Truth About Covid

Covid | Talk Show | Khun Vivek & Dr. Sant| 92 mins view




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Conversation on truth about wellness

This talk show is a Mega we care initiative, where Chief coach of Mega Khun Vivek Dhawan is in conversation with Chief wellness officer Dr. Sant; to help us search for the truth behind all the stories we hear in news on Covid.

With so much information on Covid, (a lot of which is conflicting) we the common people are often left confused.

This endeavor is about a search for finding simple answers to our everyday questions on Covid

We do not aim to find faults or crucify anyone.

It is all about a scientific journey to get around the medical jargon and to make sense of it for the common person.

It is not a claim to fame that we know all.

Using our judgement after studying the available evidence by the experts, it is an endeavour to bring this information to you.

So you can help yourself to stay healthy as long as you live.

It is about good health by yourself.

Dr Sant’s replies to Questions from Audience

Question 1: Why is it that the virus behaves differently with different individuals…for some its milder for others it’s tougher or fatal…Does ones genetics / immune response or any other factor of one’s lifestyle key? Any racial discrimination? It appears it has been less severe with blacks

Answer by Dr. Sant:

No one knows why yet. All we know is that the risk factors of COVID-19 include old age, underlying medical conditions, socioeconomic and living conditions, races (more in Hispanic or Latino persons), and lifestyle (vegetarian vs. omnivores) all play role.

Question 2: Africa has recorded the least… infact; it’s still a shock to the world and the predictions of scientists. What could be probably responsible though testing is not optimal yet the reality is that blacks have unique inbuilt Immunity?

Answer by Dr. Sant:

Yes, I agree. The continent of 1.2 billion people has only 7.6 million cases and 192,000 deaths. Much less in comparison with Europe and America. No one knows exactly why.

Question 3: Can the vaccine prevent one from contacting COVID19?

Answer by Dr. Sant:

Yes of course, but not 100%

Question 4: If I received two doses of Covishield vaccine two months ago and now have respiratory symptoms and fever, what are the chances that I will get Covid? What do I need to do in this situation?

Answer by Dr. Sant:

The statistic from India showed that the chance of breakthrough infection after two Covishield is 0.07%. From the diagnosis point of view what you need to do is still the same as before vaccination, isolate yourself and get RT-PCR done.

Question 5: Is there such a thing as the most “effective” covid vaccine? Which is the best vaccine according to the doctor, especially for us Asians?

Answer by Dr. Sant:

Unfortunately there is no comparison through randomized controlled trial done to say that yet.

Question 6: Once exposed and even there are no symptoms we are on self-quarantine, how many days do we need to continue self-quarantine?

Answer by Dr. Sant:

Days quarantine is accepted worldwide.

Question 7: Your comment on Prophylaxis with Aspirin?

Answer by Dr. Sant:

Retrospective study in US showed that low dose aspirin related to lower ICU admission rate and mortality rate. Surely the potential is there. But we will need at least one prospective randomized control trial with similar result before making aspirin a drug for COVID treatment.

Question 8: I had been infected with COIVD and today is the 24th Day. Now in order to check whether I am negative or not, when should I do the RTPCR test? Also doing antibodies test will be of no use as I had already been vaccinated with both the doses 3 months ago, so any way antibodies will be there.

Answer by Dr. Sant:

There is no point doing RT-PCR because negative or positive result will not change the way you manage the disease. In people like you if the RT-PCR is positive we will call it you have dead virus. No further treatment is required.

Question 9: You had the 1st dose of vaccine while you are positive of Covid, does the dose becomes insignificant? Does this mean you need to have the vaccine of 2 doses over again? OR you may proceed with the 2nd dose?

Answer by Dr. Sant:

You can proceed to the second dose, usually 3 months after infection. The intercept infection usually acts as the first booster dose for you. And your second dose vaccine will act as the second booster dose for you. So all equal to having 3 doses of vaccines.

Question 10: Regarding vaccine Covid-19 if I have been fully vaccinated against covid, can I still get covid and spread it to others?

Answer by Dr. Sant:

There is a small chance that you will have a breakthrough infection. In that case you still can pass the virus to others. Particularly new variant virus.

Question 11: After getting vaccinated, there are people still passed away… what could be the reason?

Answer by Dr. Sant:

Vaccination can reduce mortality down significantly, but not down to 0% mortality.

Question 12: I have not had covid yet and I got my 2 shots of Astra Zeneca vaccine last was in May, I have read that we need a third shot, i want to know if and when should I take the 3rd shot and can it be from other company? Is mixing vaccinations from different companies advisable. What’s the best period for third vaccination? Do we need to take antibody test before taking 3rd booster shot?

Answer by Dr. Sant:

After 2 shots of Astra’s I see no point having another one except if you are immunodeficiency person. At this stage we do not know much about the next (third) booster shot, which, when, of how many shots, we don’t know for sure yet. The third is kind of optional.

The latest study called The Com-Cov study showed that Astra + mRNA vaccine gives better immunity than Astra+Astra. That information may be helpful if you will have a third shot.

Question 13: Do we need a booster vaccine in the future? After complete the current one. And should we have Pfizer or moderna vaccine after we got others since study said its give more protection to newest variants? If I have been vaccinated already with Sinovac, how long can i get vaccinated again with Pfizer for travel purposes?

Answer by Dr. Sant:

How many booster doses we will need for each vaccine is a matter to be clarified by further research for each particular vaccine.

Which vaccine to be used is another aspect of boosting. Currently mixing vaccine is preferrable. In Thailand Sinovac+Astra has given better immunity than Sinovac+Sinovac. In Germany, Astra+Pfizer has given better immunity than Astra+Astra.

The proper time gap between vaccines is conventionally 1 month.

Question 14: Do covid-19 vaccines protect against virus variants?

Answer by Dr. Sant:

Yes and No. For instant, Pfizer vaccine protection range is from 42% to 96% of those fully vaccinated from delta virus. Surely not 100%. But one point worth mentioning is that although low protection rate, all vaccine provide very good in reduction of mortality rate, say 90% up.

Question 15: Currently there are many vaccines from different countries, China, USA, but many people concern about the effectiveness of each vaccine type, so are all vaccines effective the same or different in effectiveness?

Answer by Dr. Sant:

No one can answer that question yet because there is no randomized controlled trial to compare those vaccines yet. We have to wait for further information.

Question 16: How long will protection from the covid-19 vaccine last?

Answer by Dr. Sant:

No one knows. The longest data we have is at least 4 months for Pfizer vaccine.

Question 17: Can we take different vaccines for 1st dose and 2nd dose since vaccine availability in Myanmar is very limited currently? There are few of my colleagues who don’t want to take vaccine, i tried my best, what do you have to say them?

Answer by Dr. Sant:

Yes we can mix vaccine. Actually mixing may give better result than sticking to the original vaccines.

To help those who haven’t received vaccine. If it’s because the vaccine is not available, get them one. If it because he believes in conspiracy theory, well, I don’t know what to do either.

Question 18: After vaccination, people are getting carried away. Even Govt is reducing isolation time if person is fully vaccinated. Your thoughts about this?

Answer by Dr. Sant:

My point is that we have two issues here. Get vaccinated to get rid of the old virus. And protect ourselves from new variant virus. Once vaccination is completed, we can get rid of the old virus. But the new variant is now around and some of them resist old vaccine. So the universal precaution of wearing mask, social distancing and cleansing hands often must go on. For how long I don’t know.

Question 19: To what Extent has Vaccine saved lives since started administered worldwide?

Answer by Dr. Sant:

No one knows. Because no one knows the natural course of this disease yet. The disease may reduce its own virulent and create less and less mortality regardless of vaccination or not, that is one possibility.

Question 20: what should be the treatment regimen for covid being at home isolation? When in home isolation should I consider getting hospitalized?

Answer by Dr. Sant:

Home isolation needs no medical treatment because there is no proven effective drug to reduce mortality of the infected patients outside hospital. But what the isolated patients should do is to follow healthy lifestyle, eat plant based food, do exercise, get good sleep, and manage stress.

Question 21: How about cocktail Rx? We saw in India lot of patients were given combo of Azithro+Cefixime+Dexomethasone+Multivitamin (Patient were treated at home)? Immuno globulin has any role for covid patient?

Answer by Dr. Sant:

I think, that is not based on the science. That is treatment based on imagination. I cannot comment on that.

Question 22: ” To be free from isolation, after 10 days – would you recommend another PCR test to show that the viral load is lesser to ensure the covid patient is not as contagious?

Answer by Dr. Sant

No. Follow up RT-PCR test is useless in management of this disease. Negative or positive it won’t change the management plan.

Question 23: For prevention purpose – Other than Healthy food, would you recommend any supplements? People take lot of Vitamins? Role of zinc for covid patients? From day to day the virus have update new variance look faster, How your view or advice to protect ourself include some foods to be have to build our health more stronger.

Answer by Dr. Sant:

Supplement with vitamins and minerals has role only in starvation or inadequate nutrition. For healthy nutritional status, supplementing with vitamin and mineral may not change the mortality of COVID19.

For particular type of food, one big study done in six countries showed that plant base diet related to 73% infection rate when compare with animal meat based diet.

Question 24: In the cold season, people get infected with the cold virus, and the signs are the same as the signs of the Corona virus, how do we differentiate? What are the characteristics they have in common? Could one have isolated symptoms like loss of smell, for more than 3 days, light headedness, runny nose but the pcr test is coming out negative? Could that be a different infection all together?

Answer by Dr. Sant:

The most common symptoms of covid are not specific. Loss of taste and smell may be a specific symptom but it occurs relatively uncommon in COVID.

RT-PCR is the only way to differentiated common cold from Covid. And since it has very high sensitivity and specificity. It is very reliable.

Question 25: Most of our offices have centralized AC environment. In that case, when we are in the office, should one always wear a mask?

Answer by Dr. Sant:

Yes of course, we should wear mask. And if someone in the same air-conditioned room becomes infected by covid, all in that room must do self-isolation.

Question 26: What is the difference between delta variant and the previous COVID-19?

Answer by Dr. Sant:

Delta variant is more contagious and carries higher mortality.

Question 27: Does inhaling hot steam through nose and gargle throat with salt water help to reduce covid infection?

Answer by Dr. Sant:

I don’t know. No one does randomized controlled trial on this matter yet.

Question 28: What is your take on this virus being airborne

Answer by Dr. Sant:

Sure covid is an airborne virus. There are three route of infection (1) we breath in the aerosol into our lungs (2) the air droplet from the infected person land on our mucous membrane. (3) we dirt our hands with the infected material and inadvertently put in on our mucous membrane.

Question 29: Now a days, we are hearing cases in children. How does the covid progress in kids? How do we manage the isolation in kids? For how long they should be isolated? For children less than 12 years, will it be useful to give an influenza vaccine as stop gap arrangement till there is a vaccine approved for Covid for that age group?

Answer by Dr. Sant:

The mortality of covid in children is very low. The rational of giving vaccination shot to children is to prevent them from bringing the virus to others. That is why we give vaccine to children of 12 years old up.

Concerning using influenza vaccine for children to prevent covid, there is one retrospective study done in Michigan USA which showed that the kid who had flu shot previous year, were less likely to be infected with covid. In medicine there is a word called virus interference which mean once the cell is infected by one virus it will produce interferon to inhibit the coming of another virus. This is only concept. In real life it yet to be proven that influenza vaccine helps prevent covid or not.

Question 30: How covid impacts pregnant woman and what is the mortality rate? What are treatments that should be used?

Answer by Dr. Sant:

There is one good cohort study covering 2130 pregnant women in 18 countries, showed that women with COVID-19 diagnosis were at increased risk maternal morbidity and mortality, particularly eclampsia and preterm. And so do the mortality of their newborns. C/S associated with more newborn infection. The mortality is 1.6%, 20 times higher than non-infect pregnancy.

Question 31: Do people who survive exposure more immunized generally and also against the Delta variant than people who take the vaccine? It’s a conception so far.

Answer by Dr. Sant:

The comparative study showed better immunity in vaccination group than in natural infection group. Hence it is generally recommend that infected people to go ahead having vaccination.

Question 32: What is definition of Exposure to infected COVID? Can you get Exposure from covid positive person with mask on? Any duration? Can you help define who is called as Exposed? We have many examples as someone tested Positive met the person for a minute both wearing Masks

Answer by Dr. Sant:

The definition is arbitrary. CDC defines exposure as within 6 feet distance for at least 15 minutes regardless of wearing mask or not. In Thai hospitals it is not possible to treat patients 6 feet far away. So they redefine it as 1 meter instead. All are arbitrary. For me if you happened to share an air-conditioned meeting room or restaurant with infected person, that is an exposure. All exposed cases need to do a self-isolation.

Question 33: More than COIVD, people are getting more stressed and frustrated by these lockdowns, any good practices for those people working from home?

Answer by Dr. Sant:

Spend time to do things that bring you away from your own thought. Meditation, Yoga, Tai Chi, muscle relaxation etc.

Question 34: Infected person and other person with mask on, talked at distance 1 meter, after quarantine other do not have any symptoms, tests negative, do we still ask them to complete 14 days ? After coming to work again he or she if exposed again, then again 14 days quarantine is needed? Any suggestions to reduce this time?

Answer by Dr. Sant:

Yes we do. Quarantine is different from self-isolation. In Quarantine we separate an exposed (but non infected person) from others until the end of the disease incubation period (14 days). While isolation is separating the infected patients from others. We will need only 10 days after the onset of symptom on condition that there is no fever during the last 24 days. Because ten days is more than enough to make virus in the body non contagious.

Question 35: In which conditions shall we get False Negative on ATK test Ag Test kit even a person has already exposed and complaint of symptoms?

Answer by Dr. Sant:

False negative ATK can occur as often as 40%. It is notoriously not a sensitive test. If the history of exposure and the symptoms are so obvious, one should seek RT-PCT to confirm the screening.

Question 36: Can early possible Infusion of Antiviral Therapy be given to save life in first week of COVID patients to get down viral replications? Which one will you like to prescribe?

Answer by Dr. Sant:

In principle, it is generally agreeable that the earlier the antiviral drugs are used the better. But so far there is no proven antiviral drug that can reduce mortality. I can’t say which one I prefer because there is no evidence to support this. In Thailand I may choose Andrographolis because of its safety profile and its ability to reduce risk of developing pneumonitis. Outside Thailand, I don’t know.

Question 37: May we know if we can still transmit Covid or infect others even if we are fully vaccinated?

Answer by Dr. Sant:

Yes there will still be chance that people who are fully vaccinated can spread the disease through breakthrough infection.

Question 38: How to treat people who were fully vaccinated but had a close contact with a Covid positive person? Should they isolate as usual? How to treat also if they become positive themselves or is this even possible, or they can be covid-free after full vaccination?

Answer by Dr. Sant:

Anyone exposed to covid patients must go through 14 days of self-quarantine regardless of vaccination record. There is small chance of breakthrough infection. Most of fully vaccinated people will have months of covid free, but not all of them.

Question 39: Any harm with taking a third shot of the same vaccine OR a different vaccine be taken and how long after the second shot?

Answer by Dr. Sant:

No harm doing it either ways.

How many shots required for each vaccine depends on the result of the forthcoming research of each vaccine. The timing between the shot also depends. But conventional time is 4 weeks between first tow shots. Time interval for 3 rd shot could be 6-8 months, however it will soon be confirmed in countries like US, Europe.

Question 40: Mixed Vaccination, can it really cause potent immune response, I mean Pfizer vaccine first dose and second dose which one (DNA or mRNA vaccine)

Answer by Dr. Sant:

Based on the research on level of immunity produced, mixing vaccine do improve immunity.

Question 41: Is there a preferred vaccine for pregnant & breastfeeding moms? For a pregnant lady, is it safe to take vaccine shots after 33 weeks of gestation?

Answer by Dr. Sant: I cannot say anything about covid vaccine in pregnant women because there is no confirming information at all.

I can only tell you that mRNA vaccine and virus vector or DNA vaccine are new thing. Particularly DNA vaccine, it’s mechanism of action is to enter the nucleus of human cells and mingle with human DNA in such a way the required mRNA is produced in order to stimulate cell’s internal structures to build spike proteins. All these you may find complicated. But my point is that no one knows what will happen after the DNA vaccine get mingle inside human DNA. So no one really knows what will happen in the far future.

Question 42: How long Covid can be persisted all over the world?

Answer by Dr. Sant:

I don’t know and I can’t comment with available science on covid today.

Question 43: Do we need to vaccinate every year like seasonal Ful vaccine?

Answer by Dr. Sant:

That is one possibility. But no one knows the natural course of this virus. We have to wait and see.

Question 44: If we test positive for covid 19, and the Oxygen saturation is less than 90, can we do treatment in the home? And how to do the treatment at home? What is the step of action?

Answer by Dr. Sant:

I don’t think so. At later stage of disease the main problem is not virus infection but the hyperactive immune reaction which is far more complicated and far more severe to be treated at home.

Question 45: If covid-19 still stays for a long time how do we adapt with that situation? How will the current Covid disease develop in future? In term of new variants?

Answer by Dr. Sant:

I don’t know. We have got to adapt ourselves day by day, I suppose.

Question 46: What is the CT value that is considered safe?

Answer by Dr. Sant:

CT is short for cycle threshold. Let me explain to you how the RT-PCR test is done first. RT-PCR is short for Reverse transcription (RT) and polymerase chain reaction (PCR). In doing the test the take virus from samples collected from the nose and/or throat with a swab then kill the virus and amplify the body of that virus by make the mold to cast the virus and use that mold to cast out numerous new viruses many time until the amount of virus is large enough to be detected by. It is like usually you have a key and want to make a copy of it if you go to Mr. Minute. He will use his machine to copy that key for you. But instead of doing that you buy the copying machine yourself and make thousands of keys of your own. The amplification is done repetitively many cycles until there are a lot of viruses that your detection method can detect them. The number of cycle needed before you can detect the virus is called cycle threshold or CT. The RT-PCR will read positive if the CT is less than 35 rounds. The CT value more than that means the amount of virus in the body is too small to cause any problem.

Question 47: What precautions should one take when going to public gyms?

Answer by Dr. Sant:

Open doors and windows is an essential requirement for all gyms during COVID. The spreading through aerosol occurs most often in room with closed doors and closed windows. Also the universal precautions of wearing mask, distancing, and clean hands often should be maintained.