Frontline workers should be vaccinated first: Dr Poonam Khetrapal - The Daily Guardian
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Frontline workers should be vaccinated first: Dr Poonam Khetrapal

Shalini Bhardwaj



Do you think Indian authorities’ strategy is moving towards the right direction in handling Covid-19? What more can be done?

A: India acted early and took bold and decisive steps while implementing core public health measures to detect, test, trace, isolate and treat Covid cases. The country has been scaling up capacities of health workers, hospitals, laboratories  and focusing on local production to meet essential medical supplies such as PPEs, masks etc. The focus now is on areas with clusters of cases. Our measures should be guided by sub-national or even community-level risk assessment which should be based on epidemiological factors, healthcare capacities and public health capacities. Public health and social measures should be adjusted to protect the vulnerable population. The adjusting of public health and social measures, including large-scale movement restrictions, should be done to minimize the risk of COVID-19. We are already eight months into the pandemic. Though there is no medicine or vaccine yet for Covid-19, there is enough evidence that the tools in hand can help curtail Covid transmission.

Dr Poonam Khetrapal.
Dr Poonam Khetrapal.

Q: When will the cases start declining ?

A: It is hard to predict. Also, we cannot assume that the downward trend in the disease, wherever it has happened, has occurred naturally. It was only possible with tough public health measures put in place to break chains of transmission in communities.  The cornerstone of response to Covid-19 pandemic is to find, isolate, test and care, trace and quarantine contacts. Aggressively implementing these core public health measures, promoting hand hygiene, cough etiquette and social distancing is every country’s best defence against Covid-19. We are in for a long haul and cannot let our guards down.

Q: How many challenges India has to face in the coming days?

A: The pandemic has put immense strain on health systems across the world. The previous disease outbreaks have shown that disruption to essential services caused by an outbreak can be more deadly than the outbreak itself.  We must fast-track efforts and do all we can to avoid that happening, while continuing efforts to break Covid-19 transmission chains. Hence, maintaining essential health services and accelerating resumption of those services hit by the pandemic, is a priority for all countries now.

Q: When do you think India will get a vaccine? What strategy and protocols need to be followed in supply after getting a vaccine?

 A: Traditionally, it takes 5-10 years, or even more for a new vaccine to be developed before it can be used in humans. Despite accelerated efforts, the availability of Covid-19 vaccines would depend on the outcome of the clinical trials that are still ongoing. While several candidate vaccines have progressed to clinical trials phase, including some that are undergoing trials in India, it cannot be said with certainty what the results of these trials will be – both in terms of efficacy and safety – and by when we will have a vaccine available for use in populations. Once developed, a Covid-19 vaccine must be considered a global public good, that can be accessed by all of humanity. To facilitate this, WHO has co-launched the access to ‘Covid-19 Tools Accelerator’ and is supporting the COVAX Facility.  Both these mechanisms are expected to help all countries, including low- and middle-income countries gain rapid and equitable access to safe and effective vaccines.

Q: Who should get the vaccination first?

A: This was discussed extensively at a recent International Symposium on Novel ideas in Science and Ethics of Vaccines against Covid-19 pandemic, in which leading experts from across the globe participated. The allocation framework for Covid-19 vaccines that is under development also aims to help countries prioritize at-risk populations as they develop in-country vaccination strategies. It is proposed that the initial tranche of doses should be made available to all countries to ensure health and other essential frontline workers can be immunized first, followed by other high-risk populations. 

Q: Do you think  Russian vaccine ‹Sputnik V’ can be trusted ? If not then why?  

A: WHO is aware that a Covid-19 vaccine has been registered in the Russian Federation’s national medicines registry. WHO welcomes all advances in Covid-19 vaccine research and development. At the global level, WHO has been involved in guiding and accelerating R&D efforts since January 2020. Accelerating vaccine research should be done following established processes through every step of development, to ensure that any vaccines that eventually go into production are both safe and effective. Any safe and effective pandemic vaccine will be a global public good, and WHO urges rapid, fair and equitable access to any such vaccines worldwide. WHO is in touch with Russian scientists and authorities and looks forward to reviewing details of the trials.

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Medically Speaking




Stanford researchers have observed higher levels of air pollutants within 2.5 miles of oil and gas wells, likely worsening negative health outcomes for residents.

The findings of the study were published in the journal ‘Science of The Total Environment’.

The scientists analysed local air quality measurements in combination with atmospheric data and found that oil and gas wells are emitting toxic particulate matter (PM2.5), carbon monoxide, nitrous oxide, ozone and volatile organic compounds (VOCs). The findings will help researchers determine how proximity to oil and gas wells may increase the risk of adverse health outcomes, including preterm birth, asthma and heart disease.

“In California, Black and Latino communities face some of the highest pollutions from oil and gas wells. If we care about environmental justice and making sure every kid has a chance to be healthy, we should care about this. What’s novel about our study is that we’ve done this at a population, state-wide scale using the same methods as public health studies,” said lead author David Gonzalez, who conducted research for the study in Stanford’s Emmett Interdisciplinary Program in Environment and Resources (E-IPER).

The findings align with other smaller-scale studies that have measured emissions from a handful of wells. At least two million Californians live within one mile of an active oil or gas well.

“It’s really hard to show air quality impacts of an activity like oil and gas production at a population scale, but that’s the scale we need to be able to infer health impacts,” said senior study author Marshall Burke, an associate professor of Earth system science at Stanford’s School of Earth, Energy and Environmental Sciences (Stanford Earth).

The research has revealed that when a new well is being drilled or reaches 100 barrels of production per day, the deadly particle pollution known as PM2.5 increases by two micrograms per cubic meter about a mile away from the site.

A recent study published in ‘Science Advances’ found that long-term exposure to one additional microgram per meter cubed of PM2.5 increases the risk of death from COVID-19 by 11 per cent.

“We started in 2006 because that’s when local agencies started reporting PM2.5 concentrations. We’re very concerned about the particulate matter because it’s a leading global killer,” said Gonzalez.

The team evaluated about 38,000 wells that were being drilled and 90,000 wells in production between 2006 and 2019. They developed an econometric model incorporating over a million daily observations from 314 air monitors in combination with global wind direction information from the National Oceanic and Atmospheric Administration (NOAA) to determine if the pollutants were coming from the wells. They analysed locations with air quality data of before and after a well was drilled.

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Ranking healthfulness of foods from first to worst: Study



A new tool has been developed by scientists at the Friedman School of Nutrition Science and Policy at Tufts to help consumers, food companies, restaurants, and cafeterias choose and produce healthier foods and officials to make sound public nutrition policy.

The findings of the study were published in the journal ‘Nature Food’. Food Compass is a new nutrient profiling system, developed over three years, that incorporates cutting-edge science on how different characteristics of foods positively or negatively impact health. Important novel features of the system include:

1. Equally considering healthful vs. harmful factors in foods (many existing systems focus on harmful factors);

2. Incorporating cutting-edge science on nutrients, food ingredients, processing characteristics, phytochemicals, and additives (existing systems focus largely on just a few nutrients); and

3. Objectively scoring all foods, beverages, and even mixed dishes and meals using one consistent score (existing systems subjectively group and score foods differently).

“Once you get beyond ‘eat your veggies, avoid soda,’ the public is pretty confused about how to identify healthier choices in the grocery store, cafeteria, and restaurant,” said the study’s lead and corresponding author, Dariush Mozaffarian, dean of the Friedman School.

The new Food Compass system was developed and then tested using a detailed national database of 8,032 foods and beverages consumed by Americans. It scores 54 different characteristics across nine domains representing different health-relevant aspects of foods, drinks, and mixed meals, providing for one of the most comprehensive nutrient profiling systems in the world.

The characteristics and domains were selected based on nutritional attributes linked to major chronic diseases such as obesity, diabetes, cardiovascular problems, and cancer, as well as the risk of undernutrition, especially for mothers, young children, and the elderly.

Food Compass was designed so that additional attributes and scoring could evolve based on future evidence in such areas as gastrointestinal health, immune function, brain health, bone health, and physical and mental performance; as well as considerations of sustainability.

Potential uses of Food Compass include encouraging the food industry food purchasing incentives for employees through worksite wellness, health care, and nutrition assistance programs; supplying the science for local and national policies such as package labelling, taxation, warning labels, and restrictions on marketing to children and enabling restaurants and school, business, and hospital cafeterias to present healthier food options.

Each food, beverage, or mixed dish receives a final Food Compass score ranging from 1 (least healthy) to 100 (most healthy). The researchers identified 70 or more as a reasonable score for foods or beverages that should be encouraged. Foods and beverages scoring 31-69 should be consumed in moderation. Anything scoring 30 or lower should be consumed minimally.

Across major food categories, the average Food Compass score was 43.2. The lowest-scoring category was snacks and sweet desserts (average score 16.4).The highest scoring categories were vegetables (average score 69.1), fruits (average score 73.9, with nearly all raw fruits receiving a score of 100), and legumes, nuts, and seeds (average score 78.6). Among beverages, the average score ranged from 27.6 for sugar-sweetened sodas and energy drinks to 67 for 100per cent fruit or vegetable juices.

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Scientists report that children with cerebral palsy benefited most from 60 hours of Constraint-Induced Movement Therapy (CIMT) over four weeks.

The findings of the study were published in the journal ‘Pediatrics’.The study also showed that intensive therapy did not add stress for families. The findings could have far-reaching impacts on the treatment of children’s movement disorders.

The study by researchers at Virginia Tech’s Fralin Biomedical Research Institute at VTC, UVA Children’s, The Ohio State University, and Nationwide Children’s Hospital, has shown that higher doses of CIMT therapy — 20 three-hour sessions over four weeks — yield significant and lasting improvement in the use of their arms and hands, especially in everyday functional activities.

The Children with Hemiparesis Arm-and-hand Movement Project (CHAMP) study is the first to compare different dosage levels of the same type of CIMT intervention for similar children.

The study was funded by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

“CHAMP provides new findings that are practically useful for clinicians and families in choosing treatment likely to produce meaningful benefits for children with hemiparetic cerebral palsy,” said Sharon Landesman Ramey, Distinguished Research Scholar at the Fralin Biomedical Research Institute and professor of psychiatry, psychology, and neuroscience at Virginia Tech, who led the study and is the paper’s corresponding author.

The study focused on children with hemiparetic cerebral palsy (HCP), the most common childhood neuromotor disorder. Cerebral palsy affects one to four children per 1,000 in the United States, and about 40 per cent of these children will develop hemiparesis — impaired voluntary control on one side of the body, according to the Centers for Disease Control and Prevention.

The study group included 118 children with HCP, two to eight years old, at three sites — Roanoke and Charlottesville in Virginia and Columbus, Ohio. CHAMP randomised and assigned children to different CIMT treatment groups that varied in their dosage level (30 versus 60 hours in four weeks) and the type of constraint used (cast versus splint). These treatment groups were compared with a Usual and Customary Treatment group — that later was offered a form of CIMT as an ethical option for study participation.

The form of CIMT therapy, known as ACQUIREc, was developed by co-principal investigators Stephanie DeLuca and Ramey, who also co-direct the Fralin Biomedical Research Institute at VTC Neuromotor Research Clinic, along with Karen Echols and other colleagues at the University of Alabama at Birmingham.

The CHAMP study found that the higher intensity therapy sessions — three hours a day, five days a week for four weeks — significantly improved upper arm and hand abilities while a lower dosage of 30 hours per month (2.5-hour sessions, three days a week for four weeks) produced fewer gains. The children’s early improvements continued for at least six months after higher-intensity CIMT.

The therapy can be life-changing for children. Kim Hindery, whose daughter, Abigail, 6, was part of the study in Ohio, witnessed a dramatic difference during and then after the therapy.

“I could literally see her brain changing. I’ll never forget when she looked up at her hand and goes, ‘Oh!’ — just mesmerised, like, ‘It exists!’ Being able to see a light bulb go off in your child’s head that you never thought you would see go off is priceless,” Hindery said.

Those benefits are well-known to DeLuca who has overseen the delivery of ACQUIRE therapy to more than 500 children.

“The therapists are trained to ensure each child has many successes in every therapy session,” said DeLuca, who is an associate professor at the research institute and in paediatrics and neuroscience at Virginia Tech.

“The child sees and feels their improvement and becomes an active partner in the therapy. ACQUIRE therapy increases children’s willingness to tackle new and difficult activities,” DeLuca added.

The study shows parents who worried about the intensity of the therapy and use of the cast that they should have little concern. The study also unexpectedly showed that Usual and Customary Treatment benefited children more than it did in the past, which Landesman Ramey said should be reassuring to parents whose children receive other forms of therapy.

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Patients below 40 should avoid knee replacement surgeries, say experts



Doctors have warned that knee replacement surgeries in osteoarthritis patients less than 40 years of age can do more harm than good.

Osteoarthritis in young people may be caused by surgical removal of an injured meniscus, C-shaped cartilage in the knee, or injury to the articular cartilage (chondro) and the bone under it, or insufficiency of the ligament. This disturbs the alignment of the knee by placing abnormal stresses on the cartilage of the affected compartment, thus causing pain and difficulty in walking.

According to doctors, there are other procedures that can be used to avoid knee surgeries.

“Simpler technically demanding procedures like cartilage regeneration surgeries are done with the help of keyhole made into the joint and cartilage harvested and grown in the lab. These procedures can manage early degenerative changes that happen only in half the need to start with mostly the inner side. If treated on time, they can give almost like natural cartilage growing there and can avoid knee replacement surgery,” said Dr Shubhang Aggarwal, Senior Joint Replacement Surgeon, and Director, NHS Hospital, Jalandhar.

“The need for knee replacement surgery in young arthritic patients who have degenerative changes in one compartment of the knee joint is overemphasised. Even though we do robotic surgery which gives a perfect alignment and ensures that the implants which are put in last up to 30 years, still, it is advisable that in very young patients especially with osteoarthritis alternate methods of treatment even if they are surgical should be considered.” He added

Dr Vivek Mahajan, senior orthopaedic at Indian Spinal Injuries Centre, said, “Usually in younger patients, the cause of knee pain is due to meniscal tear or ligament injury or cartilage damage which if neglected can lead to osteoarthritis in future. These injuries should be addressed in time and can be managed by simple arthroscopy or keyhole surgery which can prolong the life of knee joint.”

Some of the experts also suggest that degenerative or inflammatory arthritis at a young age would be treated by non-operative treatment like weight reduction therapies, physiotherapy etc.

“As far as a knee replacement is considered, it is usually recommended in the older age group. Generally, the procedure is offered after the age of 60. That does not mean that patients below 40 should continue to suffer even if they have significant pain because of arthritis. Inflammatory arthritis such as rheumatoid arthritis can damage the joint at a relatively young age and cause serious disability. This may need a knee replacement at an early age,” said Dr Yash Gulati, Senior Consultant Orthopaedics, Joint Replacement and Spine, Indraprastha Apollo Hospitals, New Delhi.

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One of the private imaging centres in Delhi has become the first Covid-19 vaccination centre for children in India. The centre would cater to children above 2 years to 18 years and their vaccination process.

The new children-friendly Covid-19 vaccination centre has been given a catchy look and feel. The centre has been painted with cartoons and animal themes in a way that will help to reduce the injection fear among the children. It also has paintings of popular cartoons like Motu-Patlu, dinosaurs etc on the wall. This kids’ vaccination centre is getting a lot of praise from the residents and Children are also coming to see the centre.

“If we see demographic distribution then the age group of 0-18 years isn’t less. We can’t leave them unvaccinated, because diseases in children are not severe but still, they are potential carriers,” said Dr Sameer Bhati, Director, Star Imaging and Path Labs.

The purpose behind opening this centre is to engage children post-vaccination when they will be under observation and to remove fear from their minds.

Dr Bhati further said, “The anxiety and fear that parents have for children regarding vaccination, and engaging children post-vaccination is important. We have given it a catchy look in a way that can engage children in other activities after vaccination.”

The guidelines for Covid-19 vaccination for children who come under comorbidities is still pending. It’s expected that these guidelines may come soon after the complete clearance of DCGI to Bharat Biotech’s Covaxin for children. The Drugs Controller General of India (DCGI) has already given clearance to Zydus Cadila’s DNA vaccine ZyCoV-D for those above 12-18 years.

“The comorbid group in children is also at high risk. The obesity group is also at high risk. According to the latest studies, we are waiting for Covid-19 vaccination guidelines for children who come under comorbidities. SEC has recommended Covaxin also,” he added.

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How Covid-19 could bring adverse complications for pregnant women



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.

The peer-reviewed findings were published in The Journal of Maternal-Fetal and Neonatal Medicine. The study finds an increased risk of poorer outcomes for the newborns and symptomatic women with COVID-19, which adds further weight to the argument for pregnant women to be vaccinated for the virus.

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-19-positive and -negative parturients (a woman about to give birth; in labour).

Dr Eliasi said, “However, There were significant differences between the COVID-19-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 per cent of women admitted to the labour ward during this period were negative for COVID-19. Of the COVID-19-positive patients, 67 per cent were asymptomatic.

On average the increase risk of incidence of adverse outcomes was 13.8 per cent higher for asymptomatic covid patients and 19.6 per cent 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.

Limitations of this study include it being retrospective; whilst another is that the sample includes a relatively healthy population admitted to just a single community hospital. “Therefore,” the authors stated their findings, “may not be generalizable to all populations.”

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