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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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Medically Speaking

OXFORD-ASTRAZENECA VACCINE IS SAFE, SAYS SERUM INSTITUTE

Shalini Bhardwaj

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OXFORD

In a statement released by AstraZeneca, the company has admitted to its dosing error and said that the Oxford-AstraZeneca vaccine is safe and effective. Partnered company Serum Institute of India (SII), which is holding trials for the vaccine in India, also said that the vaccine candidates are safe and trials are running smoothly with strict adherence to all the necessary protocols in India and that there is no need to panic.

“The AstraZeneca-Oxford vaccine is safe and effective. Even the lowest efficacy results are at 60-70%, making it a viable vaccine against the virus. That said, varied age groups with different dosage forms will result in slight variations and efficacy. We must be patient and not panic. The Indian trials are running smoothly with strict adherence to all the necessary processes and protocols. So far, there are no concerns. However, we are going through the data that is available and will make a further statement, if needed,” the Pune-based SII said in a statement.

DCI FACES IRREGULARITIES AND CORRUPTION CHARGES

DCI FACES IRREGULARITIES AND CORRUPTION CHARGES

After the removal of Dr Majumdar as president of the Dental Council of India (DCI), the appointment of the council’s secretary has come under the spotlight. Due to procedural lapses and non-transparency in the appointment of DCI’s secretary, Dr Sabyasachi Saha may be disallowed to exercise his powers as the post-holder.

“The appointment of Dr Saha was made with the approval of the central body of DCI. Till the time the governing body reconsiders its earlier decision to appoint Dr Sabyasachi Saha as secretary, Dr Saha may be disallowed to exercise his powers as secretary, DCI, and M L Meena, Joint Secretary (Legal & Admin) may be asked to officiate as secretary, DCI in the interregnum,” said a letter issued to the Acting President by Nipun Vinayak, Joint Secretary, Department of Health & Family Welfare.

MEDICAL COLLEGES TO OPEN DOORS FOR STUDENTS

MEDICAL COLLEGES TO OPEN DOORS FOR STUDENTS

Maulana Azad Medical College (MAMC) has issued a notice to reopen the institute by December 1. The notice has been issued after receiving recommendations from apex medical regulator, the National Medical Commission (NMC), which recently issued directions to reopen medical colleges on or before December 1, 2020.

All institutions will have to adhere to Covid-related SOPs. The circular said, “All medical colleges/institutions shall ensure strict compliance of guidelines issued by the Ministry of Health Ministry Welfare State/UT Government about Covid-19 preventive measures including social distancing, use of mask and sanitisation measure of hostels, class, laboratories, lecture theatres, etc.”

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ANTIBIOTIC RESISTANCE: SILENT KILLER IN THE SHADOWS OF COVID-19

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ANTIBIOTIC RESISTANCE: SILENT KILLER IN THE SHADOWS OF COVID-19

Covid-19 has led to loss of many lives and crippling of economies of several countries. However, beyond the most obvious fallouts of this deadly disease caused by an insidious virus, the shadow of upsurge of antibiotic resistance is looming over the entire mankind which will be realised in the time to come. A medical revolution of colossal proportions happened on 28 September 1928, when the first antibiotic was discovered by Sir Alexander Fleming, a Scottish bacteriologist. This discovery was heralded as a path-breaking moment in the history of medicine as it seemed that the human race had finally found a new direction to combat deadly bacterial infections. What followed that event was the discovery, mass production, and prescriptions of several antibiotics over the next few years.

A mass optimism swept the world towards the dawn of a new period termed as the antibiotic era. A race to produce new antibiotics led to hundreds of antibiotics being churned out and consumed by the masses for bacterial infections. Even in his acceptance speech of Nobel Prize conferred to him, Sir Fleming had warned mankind against indiscriminate use of antibiotics, since that would lead to the bacteria developing resistance against the antibiotics which had been designed to kill them. Unmindful of this warning, overuse of antibiotics all over the world finally led to a global phenomenon, known as Antibiotic Resistance. This was a blanket term to describe the emergence of novel bacterial strains which are resistant to several antibiotics, known as multi-drug resistant bacteria (MDR) and all antibiotics, 2 known as all drug resistant bacteria (ADR).

The battle between the humans and these bacteria, also known as ‘Super bugs’ has set the ball rolling once again, for the sharp descent into the ‘Pre-antibiotic’ era in the future.

The new drug pipeline for drug-resistant bacteria is drying out, causing alarm and concern about the impending doom of mankind. While sometimes resistance occurs naturally, in most cases, it happens due to clinical misuse and self-medication. The other causes for antibiotic resistance are irresponsible disposal of untreated chemicals from manufacturing units and healthcare systems in the environment, indiscriminate feeding of antibiotics to livestock, and overuse of pesticides on crops, which are consumed unknowingly by humans. The multipronged solution to the worldwide predicament of antibiotic resistance includes creating awareness among the common man about the phenomenon of antibiotic resistance in order to prevent self-medication, careful monitoring of specific bacterial responses to various antibiotics, limiting the prescriptions of antibiotics by clinicians, and prevention of environmental pollution.

There is also a need to discover and design new drug molecules which could be used in lieu of the commonly prescribed antibiotics. In recent times, the outbreak of the pandemic of Covid-19 has only led to escalate the imminent threat of antibiotic resistance. Though Covid-19 is caused by a coronavirus, its health complications are often compounded by serious secondary bacterial infections. In the ensuing chaos of this pandemic, two diverse phenomena are occurring which are causing overuse of antibiotics. One, several patients are not being able to access the healthcare workers due to lockdowns and are indulging in self-medication. Second, since Covid-19 has caught the world at the wrong foot unexpectedly, many antibiotics are being widely used to combat bacterial infections in the Covid-19 patients in hospitals all over the world.

The sudden emergence of this deadly virus has not given enough time to the healthcare workers to prudently balance the treatment of the patients against the future danger of the antibiotic resistance, which will be felt for centuries to come. The bright side of the problem is that the emergence of this pandemic has brought the spotlight on the infectious diseases caused by superbugs, which is making the governments and policymakers of all the countries in the world take these phenomena seriously. This event has indicated that despite the cutting-edge technologies and sophisticated medical care, pandemics of gigantic magnitudes caused by superbugs may happen in future as well. Despite the doomsday prophecies, it is hoped that this global crisis will help the world to educate itself better about the constant and impending threat of superbugs and antibiotic resistance, and recognise the critical tip of the iceberg that we are collectively sitting on.

The mankind has valiantly fought and emerged victorious after the onslaught of past pandemics. Hence, careful monitoring of antibiotic use and aggressive repurposing of drugs to enhance the drug pipeline for new antibiotics while limiting environmental pollution will give a new direction for mankind to overcome the global threat of antibiotic resistance.

Prof Sujata Sharma is associated with the Department of Biophysics, AIIMS, New Delhi.

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SOCIAL VACCINATION IS STILL THE WAY FORWARD

Dr Neeraj Nischal

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SOCIAL VACCINATION IS STILL THE WAY FORWARD

The festive season is here, and so is winter. With all of us stranded at home for most of the year, the desire for celebration and social gathering is climbing. We are all eagerly waiting for the distribution of Covid-19 vaccines, so we may gain immunity and go about our lives as it was the case in the pre-coronavirus era. Vaccine development and immunisation are, however, time-consuming. Thus, while the scientific community works on a biologic solution, we must continue to take part in the practice of the ‘social vaccine’.

The Covid-19 social vaccine includes social distancing, hand hygiene, face masks, and isolation. Since the discovery of the mode of spread of the SARS-CoV-2 virus, these measures have been widely popularised. Over the last nine months, Covid fatigue has set in all of us, and there has been laxity in the practice of the laid down Covid appropriate behaviour. Without reinforcement, this will only worsen.

We are currently in the unlock process after a long lockdown phase. At this time, the number of cases in certain parts of India is again on the rise. The disease is just as, if not more rampant in its spread, and has not heeded to our efforts of lockdown. Social vaccination is still the only way to safeguard ourselves. The virus will enter our homes if we falter and permit it. It is up to us to keep ourselves and those around us safe and healthy.

To elaborate the measures yet again, social distancing includes physical distancing of individuals by at least six feet. We do not have to be socially or emotionally distant in these times, just physically distant. We have been blessed with technology to bring the world closer. The utilisation of these online platforms will help us socialise when we have to practice social distancing. Washing your hands with soap and water (or alcohol hand rubs) for at least 20 seconds, frequently, will keep you from spreading the virus by touch. Let us strengthen the Indian tradition of ‘Namaste’, and say no to handshakes. Face masks will not only protect you from Covid-19 but other winter viruses like the common cold, and influenza. Most importantly, remember to be socially vigilant, and isolate yourself if you are symptomatic.

A vaccine is not a magic bullet to end the pandemic. The introduction, logistics, and effects of vaccination is a drawn-out process. Even with a sound biological vaccine, social vaccination is still the most crucial aspect of disease prevention. The two should go hand-in-hand to control the disease and are not mutually exclusive. Both of these would need staggering community participation, with the social vaccine requiring the full and conscious effort of the entire population without which it is bound to fail. The fate of the pandemic rests in the hands of each and every one of us. Here’s to celebrating the festive season the way it was meant to be, with lights and goodwill.

Dr Neeraj Nischal is Associate Professor, Medicine Department, All India Institute of Medical Sciences, New Delhi. He wrote this article with the help of Dr Sujay Halkur Shankar, Resident Doctor at AIIMS.

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We have to watch out for mutations of the virus: Dr Shahid Jameel

Virologist Dr Shahid Jameel discusses the parameters for an effective vaccine against the coronavirus pandemic and how to prepare for a large-scale vaccination drive.

Shalini Bhardwaj

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Dr Shahid Jameel

In an exclusive Interview with The Daily Guardian, Dr Shahid Jameel, Virologist and Director of Trivedi School of Biosciences at Ashoka University, talks about how to judge the efficacy of a Covid-19 vaccine, how India needs to plan for the vaccination drive and whether the novel coronavirus is likely to mutate in the near future. Excerpts:

Q. What would you say about the companies claiming the efficacy of their vaccines only through press releases?

A. Press releases are quick ways for companies to make their achievements public, but they are geared more towards shareholders and financial markets. A factual position can only be judged when the scientific details of a trial are published in a peer-reviewed publication. We should wait for those. At this time, the percentage of efficacy is not important and should not be used to compare different vaccines. All this means is that vaccines based on the viral spike protein will work to protect against disease, and sometimes against infection as well.

Q. What kind of a vaccine should be given to the people?

A. A vaccine that has been proven to be safe and has good efficacy. This is the reason why human clinical trials are done in stages – Phase 1 for safety in small numbers of volunteers; Phase 2 for safety and immunogenicity in larger numbers of volunteers; and Phase 3 for safety and efficacy in very large numbers of volunteers with gender, racial and age diversity.

Q. How much efficacy should that vaccine have before being approved for people?

A. It depends upon how infectious a virus is. In this case, the WHO and US FDA have set a benchmark of 70% efficacy before a vaccine candidate will be considered for approval.

Q. Why have there been errors with the AstraZeneca vaccine?

A. I cannot answer that. All I know is what the company has said. Errors happen, but what is important is how transparently they are addressed. I am sure the regulators in all countries that want to license this vaccine will look at the data very carefully.

Q. How does India need to plan ahead for successful vaccination?

A. India’s plan should include the following. Firstly, who should get the vaccine first? The primary aim should be to use the vaccine to protect frontline workers (healthcare, sanitation, essential services), reduce mortality (elderly and those with comorbidities) and control the pandemic.

Secondly, to work out the storage-transfer-delivery logistics down to the last detail. India has a lot of experience with the polio vaccine but that was an oral vaccine not an injectable one. India also has a lot of experience with childhood and maternal vaccines, but we have never delivered such large amounts of a vaccine during a pandemic.

Thirdly, the current capacity is to deliver 1.5 million doses per month, or 18 million doses per year. The Health Minister stated that 250 million Indians would be vaccinated in 2021. That means 500 million doses. At current staff strength, it would take more than two years. Therefore, we must increase trained staff.

Fourthly, should we vaccinate those in high priority groups (e.g. healthcare workers) who have already been infected? This would make little sense and waste precious doses. If we decide not to, then there should be an inexpensive test to find out those who already have antibodies. Today the test costs as much as one vaccine dose. That cost has to be factored in.

Lastly, make the plan available for public scrutiny and comment. This will increase trust in the vaccination programme.

Q. What are the parameters which need to be considered for emergency approval of vaccines?

A. Emergency Use Approval looks primarily at safety in large and diverse populations and also a reasonable level of efficacy.

Q. For how long will these vaccines work?

A. We don’t know the answer to this simply because vaccine trial follow-ups have not been done for long enough. Extrapolating from natural infection, neutralising antibodies wane off in about six months, but that does not mean loss of protection since there are T cells and memory recall responses. Even natural infection has not been followed long enough after recovery to fully answer this question. But, going by other endemic coronaviruses, protection may last up to a year or more.

Q. Do you think this virus can mutate? If it does, what is likely to happen?

A. Every virus mutates and so does this one. RNA viruses mutate faster than DNA viruses. However, compared to other RNA viruses, coronaviruses have the lowest rate of mutation. With over 224,000 SARS-CoV2 genomes sequenced by now, mutations in the spike protein neutralizing domain have not been seen. So, that’s good from the vaccine perspective. But this region has no selection pressure on it to change. Once vaccines are deployed in a big way, such mutations will arise. We would have to watch out for that.

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Pfizer seeks emergency use of Covid-19 vaccine

Shalini Bhardwaj

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Pfizer has announced that its vaccine is 95% effective on the basis of its Phase-3 trials. On Friday, Pfizer said that it is asking US regulators to allow the emergency use of its Covid-19 vaccine.

The company announced that they will submit a request to the US Food and Drug Administration (FDA) for Emergency Use Authorisation, which will potentially enable the use of the vaccine in high-risk populations in the US by mid to end of December 2020.

“Our work to deliver a safe and effective vaccine has never been more urgent, as we continue to see an alarming rise in the number of cases of Covid-19 globally. Filing in the US represents a critical milestone in our journey to deliver a Covid-19 vaccine to the world and we now have a more complete picture of both the efficacy and safety profile of our vaccine, giving us confidence in its potential,” said Dr Albert Borla, Pfizer CEO and chairman.

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India to get 400-500 mn vaccine doses by July: Harsh Vardhan

Shalini Bhardwaj

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Harsh Vardhan

Union Health Minister Dr Harsh Vardhan has said that India is set to get 400-500 million vaccines by July 2021. He gave this statement during a virtual programme organised by FICCI FLO.

During the programme, National Treasurer Lalita Nijhawan, in an FAQ session, asked the Health Minister about the method of distribution of the vaccines across the country.

“First of all, priority has been given on the basis of medical grounds because we are a country of 135 crore people. For such large numbers of people, nobody can arrange large quantities of doses of vaccines in a single go. By July to August 2021, we will have 400-500 million dosages available. Now it is under clinical trials in many companies,” said Dr Harsh Vardhan.

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