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Death rate also increasing with cases this time: Dr Guleria

Covid-appropriate behaviour and vaccines are the two weapons needed to fight the war against the novel coronavirus, says AIIMS director Dr Randeep Guleria.

Shalini Bhardwaj

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In an exclusive interview with The Sunday Guardian, Dr Randeep Guleria, Director of the All India Institute of Medical Sciences (AIIMS), explained the reasons behind the recent record surge in Covid-19 cases, the susceptibility of youngsters and people with comorbidities, and how the infection can be tackled by a combination of isolating and treating patients and vaccinating others.

An artist makes a mural of Monalisa wearing a face mask to spread awareness for the prevention of the coronavirus in Mumbai on Thursday. (ANI Photo)

Q: Why is the second wave of Covid-19 in India progressing so quickly and why is it targeting so many people?

A: One of the two main reasons for this is that when cases started decreasing and the vaccines started rolling out in January and February, people thought that Covid has ended and ignored Covid-appropriate behaviour like wearing masks and socially distancing. As a result, the virus got another chance to spread. Secondly, the mutant viruses, especially the UK mutant, are more infectious and spreading faster than the previous one. We can see that the spike is very steep and cases are increasing at a very fast pace as we have now crossed an average of 1.5 lakh cases per day.

Q: When talking about specific mutants, like the UK variant, why are they spreading more in metropolitan cities?

A: The coronavirus is a respiratory virus that spreads through droplet infections. Wherever the population density is greater, like in metropolitan areas, urban slums or metro stations, the virus spreads faster. An asymptomatic person can also cause infections when present in a crowd. Moreover, in rural areas, the air is fresh and people tend to stay outdoors and maintain social distancing due to which the virus cannot survive for long in the environment.

Q: Keeping in mind the pace of the spread of the virus, do you think we need to make some changes in the guidelines?

A: We don’t need to change the guidelines, but need to follow them strictly. We have been testing, tracking, treating and isolating. If there is a Covid-positive case in the family, we need to isolate the patient. If they cannot be isolated, admit them to a Covid care centre so they don’t spread infections in their area. We have to see where the most cases are being reported from and divide areas into red, orange and green zones, just like we did before. The more the cases, the more the people will fall ill and need ICUs and hospital beds.

Q: More youngsters are getting affected by the infection this time. What should we do in this situation?

A: This time, cases in the younger age group are comparatively higher. This is because we saved children from the infection last time but just as we became more casual and ignored Covid-appropriate behaviour later, they got exposed to the virus immediately. Secondly, the younger age group thinks that the disease is not as severe in their age group and so they need not worry due to which they have started partying and clubbing again. However, if they are infected and unaware about it, they may spread the infection to more friends and colleagues.

Q: How can we protect kids?

A: Since the vaccine has still not been approved for kids, we need to take precautions just as we did before. Avoid crowds and non-essential activities, wash hands properly and wear masks when going out. We have started behaving casually and the virus has grown more infectious, due to which entire families are getting infected together.

Q: What is the reason for the increased mortality rate this time?

A: Last time we assumed, and the figures also showed, that the death rate is low. This time, as the cases increase, the death rate is also increasing. When a person gets infected, they go home and infect their family as well. In case any of them has a comorbidity, it may get more serious and hence chances of mortality are greater. Many people are not taking the infection seriously and visiting hospitals only when it gets serious. This is causing a delay in treatment and getting medicines, hence increasing the risk of death.

Q: Do you think a second lockdown is a solution?

A: Weekend lockdowns are okay but we need to take aggressive action. We have to contain the areas reporting the most number of Covid cases and test and treat the people in those areas. Also, we need to keep a check on travel because people travelling from red to green zones can spread infections.

Q: People, including many doctors, are getting infected after taking the second dose of the vaccine. What is the reason behind this?

A: First of all, we need to understand the purpose of the vaccine. After we receive the vaccine, we will not catch the disease even after getting the infection. Catching an infection means coming in contact with a Covid-positive person, when the virus may enter our nostrils and throat. But since we are vaccinated, the antibodies in our body will not allow the virus to spread further in our body. Therefore, we need to follow Covid-appropriate behaviour as the vaccines may save us from serious illness, but we are still able to spread the infection among others who are not vaccinated.

Q: We talked to a lot of professionals about the lack of antibodies in many people, even after vaccination. What is the reason for this?

A: Nowadays, we test upon G-antibodies, whereas we need to look for neutralizing antibodies. Cell-mediated immunity is long-lasting immunity created by the vaccine. There is another cell called the T-cell, that is also called a memory cell, which starts creating antibodies once exposed to the virus. Looking for antibody creation after vaccination is one thing but there are a lot of things apart from it like cell-mediated immunity and T-cell immunity. Research is being conducted for a booster dose vaccine which might be needed after 1.5 years.

Q: If someone receives Covishield, can the person receive Covaxin or other vaccine?

A: Right now, that is not possible due to a lack of stock of vaccines, but once everyone gets all the doses of the vaccines, we will see if we can inoculate people with a third dose as well. Some studies are being conducted upon the mixing of the vaccines and whether that will create more immunity. Until now, only a single dose was being administered during the vaccine trials.

Q: Do you think we should reduce the age limit for inoculation in view of the increasing Covid cases?

A: When talking about the vaccine, the first criterion is to reduce the mortality rate. Thus, we started by vaccinating people above 60 years of age as they are at the highest risk. Then we came down to people 45 years of age with comorbidities and covered healthcare workers and frontline workers, also to ensure that the healthcare system remains efficient. After this we have to vaccinate people who are of lower priority. But if we open vaccinations for all, we won’t be able to cover everybody because we will need a minimum of 2 billion doses to vaccinate a population of over 1 billion in our country. And if we inoculate people in the age group of 25-45 years and have no doses for people above 60, it will increase the risk factor for the country. Thus, we need to balance out the vaccine doses among the population.

Q: A lot of states are reporting a lack of vaccine doses. Many people could not get the second dose. How can we deal with this?

A: This issue is arising due to a supply-demand issue and it is not a matter of a lack of doses. Also take into account the eligibility of the people taking the doses. If at a centre, 50-75 people are visiting, we keep a record of those people and maintain the chain. But if 500 people arrive suddenly at the same centre on a given day, the chain cannot be scaled. At first, there was vaccine hesitancy but due to the sudden spike in cases, people started crowding immediately at the centres. It can so happen that if there is vaccine hesitancy at some place, we can move the surplus vaccines from there to a place with higher demand.

Q: How can vaccine wastage be controlled?

A: Vaccine is supplied in vials. A vial contains 10-20 doses. This means that we need to use all the doses when a vial is opened. Each vaccination centre needs to make a strategy and check if there are people waiting for doses before opening a vial.

Q: Do you think people need to get some tests done before receiving the first dose of the vaccine?

A: Many people tend to get their blood tests done, take Crocin and anti-allergy medicines, which are not at all needed. No tests need to be done before getting inoculated. Even if you get any side-effects after the vaccines, they can be treated. The side-effects are not major and are usually treatable.

Q: How can people with cardiac disease, high blood pressure, diabetes or any such issues take care of themselves?

A: 80% of such people are above the age of 45 and should get vaccinated quickly as these people may get severe Covid. Also, they should follow Covid-appropriate behaviour and avoid crowded places. Also, they should take proper precautions at home like maintaining hygiene and maintaining distance from people with possible symptoms of Covid.

 Q: When will the curve flatten? What would you say about the future possibilities of the disease?

A: The curve may not flatten in the upcoming days and it is difficult to say anything about the future. It completely depends upon us. If we follow Covid-appropriate behaviour, work from home and avoid going to public places, cases may reduce. 80% of people in India are still susceptible to the infection. The fight against Covid can only be won with the active participation of people. If we stop the droplet infection by maintaining social distancing, wearing masks, sanitising and washing hands, we can stop cases from increasing. Thus, everyone must take precautions.

Q: When is the Remdesivir injection needed and how does it work?

A: The timing of a drug is very necessary to be taken care of. Remdesivir is anti-viral but has not shown reduced mortality rates till now. It does reduce hospital admission. It only works when you have a moderate illness and your oxygen saturation is reducing, fever is high or there is a patch in the X-ray or CT Scan. In later stages, Remdesivir does not work. A treatment strategy needs to be implemented.

Q: As hospitals do not have enough beds, how can one treat Covid at home?

A: First, we need to check if the person has a home isolation facility or not. If not, they should be sent to a Covid care centre. Next, see the condition of the patient. Does the person need hospitalization, what are his/her symptoms, and do they have any comorbidities? The government has demonstrated the process of home isolation already. 85%-90% people catch mild symptoms of Covid and can be treated at home. Only 10%-15% of people need to get hospitalised and out of them, only 5% need to get admitted to the ICU. Thus, many can treat themselves at home.

Q: What last message do you want to give?

A: The fight against Covid is not yet over and we have to fight it together. Covid-appropriate behaviour is very necessary in this pandemic. The vaccine is a great weapon against this virus and it will assist us in this fight. If we use both these weapons together, we will get rid of this pandemic quickly.

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Study finds Covid-19 related parenting stress impacts eating habits of children

Researchers found that stress resulting from uncertainty about the job and financial security was associated with psychological distress, while concerns over family safety and stability led to anxiety

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A new study has found that the stress experienced by parents during the Coronavirus pandemic has a negative impact the eating habits of children. The findings were published in the journal Current Psychology.

When stay-at-home mandates were ordered and the school went virtual at the onset of the pandemic, many parents suddenly had to juggle multiple roles such as caregiver, employee and educator. Leslie Frankel, associate professor of human development and family studies, said all those responsibilities took a toll on parents’ mental health, and in turn, what and how much their children were consuming.

Previous research has shown that stress, in general, is known to have a negative impact on parent-child feeding interactions, but new findings reveal COVID-19 only magnified the problem.

“These parents do not have the time, energy or emotional capacity to engage in optimal feeding behaviours, so they resort to maladaptive feeding behaviours such as using food as a reward or pressuring their kids to eat,” said Frankel, the study’s lead author and expert in parent-child relationships. “As a result, their children are not able to self-regulate what or how much food they are putting into their bodies, which could have harmful consequences in the long run.”

Frankel and study co-authors Caroline Bena Kuno, a doctoral student in the UH College of Education and UH Honors College student Ritu Sampige, surveyed 119 mothers and fathers of children ages two to seven between April and June 2020.

The researchers analysed two different types of COVID-related parenting stress and found that stress resulting from uncertainty about the job and financial security was associated with psychological distress, while concerns over family safety and stability led to anxiety. The mothers surveyed reported experiencing higher levels of stress and anxiety compared to fathers who participated in the study.

“The stress doesn’t just go away. Many parents are still feeling uneasy and a parent who is overwhelmed and experiencing symptoms of depression and anxiety may not pay attention to or acknowledge their children’s cues of hunger and fullness,” Frankel explained.

To ensure children are optimising their eating habits in the event of another public health emergency or natural disaster, the research team says policymakers or non-profit organizations interested in improving outcomes for children and parents should provide support systems to help parents manage their daily stressors.

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OSTEOPOROSIS: THE SILENT DISEASE

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Osteoporosis is a disorder in which the density of bone decreases, causing it to lose strength and become brittle. Osteoporosis causes unusually porous, collapsible bone, similar to that of a sponge. The skeleton is weakened by this condition, which leads to frequent fractures (breaks) in the bones. A normal bone is made up of protein, collagen, and calcium and they all contribute to its strength. Osteoporosis-affected bones can shatter (fracture) even with small traumas that would not usually cause a bone to break. Although osteoporosis-related fractures can occur in nearly every skeletal bone, they are most commonly found in the spine, hips, ribs, and wrists.

Symptoms of osteoporosis- there are no indicating symptoms hence the title ‘The Silent Disease’. But one can look out for the following indications; height loss (getting shorter by an inch or more), change in postures, asthma (smaller lung capacity due to compressed lung capacity), fractures in bones, lower- back discomfort.

Some of the factors that increase the risk of developing osteoporosis are:

1. Gender: Women have a higher chance of having osteoporosis as they have smaller bones and lower peak bone mass compared to men. Men still are at risk particularly after the age of 70.

2. Age: Bone loss accelerates as you become older, but new bone formation slows. The bones may deteriorate over time, increasing the chances of developing osteoporosis.

3. Size of the body: Slender, thin-boned women and men are more likely to develop osteoporosis than larger-boned women and men because they have less bone to lose.

4. Race: Osteoporosis is more prevalent among Caucasian and Asian women. African-American and Hispanic women, on the other hand too face this. In fact, after a hip fracture, African-American women are more likely to die than white women.

5. Genetics: Researchers have shown that if one of your parents has had an osteoporosis or hip fracture, your chance of developing osteoporosis and fractures may be increased.

6. Hormonal changes: Certain hormone deficiencies might raise your risk of getting osteoporosis. As an example: After menopause, women’s estrogen levels drop. Low estrogen levels caused by an atypical lack of monthly cycles in premenopausal women owing to hormone abnormalities or high amounts of physical exercise. Men’s testosterone levels are low. Men who have diseases that induce low testosterone are at risk for osteoporosis.

7. Diet: A diet deficient in calcium and vitamin D might raise the chances of developing osteoporosis and fractures. Excessive dieting or a lack of protein may also raise the risk of bone loss and osteoporosis.

8. Lifestyle: Low levels of physical activity and lengthy periods of inactivity can both contribute to accelerated bone loss. They also put you in poor physical shape, increasing your chances of falling and fracturing a bone. Chronic excessive alcohol use is a substantial risk factor for osteoporosis. According to research, smoking is also a risk factor for osteoporosis and fracture.

Treatment for Osteoporosis includes proper nutrition, changes in your way of life, exercise, fall avoidance is important in order to avoid fractures, medications.

DIAGNOSIS FOR OSTEOPOROSIS

Before any problems arise, your healthcare practitioner might schedule a test to provide you with information about your bone health. Dual-energy X-ray absorptiometry (DEXA or DXA) scans are other names for bone mineral density (BMD) examinations. These X-rays utilize extremely small quantities of radiation to evaluate the strength of the bones in the spine, hip, and wrist. Regular X-rays will only reveal osteoporosis if the illness has progressed significantly. Women over the age of 65 should undergo a bone density test. For women who have osteoporosis risk factors, a DEXA scan may be performed sooner. Men over the age of 70, as well as younger men with risk factors, should get a bone density test.

When you have osteoporosis, it’s critical to avoid fractures since they can lead to other medical issues. When your health care practitioner tailors a programme to your specific needs, exercise can help avoid fractures caused by falls and increase bone strength. Before beginning any fitness programme, speak with your doctor or physical therapist if you have osteoporosis or bone loss. Furthermore, avoiding falls helps to avoid fractures. Falls raise your chances of breaking a bone in your hip, wrist, spine, or other skeleton.

This author is a Lead Consultant – Orthopedics & Joints Surgery, Aster RV Hospital

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RESEARCH: INTERMITTENT FASTING WORKS FOR WEIGHT LOSS, HEALTH CHANGES

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According to a new study review led by University of Illinois Chicago researchers, intermittent fasting can produce clinically significant weight loss as well as improve metabolic health in individuals with obesity.

The findings of the study were published in the journal Annual Review of Nutrition. “We noted that intermittent fasting is not better than regular dieting; both produce the same amount of weight loss and similar changes in blood pressure, cholesterol and inflammation,” said Krista Varady, professor of nutrition at the UIC College of Applied Health Sciences and author of “Cardiometabolic Benefits of Intermittent Fasting.”

According to the analysis published in the Annual Review of Nutrition, all forms of fasting reviewed produced mild to moderate weight loss, 1 to 8 percent from baseline weight, which represents results that are similar to that of more traditional, calorie-restrictive diets.

Intermittent fasting regimens may also benefit health by decreasing blood pressure and insulin resistance, and in some cases, cholesterol and triglyceride levels are also lowered. Other health benefits, such as improved appetite regulation and positive changes in the gut microbiome, have also been demonstrated.

The review looked at over 25 research studies involving three types of intermittent fasting: alternate-day fasting, which typically involves a feast day alternated with a fast day where 500 calories are consumed in one meal, 5:2 diet—a modified version of alternate-day fasting that involves five feast days and two fast days per week, time-restricted eating—which confines eating to a specified number of hours per day usually four to 10 hours with no calorie restrictions during the eating period.

Various studies of time-restricted eating show participants with obesity losing an average of 3 percent of their body weight, regardless of the time of the eating window.

Studies showed alternate day fasting resulted in weight loss of 3% to 8% of body weight over three to eight weeks, with results peaking at 12 weeks. Individuals on alternate day fasting typically do not overeat or binge on feast days, which results in mild to moderate weight loss, according to the review.

Studies for the 5:2 diet showed similar results to alternate-day fasting, which surprised the study’s reviewers. The subjects who participate in the 5:2 diet fast much less frequently than alternate-day fasting participants do, but the results of weight loss results are similar.

Weight loss in both the alternate day and 5:2 fasting are comparable to more traditional daily calorie-restrictive diets. And, both fasting diets showed individuals were able to maintain an average of 7% weight loss for a year.

“You’re fooling your body into eating a little bit less and that’s why people are losing weight,” Varady said.

Varady added the review set out to debunk some myths regarding intermittent fasting. Intermittent fasting does not negatively affect metabolism, nor does it cause disordered eating, according to the studies reviewed.

“Fasting people are worried about feeling lethargic and not being able to concentrate. Even though you are not eating, it won’t affect your energy,” Varady said. “A lot of people experience a boost of energy on fasting days. Don’t worry, you won’t feel crappy. You may even feel better.”

The study review includes a summary of practical considerations for those who may want to try intermittent fasting. Among the considerations are:

Adjustment time—side effects such as headaches, dizziness, and constipation subside after one to two weeks of fasting. Increased water intake can help alleviate headaches caused by dehydration during this time.

Exercise—moderate to high-intensity endurance or resistance training during food abstention can be done, and some study participants reported having more energy on fast days. However, studies recommend those following alternate day fasting eat their fasting day meal after exercise.

Diet during fasting—there are no specific recommendations for food consumption during intermittent fasting, but eating fruits, vegetables, and whole grains can help boost fibre intake and help relieve constipation that sometimes accompanies fasting.

Alcohol and caffeine—for those using an alternate day or 5:2 fasting plan, alcohol is not recommended on fast days as the limited calories should be used on healthy foods that provide nutrition.

There are several groups who should not intermittent fast, according to the studies. Those individuals include: those who are pregnant or lactating, children who are under 12, those with a history of disordered eating, those with a body mass index, or BMI, less than 18.5, shift workers—studies have shown they may struggle with fasting regimens because of shifting work schedules, and those who need to take the medication with food at regimented times.

“People love intermittent fasting because it’s easy. People need to find diets that they can stick to long term. It’s definitely effective for weight loss and it’s gained popularity because there are no special foods or apps necessary. You can also combine it with other diets, like Keto,” Varady said.

It’s definitely effective for weight loss and it has gained popularity because there are no special foods or apps necessary. You can also combine it with other diets, like Keto.

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Optimal blood pressure helps our brains age slower: Study

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People with elevated blood pressure that falls within the normal recommended range are at risk of accelerated brain ageing, according to new research from The Australian National University (ANU).

The research also found optimal blood pressure helps our brains stay at least six months younger than our actual age. The researchers are now calling for national health guidelines to be updated to reflect their important findings. The ANU study, published in Frontiers in Aging Neuroscience, found participants with high blood pressure had older and therefore less healthy brains, increasing their risk of heart disease, stroke, and dementia.

Participants with elevated blood pressure, but within the normal range, also had older-looking brains and were at risk of health problems. “This thinking that one’s brain becomes unhealthy because of high blood pressure later in life is not completely true,” Professor Nicolas Cherbuin, Head of the ANU Centre for Research on Ageing, Health, and Wellbeing, said.

“It starts earlier and it starts in people who have normal blood pressure.” Normal blood pressure is defined by pressure below 120/80, whereas an optimal and healthier blood pressure is closer to 110/70.

The new research comes after a large international study found the number of people over 30 with high blood pressure has doubled globally. Cardiologist and co-author of the study, Professor Walter Abhayaratna, said if we maintain optimal blood pressure our brains will remain younger and healthier as we age.

“It’s important we introduce lifestyle and diet changes early on in life to prevent our blood pressure from rising too much, rather than waiting for it to become a problem,” he said.

“Compared to a person with a high blood pressure of 135/85, someone with an optimal reading of 110/70 was found to have a brain age that appears more than six months younger by the time they reach middle age.”

The ANU team, in collaboration with colleagues in Australia, New Zealand, and Germany, examined more than 2,000 brain scans of 686 healthy individuals aged 44 to 76. The blood pressure of the participants was measured up to four times across a 12-year period. The brain scan and blood pressure data were used to determine a person’s brain age, which is a measure of brain health.

Lead author, Professor Cherbuin, said the findings highlight a particular concern for young people aged in their 20s and 30s because it takes time for the effects of increased blood pressure to impact the brain.

“By detecting the impact of increased blood pressure on the brain health of people in their 40s and older, we have to assume the effects of elevated blood pressure must build up over many years and could start in their 20s. This means that a young person’s brain is already vulnerable,” he said.

Professor Abhayaratna said the research findings show the need for everyone, including young people, to check their blood pressure regularly. “Australian adults should take the opportunity to check their blood pressure at least once a year when they see their GP, with an aim to ensure that their target blood pressure is closer to 110/70, particularly in younger and middle age groups,” he said.

“If your blood pressure levels are elevated, you should take the opportunity to speak with your GP about ways to reduce your blood pressure, including the modification of lifestyle factors such as diet and physical activity,” he added.

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HOW TO TACKLE ANTIMICROBIAL RESISTANCE IN INDIA

Dr Rahul Pandit

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A recent ICMR report has left healthcare providers, patients, and infection control experts worried about the rising Antimicrobial Resistance in India. The report says that more than 50 percent of ICU patients in recent times have been battling a type of Pneumonia caused by the bacteria ‘Klebsiella Pneumonia’, which will not respond to even powerful antibiotics like Carbapenem. Another antibiotic, Imipenem, will not affect a mutated form of E-coli in 3 out of 10 cases. This means mutations in microbes, be it bacteria, viruses, or fungi—are rendering medicines useless when the patients most need them.

Given the pandemic and the extensive use of antibiotics to fight Covid-19, antibiotic resistance has been accelerated. Many experts are of the opinion that our approach to treating Covid-19 in hospitals could be exacerbating the problem.

Having said that, India with its combination of a large population, rising incomes that facilitate the purchase of antibiotics, high burden of infectious diseases, and easy over-the-counter access to antibiotics —is an important locus for the generation of resistance genes. This was the state even before the pandemic hit us.

Antibiotic resistance leads to longer hospital stays, higher medical costs, and increased mortality. We have already seen the rise of secondary infections and rare fungal infections such as mucor mycosis or black fungus, white fungus, and yellow fungus, taking a toll on Covid-19 patients during the second wave. Several studies attribute this to the injudicious use of steroids and other antibiotics medicines.

Moreover, even before the pandemic, India experienced over 56,000 newborn deaths each year due to Sepsis that is caused by organisms that are resistant to first-line antibiotics. Also, an estimated 170,000 deaths from Pneumonia in children under five, can be averted with timely access to effective antibiotics. While rising rates of resistant infections are a threat, many deaths are attributable to the lack of access to basic antibiotics.

Another important aspect is the use of antibiotics in the poultry and animal industry. This is much larger than what we imagine and obviously contributes to the growing menace of resistance.

So, how do we control and tackle growing Antimicrobial Resistance (AMR) in India?

We need to balance excessive and inappropriate use, a key driver of antibiotic resistance while ensuring live-saving medicines are available to those who need them. There is also a need to improve vaccination coverage, access to clean water, adequate sanitation, and improved hygiene.

However, efforts must be made to bring about behavioral changes in terms of hygiene practices, self-medication efforts, and proper health education. Vaccination has been shown to reduce the transmission of AMR infections and the volume of antibiotics consumed due to both, appropriate treatment of bacterial infections and viral infections.

India has undertaken many activities like Mission Indradhanush — to address low vaccination coverage and strengthened micro-planning and additional mechanisms to improve monitoring & accountability. Yet, improvements in coverage are still needed. Moreover, antibiotic stewardship programs are very much needed, to help providers and clinicians make the best clinical decisions possible for an antibiotic prescription. Antibiotic stewardship is the systemic effort to ensure effective treatment of infections, and therefore combat AMR, by monitoring and advising on antibiotic prescription and use. Another aspect is the appropriate management of antibiotics throughout the supply chain—from manufacturing to consumption. Effluents from pharma manufacturing contain active antibiotics, resistant bacteria, and resistant genes; they contaminate rivers, streams, and wells, including waters that are used for drinking and bathing. This increases both the emergence of resistant bacteria in local populations and also its spread. In addition, even lower levels of contamination in wastewater can cause resistant bacteria. In the same light, researchers have noted that contamination in areas where there is an antibiotic manufacturing industry led to an increase in bacterium causing resistance to Carbapenems.

Another source of environmental contamination is contaminated hospital waste. Untreated hospital waste may contain antibiotics and resistant bacteria. Where disposal mechanisms are inadequate, such waste puts staff and patients at increased risk from AMR. Hence, a concerted approach that incorporates diverse stakeholders to tackle and control the spread of antibiotics is essential.

The author is Director of Critical Care at Fortis Hospital, Mumbai and a member of Maharashtra’s Covid-19 Taskforce

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STUDY EXPLORES ADVERSE COMPLICATIONS FOR COVID POSITIVE PREGNANT WOMEN, THEIR NEWBORNS

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A new study, which finds an increased risk of poorer outcomes for the newborns and symptomatic women with Covid-19, adds further weight to the argument for pregnant women to be vaccinated for the virus.

The peer-reviewed findings were published in The Journal of Maternal-Fetal and Neonatal Medicine. Assessing 2,471 women in the third trimester of their pregnancy, close to their delivery, researchers found “significant differences” for symptomatic Covid-positive patients including higher rates of gestational diabetes, lower white blood cell counts, and heavier bleeding during delivery, whilst respiratory complications were witnessed in their babies. Thankfully in the group of patients—which included 172 covid positive women (56 of whom were symptomatic)—monitored at the Mayanei Hayeshua Medical Center in Israel, only one person needed mechanical ventilation, and there were no maternal deaths.

They show, lead Dr Elior Eliasi stated that Covid-19 in the third trimester of pregnancy “has clinical implications, albeit at lower rates than expected once asymptomatic patients are taken into account.”

The analysis found that there was no significant increase in cesarean delivery in women, who were Covid-19 positive and the incidence of preterm deliveries was not significantly different among the three groups (healthy, covid positive asymptomatic, covid positive symptomatic). Most pregnancy and delivery outcomes were similar between Covid-positive and -negative parturients (a woman about to give birth; in labour).

Dr Eliasi said, “However, There were significant differences between the Covid-positive and healthy controls included higher rates of GDM (gestational diabetes), low lymphocyte counts (white blood cell count) which were significantly lower, postpartum hemorrhage (bleeding during birth), and neonatal respiratory complications.”

“Our findings support the importance of vaccinating all pregnant women at all stages of pregnancy,” he added.

The study looked at births at the hospital between 26 March and 30 September 2020. A total of 93 percent of women admitted to the labour ward during this period were negative for Covid-19. Of the Covid-positive patients, 67 percent were asymptomatic.

On average the increased risk of incidence of adverse outcomes was 13.8 percent higher for asymptomatic covid patients and 19.6 percent higher for those symptomatic.

“More data is now needed to better delineate the differences between pregnancy outcomes seen in certain populations, potentially related to different viral characteristics (subtypes, viral load), patient epigenetics, or other factors. Additionally, the effects of maternal infection on the fetus both in terms of symptomatic maternal illness and vertical viral transmission remain to be further investigated,” the authors stated.

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