds and the one who finishes first wins.

Kana Mutti Bindima involves breaking one of many water filled clay pots hung overhead, using a long wooden beam. Placing the eye on the elephant is another game played while blindfolded. An elephant is drawn on a black or white board and the blindfolded person has to spot the eye of the elephant. Another competition involves feeding the partner yoghurt or curd while blindfolded.

The Banis-eating contest involves eating tea buns tied to a string. Contestants run to the buns with their hands tied behind their backs and have to eat buns hanging from a string, on their knees. The one who finishes his or her bun first, wins. Kamba adeema or Tug-o-War pits two teams against each other in a test of strength. Teams pull on opposite ends of a rope, with the goal being to bring the rope a certain distance in one direction against the force of the opposing team’s pull.

Participants of the lime-on-spoon race have to run a certain distance while balancing a lime on a spoon, with the handle in their mouths. The first person to cross the finish line without dropping the lime wins. The sack race and the three-legged race are equally fun to watch and to take part in. In the sack race, participants get into jute sacks and hop for the finish line. The first one over, wins. In the three-legged race one leg of each pair of participants are tied together and the duo must reach the finish line by synchronising their running, else they would trip over their own feet.

Pancha Dameema is an indoor game played in two groups, using five small shells, a coconut shell and a game board. Olinda is another indoor board game, normally played by two players. The board has nine holes, four beads each. The player who collects the most number of seeds win.

This is the verse sung while playing the game:

“Olinda thibenne koi koi dese,

Olinda thibenne bangali dese…

Genath hadanne koi koi dese,

Genath hadanne Sinhala dese…”

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