Leyla Fazleeva: 'If you are forced to vaccination — welcome to operational headquarters chat'

Leyla Fazleeva: Special attention from the point of view of coronavirus infection is now required by the residents of Tatarstan who have chronic diseases. On the eve of the live broadcast, the account of the operational headquarters received about 30 questions, which we address to our today's expert Diana Abdulganieva, the head of the Department of Hospital Therapy at the Medical University, chief therapist of the ministry of healthcare of the republic. Diana Ildarovna, which categories of citizens are at risk, which suffer from Covid-19, and despite the fact that a lot has been said about this, our viewers would like to hear about it again.

Diana Abdulganieva: The first is old age. If the patient is over 65 years of age, the course of Сovid-19 may not be limited to damage to the upper respiratory tract, as we call this stage — Сovid-viral respiratory infection, but go into a more severe lesion of the body, accompanied by viral pneumonia. It is for a reason that all the restrictive measures that we went through in the spring and which partially resumed in the autumn are related to age-related people.

The second is cardiovascular diseases. The list of CVD is very large, but the main ones are coronary heart disease, arterial hypertension, and those who have suffered a stroke. Why these three categories? In these diseases, the penetration of the virus into the body is much faster. There are certain proteins in our body that in patients with CVD are produced in large quantities in the body, and the virus easily gets into the cells of the body.

The third group of patients who are hard to tolerate the coronavirus is people with excess body weight, or obesity. Here, age no longer matters. BMI in 30 -, 40- or 50-year-olds is a risk factor for developing severe Covid-19, accompanied by lung damage.

Then — patients with chronic lung diseases: bronchial asthma and chronic obstructive pulmonary disease. They change the structure of the lungs, and when the Covid-19 overlaps, the disease can occur more often.

Another group is people who have malignant neoplasms. These patients always receive treatment that inhibits tumor growth, inhibits the development of metastases, or is aimed at preventing the formation of metastases. And these patients, even if they underwent surgical treatment 3-5 years ago, are under dispensary supervision, receive supportive medications, still need to treat themselves carefully. If a patient receives regular chemotherapy or immunotherapy for an active tumor process, then, of course, these patients should also observe social distance, self-isolation, and mask regime, and try not to visit crowded places.

Next, a special group that we distinguish is patients who have undergone organ transplantation. Kidney transplantation has been performed in our republic for 20 years, and there are several hundred of them. A very large pool of patients who have undergone liver and heart transplants is formed — there are dozens of them, and soon we will talk about hundreds of such patients. These people should also be very attentive to their health.

The last group — patients with diabetes of both types, and the age of the patient here does not matter, because diabetes of the first type — diabetes of the young. The presence of pancreatic lesions and insulin resistance causes rapid reproduction of the virus in the body and aggravates the course of coronavirus infection.

Leyla Fazleeva: You have already made some recommendations for patients who suffer from the above diseases. But we are all children of our parents, we all have elderly parents, grandparents, and we are very concerned about how they will survive this period. And one of the grandchildren asks the question of how to convince the grandmother of the need for vaccination.

Diana Abdulganieva: I think we are very lucky. We are now living in February of 2021, and if we think back to February of 2020, then in addition to the limitations and prospects that we will learn to treat, there were very few ways ahead, now we have a very good road opened up. The elderly are tired of sitting at home, summer is ahead, gardens, vegetable gardens, children's studies will end, everyone will want to communicate with their grandchildren. A person can not be isolated for a year, it is very difficult for the elderly. And there is a chance, this is an absolutely real chance to vaccinate the elderly. You know that Israel in general vaccinated 66% of the entire population of the country. And now it's a world experiment. We will look at how the coronavirus will behave now in Israel.

How to convince? Vaccination has been going on since September, when in Moscow our colleagues-doctors who worked in the “red zone”, they were not allowed there until they were vaccinated with Sputnik V. By the November holidays, we realised that the vaccine is very well tolerated, the level of antibodies is high, these people work in the “red zone” to this day, and none of them got sick. This is a very powerful scientific argument. The second point: during vaccination in Moscow and St. Petersburg, it turned out that elderly patients are much easier to tolerate the vaccine in terms of flu-like reactions.

In the first day, there are even reactions to the flu vaccine, mainly a fever, maybe a pain in the shoulder. One shouldn't be afraid of them, they will end — two or three days at most. It turned out that people over 70 years of age with almost no pronounced reaction to immunisation are vaccinated. It forms a good immune response, a good level of antibodies.

Now there is a decline in the registration of new cases of Covid-19, now it is a very good time to start vaccination.

Leila Fazleeva: To move from the topic of vaccination to the topic that we associated with chronic diseases, I will ask one more question on behalf of all the viewers — who exactly can not be vaccinated?

Diana Abdulganieva: First, the vaccine is not given to children, only to people over the age of 18. My children also ask if they can be vaccinated. I say, “No, you're not 18 yet.” To date, this is the case. Further contraindications are clearly outlined in all the methodological documents we are working on:

• if there is a hypersensitivity to the components of the vaccine. How do we know about this? In no way until we get the first dose of the vaccine. And if there is hypersensitivity, then you simply will not do the second dose;
• if the person has a severe allergic history. There is a group of patients who are allergic to almost all antibiotics or had an anaphylactic reaction to the introduction of other vaccines;
• if a person is currently suffering from viral respiratory infections. Only after recovery, after two weeks, it will be possible to get vaccinated;
• pregnant women.

There is a category of people for whom the coronavirus vaccine should be used with caution — this block includes the decompensation of chronic diseases. For example, in a person with diabetes, the blood sugar index exceeds the norm — 27-30, then he or she has decompensation of diabetes mellitus. It needs to be compensated, bring the sugar content to normal, and only then raise the issue of vaccination. If a person has a hypertensive crisis — this is also a conditional contraindication.

The third big block is patients with cancer and autoimmune diseases. For patients with malignant neoplasms, a cautious approach is still being taken. This is a risk, we do not fully know how the immune system of a person who is being treated for a tumor will behave. But foreign colleagues say that during a period of stable remission, vaccination is possible. As for autoimmune diseases, there, too, in the period of exacerbation, it is not recommended.

Leyla Fazleeva: Our viewer asks: “I suffer from varicose veins, do I have the opportunity to get vaccinated?" Another suffers from migraines, are they a contraindication?

Diana Abdulganieva: Varicose veins of the lower extremities are a chronic, fortunately, benign disease. There are various methods of its treatment, and if there is no acute thrombophlebitis — this is a decompensation of varicose veins of the legs, then you need to be vaccinated. The same is with migraine. It worsens the quality of life, but it does not affect the prognosis. People with migraines live as long as people without migraines. When a migraine attack is stopped, then you can raise the question of vaccination. Migraine itself is not a contraindication. These two diseases, fortunately, do not even belong to the spectrum of severe human diseases.

Leyla Fazleeva: What other ways are there to protect yourself from the severe course of Covid-19? What things should be observed?

Diana Abdulganieva: 80% of us has Covid-19 in a mild form, like Covid-viral respiratory infection. The disease is clearly described today, and despite the second wave, the new strains that will still appear are the virus, the very course of the disease, as we understood it back in March, it remains so. The first five or six days are Covid-viral respiratory infection: the first three days are high temperature, then it should decrease. And if the temperature does not fall on the sixth day of the disease, then it is necessary to consult a doctor and talk about inpatient treatment.

Prolonged fever is a sign that the lungs may have started to be affected.

The second important symptom is that after the temperature drops, on the seventh or tenth day of the disease, the temperature rises again. These two simple signs, which everyone can track, are the first harbingers that the lungs are affected.

For example, if it is a temperature above 38,5 degrees for five days, and with coronavirus it is already in the morning, then we say that, most likely, the virus has affected the lungs.

Leyla Fazleeva: Another issue is the formation of antibodies, which almost everyone is talking about. If a person has a chronic disease or if a person simply has a weakened immune system, does this somehow affect the formation of these very antibodies during vaccination?

Diana Abdulganieva: If there are heart diseases, bronchopulmonary, then they do not affect the formation of immunity. The formation of antibodies is influenced by age. People over the age of 80 have an age-related decrease in immunity, so their antibody levels may differ from those of a 60-year-old and a 40-year-old person, but antibodies are still formed in older people after vaccination. In patients receiving treatment that suppresses immunity, for example, in malignant neoplasms, in immune diseases, when receiving immunosuppressive therapy, the formation of antibodies may also be observed over a longer period of time.

We know that there will be Sputnik Light. This will be a booster dose that will be able to simply raise the level of antibodies to Covid-19.

Leyla Fazleeva: Diana Ildarovna, I thank you for the first meeting.

Diana Abdulganieva: Take care of yourself, your loved ones, we need to make an informed choice, because vaccination is a completely voluntary decision. Indeed, there has appeared a light at the end of the tunnel, and you can't imagine how happy we are about it. Thank you very much for inviting me to the live broadcast.

Leyla Fazleeva: Actually, this is not an easy question. Vaccination is voluntary, and the facts that we receive — about cases of forced vaccination, the operational headquarters receives information immediately, works on them, and if there are any, then welcome to the chat of the operational headquarters.