Karnataka Medical Education Minister Dr K. Sudhakar has instructed officials to conduct a clinical study
on re-infection cases reported in the state. Recently, a 27-year-old woman tested positive for Covid-19 for the second time at a private hospital in the state, after which, in a meeting with Task Force officials,
Sudhakar asked for a clinical study on relapse cases. During the meeting, an official said it takes 15 days to recover from the infection. Dr Sudhakar has asked for an in-depth report and treatment for such cases in other states too.
Five-year survival stories on an artificial heart
Patients facing heart failure and certain death in the absence of an immediate heart transplant are living normal lives. These patients don’t have a pulse, heartbeat or blood pressure, yet they can do everything that a healthy person can, as their blood flow has been fully restored. The left ventricular assist device (LVAD) has helped in the longevity of life for those who were facing imminent heart failure.
According to Dr Kewal Krishan, director, Heart Transplant & Ventricular Assist Devices, Department of Cardiovascular Surgery at Max Hospital, Saket, says, “LVAD is a device that adds 13 to 15 years to the life of people facing imminent heart failure. It boosts functions of the heart and is used either as a temporary measure till a heart transplant can be conducted, or as a destination therapy where the patient lives with the device permanently as they are unfit for a heart transplant. LVAD enables patients to live a normal life even after end-stage heart failure.”
“We have conducted over a dozen LVAD implants till now at our hospital ranging from a 7-year-old girl to an 81-year-old female patient. Four of those patients are living a normal life even five years after implant — they are the first and only LVAD recipients in India to have successfully survived beyond five years. Others are also doing well and hopefully will complete many more years on the device. LVAD is gradually emerging as a good alternative to a heart transplant.” he adds.
MCI dissolved, NMC takes charge as top medical education regulator in India
The government has dissolved the Medical Council of India (MCI) following the corruption charges in 2010 and it was replaced in 2018 with a Board of Governors (BoG), MCI. Now, the Centre has dissolved the BoG through a gazette notification. The National Medical Commission (NMC), a new body, will function as the county’s top regulator of medical education. The setting up of NMC was a government move to bring reforms in the medical education sector, by replacing the MCI. “Indian Medical Council Act, 1956 (102 of 1956) is hereby repealed with effect from 25 September. The BoG appointed under Section3A of the Medical Council Act, 1956 (102 of 1956) in supersession of the MCI constituted under subsection (1) of Section 3 of the said Act shall stand dissolved,” stated the gazette notification issued by the Union Ministry of Health and Family Welfare (MoH&FW).
The chairman of the NMC for three years would be Dr Suresh Chandra Sharma, who is retired HoD of AIIMS, New Delhi. It will consist of 10 ex-officio members and 22 part-time members appointed by the Central government. The NMC will have autonomous boards under the NMC Act, Under Graduate Medical Education Board (UGMEB), Post Graduate Medical Education Board (PGMEB), Medical Assessment and Rating Board and the Ethics and Medical Registration Board.
According to the new medical education structure under the NMC the common final-year Bachelor of Medicine and Bachelor of Surgery (MBBS) examination will now be known as the National Exit Test (NEXT). “Before selection in PG now medical students after MBBS has to go for NEXT based on their results selection for the PG will be done,” says Dr M.C. Misra, former director of AIIMS.
Work towards dispelling distrust before Covid-19 vaccine arrives
Union Minister of Health & Family Welfare Dr Harsh Vardhan has said in a statement that he would take the first shot of the Covid-19 vaccine to address any ‘trust deficit’ over its safety. This statement gives me a feeling of déjà vu. Almost ten years ago, the then Health Minister Ghulam Nabi Azad had taken one of the first shots of the H1N1 flu vaccine. We had failed then to build trust over vaccine safety, and are likely to fail again, unless appropriate steps are initiated now — in addition to the Health Minister taking the vaccine.
In 2009-10, the world experienced the H1N1 influenza pandemic. There was a ‘race’ among vaccine manufacturing companies to produce a vaccine and countries scrambled to get vaccines. India had reported the first case of Influenza A/H1N1 in May 2009. The Government of India had then imported 1.5 million doses of the vaccine and also provided Rs 10 crore each to three vaccine manufacturers as advance market commitment for 6.25 lakh doses from each of the companies. We had taken all the right steps to get the vaccine but failed to deliver it to the communities. Not only did we not use most of the doses of the imported vaccine, but also failed to lift even a single vial of the vaccine, worth Rs 30 crore, ordered from the Indian manufacturers. One of the reasons for that had been the poor acceptance of the vaccine because of safety concerns.
During the H1N1 pandemic of 2009, inter alia, there were doubts raised about the safety of the vaccine. Even after making the vaccine compulsory for healthcare personnel, very few took it because the fear of adverse reactions, specifically for Guillain-Barré syndrome, was high among them.
India has small but vociferous anti-vaccine groups. The anti-vaccine movement, which has its roots in the US and the UK, has gained ground in parts of the country now. In the past, they have raised their voices against the use of the Measles-Rubella (MR) vaccine, the pentavalent vaccine (for diphtheria, pertussis, tetanus, hepatitis B, and H influenza B) and polio vaccines. Social media posts — which are worryingly effective — from these groups have also been circulated in India.
The approval of the Covid-19 vaccine is being fast-tracked so that the vaccine becomes available early and is able to control the pandemic and save millions of lives. The fact that something which would normally take 10 years to develop and tested for safety and effectiveness is being made available under “expedited approval” within a few months has given an impression that the vaccines are being rushed to the market and not sufficiently tested for safety and efficacy. In a significant move, India’s Ministry of Health & Family Welfare has permitted vaccine manufacturers in India to make and stock Covid-19 vaccines which are currently under clinical trials. Though these are welcome steps and would expedite the earlier availability of Covid-19 vaccines in the country, they are fuelling public concerns for pushing inadequately tested vaccines.
One of the theories making the rounds is that the disease is not as deadly as has been made out to be and that it only affects a small group of people which is immune-compromised. Another theory is that the coronavirus vaccine has tracking chips that would later be activated by 5G and used to influence the behaviour of people. Groups are busy sowing doubts even before a Covid-19 vaccine exists and this can undermine the country’s efforts to vaccinate high-risk groups.
While Covid-19 vaccines are under development, the nature and extent of vaccine hesitancy must be assessed and addressed timely. An effective communication strategy is needed now to address the fears and uncertainties.
The writer is an Infectious Disease Epidemiologist and Independent Consultant.
Be prepared for Covid to be around for foreseeable future: Dr Nabarro
WHO’s special envoy for Covid-19 Dr David Nabarro says that we have to learn to live with the virus. ‘It hasn’t gone anywhere and it’s now multiplying,’ he tells The Daily Guardian in an interview, adding that no one knows how long it will take for a vaccine to be developed.
In an exclusive Interview with The Daily Guardian, Dr David Nabarro, who is a special envoy to the World Health Organization (WHO) for Covid-19, said that the infection should be considered a constant threat to humanity. “It hasn’t gone anywhere and it’s now multiplying. We have to live with it. I do not know how long it will take for a vaccine to be developed and when it will be accessible to everyone, everywhere,” said Dr Nabarro.
Covid-19 has infected more than 32,510,655 people and killed over 989,287 people worldwide. “Today, it is really a struggle to make sense of this virus causing Covid-19 and the extent to which it has spread. Our starting point is that the world is going to beat the virus, but the world is also going to learn that the virus is a constant threat,” said Dr Nabarro.
According to Dr Nabarro, the virus multiplying and spreading from one person to another can only be stopped or controlled by keeping in mind a few important points. “This virus multiplies by jumping from person to person. But if people are not close to each other, we can stop the virus from actually moving from one person to the other. And then, when the virus is moving between people, it’s possible to stop it from doing so, to interrupt transmission. But that is isolating people from each other, and that’s the secret to getting ahead of this virus — it is the only defence. And we have to do that because this virus can kill, it can kill the people it infects,” he warned. “So, we need to keep ahead of it by stopping it from moving from person to person, with physical distancing, face protection by using masks, maintaining the hygiene of our hands when we cough — and through the practice of staying away from others,” he added.
Some scientists and doctors are saying that the world is already going through the second stage of the Covid pandemic. On that matter, Dr Nabarro said, “This virus hasn’t gone anywhere at all. It is spreading through small outbreaks, which are then getting bigger. It’s happening continuously. In some places, the movements are slow because they have very good defences and those defences are being implemented quickly. But in some places, where, perhaps, it’s been hard to defend, the virus is quite widespread. So, I am not talking about ‘waves’, I am talking about resurgences of the disease, in the form of spikes or surges, and then those turning into outbreaks.”
“The precautions we need to take to stay Covid-19-free relate to what we do in terms of physical distancing, face protection, maintaining hygiene, isolating when we are sick and protecting others who are at risk,” said Dr Nabarro, adding that the people at a higher risk are healthcare workers. The contagious coronavirus has affected healthcare workers the most, with thousands of them having died across the world till date. “The people who work in healthcare, nurses and doctors, attendants and people who provide health services: we have to give them special attention. They have high death rates, with many thousands of health workers dying in the last few months,” Dr Nabarro stated.
Talking about other major challenges which people are facing, Dr. David commented, “Covid is also causing lots of problems. We need to recognise that it causes health challenges, makes people sick, and some of them very sick, but it is also leading to all sorts of other challenges. There are unemployment systems in place, a system protecting people who are poor. You have to recognize that poor people get hit the worst, and if their movement is restricted, the poor suffer the most. So, Covid is also revealing some of the inequities in our society, and we must support poor people first.”
Besides social concerns, the vaccine is the biggest question on everyone’s minds right now. About that, said Dr David, “We don’t know whether the vaccine we have works well or whether we will have a vaccine which is safe. But we know we need to wait for sometime before the vaccine is widely available.” So, what can we do until a safe and effective vaccine is out? “All you can do is learn to live with the threat of Covid, and at the same time, try to find new ways of diagnosing it, so we can test more easily. We will try to find out the vaccine, but don’t wait for one particular thing to appear, especially since we have no certainty that it will come. Try not to put dates on when we will have vaccines. If you do that, you create false expectations,” advised Dr Nabarro.
Lastly, addressing the concern about how long this virus will remain with us, Dr David said, “This virus is a coronavirus, and generally, a coronavirus is quite stable. There is a lot of evidence that this virus stays pretty consistent. But it hurts people and kills people, and I think we need to be prepared for this virus to be around for the foreseeable future and become another issue in our ecosystem which we have to manage.”
IMA submits a list of 393 doctors who died during Covid
The Indian Medical Association (IMA) has submitted a list of 393 doctors who lost their lives during the Covid-19 pandemic, being disappointed with Union Health Minister Dr Harsh Vardhan’s statement in Parliament and the response of MoS, Health Ministry, Ashwini Kumar Choubey. No country has lost as
many doctors and healthcare workers as India has in the pandemic, the IMA said in a statement.
“However, it conceals the morbidity and mortality of doctors, nurses and healthcare workers. This indifference to the sacrifice of doctors and health- care workers is the reality of Covid-19,” said Dr R.V. Ashokan, secretary general of IMA. Ashokan added, “Doctors of the country will be happy, we are fighting our honour, we are not looking for our benefits. We dedicate ourselves and the government should at least acknowledge.” Meanwhile, Dr Rajan Sharma, president, IMA, added that doctors suffered four times the mortality of ordinary citizens while the private practitioners suffered the same eight times more.
Maharashtra government to recruit medical students
The Maharashtra government has decided to draft 2,852 medical students from their college campuses to work in hospitals across the state. Maharashtra is the worst affected Indian states as far as Covid-19 cases are concerned. The government has sanctioned the appointment of 1,204 specialised final year medical students, and others are those who have appeared for final year exams and post graduate medical courses have been pressed into government service.
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