Khalit Khayertynov: 'Vaccination is a kind of shield from COVID-19'

What variant of coronavirus mutation can become a disaster for humanity

Khalit Khayertynov: 'Vaccination is a kind of shield from COVID-19'
Photo: kazanfirst.ru

Some opponents of vaccination believe that it is better to get contacted. But this is a huge risk, says the infectious disease specialist. “We, medical workers, see patients every day who have COVID-19 in a medium-severe, severe form. They do not have enough oxygen, they are suffocating — this makes an impression. Apparently, this is what should be shown more often on TV. This is not happening somewhere on another planet, but among us. Those who have seen such patients will have a different attitude to the need for vaccination," says Khalit Khaertynov, chief visiting infectious disease specialist of the Ministry of Healthcare of Tatarstan, Doctor of Medical Sciences, Associate Professor of the Kazan State Medical University, in the interview with Realnoe Vremya. He spoke about what antibody titer is sufficient to protect against COVID-19, about the threats of new coronavirus mutations, about the lethality and “rejuvenation” of the main disease of today.

“New waves are associated with a mutated strain”

What is the current situation with vaccination in Russia?

Now in the Russian Federation, according to official data, about 25 percent of the population has been vaccinated. It's not much. There is still a significant part that has been infected. The purpose of vaccination is to create the notorious collective immunity. When it is formed, then the incidence is expected to decrease. For comparison, in many European countries, about 70 per cent are vaccinated, this is a good indicator.

There is one problem. Periodically, the virus mutates, which can contribute to the emergence of new waves of morbidity. For example, last autumn, the second wave was recorded, now it is the third. When there is an increase in the incidence and a new wave of the disease comes, as a rule, this is due to the appearance and spread of a new mutated strain. Either there are no antibodies to it, or the available antibodies are not enough to resist the virus. Therefore, it is very important to maintain the antibody titer at a high level.

Modern coronavirus vaccines are based on the classic Chinese Wuhan strain. Data were published that indicate: the antibodies produced after vaccination are about five times worse at neutralising the Indian delta strain than the Wuhan strain. This is not very good news. On the other hand, there is a good one — antibodies are still able to neutralise the modified virus. Given that the neutralisation of the Indian strain is happening, but worse than the Wuhan strain, there should be as many antibodies as possible.

Photo: mos.ru
Now in the Russian Federation, according to official data, about 25 per cent of the population has been vaccinated. It's not much. There is still a significant part that has been infected

“Antibody titer should be with a margin”

What antibody titer, in your opinion, is sufficient? Because now it is considered that there is no single indicator of the protective titer…

Such an indicator is not registered anywhere at the moment. I assume, taking into account the information that the Indian strain is neutralised by antibodies about five times worse than the Wuhan strain, then the titer should be with a margin — more than five times higher than the initial minimum level. In turn, the initial minimum level is determined by the specific reference values of the laboratory where the study is conducted. But this is my personal opinion: if you make mathematical calculations, you can build such an assumption.

The COVID-19 revaccination campaign has been launched in Russia for people vaccinated more than six months ago. How justified is the revaccination with such a low percentage of vaccinated people in Russia, also taking into account interruptions in the supply of vaccines?

I think this work should be carried out simultaneously. There are people who have been vaccinated, but their antibody titer decreases. According to the latest recommendations of the Ministry of Healthcare of Russia, revaccination against COVID-19 is desirable to be carried out six months after the completed vaccination.

“The third wave has exceeded the second one in terms of the number of deaths from COVID-19 a day”

Is the mortality rate from COVID-19 increasing with appearing of new strains?

Data from the Operational Headquarters for Combating COVID-19 in the Russian Federation have been published recently, which shows the dynamics of morbidity and mortality from coronavirus since the beginning of the pandemic. The third wave has not yet exceeded the second in terms of the number of cases. But in terms of the number of deaths a day, it already has. Recently, the data on mortality in Russia from COVID-19 per day has approached 800 — such has not been before.

In this regard, it is necessary to take active actions: there is a shield, and there is a sword. Relatively speaking, the sword is therapeutic action, but there should also be a shield to effectively fight the new coronavirus infection. And vaccination performs the role of this shield. It is necessary to take effective decisions, and it is desirable to do it very quickly.

Photo: Ilya Repin
Some opponents of vaccination believe that it is better to get contacted. But this is a huge risk! How do we know that a person who has fallen ill with coronavirus will recover and the disease gets a mild form?

What do you associate with the trend in mortality from COVID-19 in Russia? Is Delta harder to treat?

There is no data on the prevalence of the Indian strain in Tatarstan. Large-scale studies of which strain dominates here have not been conducted. The studies conducted in Moscow and St. Petersburg showed that about 89 per cent — it was exactly Delta.

With the appearance of this strain, the clinical picture has changed. The proportion of middle-aged and young patients, including those who need hospitalisation, has increased. Unfortunately, even young ones die. During the first and second waves, elderly people dominated among those infected.

Besides, with the appearance of the Indian strain, the period during which the patient's condition becomes heavier has been reduced. For example, a patient is hospitalised with a lung lesion volume of up to 25 per cent — this is CT 1 degree. Literally in three or four days, the volume of the lesion can increase up to 75 per cent — this is already CT 3 or even CT 4, and in a short period of time. This was not the case during the first and second waves.

Besides, the new strain is less responding to therapy. There are patients who do not respond well enough or even poorly to therapy. Of course, there are drugs for treatment — antiviral, anti-inflammatory, anticoagulants. But here we need to act ahead of the curve.

Some opponents of vaccination believe that it is better to get contacted. But this is a huge risk! How do we know that a person who has fallen ill with coronavirus will recover and the disease gets a mild form? It is very difficult to give such a guarantee. Given that people die from COVID-19, and those who have recovered may have long-term consequences in the form of the so-called post-covid syndrome, it is necessary to take decisive measures to stop the spread of infection. The history of the fight against infectious diseases shows that there is no more effective method of prevention than vaccination. We need to use this opportunity. Moreover, there are four vaccines in Russia, we were the first in the world to register the vaccine from COVID-19 — Sputnik V, but we are still far behind the same European countries in terms of vaccination rates...

Photo: mos.ru
Studies conducted in Moscow and St. Petersburg showed that about 89 per cent — it was exactly Delta

“There are quite a lot of cases of deaths of pregnant women from Covid-19"

You have already said that now young people and middle-aged citizens get infected more often and more seriously. Do you see a trend in Tatarstan that children and adolescents are getting infected more often and suffer the disease more severely?

Children for the most part cope easily, although severe forms of the disease are also possible. Compared with children, the incidence rates, the need for hospitalisation and mortality are higher in older people, especially in the elderly. This can be influenced by various factors. One of them is concomitant diseases. Obesity, chronic diseases of the cardiovascular system, diabetes mellitus — all these are risk factors for the development of a severe form of coronavirus. Of course, this does not mean that every overweight person will have a difficult course of the disease. But the risk of developing severe forms in them is much higher than without these factors.

Last week, I was shocked by the regular report of the republican operational headquarters on the people of Tatarstan who died from COVID-19. There was a woman born in 1994. Was she pregnant?

Yes, unfortunately. Currently, pregnancy is considered as a risk factor for the development of severe forms of Covid-19. The third trimester is particularly dangerous. With Covid-19, it is very important to make a diagnosis in time and start treatment in a timely manner. Anti-cytokine drugs, which are one of the most important drugs in the fight against COVID-19, previously could not be used during pregnancy, but they are allowed in the new recommendations for the treatment of Covid-19 in pregnant women, because they have shown their safety and effectiveness. This can save the life of the expectant mother.

“Vaccination is carried out not with the desire to harm”

How much does the effectiveness of the vaccine decrease agaisnt the new strains?

If we take the data of the developers of Sputnik V, then initially the effectiveness of the vaccine is about 92 per cent. In relation to the Indian strain, the effectiveness is already lower — up to 85-88 per cent.

In Tatarstan, we have taken the path of mandatory selective vaccination at enterprises. What other ways can be used to encourage people to get vaccinated?

A whole range of measures should be implemented here. On the one hand, it is important to inform the population about COVID-19. Although there is a lot of talk about this and it is shown on television, apparently not everyone watches these stories. Maybe there are also elements of distrust of what is being said.

We, medical workers, see patients every day who have COVID-19 in a medium-severe, severe form. They lack oxygen, they suffocate, they are connected to artificial respiration machines. Believe me, it makes an impression. Apparently, this is what should be shown more often on TV. This is not happening somewhere on another planet, but among us. These patients do not walk the streets, but concentrate in medical institutions. These patients are seen only by medical workers or close relatives until the moment of hospitalisation. Those who have seen them will have a different attitude to preventive measures and the need for vaccination.

Vaccination is carried out not with the desire to harm, but to stop the further spread of infection, so that our citizens do not die. There are actually only two possible options: either a person will get infected with COVID-19 sooner or later, and the prognosis is unknown here, because people of all ages die, or it is necessary to get vaccinated. There is no other way.

Photo: mos.ru
Vaccination is carried out not with the desire to harm, but to stop the further spread of infection, so that our citizens do not die

“If coronavirus becomes more contagious, it will be a disaster”

What else are new coronavirus mutations dangerous for?

New mutations can radically change the clinical picture of the course of the disease. The World Health Organisation has divided mutations into three main groups. There are mutations that do not pose any danger. The second group includes mutations that cause concern, anxiety. Mutations of this group can affect the epidemiology — viruses can become more contagious. This group includes the British, Indian, Brazilian and South African strains. And the third group of mutations, the most dangerous, which, fortunately, has not yet appeared in the situation with the coronavirus, includes variants that will have the most serious consequences in terms of influencing clinical manifestations, contagion and mortality. There is no such variant yet, but its appearance is quite possible.

In this case, it can become even more contagious, and then one patient with the coronavirus can infect a huge number of people. If the coronavirus acquires such a property, it will be just a disaster. A huge number of people can get sick massively and simultaneously, the proportion of severe forms of the disease will increase. Then it will be a huge burden on the healthcare system.

Already now, not only infectious diseases but also multidisciplinary hospitals are involved in providing assistance to coronavirus patients. If the contagion increases, it will require even more medical resources. Mortality may also increase. In fact, the coronavirus progresses as a particularly dangerous infection. If we talk about known diseases with high mortality, these are hemorrhagic fevers — for example, Ebola, in which the mortality rate reaches 70-80 per cent.

Theoretically, if coronavirus mutations occur, which are classified as variants with consequences according to the WHO classification, the mortality rate from COVID-19 can also increase dramatically. But, fortunately, there are no such respiratory viral infections yet, in which there would be such a high mortality rate as in hemorrhagic fevers. Here I have only built a theoretical model of what we can face when dangerous new mutations occur. To avoid such a scenario, collective immunity is needed.

Photo: Maksim Platonov
There should be a counter-movement: on the one hand — the active work of medical workers, on the other — the understanding and support from people. The understanding that without vaccination, it is impossible to defeat any epidemic associated with an infectious disease

“It is quite possible to achieve the figure of 90 per cent of vaccinated people”

At a recent briefing, deputy head of the ministry of healthcare of the Republic of Tatarstan Vladimir Zhavoronkov said that 27 per cent of the adult population has been vaccinated in Tatarstan. But at the same time, it is worth moving away from the goal of achieving collective immunity in 60 per cent of people with antibodies, and to focus on 80 and even 90 per cent…

These were the initial estimates — 60-70 per cent. It was assumed that if the collective immunity of such number of patients is formed, it will significantly affect the epidemiological process. On the other hand, the experience of fighting infectious diseases shows that in order not to increase the incidence or worsen the situation, it is important to maintain the immune layer of the population, the same collective immunity, at the level of 90-95 per cent. Of course, it is impossible to vaccinate absolutely everyone. Some people have absolute contraindications to vaccination. But it is possible to achieve the figure of 90 per cent — with the desire, will, and joint work of medical workers and the population. This is necessary not only for the ministry of healthcare and doctors, but also for the entire population. There should be a counter-movement: on the one hand — the active work of medical workers, on the other — the understanding and support from people. The understanding that without vaccination, it is impossible to defeat any epidemic associated with an infectious disease.

“Sputnik V produces antibodies very well”

Many people doubt the need for vaccination, explaining this by that the vaccination will not protect 100 per cent from infection and even, according to some reports, from the severe course of the disease... Why then get vaccinated if it does not give guarantees?

I am a supporter of the fact that vaccination is a good thing. There is not a single 100 percent effective vaccine in the world. There are always people who, due to the individual characteristics of the immune system, will not develop an effective immune response. Even if live vaccines are used, the effectiveness is about 95 per cent. For inactive vaccines, which, for example, include CoviVac, the effectiveness will always be slightly lower, about 85 per cent. But it's still a lot. The purpose of vaccination is to reduce the spread of infection, reduce morbidity and mortality. If a vaccinated person becomes ill, the infection should occur in a lighter, not severe form. Vaccinated people should not die.

You've mentioned both Sputnik and CoviVac during the conversation, but you are not telling about EpiVacCorona. Is your attitude to this vaccine as ambiguous as that of many specialists?

As an employee of the Medical University, I work on the basis of the Republican Clinical Infectious Diseases Hospital, this is one of the centres of immunoprophylaxis in Kazan. We carry out vaccination with Sputnik, Sputnik Light, and CoviVac. And we did not have EpiVacCorona, and I am not talking about this vaccine not because I treat it well or poorly, but because I have no experience of using it.

I can say for sure that Sputnik V produces antibodies very well. This is one of the most effective vaccines — of the same order as the Western-made mRNA vaccines. By the way, Sputnik is well tolerated. Many of my friends and colleagues have been vaccinated. Some had minor reactions in the form of fever, general malaise, but not for long. All this suggests that the vaccine is generally well tolerated.

Photo: mos.ru
At the beginning of the pandemic, around February-March last year, we assumed that since this is mainly an airborne infection, everything will be over by the beginning of summer. But nothing of the kind happened

“Coronavirus has destroyed many stereotypes”

COVID-19 is unpredictable. Earlier, it was predicted that there would be a decline in the summer, and a new wave would begin in the autumn. However, the third wave occurred in the summer. What are your forecasts about the future situation at such rates of vaccination? After all, in the autumn, everyone will come back from vacation, go to schools, universities…

You are quite right to note that the coronavirus has destroyed many stereotypes. At the beginning of the pandemic, around February-March last year, we assumed that since this is mainly an airborne infection, everything will be over by the beginning of summer. But nothing of the kind happened. The maximum increase in the incidence was in May-June.

The second wave proceeded according to the scenario of airborne infections — in the autumn, in the cold season. But the third wave came again in the summer, and the hottest months are June-July.

I believe that any new wave is associated with the appearance of a new mutant strain. If there is no new serious mutation, there may be no fourth wave. But if a new serious mutation occurs again, then we may face the fourth wave. Now the world has changed. Initially, COVID-19 was compared to the Spanish flu, which also had three waves. But then there was no such active population movement. If a new strain appears in some other country with which we have air traffic, then there will be a risk of importing it to our country. We live in a world where everything depends not only on our actions.

In general, it is better if the whole world gets vaccinated…

This, of course, would be the optimal scenario for the development of events. But we must first do what is necessary in our country and only then talk about others. You should always start with yourself.

Kristina Ivanova
Tatarstan