What Are COVID-19 Breakthrough Infections? How Long Does Immunity Last After COVID-19 Vaccination? An Expert Explains

New Delhi: While COVID-19 vaccines are considered as a critical tool to contain the COVID-19 pandemic, according to the top Health Ministry sources, over 87,000 people across the country have been reported Covid positive after the second dose of vaccination, while 46 per cent of those cases are from Kerala.

World Health Organisation states if a person, who has received both the doses of COVID-19 vaccine gets infected with the COVID infection then that is known as a breakthrough infection. There are cases of people getting Covid infection days after getting fully vaccinated are being reported from across the globe. NDTV’s Banega Swasth India team speaks with Dr Rahul Pandit, Director Critical Care, Fortis Hospitals, Mumbai to know all about breakthrough infections and how can one protect themselves from catching COVID after vaccination?

Also Read: Mumbai Gets Ready For The Third Wave Of Coronavirus, Inaugurates COVID Care Center For Children

Question: What are breakthrough infections?

Dr Rahul Pandit: When we look at the word breakthrough it means that there was something that was stopping the infection from happening, that stopping is caused by the antibodies present in the patient’s body. Now, where does these antibodies come from, these come when we vaccinate a person. So, once you have completed the schedule of the vaccine and 15 days have gone beyond that then you have essentially got the complete immune status. But still when the person gets infected with COVID-19 infection then that is called a breakthrough infection.

Question: Why getting COVID-19 vaccine is still very important and how does it really protects the individual?

Dr Rahul Pandit: Vaccinations are still very important, the main purpose of vaccines and I would rather call it the most important one is to prevent deaths. You look at any vaccination programme in the world, even the one, which was started in the beginning of 19th century, the main motto was to prevent deaths in the individuals and the second purpose was to see the decrease in the infection. Lastly, the third purpose is to see if vaccines can eradicate the disease and that one can only see if they have immunised every individual, example of this we have seen while dealing with diseases like smallpox and polio.

In terms of COVID-19, there are six of the vaccines currently approved in India and all provide very good protection from deaths and severity of the infection. That means, majority of the individuals who are vaccinated will stay safe, smaller percentage of that population might get infected with COVID again, but that will be a very mild infection, one will not need hospitalisation or oxygen support.

Also Read: Please Send Your Child To School, Families And School Staff Should Be Vaccinated: Dr NK Arora, Expert Panel Chief

Question: In India, why are we seeing more and more COVID vaccinated people catching infection? Is it happening at a very high rate, should we be worried?

Dr Rahul Pandit: One thing that needs to be clarified is that fortunately the number of people who are fully vaccinated and who are catching the virus is not very high. The overall percentage of people who are catching the virus even after getting fully vaccinated is much much smaller.

The good thing is that when you compare the two groups – individuals who are catching the virus after taking both the doses of COVID vaccination versus individuals catching the virus without their vaccination, you see that the group which was vaccinated are not requiring any oxygen support or hospital beds, in majority of the cases. The live example of this is the United Kingdom, you see there are some 25,000 to 40,000 cases coming on a daily basis there but not once we have heard that their hospitals are full or stretched. Most of the people are being cared at home, simply like we treat influenza or flu patients.

Question: Does COVID-19 virus affect women’s menstrual cycle?

Dr Rahul Pandit: COVID-19 is one virus, which is known to affect every part of the body and one of the system is the hormonal regulation. So, COVID does have an effect on women’s menstrual cycle, but what we have realised is that most of this hormonal imbalance does settle down with time. It may take patients upto 3 to 6 months for their hormonal cycle to settle down. Incase it doesn’t happen, then the patient should visit their gynaecologist.

Also Read: First Covid Vaccine For Children Above 12 Approved In India, All You Need To Know

Question: Will third wave in India have a major impact on children? Should children be sent to school, if adults or their parents are fully vaccinated?

Dr Rahul Pandit: There are increasing evidence now that children have got some antibodies in them. There are reports that states that 50 to 80 per cent of children have got some form of antibodies, so this is little reassuring that maybe if they get infected it will be a mild infection and not a severe one. Secondly, why we shouldn’t be worried much is the fact that we know children below 12 years of age have higher immunity in them because of thymus gland. So, I think absolute number of children getting infected in the third wave may be higher than the second wave but we are not looking at the scenarios where hospitals are badly stretched like last time.

On the school front, I think, once we have adults – not just their parents, but their teachers and every staff in the school vaccinated, we can open the schools. The thumb rule should be on following COVID-19 protocols and vaccination. I think, school is very important part for both physical and mental development of the child. It is good not just for education but for their overall development. So, it is highly important that they should start their school as soon as possible, but having said that, we all need to make sure that the environment there is safe and healthy.

Question: When can we anticipate the arrival of third wave in India? What stage are we at, currently?

Dr Rahul Pandit: If you look at COVID-19 waves, there is a pattern and that is of a 100 days cycle where we see cases going up and then going down and then you have a 100 days of null period, wherein we continue to see a huge dip in coronavirus cases. Right now, majority of the country is in that null cycle, where the cases have come down drastically. The aim for us should be to try and push this gap to 200 or 300 days gap. How can we do so – if we follow the COVID appropriate behaviour, which is masking, sanitisation and maintaining social distance. If we follow these three thumb rules along with vaccination, we will be able to get a larger buffer time, wherein we can vaccinate more and more people. If we get 70 to 80 per cent of our population vaccinated in 100 to 120 days, then even if the future waves come, the effect of it will be so blunt that we will not feel the pain, it will not disturb our day to day life.

Currently, the rate at which we are vaccinating and the rate at which people’s COVID appropriate behaviour is going down, we are not helping in increasing the gap further, which is a cause of concern. So, the third wave will hit us if the COVID appropriate behaviour comes down and the rate of vaccination doesn’t increase. It can be in September or October, nobody knows that prediction. The basic rule is that we need to push it further as much as possible.

Also Read: Experts On WHO Team Say Search For COVID Origins Has Stalled

Question: How much protection do we get from COVID-19 vaccines? How common are breakthrough infections?

Dr Rahul Pandit: There was a study done by Christian Medical College Vellore, it was done on 24,000 healthcare workers, who were double vaccinated. In that study, when breakthrough infections were studied, it was found that a very small percentage of those healthcare workers got infected with COVID-19 again, there was just one mortality that was reported and maximum individuals there did not require any hospitalisation or ICU or oxygen support, proving that vaccines are very safe and effective. Why do I say so – healthcare workers are one who are most prone to catch the virus as they see and deal with the virus on a day to day basis. Now, if the breakthrough infections are happening less in them then it only means that our vaccines are effective.

Question: Should we look at getting booster shots? What should be the priority?

Dr Rahul Pandit: We know people who have taken two doses or are fully vaccinated, in them the immunity stays strong till 6 to 8 months. Currently, I think, people who are immunocompromised or have some or other immunocompromised disease, in them, maybe the antibodies response doesn’t last for long, so may be they will need a booster shot in sometime.
Another group which we should be looking at is frontline workers – healthcare staff, sanitation workers, policemen, warriors, NGOs, to name a few, because they come in direct contact with the virus on a daily basis. But till the time one dose of vaccination is given to the entire population, till then we cannot take the decision of giving the third dose.

Currently, the number one protection for people against the virus is masking, sanitisation, social distancing followed by vaccination. Till everyone is vaccinated, these three things cannot be avoided.

Question: Your take on intranasal vaccines and the newer vaccines for children?

Dr Rahul Pandit: I think, intranasal vaccines will be the game changer because right now one of the hindrance is that COVID-19 is a needle based vaccine. So, we require trained people for administering it, it also require monitoring time. But, if we have nasal drops, then all this will be cut, I think, it will just help speed up the process of vaccination.

Secondly, the new vaccine – Zydus Cadila that have come out, which is actually a three dose vaccine is absolutely safe. It is studied in 28,000 volunteers and in that it had 1,000 plus children and it was found that the vaccine provides excellent immunity against the disease. It has got very good safety profile. In sometime, we will also get Covaxin being approved for children, currently, the data is being studied, trials are being held.

Question: Is the second dose more important in the fight against coronavirus?

Dr Rahul Pandit: We have seen that with one dose of COVID-19 vaccine, one gets only 30 to 40 per cent of protection, which is not enough to fight the virus. With the second dose one gets 75 per cent of protection. So, my suggestion to everyone will be they should be getting vaccinated as soon as possible and should get vaccinated in their designated schedule.

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.