Ask the Experts: Cayman’s doctors talk vaccines & COVID-19

On Monday, 20 Sept., the Cayman Compass hosted “Ask the Experts: Cayman’s doctors talk vaccines & COVID-19.”

Watch the one-hour roundtable discussion here.

The panel participants included:

Ministry of Health and Wellness
Dr. John Lee, chief medical officer

Health City Cayman Islands
Dr. Archita Joshi-Bhat, head – infection control and COVID-19 advisory chair

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Doctors Hospital
Dr. Yaron Rado, chief radiologist

Seven Mile Medical Physicians
Dr. Nyali Taylor, vascular surgeon
Dr. Beatriz Esteban, GP
Dr. Sook Yin, GP
Dr. Sarah Cuff, GP

Cayman Fertility Centre
Dr. Joseph Davis, fertility specialist

Here’s a selection of highlights from the Q&A with the experts:

Q: Why does Cayman not recognise vaccination certificates without a QR code?

A: It was under Cabinet’s instruction that we only accept securely verified vaccinations. I understand the reasoning behind it and of course, they were provided with information related to it. I’m very comfortable with the decision because we have had a lot of reports from INTERPOL and other sources that vaccination certificates are being forged.

Of course, I am not saying at all that the worthy people wishing to travel to Cayman are forging their certificates, but we have to – in the face of such a vicious, infectious virus – try to protect our borders and we have done so by making sure that people are securely verified to have the shortest quarantine period.

The list of people who can get a QR code is growing by the week. Every single week we get more reports of either different systems or people jumping on to other systems that are already present. We would encourage you to keep going back to your provider saying “we need this QR code”.

We had a very good conversation with Public Health England just around a week ago, in which they acknowledged that we can no longer rely on our little yellow books with a stamp in there to say we’re vaccinated. We need something more secure, that we can prove is tied to ourselves, that we can follow right back to the place of the vaccination.

Dr. John Lee

Q: Why does transmission still occur, even when you’re vaccinated?

A: There’s a lot of discussion out there, looking at this like a black-and white situation: You’re vaccinated, you’re good; you’re not vaccinated, you’re not good.

In this case, if you’re vaccinated, the likelihood of you getting COVID is extremely diminished, but it’s not gone. You still can get COVID, but you will, most likely, have a much lighter version of COVID than you would have had if not vaccinated.

At the same time, the time you are actively spreading the virus is going to be contained, it’s going to be shorter than if you were not vaccinated.

What the vaccine helps with doing – even if you get it, even if it doesn’t protect you 100% – you can look at it like a soda bottle that falls to the floor. If you open it slowly, you can still drink it. If you open it in one go, you will have most of the soda on the floor.

You will still need to wear masks, you will still need to protect yourself. All of us are going to get COVID-19, Delta variant, this way or another, sooner or later, with masks or without masks, probably with vaccination or without vaccination.  But the big deal in this is to delay the transmission so that we can get through this and, at the same time, keep our healthcare system working and protected.

Dr. Yaron Rado

A: The big advantage of having vaccination is how it induces immunity within us.

There is something called an infection and something called a disease. It does not prevent the virus from entering our nasal passages and from us getting infected. It does prevent a severe form of the disease developing in those vaccinated individuals.

It doesn’t weaken the virus really, not for an individual at least; the virus can still come and colonise your nose or aural passage. What it does, is modify your immune response so you will be able to fight it off sooner, or the viral shedding will reduce sooner, so you will not be infected very long, but you still need to protect yourself.

With the emergence of new variants, this becomes even more important. The Delta variant is almost twice as transmissible, so we can still become ill but hopefully only mildly or moderately so.

Dr. Archita Joshi-Bhat

Q: What about the risk of COVID-19 for expectant parents? 

A: The pandemic has been going on for almost two years now, so we do have a lot of people who have been pregnant, become pregnant or delivered during the pandemic, so there is data.

There is actually a large, ongoing trial out of the University of California, San Francisco, called the ‘aspire’ trial, where they are doing a three-year follow-up study to see women who, either with fertility, or became pregnant without fertility treatments, all the way through pregnancy and early birth. That data is not available yet. But what we have seen, women who do get COVID while pregnant, particularly in the third trimester, tend to have more severe symptoms, they tend to be higher risk of admission to the hospital, mostly due to respiratory symptoms, having difficulty breathing and needing support.

There has been a lot of questions on miscarriages and impact in the first trimester, which hasn’t been shown consistently in the data.

Unfortunately, miscarriages do happen quite frequently and for lots of different reasons, so there doesn’t seem to be a direct correlation, other than people who are extremely ill with viral infections, the body has lots of different things it has to do to fight the infection.

From a vaccine standpoint, we know the antibodies either from natural infection (from being exposed to the virus and recovering) or from vaccination, do cross over and pass on to the baby and confer some level of protection.

Children do have a better ability to handle COVID, there’s actually been a few studies looking at newborns whose mums had COVID. Many of those newborns – who you’d think would be very sensitive to infection – actually do quite well, even when their mothers are in isolation for COVID.

Move forward with your family-building plans; protection against COVID is really important, including good hand hygiene, social distancing, doing all those things to prevent the risk, is always the best idea, whether you’re early pregnancy, late pregnancy or just considering pregnancy.

Dr. Joseph Davis

Q: What is the scientific basis for mandating masks in schools?

A: Preventive measures should be the mainstay here. The most important measure would be for parents to recognise if their children are coming down with respiratory symptoms (flu-like illness or low grade fever) to prevent them from going to school and get them screened or tested.

Most international guidelines do recommend masks indoors, especially now we have seen some cases happening in a local school. It’s a good idea to encourage masks indoors for anyone attending school, including the teachers.

Dr. Archita Joshi-Bhat

A: Children are much more compliant, they are actually quite happy to wear the mask. It’s the adults we’re having trouble with.

The children are used to having masks. In general practice, most of us see when they come to clinic, they put on their mask and they’re quite happy with it. Children are much more adaptable to it than a lot of the… adults.

Dr. Sook Yin

A: There’s also lots of different types of masks, from the homemade cloth mask, to the surgical, up to the N95 type mask. They do have different properties.

The cloth masks do need to be washed regularly. We should think about how frequently we’re washing them or disposing of them if they are disposable.

If you have a soiled mask you’re wearing over and over again, that’s more likely to be a cause of problems than a preventative measure.

Dr. Joseph Davis

Q: What about natural immunity and should we be concerned about the decreasing efficacy of the vaccine?

A: Most physicians are always talking about the basics of health; this is why we tell you to eat well, get your sleep, how is your mental health doing, make sure you’re exercising, how is your cholesterol, all these other things. This is all part of your general health. All of that is being done on a daily basis. It hasn’t changed because COVID is here.

If there are alternative things you can use, vitamins and minerals that can be used to supplement, that’s part of your general health. Most of us have low vitamin D, those are all parts of general wellness. It’s not true that we’re not focussing on general health. Prevention is worth way more than cure. We’re focussed on doing that all the time.

With COVID, there just isn’t good prophylaxis. As far as I’m aware, as recently as September in the scientific papers, there is nothing that suggest any of these other medications that we’ve seen are proven to give you better outcomes. There’s most likely more risk.

We can’t push things that could harm you. We’re trying to move forward on things we know can help. Vaccination is the way we can help best, in the safest way, and reach as many people as we can. That’s why we talk so much about it; this, in COVID, is a targeted way we can really reduce the numbers of people who can be extremely ill.

Dr. Nyali Taylor

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  1. “Ask The Experts”?????
    From the above article, the experts include a vascular surgeon, a radiologist and 3 general practitioners.
    This is the problem with the management of the Covid crisis. You have the premier and the Chief Medical Officer (is Dr. Lee a Board Certified Infectious Disease specialist?) making all these decisions.
    Where is there any input from government health agencies such as the FDA or the British equivalent? I sincerely doubt that that they would recommend the recent plans to delay the re-opening of the borders.

  2. So by avoiding answering the question, the experts silently concede that there is no scientific basis to wearing masks in the presence of an aerosol virus like the CCP virus. In actuality, only N-95’s worn by an infected patient in a clinical setting made any significant reduction in spread. Cloth masks are useless other than being portable microbial incubators. But yes, the children are so compliant–it’s those critically thinking adults we need to conform!

  3. There are two sides to the coin yet the panel chosen is meant to highlight only one. How can the people of these islands make an INFORMED decision if they are only being told the benefits and pros. Everything in this world has cons and it is our right to hear not only the good, but the bad, from our leaders.