Air pollution may further aggravate Covid-19: Dr Randeep Guleria - The Daily Guardian
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Air pollution may further aggravate Covid-19: Dr Randeep Guleria

The chance of the spread of corona is more when pollution goes up; pollutant particles may also
carry the deadly virus and allow it to stay for a longer duration of time, says the AIIMS Director.

Shalini Bhardwaj

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With Covid-1 9 cases increasing rapidly in India, people must take proper precautions and keep themselves safe from the infection. If proper precautions are taken during festival season and winter, then coronavirus infection cases will start showing a downward trend till December. These are some of the observations that AIIMS Director Dr Randeep Guleria made while speaking exclusively to The Daily Guardian. He spoke about reinfection and preparedness India must have in order to tackle the pandemic. Excerpts:

 Q: A study has revealed that Covid-19 patients re-infect after 90 days of treatment. How much is this study reliable and how is that possible? 

A: When we are talking of Covid-19, then we are also looking for re-infection. So, one issue is that some fear that Covid-19 patients may continue to be infectious for a long period of time. But now a lot of studies show that after some time RTPCR may be positive, but if culture is negative that means that a person is just shedding viral particles or dead viruses. Therefore, you are usually not infectious once you have the infection and you have immediately recovered from the infection but you may continue to be RTPCR positive. RTPCR picks up the virus particles, but it doesn’t say whether the virus is living or dead. Some people keep shedding dead virus from the nasal even for a week but they are not infectious. So, it’s unlikely that a person will be infectious once he/she has recovered for the first three months. Now, after three months, there is a lot of debate that some people may have very low immunity and may have a chance of what we call reinfection that means you had infection which was very mild or your immune system didn’t react that much or did not develop that much antibodies that can protect a person for a longer duration. After sometime you are susceptible to the re-infection. Current data suggests that it may not be that common because very few reports have shown. But we cannot say it is zero chance because it can happen which is very rare. So, the takeaway message is that even if you recover from Covid-19 you must continue to practice all the precautions in terms of physical distancing, wearing a mask, handwashing because it doesn’t give you an immunity passport. Previously people felt that if you get Covid-19 and you recover, then you have an immunity passport. Now there are some doubts that you may not have protection after a few months, especially if you had a mild infection in the past. 

Q: Do you think the pandemic is at its peak in India? What precautions should be taken during the coming festival season? 

A: The ten days of data shows that the curve is flattening. We were very worried 2-3 weeks back about crossing one lakh cases per day on a regular basis. But that did not happen and the Covid cases have now come down from more than 90,000 cases per day. This trend has to be sustained for the next two weeks. We should continue to see that the trend doesn’t change. With the festive season round the corner, we have to be careful and not crowd markets and religious places. We should limit these activities and have very limited celebrations, otherwise cases will increase. These events can sometimes lead to what we call super-spread. One person may spread the infection in crowded areas like a function like this where people gather in a large number and then they can spread it to others and that can lead to spike in cases. So, we have to prevent that from happening.

 Q: Do you think during winters Covid-19 cases will increase more rapidly? 

A: In winters, viral infections tend to increase especially because people tend to stay more indoors and spread the infection inside a closed environment. We have to make sure that we continue to have proper precaution when we are indoors, like in terms of cross-ventilation and physical distancing. If we continue to take these precautions, then we can say that we have crossed the peak and gradually the cases will come down. If that happens, then we will see a downward trend till December.

 Q: What kind of precautions need to be taken during winter? 

A: During the day time if people can sit outside, try and spend more time outdoors as compared to indoor. If possible, keep good crossventilation, avoid crowded indoor functions, try to maintain physical distance and wear a mask. Q: When do you think a vaccine will come? How far have the trials reached? A: All three vaccines haven’t shown any adverse effects and the safety data is very good. Now we are waiting to see what their efficacy is, how effective are these vaccines. If we find that efficacy is good then hopefully by the end of this year or in the beginning, we will get the vaccine. The challenge will be about mass production of so many million doses and distribution to different parts of the country to all high-risk groups.

 Q: How long will the vaccine work? 

A: It’s a very important question. We will get to know only once the data is out as to how long the vaccines continue to give the immunity or whether you need more booster doses after sometime so that the immunity arises and secondly, how the virus behaves because if the virus also mutates significantly then the efficacy of a vaccine becomes less and you will have to make slightly different vaccine depending on the mutation. So, the current data suggests that the virus doesn’t mutate that rapidly, unlike the influenza viruses. 

Q: Will air pollution increase Covid-19 infection?

 A: This year we have to be very careful on that front. We need to take aggressive steps to decrease the poor air quality that we have every year during winter month. This is because we already are fighting with the pandemic and our health systems are already strained and suddenly the cases increase because of air pollution it will cause more problems. Also, there is some data that suggests that the chance of the spread of the virus is more when pollution goes up, pollutant particles may also carry the virus and may allow the virus to stay for a longer duration of time. Pollution may also lead to aggravation of coronavirus and it may also lead to respiratory and heart diseases. So, we should be very aggressive this year in terms of not allowing very high levels of air pollution. 

 Q: What should asthmatic patients do?

 A: The asthmatic patients should take inhalers properly. They must also take influenza vaccines so that they don’t contract the influenza and they should regularly wear the masks and maintain physical distance. Both asthmatic and bronchitis patients need to be very careful because they can have both Covid-19 and co-infection that can cause more problems. 

Q: How should India be prepared to deal with such epidemics in future? 

A: We need to understand now as we travel a lot around the world and we can reach from one end to another in a few hours so there will be a spread of infection accordingly. Therefore, we have to develop a system of containment from infection to prevent it from spreading. Good surveillance system needs to be there and a lot of focus should be on developing good health infrastructure. If we are able to have good surveillance, then we could control the spread of a virus early. We must develop good mechanisms of surveillance globally and good partnerships. Then only we will be protected. The healthcare system should be upgraded. What this pandemic has shown is that if you don’t develop a good health infrastructure, it will be difficult to deal with such a situation effectively. Once an outbreak is massive, then it starts affecting everything the economy, livelihood, etc.

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UNCOMMON FOR UNBORN BABIES TO CONTRACT COVID-19

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According to a study led by UCL researchers with Great Ormond Street Hospital for Children and the NIHR Great Ormond Street Biomedical Research Centre, it is only possible for an unborn baby to contract Covid-19 if their gut is exposed to the SARS-CoV-2 virus.

The research was published in the ‘BJOG – An International Journal of Obstetrics & Gynaecology Journal’. Although the study did not look specifically at mothers with Covid-19 and whether their infection was transmitted to an unborn baby, it found that certain fetal organs, such as the intestine, are more susceptible to infection than others.

However, researchers said, that opportunities for the Covid-19 virus infecting the fetus are extremely limited, as the placenta acted as a highly effective and protective shield, and evidence suggested fetal infection, known as vertical transmission, is extremely uncommon.

Researchers set out to understand how newborn babies could have developed Covid-19 antibodies, as it had been reported in a small number of cases.

Specifically, they wanted to know if and how the virus could be passed from an infected mother to the unborn fetus.

To answer this question, researchers examined various fetal organs and placenta tissue to see if there was any presence of the cell surface protein receptors, ACE2 and TMPRSS2. These two receptors sit on the outside of cells and both are needed for the SARS-Cov-2 virus to infect and spread.

Researchers found the only fetal organs to feature both the ACE2 and TMPRSS2 were the intestines (gut) and the kidney; however, the fetal kidney is anatomically protected from exposure to the virus and is, therefore, less at risk of infection.

Therefore, the team concluded that the SARS-CoV-2 virus could only infect the fetus via the gut and through fetal swallowing of amniotic fluid, which the unborn baby does naturally for nutrients.

After birth ACE2 and TMPRSS2 receptors are known to be present in combination on the surface of cells in the human intestine as well as the lung. The gut and lung are suspected to be the main routes for Covid-19 infection, but in younger children, the intestine appeared to be most important for virus infection.

Senior author, Dr Mattia Gerli (UCL Division of Surgery and Interventional Science & the Royal Free Hospital) explained, “The fetus is known to begin swallowing the amniotic fluid in the second half of pregnancy. To cause infection, the SARS-CoV-2 virus would need to be present in significant quantities in the amniotic fluid around the fetus.”

“However, many studies in maternity care have found that the amniotic fluid around the fetus does not usually contain the SARS-CoV2 virus, even if the mother is infected with Covid-19. Our findings, therefore, explain that clinical infection of the fetus during pregnancy is possible but uncommon and that is reassuring for parents-to-be,” Gerli added.

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Study reveals meditation increases error recognition

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A recent study by the Michigan State University has found that if you’re forgetful or make a lot of mistakes, meditation is the answer to your problems.

The research was published in the ‘Brain Sciences Journal’. The researchers tested how open-monitoring meditation — or, meditation that focused on awareness of feelings, thoughts or sensations as they unfold in one’s mind and body — altered brain activity in a way that suggested increased error recognition.

“People’s interest in meditation and mindfulness is outpacing what science can prove in terms of effects and benefits,” said Jeff Lin, MSU psychology doctoral candidate and study co-author.

“But it’s amazing to me that we were able to see how one session of a guided meditation can produce changes to brain activity in non-meditators,” he added.

The findings suggested that different forms of meditation can have different neurocognitive effects and Lin explained that there is little research about how open-monitoring meditation impacted error recognition.

“Some forms of meditation have you focus on a single object, commonly your breath, but open-monitoring meditation is a bit different,” Lin said.

“It has you tune inward and pay attention to everything going on in your mind and body. The goal is to sit quietly and pay close attention to where the mind travels without getting too caught up in the scenery,” Lin added.

Lin and his MSU co-authors — William Eckerle, Ling Peng and Jason Moser — recruited more than 200 participants to test that how open-monitoring meditation affected how people detected and responded to errors.

The participants, who had never meditated before, were taken through a 20-minute open-monitoring meditation exercise while the researchers measured brain activity through electroencephalography or EEG. Then, they completed a computerized distraction test.

“The EEG can measure brain activity at the millisecond level, so we got precise measures of neural activity right after mistakes compared to correct responses,” Lin said.

“A certain neural signal occurs about half a second after an error called the error positivity, which is linked to conscious error recognition. We found that the strength of this signal is increased in the meditators relative to controls,” Lin added.

While the meditators didn’t have immediate improvements to actual task performance, the researchers’ findings offer a promising window into the potential of sustained meditation.

“These findings are a strong demonstration of what just 20 minutes of meditation can do to enhance the brain’s ability to detect and pay attention to mistakes,” Moser said.

While meditation and mindfulness have gained mainstream interest in recent years, Lin is among a relatively small group of researchers that take a neuroscientific approach to assess their psychological and performance effects.

Looking ahead, Lin said that the next phase of research will be to include a broader group of participants, test different forms of meditation and determine whether changes in brain activity can translate to behavioural changes with more long-term practice.

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STUDY FINDS DYSLEXIA MAY CAUSE VISUAL DISABILITY , READING IMPAIRMENT

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According to a new study, children who suffer from dyslexia go through visual issues as well along with dealing with reading disabilities.

The readings were published in the ‘Neurosci Journal’. It was the first to combine new methods to understand visual processing and brain activity in dyslexia, challenged a group of children aged six to 14 to identify the average direction of motion of a mass of moving dots, while their brain activity was measured.

It was found that children with dyslexia took longer to gather the visual evidence, and were less accurate, than their typically developing peers, and that the behavioural differences were reflected in the differences in brain activity.

Although reading ability is known to be affected by dyslexia, researchers are still unclear on which brain processes are affected by the condition. Increased understanding of this could potentially lead to more effective support for those affected.

Dr Cathy Manning, lead researcher in the Centre for Autism at the University of Reading, said, “These findings show that the difficulties faced by children with dyslexia are not restricted to reading and writing. Instead, as a group, children with dyslexia also show differences in how they process visual information and make decisions about it.”

“Future research will be needed to see if these differences in visual processing and decision-making can be trained in order to improve reading ability in affected children, or provide clues as to the causes of dyslexia,” Cathy added

Brain activity monitoring using EEG in the study showed synchronized activity over the centro-parietal regions of the brain involved in decision-making steadily increased in all of the children during the task until they made a decision. However, this happened more gradually in the children with dyslexia.

The study supported a link between motion processing and dyslexia, although the causes are not yet known.

Whether dyslexia is, at its core, a visual processing disorder is hotly debated among researchers. With reading and writing a key challenge among children with dyslexia, increasing understanding of its effects on the brain might aid how we improve existing interventions.

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TEA, COFFEE LINKED TO LOWER RISK OF STROKE, DEMENTIA

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According to recent research, drinking tea and coffee might be linked to a reduced risk of stroke and dementia. Drinking coffee was also linked with a reduced risk of post-stroke dementia.

The study was published in the ‘PLOS Medicine Journal’. Strokes are life-threatening events that cause 10 per cent of deaths globally. Dementia is a general term for symptoms related to declining brain function and is a global health concern with a high economic and social burden. Post-stroke dementia is a condition where symptoms of dementia occur after a stroke.

Yuan Zhang and colleagues from Tianjin Medical University, Tianjin, China studied 365,682 participants from the UK Biobank, who were recruited between 2006 and 2010 and followed them until 2020. At the outset participants self-reported their coffee and tea intake. Over the study period, 5,079 participants developed dementia and 10,053 experienced at least one stroke.

People who drank 2-3 cups of coffee or 3-5 cups of tea per day, or a combination of 4-6 cups of coffee and tea had the lowest incidence of stroke or dementia. Individuals who drank 2-3 cups of coffee and 2-3 cups of tea daily had a 32 per cent lower risk of stroke (HR, 0.68, 95 per cent CI, 0.59-0.79; P <0.001) and a 28 per cent lower risk of dementia (HR, 0.72, 95 per cent CI, 0.59-0.89; P =0.002) compared with those who drank neither coffee nor tea. Intake of coffee alone or in combination with tea was also associated with a lower risk of post-stroke dementia.

The UK Biobank reflected a relatively healthy sample relative to the general population which could restrict the ability to generalize these associations. Also, relatively few people developed dementia or stroke which can make it difficult to extrapolate rates accurately to larger populations. Finally, while it’s possible that coffee and tea consumption might be protective against stroke, dementia and post-stroke dementia, this causality cannot be inferred from the associations.

The authors added, “Our findings suggested that moderate consumption of coffee and tea separately or in combination were associated with lower risk of stroke and dementia.”

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WHAT YOU MUST KNOW ABOUT NEW OMICRON COVID VARIANT

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When the entire world was hoping to bring back normalcy despite the continued stress of the pandemic, COVID strikes us back with a new terror. A new variant B.1.1529 has been discovered in South Africa that is said to be a heavily mutated version discovered so far. The variant is named as Omicron by the World Health Organization.

The Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE) is continuously monitoring the evolution of SARS-CoV-2 and assesses if specific mutations and combinations of mutations alter the behaviour of the virus. Bases on the TAG-VE advised WHO has designated the Omiicorn virus as a VOC and will communicate new findings with Member States and to the public as needed.

WHO has also asked all the counties to enhance surveillance and sequencing, submit complete genome sequences and associated metadata, report initial cases/clusters associated with VOC infection through the IHR mechanism. In view of the same India’s National Centre for Disease Control has reported to the health ministry that multiple cases of Covid-19 variant B.1.1529 have been reported in Botswana (4 cases), South Africa (22 cases), and Hong Kong (2 cases). The Ministry said that the variant is reported to have a significantly high number of mutations, and thus, has serious public health implications for India in view of the recently relaxed visa restrictions and opening of international travel. Here are answering a few questions that might arise in your mind.

WHY IS THE NEW VARIANT DANGEROUS?

The new variant is said to be incredibly heavily mutated. As per experts from the Centre for Epidemic Response and Innovation in South Africa, there was an unusual constellation of mutations and that it was very different to other variants that have circulated. Until today there were 50 mutations overall and more than 30 on the spike protein, which is the target of most vaccines and the key the virus uses to unlock the doorway into our body’s cells. Zooming in even further to the receptor binding domain (the part of the virus that makes first contact with our body’s cells), it has 10 mutations compared to just two for the Delta variant that swept the world.

According to researchers, this level of mutation has most likely come from a single patient who was unable to beat the virus. The biggest concern that researchers have is this virus is now radically different to the original one that emerged in Wuhan, China. Although the current SARS-CoV-2 RT-PCR diagnostics continue to detect the new variant, we are yet to gather data on whether this variant could evade vaccine or natural immunity or have higher transmissibility.

However, it is important to know what those mutations are doing. We will need to know what these mutations do to the inherent abilities of the virus. But that’s hypothesis and needs more evidence. Having many mutations does not mean that the virus will be deadlier or more dangerous. Nevertheless, every variant would have the potential to impact the pandemic. However, the data here is very limited at this moment the potential impact and real-world effects as a result of this cannot be commented on

WHAT DO WE DO ABOUT IT AND DOES THIS PUT INDIA AT A RISK AGAIN?

It is important to note that the coronavirus evolves as it spreads and many new variants, including those with worrying mutations, often die out in the course of time. Scientists are currently monitoring for possible changes that could be more transmissible or deadly. However, sorting out whether new variants will have a public health impact can take time. Right now, there is no need for panic. Although we are left with a variant that raises significant concerns despite huge gaps in our knowledge, we need to be watchful and not let our guards down.

Now, you might wonder how can Mumbai – a high footfall and dense air transit metropolitan city safeguard itself, especially at a time when schools, colleges and travel is resuming in full force?

To this end, the government has currently notified that safety measures should and will continue to remain. Even with restrictions easing in many ways, the one thing that has not and will not change is the COVID-19 safety mandate — of wearing a mask, social distancing, testing before and after travel and so on.

For schools, the safety measures would include: wearing a mask; one student on one bench; temperature checks; repeated sanitising; less chances of peer-to-peer interaction; no sharing of lunch or eating together; Limited school hours and no roaming around after school hours

If you decide to take to the skies for business or leisure, keep in mind that staying safe on a plane requires far more than just wearing a mask. Before you even get to the plane, you have to contend with check-in terminals and security lines. This means coming in contact with frequently touched surfaces and being around a lot of people. While your concern might be centered on staying safe on the plane, you should also focus on protecting yourself before boarding. Wear your mask at all times, keep your hands clean and avoid touching your face with this the risk can be lowered.

The author is the Director of Critical Care, Fortis Hospitals Mumbai & Member of the Supreme Court-appointed National COVID19 Task Force.

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HIGHER COFFEE INTAKE PREVENTS DEVELOPMENT OF ALZHEIMER’S

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If you are one of those people who can’t start their day without a cup of hot coffee, we have some good news for you. New research has found that drinking higher amounts of coffee can make you less likely to develop Alzheimer’s disease.

The findings of this research were published in the ‘Frontiers in Aging Neuroscience Journal’. As part of the Australian Imaging, Biomarkers and Lifestyle Study of Ageing, researchers from Edith Cowan University (ECU) investigated whether coffee intake affected the rate of cognitive decline of more than 200 Australians over a decade.

Lead investigator Dr Samantha Gardener said that the results showed an association between coffee and several important markers related to Alzheimer’s disease.

“We found participants with no memory impairments and with higher coffee consumption at the start of the study had a lower risk of transitioning to mild cognitive impairment – which often precedes Alzheimer’s disease – or developing Alzheimer’s disease over the course of the study,” she said.

Drinking more coffee gave positive results in relation to certain domains of cognitive function, specifically executive function which includes planning, self-control, and attention.

Higher coffee intake also seemed to be linked to slowing the accumulation of the amyloid protein in the brain, a key factor in the development of Alzheimer’s disease.

Dr Gardener said that although further research was needed, the study was encouraging as it indicated drinking coffee could be an easy way to help delay the onset of Alzheimer’s disease.

“It’s a simple thing that people can change,” she said.

It could be particularly useful for people who are at risk of cognitive decline but haven’t developed any symptoms.

“We might be able to develop some clear guidelines people can follow in middle age and hopefully it could then have a lasting effect,” she said.

If you only have allowed yourself one cup of coffee a day, the study indicated you might be better off treating yourself to an extra cup, although a maximum number of cups per day that provided a beneficial effect was not able to be established from the current study.

“If the average cup of coffee made at home is 240g, increasing to two cups a day could potentially lower cognitive decline by eight per cent after 18 months,” Dr Gardener said.“It could also see a five per cent decrease in amyloid accumulation in the brain over the same time period,” she added.

In Alzheimer’s disease, the amyloid clump together forming plaques that are toxic to the brain.

The study was unable to differentiate between caffeinated and decaffeinated coffee, nor the benefits or consequences of how it was prepared (brewing method, the presence of milk and/or sugar etc).

Dr Gardener said that the relationship between coffee and brain function was worth pursuing.“We need to evaluate whether coffee intake could one day be recommended as a lifestyle factor aimed at delaying the onset of Alzheimer’s disease,” she said.

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