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Why teens shouldn’t exercise after vaccination

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OP-EDS

Tens of thousands of 12 to 17 year olds around the country presented for their COVID-19 vaccines this week. What advice should teens be given after being vaccinated?

The concern is that strenuous exercise in the week after a vaccine, while the immune system is mounting a response, may predispose teenagers and young adults to the very rare complications of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the thin membrane that surrounds the heart).

Myocarditis and pericarditis occur at a rate of 65 per million doses of Pfizer vaccine, more frequently after the second dose. To put it into perspective, the rate of myocarditis in patients infected with the SARS-CoV-2 virus is 450 cases per million infections. Cases that have occurred after vaccination have mostly been mild and resolved in a few days.

There are no official guidelines on exercise post vaccination. Out of caution, some countries, such as Singapore have advised adolescents and patients under 30 years of age to avoid strenuous physical activity (intense exercise) for one week after receiving a vaccine.

Hatzolah is advising patients to avoid strenuous exercise for one week post vaccine, and based on this, some schools in Johannesburg have suspended all sports for this week following a mass vaccination campaign at schools.

My advice to teens is to avoid very strenuous activity such as running, cycling, rugby, soccer, and other cardiovascular activity for five to seven days. Within this period, they should monitor their heart rates and how they are feeling when participating in milder activities.

If they have fever, excessive fatigue, or severe muscle pain, they should rest completely for a few days. These symptoms can be treated with Panado.

Should their resting heart rate be elevated above normal or their heart rate go up more than usual while exercising, they should rather rest for a longer period. Symptoms to watch out for in teenagers in the two weeks following vaccination include chest pain, shortness of breath, a fast, irregular heart rate, and fatigue. In the unlikely event that your teenager develops any of these, you should seek medical care.

For teens participating in competitive sports or intense training, the timing of the vaccine should be carefully considered. It’s best to plan for at least five days off intense training. This may sound inconvenient, but remember that the recommended rest time from exercise after testing positive for COVID-19 is two weeks after recovery.

Teens who are in quarantine or isolation following exposure are also not able to participate in sport. Vaccinating high school students will ultimately reduce the amount of time spent off school and off sport, making a one-week rest period easier to accept.

In a webinar for health professionals on 26 October, Professor Claudia Gray, a paediatrician from Cape Town, outlined five reasons why she believed that adolescents should be vaccinated against COVID-19.

  1. While mild disease is likely, it’s not guaranteed and one doesn’t know which previously healthy teenagers may be severely affected. The Delta variant has caused a higher number of infections in teenagers, with an increase in admissions to intensive care, teenagers needing ventilation, and death, which is “unacceptable in a disease that is modifiable by vaccination”;
  2. Complications such as multi-system inflammatory disease and long COVID-19 can be prevented;
  3. Transmissibility can be decreased, which has widespread repercussions for the community. Teenagers find it difficult to distance themselves physically from others and isolate;
  4. Vaccinating this group helps to prevent new and potentially more transmissible or more severe variants from evolving; and
  5. It gives us a chance to normalise our community – the more people vaccinated, the greater the chance of, for example, watching our children play sport again.

Esteemed critical-care professor at the University of the Witwatersrand, Professor Guy Richards, concurs with this, reinforcing the ways in which vaccines reduce transmission, including less spread from asymptomatic individuals and a shorter period of viral shedding in vaccinated patients.

Gray said that she timed the vaccination of her own adolescents before the weekend so that they could have a 48-hour complete period of rest from exams and sport, so that if they got a sore arm, headache, or fever, they would be able to rest. She advised that young males should avoid all exercise for two days, and avoid intense, strenuous exercise for five days. She reminded doctors that it takes three to four weeks to build up immunity, and said parents should consider vaccinating in time for teens to have immunity before the December holidays.

Though serious side effects following vaccines in adolescents are exceedingly rare, it’s wise rather to be cautious and invest in a few days of rest before undertaking strenuous exercise following vaccination.

  • Dr Sheri Fanaroff is a GP in private practice in Johannesburg.

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2 Comments

2 Comments

  1. Rabbi Doctor David Nossel

    Oct 28, 2021 at 11:10 pm

    There are respected medical specialists who are of the opinion that it is wise to exercise caution in this matter. In a population group where the disease risks are low and the long term safety and efficacy are still unknown it seems’secheldik’ to wait and see.

  2. Larry

    Nov 2, 2021 at 4:14 pm

    I’ve never seen such crap reasons to give kids a jab. All of the reasons given are seriously flawed. It’s like this article would have made sense last year, but cu ft rent knowledge contradicts all of this. Kids are not high risk. Never were. And Vax efficacy had been severely criticised worldwide,with boosters needed continually. I also would like to question the “tens of thousands” of kids running to get vaxed? Don’t think it’s that popular.

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OP-EDS

Omicron: hoping for a storm in a teacup

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An avalanche of panic calls, contact questions, and quarantine-bound disappointed families was certainly not what I expected in the last week of November. I have, once again, awoken this morning to a stream of positive COVID-19 test results.

Every day this week has been similar. This after a month of not a single COVID-19-positive result detected through my practice.

COVID-19 has been described as a pandemic of disease, economic challenge, and patient anxiety, and it’s always that anxiety that we, family medical practitioners, have grappled with at the start of a new wave.

This community anxiety is applaudable because it reflects the deep respect that this virus has gained. The trauma our community has experienced over the past 22 months has scarred us. It’s this deep respect that, in fact, propels our community to contain COVID-19 outbreaks and directly act to save lives now.

However, anxiety needs to be transformed into evidence-driven knowledge to be productive. Knowledge empowers patients to make informed choices about socialising, travelling, and even the symptoms to look out for in their bid to keep safe and still live “normally” during a COVID-19 surge.

Imparting this knowledge is the most time-consuming occupation for my GP colleagues and myself at the moment. We have, once again, invested deeply in responding to every question, sharing sound information, and finding innovative ways to educate our community appropriately.

The mental fatigue from the formidable task of caring virtually for dozens of COVID-19-positive patients is balanced by the sense of worth in making a dent in this pandemic.

I recognise that as much as long workdays and being a distracted father may not be the best input I could give my family now, these efforts may truly assist a large number of other families to get through this unexpected twist at the end of this challenging year. Each of the GPs in our community has expressed similar sentiments.

The COVID-19 sky isn’t so dark this time round. We’re familiar with managing COVID-19 at home. I think back to June 2020 with its grocery sterilisations, runs on hydroxychloroquine, debates about whether masks actually matter, and even COVID-19-toe queries, and realise how far we’ve come.

We now know what evidence-based vitamin regimens to give patients early on in the disease. We know how to track their vital metrics at home. We know what signs of deterioration to look out for, and we have a good idea how to prevent the spread of infection.

The Omicron finding has been trying. We are now dealing with an “extra-novel” coronavirus. Virologists have warned that with more than 50 new mutations, more than 30 of which are on the spike protein by which the virus enters the human cell, we can predict serious disease and a resultant escalation in hospitalisations and death.

The thought of once again conducting midnight rushes of hypoxic patients to hospital, running daily blood tests on serious patients at home, and counselling patients after regrettable losses is overwhelming.

However, our experience this week on the ground has been the saving grace so far. Our community is largely vaccinated, unlike the majority of South Africans who unfortunately aren’t.

Amidst all the speculation as to whether vaccines work against the Omicron strain, we are seeing vaccinated patients easily contracting COVID-19, even if they have had a previous infection in the past three months.

Thankfully, though, they aren’t becoming particularly ill.

Although routine COVID-19-positive swabs aren’t undergoing genomic sequencing to establish whether or not they are the Omicron strain, the massive uptick in cases with a concomitant community finding of a new variant suggests they are.

The juxtaposition of these facts implies that either Omicron is, in fact, mild, or that vaccines are, indeed, protective. It’s too early to predict that this surge of Omicron will be mild, but if you are a clinical optimist, the prospects are looking good.

I have experienced a flood of questions this week requiring a recap of the basic facts.

* Exposure to a COVID-19-positive individual still requires a 10-day quarantine. A negative test at five days doesn’t shorten that time;

* Exposure is defined as contact within two metres. Masks are protective, but in closed environments, masks don’t obviate the need to quarantine unless the exposure is both outdoors and distanced;

* There are no new novel treatments for early COVID-19 infection. Vitamins remain the mainstay of early treatment, and steroids are largely contraindicated in the first week. (Regeneron, molnupiravir, and ritonavir are all new effective treatments for early COVID-19, but aren’t yet available in South Africa.);

* Isolation for infected patients remains 10 days;

* Secondary contacts don’t need to quarantine; and

* Vaccinated individuals who are exposed to positive patients need to quarantine as well.

I believe the next two weeks will be the most telling time for our community in this pandemic thus far. We have all worked tirelessly to get ourselves vaccinated, and we are desperate to continue our former lifestyles, even alongside COVID-19.

I’m filled with optimism, and hope that for those of us who have been vaccinated, the worst of this new strain of COVID-19 will be a disruption of our holiday and perhaps the experience of a contagious flu upon some of us.

However, until we know more, and while so many of the South African population is unvaccinated, it’s vital that we pull up our masks, socialise safely, and test appropriately over this peak.

I look forward to the next relaxation of these measures, a population greater vaccinated, and a less daunting situation next year.

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After all the bad news, the economic outlook is still positive

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The legendary New York Yankees’ catcher, Yogi Berra, renowned for his paradoxical axioms, was attributed as saying, “It’s like déjà vu all over again.” Just as infections and hospitalisations were falling and we were beginning to delight in the pleasures of our former lives, along comes news of a new COVID-19 variant that has put an abrupt halt to our holiday plans.

At this point very little is known about Omicron – the name given to this new mutation. Apparently, it’s fast spreading, but other than that, we don’t know whether it’s dangerous and if our vaccines are sufficiently effective to fight it off. And as we have witnessed in the past, no one is hanging around to wait for the answers. While countries have slammed shut the doors to travellers from South Africa, in financial markets some investors, fearing a resumption of harsh social and economic measures to contain the spread of this new variant, have abandoned equity and commodity markets, seeking safety in the US dollar and US government bonds.

The past two years have been difficult for us in many respects, from worrying about our physical and mental health to being concerned about our relationships, our jobs, our businesses, and our families. From the outset, medical experts warned that it would take years of effort before the virus was tamed and relegated to nothing more than a commonplace flu. The good news, though, is that while things still seem bad, they’re getting a little less bad each day.

The pandemic caught the world off guard. Healthcare systems were inadequately equipped and organised to handle the load of wide-scale hospitalisations, COVID-19 testing, and vaccine rollouts. It could have proved to be a moment for global cooperation but, instead, each country acted on its own, protecting its borders and looking to develop its own remedies. Developed countries did little to safeguard less developed countries or share vaccines with them. Yet again, the latest outbreak demonstrates that until the whole world is vaccinated, no one is safe.

In response to these failings, vast amounts of money are being invested in global healthcare. Several new vaccines and drugs to treat chronic diseases will be released next year. Innovative genetic therapies – aimed at curing diseases by modifying or removing human genetic information – are finding their way to market, together with pioneering robotic surgical devices and groundbreaking diagnostic tools.

While domestic politics uncaringly controlled how countries chose to fight the pandemic, encouragingly, central bankers and governments took appropriate action to address the negative impact of an economic shutdown, pumping liquidity into the market, slashing interest rates and providing financial support to businesses and individuals. Also, recognising that the recent crisis was a health crisis and not a financial one, the world economy is favourably positioned to work its way back to prosperity. Corporate earnings are above their pre-pandemic levels and individuals, flush with savings hoarded during lockdown, are eager to splurge.

The pandemic has changed our behavioural patterns, and even when we return to normality, the way we go about our lives, jobs, and relationships will never be the same. The pandemic brought forward the future. It accelerated our use of technology, from video conferencing to online shopping. It fast-tracked our adoption of technology to levels that had not been expected for years. In a matter of a few weeks, we were propelled five years forward. Yet more than anything, the pandemic burned our consciousness about the world in which we live, stirring us to build a new order rather than trying to return to or repair yesterday’s ways.

You can sense this in political calls for wealth redistribution and environmental action, and in society’s push to embrace gender and race equality at home, in schools, and in the workplace. Governments, eager to achieve net-zero carbon transition, are fast introducing legislation to penalise consumers and businesses that breach accepted pollution and emission standards. The path to clean air has become one of the most significant investment trends at present, opening appealing opportunities in renewable energy and carbon reduction solutions.

The drive to fight climate change has engulfed the motor industry that’s now riding a wave of exciting electric car strategies. Mainstream manufacturers cannot abandon petrol and diesel production altogether, but almost all are targeting all-electric output by 2030.

Electrification is not only the dominion of the motor firms but a big theme for the producers of semi-conductors and batteries too. It’s estimated that between $2 500 (R40 354) and $3 000 (R48 425) worth of computer chips will be embedded in each new-generation motor vehicle, while the challenge facing the battery industry is to reduce the size and weight of batteries and, at the same time, double its output and power. The need to secure metals essential for the manufacturing of batteries is a further demand. Apparently, a passenger vehicle battery requires 20kg of nickel, 20kg of cobalt, and 60kg of lithium compounds.

Besides possibilities arising out of the need to control our environment, the transition to automate business processes, boost efficiencies, and improve the quality of strategic decision-making will continue to spur investment spend. Disruptive technologies such as artificial intelligence, the use of big data, cyber security, and the rollout of 5G will remain dominant themes for at least the next decade. The downside to these enabling technologies is that with the number of connected devices growing rapidly, the hazard of online attacks has increased significantly.

Despite the odd setback, conditions in the world economy are improving. The success of the vaccine rollout backed by huge stimulus has enabled economies to open up. People are returning to work, socialising, spending, and getting their lives back. The erratic nature of the recovery has caused imbalances that will need to work their way through the system. These imbalances have manifested themselves in higher prices, especially in energy and labour, and until these are ironed out, interest rates will remain lower for longer. The economy that emerges from the pandemic will not be like the one we left behind, but that opens the way for attractive investment opportunities. The outlook for 2022 and beyond is encouraging.

  • David Shapiro is a veteran stockbroker, market commentator, and deputy chairman at Sasfin Securities.

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The Stockdale Paradox has lessons for locked-out South Africans

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*Trigger warning: This opinion piece references domestic abuse.

What do you call it when you’re dependent on someone and feel you can’t escape them? What is it when you’re being controlled and beaten down daily and locked up, having done nothing wrong? When your only crime was to simply be in the wrong place at the wrong time, and yet you feel like you’re being punished in inconceivable ways.

Ongoing isolation from those you love and being made to feel like nobody wants you has become a part of daily life. Locked away, you obsess over ways to escape. When you do, you find another gate is there to keep you ‘secured’. You try everything. Resources are all but consumed by your battle for escape. Your family are begging for you to get to them, but you’re cut off with what feels like no hope.

Every day you look through the bars at others who somehow made their escape and yearn for your day to come. Gradually more and more break free.

Your anger diminishes as you focus on the freedom that lies ahead as your day seems to be approaching. Excitement builds.

You try to suppress that nagging warning at the back of your head reminding you that this isn’t the first time you’ve felt this close and that you need to step cautiously. And just as you’re ready to step out, the door slams loudly in your face. You run to another door, but it was double locked before you got there. Even the back door clangs shut as you speed towards it. You’re desperate.

You beg and plead, but no one seems to hear you. As the lights grow dim, you sit in the corner depleted – deathly afraid to try again. What’s the point?

This is what it feels like for many stranded in South Africa at the moment. This is what they have been and are again being subjected to.

When I was made aware on Wednesday morning of a new variant of the COVID-19 virus sequenced by South African scientists, I immediately called a few volunteers to warn them of the possibility that South Africa was about to feel the backlash. But never in my wildest imagination did I expect it to be within a matter of hours and with such intense escalation.

Since the first news of a country closing its doors to South Africa came that evening, my phone has not been quiet. The speed at which countries jumped on the banning bandwagon is unprecedented, even since the pandemic began. All sense of logic seemed to vanish instantaneously and what was put into action is what I refer to as the ‘vicious 3-Ps cycle’.

I have to believe that South Africa’s scientists had good intentions. Perhaps they didn’t realise the power of sharing their discovery. But when the 3Ps take over, there’s no stopping them.

The PRESS

The PANIC

The POLITICIANS

Each dangerously feeds the next. The press uses this news to grow their readership, exercising their global online reach to create, eagerly selling more advertising space.

The now anxious global citizens implore their governments to keep them safe from the ‘scary variant’ they actually know little about.

Enter the politicians, many previously feeling the backlash from their voters blaming them for not having dealt rapidly enough with the Delta variant. They spring into banning action. There’s no time to reason and little to no logical consideration.

The press grabs hold of the fast-acting bans and race to cover them, creating more fear. The more experts try to engage with world leaders and reason with them over the fact that this isn’t exclusive to our country and is already found around the world, the more political heels are dug in for fear of losing face and votes.

Panic builds within South Africa. The press eat it up.

Everyone needs to step back, calm down, and take a strategic pause. There is a solution to navigate all this.

The best approach for most is to heed the Stockdale Paradox, so termed by Jim Collins, which highlights the incredible benefit of maintaining unwavering faith that, in the end, you will prevail in spite of the current struggles, but simultaneously remain cognisant of the harshest reality.

When Admiral James Stockdale was asked how he survived the torture of the ‘Hanoi Hilton’ war camps during the Vietnam War, not knowing when it would end, he answered, “I never lost faith in the end of the story … I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event of my life, which, in retrospect, I wouldn’t trade.”

He noted that the men who didn’t make it were the optimists’. They were the ones optimistically setting deadlines for when they felt it would end. Deadlines that continued to be made and missed. “And they died of a broken heart.” Stockdale’s approach was, “We’re not getting out by Christmas. Deal with it.”

Unfortunately for many, deadlines are an obvious requirement when it comes to booking tickets and planning our travel abroad. But if we learn from Stockdale and his paradox, we would plan our journeys in pencil for now, keeping our eye on the inked, highlighted, and underlined goal of the destination and reunions. The time will come. It did before. And we will prevail. It’s just a matter of when and how.

Community Circle Home SA has been incredible throughout the pandemic but even more so in recent days, holding space for each other and providing updates and compassion. As I proudly watched the Facebook group grow by thousands this week, I wish it was for better reasons, but overwhelmingly grateful that we have a space that can guide those stranded and support them within the circle. We will help you navigate this. We will guide you to your goal and help make reunions a reality.

Kim Kur is the founder and lead volunteer of Community Circle Home SA.

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