In Part 2 of the ‘Ask Paul Anything‘ session live-streamed on his Facebook page, Professor Paul Tambyah, who is currently the Chairman of the Singapore Democratic Party (SDP) as well as a doctor and professor of infectious diseases, answered further audience questions on COVID-19. This was a follow-up to Part 1 last week.
Broadly, audience’s concerns were mostly in relation to whether or not those with underlying conditions should take the vaccine, whether or not one could get infected despite taking the vaccine, and what are the side effects of the vaccine?
Prof Tambyah was keen to remind the audience that he could not provide personalised medical advice given that he does not know the medical history of the people who were asking the questions, and advised people to seek their own medical advice before deciding whether or not to take the vaccine.
He said this in response to a number of questions as to whether or not those with low blood platelets, those on blood thinners, and those who have high blood pressure, diabetes, or glaucoma should take the vaccine.
However, Prof Tambyah reassured the audience that the Government is very careful in how it handles the vaccination process and that it would not have given the vaccination if it did not consider the suitability of one’s health. He also reminded everyone to declare all of their medical concerns to the vaccination team so that they could accurately assess their suitability.
Concerns on side effects of the vaccines
In relation to questions on how long it took for side effects to show up post-vaccination, he said that most short-term reactions should surface within 15 to 30 minutes, which is why people are kept for 30 minutes post-vaccination so that the vaccination team could monitor them. That way, if a reaction is triggered, they can immediately be dealt with.
When asked about the dangers of anaphylactic shock, Prof Tambyah noted that as compared to the flu vaccine (1.5 per cent per million), the COVID-19 vaccine does have a higher rate. The Pfizer vaccine reports 5 per cent per million people, while the Moderna vaccine reports 2.5 per cent per million.
However, he pointed out that the reaction would be prompt with symptoms such as face and eye swelling, difficulty in breathing, and drop in blood pressure, which the vaccination team can immediately resolve with via an adrenaline shot. He also cautioned those who have a history of such symptoms to seek advice from their doctors.
As for allergic reactions to the second dose, Prof Tambyah said that if one did not develop severe allergic reactions to the first dose, they would be unlikely to develop severe allergic reactions to the second dose. If one got a severe allergic reaction to the first dose, then they would not be given the second dose, he added.
He did, however, mention that the minor side effects might be worse after the second dose. He used himself as an example. After the first jab, his arm was painful for three to four hours while after the second jab, it was painful for four to five hours.
Where longer-term side effects are concerned, Prof Tamyah argued that there isn’t enough data yet to form a conclusion given that COVID-19 is a very new disease, though he did highlight that the US Food and Drug Administration (FDA) requires at least two months worth of data before it approves the vaccination.
Questions on effects of smoking and mRNA vaccine
A question was raised as a follow-up to Prof Tambyah’s comments from the previous live session where he said that smoking within 30 minutes before a COVID-19 test could result in a false negative as the heat from the smoking would kill the virus on the areas where the swab was taken. The querent wanted to know if smoking could prevent COVID-19.
The professor was quick to state that smoking is bad for health and that smoking would not kill the coronavirus unless one smoked 24 hours, 7 days a week – which is not only impossible but would also cause a whole host of other health problems.
Someone also queried whether the mRNA vaccine could lead the body into becoming a single purpose army which only knows how to defend itself against COVID-19. Prof Tambyah assured that our bodies’ immune systems are multi-talented and are able to fight different infections.
However, he noted that the jab may not be given to people on heavy immune-suppressing drugs as their bodies would not be able to mount the defence required.
When asked whether there was an overlap between Tuberculosis and COVID-19, Prof Tambyah said that this was an area interest as there might be some overlap although more research would be needed.
Unfortunately, even post-vaccination, some can still be reinfected although this is very rare, he added. Some people have also got infected with COVID-19 more than once. Out of 100 million infections, only 100 were re-infected. He stated that the reasoning behind this is not known at the moment.
Questions on SNEC’s error and vaccination for older people
Unsurprisingly, a question was asked about the error at the Singapore National Eye Centre (SNEC) where a member of staff was given the equivalent of five doses of the vaccine. The querent wanted to know if it is indeed true that it is not harmful to get five doses.
In reply, Prof Tambyah pointed to phases 1 and 2 of the Pfizer clinical trials where both 30mgs and 50mgs were given. Those that ended up receiving 100mgs did not come to any harm which suggested that it was unlikely to be harmful. He also pointed out that unlike the chickenpox vaccine, there is no live virus in this vaccine, adding that the mRNA vaccine is just protein.
The professor was also queried on how useful the vaccination would be for older people given that older people do not appear to respond to vaccines as well as young people do. While he confirmed that this is a general rule of thumb, he assured that the vaccination still works for older people.
What’s more, to circumvent potential pitfalls, Prof Tambyah asserted that those with older people in their household should also be vaccinated so as to protect the older ones.
Moving on, he stated that if someone has had COVID-19 before, antibodies to the virus should last between three to six months. As for comparisons with SARs, he argued that SARs was easier to detect and isolate because the most infectious period of SARs was in the second week where the patient was already very ill. COVID-19, on the other hand, is much more sneaky because a person is infectious one day before they start displaying any symptoms.
In relation to vaccine choices, Singapore currently only has the Pfizer-BioNTech vaccine. Moderna is due to arrive in March, and there is no news yet on the Sinovac vaccine.
As for concerns that the mRNA virus could alter one’s DNA, Prof Tambyah assured that the mRNA is downstream, and for DNA to be affected, it has to go upstream. mRNA also degrades quickly and is only in the body for a short time which makes claims that DNA could be altered simply false. He also confirmed that the mRNA vaccine contains no animal products and no alcohol.
As for the transmission of the virus from asymptomatic people, he noted that asymptomatic people are less likely to transmit the virus given that they would not be coughing or sneezing. However, he stated that it can still be transmitted by people who are asymptomatic.
In relation to the cycle threshold, Prof Tambyah said that Singapore follows the World Health Organisation (WHO) in terms of reporting. If the cycle threshold is above 40, one is not considered infectious, and if the cycle threshold is below 30, one is considered infectious. The lower the cycle threshold, the higher the quantity of viral genetic material in the sample.
Concerns on Government’s decisions following the increasing number of imported cases in Singapore
As for questions on why Singapore is not shutting its borders despite the increasing imported cases, the professor straddled both the political and medical fronts. He asserted that the Singapore economy is one that is very dependent on workers from both the higher end (Employment Pass) and the lower scale (Work Permit).
On the higher end, it is to fill in gaps in our education system which really ought to be rectified while on the lower end, Singapore seems to be “addicted” to cheap foreign labour where there is no minimum wage.
This tied in with a question about whether there are vaccines being made in Singapore where Prof Tambyah said that people should not assume that the Government has all the answers and that Singapore needed creative people who have the freedom to come up with solutions that the Government does not have.