Dr Arun Gaur,medical superintendent of Mahatma Gandhi Hospital in Bhilwara, one of the first Covid hotspots in India, recounts the vaccination launch and the battle against the pandemic
For the vaccination on the launch day, January 16 that is, I personally invited the frontline staff enrolled for the serum shot. We had enrolled 900 persons from our hospital which not only included doctors but also nursing staff, lab technicians, computer operators, sweepers, guards and the canteen staff – in equal numbers. We included all these persons in the first list as this team has been working tirelessly since the pandemic outbreak in March, 2020.
I am proud to say that we successfully vaccinated 100 persons on the first day. There had been some apprehensions, even among frontline workers, regarding the vaccine and its after-effects. So, each person was kept under observation for half an hour after being vaccinated. I am glad that none of them showed any side effects.
So, after the process was over, we organised a guard of honour by the police band for the first batch. We also issued an appreciation certificate to all of them. The district administration also supported us in managing this. The district collector and SP had joined us and felicitated the workers.
Today, as I look back at our battle against pandemic, I take pride in our efforts. When Bhilwara became a Covid-19 hotspot, the challenges were unique and unknown. No one knew about the novel virus, how it spread, how a sample was to be collected, or how to treat the patient. But the challenges also motivated us to fight back. Fortunately, not a single case was referred to any outside facility. On the contrary, we saw patients coming in from other districts, even states, to Bhilwara for treatment in the past six months. I see this as an achievement.
We were greatly supported by our families, the administration, the state government and health workers. We formed a critical care team, made all decisions in a group, took suggestions from every faculty member be it a physician or a pediatrician and involved them. We were the first to start some of the investigations that were required in the treatment. We even managed a C-section of a Covid-19 patient who delivered twins. There were anxious moments about the new-born health but the infection was not transmitted.
The credit also goes to the state leadership. Our chief minister Ashok Gehlot was directly in contact with us after the district was declared a hotspot. He provided all necessary support that we required, including RT-PCR testing machines, 40 ventilators, other resources, and a help desk. The support from the media was also unprecedented.
I believe every achievement brings an extra responsibility on your shoulders. I still have to protect my team and patients because the expectation is high. Even before the second dose we get, we have to follow the prescribed preventive measures for another six months very strictly. We understand that 30 percent population has already been infected by the virus and when 30-40 percent population get vaccinated, the overall immunity will be more than 60 percent. Only then there could be some relief for all of us. Till that time, our fight against the pandemic is not over.
Kunal Subhash Agarwal, co-founder of Kool-ex, the first logistics company assigned to transport Covid-19 vaccines, talks about the proud consignment and the challenges it entails
In the last 30 hours, we have transported 1.1 crore Covid-19 vaccine vials to their destinations. The last three days, since we were assigned the task of transporting the vaccines, have been super busy. But it feels great to be a vital cog in the national vaccination machine.
We have been in business as a pharma distribution company for a decade or so and transporting similar cargo across the country. So, while in terms of work this is business as usual, several facts make this moment unique.
First, we have not seen a pandemic of this volume in our lifetime. India has been one of the worst hit countries but also one of the first few to fight back with an indigenous immunization programme. The scale and geographical diversity of our country makes it even more challenging and special. Therefore as a service to the nation, to our countrymen, this is both an emotional and proud moment for us at Kool-ex.
Today, when the first batch of trucks was getting flagged off, we did a small ceremony of sorts to cherish it as a memory in future. The national Tricolour was placed on the trucks and having secured the permission from the police to film the event, we shot some videos to share it on social media too.
Kunal Subhash Agarwal (extreme left) has given Kool-ex fleet (right) a new ‘Make in India’ look
Here, I would like people to know how a pharma distribution company operates in contrast to a non-pharma cargo service. First, we are part of a cold chain logistics, which essentially means moving goods in a temperature-controlled set-up, unlike carriers in the movers & packers category. Then in the cold chain, there are two segments: pharma and non-pharma. The non-pharma segment comprises supplies such as dairy products, perishable food items, yeast, even blood.
The pharma segment is mainly restricted to medicines or vaccines that also require a temperature-module during transportation. As it involves saving lives, the quality-control measurement in the pharma supply are much more stringent than other cold chain carriers, even though the vehicles used are similar.
For example, all our trucks are fitted with sensors that tell you live temperature across India. We have a monitoring cell that screens each and every truck, their temperature and movements through GPS devices. We also have door-open sensors linked to the monitoring unit, so that we know if a door has been opened, and for how long. So basically, it is a tech-enabled fleet.
To maintain such operations is not an easy task. A pharmaceutical company will never work with a company that is dealing with anything non-pharma for the risk of contamination. So even if someone has used a truck for food and it comes in for loading it will get rejected.
Incidentally, I have realised that keeping such strictly-monitored operations is an easier task than managing the media in our country. Ever since the news hounds got the wind of our work, we were flooded with calls from all corners. And I knew not how to manage their queries.
Savita Paliwal, 52, a senior vaccinator in Moradabad (UP), is happy to see India among the first few countries to launch vaccination programme early. She explains how the monumental process will unfold
I have been in the medical profession for nearly three decades now and have been involved with quite a few vaccination and immunisation programmes. As a government employee at the Community Health Centre at Thakurdwara, Moradabad, I have been actively involved in building a healthy society. However, this time it is quite different.
Dealing with the Covid-19 is something that we have never seen before in our entire career. Healthcare professionals have been on their toes for nearly a year now. And with new strains coming up at different parts of the world, the challenge is only getting tougher.
It was therefore both a moment of relief and pride when we were informed that India is one of the first few countries to start vaccination programme. We have compiled the beneficiary list in our zone and have had two dry runs, on January 5 and 8.
We have been divided into two teams of three members each. Both teams have one vaccinator, one helper and a data expert (someone who keeps track of the beneficiaries who get vaccination). Healthcare professionals, especially the pharmacists and paramedical staff will be given the vaccine on priority basis.
The phase 1 of the programme begins on January 16. Each team is supposed to vaccinate 25 people in a day, so in our locality you can say that the Community Health Centre employees will be vaccinating around 50 people daily. The process will be spread across five rooms with standard operating procedure in place like regular sanitization, temperature screening etc.
Savita Paliwal (middle) with her colleagues at Moradabad community health centre
The DM (district magistrate) was very involved in how the dry runs were conducted and there was total cooperation from the Chief Minster’s office as well. I feel happy that we are all functioning as one smooth machinery.
Of course, many people are scared of taking vaccines but as someone with an extensive experience in this field I know how to soothe people. Asha workers are also involved in the vaccination programme, and spreading awareness about it.
Moradabad was declared a hotspot last year and I would say we expect most people to be co-operative. No query of the beneficiaries will be considered insignificant and we will take care to also inform them of the minor side-effects they might encounter after the vaccination.
I feel lucky to be a part of this monumental process. I have been keeping myself updated with all the news about vaccines developed in India as well as other countries and I would say so far we have handled the Covid-19 situation really well. But it is not over yet and the pandemic needs the cooperation of every single citizen of the country. I make it a point to carry extra masks in my bag and hand them free to anyone I see not wearing a mask.
I feel proud that India developed and mass-produce a vaccine in good time and now we aren’t dependent on any foreign country for the immunity programme. I wonder how the scientists who developed the vaccines must have raced against time to save as many lives as possible. I hope the process goes smoothly. We have managed and eradicated polio and now we are confident we shall put corona virus behind us too.
Despite the Toxic English Variant of the Corona virus there is relief and even euphoric hope in United Kingdom and USA as the long awaited vaccine against Covid-19 Virus has been rolled out. Yet not everyone is convinced. There are plenty of scare stories about the virus too including that Bill Gates has put a chip in it to control our minds.
Science has become too complex for the average person to differentiate between fact and fiction. Simply put, a vaccine, uses a neutered pathogen to provoke the immune system to be almost fully armed when the real one strikes.
Every nano second, the body is fighting ‘enemies of the body’. These invaders fail because of the incredible immune system of defence and offence. It is far more advanced than the American Army and possesses precision bombing that actually delivers precision targeting of enemy.
Antigen is material that invokes the body’s immune system to come charging at it. Most antigens are alien and from pathogens. Pathogens are nasty things that damage our body. They can be bacteria, fungi, protozoa, worms and not to forget the ubiquitous viruses. Let’s stick to viruses.
Unlike bacteria that fight straight, viruses are real insurgents. They invade cells and then use their material to survive and multiply, killing the cells in the process. The toxins produced can cause a lot more harm. The human defence mechanisms fight off these viruses in a number of ways. The body has more ranks of soldiers than the Chinese army.
There are macrophages, T-cells, B cells, helper T cells, T helper cells, memory T helper Cells, memory Killer T Cells, antibodies and so on, rank IDs that can fill this page, so we stop the list here. The body defence system is called the immune response. The immune system has a strong sense of nationalism and protects citizen cells.
A virus is destroyed either when it is in the invaded cell or before it goes into cells. When it is in the cell, both cell and virus get destroyed. The invaded cells send SOS to the immune system.
The immune system has two main forms. The innate system and the acquired system. Innate comes with birth (ancestral). It is first responders and non-specific. The acquired is a learnt system specific to a particular bacteria, virus etc. The factory making them is the bone marrow, the spongy bit in bones. There are a number of very intricate satellite production and distribution systems, such as lymph nodes, more in number than the Mandis in Punjab and Haryana.
As part of the first responders, the patrol soldiers, called macrophages attack virus infested cells by engulfing them and disintegrating them. Macrophages can’t attack viruses directly as the latter are too wily. Macrophages present the viral antigens to T cells and B cells in the bone marrow. These are soldiers of the Acquired Immunity Battalion. Each T cell and B cell is engineered to ‘hate’ a particular bacterial or viral antigen and becomes a commando.
T cells work like macrophages but are specific, and attack cells that are infected by the virus that they don’t like. They go straight to cells invaded by their hated foe.
B cells produce small identifier darts called antibodies. Each B Cell produces an antibody that is targeted at only one viral or bacterial type. The dart antibody does a sort of leg clasp on the virus, latching on to it. The clasping bit and the part of the virus it latches are specific. So the specific antibody cant tackle other antigens. If the virus mutates a bit, it does not matter because the antibody may still have enough clasp points to latch on to. This action makes it difficult for the virus to get into a normal citizen cell. Macrophages and T Cells quickly come and gobble them both, destroying them.
Trouble is that this system takes a couple of weeks. Think of it as the factory needing to calibrate machines etc. By that time the virus has done enough damage to the body. The first responders (innate system) cannot hold back virus invasion for long. By the time the T cells and B cells are made, the Virus has scaled most walls in the body that it wants to. Most people survive but many die or sustain damage to internal organs.
Body’s immune system has a memory of its enemies
Once infected the body’s immune system develops memory in the T and B memory cells. So when the virus attacks again, the T Cells and B cells are ready. The factory in the Bone Marrow has production machines on standby. They quickly attack the virus before it does damage. But can this be done even before the virus attacks first time and before it gets into the cells? That’s where vaccines comes.
To create memory for the specific virus, the virus itself or a form of it has to be introduced into the body so that memory T Cells and memory B cells with precision targeting can be ‘manufactured’. But that is also dangerous. What if the virus multiplies and gets out of control. Send for the white coated scientists.
Scientists work to produce attenuated form of the virus, a neutered version that cannot multiply. Or they take a part of the virus or a gene that is like the virus. The body immune system however destroys the attenuated virus or its version and memorises its structure. So when the real virus attacks, not only the first responders, but the precision commandos of the Acquired Immune Battalion are also ready.
Vaccines are not a treatment. Vaccines are a way of preparing the body for the first attack by the virus so that it destroys the virus before it overwhelms the body. Simple as that. Next time Covid-19 comes barging into the body, the B Cells and T Cells are already on stand by to pin it down.
The Pfizer/BioNTech vaccine uses a prepared gene that invokes antibody production against a spike protein of Covid-19 Virus. The virus uses this to break into cells. The antibody stops that.
It appears simple. But is very complicated. A lot of trials need to happen to ensure there are no immediate or long term side effects of the vaccine. But the rapid spread of Covid-19 virus has necessitated shortening the period of trials.
Vaccines or their makers and supporters have to fight off another attack. Disinformation!
The first one doing the rounds is that ‘the vaccine has corona virus’ shock horror! Of course it is coronavirus or something mimicking a genetic part of it in the vaccine. Despite Facebook, Snapchat and mobiles, there is no technology to take a picture of the virus and send it to the Bone marrow ‘factory’ manufacturing precision target T Cells and B Cells. Cells cant read jpeg etc.
The second alleged ‘devastating revelation’ is that there can be side effects and scientists are not telling us! Every medicine has some side effect. They are listed in the leaflet in the box. Just read it. No secret. Side effects are from immediate allergic reaction to effects of immune response such as headaches, itching, feeling unwell for a day or so. But for the vast majority they are no reactions or ones so minor, that the benefit of the vaccine outweigh the small side effects.
The third ‘alarming inside’ info doing the rounds better suits green men in mars territory. On social media they say ‘Did you know the virus was invented by Bill Gates and the Vaccine has a microchip to read your mind and everything’. Once a person is in this wacco stratosphere, it is best to wait for him/her to descend back to earth.
So in brief summary, a vaccine uses a neutered virus or a part of it or a gene similar to it and provokes the body’s immune system to first attack it and then develop memory to be able to tackle a real attack. Memory is not ever lasting. So it might take repeat provocative vaccines to maintain the defence system up to date.
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