Covid-19 Vaccines Mythbusting — Part 2 : Debunking a fake news prevalent in Madurai

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The recent news about a 26-year old female doctor’s ( Dr. Hari Harini ) death has become a source of fake news and fearmongering against Covid-19 vaccines in and around Madurai.

The doctor had taken her first shot of Covishield on 5th of February. A month later, she had developed body pain and fever. Her spouse who is also a doctor administered a painkiller injection called Diclofenac in a bid to treat her.

As per police reports, she fell unconscious a few hours later. She was taken to a hospital and was put on mechanical ventilation. Unfortunately, she died 6 days later. After her death, a lot people started forwarding messages saying that the vaccine was the cause of death.

District Immunisation Officer Dr K V Arjun Kumar confirmed that the vaccine was not the cause of death. Unfortunately, there is a lack of trust among the public. Let’s look at a science backed explanation to understand what happened and then make conclusions.

The autopsy report has mentioned that she suffered from hypoxic ischemic encephalopathy (brain dysfunction due to inadequate oxygen supply) due to anaphylactic shock (severe allergic reaction).

Now that’s a lot of medical terms in one sentence, so let’s understand them one by one.

Hypoxic Ischemic Encephalopathy is a type of brain dysfunction that occurs when the brain doesn’t receive enough oxygen or blood flow for a period of time. Brain dysfunction is when the brain is exhibiting some kind of abnormality or impairment. So, Hypoxic Ischemic Encephalopathy is a condition when the brain experiences some abnormality or impairment when there is lack of oxygen supply to the brain.

But, does that signify anything? Well for a person to die, either of the following should happen:

1. Reduced activity in the heart.
2. Reduced blood supply to the brain. Reduced blood supply to the brain implies reduced oxygen supply to the brain because blood is the carrier of oxygen throughout the body.

So, the mention of ‘Hypoxic Ischemic Encephalopathy’ alone isn’t of any significance. But, if we know what caused reduced oxygen supply to the brain, then it’ll be easy for us to infer the cause of death.

In the autopsy report, it is also mentioned that cause of ‘Hypoxic Ischemic Encephalopathy’ is an anaphylactic shock.

An anaphylactic shock is a severe allergic reaction to certain medication, insect bites or even food. If not treated immediately, anaphylactic shocks can be fatal. But an important point to note is that if incur an anaphylactic shock, you’ll face the symptoms of it immediately.

Alright, now that we have understood those two terms, let’s tackle the fake news.

After the death, word began to spread that the vaccine was the cause of the death, leading to many starting to fear the vaccines.

But was the vaccine the cause of her unfortunate medical complications and the eventual death?

Let’s look at what we know. We know that she took her first shot of Covishield on 5th of February. We also know that she was administered Diclofenac injection on March 5th and that she started vomiting and then fell unconscious just hours after she was administered the Diclofenac injection.

The autopsy report showed that the cause of death was ‘Hypoxic Ischemic Encephalopathy’ due to anaphylactic shock.

However it was already a month since she took the vaccine. So, there is absolutely no reason to believe that the vaccine was responsible for the anaphylactic shock that she faced on March 5th. As I already mentioned, anaphylactic shock is something that happens within a short period after the person has taken a medication that he/she is allergic to. So the vaccine cannot be the reason.

Let’s look at the medication that she was administered on March 5th; Diclofenac.

Even though cases of these are extremely rare, we know of some medicines that can cause anaphylaxis; but it is extremely rare. Penicillin and Diclofenac are among those medications that can cause anaphylaxis. Diclofenac and many other injectable painkillers are generally avoided and not regularly used in many healthcare facilities nowadays. Even when administered, these painkillers are injected only under clinical supervision because even if something adverse happens, it can be immediately treated.

Back in 2001, a case presented in the European Journal of Anaesthesiology by Schäbitz, W. R. et al., gave details about a nurse who self-administered Diclofenac for chronic back pain. The 38 year old nurse self-administered 100mg Diclofenac intramuscularly to treat her back pain. Five minutes later ,she collapsed and developed coma. She was admitted in a hospital and was put on controlled ventilation. Four days after the onset of symptoms, MRI and CT scans showed signs of hypoxic brain injury. Hypoxia is a condition where a region of our body does not receive adequate oxygen supply at the tissue level. In this case, the MRI scans showed that the brain did not receive enough oxygen.

But, one lone incident cannot be used to imply that Diclofenac is the reason behind the above mentioned patient’s death. This is where a study published in the journal BMC by Alois J Schiefecker et al. is useful. In their study, they administered Diclofenac on a control group and found out that in 38% of the patients in the control group, oxygen levels decreased in their brain tissues.

It is a known fact that some medications can cause anaphylaxis, and there is little to worry because those medicines are supposed to be administered under clinical supervision. Diclofenac is one such medication. However, the problem occurs when these medications are self-administered or when they are administered in a place where proper facilities are not available to treat if any adverse event happens.

There are four lessons to be learned here.

1. The vaccine wasn’t the cause of the anaphylactic shock, since it happened four weeks after the vaccine was administered.
2. Since Diclofenac was administered to her by her spouse hours before she faced the symptoms of an anaphylactic shock, it is likely that Diclofenac was the reason. But there is no scientific explanation for why the vaccine could have been the reason.
3. Thirdly, don’t inject medications without proper clinical supervision.
4. Don’t spread misinformation on social media without verifying and understanding the science behind it.

P.S: The vaccines are safe and have gone through rigorous trials. So please take one when you are eligible so that you and the people around you can be safe. Don’t spread or forward misinformation on social media.