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At The Forefront: Praveen Buddiga, MD “Helping America and the world end the COVID-19 Pandemic” — An Immunologist’s Perspective

By Praveen Buddiga, MD, FAAAAI | Article Originally Posted on Medium

How It Began

In December 2019, an international flight coming from abroad to the United States carried passenger, R1who exhibited early signs of a flu-like illness, feeling tired, jet-lagged with a cough and mild body chills. R1 (a male) on arrival proceeded through customs, immigration, and baggage claim, all while coughing occasionally. Arriving home a few hours later, R1 believed he had developed a bad sinus infection or respiratory infection during the long flight. Pleased to be back home, he kissed his wife, hugged his kids, and then decided to rest.

Little diR1 know that he carried the COVID-19 virus along with many others through various ports of entry and from various countries to which it had spread silently. The result was exposure to 335 million people living in United States to an unforgiving, air vector transmissible and actively mutating contagion with no known cure and only seen in science fiction movies.

Within one week, the first cluster of the virus-related deaths of R1’s family were reported to the Centers for Disease Control, (CDC) in Atlanta, Georgia. By that time, it was too late to stop the infections, the virus had spread rapidly and aggressively across both the eastern seaboard and western United States, moving clandestinely into small town America. The nightmare that followed, resulted in a deadly pandemic with a total mortality rate higher than the Spanish flu of 1918, at more than 775,000 deaths in less than 2 years.

Where We Are Today

Moving forward to December 1, 2021, the CDC, and the United States Food & Drug Administration (FDA) has approved vaccines for all age groups 5 years and above as well as booster vaccines for those greater than 18 years of age. In the United States to date, 60% of the adult population have already received the two dose vaccine series to immunize against this illness and 75% have received at least one dose of the vaccine.

This pandemic has touched every fiber in the fabric of American Society as well as the entire world. Fear, ambiguity, and unchartered waters at a global scale led to inconsistent leadership decisions, and rocked the world’s economy, even as many heads of states (Presidents, Prime Ministers, dictators, and other societal leaders) suffered or died from COVID-19.

Every human is susceptible to the virus as well as being a transmissible carrier, whether it is the most advanced nation in the world or the poorest developing nation. The COVID-19 virus and its variants are ubiquitous and do not discriminate between geographic borders — They propagate and reproduce using human machinery even at the expense of the life of the host. After the immunization battle with the Delta variant of COVID-19 and its huge death toll now we have a new emerging variant known as Omicron (B.1.1.529), that is known to have more transmissibility by having more regions of spike attachment and changes in its protein structure to evade the blocking antibodies of the Pfizer, Moderna and Johnson & Johnson/Janssen vaccines.

Its goal is to achieve infinite copies of itself — marching humankind towards viral Armageddon unless most of the worldwide human population receives immunizations in a timely manner to vanquish this cloaked contagion.

The Importance of Vaccination

With the application of scientific ingenuity, the design, testing and manufacture of life-saving vaccines were accomplished in record amount of time by Operation Warp Speed COVID-19 Rapid Response Team [which included the Biomedical Advanced Research and Development Authority (BARDA), the National Institutes of Health (NIH), the Covid-19 Prevention Trials Network, and the Department of Defense (DOD)]. Within nine months, between March and November 2020, three effective vaccines against COVID-19 were developed. What normally required decades to achieve, took only weeks. Distribution being the most difficult part of the equation due to geo-political instability across the globe, cost-bearing challenges, and a broad acceptability of the vaccines, significantly hindered putting this pandemic behind us.

Being a board-certified Immunologist, scientist and physician caring for thousands of lives and personally delivering shots into thousands of arms, I plead to the citizens of the world to get yourself and your family vaccinated.

What are the types of Vaccines? Overview

The following are the approved vaccines in the United States against COVID-19.

1- mRNA vector Vaccines — Pfizer, Moderna

These are a new subtype of vaccines that have been deemed safe and use messenger RNA (mRNA) as a vector given by intramuscular injection of a protein encoded message that allows a native human immune cell to manufacture antibodies against the SARS2-CoV coronavirus spike glycoprotein. These antibodies block the attachment of the virus to the human cell and prevent infection in addition to providing the immune system time to eradicate the virus. The two approved mRNA vaccines are

a- Pfizer — BioNTech (BNT162b2)

b- Moderna (mRNA-1273)

2- Adenovirus vector Vaccine — Johnson & Johnson / Janssen (Ad26.COV2. S)

A single intramuscular dose of Ad26.COV2. S protected against symptomatic COVID-19 and asymptomatic SARS-CoV-2 infection and was effective against severe–critical disease, including hospitalization and death.

Are the pediatric vaccines and dosages safe for children?

Rigorous clinical trials performed in the 5–11 years and 12–15 years age groups showed significant effectiveness of the Pfizer vaccine. Dosages were less than those of >16 years of age and were deemed by the FDA & CDC to have an acceptable safety profile.

How do we get vaccinated? Where?

We can get vaccinated through our doctors’ offices. In addition, all the major pharmacy chains are offering the vaccine as well as community drives and State Public health agencies. There is no waiting period, and all residents are eligible to receive the vaccine except those < 5 years of age.

Should we get a booster?

Yes, those who received their last vaccine six to eight months ago should receive a booster dose. This is confirmed by an Israeli study showing that protective antibody levels start to wane after approximately six to eight months. Additionally, having a booster dose may help decrease the immune pressure towards new variant development of COVID-19 that may arise over time.

(Links to Institutions, websites, phone numbers)

CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html

NIH: https://www.covid19treatmentguidelines.nih.gov/

FDA: https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19

John Hopkins University COVID19 tracker

https://coronavirus.jhu.edu/map.html

Vaccine information:

COVID-19 Vaccination Clinical and Professional Resources | CDC

1- Pfizer- BioNTech

Website: www.cvdvaccine.com

Medical information: 800–438–1985

Customer service: 800–879–3477

http://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/index.html

2- Moderna

Website: www.modernatx.com

Medical Information: 866–663–3762

http://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/index.html

3- Johnson & Johnson / Janssen

Website: www.vaxcheck.jnj

Medical information: 800–565–4008

Q: Once infected with COVID, will the illness effects continue to return for remainder of your lifespan?

The long term illness effects are determined on a case-by-case basis and depend on the organ system. To be honest, there are many unknown variables in this area of future lifespan after-effects. Important criteria are the degree to which the virus caused an inflammatory change within the system involved such as the respiratory system (lungs) versus the heart muscle of the circulatory system. Genuinely concerning are the new variants that are emerging in distinct parts of the world based on mutation pressure and lack of vaccination making it a perfect storm for viral disease progression and causing syndromes such as MIS-C — Multisystem Inflammatory Syndrome in children. MIS-C is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. More clinical studies are currently underway to answer this question regarding long term COVID-19 effects based on organ system, age/gender of the person and other data signals, as well as the best treatment approach for these individuals.

Figure 1

Description: 3D print of a spike protein of SARS-CoV-2 — also known as 2019-nCoV, the virus that causes COVID-19 — in front of a 3D print of a SARS-CoV-2 virus particle. The spike protein (foreground) enables the virus to enter and infect human cells. On the virus model in the background, the virus surface (blue) is covered with spike proteins (red) that enable the virus to enter and infect human cells. Source: NIH.gov

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