Expert Opinion on Covid-19 Vaccines Facts and Myths, Kenyan Experience

Prof Walter Jaoko, Director KAVI-Institute of Clinical Research at University of Nairobi, Kenya, said:

Covid-19 Third-Wave in Kenya

 “Covid-19 is caused by a group of viruses called corona viruses. They are barely called corona because of their crown-like appearances. It usually affects animals but it can cross over to human beings. We’ve had outbreaks before,”

“In 2002 we had what we call the SARS-COV outbreak. At that time it was not SARS-COV 1 since we did not expect a second outbreak. It spread in 24 countries and then died out. In 2002 we had MERS COV which is the Middle-East Respiratory Syndrome corona virus that affected 27 countries and by the time it was ending, it had caused up to 850 deaths,”

“The most serious of these corona virus infections has been what we have now called by SARS-COV 2. The outbreak started in December 2019 and by now it has caused up to 2.9 million deaths globally. Associated with the outbreaks are palm civet, camels and pangolins respectively,”

“I will talk about the third wave in Kenya and I’m sure the same is being experienced in other African countries as well. So, in Kenya the disease started around mid-March and the numbers of death were rising up and it peaked in mid-August and then the numbers then started coming down. And we were hoping we will keep it down but unfortunately the number started rising again and peaked in November and then they started coming down and by January we had very few cases. Unfortunately the number started rising again and that is what we are calling the third wave. The rising up and falling down like a tide is what is called a wave,”

Clinical presentation of Covid-19

“The problem with Covid-19 is that it represents itself in a range of symptoms. So, it can be asymptomatic where somebody has no symptoms at all, it can also be that  group of people who have mild disease and unfortunately some people develop severe disease and that is where the problem is,”

“Mild symptoms that we all know are cough, tiredness, joint pains, fever, sore throat, and headache, loss of smell or loss of taste. The common ones are the cough, the fever and the sore throat.

“Unfortunately some people start developing severe disease and they start experiencing shortness of breath/ difficulty in breathing, pneumonia, and blood-clots. They are at risk of developing diabetes mellitus and some even get to renal failure where they require dialysis unfortunately some progress to die. Globally about 81% of the people develop mild disease, 14% develop the severe disease and about 5% develop critical disease and that is why it leads to death. Unfortunately you cannot predict the cause of disease in any patient. So anybody who gets Covid, you prepare for the worse,”

Risk for Developing Severe Disease

“One is age. The older you are the more likely you are likely to develop severe disease. And the other one is what we call Co-morbidities. If you have other diseases such as cardio vascular diseases or diseases of the heart, if you have chronic lung disease or cancers you are at risk of getting the severe disease,”

“Also smokers are at a risk of developing the severe disease. Gender is a factor. Males tend to get more severe disease than females. The viral load, the intensity of the viral infection that you tend to acquire also predisposes you to getting the severe disease,”

“We have also known that obesity or being overweight puts you at a risk of getting severe disease. Pregnancy is also a risk factor. More and more are looking at genetics to see if there is any genetic association with the severe disease. Some studies have shown that there is a link between the blood groups with people who are in Group -‘A’ tending to have more severe disease compared to people in blood Group -‘O’ who tend to have mild disease. Now for all these risk factors there tend to be some exceptions hence you find there are people with none of these risk factors but still tend to get the severe disease,”

Virus versus Host

“What could have caused the waves that we are seeing in Africa? For example, specifically looking at Kenya, there is a possibility that it could be a mutation of the virus, but we are not sure because there is no strong evidence. Globally, there are three mutants of Covid 19-causing virus that have raised a lot of concerns,”

“One is the UK Variant, also known as B.1.1.7, the South African variant B.1. 351 and the Brazilian variant known as P.1,”

“What people tend to worry about is that the mutation can lead to increased risk of transmission in that a mutant becomes easily transmitted, or it can also cause more severe disease. There is worry that this can lead to difficulty in diagnosis, what is called diagnostic escape, and with the merging of vaccines, we will have concerns on whether the mutant will be able to escape the vaccine,”

“The only strong evidence we have is that the Brazilian and UK strain seem to be easily transmitted compared to the original strain.

The other thing that leads to this strain is the host/human behaviour. Control of this disease has a lot of human behaviour that can control the spread. That is why we advocate the wearing of masks, social distancing, washing of hands and sanitizing, and if someone is unwell, stay at home,”

“In my opinion, I think that the host behaviour has played a significant role especially here in Kenya in regard to the third wave. During the epidemic, there are political rallies and many people gathering do not wear masks or observe Covid-19 control protocols,” “How do we address and control Covid-19. Scientists majorly believe that in addition to the control measures that we are using, a vaccine would be the most appropriate way to end the pandemic,

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