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Is Patanjali’s Coronil really the first drug for Covid-19?

Immunity boosters have their benefits but Patanjali’s Coronil should not be marketed as a drug against coronavirus, say the country’s top medical experts.

Shalini Bhardwaj

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Patanjali’s Coronil has faced controversy since Baba Ramdev’s company came out with claims of the drug being the “first evidence-based medicine” to treat Covid-19. Debating the issue, top doctors of modern medicine and Ayurveda—Dr J.A. Jayalal, president of the Indian Medical Association, Dr Girish Tyagi, former president of the Delhi Medical Association and registrar of DMC, and Acharya Ram Gopal Dixit, president of Arogya Peeth and a neuropathy expert—countered questions and presented their opinions to The Sunday Guardian.

Q: What is the reason behind the controversy surrounding Coronil?

Dr Dixit: I don’t see any reason behind this controversy because Coronil is a kit that increases immunity which further enables the body to fight diseases. Those creating the controversy should get informed about Ayurveda. When we talk about India, Ayurveda should also be talked about. It has been in the backdrop of our culture till now. No matter which field we are in, we should respect the scientific skills and knowledge of our nation instead of spreading controversies. Corrections and discussions should be welcomed but some things should not be criticised just for the sake of your own profit. 

Q: How ethical is it to promote this medicine?

Dr Dixit: Each one of us must have had kadha during this pandemic. Coronil comprises all those essentials in order to prevent diseases, which includes lung disease. My friends and I caught the coronavirus and were hospitalised. And apart from the medicine given to us by the doctor, we used household remedies to treat the infection. I think the name is the main reason behind the controversy. You cannot call this kit a preventive measure, treatment or post-care kit against Covid-19, because then the vaccine will have no use in the country, but you may call it an immunity booster.

Q: What are your concerns regarding the kit?

Dr Jayalal: We are not against the prestige of a drug. The only concern is the claims of the function with which it was marketed to us. We are well aware of the benefits of immune-boosters but in case of a pandemic with a mortality rate of 1.6 million, if we call Coronil as a preventive, treatment and post-complication care against Covid, we will call it as the monetary benefit of a company. We accept the Ayurvedic drug wholeheartedly, but if someone claims it to be an evidence-based drug of choice for the treatment, it is subjected to question.

When the press asked questions regarding the drug, they showed the evidence proved in the pilot study of a phyto-medical journal. A pilot study is a study that occurs prior to a proper study, and is also called a sample study. They have included only 45 people in the study where every individual was asymptomatic. They say they did it in IL-6 and TNF factor, but how can these biomarkers be raised in an asymptomatic person? To mount on that, the researcher is Patanjali itself. Conflict of interest will always be created if there is no second opinion from other scientists and researchers, but the company itself. If Baba Ramdev claims it as an immune-boosting kit, there is no issue. But they cited it as the first evidence-based drug and claimed to have WHO certification in the presence of the WHO director. This should have been avoided. We respect Ayurveda and Dr Acharya. But we plead the Government of India not to give out a false message to common people.

Q: Trials have been conducted on the false projections of the Coronil kit and a lot of people have shown their concerns about it. What would you say regarding the trials?

Dr Dixit: The Covid pandemic is now under control and we appreciate the vaccine and the achievement of our country in its development and distribution. We are talking about the research on the basis of modern medicine. The Vedic research cannot be conducted for a larger picture. But Ayurveda believes that if all the three Doshas become one, all illnesses will reduce automatically. All the Agnis should be equal and all the seven Dhatus should be equal too. For this, Coronil contains all the essentials.

Q: People are avoiding the diagnosis and treatment of Covid, believing the claims of an immune-booster drug, which is wrong.

Dr Dixit: I would like to say that the number of Covid-positive people being represented to us and the actual number of active cases don’t match at all. Literate people do go to doctors for the treatment of Covid but more than 70% people are treating the disease at home. They don’t tell the medical team about their disease fearing quarantine. Many people who were given HCQ also died, even after being admitted to the ICU.

Dr Tyagi (to Dr Dixit): Can you claim that death won’t be the end result after Coronil?

Dr Dixit: No, I can’t.

Dr Tyagi: Stop claiming that the kit will prevent Covid as it is wrong to do so.

Dr Jayalal: India had a recovery rate of 97%. More than half of the remaining 3% died because they had low immunity and were already suffering from other diseases.

 Q: Some of those who died may have had co-morbidities, but some included young doctors and other young people too.

Dr Jayalal: If you see, 80% of the deaths occurred of the hyper-immune syndrome. This means that immunity is overreacting, which produces more Ferritin, IL6 levels. This is the area which is still not understood. We may say that low immunity is a problem, but other than that, the deaths also occurred due to a cytokine storm, which produces immune cells mismatched to the disease. You can recall the benefits of immune-boosters but how immunity works is still a question. You can claim evidence only on the basis of good research. Otherwise, don’t call it a therapeutic drug. It is very disrespectful for us when Ayurveda claims Coronil as the “first evidence-based drug”. Let us not allow our knowledge to be hijacked on scientific grounds for the profit of a company.

Q: What would you like to say about this, Dr Dixit?

Dr Dixit: I talk about Coronil and not the company. I can only talk about the contents of Coronil and I too am not supportive of the claim that Patanjali makes. Information and claims are two very different things. But I would say that these contents do promote immunity and enable the body to fight any viral or lung diseases.

Q: The kit comprises three components. What are they?

Dr Dixit: One of them is swasari pravahi to normalise breathing. The second one is a nasal spray that clears the nasal passage so that the mucous lining doesn’t clog it. And the Coronil tablet helps to boost immunity.

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Medically Speaking

Chemotherapy can induce mutations that lead to pediatric leukemia relapse

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A new study has found that a group of chemotherapy drugs can result in mutations that may trigger the relapse of blood cancer in children.Chemotherapy has helped make acute lymphoblastic leukemia (ALL) one of the most survivable childhood cancers. Now, researchers working in the US, Germany and China have shown how chemotherapy drugs called thiopurines can lead to mutations that set patients up for relapse. The findings of the study were published in the journal ‘Nature Cancer’.

The research provided the first direct genomic and experimental evidence in pediatric cancer that drug-resistant mutations can be induced by chemotherapy and are not always present at diagnosis. “The findings offer a paradigm shift in understanding how drug resistance develops,” said Jinghui Zhang, PhD, Department of Computational Biology chair at St. Jude Children’s Research Hospital.

“The results also suggest possible treatment strategies for ALL patients who relapse, including screening to identify those who should avoid additional thiopurine treatment,” added Zhang. Zhang is co-corresponding author of the study with Bin-Bing Zhou, Ph.D., of Shanghai Children’s Medical Center; and Renate Kirschner-Schwabe, M.D., of Charite-Universitaetsmedizin Berlin.

THE ROOTS OF RELAPSE

While 94 per cent of St. Jude patients with ALL become five-year survivors, relapse remains the leading cause of death worldwide for children and adolescents with ALL. This study involved ALL samples collected from relapsed pediatric ALL patients in the US, China and Germany. Researchers analysed more than 1,000 samples collected from the patients at different times in treatment, including samples from 181 patients collected at diagnosis, remission and relapse.Co-first author Samuel Brady, PhD, of St. Jude Computational Biology, identified a mutational signature that helped decipher the process. Mutational signatures reflect the history of genetic changes in cells.

Brady and his colleagues linked increased thiopurine-induced mutations to genes such as MSH2 that become mutated in leukemia. The mutations inactivated a DNA repair process called mismatch repair and rendered ALL resistant to thiopurines. The combination fueled a 10-fold increase in ALL mutations, including an alteration in the tumour suppressor gene TP53. The mutation, TP53 R248Q, promoted resistance to multiple chemotherapy drugs, including vincristine, daunorubicin and cytarabine.

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STUDY SUGGESTS EXCESS COFFEE CONSUMPTION COULD INCREASE RISK OF DEMENTIA

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It’s a favourite first-order for the day, but while a quick coffee may perk us up, new research from University of South Australia showed that too much could be dragging us down, especially when it comes to brain health.In the largest study of its kind, researchers have found that high coffee consumption is associated with smaller total brain volumes and an increased risk of dementia. The findings were published in the journal ‘Nutritional Neuroscience’.

Conducted at UniSA’s Australian Centre for Precision Health at SAHMRI and a team of researchers, the study assessed the effects of coffee on the brain among 17,702 UK Biobank participants, finding that those who drank more than six cups of coffee a day had a 53 per cent increased risk of dementia. Lead researcher and UniSA PhD candidate, Kitty Pham, said the research delivers important insights for public health. “Coffee is among the most popular drinks in the world. Yet with global consumption being more than nine billion kilograms a year, it’s critical that we understand any potential health implications,” Pham said.

“This is the most extensive investigation into the connections between coffee, brain volume measurements, the risks of dementia, and the risks of stroke – it’s also the largest study to consider volumetric brain imaging data and a wide range of confounding factors,” Pham added.

“Accounting for all possible permutations, we consistently found that higher coffee consumption was significantly associated with reduced brain volume – essentially, drinking more than six cups of coffee a day may be putting you at risk of brain diseases such as dementia and stroke,” Pham further said.Dementia is a degenerative brain condition that affects memory, thinking, behaviour and the ability to perform everyday tasks. About 50 million people are diagnosed with the syndrome worldwide. In Australia, dementia is the second leading cause of death, with an estimated 250 people diagnosed each day.

Stroke is a condition where the blood supply to the brain is disrupted, resulting in oxygen starvation, brain damage and loss of function. Globally, one in four adults over the age of 25 will have a stroke in their lifetime. Data suggests that 13.7 million people will have a stroke this year with 5.5 million dying as a result.Senior investigator and Director of UniSA’s Australian Centre for Precision Health, Professor Elina Hypponen, said while the news may be a bitter brew for coffee lovers, it’s all about finding a balance between what you drink and what’s good for your health.

“This research provides vital insights about heavy coffee consumption and brain health, but as with many things in life, moderation is the key,” Professor Hypponen said. “Together with other genetic evidence and a randomised controlled trial, these data strongly suggest that high coffee consumption can adversely affect brain health. While the exact mechanisms are not known, one simple thing we can do is to keep hydrated and remember to drink a bit of water alongside that cup of coffee,” Professor Hypponen added.

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A NEW STUDY FINDS COVID-19 PATIENTS WITH MALNUTRITION AT HIGHER RISK OF DEATH

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According to a new study, adults and children with COVID-19 who have a history of malnutrition may have an increased likelihood of death and the need for mechanical ventilation. The findings of the study appeared in the journal ‘Scientific Reports’. Malnutrition hampers the proper functioning of the immune system and is known to increase the risk of severe infections for other viruses, but the potential long-term effects of malnutrition on COVID-19 outcomes are less clear.

Louis Ehwerhemuepha and colleagues investigated associations between malnutrition diagnoses and subsequent COVID-19 severity, using medical records for 8,604 children and 94,495 adults (older than 18 years) who were hospitalised with COVID-19 in the United States between March and June 2020.Patients with a diagnosis of malnutrition between 2015 and 2019 were compared to patients without.

Of 520 (6 per cent) children with severe COVID-19, 39 (7.5 per cent) had a previous diagnosis of malnutrition, compared to 125 (1.5 per cent) of 7,959 (98.45 per cent) children with mild COVID-19. Of 11,423 (11 per cent) adults with severe COVID-19, 453 (4 per cent) had a previous diagnosis of malnutrition, compared to 1,557 (1.8 per cent) of 81,515 (98.13 per cent) adults with mild COVID-19.Children older than five and adults aged 18 to 78 years with previous diagnoses of malnutrition were found to have higher odds of severe COVID-19 than those with no history of malnutrition in the same age groups.

Children younger than five and adults aged 79 or above were found to have higher odds of severe COVID-19 if they were not malnourished compared to those of the same age who were malnourished. In children, this may be due to having less medical data for those under five, according to the authors. The risk of severe COVID-19 in adults with and without malnutrition continued to rise with age above 79 years.

The authors suggest that public health interventions for those at the highest risk of malnutrition may help mitigate the higher likelihood of severe COVID-19 in this group.

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HOW TO DEAL WITH ‘LONG COVID’ IN KIDS

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Coronavirus has left a scar on our minds, and its impact is not only felt by adults but kids as well. The concept of ‘long COVID’ is not well defined yet, but there are several research papers that highlight the long-term effects of COVID on various age groups. Children who have battled COVID are coming back to hospitals with post-COVID symptoms like persistent headaches, fatigue, abdominal pain, gastric issues, heart palpitations, difficulty to sleep, muscle pain, loss of smell, and Tachycardia (increased heart rate). This symptom typically manifests after 2-4 weeks of the initial infection and may last for weeks to months. 

RISK FACTORS FOR KIDS: Adolescents and teenagers may be prone to witness long COVID symptoms. Moreover, children with higher BMI or obesity are at higher risk of experiencing long COVID.  Initially, we were under the impression that long COVID can occur in kids having acute infections. However, that has changed over time, and we see a lot of children with asymptomatic and mild infection also experiencing long COVID. Having said that it is important to note that kids experiencing such symptoms should be properly screened by medical experts as many of these could be a result of mental health issues induced by the lockdown and pandemic. 

 There are studies that indicate that isolation and lockdown have resulted in mental health issues among kids, further resulting in headaches, fatigue, anger, misbehaviour, and similar issues. Parents and doctors need to ensure proper diagnosis of these health ailments. 

MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C) A CAUSE OF MANY SUCH LONG COVID ISSUES IN KIDS: MIS-C in children is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. We know that many children with MIS-C had the COVID virus or had been around someone with COVID19. When a child’s immune system reacts extensively to fight the virus in such cases, the immune system adopts in abnormal ways to fight the disease and that’s when organs start to get inflamed causing MIS-C. MIS-C can be serious, even deadly, but most children diagnosed with this condition have gotten better with medical care. 

SYMPTOMS OF MIS-C: Signs and symptoms of MIS-C in children include: 

• High-grade fever that lasts 24 hours or longer 

• Vomiting 

• Diarrhoea 

• Pain in the stomach 

• Skin rash 

• Feeling unusually tired 

• Fast heartbeat 

• Rapid breathing 

• Red eyes 

• Redness or swelling of the lips and tongue 

• Redness or swelling of the hands or feet 

• Headache, dizziness, or light-headedness 

DIAGNOSIS AND TREATMENT OF MIS-C: If MIS-C is suspected, a diagnostic or antibody test for COVID19 can help confirm current or past infection with the virus, which aids in diagnosis and treatment. 

TESTS YOUR DOCTOR MAY PRESCRIBE, TO LOOK FOR INFLAMMATION OR OTHER SIGNS OF THE DISEASE, INCLUDE: 

• CBC Blood tests 

• C-reactive protein test 

• Chest X-ray 

• Heart ultrasound (echocardiogram) 

• Abdominal ultrasound 

Usually, supportive care for symptoms i.e., medicine and/or fluids are given to make your child feel better, coupled with various medicines to treat inflammation. Most children who become ill with MIS-C will need to be treated in the hospital. To treat this condition normally, Intravenous Immunoglobulin (IVIG) to improve antibody content or steroids in appropriate dosages is given. All these medications are given, and the children are kept under observation. Some children may need to be treated in the Paediatric Intensive Care Unit (ICU) if they are severely ill. 

Above all, prevention is always better than cure. Vaccinate your kids with the flu vaccine to reduce the impact of any viral infection. More so, follow COVID-appropriate norms at home and outside. Ensure that your kids stay hygienic and maintain COVID19 norms. 

The Author is Consultant Paediatrics & Neonatology, Fortis Hiranandani Hospital Vashi & Dr Asmita Mahajan, Consultant Neonatology & Paediatrics, SL Raheja Hospital, Mahim. 

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Benefits and afflictions of using Giloy

Meenakshi Upreti

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A year and a half have passed since the Covid-19 pandemic swept across the globe. While there seemed no possible cure for the disease and researchers intensified their search for effective treatment and vaccine, many clinical trials were happening around the world and herbs emerged as a possible alternative treatment. Two of them include Giloy and Ashwagandha.

Giloy is a popular ayurvedic remedy for a number of health conditions including fever, infections and diabetes. However, there have been numerous debates about its benefits. While Ayurvedic doctors have claimed that the herb is not harmful, there have also been some reports claiming that giloy can lead to liver damage. A study published in the Journal of Clinical and Experimental Hepatology claimed the herb is harmful to the liver. On the other hand, the Ministry of AYUSH argued that giloy had been scientifically proven to be an effective remedy for multiple disorders.

To comprehend the facts related to the medicinal herb, we interviewed some eminent personalities from the field of gastroenterology and hepatology. An expert from the field of liver and gastroenterology suggested that alternative medications like giloy can cause some serious liver injuries. Dr Kaushal Madaan, Head of Hepatology, Max chain of hospitals, said: “When this pandemic came, we realised that there were many patients who came to us with unexplained liver failure and liver injury and some of them had even died. Only after a few months, we realised that they were taking a concoction and the most common ingredient of that concoction in these particular patients was giloy.” He pointed out that people were consuming kadhas or concoctions, twice or thrice a day, for a year, which could have caused serious liver damage.

“Even before the pandemic started, we had been advising our patients, whether or not they have underlying liver disease, to avoid taking herbal medicines of whose ingredients we are not sure about,” Dr Kaushal added, in the context of herbal and alternative medicines.

Alluding to the fact that all medicines — allopathic, homoeopathic or ayurvedic — have their pros and cons, Dr Sarin, Director, ILBS, said, “I can certainly say that there are certain herbs that can be harmful. There are certain preparation; unless they have published data, or they have data that they are only beneficial, just don’t take them if they have no scientific evidence.”

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ANALYSING IMPACT OF COVID-19 ON LIVER DISEASE PATIENTS

Health experts recommend treatment and follow-up care for people with chronic liver disease.

Meenakshi Upreti

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Chronic liver diseases are common worldwide, especially in developing countries. The rapid spread of Covid-19 leads to the infection of many patients with underlying chronic liver diseases. To discuss the same, we spoke to Dr Shiv Kumar Sarin, Director of Institute of Liver and Biliary Sciences (ILBS); Dr Anil Arora, Chairman, Institute Of Liver Gastroenterology & Pancreatic Biliary Sciences Sir Ganga Ram Hospital, and Dr Kaushal Madaan, principal director and head of Hepatology from Max chain of hospitals. 

Excerpts: 

Q. What would be your advice regarding checkups to people with liver diseases and fear contracting Covid-19?

Dr Sarin: If somebody has cirrhosis, alcohol liver injury or cancer, they all require treatment and monitoring. So don’t put it away. Treatment for all liver diseases must be given and should not be delayed. Treatment is essential whether you opt for teleconsultation or go to the hospital. What you can do at home is to continue your diet and the prescription that the doctor has given.

Q. What would be your stand on alternative medication for liver diseases?

Dr Arora: Liver is an organ that does not require any servicing and maintenance till you intentionally or accidentally try to injure it. You don’t need any medication. You don’t need a specific diet. You don’t need any type of maintenance but do everything to prevent the damage. 

Two major reasons why the liver gets damaged are if you are having too many of the calories in the diet, so initially, it gets deposited in the peripheral tissue that is subcutaneous tissue, and once those stores get exhausted, it tends to get into the vital organs. The liver is a central organ for the metabolism, production and synthesis of various proteins, and the integrated metabolism of fat, carbohydrates as well as proteins. It also is known to produce a number of coagulation and anticoagulation factors.

There have been guidelines from CDC, from our own ICMR and the Government of India and AIIMS, that stress on minimum medication. Even allopathic medicines are needed in minimum doses for a minimum duration of time. They will do more harm than good. Especially all chemicals, all ingestions, all food has to be metabolised through the liver. So anything and everything that you are taking for any purpose you have to take under the guidance of a registered medical practitioner, take it for a minimum period of time, at a minimum dose, for a minimum duration. Never self-medicate yourself.

Q. There were reports that drugs like azithromycin and remdesivir could affect the liver but they were widely prescribed by physicians. What would you say to liver patients?

Dr Sarin: Remdesivir cannot be given to patients with liver disease. Secondly, it is not proven beneficial. So I would be very hesitant to give. Azithromycin can also give liver injury. In fact, there is no reason to give these drugs if the patient has pre-existing liver diseases. Some Lancet papers stated that Covid-19 was more serious in those patients who had a BMI of about 25. In India, nearly 30%, one in three people, have a high BMI, they all have fatty liver. So, the disease is more common, more susceptible, injury is more progressive, and liver injury enzymes being abnormal or very high. Also, some people were mixing alcohol with Covid-19 pills as people were staying home and they were drinking.

Q. What would you say to those who have liver diseases, perhaps got Covid-19, have recovered and are craving alcohol?

Dr Arora: Drinking as a habit, when it is harmful for you, it is not recommended. If you look at our baseline population, which has non-alcoholic fatty liver disease coupled with so many metabolic abnormalities like diabetes, hypertension, these are all the risk factors that will aggravate the injury related to alcohol. Once in a while, socialising is understandable, but the problem is that alcohol is an addictive agent. If you look at the data from the US, the maximum number of cases that are being reported after cure from hepatitis is related to alcohol.

This is absolutely preventable. Not only on its own it causes problems, but in patients with underlying fatty liver or those with hepatitis B or C, this alcohol is an added synergistic effect to cause further liver damage. So, unless you are sure that there is nothing wrong, you should avoid alcohol.

Q. Does Covid affect more severely to liver cirrhosis and liver transplant patients?

Dr Madaan: There is ample data to suggest that patients who have the fatty liver disease will have a severe lung disease when they get Covid-19. They have very poor outcomes and more of them end up in the ICU. Patients, who are just at the stage of waiting for a transplant, are the ones with advanced liver diseases. So, if they get Covid-19, they are at high risk of dying. If they have a new liver, they already are immunosuppressed. Some schools of thought say that since they are already immunosuppressed, they’re not able to mount an immunoinflammatory response to Covid-19 so they may have mild disease. But this is a controversial issue.

Dr Sarin: If the transplant was done within the last three months, Covid-19 can be very severe, and you should act quickly. People who are on heavy immunosuppressants have rejections even after a year, and if they get a Covid infection, there is a problem again. Covid-19 does not make people’s health condition worse but they are already predisposed to other illnesses.

The liver is the root cause of diabetes and blood pressure and high triglycerides. If you have fatty liver or are obese, diabetic, comorbid, then you must look at the liver enzymes. Covid-19 gives you all a chance to lose weight. Become healthy, lean, and thin, so that unfortunately, if the third wave comes, you are strong, your liver is strong, and your body is strong.

Q. Tell us about the post-Covid care for liver patients? 

Dr Sarin: Patients with liver disease have weak muscles. We call it sarcopenia. Even if they are obese, they have limited muscle power. If your liver is weak, your muscles are also weak and after Covid-19, there is extreme fatigue and loss of appetite. You have to be more careful about this and get your antibodies done if you need them. For a patient with cirrhosis after recovering from Covid-19, he needs to remember that the liver can digest more fats than pure carbohydrates. So avoid carbs. Your main diet should be protein-based and the energy source can be fat. Exercises are essential.

Dr Arora: All those who suffer from Covid-19 are likely to come down with ‘Long Covid’. There are many reasons for that. You may have a bit of virus or the immune process which may still be simmering around the body or an immune complex disease that may be present or activation of the immune system. Coming back to the liver patients, if you have a concomitant Covid, you may have multiple reasons why the liver can get affected. It may occur due to the hyperinflammatory syndrome which comes out from the lungs and gets disseminated in the body, of which the liver gets the major share of the blood. Several drugs that are given to treat Covid-19 have indirect toxicity on the liver. If you have had a recent infection, you are likely to come down with more complications. Regularly follow up with a liver specialist if you have underlying liver disease.

Q. Liver patients have compromised immunity, they may not have enough antibodies. So, is the vaccine good for them? 

Dr Arora: In the initial registration trials that were conducted in the US and UK, they excluded patients who had chronic liver diseases or those with an immunocompromised state. There is data published on Pfizer’s registration trial that has shown that the chance of development of antibodies is only 20% in patients with advanced liver disease or liver transplantation. Not all those with the immunocompromised state will develop antibodies. All patients who have an immunocompromised state will not produce antibodies. But in case you have developed antibodies and can be more confident that you won’t have the viral infection, don’t be under the wrong impression that you have been protected. If you don’t have antibodies even after vaccination, you have to be extra careful. You must be extra cautious.

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