6.4. Risks Still Posed to Vaccinated People
Vaccinations help in imparting protection against the disease; however, they come with certain risks and side effects as discussed earlier. The rate of mortality due to COVID-19 infection in vaccinated people is comparatively less and was reported to be 0.4% in the Indian population. Vaccinated people still have the risks of infection with new variants or re-infection if they are weak and do not follow the COVID-19 protocols. Some reports describe re-infection in many people who were already COVID-19 positive a few months ago, with India having a COVID-19 re-infectivity rate of 4.5%. This suggests the need for booster doses of vaccine that can help in preventing the further spread of disease and better management of COVID-19. Currently, discussions of administering booster vaccine doses have started due to mainly two reasons 1) the fact that the levels of serum antibodies produced after vaccination drops after a few months post-vaccination and 2) rapid evolution of the virus and emergence of variants that can be a breakthrough in the disease epidemiology with a capacity to induce higher viral load even in vaccinated people. A third booster dose has been developed by Moderna, Pfizer–BioNTech, Oxford–AstraZeneca, and Sinovac which can be administered 6 months after the 2nd vaccination dose, and this helps to boost the neutralizing antibody titers, making the vaccination effective against all the variants of the virus.
CHALLENGES IN MANAGEMENT OF COVID-19
The most reliable approach to control the spread of COVID-19 is prevention, treatment, and management of the disease. For this, a combined effort from both the public and the government is essential. There are a variety of measures that can be taken to effectively manage the transmission of the virus and each possible way is presented with its challenges.
Due to the rapid transmission rate of the virus, social distancing was immediately implemented with the thumb rule of keeping a distance of 1.5 meters between people as this can help prevent the spread of respiratory droplets and thus most infectious respiratory diseases . This disease is spread through air droplets so it is also essential to wear masks, wash hands often and disinfect with alcohol-based cleaning products. However, with social distancing, the possibility of increased depression and anxiety might increase in people . In addition, wearing masks is advised even now even after a majority of the population are completely vaccinated or at least vaccinated with one dose. However, there are two challenges observed concerning the wearing masks, the first being that due to the sudden high demand there is a shortage observed and the second is spreading awareness on how to use masks properly, understand their necessity, and ensure they are worn .
Again, the rapid rate of transmission of the disease causes many people to get infected and a lack of comprehensive understanding of the virus at the cellular and molecular level at the onset of the pandemic led to hospitals being overwhelmed unable to treat all patients. There was unpreparedness concerning medications and adequate resources including hospital equipment. A variety of resources are required to treat patients such as an ICU bed, ventilators, oxygen supply, PPE kits for the health care workers, etc. Thus, it became a clinical challenge for both clinicians and front-line workers to deal with this.
As this is a disease that affects the respiratory system, ventilators are essential as they provide respiratory support to patients whose lungs are compromised due to the infection. There has been an extreme shortage of ventilators experienced by many of the countries including India, that have been hit hard by the pandemic due to the global supply chain . Hence there is a requirement to escalate the production of ventilators and to find alternative manufacturing processes to deal with the shortage. There was also a massive hospital bed shortage and it was observed that high-income countries had a greater number of bed facilities than low-income regions, which directly affected the quality of the care given to the patients .
Moreover, it is essential to also have a preventative measure rather than facing a multitude of problems associated with COVID-19 treatment. This is where vaccines come into the picture. Within less than a year of the start of the pandemic, there were several potential vaccine candidates, many of them were seen to obtain the emergency use authorization as well. There were however many challenges observed such as maintaining R&D incentives, conducting in-depth clinical trials, obtaining the required authorizations, manufacture, supply, global distribution plans, and post-market surveillance . However, even with all the advancements in technology in the health care system, the COVID-19 pandemic is still ongoing due to the emergence of multiple variants of viruses for which the vaccines don’t work. This has created a clinical challenge for both researchers and clinicians. Thus, we suggest that, apart from vaccinating people with booster doses, more research needs to be carried out on emerging variants to understand their mode of transmission and pathogenicity.
FUTURE RESEARCH DIRECTIONS
It is possible to manage the spread of COVID-19 using an integrated and balanced approach through a fine interplay between academic, scientific, social, political, and economic factors. Lots of efforts have been put into identifying various viral targets that can be used to formulate drugs, however, besides the great potential and benefits offered by phytochemical-based drugs, most of the drugs currently available for use are chemical-based, indicating that there is a growing need for increasing the attempts at bringing a phytochemical-based drug into the market for patient consumption. Nanotechnology seems to be playing an important role in disease-prevention strategies, diagnosis, and treatment. Further research can be performed in incorporating nanotechnology in drug or vaccine delivery to develop more efficient drug delivery systems. The pandemic that seems to have been going on forever has directly or indirectly made its mark on the whole of the global population, however, it seems to have affected children on more than one level. The increasing cases of mental health issues arising out of social isolation and economic instability in households is a clear indication that there is a necessity to develop and implement appropriate virtual health care systems that can offer maximum health support to children. The different vaccines that are currently available and those that are under different stages of clinical trials are proving to be successful, however, most of them have not considered the effects and consequences of vaccination in the immunocompromised group of population. There is a lot of ambiguity when it comes to vaccination and its associated risks in this group, and further insight is required along with clinical evidence concerning this issue. Apart from the obvious requirement for overall development in prevention, diagnosis, treatment strategies, it is of utmost importance to spread awareness regarding the consequences of the disease and where it is headed in the near foreseeable future, and to form protocols and guidelines accordingly. Every country must be prepared for any unexpected turn of events. The major factor that ensures the success of the management and prevention strategies of COVID-19 is the complete cooperation from the people, without which, it will extremely difficult to overcome the pandemic.
CONCLUSION
For almost 2 years now, COVID-19 has been the talk of the town and has carried its roots all over the globe. The virus continues to emerge in the form of different variants with different characteristic symptoms and severity of infection. The initial outbreak of the disease wreaked havoc, taking countless lives because the situation was completely unexpected and there were no clear management strategies in place to control the situation. From affecting the health of the population to causing a global economic crisis, the pandemic has shown far-reaching consequences, affecting everyone from infants to adults, mentally, socially, and economically. However, we have come a long way since the first outbreak of the infection, with better control strategies and protocols in place now to prevent another deadly wave of the infection. Consistent efforts are being made to identify potential drugs against various drug targets in the SARS-CoV-2 virus, with a major focus now shifting towards phytochemical-based drugs. The fast-tracked approach towards developing vaccines has been successful, many of which have been approved for use and are widely being administered. Even after formulating strict protocols and guidelines regarding the management of COVID-19, directly, or indirectly, there are many risks posed to different groups in the population, and completely controlling the spread of the disease continues to remain a challenging task. Close surveillance, monitoring, and reinforcement of the guidelines are required to better manage and control the spread of the infection.