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.