HOW CLIMATE CHANGE HELPS IN THE SPREAD OF INFECTIOUS DISEASE PANDEMICS - The Daily Guardian
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HOW CLIMATE CHANGE HELPS IN THE SPREAD OF INFECTIOUS DISEASE PANDEMICS

Dr Neeraj Nischal

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Climatic change has been associated with an increase in infectious disease pandemics, especially by previously unknown pathogens. The changing climate has been proposed as a basis for the Covid-19 pandemic. A recent paper in the journal Science of the Total Environment has unfolded the link between climate change and the ongoing Covid-19 crisis.

It has been postulated from the beginning of the pandemic that this novel coronavirus has jumped to humans from bats. This link is a near-sighted view obscuring the big picture. Human greed has resulted in deforestation, urbanisation, and overcrowding, all of which have resulted in the greenhouse effect causing global temperature to rise and changing rainfall patterns. The change from a tropical shrub-land to a deciduous woodland has made the environment more conducive to bats. This has led to bats harbouring numerous viruses, migrating to the area, and increasing the probability of viral transmission to humans.

This is just one of the many plausible theories. The rising global temperatures have led to many animals migrating away from the tropics towards the cooler poles. Such an erratic migration pattern leads animals to come in contact with other animals that they normally wouldn’t creating an opportunity for pathogens to get into a new host.

Deforestation for industrial and agricultural purposes has led to major habitat loss as well. These dynamics increase contact between animals and humans which has not been observed before. The increased contact raises the probability of transmission of zoonotic diseases with increasing frequency.

Urbanisation and overcrowding provide an easy opportunity for the respiratory spread of the infection and so does poor sanitation leading to many water-borne disease outbreaks. With easy accessibility for people from the world over to move from one place to another across the globe due to widespread air travel, diseases are no more confined by geographical boundaries. Hence causing global pandemics.

While the beginning of the Covid-19 pandemic might have roots in climate change, the transmission of Covid-19 rests on human shoulders. Rising pollution levels across the globe lead to the increasing transmission of airborne and droplet viruses. Areas with elevated pollution levels are also shown to have increased severity of respiratory illnesses and may contribute to the severity of Covid-19 with higher mortality rates.

This pandemic has been a warning. Climate change has taken a back seat now that all resources are directed to the management of Covid-19 cases. However, we should realise that we are focusing only on the tip of the iceberg. The worst is yet to come if we do not take emergent stringent action to reverse the damage our species has already caused to this planet. It is prudent to consider health aspects while making environmental policies and come up with global health policies to prevent future pandemics.

The writer is an Associate professor, Department of Medicine, AIIMS.

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Medically Speaking

NO COVID-19 VACCINATION ON 27-28 FEB; GOVT TO UPDATE CO-WIN

Shalini Bhardwaj

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New Delhi: The Union Ministry of Health and Family Welfare announced that the vaccination drive will be halted for two days, i.e., February 27 and 28, on account of a software change necessary for the second phase of vaccinations. The second phase of the Covid vaccinations will begin from March 1 across the country.

The second phase of the Covid-19 vaccination drive is for people aged 60 years and those above 45 years with co-morbidities. The two-day pause comes at a time when India is being criticized for a slow vaccination process. The vaccination drive in India was started on January 16 and the first jabs have been given to healthcare workers, followed by frontline workers like police personnel, people of the armed forces, municipal workers, teachers, etc.

A high-level meeting was also conducted with States and UTs to inform them about the 2.0 version of the digital platform Co-WIN.

“The States and UTs were explained the basic features of version 2.0 of the digital platform Co-WIN. Private sector hospitals will be involved as Covid vaccination centres to harness their potential to expand the vaccination capacities,” stated the Government of India.

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METALLIC PIN REMOVED SUCCESSFULLY FROM CHILD’S LUNG

Shalini Bhardwaj

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New Delhi: A team of doctors from a Mumbai hospital gave a fresh lease of life to a 10-year-old girl who had accidentally swallowed a large metallic pin with a sharp end two years ago. A team led by ENT doctors Dr Kshitij Shah and Dr Shalaka Dighe, ably supported by paediatric pulmonologist Dr Sagar Warankar and an anaesthesia team led by Dr Pramod Kale, performed a successful surgery at the hospital to remove the pin from the girl’s lung. The patient recovered and was discharged within 48 hours.

Naira Shah (name changed) from Mumbai had accidentally swallowed the metallic pin two years ago. An X-ray of the abdomen had failed to reveal the foreign body and the incident was forgotten about, until Naira started complaining of a dry cough and was taken to Zen Multispeciality Hospital for further investigations.

“To our utter surprise, an X-ray of the chest revealed a metallic foreign body in the lower airway on the left side. A CT scan of the chest was done to precisely locate the foreign body. After an initial attempt at removal of the foreign body by flexible bronchoscopy, a decision was made to perform a rigid bronchoscopy,” said ENT surgeon Dr Kshitij Shah.

“Rigid bronchoscopy is a procedure done to gain access to the patient’s airway using a hollow metallic tube under general anaesthesia. The foreign body was successfully removed without any complications and without an external scar on the body after an hour-long surgery,” informed ENT surgeon Dr Shalaka Dighe, adding, “The child was hale and hearty in a couple of hours after surgery. Failure to remove the foreign body via bronchoscopy would have meant a very morbid open surgery (thoracotomy) to remove it.”

“For over 1.5 years, Naira (name changed) was fine and did not encounter any problems. But suddenly she started coughing. We panicked, feared Covid and took her to Zen Hospital. We are thankful to Zen Hospital for promptly treating our child. We urge other parents like us to keep sharp or metallic objects like pins or coins away from their children,” concluded the patient’s father, Sanjiv Shah (name changed).

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UNRESPONSIVE MOUTH ULCER CAN BE CANCER

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Mouth ulcers are quite common in all age groups and can make regular activities such as eating, drinking, and talking very uncomfortable. However, mouth ulcers can be cured with antimicrobial or painkilling mouthwash, gel or spray. However, if the ulcers persist for several weeks even after treatment, one must not ignore the signs as it may indicate a cancerous growth. There are many signs of mouth cancer but red sores that do not respond to treatment or heal is a telling sign. Lifestyle habits such as drinking alcohol or consuming tobacco—both smoked and smokeless—can cause cancer of the mouth. Besides human papillomavirus (HPV), known to cause sexually-transmitted infections (STI) and cervical cancer, can also cause mouth cancer. HPV-affected mouth cancer is seen in the soft palate, tonsils, base of the tongue, and pharyngeal wall areas.

SYMPTOMS OF MOUTH CANCER

1. Persistent and unexplained lumps in the mouth or the neck

2. Unexplained loose teeth or sockets

3. Unexplained, persistent numbness on the tongue or lips

4. White or red patches on the lining of the mouth or tongue

5. Changes in speech like lisp

The types of mouth cancer are categorised by the type of cell it starts to grow in. Medically it is known as carcinoma. The most common type is squamous cell carcinoma that affects 9 out of 10 cases of mouth cancer.

LESS COMMON TYPES

1. Adenocarcinoma in which cancer develops inside the salivary glands

2. Sarcoma in which cancer develops from the abnormalities in cartilage, bone, muscle, or any other tissue

3. Oral malignant melanoma in which cancer starts in the cells that produce skin pigment (melanocytes). They often bleed and appear as dark, mottled swellings

4. Lymphoma in which cancer grows from cells in lymph glands

Mouth cancer as well as treating it can cause complications and affect the appearance of the mouth. Besides, it can cause dysphagia (problems with speaking and swallowing). Dysphagia can be a serious complication. If a small piece of food enters the airways when you try to swallow and gets lodged in the lungs, dysphagia may lead to aspiration pneumonia (a kind of chest infection).

PREVENTING AND TREATING MOUTH CANCER

Cancer of the oral cavity (lips, tongue, buccal mucosa, tonsils, and palate) can give rise to various complications that include difficulty in eating, speech, alteration in voice, inability to open mouth fully, pain in the ear, and bleeding if not treated in time.

Easy lifestyle changes and preventive measures including but not limited to the following can help in preventing mouth cancer in most people:

1. Quit smoking or consuming smokeless tobacco as well as alcohol

2. Get vaccinated against HPV

3. Using a condom during oral sex to lower the chances of HPV infection

4. Visiting a dentist regularly for screening

5. Consuming a balanced diet of fresh vegetables (especially tomatoes), citrus fruits, olive oil, and fish with omega-3 fatty acids

If diagnosed early, mouth cancer can be completely cured in 9 out of 10 cases using surgery.

The writer is working in Clinical Oncology, Columbia Asia Hospital, Palam Vihar, Gurgaon.

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NATIONAL POLICY ON RARE DISEASES: AN URGENT NEED FOR INDIA

Shalini Bhardwaj

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While certain southern states in the country have initiatives in place for supporting patients with rare diseases, the Centre needs to take a more serious note of the issue, especially regarding a sustainable funding mechanism for Group 3 rare disease patients in India.

With the Union Ministry of Health & Family Welfare likely to finalise the long pending National Policy on Rare Diseases and notify it by March 31, serious concerns are now being raised by patients and support societies that the revised policy may meet the same fate as the earlier National Policy for Treatment of Rare Diseases 2017 without any provision to support the treatment of patients diagnosed with Group 3 disorders like lysosomal storage disorders (LSDs).

Patient advocacy groups like the Organisation for Rare Diseases India (ORDI) and Lysosomal Storage Disorders Support Society (LSDSS) are concerned that the Union Ministry’s proposed crowdfunding mechanism may be inadequate, just like the provisioning under the umbrella scheme of Rashtriya Arogya Nidhi (RAN), to provide immediate treatment support to patients with these life threatening conditions—categorised as Group 3 disorders—and particularly those for which Drugs Controller General of India (DCGI) approved therapies are available.

According to patients who have been long awaiting support to start treatment, the Union of India should make immediate necessary provisions for all orphan diseases, as has been done by many other countries.

In the absence of a National Policy on Rare Diseases, a few states in the south have sought support from the Union of India to provide a matching grant in order to sustain the ‘proof of concepts’ shown in providing the much-needed funding support to patients diagnosed with life-threatening rare disease conditions, including LSDs.

Group 3 disorders are a category of rare diseases like Pompe disease, Gaucher disease, Fabry disease and MPS I which are serious, chronic, debilitating and fatal disorders, often requiring long-term, specialised treatment and chronic management and often causing severe handicaps and a catastrophic impact on the entire family. This group of rare diseases particularly impact children, causing 35% of deaths before age 1, 10% between the ages of 1-5 years and 12% between 5-15 years.

Karnataka has been engaged with this programme for close to five years now, providing treatment support to such children. Karnataka has reportedly spent around Rs 40 crore on providing treatment and other life support to the patients diagnosed with rare diseases.

Kerala and Tamil Nadu have also allocated funds from the state exchequer to provide life-saving therapies to a few of these children. In September 2020, the Kerala state government started an initiative to enrol two toddlers suffering from Pompe disease for the life-saving Enzyme Replacement Therapy (ERT) at the Government Medical College, Kozhikode. The infusion therapy was started following an order by a division bench of the Kerala High Court hearing a writ petition filed by the patient advocacy group LSDSS, set up to fight the cause of patients suffering from rare diseases across the country. Under the order of the Kerala High Court, the Centre allotted an amount of Rs 1.5 crore while the state sanctioned another Rs 50 lakh for the treatment of the two patients. Interestingly, members of the Kerala High Court Advocates’ Association, following an appeal by the High Court, also mobilised an amount of Rs 5 lakh for the treatment of the rare disease patients.

As for Tamil Nadu, in March 2020, the Madras High Court directed the Centre to pay Rs 4.4 crore for the treatment of patients with rare disease patients in the state. In the same order, the High Court also instructed the Tamil Nadu government to allocate Rs 5 crore for the treatment of the 11 rare disease patients in the state following a public interest litigation filed by the Delhi-based LSDSS in the Madras High Court, seeking financial aid from the government for the treatment of rare disease patients in the state of Tamil Nadu.

The health departments of each of the three states have also written to the Union of India to support the initiative by providing matching grant in order to provide sustenance to the programme besides allowing a scope to expand the treatment support to other eligible patients awaiting funding support.

With Rare Disease Day celebrated worldwide on 28 February each year to raise awareness about the issue, it has been sincerely requested that the government address the urgent need for a sustainable funding mechanism for Group 3 rare disease patients in the country.

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Spread of new Covid-19 mutants is preventable through caution: Experts

Continue wearing masks, follow social distancing and get yourself vaccinated if you have the chance, advise top doctors, as the country sees a spike in coronavirus cases again.

Shalini Bhardwaj

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With the new mutants of the coronavirus entering India and certain states experiencing a spike in new cases, concerns about the infection spreading widely have come up again. However, in an exclusive interview with The Sunday Guardian, Dr Anjan Trikha, Professor of Anesthesiology, Pain and Critical Care at AIIMS, and Dr Rakesh Mishra, Director of CCMB, say that people can keep themselves safe from the surge if they stop taking safety norms for granted and follow all precautions.

Dr Rakesh Mishra
Dr Anjan Trikha

Q: Do you think the new strain could be more dangerous for our country?

Dr Rakesh Mishra: Normally, new strains are just another variation of the coronavirus. We have recently documented close to 7000 mutations in Indian isolates. While most of them won’t be seen again, others may acquire the status of a variant if they spread rapidly, but that doesn’t mean they are dangerous. They may still be responding to the vaccine, may be asymptomatic and have a similar mortality rate. But studies show that these variants aren’t more dangerous than the existing one, just sequentially different. There may be new infections arising from them but if precautions are not taken, new mutations might occur and we may end up with something more dangerous than the existing situation. So, we must prevent the spread of any disease. So far, variants are not clinically different or problematic but it can happen in the future.

Q: What can be the reason behind the spike in cases in Maharashtra and Kerala?

Dr Rakesh Mishra: The most probable reason is that people have taken the norms for granted now and are not following precautions like wearing masks and maintaining social distancing. This may have caused the sudden spread. We will know when the Maharashtra sequences will be available. They are being processed at NIB and NCC. In Kerala, no new variant is emerging, which means the existing one is spreading at a higher rate. If you don’t prevent person-to-person spread, cases will rise. You don’t need a new variant for super spreading to happen. The new variant doesn’t overcome the immune response, thus there are less chances of re-infection. But this spread is preventable through more caution.

Q: Do we have enough capacity to fight against new mutated viruses?

Dr Anjan Trikha: When the first patient of the existing variant came to me in March, we had no idea about how to cure or prevent this disease. We had no medicine or any idea except from what we learnt through social media trends that came from Italy, China or Europe. Whatever came was frightening, but we did fight it. If we intend to fight a viral disease, we can, so there is nothing alarming about it. We must keep the fundamentals in mind and teach it to our elders and children. We cannot afford to be inside for another year. Inform everyone that the disease is not over yet. Viruses are known to mutate and you will find me wearing a mask in 2022 too.

Q: Are the vaccinated ones still a threat to those who haven’t been vaccinated yet?

Dr Anjan Trikha: India is a land of controversies, so be cautious against rumors. Nobody knows about efficiency and efficacy apart from the doctors who are administering it. If the government is giving you a vaccine, believe that it will prevent you from catching severe infections. So, you may get infections or you may not, but if you do, you will not get serious infections if you have already been vaccinated. Have faith in the government and do get vaccinated. The government has a plan to get all people vaccinated. You have seen what is happening in Maharashtra, Kerala and Dubai. They decided to open up for tourism and then had to shut it down. My trauma centre still is open for Covid patients and we have empty beds. This is what happens in a pandemic — you need to wait and be prepared for anything.

Q: What message would you like to give regarding the rise in cases?

Dr Rakesh Mishra: We are going through an unprecedented situation of this century. In comparison with other countries, India has performed extraordinarily in terms of active cases, mortality rate, etc. But we have paid our price for it, gone through lockdowns and severe crises of reverse migration. We still need to practise precautions like wearing masks and social distancing. Secondly, go for vaccination confidently and as quickly as possible. If we don’t do so, we will leave the enemy half dead and it will bounce back just as it did before. I may be asymptomatic but what about my family members and seniors who have comorbidities? So, we must be responsible and follow precautions and take the vaccine because they are tested and safe. A lot of people have been vaccinated and none of them have gone through any serious consequences. But after getting vaccinated, do wear masks because 10%-20% of you may not be affected by the vaccine or the vaccine might take a month or so to set in full force. New variants may also prove the vaccine to be less effective on them. We are almost there but have not won yet.

Q: Do you think vaccinations should be available for common people now?

Dr Anjan Trikha: Opening up the vaccines for common people is crucial but should be done in time. First, it has to be given to the healthcare workers, then to the frontline workers, then the elderly above 50 years of age who may have comorbidities and then, finally, to everyone else. We must remember that the vaccine has also been licensed for emergency authorised use only. Studies are still coming out about whether to give it to children below 17 years of age or pregnant women. We assure you that the government will open it for all soon, but we must remember that the vaccines need to pass through guidelines and rules. The Drug Controller office and FDI Bhawan have a lot of experts who scrutinize the data for the vaccine and then approve it. It is just that everything needs to be managed the right way. If you are called or messaged to inform you that your chance has come, go get vaccinated. Tell the doctor if you are allergic so the doctor decides whether to give you the vaccine. There may be some adverse reactions after taking the vaccine, just like with any other vaccine. Also, follow social distancing and wear masks because we are still susceptible to the disease.

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THREE PROFESSORS TERMINATED BY AIIMS PATNA

Shalini Bhardwaj

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The AIIMS facility of Patna has given consent on the motion to terminate its faculty members for lacking basic qualifications at the time of their recruitment.

These members include Ajit Saxena, professor and head of the pathology department, Sushmita Das, associate professor in the microbiology department and Alok Ranjan, an assistant professor in the department of community and family medicine. One of them had even been promoted during the August-September 2017 assessment promotion scheme of the institution.

The government body of the institute made no comments on the decision it took on Thursday regarding the matter.

According to a media report, the matter goes back to 2011 when the institute advertised for faculty recruitment in December. However, the advertisement had clearly mentioned that the appointment required a PG degree recognised by the erstwhile Medical Council of India (MCI), now National Medical Commission (NMC). However, two of the faculty members only had postgraduate degrees in zoology, a non-medical subject, during their appointment in 2012-2013. Meanwhile, although Ranjan had the required qualification, he lacked a Ph.D. degree at the time of his recruitment.

Sources informed The Sunday Guardian that the assistant professor had fulfilled the required criteria within nine months of his joining (September 7, 2012) and submitted his Ph.D. degree from a USA-based university. However, the other two still lacked the required qualifications.

A total of 19 faculty members were scrutinised regarding the matter. Some of them criticized the penalty which they faced eight years after the fault committed by the Selection Committee, while a few have moved the court against the disciplinary action taken by the institute.

Sources informed that an IPS officer blew the cover of the terminated professors while Kishore Yadav, Deputy Director (Administration) of AIIMS-Patna, brought the matter to light in 2013.

Later, the Vikas Arya committee, constituted by the Union Health Ministry in 2014, also marked the appointments faulty. Finally, a five-member high-powered committee consisting of directors of AIIMS-Bhubaneswar and AIIMS-Patna also found the recruitment of the three members bogus.

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