Active shooter events, characterized by individuals engaging in mass shootings in public places, have tragically become a global concern. Such events have been associated with terrorism, conflicts, and mental health issues. These incidents, often marked by the randomness and unpredictability of their occurrence, present a significant challenge for societies and emergency responders worldwide. Within the broader context of disaster management, active shooter events are considered “Black Swan” events – rare, unexpected, and have severe consequences.

Throughout history, the world has witnessed numerous active shooting incidents, leading to devastating loss of life and immense psychological trauma. Some infamous examples include the Columbine High School Massacre in Colorado, the Virginia Tech Shooting, and the Sandy Hook Elementary School Shooting in the United States. These incidents have sparked debates on gun control, mental health support, and security measures in public spaces. Coming near to home, one noteworthy active shooting incident in India occurred on a passenger train traveling from Jaipur to Mumbai, in 2023. A Railway Protection Force constable opened fire on his colleague and three other passengers. The incident resulted in fatalities and injuries. Similarly, in November 2008, Mumbai, India, witnessed one of the most devastating terrorist attacks in its history.

As of now, active shooting events have not gained priority in the list of potential hazards in Nepal. Therefore, it has not been seen to be addressed separately in disaster management plans and capacity-building training. One of the possible reasons might be the strict gun law in Nepal which is governed by the Arms and Ammunition Act of Nepal, 1962 (revised 2018). This prohibits the unlicensed acquisition of firearms and carrying them in public places. Nepal is also known for its cultural diversity and harmony and has largely enjoyed a peaceful existence. However, the possibility of an active shooter incident cannot be ignored in today’s interconnected world, geopolitical situations, and emerging trends. On June 1, 2001, a tragic incident known as the “Royal Massacre” occurred in Nepal, where ten members of the Nepalese royal family, were assassinated at the Royal Palace. The Royal Massacre was a Black Swan event that caught the nation and its healthcare system off guard.

Black Swan events in disaster medicine, such as the Royal Massacre in Nepal and the Taj Hotel shootout in Mumbai, underscore the critical importance of disaster preparedness and response planning. While such events are rare, they can have far-reaching consequences, impacting healthcare systems and communities. By learning from these incidents and implementing the lessons learned, Nepal can strengthen its disaster medicine capabilities and better protect its populations in the face of unforeseen disasters. Preparedness, coordination, and a focus on both physical and psychological aspects of disaster response are key to mitigating the impact of such tragic events.

Given the unpredictable nature of active shooter incidents, preparedness is paramount. Healthcare systems, law enforcement agencies, and emergency responders must have comprehensive active shooter response plans in place. Regular drills, training sessions, and coordination exercises are essential to equip professionals to handle such unexpected disasters. Personal protective equipment and specialized training in tactical emergency casualty care are also critical for effective response.

Ashis Shrestha
NSEDRM

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Flood Risk in Nepal

As per the disaster risk reduction portal of Nepal Nepal is home to over 6,000 rivers and rivulets that flow from the north to the south. Among them, there are perennial rivers like the Koshi, Narayani, Karnali, and Mahakali, which are fed by snow and originate from the Himalayas and snow-capped mountains. These rivers traverse through the hills and eventually reach the Terai plains. However, during the monsoon season, which spans from June to September, these rivers experience a significant increase in their water levels, resulting in severe damage to villages, croplands, and the inhabitants and livestock residing within the river basins. Even 6 inches of water can cause a person to fall, and just 2 feet of water can easily sweep away a car.

Health Concerns During Flood

The priority of flood survivors is shelter, food, and warm clothes, approximately 0.2% to 2% of flood survivors require urgent medical care. Drowning is the primary cause of death during floods, due to the challenges of reaching victims during the acute phase of a flood, cases of near-drowning leading to emergency department presentations are relatively uncommon. However, successful resuscitation and complete neurologic recovery have been reported for patients submerged in cold water for 40 minutes, thanks to the neuroprotective effects of hypothermia.

Fast-flowing floodwaters carry various large debris, including cars, trees, and other objects, resulting in trauma, such as orthopedic injuries and lacerations. Contaminated wounds resulting from traumatic injuries caused by floodwaters should be managed conservatively through irrigation and allowed to heal through secondary intention. There have also been reports of floodwaters displacing snakes and other animals, leading to an increased risk of animal bites. Moreover, the presence of excessive water during and after a flood contributes to a higher incidence of insect bites and the transmission of vector-borne illnesses. The force of floodwaters may also lead to the disruption of power lines, flood electrical circuits, and submerge electrical equipment, heightening the risk of fires and electrical hazards.

The temporary shelters to accommodate those displaced by flooding can create crowded and unsanitary living conditions, thereby increasing the likelihood of gastrointestinal and other infectious diseases. Victims of floods, as well as other natural disasters, are prone to elevated risk of developing mental illnesses and substance abuse disorders. The population affected may be devoid of basic health needs like basic health services, emergency health services, and sexual and reproductive health. Besides this Gender-based violence (GBV), and managing the health needs of disabled persons and patients living with chronic illness increases the vulnerability.

Health Care Facility Planning and Preparedness for Flood

• Evacuation routes should be planned and practiced.
• The availability of an emergency communications system such as two-way radios, cell phones, and internet connectivity is important.
• Social media resources in community and hospital communications plan for information sharing and reporting of health and rescue needs are important parts of planning.
• Floods can be long-term events lasting days to weeks, so hospitals should have at least 72 hours’ worth of disaster supplies, including food, water, and essential items.
• Emergency kits should include a portable battery-operated radio, flashlights, batteries, first aid kits, personal sanitation items, local maps, and a cell phone with a charger or spare batteries.
• Hospitals should establish a plan for requesting additional staffing, services, or evacuation assistance through their emergency communications system.
• During floods, transport times may increase, and hospitals may rely on alternative means of transport, such as aeromedical support needs to be planned.
• Planning for addressing GBV, SRH, and shelter for mothers and newborns are important aspects of preparedness.
• Disaster plan needs to be disability-inclusive and address the needs of the patient with chronic illness.

Conclusion

In order to uphold the constitutional right to free Basic Health Services and ensure that every citizen has access to emergency care, it is imperative to establish comprehensive preparedness measures. This entails developing robust systems and protocols to effectively respond to health emergencies, providing necessary resources and training for healthcare professionals, and implementing efficient emergency medical services. By prioritizing preparedness, Nepal can ensure that its citizens are not deprived of essential healthcare services during critical times.

Ashis Shrestha
NSEDRM

Background

Cyclone Freddy, which lasted for 5 weeks and 3 days, holds the record for the longest-lasting cyclone. Initially starting as a tropical storm on 4 February 2023, it progressed into a Category 5 cyclone on the Saffir-Simpson Scale before finally settling down on 14 March 2023. It formed in the Australian region cyclone basin before moving to the South West Indian Ocean basin. The storm’s maximum sustained winds of 270 km/hour lasted for 1 minute, while those of 220 km/hour lasted for 10 minutes. Several areas, including Mauritius, Réunion, Madagascar, Mozambique, and Malawi, were affected by the cyclone, with Malawi being the most severely impacted, followed by Mozambique. The total number of fatalities was 696, with 556 missing, 1,712,987 affected, and 1,612 injured. The areas suffered from strong winds, flooding, and landslides, leading to the destruction of crops, homes, schools, and health centers. Additionally, the storm struck Mozambique amid a cholera outbreak.

Devastating earthquake of magnitude 7.8 hit southern Turkey and parts of Syria at 4.17am on Monday followed by magnitude 7.5 nine hours later. According to United States Geological Survey (USGS), the depth of the first earthquake was at a depth of 18 kilometers and 7.5 magnitude aftershock was 10 kilometers. The relatively shallow depth earthquake has been classified “major” on Richter scale.

The region lies in an area where three tectonic plates meet, making it one of the most earthquake-prone in the world. The region has experienced number of earthquakes in the past, which includes a quake in 1999 of magnitude-7.4 around 11 kilometers southeast of Izmit that killed more than 17,000 people. After this earthquake new building codes was introduced by the government of Turkey.

However, the recent earthquake has taken more than 35000 lives and affected nearly 13 million people. According to Turkish authorities, at least 33,143 buildings have been destroyed and the death toll rising as bodies has been pulled out of the collapsed structure. With such a damage, experts have started questioning the implementation of building code. It is known fact that building code always tries to avoid total collapse which was the opposite that was seen in Turkey.

The stricking feature of the building damage is the type of collapse which is called pancake collapse (floors piled one on top of another with the walls fallen away completely). Reports says that there was tremendous loss of life from pancaked buildings as this type of collapse makes it difficult to save life as Kathmandu had experience in 2015 Gorkha earthquake.

The modern building (built from concrete) collapsing in pancake mode has raised the alarm on safe building construction and implementation to seismic building code. Among different factors, experts have identified inadequate seismic reinforcement and poor quality of building the main reason for such a massive damage.

The massive damage of building in Turkey reminds of the damage of modern buildings in Kathmandu during 2015 Gorkha earthquake.  It is time for us to learn the role of local agency in constructing safe building.

Inu Pradhan Salike
NSEDRM

It is a discussion-based exercise to evaluate an organization’s preparedness for a particular disaster by using simulation scenarios in a stress-free environment to inform the required participants about their roles at the time of response.

Key components and their roles in TTX

1. Participants
   • Response members of specific disasters
   • Willing to engage themselves
   • Worked within scenarios of presented parameters
   • Challenge oneself and others in a cordial manner
2. Facilitators
   • Prepare and control the pace of the exercise
   • Ensure each member is participating
   • Stimulate discussion among the participants in order to draw out answers and solutions from groups
3. Evaluators
   • Identify strengths and weaknesses of the exercise and means and ways of improvements
   • Prepare After-Action Reports

4. Observers
   • Ready to participate in discussion when asked

Reasons for conducting TTX

1. Preparation
   • Institutions should have a concrete plan and disseminate it to each and every member of the institution
   • The scenario going to be discussed in TTX should be informed to authorities and external experts in advance in order to find out flaws or gaps in the institution
2. Testing
   • Testing the preparedness plan in a safe environment will identify the effectiveness of the response plan and can be effectively compared between different responses according to the scenario
3. Identify flaws in the plan
   • Conducting TTX will help to improve the plan by identifying missing links in the chain of command and finding gaps in our recovery processes
4. Returns of Investments
   • Knowing their responsibilities at the time of disaster can maximize the effectiveness of response and saves needed limited resources
5. Coordination and communication
   • Internal and external coordination and communication during a disaster are key to a successful response which will be clearly outlined during TTX
6. Determine roles
   • Identifying key members for responding to disasters will minimize chaos and clarify roles and avoid confusion
7. Peace of mind
   • The information gathered from your tabletop exercise discussions can help provide a personalized roadmap to strengthen our plan and make responders confident during the response

Dr. Bikal Shrestha
NSEDRM

On January 15, 2023, a fatal aircraft crash in Nepal killed 72 onboard. The committee investigating found an issue with the engine of the aircraft and is further investing human and technical errors associated with the air crash.  In the last three decades, 52 flights have crashed in Nepal ranking it 33 out of 207 countries with the most air crashes between 1990 and 2023. An aircraft crash is a highly visible event that gathers intense public and media scrutiny. Response activities are carried out by untrained local first responders, emergency managers, local leaders, and security agencies. Though a majority of aircraft crashes (80%) occur during takeoff and landing at an airport or nearby, a potential threat of crash always lies in the community with aircraft flying overhead.  The potential for fatalities and injuries is both for passengers flying and the local populace at the accident site.

Pre-incident preparedness consideration includes considering the size, capabilities, and ability of medical facilities closest to the airport as a response may begin from Airport Firefighting (ARFF) services but will quickly escalate to a mutual aid response. Planning considerations also include planning for trauma centers near the airport and transportation services. Airports must have an Airport disaster management plan updated regularly with drills and simulation exercises. As the scale of aircraft crashes is often large, they require support beyond the airport authority, so drills and exercises must involve local and regional hospitals, emergency operation centers and managers, fire, and security forces, and public health services. Local experts in disaster medicine should be invited to planning, training, and testing exercises. The size of the airport, the size of the aircraft, passenger capacity, and the types of aircraft landing will determine the nature of fatalities and injuries and they should be kept in planning consideration. Improved structural integrity, enhanced occupant protection mechanisms, improved fuel cutoff, and fire extinguishing capabilities, and suppression of toxic fumes from burning cabin materials, and aircraft conditions during and immediately after an air crash, all determine the survivability of passengers. Risk to passenger safety increases with fire or explosion as trauma is compounded by burns and rapid incapacitation by heat, smoke, and toxic fumes.

Post-incident air crash operations are likely to follow four distinct operational phases: emergency response, transition, stabilization, investigation, and recovery. In the emergency response phase, the focus is on lifesaving, firefighting, and safety-related operations involving unified command center establishment, on-site management, passenger tracking, and safety and security of the incident site. The emergency phase ends when the last surviving passenger is transported from the scene and all hazards at the crash site are eliminated. The transition and stabilization phase occurs simultaneously with the emergency response phase. The disaster site is assessed, recovery plans are developed, morgue operations are established, a family support center is established and forensic support is initiated. This is a collaborative phase of air crash response where airline representatives, health executives, law enforcement agencies, and transportation authorities all work together to help with forensic services like identification of victims, counseling relatives, and communicating with foreign governments. The investigation phase will initiate after the stabilization of the crash site and may last for several days to months. This will determine the cause of the aircraft crash. The final phase of recovery starts with the end of the investigation and may also last for days to months and begins with the transition to normal flight operations. This also means clean-up operations at the crash site, demobilization of resources, and finalization of all reports with proper documentation. This is completed by an after-action review of the accident.

Types of injuries in an air crash are primarily related to a combination of blunt, penetrating, and thermal injuries during explosions as well as during the evacuation process. Fractures are the most common injuries followed by head trauma, thermal and burn injuries, and inhalation injuries. In catastrophic crashes, no chances of survival are expected.

The first responders on aircraft crash away from the airport are always from the community and are neither trained to manage the incident nor maintain personnel safety during response. Hence, appropriate community awareness programs should be conducted by authorities and community engagement during exercises and drills is important.

Naveen Phuyal
NSEDRM

The southeastern Turkey and northwestern Syria experienced a devastating earthquake of 7.8 magnitude on 6^th February, 2023 at 4:15 am local time. A number of buildings collapsed, increasing the death toll to 5000 in 30 hours. The size of the earthquake is a significant element, but it is not the only one. More than 200,000 people died as a result of the 2010 Haiti earthquake, which had a magnitude of 7, the 2011 Japan earthquake, which had a magnitude 9 claimed 12000 lives, and the 2015 Nepal earthquake, which had a magnitude 7, claimed 8000 lives. Therefore, factors that are associated with deaths are the population, the structural and non-structural elements and the readiness of the medical response.

According to studies, the need for medical attention peaks between 12 hours and 3 days after an incident, and the number of patients seeking emergency care peaks between 24 and 48 hours. Soft tissue, bone, chest, and brain traumas are the most frequent types of injuries. Renal failure as a result of crush injuries is also rather prevalent, particularly in densely populated urban areas. It’s also wise to prepare for the burn brought on by a flash fire due to natural gas pipe break. In addition, lung injury brought on by dust inhalation from a building collapse are also possible.

In such condition medical response requires, arrangement for management of trauma, intravenous fluids, dialysis as well as preparedness of burn center and management of respiratory problems. The coordination of effort can be best done by activating hospital incident command system. Surge plan needs to be activated by coordinating hub and satellite hospitals.  Best response is achieved by working on preparedness, therefore preparedness is the key to effective response. The country like Nepal which is also prone to earthquake must consider investment in preparedness. This includes implementation of building codes; structural, non-structural improvement; training medical persons, stock piling and development of disaster management plan.

Ashis Shrestha
NSEDRM

The importance of leadership in healthcare was seen during Covid-19 when the whole world was confused and relied on the healthcare system to steer and guide the planet towards certainty, to continue human efforts towards progress, and safeguard the human development related to health in all aspects. In line with the concept that leaders are not born but made, there have been many initiatives to train leaders in all sectors including health. Leadership has many definitions and varies from context to context but the simplest way to define leadership is the ability to influence others to attain your goal.

There are different levels of leadership, and competencies of leaders based on the foundation of the character of the leader that is built over a period of time with training, experience, and responsibilities and measured during disasters, pandemics, and tough times. Leadership in today’s world means simplifying the complexities of health issues and putting everything you have learned into practice.

With the right competencies and characters, everyone in the healthcare system can become a leader, all you need is a set of guiding principles, a few mentors, and an aim to learn from each and every situation.

Are you prepared to be a leader in the healthcare system today?

 Dr Naveen Phuyal
NSEDRM
[email protected]

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On November 8, 2022, Doti District, Nepal was hit by the experienced earthquake and its aftershock between 7 to 8 pm. It was a minor earthquake with no damage. However, on 9^th November, at 2:12 am we experienced the second aftershock which was a 6.6 rector earthquake lasting for about 4-5 seconds causing damage to buildings. The third aftershock was experienced at 3:30 pm which lasted for 2 seconds. Buildings that were cracked would have collapsed if the aftershock had been stronger.

At four in the morning, the Chief District Officer and the Superintendent of Police informed me about the injured victims. We started emergency preparedness, activated rapid response teams, and prepared emergency, X-ray, and pharmacy staff to receive injured patients. We additionally organized IV cannula, analgesics, IV fluids, POP, and dressing sets.

The place that had the biggest impact was Gaida, which was an hour drive from the hospital followed by a 90-minute walk. So, we started receiving patients from 7 am. There were six patients, four of the patients had a minor injury, one patient had injury around the shoulder joint and one patient had multiple rib fractures, pneumothorax and cervical spine fractures. These two patients were referred to Seti Zonal Hospital. There were six dead reported to us, so we sent a team of doctors for verification and documentation.

The patient with pneumothorax was treated with chest tube. As soon as we inserted chest tube, the local attenders transferred the patient to the ambulance because the helicopter had landed. The anxious group took the patient to helipad not knowing the consequences of cervical spine injury despite of our effort to make them understand. We had not finished writing our clinical note when the ambulance moved. We completed the clinical note quickly and followed the ambulance in motorbike to handover the clinical note at helipad.

The transfer was coordinated by District Disaster Management Committee which is under the Chief District Officer. Air evacuation was carried out by the team of the Nepali Army.

It was a bad experience after the 2072 earthquake.

Dr. Nirajan Shrestha
General Practitioner, Doti District Hospital

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In 2015, two powerful earthquakes hit Nepal, killing almost 9000 people. Starting from 2020, the COVID-19 pandemic has taken the lives of more than 12000 people in Nepal. Health is one of the fundamental rights in the constitution of Nepal. Article 1 (35) states “Every citizen shall have the right to free basic health service from the State, no one shall be deprived of emergency health services.” The constitution provides the authority for disaster risk reduction and management at all levels including the health system.

Nepal only had the Natural Calamity act, which provided relief work after a disaster. And, only in the aftermath of the 2015 earthquake disaster risk reduction and management (DRRM) act was formed, which recognized the importance of risk reduction and preparedness for disaster. The constitution, Health/ Public health service Act, and regulations includes: Infectious Disease Act (1964), Public Health Service Act (2018), and the Public Health Service Regulations (2020). The Public health service act and regulations contain a provision for emergency health service and management. It has provided the right to all three tiers of government to form and implement emergency health plans with standards determined by federal law. The infectious disease act of 1964, enforces necessary steps for the prevention, information, and management of infectious diseases by health organizations.

Nepal has now achieved a legal framework, which purposes a multilevel disaster risk management institutional structure at the national, provisional, district, and community levels. This ensures a reduction in dependency on international aid, improved health outcomes, and fast economic recovery.

The structure is primarily divided into two bodies. The first one makes policies and administrative decisions and includes the DRRM national council (led by the prime minister of Nepal), the DRRM executive committee (led by the home minister), and the expert committee. The expert committee is responsible for the formulation and implementation of policies and plans which are purposed to the DRRM national council for approval. There is a division in the Ministry of Health and Population (MoHP) under the Minister and Secretary of Health Emergency and disaster management unit (HEDMU) composed of Medical officer and a section officer. This unit coordinates through the health emergency operation center (HEOC) and acts as the secretariat of MoHP-ICS and health sector center point and the central communication body for health emergencies and disasters. The HEOC Network consists of provincial HEOCs known as PHEOC which were established as a coordination hub in 2015. It aims at coordinating with the 25 hub hospitals and satellite hospital network, relevant health partners, and non-health EOCs for disaster preparedness and response. The HEOC has also been entitled to activate the health (WHO) and nutrition (UNICEF) cluster during emergencies followed by the inclusion of key humanitarian partners.

Furthermore, there is district disaster management at the district level as District Emergency Operating Centre (DEOC) which is chaired by Chief District Officer (CDO), and Local Emergency Operating Centre (LEOC) at the municipality level under the chairperson of the Mayor. The LEOC coordinates with PEOC directly and NEOC through DEOC. Besides HEOC, NEOC also coordinates with National Bhukampa Mapan Kendra, TIA, UN emergency center, Disaster Adhyananushadhan Kendra, NRCS, Nepal Army, APF, Nepal Police, Fire brigade, and Meteorological division.

Disaster is always a challenging situation at all levels including the health sector despite the preparedness. The healthcare system becomes a high-profile element, critical to the immediate health response and recovery phase during any disaster. The earthquake in 2015 was a big wake-up call for disaster management in Nepal. Though there has been remarkable progress in all phases of disaster management cycle after 2015, we still felt the void during the COVID19 pandemic 2020. Awareness, education and understanding of the existing system is important for progressiveness in disaster management therefore this write-up is a small nudge regarding our existing disaster management in the health system of Nepal.

Dr. Dipesh Mangal Joshi (MD, Fellowship in EM) and Dr. Rony Maharjan (MD, Fellowship in EM) are faculties at Patan Academy of Health Sciences, Lalitpur, Nepal

[email protected]

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On October 30, 2022, South Korea saw one of the most tragic nights when more than 150 people died in a stampede. A similar event was experienced in Nepal where 70 death was declared officially in 1988, during a friendly match between Nepal and Bangladesh at Dashrath rangasala. There are many mass gathering events in Nepal like Jatra, Parba, Mahotsav, Aamsabha, concert, ralley etc; some of which include activities like Chariot pulling and mass movement. This type of mass gathering events requires optimal preparedness to avoid disaster.

During big gatherings, those in the back row begin pushing those in the front row as they move forward, creating a continual force. Each person forms a barrier to the mobility of other people, and if someone falls, it is impossible for them to get back up. As a result of their fear, people start moving erratically, crowding, and making physical contact with one another. The pressures generated by crowds can exceed 4500 N (1000 lbs) which is sufficient to collapse brick walls. The majority of deaths are due to compressive asphyxiation, where people are stacked vertically or horizontally, creating compressive and tilting forces. Traumatic asphyxia is a leading cause of death and serious injury.

During the mass gathering, the nature and type of disaster are unpredictable, however, it is not the incident but the lack of preparedness that takes more life. Therefore, in large mass gathering events, avoiding fixed barricades, ensuring multiple exits, minimizing bottlenecks, limiting access to alcohol-drugs, and improving preparedness will help in minimizing casualties. The coordination mechanism with various agencies like Hospitals, Fire brigades, Police, etc must be in place. In each event, the system of incident command must be practiced, planning and coordination mechanisms must be checked with tabletop exercises.

Dr. Ashis Shrestha
NSEDRM
[email protected]

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NSEDRM, 27 September 2022

Dengue has hit Kathmandu valley with surge of cases in hospitals. This is the state of disaster that has been continuing for past many weeks. Though this has low mortality than COVID-19, the healthcare facilities in the Kathmandu valley has received an overwhelming patients. Prevention is the best modality to control Dengue.

On this context Dr. Bikal Shrestha is providing a brief information (Podcast) on Dengue. This information is helpful to both medical and non medical persons. Dr. Bikal Shrestha is a Preventive medicine specialist.

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Simulation Exercises

Simulation exercises is valuable in health sector as it helps to prepare well. This type of exercises can be done in any sector of health, however it plays a crucial role in disaster preparedness. There are four types of simulation exercises: table top, drill, functional exercise and full scale simulation exercises. It is not very helpful to perform full scale simulation exercises without preparation and capacity building. At the initial stage of planning and development, table top exercises are good to find the gaps. Once the activities and actions are set, those activities can be tested and fine tuned with drills. For example, triage activity can be tested with drill and improved as per the finding of the drill. Once every components of activities of the system are set, the coordination mechanism needs to be addressed in the policy and practice. This mechanism can be tested with functional exercise where injects are given but simulated patients are not mobilized. This is followed by full scale simulation exercise,  where the system can be tested once the capacity building has reached operational level. In this type of exercise victims are mobilized (video link below).

Simulation exercises are important part of health care. Its practice needs to be implemented from medical school as a part of training to testing of hospital system, and national policy.

http://https://youtu.be/-oz6HXFP9zw

Ashis Shrestha
NSEDRM
[email protected]

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Vaccine effectiveness against symptomatic Covid-19 with the delta variant decreased with ChAdOx1-S and the BNT162b2 vaccine after 20 weeks of second dose. However, effectiveness against hospitalization and death did not decrease much at 20 weeks.

The wening was more in

ChAdOx1-S vaccine as compared to BNT162b2
Persons 65 years of age or older
Clinically extremely vulnerable group
Persons 40 to 64 years of age with underlying medical conditions
Effectiveness of BNT162b2 vaccine during proxy omicron period was 70%.

Reference: NEJM

DOI: 10.1056/NEJMc2119270
DOI: 10.1056/NEJMoa2115481