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So, can we mix and match vaccines?

So, can we mix and match vaccines?

As the first dose recipients of the AstraZeneca vaccine started to reach the 12-week mark in May, a lot of people were dismayed that they wouldn’t be able to receive the second jab in a timely manner. A lot of conversations began to revolve around “well, what happens to my immunity?” or “can’t we use another vaccine as a second dose?” and at the time, there weren’t much scientifically sound answers to ease people’s nerves. 

The dearth of the second jab of AstraZeneca vaccine for over 500,000 in Colombo was largely due to the Indian COVID surge shutting down Serum Institute exports in late March. As India hurried to absorb all its domestic production to stop a calamitous third wave, a large number of developing countries, including ours, were left without a way forward. 

In December, Russia & the UK began a study of the safety & efficacy of following up a first AstraZeneca dose with a Sputnik booster and in the UK & Spain, researchers started studying the effects of a follow-up Pfizer booster.

Short answer: The jury is still out on exact findings but some preliminary data is available: side effects were more pronounced in intensity (however not severe and no hospitalisations) and higher antibody levels were seen after a Pfizer booster. 

Want more details? Read on: 

What do we know about safety?

In a UK trial, of the ca. 460 people (median age of 50+ years) that received the AZ jab and then a Pfizer booster 28 days later saw greater intensity in post-second jab side effects than those that received a second AZ dose (“control group”). 

More people felt feverish, had chills, felt fatigued, had joint pain and muscle aches in the study group than in the control group. Most of these effects were felt in the first 48 hours after. Efficacy data has not yet been made available. 

Safety and efficacy data of a booster shot being administered after 84 days is expected in June.

What do we know about efficacy?

A study by the Carlos III Health Institute in Madrid enrolled 663 people who had received the AstraZeneca first dose to receive the Pfizer second dose after eight weeks. The control group did not receive any booster shots. 

The results showed a much stronger immune reaction producing a higher level of antibodies in the Pfizer group than they did with the first dose of AstraZeneca. No severe side effects were reported.

What about a Sputnik booster? 🇷🇺

In December 2020, the UK & Russia began to partner on a study to test safety and efficacy of mixing these two vaccines. On May 28th, Russia announced a hold on it’s mix and match trial with Sputnik as the national ethics committee awaited further data.

What about a Sinopharm booster? 🇨🇳

No data is available at the time of publication however Bahrain has allowed mixing with a second dose of SinoPharm. 

What are other countries doing?

Some countries have already begun allowing a second dose of mRNA to supplement the first dose of another brand. On 1st June, Canada’s National Advisory Committee of Immunization announced it would allow second doses of mRNA to be administered to those that received the first dose of another brand of vaccine. 

Bahrain, Finland, France and Norway had begun allowing second doses of mRNA to be administered to those with AstraZeneca first doses.

What about us in Sri Lanka? 🇱🇰 

The health authorities have not approved the mixing of vaccines in Sri Lanka at the time of publication. The government is attempting to procure the shortfall of AstraZeneca doses by any means possible and has signed an agreement with Pfizer for 900,000 doses for delivery in July. 

The recent crowdings and altercations at AstraZeneca vaccination drives serve to be more harmful than helpful when limiting the spread of COVID19. Until sufficient data is available and vaccines are approved & available for mixing, we believe it’s most prudent for those that received the first AZ dose to adhere to strict COVID19 protocols, limit travel as much as possible and avoid crowded gatherings. 

If you or a loved one have been diagnosed with COVID19 and are awaiting transfer to an intermediate care centre or government facility, oDoc Home Care is available for you. 

With oDoc Home Care, you receive daily calls from a medical doctor for symptom monitoring & medical advice, a wellness bundle including gloves & masks, a pulse oximeter and blood pressure monitors. Click here for more details. 

Sources

  1. Shaw, R., et al (2021) Heterologous prime-boost COVID-19 vaccination: initial reactogenicity data., The Lancet., 397:2043-2046. 
  2. Callaway, E (2021) Mix-and-match COVID vaccines trigger potent immune response, Nature Magazine
  3. Miller, A (2021) Canada recommends mixing and matching AstraZeneca, Pfizer and Moderna COVID-19 vaccines, CBC
  4. Explained: Which are the countries allowing you to mix Covid-19 vaccines?, Indian Express (2021)
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You test positive for COVID-19. What Now?

You test positive for COVID-19. What now?

Updated May 22nd, 2021.

Medically Reviewed by Dr. Rashmira Balasuriya BSc (Hons) MBBS PGCert (MedEd)

covid positive

With the number of COVID-19 cases rising across the country, it is more likely than ever that we have either interacted with or know of a person who has been tested positive for COVID-19. And if we’re feeling a little temperature or a sore throat, our next thought tends to be “Should I take a PCR test?”. With the amount of ambiguity and daily change of regulations, we, at oDoc, want to keep you informed and updated with the latest news regarding COVID-19 processes in Sri Lanka.

What should you do after finding out you’ve been tested positive for COVID-19?

Contacting your local PHI

You can find out who your local PHI is from this website (On the navigation bar at the top, click ‘Find PHI’ and fill in your area details) The lab or hospital where you were tested for COVID-19 will also inform your local PHI and Ministry of Health.

Things you should keep in mind for your conversation with the PHI officer:

  • COVID-19 symptoms
  • How long you’ve been having these symptoms
  • Any known medical illnesses (i.e. asthma, diabetes, etc)
  • Any medications taken for known illnesses or after becoming COVID positive
  • Any allergies
  • Any previous surgeries
  • If you’re a smoker or not
  • People you have been in contact with over the last few days
  • Have an emergency contact number of a family member/friend
pcr test

Home Isolation 

To reduce the burden on hospitals and COVID-19 care centers, the Ministry of Health has introduced the option of low risk COVID-19 patients isolating in their homes. If the Ministry of Health gives you the option of home quarantine and you agree to that option, here are a few things to keep in mind:

  • REST.
  • Remain in a separated well-ventilated room.
  • Avoid contact with others as much as possible. Identify one family member who is low risk to be in contact with you. Wear a surgical mask and wash hands before coming into contact with anyone else.
  • Do not share washrooms if possible. If sharing, you should disinfect the washroom after each use.
  • Eat a healthy diet.
  • Stop smoking.
  • Do not routinely take antibiotics or steroid medication. Only take medication prescribed by a licensed medical practitioner.
  • Have warm fluids frequently such as tea, kothamalli, jeewani
  • Steam inhalation – only for symptomatic relief and always ensure safety
  • Keep track of any new or worsening symptoms – If possible, keep a check on your basic vitals – temperature, pulse rate, respiratory rate (count the number of breaths per minute), blood pressure and oxygen saturation.
  • You should use separate cutlery, plates, dishes and bedding from the rest of the household members.
  • Clean frequently touched surfaces often.
  • Keep your bed linen and clothes in a laundry bag separate from others.
  • All household members should remain at home and avoid any contact with people who don’t live in the same household.
  • No visitors should be allowed during the home isolation period.
  • Call 1990 if you have any difficulty breathing, chest pain or loss of speech/mobility.
  • Keep emergency contact numbers close by.

How will you be accessed during home isolation?

The PHI will keep a check on you while you’re at home. You can choose to do audio or video consultations with a GP. You must inform your PHI or MoH on your choice of doctor. Taking care of your mental health during this period of isolation is also important and can help in making you feel better, so consider speaking to a mental health professional during this time as well.

During your home isolation period, you can purchase Home Care with oDoc. Here’s what you have access to:

  • A dedicated doctor assigned to you to virtually monitor your symptoms for 14 days
  • A Pulse Oximeter and Blood Pressure Meter (both NMRA approved) to be sent to your home
  • At-home PCR testing by our lab team, oLabs
  • A Wellness Package of masks, gloves, sanitizer, and a box of Panadol to be sent to your home.

Click here to find out more about Home Care with oDoc.

A minimum of 14 days is required for the home isolation period. The Ministry of Health and your doctor will make the decision on when you should stop the home isolation period. This will depend on your symptoms and how many days have passed since the onset of symptoms. If the MoH decides you can remove yourself from isolation, it is still recommended that you quarantine at home for a further 14 days.

Government/Private Care Centers

If the PHI/MoH decides that you need to be treated at a hospital or care center, there are options to stay in a government care center for free or a private care center for a fee. If you choose to quarantine at a private care center, you can find all the information on space availability, rates and medical support here.

You may have to remain at home before a bed becomes available at a COVID care center. If you need to remain at home for a few days, please follow the above guidelines. Your local PHI will transfer you to an Intermediate COVID care center when a bed becomes available to you.

Discharge Process at Care Centers

The length of quarantine and discharge process is different for each person who has been tested positive for COVID-19. This depends on the severity of COVID-19 symptoms, the cycle threshold value of the initial PCR test done on admission (more information here) and the clinical fitness of the patient.

Currently, the length of quarantine and discharge policy at care centers are as follows for most patients.

  • If you are positive for COVID but don’t show any symptoms and are not in a high-risk category, you will be sent to an ICC. You will be discharged from this center after 10 days and will be required to home quarantine for 4 days.
  • If you are positive but show mild to moderate symptoms and are not in a high-risk category, you will be sent to an ICC. You will be discharged from this center after 14 days.
  • If you are positive with severe symptoms, you will be sent to a COVID-19 hospital and will be kept there for 3 weeks or more depending on how severe the symptoms get. You will only be discharged after a negative RT-PCR test.
  • If you have been placed in a quarantine center through contact tracing after a close associate of yours was tested positive for COVID-19, you will need to remain in quarantine for 14 days. You will only be discharged if you test negative on a RT-PCR test.

Please keep in mind, this process can change due to the rise in COVID-19 patients and can also vary between patients depending on their condition.

How long after you’ve recovered from COVID-19 can you take the vaccine?

If you’ve had a mild/moderate version of COVID-19, you can take the vaccine 2 weeks after recovery. If you’ve had a severe form of the disease AND received monoclonal antibody/plasma therapy as part of your treatment, you will have to wait at least 1 month before vaccination.

We will continue to update this article if and when regulations change so keep checking this space for any COVID-19 related news in Sri Lanka.

If you would like to read more about the SinoPharm and Sputnik vaccines, read more here. 


If you or a loved one would like further advice on COVID-19 symptoms, consult with our on-demand GPs who are available 24/7.  You can download oDoc here.

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