As of today, less than 10% of our population has been vaccinated against Covid-19.
This is far from achieving herd immunity, which is essential in combating the disease.
Elderly people aged 60 and older are at higher risk of serious illnesses, complications and death from Covid-19, especially if they have chronic diseases such as diabetes, high blood pressure, heart and lung diseases.
Although only 11% of Malaysia’s total population is above 60 years, about 70% of Covid-19 deaths comprise elderly people.
The initial symptoms of Covid-19 may resemble a common cold or mild flu, but in the elderly, it may worsen rapidly.
Older people may not have the typical symptoms such as fever, cough, shortness of breath, changes in smell and taste, and fatigue, but may show non-specific symptoms, including weakness, confusion, diarrhoea, dizziness, headache, falls, loss of appetite and chest pain.
As a result of this, there might be a delay in diagnosing Covid-19 in older people, and the virus can easily spread to others during this period.
Side effects concerns
Many individuals are reluctant to get vaccinated because they are worried about the side effects.
They think they will not be the one who is “unfortunate” to contract the potentially deadly disease if they stay at home, but this thinking is very dangerous.
Other people who have not been vaccinated might get infected with Covid-19, be asymptomatic or have mild symptoms and spread the infection to them.
Vaccination is one of the key steps to protect yourself and your family.
It can prevent you from becoming severely ill as a result of contracting Covid-19 and protect a large number of people through vaccination, making it difficult for the virus to spread.
Herd immunity will greatly reduce the risk of a large-scale outbreak.There are currently three Covid-19 vaccines approved for use in Malaysia, namely Pfizer, AstraZeneca and Sinovac, each of which is safe and effective.
Although some studies have shown that the efficacy of the vaccines among elderly is as good as that of the younger people, there are currently few published studies on the efficacy and safety for the elderly. However, real world studies (research conducted with real world data) show that there have been great reduction in the number of Covid-19 infection and mortality in the elderly compared with a year ago when the vaccine was unavailable.
Blood clots unlikely
Serious adverse events of the vaccine are very rare, such as blood clots and low platelet counts.
In every one million vaccine recipient, only about 10 people developed blood clots, and even fewer people ended up dying.
Elderly people are less likely to have blood clots when vaccinated.
However, in every one million Covid-19 cases, 180, 000 people die, while many others develop complications –16.5% of patients developed blood clots, which was 40, 000 folds higher than blood clots caused by the vaccine!
Therefore, everyone should seize any opportunity to be vaccinated.
Of course, there is no so-called “safest vaccine” in the world.
Every vaccine has risks and cannot guarantee 100% prevention of any disease.
Although it is still possible to contract Covid-19 after vaccination, the chance is very low.
In particular, if you continue to wear a mask after vaccination, maintain physical distancing, wash your hands regularly and reduce unnecessary outings, the risk of infection is minimal.
All in all, vaccines are our only way out of the pandemic.
As long as our country’s vaccination rate reaches 60% to 80%, the day to defeat the virus is just around the corner.
Countries where the pandemic was once very severe, such as the United States, Spain and the United Kingdom, have been brought under control after large-scale vaccination.
Heed these precautions
Many older people have chronic diseases, making them at risk of serious illnesses. Hence, there is a greater need for them to get vaccinated as soon as possible.
Most older people are suitable for vaccination, except people with anaphylaxis (severe allergy) which includes severe angioedema (rapid swelling of the lips and/or eyes); bronchospasm (acute narrowing of the respiratory airway, causing wheezing and shortness of breath); and/or low blood pressure, to medications, vaccines, food, insect stings, or unknown triggers.
Immunosuppressed people (e.g. transplant patients, those taking immunosupressants or undergoing chemotherapy) might be unsuitable for the vaccine.
If older people have any of these contraindications, it is advisable for them to consult their clinician on whether they can take the vaccines, the optimal time to be vaccinated, and if they need to withhold certain immunosuppressants (drugs that suppress, or reduce, the strength of the body’s immune system).
However, if you are still concerned about the safety of the vaccines with regard to the medical illnesses that you have, please consult your doctor.
Before vaccination, we need to make sure that the elderly are in good health.
As long as the condition is stable, such as controlled high blood pressure or stable blood sugar, they can get the Covid-19 vaccine.
Delaying vaccination
In acute febrile illness or any acute illnesses that require hospitalisation, vaccinations should be deferred.
Vaccines can be given once they recover from the acute illness, are able to perform their usual daily baseline activities and are deemed clinically stable by the treating clinician.
Compared with the natural immunity produced by the body, vaccination provides a stronger and more reliable immune system response.
In those who have been diagnosed with Covid-19, they can be vaccinated after they are fully recovered, asymptomatic and meet the criteria to discontinue isolation (14 days).
However, there is no urgency in vaccination because the antibodies produced after contracting Covid-19 exist for at least three months.
If the elderly have recently received any other vaccines, such as the influenza or pneumococcal vaccine, the Covid-19 vaccination should be postponed for at least two weeks.
The elderly need to have adequate rest and sleep before vaccination, drink sufficient water, eat moderate amounts of food but not too full, because this may cause vomiting in those who are very nervous.
If they are in good health, they do not need to specifically measure their blood pressure, heart rate, blood oxygen saturation, blood sugar level or perform any blood tests before vaccination.
They should take their regular medications as usual, whether it is before or after the vaccination, including insulin.
However, if they are taking an anticoagulant, such as warfarin, they should take it after the vaccination and not miss the dose.
For people taking immunosuppressants, they will need to discuss with their specialists to see if these medications need to be withheld.
After vaccination
Side effects are part of the human immune system’s response to vaccines and each person has different symptoms.
The currently known side effects of the Covid-19 vaccine are mild and temporary.
The common ones are pain, swelling or redness at the injection site, fatigue, headache, chills, fever, joint pain, muscle pain, nausea, diarrhoea, feeling unwell, lymph node swelling and itchiness, though this is less common in the elderly.
However, please be assured that if there are no side effects after vaccination, it does not mean that the vaccine is ineffective.
Due to weaker immunity, the side effects of vaccination in the elderly are usually milder than those who are younger, but the impact may be greater.
Take arm soreness, for example.
Young people may not be troubled with daily activities, but the elderly may be unable to walk with a walker, or unable to eat or drink on their own, leading to dehydration.
Older people, especially those who are very frail and receive the Covid-19 vaccination should be monitored post vaccination for at least 72 hours for symptoms of fever, poor oral intake, confusion and weakness, which may lead to an acute deterioration in their condition. Therefore, it is recommended that family members or caregivers pay more attention to the elders and provide support and help in a timely manner.
If the side effects of the elderly have not subsided after three days, are very serious and do not improve by simple measures and medications, or if they are unable to eat, drink, or fall a lot due to weakness, pain, etc., they should seek medical advice promptly.
If the elderly have other symptoms that are not listed as side effects of vaccination, they should also seek medical advice, as they may happen to have other underlying health conditions.
How to deal with minor side effects of elders at home after vaccination?
- Painful, red or swollen site of injection: Paracetamol can be taken. Cold pad can be applied.
- Tiredness: Eat and drink sufficiently and ensure adequate sleep.
- Headache: Paracetamol can be taken, but avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, diclofenac and so on.
- Muscle and joint pain: Paracetamol can be taken, or analgesic gel can be applied.
- Chills or fever: Paracetamol can be taken. Elderly people should drink more water and keep their body temperature down by wearing only thin layer of clothes, turning on the air conditioner or fan.
- Nausea: Antiemetic drug (drug that is effective against vomiting) can be taken.
- Diarrhoea: Antidiarrhoeal medicine can be taken and drink plenty of water.
Remember, older people who get infected with Covid-19 are much more likely to get severe illness due to multiple chronic medical illnesses.
Therefore, they should be vaccinated.
Dr Tay Hui Sian is a consultant physician in internal and geriatric medicine. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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