Experts: Vaccine good trumps risks for seriously ill people

By Patricia B. Mirasol

FILIPINO ADULTS with comorbidities, including chronic kidney disease, diabetes, and cardiovascular diseases such as hypertension, shouldn’t hesitate getting vaccinated against coronavirus disease 2019 (COVID-19). These individuals, who are classified under the government’s A3 priority group, are best poised to reap the benefits of COVID-19 vaccination, said doctors at an April 27 forum.

“The best vaccine is the one in your arm, especially for those in the eligible groups,” said Dr. Deborah Ignacia D. Ona, an associate professor of the University of the Philippines-Philippine General Hospital (UP-PGH)’s Division of Hypertension “Kaya kayo nandun sa list, kasi kayo ‘yung best person na magkakaroon ng benepisyo for this (You’re in the list because you’re one of the persons who will reap the most benefits from it). If you have the opportunity to be vaccinated, do not hesitate — regardless of the vaccine brand.”

Be brand agnostic, added Dr. Maaliddin B. Biruar, a nephrologist at the National Kidney and Transplant Institute. “Tanggapin na po natin ang meron (accept what’s available),” he said. “Remember that all vaccines are under Emergency Use Authorization. Emergency ito, tapos ipapagpaliban natin dahil sa brand (This is an emergency, but some decide to defer vaccination because they weren’t given their preferred vaccine brand). It doesn’t make sense. You deserve to receive the vaccine.”

Patients on dialysis, Dr. Biruar added, may schedule their vaccination the day after a dialysis session. “If your last session was on Tuesday, and the next one is on Friday, get vaccinated on Wednesday,” he suggested. Dialysis patients who contract COVID-19 have a mortality rate of more than 20% because of their poor immune system. In contrast, the mortality rate of the general population is 1.7%, highlighting the need for an added layer of COVID-19 protection for chronic kidney disease patients.

HIGH BLOOD PRESSURE, HIGH BLOOD SUGAR?
Prior to vaccination, hypertensive patients should control their blood pressure, which requires regular check-ups and medication compliance.

Maintenance medications should be taken per usual — even during vaccination day itself, Dr. Ona said. “Bring extra medication (to the vaccination site) in case you might need it. Don’t forget to follow the usual protocols of physical distancing, mask wearing, and hand washing. Do relax and go to your doctor the following day if your blood pressure rises.”

Medical clearance is not a prerequisite for COVID-19 vaccination, clarified forum speakers, despite the surge of requests. The exceptions to this, according to the Department of Health, are immunocompromised patients like those with autoimmune disease, HIV (human immunodeficiency virus), cancer patients currently undergoing immunosuppressive therapy, transplant patients, those undergoing steroid treatment, and patients who are bedridden or with a poor prognosis.

“What’s good about this vaccination is that patients who I haven’t seen in one or two years are suddenly scheduling follow-up consultations,” said Dr. Ona.

Even those who have high blood sugar can be vaccinated, said Dr. Nemencio A. Nicodemus, Jr., a clinical professor  at UP-PGH with a speciality in internal medicine, endocrinology, diabetes, and metabolism, provided that they maintain their medication use.

“What I do for patients who insist on a medical clearance is write that they have diabetes, are on maintenance medication, and that they can get the COVID-19 vaccination,” Dr. Nicodemus said, adding that there haven’t been any reports of DKA (diabetic ketoacidosis) or HHS (hyperosmolar hyperglycemic syndrome) — both life-threatening complications of diabetes — after the vaccination of diabetic individuals.

Diabetes in patients is associated with a two-fold increase in severity of COVID-19, as well as a two-fold increase in mortality, Dr. Nicodemus said. Like hypertensive patients, diabetic patients are also at three times more risk for COVID-19 hospitalization as compared to those who don’t have either disease. The established reasons for increased severity of COVID-19 in diabetic patients are obesity, cardiovascular disease, renal damage, psychiatric disease, and immune system dysfunction, he said.

While waiting in line at the vaccination site, it is best for everyone — especially those who are diabetic — to eat even before they start to feel hunger pangs, as hunger might lead to one’s blood sugar falling below the normal level.

“Magbaon ng pagkain. Huwag magpagutom, lalo na if naka-maintenance (Bring food along with you. Don’t allow yourself to feel hunger, especially if you have diabetes and are on maintenance medication),” Dr. Nicodemus said.