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Covid-19 is not an airborne disease, says Dr David Nabarro

World Health Organization’s special envoy for Covid-19, Dr David Nabarro, says that air is not the primary mode of coronavirus transmission and there is not enough evidence to suggest the same.

Shalini Bhardwaj

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response has to be modified when it comes to encouraging Covid readiness. There is a need for clear and well-communicated strategic principles, modified in light of new evidence. This should be accompanied by guidance on how the principles can be adapted so they enable all stakeholders to work out for themselves and how they can best contribute to the response in their own localities. Second, those responsible for managing responses should take advantage of opportunities. They have to “convene, coordinate, curate and communicate”. When these elements are prioritised, power and authority at the local level are used to their best effect. We offer four suggestions on how this can be done: l There must be a narrative. It should describe a clear vision and identifiable pathways for societies to move into the Covid-ready state. How to encourage this to emergence from the present situation with widespread movement restrictions? l Information must be locally specific. If people are to be enabled to act at a local level, they depend on high quality and specific information about what is happening in their locations. Where is the virus? How many people are infected? Which groups are most at risk? l Responses must make sense to people. This is about people being able to make sense of the narrative and updates in the news. What are the implications of the latest scientific findings? What does that say about safety in schools, on public transport, the wearing of face coverings? Every effort must be taken to avoid stigmatisation. l Values of decision-makers must be explicit. People are bound together in solidarity, getting ahead of the virus, by a sense of what they hold in common. This includes caring for older people and those who are vulnerable. Our values are known because we state them, but they are believed when we live them. We may not be believed if we say we value care workers if it becomes clear that they are unable to be tested for the virus or to access equipment they need for protection. What we do and how we do it is much more powerful than anything we say. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) looks like a super mysterious virus throwing googlies even after six months of the pandemic. We as pulmonologists imagine lung fibrosis to happen in chronic phase (after weeks) of any pneumonia or Acute Respiratory Distress Syndrome (ARDS). Some of the observations based on autopsies done in SARS-CoV-2: 1. A total of 159 patients with ARDS, fibrosis was noted in three (4%) of 82 patients with a disease duration of less than a week, 13 (24%) of 54 patients with a disease duration of between one to three weeks, and 14 (61%) of 23 patients with a disease duration of greater than three weeks. 2. The post-mortem also reveals vascular endothelial inflammation with intracellular SARS-CoV-2 virus and disrupted endothelial cell membranes. Electron microscopy showed that there is enhanced intussusceptive angiogenesis (the process whereby a new blood vessel is created) which intrudes the lumen (the cavity or channel within a blood vessel) and further leads to thrombosis (clot inside a blood vessel). This finding is not seen in other ARDS like influenza during acute stages. 3. There is evidence that vascular dysfunction (a disorder of the vascular system characterised by poor function of the blood vessels) is a key component of the switch from ARDS to fibrosis, with VEGF (Vascular Endothelial Growth Factor), Interleukin 6 (IL-6), Interleukin-1 (IL-1), Tumor necrosis factor (TNF) Alfa as main mediators. 4. It remains unclear why certain individuals can recover from it whereas in others there is a shift to unchecked cellular proliferation with the accumulation of fibroblasts and myofibroblasts and the excessive deposition of collagen alongside other components of the extracellular matrix to result in progressive pulmonary fibrosis. Three tips to prevent fibrosis: a) any potential antifibrotic intervention should be considered within the first week of ARDS onset; b) drugs which inhibit IL-1 “Nintedanib” can play a beneficial role. The role of IL-6 inhibitors is still not clear and confusing. An experimental study showed that IL-6 in the early phase of lung injury promotes fibrosis and that inhibition in the later stages of injury at the onset of the fibrotic phase might ameliorate fibrosis; c) older the age and severe the disease (requiring ICU) leads to more chances of pulmonary fibrosis. The writer is a pediatrician at Sir Ganga Ram Hospital in New Delhi. The World Health Organization (WHO) and UNICEF have warned that around 2-3 million children across the world may miss life-saving vaccines and immunisation programmes around the world due to disruptions caused by Covid-19. These vaccines are used to protect children against life-threatening diseases such as measles, smallpox, DTP3, among others. According to new data by WHO and UNICEF, these disruptions are now a threat which can reverse the hard-won progress against deadly diseases through immunisation programmes. “Vaccines are one of the most powerful tools in the history of public health, and more children are now being immunized than ever before. But the pandemic has put those gains at risk. The avoidable suffering and death caused by children missing out on routine immunisations could be far greater than Covid-19 itself,” said Dr Tedros Adhanom Ghebreyesus, Director General, WHO. Several countries are facing disruptions in the delivery and uptake of immunisation services due to the coronavirus outbreak and lockdown. Due to an increase in the number of cases not only in India but in various countries, at least 30 measles vaccination campaigns are at risk of being cancelled, which could result in a further outbreak in 2020 and beyond. In many cases where services for vaccination are offered, people are unable to reach for their kids’ vaccination due to interruptions, economic hardships, restrictions on movement, or fear of coronavirus infection. Most of the cases are from Africa where one of the reasons is lack of access to health services during the pandemic. Two-third of them are concentrated in 10 middle and low-income countries like Angola, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan, and Philippines. Covid-19 has directly affected immunisation which is one of the most cost-effective public health interventions till date. Covid-19 is not an airborne disease, says Dr David Nabarro EXCLUSIVE PRESCRIPTION Medical news DOC TALK World Health Organization’s special envoy for Covid-19, Dr David Nabarro, says that air is not the primary mode of coronavirus transmission and there is not enough evidence to suggest the same. medically speaking the daily guardian 18 july 2020 8 new delhi Covi d and after: Is India prepared for mental health pandemic? SARS-CoV-2: Super mysterious virus causing big damage 3mn kids won’t be vaccinated due to Covid, warns WHO Shalini Bhardwaj New Delhi Dr Srinivas Rajkumar New Delhi

Q. Do you think Covid-19 is airborne?

A. It is primarily dropletborne and most droplets do not travel further than one metre. There is a possibility that in some settings, very small droplets may carry virus further than a metre with transmission being described as airborne. WHO considers that this is not the primary mode of transmission.

 Q. Covid-19 cases in India are rising rapidly and have crossed the 10 lakh mark. What can be done to control the situation?

A. The important thing is to establish basic health infrastructure that can identify and isolate people with Covid. The people and government must maintain efforts to build this capacity everywhere. It is a difficult time. The authorities need data on where the virus is being transmitted to focus containment efforts where they are most needed. The performance of this Covid response is key to determine whether the levels of infection will continue to increase in India. The constant defence against transmission and the buildup of outbreaks is key. It is a continuous process. Detect cases, isolate, trace contacts and isolate them. This is the most effective method to control the spread.

Q. What lessons the world needs to learn from Covid-19?

A. There are lessons to be learned from our experiences of tackling Covid-19 so far. First, the command-andcontrol approach so often favoured in crisis response has to be modified when it comes to encouraging Covid readiness. There is a need for clear and well-communicated strategic principles, modified in light of new evidence. This should be accompanied by guidance on how the principles can be adapted so they enable all stakeholders to work out for themselves and how they can best contribute to the response in their own localities. Second, those responsible for managing responses should take advantage of opportunities. They have to “convene, coordinate, curate and communicate”. When these elements are prioritised, power and authority at the local level are used to their best effect. We offer four suggestions on how this can be done:

  • There must be a narrative. It should describe a clear vision and identifiable pathways for societies to move into the Covid-ready state. How to encourage this to emergence from the present situation with widespread movement restrictions?
  •  Information must be locally specific. If people are to be enabled to act at a local level, they depend on high quality and specific information about what is happening in their locations. Where is the virus? How many people are infected? Which groups are most at risk?
  • Responses must make sense to people. This is about people being able to make sense of the narrative and updates in the news. What are the implications of the latest scientific findings? What does that say about safety in schools, on public transport, the wearing of face coverings? Every effort must be taken to avoid stigmatisation.
  • Values of decision-makers must be explicit. People are bound together in solidarity, getting ahead of the virus, by a sense of what they hold in common. This includes caring for older people and those who are vulnerable. Our values are known because we state them, but they are believed when we live them. We may not be believed if we say we value care workers if it becomes clear that they are unable to be tested for the virus or to access equipment they need for protection. What we do and how we do it is much more powerful than anything we say.

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Medically Speaking

India to get desi drug for treatment of Covid-19 next week: Chandrasekhar

CSIR-IICT director S. Chandrasekhar tells The Daily Guardian that Ciplenza, indigenous version of Favipiravir, will be much cheaper and thus not out of the reach for common people.

Shalini Bhardwaj

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To ramp up India’s fight against Covid-19, pharmaceutical company Cipla and CSIR-Indian Institute of Chemical Technology (IICT) have developed Ciplenza (indigenous version of Favipiravir drug) — a convenient and cost-effective drug for Covid treatment. While speaking exclusively to The Daily Guardian, S. Chandrasekhar, director, CSIRIICT, said that the medicine would hit the market next week. He also added that since discovering a drug in such a short time during the pandemic was not possible, they went for “repurposing” an existing drug, which would be cheaper and thus not out of the reach for common people. Excerpts:

S. Chandrasekhar.
S. Chandrasekhar.

Q. When do you think indigenous versions of Favipiravir will be available in the market?

A. The Favipiravir by Glenmark is already in the market. Our collaborator Cipla will make Ciplenza available next week.

Q. What is the concept of repurposing the drug? How is it useful in making Ciplenza?

A. Repurposing means using a drug which was initially discovered for a disease for another disease if symptoms and mode of action are the same. Favipiravir was initially discovered for influenza virus in Japan.

Q. What would be the cost of Ciplenza?

A. Now it is priced at Rs 68 per tablet but it will reduce further depending on the demand and supply.

Q. How much dosage has to be given to the patient?

A. It depends on the patient’s condition but the course is for 14 days: 3.6 gm for the first day and 1.6 gm from the second day.

Q. How did you source the chemicals and reduce the price of the drug?

A. The indigenous chemicals are completely sourced from Indian companies which have helped in bringing down the import dependency so that an affordable version of the drug could be made available for the country.

Q. What was the first thought in your mind about a drug when the pandemic broke out?

A . We had multiple thoughts like discovering a new drug which was not possible quickly; repurpose existing drugs which helped us to work on Favipiravir and Umifenovir and vaccine development which luckily has progressed very well.

Q. What are the challenges you are facing in drug supply during Covid-19 pandemic?

A. There are many challenges including supply chain disruption. Students and faculties had to work at odd conditions because of social distancing. Suddenly the workforce was required to be in isolation to protect them from getting Covid-positive. Also, several students and project staff were stuck at various places but now slowly they are joining.

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Son attacks doctor after mother dies of Covid-19

Shalini Bhardwaj

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A Latur-based doctor was allegedly attacked by the son of a woman who died due to Covid-19. The deceased was admitted to Alfa hospital in Latur in Maharashtra after multiple chronic ailments. Dr Dinesh Verma after checkup informed her kins about her serious condition. Instead of listening to the doctor, the relatives got into a heated argument with him and ultimately the son attacked the doctor with a sharp knife. He stabbed the doctor’s neck, back, chest and hand. The injured doctor was rushed to another hospital. After treatment, his condition is stable now and he has also joined duty. The police have arrested the attacker.

Meanwhile, the Indian Medical Association (Latur and Maharashtra) has registered sharp protests and has also demanded roundthe-clock protection for medical staff. Indian Medical Association headquarters has also strongly condemned the attack on Dr Dinesh Verma and released a statement demanding stringent action against the accused.

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Protest at Jhajjar’s medical college continues

Shalini Bhardwaj

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Even after 10 months, medical students of World College of Medical Sciences in Jhajjar, Haryana, are continuing their protests and are demanding to get themselves transferred to a college recognised by the Medical Council of India (MCI) after court orders. Earlier, their college was refused renewal by the MCI and since the last two years, the students have been struggling to get themselves transferred to an MCI-recognised college.

“We wanted to become doctors but unfortunately, it seems like the nation isn’t worried for us. We have been protesting and have also given applications to the government but nothing has been done. No one is helping us,” protesting students said.They further added,” We qualified NEET examination through the proper channel, paid the fees on time, and passed all exams but we are not getting quality of education and there is no faculty in the college. Our life has been destroyed while studying here.”

“Protesting students of World Medical College Jhajjar have not been shifted to another college even after court orders & MCI’s recommendations. This is beyond imagination and is open hooliganism of college owners. They are trying every possible way from the last 2 years but all in vain because the owner of the college is a very influential and powerful person. The college doesn’t have any facilities for quality medical education so those students should be shifted to other colleges.” said Dr Harjit, AIIMS.

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Hepatitis: Debunking common myths and misconceptions

Dr Ansul Gupta

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Hepatitis is a condition that causes inflammation of the liver. Today, Hepatitis viruses are the most common cause of hepatitis but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also result in the inflammatory condition of the liver.

There are 5 main types of hepatitis viruses, referred to as A, B, C, D and E. However, the majority of people who have hepatitis are unaware, as it doesn’t often show symptoms right away. If left untreated, hepatitis can lead to serious health problems.

Myths and misconceptions about the disease often stop people from getting diagnosed and prevent early care. Here are of common myths associated with the disease:

Myth 1: All Hepatitis viruses are the same.

Fact: Not all Hepatitis viruses are the same. Hepatitis A, B, C, D, and E are different from diverse methods of transmission and clinical manifestations. While Hepatitis A and E are transmitted through food, Hepatitis B and C are spread through blood transfusion, unprotected sex, and tattoos. Hepatitis D occurs to patients suffering from Hepatitis B.

Myth 2: Don’t eat food prepared by someone with hepatitis. It may be contaminated and you might catch it.

Fact: You may get hepatitis A and E from food prepared by someone with the disease but only if proper hygiene is not maintained. Hepatitis B and C are not transmitted by casual contact.

Myth 3: Women with hepatitis should abstain from breastfeeding their babies to avoid passing the infection.

Fact: Hepatitis C and B are not transmitted through breast milk, although there is a risk of transmission through cracked nipples.

Myth 4: People who have hepatitis B or C should not have children because they will pass it on to them.

Fact: The risk of transmission from mother to baby is different for hepatitis B and hepatitis C. But having either of these conditions is no reason for not having children. Overall, the risk of mother to baby transmission of hepatitis C during birth is very low. It is recommended to consult your doctor. There is a risk of transmitting hepatitis B from mother to infant during the birthing process. However, most transmissions to the baby can be avoided by giving baby hepatitis B immunoglobulin (HBIG) and the first shot of the hepatitis B vaccine at birth.

 Myth 5: People suffering from Hepatitis should consume only bland and boiled food.

Fact: Good nutrition is important during hepatitis. If the patient is nauseated, whatever he/she desires to eat should be welcome. Glucose solution, sugarcane juice, bitter gourd, radish are not recommended. Turmeric has anti-inflammatory properties, it can also be taken.

Myth 6: People with hepatitis can never drink alcohol.

Fact: While it is best to abstain from alcohol if your liver is damaged, people with hepatitis can still drink alcohol in limited quantities, depending on the state of their liver health.

Myth 7: One can differentiate between various types of Acute Viral Hepatitis (AVH) based on clinical symptoms.

Fact: Patients with AVH develop a short febrile illness followed by loss of appetite, highcoloured urine, and vomiting. Jaundice usually lasts for 2 to 3 weeks and may be associated with intense itching. The type of virus can be differentiated only by blood tests.

Myth 8: Vaccine is available against all types of Hepatitis virus.

Fact: Vaccines are available only against Hepatitis A and B.

 Dr Ansul Gupta is Consultant Gastroenterology at Nayati Medicity, Mathura.

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Balanced diet: Healthy eating improves quality of life

Dr Suneet Khanna

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Healthy eating is not about strict dietary limitations, staying unrealistically thin, or depriving yourself of the food you love. A good diet can improve all aspects of life; it is about feeling great, having more energy, improving your mental health, stabilising your mood.

The foods you eat have huge effects on your health and quality of life. If you feel overwhelmed by all the conflicting nutrition and diet advice out there, you’re not alone. It seems that for every expert who tells you a certain food is good for you, you’ll find another saying exactly the opposite. Although eating healthy can be fairly simple, you just have to:

1. Learn how your diet affects your mental as well as your physical health

2. Set yourself up for success by making changes gradually

3. Don’t think of food as “offlimits”

4. Reduce your portion sizes and fill up with more fruit and veg

5. Learn to spot hidden sugar in your food and avoid it

6. Differentiate between healthy and unhealthy fats

7. Find out how fiber intake can fill you and help lose weight

8. Drink plenty of water and keep yourself well-hydrated

We all know that eating right can help you maintain a healthy weight and avoid certain health problems. Various studies have linked eating a typical Western diet filled with processed meats, packaged meals, takeout food, and sugary snacks with higher rates of depression, stress, bipolar disorders, and anxiety.

Eating an unhealthy diet may even result in disorders such as Alzheimer’s disease and schizophrenia or an increased risk of suicide in young people.

 Instead of emphasising on one nutrient, we need to move to food-based recommendations. What we eat should be whole, minimally processed, nutritious food as close to its natural form as possible.

 Here are a few recommendations to have a healthy diet:

1. Have breakfast and eat smaller meals throughout the day

2. Avoid eating late at night

3. Cut back on sugar

4. Moderation and not feeling stuffed is the key to a healthy diet

5. We need a balance of proteins, fat, fiber, carbohydrates, vitamins and minerals to sustain a healthy body.

Dr Suneet Khanna is a well-knwon nutritionist.

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Don’t let your guard down, Covid can return: AIIMS Director

Dr Randeep Guleria, Director, All India Institutes of Medical Sciences, Delhi, says there has been no community spread in India yet, but corona cases can spike if precautionary guidelines are not followed.

Shalini Bhardwaj

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Do you think infection rate has come down in Delhi?

 A. Infection rate is coming down in Delhi and in few other cities as well. It’s possibly increasing in smaller cities as in few cities like in Patna and Guwahati, cases are increasing. So, there are different areas where cases are peaking and flattening at different times. I think certain larger cities have started peaking and flattening but smaller cities are now showing an increase in cases and will peak in a few days.

Q. Serological survey shows infection rate is high in Delhi. What does it mean?

A. It shows there are certain numbers of people who have mild symptoms or are asymptomatic but they had Covid-19 infection. It means that a significant number of people have mild infection as compared to serious infection. We have to continue the protective measures like social distancing, masks, testing, tracking and isolating. If we will not follow such precautionary measures then again people have to face a spike.

Q. Do you think if migrants will return then the cases will rise again? As you said earlier that case would spike again in the month of September?

A. We have to be very careful how to manage when people return back to Delhi or other cities. Monitoring people closely in case of infection and they have to be properly isolated as well. If we are not careful, then there will be a rise in cases.

Q. What is herd immunity? How does it work? Do you think India can get herd-immunity?

A. In case of herd immunity, it has to be 60 percent of positive cases then only it works. We have just 23 percent positive cases, meaning it is going to be difficult to achieve herd immunity; another way to get herd immunity is vaccination. It will help people become immune because this will break the chain and will reduce the number of cases. This virus takes time to make antibodies. In most countries, infection rate is less and for herd immunity infection rate should be high.

Q. Have you seen the mutation of this virus? If there is mutation then it’s going to make the virus more virulent, or does it make it more infectious in increasing cases?

A. A lot of research is going on virus mutation. If it happens then there will always be a mild mutation but till now, we don’t have much data that the virus has changed so much that it’s spreading very rapidly as compared to the past or causing more deaths. Some people have a hypothetical reason that there is less mortality in India or Asia because the virus may have mutated when it came to this part of the world, causing less mortality, but there is now scientific data to support this.

Q. Do you think there is community spread in India?

A. According to the sero survey, there is no community spread. Earlier Bengaluru was doing very well but people started going to the bars, gatherings and the virus again came back. Even now in Delhi cases are coming down significantly. Earlier there were 4,000 cases in a single day but it’s decreased. But on the other hand, the sero survey says that 77 percent of the population is still susceptible therefore you can’t let your guard down and you have to be cautious in terms of social distancing, mask wearing. In Karnataka, they opened up too quickly which led to an increase in the number of cases. It’s also happened in some states of the US.

Q. Do you think Covid-19 can become worse if pollution level is high?

A. There is no conclusive study. I don’t think it’s true. During lockdown pollution came down significantly, but viruses didn’t come down.

 Q. What do you think about school opening for children?

A. It depends on the situation in that particular city. We have to be very careful because if children go to the schools, they won’t be able to maintain social distancing. There may be a certain spread in the school but they might not know that. Children can get the infection and they can take it to their grandparents who can get a very serious infection and that can also lead to a higher chance of death.

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