For a personal impression of life in Spain and Covid vaccine, InSpain.news asks Dr Jan Otto Landman to share his views with us. He lives and works in Spain (Costa del Sol), arriving more than 20 years ago. His medical practice is in Torremolinos.
The Easter holidays are now over and we returned to work last week, albeit to a limited extent. In the first days, two patients had a COVID rapid test because of unexplained persistent abdominal complaints, but negative in both cases. Since then no suspicions of COVID in our practice. During Easter week we had guests to stay who wanted to escape the strict measures in the Netherlands for a while. After a stressful year, 10 days of carefree enjoyment of the Spanish sun. They were lucky because the weather was nice, lots of sun and temperatures of up to 25 degrees. The first night at a nice dinner on a terrace, they saidthey had wondered if I, as a doctor, would not find it antisocial they had gone on vacation.
Infections rise slightly in Spain
Travelling within Europe has not been shown to have a negative effect on the spread of COVID. In addition, the virus situation here has recently been extremely favourable. Spain has had per 100,000 inhabitants considerably fewer infections in recent months than many other countries in Northern Europe. Our guests loved it, just shopping, eating in restaurants, having a drink on a terrace. Rested and tanned, they returned home.
In the last week, the number of infections in Spain increased slightly, probably as a result of increased mobility and the number of meetings around Easter. Nevertheless, this number is low in Spain, 196 per 100,000 inhabitants over the last 2 weeks, compared to most European countries. In Ireland it is even lower (130) but in other European countries the infection rate is significantly higher: Germany 277, Belgium 477, the Netherlands 586, France 764 and Sweden even 756. Mortality rates in Spain are low and still show a declining trend. The UK with its successful roll out of vaccinations scores best, less than 50.
In addition, the Spanish government announced that with the expected delivery of vaccines, 70% of the population will be vaccinated before the end of August, which would mean herd immunity. The state of emergency will be lifted in Spain on 9th May. And all this with the schools, sports clubs, shops and terraces open for months. There is still a curfew (in Andalucía from 11 pm) and the freedom of movement between provinces is limited.
Optimism around Spanish vaccination programme
In all optimistic Spanish vaccination forecasts, we must of course hope that the vaccine from AstraZeneca remains usable. Indeed, there appears to be a link between the reported blood clotting complication and the vaccine. But the chance of getting this complication is very small.
One review showed the risk of the coagulation disorder in the UK after administering over 20 million doses was about 4 in a million. For the affected individual serious, of course, but at the population level, many more COVID deaths have been prevented. In addition, large-scale vaccination in the UK has resulted in hospitals being able to function normally again for non-COVID patients. Society can slowly move back to normal.
The EMA (European Medicines Agency) considers the benefit of vaccination for public health to be much greater than the adverse side effect of AstraZeneca. It seems these complications mainly occur in people younger than 65 (especially women, average age 45 years). However, further analysis will have to clarify this. In Spain, only 60 – 65 year olds will be vaccinated with the Astra Zeneca vaccine from this week.
In the coming months, the Janssen (Johnson & Johnson) vaccine would play a major role in achieving a high vaccination coverage in Europe. The big advantage is only one injection is required. However, coagulation disorders also appear possible with this vaccine (comparable to AstraZeneca). In the USA, after the administration of 6.8 million vaccinations this side effect was reported in 6 women. The relationship with the vaccine is currently being studied and the vaccination programme in the USA has been temporarily halted. Deliveries to Europe have been cancelled for the moment.
Investigations into blood clotting following AZ vaccine
Investigation of serious side effects is of course an important matter. I will try to explain here how the coagulation disorder is caused by AstraZeneca. In this case it concerns a dysregulation of the coagulation system that leads to a shortage of platelets and the formation of clots. Platelets are important for blood clotting. At first glance you would think: the fewer platelets, the less chance of clots, but that is different here.
In some cases, we see this abnormality also occur in patients treated with the blood thinner heparin: HIT, Heparin Induced Thrombocytopenia (shortage of platelets caused by heparin). Heparin is administered precisely to prevent clots. One effect of heparin is that it binds to PF4, a protein that binds to platelets and thus regulates the activation of platelets. These complexes, platelet PF4-heparin, can in some cases be perceived by the body as hostile, causing the immune system to produce antibodies.
Here is the problem. The antibodies form complexes with platelets, PF4 and heparin to form large clots. This explains the formation of blood clots in combination with low numbers of circulating platelets (they are bound in complexes). English doctors also discovered high levels of antibodies against PF4 heparin in patients who developed clots after AstraZeneca.
Blood thinner heparin is now counterproductive
Patients who report to hospital with clots are normally treated correctly with heparin, but that is now counterproductive. Administering thrombocytes (platelets) will also make clot formation worse. The FP4 antibodies responsible for this unwanted side effect can be measured in the blood. For several days, patients with blood clots after AstraZeneca will therefore first undergo a PF4 determination. Afterwards, they will be treated with blood thinners of a type other than heparin.
Particular attention will be paid to slowing down unwanted antibody production (by suppressing the immune system, for example by administering cortisones). Diagnosis and treatment of bloodclots after the AZ-jab have changed drastically over the last week. This will greatly increase the chances of survival. With this new knowledge, it seems justified to minimise the delay in vaccination programmes.
Adjusting the age groups is sensible at the moment, but not if the vaccination programme is delayed as a result. After all, we can now determine the cause of this serious side effect and know better how to treat it. And let’s face it, the chances of developing the complication are about the same as a woman developing a clot after taking the contraceptive pill for 1 week. The number of serious complications that occurred after vaccination with AstraZeneca or Janssen does not outweigh the number of lives saved by the vaccines. Not to mention the benefit for patients with other conditions the decreasing burden on hospitals brings. When people ask me if I would be injected with either vaccine, the answer is a resounding “yes”.
