Some right moves to tame COVID-19 in JamaicaSunday, March 07, 2021
DR LEON WRIGHT
THE Minister of Health and Wellness, Dr Christopher Tufton's engaging of Jamaicans in an ongoing conversation regarding COVID-19 is wise, and a necessary first step to addressing control of the disease while aiming to reduce the disease morbidity and mortality.
Many active health care providers have some difficulty remaining current with the constantly changing information regarding COVID-19 caused by the SARS-CoV2 (coronavirus). The details around mask-wearing, the types of mask and the efficacy provided against COVID-19 transmission have seen adjustments in approach during this pandemic.
The emergence of the new, more infectious, and more dangerous COVID-19 variants which spread more easily and are producing higher rates of illness and death have provoked vigorous debate and discussion. The rapid development and deployment of COVID-19 vaccines, using new technology, their efficacy, benefits, side effects and potential complications have all been in the news.
It is no surprise then that people become confused about the virus and develop COVID-19 fatigue, are distrusting, hesitant to believe new COVID-19 information and statistics, and appear somewhat resigned to their COVID-19 fate. Engaged leaders who provide upto- date, believable information will enhance acceptance and confidence in the data and the process. People will eventually come to accept that the process is not being manipulated or politicised.
Some information about masks
In the correct setting the proper wearing of an effective face mask is the single most reproducible and dependable, widely, and readily available way to decrease COVID-19 spread from person to person.
The N95 mask/respirator or similar respirators provide the highest filtering capacity for small particles and is usually deployed when airborne isolation is required (particle size less than 5 μm). These masks are indicated when a patient requires more than 5L PM O2 by nasal cannula, or in similar conditions where aerosolization of COVID-19 particles is anticipated and the risk for particle dispersion is increased.
These masks are typically used for patients who require TB (tuberculosis), measles, chicken pox, or similar isolation. Each of these masks is thought to be effective for continuous use, with a 12-hour lifespan when used under such conditions. User protection beyond that 12-hour window when using an N95 mask/respirator may be unreliable. These respirators/masks require an initial fit test before use to ensure maximum protection.
A surgical mask when compared with the N95 respirator/ mask offers less protection and is most effective for droplet isolation when airborne particles are greater than 5 μm in size. To increase the efficacy of surgical masks to protect from COVID-19 infection it has been suggested that two surgical masks be worn simultaneously. Use beyond 12 continuous hours may be associated with decreased protection against respiratory COVID-19 transmission.
Both surgical masks and N95 masks/respirators have an adjustable bridge that should be tightly squeezed over the root (topmost part) of the nose to maximise seal and fit. For proper use of the mask, both the nose and mouth must be completely covered at all times in areas where protection is deemed necessary. Users should avoid touching the inner surfaces of the mask with the hands as mask contamination with infectious particles that are on surfaces is then possible, thus increasing the user's risk to infection despite otherwise complying with the wearing of these facial coverings.
Make mask-wearing a habit
Every Jamaican should be constantly reminded and encouraged to wear a mask when he or she is likely to be less than six feet from another person, and for the entire duration of that potential exposure. By wearing a mask, the additional benefits of continuous airflow and warm environmental temperature in minimising COVID-19 exposure are maximised. Where there is reduction in natural airflow a HEPA (high-efficiency particulate air) filter may be considered to minimise the infectivity due to dead air filled with COVID-19 particles which collected in a contained, restricted space (patient waiting rooms, banks, large public and government buildings).
The old way — measles and polio vaccines
Older virus vaccine development techniques employed for the measles and polio vaccines involved use of a whole germ which was either attenuated (reduced potency) or inactivated (killed). Those antiquated methods took up to 10 years from initiation of the vaccine development process to the deployment of a vaccine for immunisation of the public. Early forms of those vaccines also came with some risk of infection from the vaccine since they were whole germ vaccines.
COVID-19 vaccine technology and vaccine contents
The vaccine technology applied for the Pfizer-BioNTech (Biomedical Nanotechnology) and Moderna (synthetic nucleoside- modified mRNA (ModRNA)COVID-19 vaccines had not previously been widely used for global vaccine deployment. The mRNA technology had, however, been in development for over a decade. There are minimal contents including mRNA, fatty lipids (butter-like substances present in common medicines like Acetaminophen and Benadryl), salts (KCl and NaCl) and sugars (sucrose to which our body is normally exposed), and no preservatives in these new COVID-19 vaccines.
Sodium chloride (NaCl) and potassium chloride KCl) are normal body contents that are crucial to the normal function of our body's muscles and nerves and are included in the vaccine to balance its acidity, while the sucrose aids in stabilising the vaccine structure.
The mRNA contains the spike protein from the coronavirus (a non-infectious piece of the virus) and acts as a messenger (telegram) delivering the virus spike protein to the cytoplasm of the human cell. The enclosed spike protein directs the body's cells to make proteins (antibodies) that then recognise the spike protein as though it were the entire harmful whole coronavirus. The body retains memory of this interaction with the mRNA protein and is primed to kill the real coronavirus if exposed to the germ in the future in our surroundings (breathing in infected air, or touching our mucous membranes with virus picked up from a contaminated dirty surface).
The new coronavirus variants and current COVID-19 vaccines
The available information supports these vaccines as being 95 per cent effective in preventing coronavirus infections. Early data indicates the Pfizer-BioNTech and Moderna COVID-19 vaccines offer protection against the more recent coronavirus variants present in Brazil, South Africa, the US, and the United Kingdom. Reported side effects associated with the vaccine use are considered minimal and may include fever, chills, headache, and injection site pain. The probability of knowing someone who dies from infection with the wild (natural) SARS-CoV2 infection is astronomically higher than it is to likely know someone who dies from the complications of COVID-19 vaccination.
The disproportionate worldwide COVID-19 vaccine distribution to rich countries, and the burdensome vaccine cost will limit immunisation of the appropriate percentage of the Jamaican population required to offer satisfactory protection from herd immunity in the foreseeable or immediate future. Population vaccination strategy is only useful if about 80 per cent of the entire population can be vaccinated as rapidly as possible, as demonstrated by the Israeli COVID-19 vaccine experience. So, in the short-term, Jamaica is best served by compliance with mask-wearing, social distancing, hand hygiene, avoiding exposure to crowded situations, and prudent use of curfews as appropriate.
Uncertain worldwide travel landscape
With mandated quarantine of Canadians returning from the Caribbean and South America, at their own expense, the urgency of containing COVID- 19's spread in Jamaica has become even more urgent and consequential.
Those having an interest in the Jamaican tourism sector as investors, employees, or as well-wishers, for the good and overall interest of the Jamaican economy, must now mobilise to galvanise the society around COVID-19 reduction strategies. Israel, a country highly dependent on tourism, as a society went all in to successfully immunise its entire population using the available COVID-19 vaccines. Even the most hardened sceptics, and those not normally receptive to vaccination, complied with vaccination recommendations, clearly understanding the impact of full vaccination to the economic survival of the entire society.
Jamaican-born Dr Leon Wright is an infectious disease specialist operating in the Diaspora.
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