What a difference a year makes. Twelve months ago the roads, our local high street and the surgery waiting room were eerily quiet as the first lockdown started to bite. If you would have asked me then how long it would take to come up with a vaccine I would have guessed at least two to three years, but cautioned that it might not prove that effective. Even that prediction would have been overly optimistic based on the history of vaccine development.
Yet here we are, with a choice of vaccines that offer near total protection against serious Covid infection and one of the best national programmes in the world. Six out of ten adults in the UK have now received at least one dose. One in ten has had two (one in five in Wales). More importantly the most vulnerable have been protected with 97 per cent of the over-50s in my region (southwest England) now vaccinated.
Rates of new infection are low in most parts of the country, but the pandemic is far from over. Covid is going nowhere, and worrying new variants will continue to emerge for years to come. And it has exacted a considerable toll. Out of the 4.4 million confirmed cases so far, more than 127,000 people have died within 28 days of diagnosis. And, just as lockdown starts to ease and things start to look up, there are concerns about rare side effects (see below) with our main vaccine — the Oxford/AstraZeneca version. Concerns that have lit up the switchboard at our practice. Here are some of the more common queries we have been dealing with.
I am due my second dose of Oxford/AZ — can I switch to another?
We can mix vaccines, but this is only done as a last resort and there is no reliable long-term data on effectiveness or safety. So far any concerns have centred on the first dose of Oxford/AZ and if you had yours without a problem then you should carry on with the second as planned. In practice, you won’t get a choice anyway.
Are the side effects worse with the second dose?
Clinical trial data, and real-world experience, suggests that short-term side effects such as headache and feeling unwell tend to be more common with Oxford/AZ than the Pfizer version. Although with second doses it tends to be the other way around, with more people complaining of worse reactions with their second Pfizer, and fewer after their second Oxford/AZ.
Advertisement
Would taking an aspirin help to prevent rare brain clots?
A common question, and the simple answer is no. First, the risks are tiny — of a similar order to the risk of paralysis (typically temporary) after a flu jab. Second, if there is a definite link to the vaccine then it is likely to be an immune response and aspirin will not help. Indeed, given that these extremely rare cerebral sinus thromboses are often accompanied by low platelet levels (which increases the risk of bruising and bleeding), aspirin may actually make matters worse. And that is before you consider the risk of bleeding in anyone taking an aspirin. If you have a headache or fever after any of the vaccines (as some people will as part of their normal reaction) then it is better to take paracetamol.
What will I be offered if I am under 30?
Guidance is still being finalised, but at the moment, given available supplies, it is likely to be either Pfizer or Moderna. And if you are under 30 and awaiting your second dose of Oxford/AZ because you are at high risk from Covid or are a frontline health or social care worker, then the latest advice is that you should proceed with your second dose as normal (assuming you had no serious problems with the first one).
If you are over 30 and awaiting your first dose then it is business as usual and you are likely to be offered Oxford/AZ. My daughter is 32 and awaiting hers and will take whatever she is offered. The Medicines and Healthcare products Regulatory Agency (MHRA) has raised one caveat by advising we consider alternative vaccines for first doses in people with a history of cerebral venous sinus thrombosis or an inherited tendency to abnormal clotting (such as thrombophilia and antiphospholipid syndrome). We are expecting further clarification on this.
Will my second dose be given on time?
Yes. We are prioritising second doses over first ones given that we have moved into the lower age groups and circulating virus levels are generally fairly low. If you are waiting for your second injection at a local GP hub then you may not be contacted until the last minute (just a few days before in some cases) as we like to ensure the vaccine is definitely coming before booking hundreds of patients in (we have been let down in the past). You will be in the system, and will be contacted.
You can read the latest update from the MHRA on the Oxford/AZ vaccine at gov.uk
Blood clots: the facts
Blood clots, including the extremely rare cerebral sinus thrombosis (CST), occur in unvaccinated people as well as those who have had Covid and/or a Covid vaccine.
Advertisement
Cases that may be linked to vaccination typically occur five to 28 days after the first dose of Oxford/AZ. The risk of dying from one is in the order of one in a million.
Symptoms of CST include a headache lasting more than four days after vaccination that is persistent, worse on coughing and straining and not relieved by simple painkillers. Others include blurred vision, stroke-like symptoms and pain in the ear/face.
Clots outside the brain (deep vein thrombosis and pulmonary embolus) can cause swelling of the leg, calf pain, shortness of breath, chest discomfort and coughing up blood.
Low platelet levels (another rare side effect associated with CST) may cause unusual bruising and a characteristic pinprick reddish/purplish rash that does not blanch with pressure (use the side of a glass).
Your GP/emergency department can use blood tests and scans to look for clots/low platelet levels, but are dealing with lots of concerned patients (we dealt with five in 24 hours last week — all negative so far).
