By Dr Sheri Fanaroff  MBBCh FCFP MFamMed, a Family Physician, practicing in Melrose, Johannesburg. Fanaroff is a member of GGPC (Gauteng General Practitioners Collaboration) which has created a platform for doctors to share resources during Covid-19. Look for  #voicesthatcare on the GGPC Facebook page.

Doctors in South Africa are thrilled that some of our “mature” patients have managed to get their first dose of vaccines this week. We feel the frustration of all those high risk patients who are still anxiously awaiting an sms. Please try to be patient – as long as you are registered on the electronic database and are over 60, your turn should come quite soon.

If you hear of sites with spare doses at the end of the day and haven’t yet received an sms, we encourage you to go if you are prepared to take a chance.

1. How do I register for a Vaccine?

There are now 5 ways ways to register on EVDS:

  1. Click here to register online
  2. Use the whatsapp line 0600 123456
  3. SMS – dial *134*832#
  4. Call the COVID-19 hotline 0800 029 999
  5. Use the new QR- simply scan and follow the prompts. (The QR code will be published widely and can be found on sacoronavirus website or the National Department of Health Website).

Some Medical Aids have their own registration – you should ALSO register on this system.

2.  I registered ages ago but never received an SMS- What should I do?

You should have received confirmation of initial registration (via sms) within 3  days of registering
If you received this, you need to wait for an sms for an appointment.
If you never received a confirmation sms, click here and fill in your ID number and details again.

3. When can I expect an SMS with my appointment details

  • Most people who have received sms appointments have been notified late at night about an appointment the next day.
  •  Keep checking your SMS’s and try to be flexible so that you don’t miss your turn.
  • It seems to be quite random who has received an appointment so far. Some over 90s have not yet received one, and some healthy 60 year olds have.
  • Unfortunately we have no control over this – we just have to wait and see.

4. Where will I get the vaccine?

At the moment there are only a few private and some government sites operational, with many more to follow in the coming weeks. Your appointment should be scheduled for a site close to your home.

People who live in retirement homes should be able to receive their vaccines at the retirement home, which means they can avoid standing in a queue. Please check that you have been registered on your retirement home database.. Some have already started with vaccinations.

Over 60s should receive an appointment on EVDS with a date, time and location.

Click here for a full list of vaccination sites.

If you are going to take your chances and queue as a walk-in, remember to wear a mask (or double mask), take your own pen, sanitise and social distance as much as possible.

5. I’m not yet 60 but have co-morbidities.  How can I register?

  • Unfortunately, even those younger patients with significant co-morbidities are not yet able to register on EVDS.
  • The system only accepts registration if you are either over 60 or a healthcare worker.
  • Based on data that older patients are generally more vulnerable to severe Covid disease and death, and that many people in this age group also have multiple co-morbidities, the Department of Health made a decision to start with this older age group.

6. What should I take with me when I go? 

  • Your ID document or passport that you registered with
  • Your phone with your sms message of appointment and/or your vaccine code
  • Your medical aid card
  • A good mask covering your nose and mouth
  • Sanitiser for your hands
  • A pen
  • Patience (be prepared to wait and don’t forget to wait for a 15 minute observation period after.

7.  Should I take any medication before or after my vaccine? 

We recommend that you take two Panados just before or just after the vaccine, and two Panados eight hourly for 24 hours after. Should you experience any side effects that are not controlled by Panado, please contact your doctor for further advice.

vaccine preparation

Photo by Prasesh Shiwakoti (Lomash) on Unsplash

 

8. What side effects should I expect?

Common side effects from both the J & J and Pfizer vaccines include pain, redness and swelling at the injection site, tiredness, headache, muscle pain, chills, fever and nausea.

These side effects usually start within a day or two of getting the vaccine. Side effects might affect your ability to do daily activities, but they should go away in a few days.

Side effects are reportedly worse after the SECOND dose of Pfizer vaccine.

Anaphylaxis (allergic reactions) and fainting are rare side effects that may occur immediately after the vaccine. For this reason it’s important to be observed for 15 minutes after receiving the vaccine, so that you can be treated.

9. What if I had my flu vaccine and get an appointment for Covid Vaccine? What if I can’t make my appointment.

It is recommended that there should be a minimum of two weeks between Covid vaccines and any other vaccines. If you had a flu vaccine, or pneumovax or Prevenar within the last two weeks, you will need to reschedule your appointment.

The Health Minister stated that “If you miss your vaccine appointment for any reason, you will be rescheduled, that is given another date and time to be vaccinated. If you miss three appointments, you will not be rescheduled again. However, you will still be on the system, and can ask to be scheduled again by phoning the COVID-19 hotline or visiting a registration site.

10. How long after I’ve been vaccinated will I be immune ?

The J & J vaccine is considered to be effective TWO WEEKS after administration.

The Pfizer vaccine is considered to be effective only TWO WEEKS after the SECOND DOSE. It is critical that the second Pfizer dose is not missed. In the immediate couple of weeks after the first vaccine dose, there is very little immunity.

Remember that the vaccines are not 100% effective – you can still get Covid after being fully vaccinated and you may still be able to transmit it.

It is important to remain careful and to continue following Covid protocols, especially as the cases in South Africa, and particularly in Gauteng are rapidly escalating.

11. Will I have any immunity after my first dose of Pfizer?

In the immediate couple of weeks after the first vaccine dose, there is very little immunity. You need to be particularly cautious during this time.

From about two weeks after the first dose, some immunity starts to develop.

A recent study showed that a single dose of Pfizer was 80% effective at preventing hospital admission with COVID-19 and a single dose was 85% effective at preventing death. It is unknown how long this immunity lasts though.

It is crucial to get the second dose of Pfizer in order to develop a robust immunity that will persist.

12. Should I have an antibody test to check if my vaccine has worked?

It is not recommended to have an antibody test to see if you have developed immunity from the vaccine.

There are a number of reasons for this, including that:

  • the lab tests available do not test for the neutralising antibodies that the vaccine induced,
  • antibodies may take up to 30 days to develop,
  • and the tests do not detect T-cell immunity which is an important part of the immune response.

Thus, should one test negative for antibodies after having a vaccine, it does not mean that you have no immunity, and certainly does not mean you should repeat the vaccine.

13. How effective is the Johnson and Johnson Vaccine?

From the reported studies, two weeks after vaccination:

66.3% protective against moderate to severe Covid infections overall from 28 days after injection (with variability based on geographic locations). NB **This is longer than the 2 week period suggested by CDC.

72% protective in the United States, 66% protective in South America, and 57% protective in South Africa.

85.4% protective against severe disease, (with no differences across the eight countries or three regions in the study, nor across age groups among trial participants).

NO hospitalizations or deaths in the vaccine arm of the trial after the 28-day period in which immunity developed.

100% effective against severe disease after day 49 in clinical trials (We await real world data from the Sisonke trial, as there have been a few healthcare workers hospitalised after being vaccinated).

14. How effective is the Pfizer vaccine? 

  • From the reported studies, once fully vaccinated (2 weeks after second dose):
  •  efficacy of 95% at preventing symptomatic Covid infection.
  • 72 to 75% efficacy against preventing infection from SA variant (study from Qatar)
  • 90% protection from severe disease in clinical trials (97% from real world data)
  • 100% protection from hospitalisation from clinical trials (94% from US real world data)
  • 100% protection from death in clinical trials (97% from Israel and Qatar real world data).

15. What should the timing be between the first and second doses of Pfizer?

Originally, the time between the first and second doses was set at 21 days (3 weeks). Most people who were vaccinated this past week have received a return date in 21 days time.

However, the Health Minister announced last week that the interval between doses will be extended to 42 days (6 weeks). This is based on a new study from the U.K. that showed an increased antibody response (by 3 and a 1/2 times) in older patients who delayed the second dose. Based on this, the UK has extended their dosing interval to 8 weeks and India to 12 weeks.

It is very reasonable in South Africa to extend the dosing interval from 21 to 42 days – this will firstly induce a better immune response and secondly allow time for more people to receive their first dose of vaccine.

I suspect that even if your return date has been given for 21 days, EVDS system will only schedule your appointment for 42 days – we await further clarity on this.

16.  How long will my immunity last? 

Both Pfizer and J and J vaccines have demonstrated good immune responses lasting 6 to 8 months after vaccine; however it is still early and it’s possible immunity lasts much longer.

This will continue to be monitored and tested.

17. Will I need a booster dose?

This is still unknown, but is likely, especially as new variants develop.

Current trials are looking at boosting with a different type of vaccine to the original one that was received, eg. boosting with an mRNA vaccine such as Pfizer, twelve months after receiving J & J.

There are also trials looking at giving a second dose of J & J vaccine, instead of just one.

18. Can I stop wearing my mask and hug my grandchildren after I’ve been vaccinated?

In private settings:

CDC advises that indoor visits between fully vaccinated people even when no masks are worn and physical distancing is not maintained are likely to be low risk.

Unvaccinated people can visit with fully vaccinated people indoors, but should still be cautious. So vaccinated grandparents CAN hug unvaccinated grandchildren who are well and have not had Covid contacts. 

If any of the unvaccinated people or their household members are at increased risk of severe COVID-19, all attendees should take precautions.

If unvaccinated people come from multiple households, there is a higher risk of SARS-CoV-2 transmission among them. Therefore, all people involved should take precautions.

In public  settings

Bear in mind that while most South Africans are still not vaccinated, we still advise extreme caution in public settings.

It is still advisable to:

  • avoid large gatherings,
  • wear a mask in public
  • and maintain social distance.

This is particularly important as we enter our third wave in Winter with most of the country unvaccinated.

Click here to find the CDC guidelines for fully vaccinated people.
(NB : This is only valid two weeks after your last vaccine).

19.  If I’m vaccinated and have been in contact with someone who has Covid do I still need to quarantine?

Yes – the same rules still apply – 10 days of quarantine are still required for close contacts of positive patients, even if they have been vaccinated.

Vaccinated people may still be able to transmit infections.

20. If I have Covid symptoms but have been vaccinated, do I still need to be tested and isolate?

😊Yes – the same guidelines apply – if you have a fever, cough or other common Covid symptoms, discuss with your doctor whether you should get tested. It is still possible to get Covid infection following a vaccine (although it should be mild).

As we approach herd immunity, it is likely that the guidelines in 19 and 20 will become more relaxed.

vaccine message

Conclusions

EVDS is only open for registration for over 60 year olds and healthcare workers. If you are registering and don’t fit this category, you are literally taking away a vaccine from someone who needs it more than you do.

Many patients over 60 and many, many over 40s with co-morbidities, who need to be at the front of the queue cannot get appointment slots because younger people are somehow managing to register. Many healthcare workers have also still not managed to get appointments.

While we have absolutely no problem with younger people who are at risk or feel vulnerable accessing vaccines at the end of the day when there are spare, it is much more important for the elderly and vulnerable to get vaccinated first as they are much more at risk for severe infection. PLEASE wait your turn!!!I

It is exciting and a relief to see so many people starting to be vaccinated. However, until a much greater portion of the country (and particularly the vulnerable elderly population) are protected, while the numbers continue to climb, it is important to continue following the COVID-19 protocols

 

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