‘If you have a healthy immune system but administer a trigger too soon after the first infection, your immune system will not respond as effectively as it should. Delaying it too long, on the other hand, may result in re-infection, which could be fatal. As a result, it’s best to get vaccinated three months following the initial infection, because an infection during this time isn’t deemed dangerous’, Dr Rajesh Malhotra explains when asked about the optimal time for vaccination of Covid recovered patients.
Following are a few snippets from the discussion with the AIIMS Trauma Centre Chief:
What is the co-relation between Covid Immunity and the vaccination?
Dr. Rajesh Malhotra: The level of immunity is different in each individual and the robustness of the response may vary across ages, comorbidities, sex, etc. Natural infection mounts immunity and vaccination but the immune response mounted by vaccine is much more robust because the infection manipulates immune system in order to thrive in the body, as per a study conducted by a University in London.
People who developed immune response after getting infected by Sars in 2003 carried circulating Antibodies in their bodies in 2020. Therefore, some people may carry the immunity against coronavirus for a lifetime whereas some may get reinfected due to their weak immune system. Another cause for recurrence is the variant, which goes unidentified by the body. Third reason could be if a person’s immune system is fully compromised and has got the persistent infection for months together, the virus inside his body may mutate and come out as a variant which can cause a reinfection. Fortunately, these possibilities are rare.
Can someone, who has developed a mutation, spread the infection while in recovery stage?
Dr. Rajesh Malhotra: A healthy person can recover from Covid in 14-17 days but may spread virus which is dead cannot multiply. On the other hand, an immunocompromised person who has virus multiplying in his body can spread live virus. They may also land up with a mutant due to its prolonged stay because it is a known fact that mutations occur during the prolonged stay of a virus.
What should the immunosuppressed person do in such a condition?
Dr. Rajesh Malhotra: They must wear mask at all times as they may shed mutants. Secondly, they must get vaccinated and if they are vaccinated, various agencies have recommended a booster response in order to control the infection. But the most effective way out is early administration of monoclonal antibodies which can mitigate the persistence of the virus and also the emergence of the variants in their bodies. They should also be isolated from their family members and the family should be vaccinated which will cause an important epidemiological intervention.
Is it a right approach to get vaccinated right after the recovery?
Dr Rajesh Malhotra: The right approach is to get vaccinated which reduces the risk of infection by half. The period between two infections is roughly around hundred days which means that the safe time to get vaccinated is within three months of recovering from the first infection.
I would not worry about antibodies in an immunocompetent people. The other fact that people forget that T-Cells are the most important among the four forces that fight the infection (Antibodies, B-Cells, T-Helper Cells and Killer T-Cells), while antibodies are only ammunitions.
Are you saying that a recovered Covid patient need not get an antibody test right away and can wait 90 days before getting vaccinated?
Dr Rajesh Malhotra: There are no such drugs that can counter the virus, just some drugs that reduce replications. If you have a competent immune system and give a trigger too early after the first infection, the response will not be as robust as intended. On the other hand, delaying it too long may cause re-infection that may be fatal. Thus, it is ideal to get vaccinated after 3 months of the first infection because having an infection in this period of time will not be considered harmful.
Question: Everyone is talking about the third wave. What is the status actually, is it still impending or is it already here?
Dr Rajesh Malhotra: Epidemic has not checked off. Secondly, virus has not been conquered. There is always a risk that it could come back in a way that it could escape the immune system and the vaccination. UK and USA are going through fourth wave, Japan is going through the fifth wave while many countries like South Africa and Bangladesh are suffering from third wave. Many states of India, like Kerala are already going through the third wave. Think Globally, Nationally and Locally. Every area and state needs to have its own plan of action but keep a check on what is happening in other nations and learn from their experience. Nobody should feel secure depending on the number if cases in their states and the strategy should be locally relevant.
Is the healthcare infrastructure of India prepared to face the similar number of cases like the second wave?
Dr Rajesh Malhotra: I would agree that each hospital is better prepared because there are very competent healthcare professionals in our country. Every state is making position for ICU care, thrust on pediatric care and augmenting their healthcare infrastructure.
Herd immunity is being approached, which is why we may not have such a huge a surge. We were caught off guard during the second wave because after the first wave, serosurvey showed high seropositivity. Firstly, since we did not have vaccines at that time, the natural immunity weened off gradually. Secondly, the variant emerged causing huge distinction between the first and second waves.
On the contrary, now we have vaccines as a boost. The variant strain will be kept in mind. A lot of people who are vaccinated or immune due the previous infection can develop asymptomatic or minimally symptomatic re-infection and thus become spreaders. Hence, it is being insisted to follow the Covid protocols.
How important it is for children to get vaccinated?
Dr Rajesh Malhotra: We keep on saying that this virus will eventually become an endemic like HIV AIDS. It’s mortality will reduce. In the coming times, children will go for Covid vaccination like any other vaccine. About now, only children with serious comorbidity should be protected. It is now being said that Delta variant is as contagious as chickenpox or measles and as you know children cannot comply with mask in schools or social distancing. They may therefore spread it rapidly among themselves and people as well, which is why we are encouraging vaccination among children. Although, the mortality is very low among them.
