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Frontline workers should be vaccinated first: Dr Poonam Khetrapal

Shalini Bhardwaj

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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.

Medically Speaking

New blood test predicts which Covid patients at severe risk

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Amid the ongoing battle with Covid-19, scientists have developed a score that can accurately predict which patients will develop a severe form of coronavirus. The measurement, called the Dublin-Boston score, is designed to enable clinicians to make more informed decisions when identifying patients who may benefit from therapies, such as steroids, and admission to intensive care units. Until this study, no Covid-19-specific prognostic scores were available to guide clinical decision-making.

 According to the findings, published in the journal EBioMedicine, the DublinBoston score can now accurately predict how severe the infection will be on Day 7 after measuring the patient’s blood for the first four days.

 “The Dublin-Boston score is easily calculated and can be applied to all hospitalised Covid-19 patients,” said study author Gerry McElvaney from the RCSI University in Ireland. 

The blood test works by measuring the levels of two molecules that send messages to the body’s immune system and control inflammation.

 One of these molecules, interleukin (IL)-6, is pro-inflammatory, and a different one, called IL-10, is anti-inflammatory. The levels of both are altered in severe Covid-19 patients. 

Based on the changes in the ratio of these two molecules over time, the researchers developed a point system where each 1-point increase was associated with 5.6 times increased odds for a more severe outcome.

 “More informed prognosis could help determine when to escalate or de-escalate care, a key component of the efficient allocation of resources during the current pandemic,” McElvaney said.

 “The score may also have a role in evaluating whether new therapies designed to decrease inflammation in Covid-19 actually provide benefit,” McElvaney added.

 With IANS inputs

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Medically Speaking

Delhi to be quack-free in 2021: New DMC chief

Shalini Bhardwaj

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Dr Arun Gupta has been re-elected as president of the Delhi Medical Council (DMC) for a second fiveyear term. Dr Gupta, a practising paediatrician for the last 30 years, worked for digitising medical processes during his previous tenure.

 Speaking of the DMC’s current goals, he said, “One of the mandates is to eradicate quackery. We have decided that by the end of the year 2021, Delhi will become the first anti-quackery state in India. We are working on it in collaboration with the Delhi Government. We don’t have any authentic data yet but more than 20,000 quacks are in Delhi only.” 

The DMC is responsible for handling and settling medico-legal issues against doctors. Currently, there are over 72,000 doctors registered with the council.

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Medically Speaking

National Medical Commission starts its website

Shalini Bhardwaj

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The National Medical Commission (NMC), constituted by the National Medical Commission Act, 2019, which came into force on 25 September, 2020, has launched its website. Citizens wishing to know about the National Medical Commission and its current medical working rules and regulations can log on to https:// www.nmc.org.in/.

 The NMC website also has highlights about its autonomous boards, members and organisational structure. The chairman of NMC is Dr Suresh Chandra Sharma and the commission has 33 members including the chairman, 10 ex-officio members and 22 part-time members. It also has four boards, the Under Graduate Medical Education Board, Post Graduate Medical Education Board, Medical Assessment and Rating Board, and Ethics and Medical Registration Board. The commission has 84 members from all over India as members of the medical advisory council.

 Cow dung chip will protect against mobile radiation: RKA chairman Rashtriya Kamdhenu Aayog (RKA) chairman, Vallabhbhai Kathiria, has launched a “chip” made of cow dung, claiming that it reduces radiation from mobile phones significantly.

 The chip, named Gausatva Kavach, has been manufactured by Rajkotbased Shrijee Gaushala. “This is a radiation chip. You can keep it in your mobile and it will reduce radiation. It will also keep you away from diseases,” said Vallabhbhai Kathiria during the launch of a nationwide campaign, ‘Kamdhenu Deepawali Abhiyan’

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Medically Speaking

India’s syringe makers to increase Covid-19 vaccine stocks

Shalini Bhardwaj

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India is one of the largest syringe makers in the world when it comes to 0.5 ml auto-disable syringes for intramuscular vaccination. With the current race towards procuring and distributing a Covid-19 vaccine, syringe manufacturers in the country are ramping up their capacities further by over 30% to meet the expected rise in global demand.

ISCON, Becton Dickinson, and Hindustan Syringes and Medical Device (HMD) are the three major Indian medical device companies which manufacture the 0.5 ml auto-disable syringes which would be required to administer a Covid-19 vaccine. The companies together have planned to expand their capacities to manufacture 1.4 billion pieces per annum by June 2021 next year.

“We are planning to ramp up our capacity to a billion 0.5 ml AD syringes and offer 50% to the Government of India and 50% as exports, which amounts to 200-250 million by June 2021 and another 250 million from June to December 2021,” said Rajiv Nath, Managing Director of Hindustan Syringes and Medical Devices Ltd.

“We have 70 million AD syringes in stock against our orders of standard immunisation campaign and can offer 100 million to Government of India by end of 2020, if needed,” he added.

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Medically Speaking

Efficacy of three primary diets in drug-resistant epilepsy

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Epilepsy that fails to get controlled by two antiseizure drugs is unlikely to respond to the addition of other medications. These children are designated to have drugresistant epilepsy. The principal treatment options for these children include either surgery or starting them on a ketogenic diet.

 The choice of surgery cannot be exercised in all patients: Epilepsy surgery is curative in specific diseases, and in certain conditions, it may be associated with permanent disabilities. Also, the expertise for performing epilepsy surgery is available only in a few centres across the country. The other option includes initiating a ketogenic diet.

 There are three main methods of providing these diets. The classical ketogenic diet often requires the patient to get admitted to the hospital, strict adherence to protocol and weighing the food items. The modified Atkins diet is less severe than the ketogenic diet. The low glycemic index therapy diet requires only minor diet modifications. So far, there has been adequate evidence about the efficacy of the ketogenic diet and the modified Atkins diet.

 The child neurology division of the department of paediatrics, All India Institute of Medical Sciences, carried out a first-of-itskind trial (The DIET Trial). They compared the three primary dietary therapies. This research showed that the seizure burden reduced by more than 50% in 67% of children receiving a ketogenic diet, 52% receiving a modified Atkins diet, and 59% of patients receiving a low glycemic index therapy diet. Also, the side effects were least with a low glycemic index therapy diet. 

Thus, this study adds a modified Atkins diet and low glycemic index therapy diet to the armamentarium for the management of drugresistant epilepsy. The added benefit is that since the study has been conducted in India, it can benefit a large population of drug-resistant epilepsy with local dietary menus. 

The writer is chief, child neurology at AIIMS.

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What happens when corona meets toxic air? CSIR to detect soon, says Dr Shekhar Mande

CSIR labs in Hyderabad and Chandigarh have collected samples from different locations and are working
on research regarding the effects of air pollution on the Covid-19 pandemic, says the CSIR Director General.

Shalini Bhardwaj

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With experts saying that rising pollution levels can worsen the effects of Covid-19, the Council of Scientific and Industrial Research (CSIR) has started its own research on the matter at the National Environmental Engineering Research Institute (NEERI), Nagpur. Director General of CSIR, Dr Shekhar C. Mande, speaks on the subject and about other Covid-related developments like the “Feluda test”, in an exclusive interview with The Daily Guardian. Excerpts: 

Q. Is CSIR going to do research on the link between air pollution and Covid-19?

 A. Of course, but the research will take some time to accomplish. Our labs are working on it already and the National Environmental Engineering Research Institute (NEERI) in Nagpur has started some work too.

 Q. When is CSIR expected to complete its research on whether Covid-19 is air-borne or not?

 A. Researchers have started compiling the results of the airborne study. They are conducting this research at two centres in Hyderabad and Chandigarh. Samples for the study have been collected from various places of India, from places like ICUs, hospital corridors, waiting rooms, places where healthcare workers are most at risk, high rise structures, etc. We are detecting how far this virus can travel. We have taken samples multiple times and are still sampling from different locations with different distances from patients, 4ft, 8ft and 12ft. Now, we have to wait for the results which are expected to come in the next ten days. 

Q. CSIR has tied-up with the UP government. Which projects are the CSIR going to focus on? 

A. We are going to work with the UP government on the types of projects which are required. If they have some ambitious plans on agriculture, the pharma industry or the environment, we will work as a knowledge partner. We are proposing some documents along with the UP government on pharma and we will be doing many other projects too. 

Q. When will “Feluda” come to the market? How does it work? 

A. It’s almost ready to enter the market. Feluda stands for FnCas9 Editor Linked Uniform Detection Assay. It detects active Covid-19 infection by using a CRISPR CAS 9-based readout on a paper strip. Detection takes place in less than an hour. It doesn’t require a real-time PCR machine, will be cheap, and can be performed at the point of care settings where a simple PCR machine is present. The virus has regenetic material RNA and we need to detect that particular RNA. We first do a reaction called RT-PCR (Reverse Transcription Polymerase Chain Reaction) in which we make DNA from RNA and amplify those copies of DNA. Then there is an enzyme which actually tries to match with the virus. It goes to the correct site and identifies the sequence for Covid. A paper strip is dipped into a solution, and if it is Covid-19 RNA, then you get a band that can be seen. The test gives its results in 45 minutes.

 Q. What should be the comprehensive distribution and delivery mechanism for vaccines?

 A. The Government of India is coming up with a very comprehensive plan and will take very considered decisions as a high priority. Those plans are pretty much in place and the people who have drawn these plans are technical experts in their area and therefore it’s going to be very robust. 

Q. In your opinion, who should get the vaccine first?

 A. People who are at high risk should get the vaccine first because they are handling Covid-19 patients every day. They deserve to get the vaccine first.

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