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HOW TECHNOLOGY HAS CHANGED VERTIGO AND DIZZINESS TREATMENT

Technological advancement has helped in the accurate diagnosis and treatment of vertigo and balance disorder effectively.

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Vertigo is a feeling of imbalance that can range from intense spinning to a mild unsteadiness on movement. Patients often describe it in different ways like chakkar, imbalance, or difficulty in focusing. It is often due to inner ear problems but may also occur due to disorders of the brain or other systems in the body. Vertigo is quite a common complaint affecting about 15% of the population. Around 180 million people in India have balance and dizziness problems.

Dizziness often is a recurring symptom and may cause the person to lose confidence. Anyone who has suffered from vertigo is familiar with how dreadful the sensation of being dizzy or feeling off-balance is. It affects the ability to perform daily activities and may also cause psychological and emotional stress. Vertigo can impair the reaction time thereby affecting people’s ability to multi-task. This makes people prefer to limit their activities and even become reclusive at times. This is the reason why vertigo sufferers are often anxious or depressed.

Vertigo can occur in all age groups, from a young child to the elderly. Falls due to dizziness in people over 65 years are known to be the leading cause of accidental deaths. Some causes of vertigo-like vestibular migraine run in the family. Post-traumatic dizziness often lasts for long durations after the injuries. Certain medicines called ototoxic drugs (like chloroquine, TB medicines, and some antibiotics like amikacin) can have an adverse effect on the balance system. Sometimes elderly patients and patients on treatment for hypertension may have sudden falls in blood pressure on standing up. This condition is called orthostatic hypotension and can cause a feeling of unsteadiness or blackouts due to the fluctuation in blood supply to the brain.

Vertigo is just a symptom of an underlying disorder and not a disease itself. There are around 40 common diseases affecting the inner ear and brain that cause vertigo. It is important to find the disease-causing vertigo to be able to decide which treatment will be required. Benign Paroxysmal Positional Vertigo or BPPV is one of the most common disorders causing dizziness due to displaced calcium carbonate crystals within the inner ear. Meniere’s Disease is caused by increased inner ear fluid pressure. A vestibular migraine is a form of migraine which affects the balance nerve leading to imbalance. Labyrinthitis and vestibular neuritis are infections of the inner ear and balance nerve. Thus, there are many disorders that can cause dizziness and it is essential to find which disease is present to be able to treat it.

Different causes of vertigo can present in different ways. Many people have spoken about the distress that they had due to vertigo. Top Australian batsman Steve Smith had said that he has had a ‘bad dose of vertigo’ just before his second one day match against India. The attack was so severe that he was unsure about playing the match. His team doctor Leigh Golding performed the Epley maneuver which involves a series of head and body movements to treat the inner ear disorder called BPPV. This almost magically made vertigo disappear and he scored 100 in just 62 balls!

The vertigo episodes can last for hours with spinning, vomiting, and hearing loss as is seen in Meniere’s disease. It can be present as persistent unsteadiness as is seen in bilateral peripheral vestibulopathy. In BPPV, the spells usually last for less than 30 seconds. Patients with recurrent vertigo often lose their confidence and are scared of travelling alone or driving, wary that they may have a dizzy spell.

Can Vertigo be treated? The emphatic answer here is that vertigo can be treated after a correct diagnosis! People often panic thinking that once they experience the attack of vertigo, they will have to live with it. Many people with vertigo are seen to go undiagnosed even for years and continue to live with this debilitating state only taking medicines to suppress the dizziness. Accurate diagnosis, followed by the correct management program, can help in controlling vertigo and balance disorder effectively.

Now the question arises, how can Vertigo be treated? Vestibular evaluation is required to understand the underlying disorder giving rise to vertigo. Much technological advancement has taken place in the last two decades which has increased our understanding of the functioning of each part of the balance system. These technologies provide physicians with an accurate means to diagnose the cause of vertigo and treat them effectively.

There are specific treatments for different causes of vertigo. For BPPV, various positional maneuvers are recommended (just like Steve Smith was treated with the Epley’s maneuver). The key to the proper treatment of BPPV is identifying the location of the displaced crystal. The correct repositioning maneuver brings the crystal back to its correct position in the inner ear. Vestibular migraine treatment depends on the age and weight of the patient along with any co-morbidities. Vestibular rehabilitation exercises are the mainstay of treatment in vestibular neuritis. Thus, it is obvious that the treatment will be tailored to the underlying disease.

India has made significant progress for correct diagnosis and treatment of vertigo. The treatment requires a multi-disciplinary approach with a detailed history and thorough functional assessment. Specialised technology is used to provide customised medical treatment and vestibular rehabilitation. We often get patients with long-standing vertigo who have been on vestibular suppressants for several years. However, once we diagnose the underlying cause of the disorder, appropriate treatment and vestibular rehabilitation help these patients to become symptom-free, and the drugs are discontinued. It is truly heartening to cure patients who have suffered due to this health condition.

The writer is a Neurotologist and ENT specialist, founder of NeuroEquilibrium, and author of an e-book on Benign Paroxysmal Positional Vertigo(BPPV).

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Health & Wellness

NUTRITIONAL GROWTH: DIETARY SECRETS OF B-TOWN CELEBS & SPORTS STARS REVEALED

Ryan Fernando

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Bollywood and Sports stars are worshipped in this country. The aam janta has a keen interest in their favourite celebrities’ lives and wants to acquire as much information as possible.

I, too, get asked these questions very often. What nutrition strategy led to Sushil Kumar winning two Olympic medals? What was Aamir’s Dangal diet? What Virat eats on matchdays? How diet was genetically aligned to Abhishek Bachchan’s training and fitness regimens? What are the diet secrets that helped us break two Guinness World Records in human performance?

Even when people love to imitate their role model/favourite celebrity, it is imperative to understand that nutrition is bio-individual. Each of us is unique; we have different needs, lifestyles, goals, objectives, food cultures, genetics, etc. hence nutrition should be customised.  

One man’s food is another man’s poison. I remember asking Shikhar Dhawan to quit Milk, against the common notion that Milk is a must for athletes because his gene report showed that he was lactose tolerant.

India women’s cricket team captain Harmanpreet Kaur, who took the world by storm after scoring jaw-dropping 171 against Australia in the 2017 World Cup semi-final, struggled with her post-match recovery, as she was gluten intolerant. Being a Punjabi, her diet was loaded with wheat-based foods, which was creating havoc in her body.

So there is a lot of science behind what you see on a celebrity’s plate. Before giving them diet suggestions, we capture a lot of data in the background and then work around it to identify key foods and nutrients that would work for their body.

What data do we capture?

1) Blood Reports

We analyse their blood chemistry. It gives us an internal picture of the body’s health status. It also helps us to identify if there are any existing nutrition deficiencies. So when a leading actress told me that she often feels fatigued during a shoot, her blood test report came back saying that her haemoglobin levels were low.

2) Genetics

If the body is hardware, genes are your software. Your genes are a gift from your parents. You can’t change it; you have to live with it. Best, acknowledge & work on it, and you probably might end up getting the best results out of them. I have seen Gluten Intolerant athletes, once they do away from wheat, they start performing well. For any movie stars, this could be the reason why you are not getting that flawless skin.

3) Body Measurements

A lot of celebrities come to me to lose weight. I ask them they want to lose weight or fat? Modern-day nutrition planning takes into perspective fat and muscles. A 60kg person with 10% body fat has a greater metabolism and calorie demand than the same 60kg with 20% body fat.

4) Medical History

Since many illnesses run in families, this knowledge provides your nutritionist with a wealth of information about what’s going on with your health. It also helps to determine what health problems you may face in the future.

5) Schedule

Training, Traveling, Matchdays, Shoot days, Rest days: we have different calorie needs to different days. Also, it helps to plan your nutrition in advance so that you can carry your food or get it arranged to meet the calorie requirements.

6) Food culture & preferences

It is crucial to understand how flexible a person is on taste buds. Different cuisines offer different nutrients and benefits. No food is bad until you abuse it. Once we get a clear picture of your eating habits they can be aligned to meet calorie requirements based on goals and objectives.

Apart from these, a lot of data is captured to scientifically customise a nutrition plan. 

Sharing a list of favourite foods that I like to feed my celebrity clients:

• Beetroot – Beetroot is well-known for its ability to increase energy levels. Beetroot contains a compound called nitrates, which aids vasodilatation, or the ability of your blood vessels to expand and bring more blood and oxygen to your exercising muscles while also removing more carbon dioxide and lactic acid.

• Eggs – To satisfy your protein needs, you can eat up to four whole eggs a day, plus egg whites. Based on your physical activity levels protein requirement ranges from 1 to 2 gm per kilogram of body weight.

• Dates – Dates provide iron, calcium, potassium and other minerals. Great food to have a fast boost of energy. If you have low iron levels or haemoglobin, which causes fatigue, include dates in your diet. Dates are easy to carry while travelling, during training and shoots. 

• Berries – Berries are high in anti-inflammatory compounds and vitamins, which may help you, avoid premature ageing. Berries are also high in vitamin C, which helps to keep skin healthy. The antioxidants in berries protect against harmful free radicals, which can trigger wrinkles and disease.

• Cinnamon – Cinnamon increases the metabolic rate, which aids weight loss. Cinnamon also helps to control blood sugar levels and increases insulin function. It also contains a lot of fibre, which keeps you complete for a long time. This leads you to eat fewer calories, resulting in weight loss.

The writer is the Founder of QUA Nutrition as well as a Celebrity & Sports Nutritionist.

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Health & Wellness

ASTHMA AND COVID-19 COMPLICATIONS

Tackling an asthma attack effectively, especially in Covid positive patients, is crucial in saving lives.

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Asthama

Asthma, a condition constricting the airways carrying air into the lungs, can not only make it hard for people to breathe but can often lead to wheezing, chest tightness, breathlessness, and coughing. The Covid-19 pandemic has only worsened the situation for asthma patients as they are much more susceptible to contracting the virus. Also, their Covid-19 symptoms can be amplified considerably more.

Respiratory viruses can trigger and worsen asthma symptoms, and if a person has uncontrolled asthma, they may develop or face severe Covid-19 symptoms. Uncontrolled asthma can mean that there will already be inflammation in the lungs, and airways will be compromised so in many cases Covid-19 may even lead to pneumonia, fibrosis (thick and stiff lung walls), or other intense respiratory diseases.

Elaborating on how to tackle an attack especially if the patient is not sure if it is due to asthma or Covid-19, Dr Sandeep Nayar, Senior Director & HOD, Chest & Respiratory Diseases, BLK-MAX Super Speciality Hospital said, “People feeling breathless may sometimes confuse between Covid-19 symptoms and an asthma attack. The major symptoms seen nowadays in Covid positive patients are breathlessness instead of fever or any other common Covid-19 symptoms such as sore throat, headache, cough etc. In such a situation it is best to use the inhaler so the asthma attack can be managed. In the case of asthma patients having contracted Covid-19, inhalers and bronchodilators, as well as other medications, should be continued as per schedule. Nebulisers are again very useful in handling Covid induced bronchospasms. Asthma patients can easily use nebulisation, with or without steroids, to help alleviate chest congestions and pressure.”

Dr Nayar stressing upon the need for vaccination, “All asthma patients above 18 years of age must get vaccinated to prevent the deadly implications of the virus even if they get infected. Vaccination will not just help in protecting from the virus but will also help reduce the severity of the symptoms. However, those having had an immediate or severe allergic reaction to the vaccine or any of its ingredients must consult their physician.”

The doctor suggests some measures that asthmatic patients must observe to stay safe:

• If you’ve recently recovered from an acute Covid-19 infection, delay getting the vaccine until you’re fully recovered and done with self-isolation and quarantine measures

• If you had the infection after receiving the first dose of vaccine, then wait for at least one month after recovery before getting the other dose

• If, along with asthma, you also have other conditions causing immune deficiency like HIV or cancers, consult your doctor before getting the vaccine

• Do not step out of the home. If unavoidable, wear a double mask while going out

• Quit smoking as it can be very dangerous for patients with asthma or other respiratory illnesses

• Avoid outdoor exercises, focus on breathing exercises, and doing yoga indoors

• Take prescribed medicines and inhalers. Keep necessary medicines stocked up

• Eat a healthy diet rich in nutrients and proteins. Avoid foods rich in oil and eating out

• Take steam twice daily to avoid chest congestion

• Keep anxiety and stress levels as low as possible

Asthma may not be considered a serious condition by most people, however, asthma compounded by other infections can increase the risk. A crucial aspect for all patients is to know the triggers so one can stay away from them and be protected from another attack.

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HOW CAN NATUROPATHY & YOGA BENEFIT BRONCHIAL ASTHMA PATIENTS?

While modern medicine works in a reactive approach to manage symptoms of asthma when they arise, naturopathy works to eliminate the cause and reduce the severity of the disease.

Dr H.P Bharathi

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One of the most common chronic diseases of the respiratory system, asthma affects more than 300 million people across the world with around one-tenth of them in India. Every year, World Asthma Day is celebrated on the first Tuesday of May. This year, it is being observed on 4 May. This day is observed to raise awareness about chronic respiratory disease and to break the stigma around it. 

While the prevalence of asthma is higher in developed countries, the burden of asthma-related deaths is much higher in developing countries like India. In fact, according to a report published by the World Health Organization (WHO), over 80% of asthma deaths take place in developing countries. 

While environmental allergens like dust, pollen, insects, and domesticated animals are the leading triggers of asthma, outdoor air pollution has also emerged as a problematic trigger. Researchers from the French Institute of Health and Medical Research found that high traffic intensity and ozone exposure has increased the risk factors in individuals living with asthma. With rising environmental pollution, the incidence of respiratory disease is increasing in India, particularly among children. It is important therefore to introduce a holistic approach towards the management of this condition through the use of naturopathy and yoga. Evidence suggests that a naturopathic approach can offer long-term health benefits to people with asthma by reducing the intensity of the disease, improving symptoms, and lung function while significantly reducing drug requirement.

BRONCHIAL ASTHMA AND ITS TRIGGERS

Bronchial asthma is a condition that causes inflammation in the airways of the lungs. This results in narrowing of the air pathways and excess mucus cause wheezing, cough, and difficulty in breathing. The disease is chronic and interferes seriously with daily life. If not treated properly, this chronic inflammatory disease is not just debilitating but can even turn fatal. Our environment has all the asthma triggers. Even dust accumulated in curtains and pollens in the environment is enough to trigger an attack in addition to the harmful emissions from motor vehicles. Modern medicine relies heavily on the use of steroid inhalation and anti-inflammatory drugs to manage the condition. These drugs work by reducing inflammation and mucus production in the airways, thereby improving symptoms and controlling the condition. However, the high cost of drugs and their potential side effects remain a cause of concern. A naturopathy based treatment, on the other hand, uses a drugless approach that is much safer and sustainable.

THE NATUROPATHY AND YOGA APPROACH IN TREATING ASTHMA

Naturopathy is holistic rather than a compartmental way of treating and managing a condition. While modern medicine works in a reactive approach to manage symptoms when they arise, naturopathy works to eliminate the cause and reduce the severity of the disease. The alternative system of medicine believes that all diseases are caused due to an accumulation of toxins, morbid matter in the body, and negative vibrations in the mind. The therapeutic plan in naturopathy is executed in three phases – the eliminative phase, which focuses on cleansing the body of accumulated toxins, the soothing phase, which focuses on rejuvenating the body and supplying the necessary nourishment, and the constructive phase, in which the body’s metabolic activity is regulated. 

To establish the efficacy of naturopathy, a significant study was conducted at Jindal Naturecure Institute, Bengaluru between the year 2003-2006. A total number of 60 patients between 25 years to 70 years of age was treated for bronchial asthma for 21 days as part of their research programme. Their treatment procedure was divided into three therapy sections – Nature cure therapy, Diet therapy, and Yoga therapy. 

Nature Cure therapy consisted of a chest pack applied from 30 minutes to an hour once or twice a day depending upon the clinical condition of the patient. This was accompanied by a combination of hot foot and arm bath, partial massage therapy to upper back and chest, fomentation, asthma bath, oxygen bath, steam and sauna bath, enema, steam inhalation, and drainage therapy. 

Under the Diet therapy, patients were prescribed nutritionally calcium-rich, non-mucus, and non-acid generating food items along with herbs such as tulsi, pudina tea etc, and lots of water. All foods which are traditionally known to increase the production of mucus were avoided. Also, the foods which are allergic in individual cases were identified and avoided. The general observation of asthma patients also revealed that animal milk is one of the triggering factors and must be replaced with soya milk.

Yogic kriya, Yogasana, Pranayama, and Yoga Nidra spanning into a three-week programme with a gradual gradation in the severity of the practices was the third pillar of the treatment approach.

The study combined with a year follow up of patients had shown highly promising results. The naturopathy approach helped these patients to improve their lung function and symptoms while reducing the requirement of drugs in most patients. When Jindal Naturecure Institute began this study with 60 patients, there were only five cases that required no medication at the time of admission. 

However, during the discharge, the cases of no medication increased from 5 to 48, after a gap of 21 days only. Further, the treatment proved to have long-lasting effects on the majority of patients. Nearly two-thirds of the patients did not have to use any other medication as observed at different intervals during one year. 

THE TAKEAWAYS

With the high burden of asthma affecting our country, we will do well to use some of our traditional knowledge in dealing with this menace. Modern medicine has so far failed to find a cure for chronic diseases such as asthma. Their treatment protocols focus mostly on relieving symptoms without doing anything to address the root cause of the disease. Naturopathy, on the other hand, incorporates a holistic and individualistic approach for treating different diseases and uproots the disease from its core. This implies treating the individual rather than the disease. 

The writer is Deputy Chief Medical Officer, Jindal Naturecure Institute.

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Health & Wellness

WHICH TYPE OF MEDITATION WILL SUIT YOUR PERSONALITY?

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Some meditation practices are general in nature and meant for everybody. There are over 7 billion people in the world and we all are unique individuals. We each have our own goals, dreams, and desires that we wish to pursue and see fulfilled during this lifetime. When every single person has his or her own unique fingerprints, then it is quite obvious that we will also differ in personality. So accordingly, there will be meditation techniques to suit different moods, different needs, and requirements.

SWAAS DHYAN

Meditation techniques such as Swaas Dhyan or Breath meditation is a simple and easy method to bring yourself back into alignment. By focusing on your breath you can easily start to build the connection between the mind and the body through this singular point of focus. This meditation requires you to sit in any comfortable position with your spine held upright. You can keep your eyes gently closed or even keep them open as you feel comfortable. Once you are settled in this position simply begin to focus on your inhalation and exhalations. If you find that your mind is wandering which is natural, you can bring it back to focus gently. Through this technique of meditation, you can slowly work on improving the way that you breathe.

STHITHI DHYAN

The practice of Sthithi Dhyan helps to build awareness within oneself. Many people have a problem where they lack focus and awareness of their surroundings. What this practice does is that it builds your observation power and helps you to take better notice of things situations of people that you are surrounded by. This helps you to live in a more mindful way which makes you connected to the present.

SIDDHO HUM DHYAN

Siddho Hum Dhyan is an ancient yogic practise that is a meditation technique. It is considered auspicious to begin, and end your practice with Siddho Hum Dhyan. You will reap the most benefits when you practice this in a natural environment like a forest or in the mountains. It is essential to maintain a level of personal cleanliness before you sit down for this meditation technique.

SUPERPOWER MEDITATION

This is also a highly recommended practice as this influences the rate at which your body can heal itself. Meditation techniques can improve your mood, calm your mind and help relax you. To practice this, seat yourself on a peak of the mountain in Sukhasana or any other comfortable pose that gives you the shape of a pyramid. In this position, you need to visualise a reverse triangular shield in your chest and then meditate. During the meditative process, with every inhale, this shield allows you to welcome all the positive energies of the world into you. And, as you exhale you release unwanted toxins, miseries, and negativity from within you.

AARAMBH DHYAN

It is always better to adopt a healthy sense of optimism and positivity in one’s life. But this might not always be the case with many people. Despite being blessed with an abundance of health, wealth, love, and relationships some people are constantly dissatisfied. Instead of being content with what they have, they are constantly seeking more to fill that void within them. To address and heal this issue and to make the person more positive and grateful you can practice Aarambh Dhyan or Beej/Seed Meditation. This particular technique requires you to imagine two holes. One is white representing light and the other is black representing darkness. Exhale negativity and emotions like guilt, fear, shame into this black hole and inhale lighter emotions such as gratitude, joy, and peace from the white hole.

AAKASH GANGA DHYAN

Aakash Ganga Dhyan or Galaxy Meditation is a technique where you imagine yourself as an earthen pot filling yourself up with the cosmos and becoming one with this entire universe. Similarly, there are many other techniques such as Agni Dhyan, Jal Dhyan etc. Tratak Meditation can be done either on a candle flame, the sun, moon, an object or even a black circle on a wall. In this way meditation is a universal practice for the benefit of mankind and there are so many to choose from depending on your particular requirement.

The writer is an internationally acclaimed spiritual yogic master, author and TEDx speaker.

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Health & Wellness

POST RECOVERY CARE FOR COVID-19 PATIENTS

DR BEHRAM PARDIWALA

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So you have made it out of the storm! Covid-19 has been a storm that is taking away a lot of lives with it. But the good part is that there is a huge number who are getting through without any major complications. So let’s focus on the positive and see how you can get better post-Covid.

Recovering from Covid-19 takes time, the duration of which is unknown. Mild cases usually take two weeks and severe cases may take up to a month or even more sometimes. And that is where the term long Covid has evolved. The current recovery rate in India is approximately above 90% which is again a good sign.

Irrespective of whether you struggled with a mild or a severe infection, your body needs time to recuperate and rejuvenate. You have just come out of a deadly disease and your body needs a break. Lethargy and fatigue post-Covid is quite normal.

You have gotten out of the disease but you need to be cautious about your health over the next few weeks. Here is a complete to-do list of post-Covid care for you:

REST, RELAX, REPEAT

Although your symptoms have disappeared, it is possible that you still have residual weakness and lassitude. Give yourself a break. Take some time off and help your body recover. When you are well-rested, your body can heal faster. Get your beauty sleep of 7-8 hours minimum to speed up your recovery. Avoid getting back to your old lifestyle of constant hurry. Do not immerse yourself into work right away. Stress and work can worsen your symptoms.

EAT HEALTHY

A healthy, nutritious, balanced diet is going to do you good. Food ensures that the path to recovery is smooth. Eat all healthy foods to gain strength and energy. Include plenty of liquids like soups, juices, coconut water in your diet. Eat a protein-rich diet to promote healing and repair. Include legumes, lentils, seeds, nuts, lean meats, and eggs for adequate protein intake. Eat 1 fruit a day and add lots of veggies to your diet. Your plate must be as colourful as the rainbow to ensure complete nutrient-packed meals.

BRAIN EXERCISES

Covid-19 is notoriously known to damage brain and neural cells. To prevent further damage and avoid future memory issues, it’s best to exercise your brain cells now. Indulge in some memory games like sudoku, mathdoku, jigsaw, crosswords, chess. Get your brain cells working and rack your brain to solve these puzzles daily. Take it slow but be consistent. It is necessary to regain your cognitive thinking abilities, memory, and increase your attention span.

With these easy post-recovery care tips, it will make your convalescent phase smooth and quick. While trying to recover, do not lose focus on your symptoms. Watch out for any symptoms that are uncalled for. Monitor your blood oxygen levels using your pulse oximeter and look out for any new symptom that may arise as a part of Covid-related complications. If you experience shortness of breath, severe pain or tightness in the chest, warm flushes or anything away from your normal, consult your physician right away.

The writer is a Consultant, Internal Medicine, Wockhardt Hospitals Mumbai Central.

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WHY GENETIC SURVEILLANCE SYSTEM IS CRUCIAL TO FIGHT NEW COVID VARIANTS

The ‘double mutant’ variant of coronavirus is likely to trigger an ‘intense second wave’. It is estimated that this mutated Covid variant is over 50% more transmissible and 60% more lethal.

Dr Vishal Rao

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The biggest challenge of the Covid-19 resurgence has been the emergence of new virus variants across the globe. In the fall of 2020, the United Kingdom (UK) identified a fast-spreading variant called B.1.1.7 or VOC-20DEC-01 which has since been detected in many countries around the world. Experts believe it may potentially carry an increased risk of death compared to other variants. In South Africa, another variant called B.1.351 or VOC-20DEC-02, detected in early October 2020, shares some mutations with B.1.1.7. cases of this variant were reported in the US at the end of January 2021. In Brazil, a variant called P.1 or VUI-21JAN-01 was identified during routine screening at a Japanese airport in early January. This variant contains a set of additional mutations that may be able to escape natural antibodies. It was first detected in the US at the end of January 2021.

INDIA REPORTS UNIQUE ‘DOUBLE MUTANT’ CORONAVIRUS VARIANT

The Indian government in recent times announced a new coronavirus variant detected amid a new surge of Covid-19 cases across several states. This is a unique “double mutant” coronavirus variant with a combination of mutations not found anywhere in the world. However, it is still to be established if it increases infectivity or severity of Covid-19. Genome sequencing of a section of virus samples by a consortium of 10 labs across the country, called the Indian SARS-CoV-2 Consortium on Genomics (INSACOG), revealed two mutations, E484Q and L452R together, in at least 200 virus samples from Maharashtra, as well as a handful in Delhi, Punjab and Gujarat. 

Mutations in the virus per se are not surprising, but specific mutations that either help the virus evolve to thwart vaccines or the immune system or are linked to a spike in cases or disease severity, are a cause for concern. While the two mutations have been individually identified in other variants of SARS-CoV-2 globally and have been associated with a reduction in vaccine efficacy and infectivity, their combined effect and biological implication has not yet been fully comprehended. In the days ahead, the INSACOG will submit details of this variant to a global repository called GISAID and classify it as a ‘Variant of Concern’ (VOC) if required.

It is important to note that the ‘double mutant’ variant is likely to trigger an ‘intense second wave’. It is estimated that the virus is over 50% more transmissible and 60% more lethal, i.e., 1.6 deaths for every one death caused by the previous version of the virus.

REAL-TIME GENETIC SURVEILLANCE FOR COVID

We do not have any Genetic Surveillance system operational in India but it is undoubtedly the need of the hour. Whole viral genome sequencing allows for a better understanding of the virus transmission, including the knowledge of whether it is mutating and becoming a larger threat. In addition, genomics can help explain why people respond to Covid-19 in different ways, thereby helping us better protect those at greater risk. 

There is hence an acute need for employing genomics to help public health bodies respond faster to emerging outbreaks. Towards this effect, COG-UK and the Sanger Institute have raised 12.2 M pounds from the Testing Innovation Fund of the Department of Health and Social Care for creating a real-time surveillance system of emerging outbreaks. This system will be supported by new software being developed by the Sanger Institute and involving researchers from across the consortium’s network. Instead of relying on epidemiological exceedance, which “often requires a large number of cases to detect” outbreaks, genomics can help identify and respond to large clusters in an efficient and timely manner. For example, genome sequencing can show there are five identical SARS-CoV-2 viruses within one workplace on the same day, thereby suggesting the extent and severity of Covid-19 transmission happening in that workplace. If we didn’t have genomics we might know we had five cases, but we wouldn’t know if they were related and constituted an outbreak. It is possible that all five cases could be different, implying that they would have separate sources and do not represent a cluster. 

For a real-time surveillance system to be effective, the process of genomics sequencing would have to be expedited, which is what the COG-UK, the Sanger Institute and the consortium’s researchers are working on currently. The Department for Health and Social Care Testing Innovation Fund has backed the Welcome Sanger Institute and the Covid-19 Genomics UK (COG-UK) Consortium in expanding whole genome sequencing of positive SARS-CoV-2 virus samples to map the spread and evolution of CovidD-19. 

Notably, the 12.2M pounds funding will facilitate Sanger Institute to build a national real-time genomic surveillance system of Covid-19 by covering the cost of Whole Genome Analysis (WGA). The cost for WGA per sample in INR terms is Rs. 35000 + GST for 10X coverage and Rs 75000+GST for 30X coverage. 

A similar initiative must be spearheaded in India, that of establishing a Genetic Surveillance system to identify the ‘double mutant’ variant and protect the population from the greater risk of infection severity and mortality. 

The writer is Regional Director – Head & Neck Surgical Oncology and Robotic Surgery, Associate Dean – Academics, HCG Cancer Hospital, Bengaluru.

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