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Shalini Bhardwaj



New Delhi: Delhi High Court has refused to interfere with the Delhi government’s decision on refusal of granting study leave to pursue for Post-grade MD /MS course in Paediatrics from PGI Chandigarh. A single-bench of Justice V. Kameswar Rao made the observations while hearing the plea filed by the petitioner who is a doctor seeking the direction against the respondent to issue the relieving order.

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Medically Speaking




Currently, there are 9 approved vaccines against SARS-CoV-2 virus that are used to prevent transmission, and prevent hospitalisation and deaths. However, all vaccines are given intramuscularly and appear to induce systemic protective immunity and not sterile immunity, and carry minor side effects. Current vaccines predominantly induce IgG antibody response and very little IgA responses. IgA is a predominant protective antibody in the nose and pharynx.

In natural Covid-19 infection, both IgG and IgA responses are induced. This is one of the reasons why after full vaccination some individuals, though rare, are still susceptible to SARS-CoV-2 infection. Taking into consideration current status of repeated surges and mutations in SARS-CoV-2, it is likely that this virus would be with us for some time. We also do not know how long vaccine-induced immunity would last.  Therefore, we may require booster vaccines and modified vaccines to overcome mutant strains.

Furthermore, there is a hesitation in getting injectable vaccines, and then there are problems with storage and shelf life of vaccines. Thus, there is a need to develop vaccines that are not only directed against spike protein where most mutations occur, but directed against other viral proteins that are not susceptible to mutations, for example nucleocapsid and membrane proteins. In addition, there is a need to develop vaccines that may be administered by alternative routes including orally, inhalation, and under the skin. A number of such vaccines are in Phase I trial to determine safety. If proven safe, these vaccines will undergo phase II and phase III clinical trials to determine effectiveness of the vaccine. UB-612 multitope peptide-based vaccine (COVAXX; developed by United Biomedical, Inc) is composed of SARS-CoV-2 amino acid sequences of the receptor binding domain.

Further formulated with designer Th and CTL epitope peptides derived from the S2 subunit, membrane, and nucleoprotein regions of SARS-CoV-2 structural proteins for induction of memory recall, T-cell activation, and effector functions against SARS-CoV-2. In Taiwan, phase 2 trial, and phase 2/3 trial in Brazil have started. Altimmune, Inc has developed intranasal COVID-19 vaccine (AdCOVID). It is a single-dose vaccine. Preclinical results showed stimulation of antigen-specific CD4+ and CD8+ T-cells in mildly affected lungs as early as 10th day. Phase 1 safety and immunogenicity study has begun in Q4 2020. University of Oxford, UK has developed ChAdOx1 nCov-19 inhaled vaccine. 

Dose-ranging trial for orally inhaled vaccine phase 1 trials in 30 volunteers has started. Self-amplified (saRNA) synthetic inhaled vaccine is developed at Imperial College of London. VXA-CoV2-1 is an oral vaccine (Vaxart). Recombinant adenovirus vector type 5 (Ad5) expressing coronavirus antigen and a toll-like receptor 3 (TLR3) agonist as an adjuvant is used. Preliminary phase 1 trial in a large number of subjects, vaccine induced CD8 T-cell responses to the viral spike protein. Neutralising antibodies not detected in most subjects. Company is evaluating an optimal dosing schedule in order to assess efficacy in phase 2 trials. The PittCoVacc Covid-19 vaccine has been developed by two scientists at University of Pittsburgh School of Medicine, Pittsburg, PA. Vaccine candidate using transdermal micro-needle for Covid-19. In mice, vaccines produced antibodies over a 2-wk period; micro-needles are made of sugar, making it easy to mass-produce and store without refrigeration.

In near future, we can expect many more vaccines targeted against multiple components of SARS-CoV-2 to be delivered by convenient oral and inhaled routes that would be effective against expanding mutant strains.

The writer is Professor of Medicine, University of California, Irvine, California, USA.

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Medically Speaking


Shalini Bhardwaj



Seeing India hit record highs in Covid-19 cases every day has left a lot of people panicking and looking for advice on what to do if someone shows symptoms of the infection. Three of India’s best doctors—Dr Randeep Guleria, Dr Naresh Trehan and Dr Devi Shetty—provide answers to common queries and highlight the most important points that people must keep in mind amid the ongoing surge.


More than 85% of Covid patients will recover without any specific treatment. Most will have symptoms like common cold, sore throat, etc. Over 5-7 days, they’ll recover with symptomatic treatment. Only 15% may advance to a moderate form of the disease.

Oxygen is a treatment, like a drug. Taking oxygen intermittently is an absolute waste of oxygen. There is no data that shows that this will be of any help to you and therefore you shouldn’t do it.

In healthy individuals with oxygen saturation of 93-94, there’s no need to take high flow oxygen just to maintain saturation at 98-99. It’s not going to be of any benefit. If it is less than 94, you need close monitoring, but you still may not need oxygen.

Do not consider Remdesivir to be a magic bullet. Most of us who are in home isolation or in the hospital don’t actually need any specific treatment. Only a small percentage requires Remdesivir.

In terms of the number of people who need oxygen and oxygen supply, we are well balanced. As a country, if we work together and use oxygen and Remdesivir judiciously, there will be no shortages anywhere.

The vaccine prevents you from getting the disease in the form of a severe illness. It may not prevent you from getting the infection. It is important to understand that even after taking the vaccine, we may get a positive report. That is why it is important to wear a mask even after the vaccine.

Cross-ventilation reduces the risk of infection in closed places. Don’t be in groups, whether any of you are positive or not.


Today we have enough oxygen, if we try to use it judiciously. I want to tell the public that if you don’t need oxygen, then don’t use it as a security blanket. Wasting oxygen will only lead to depriving someone who needs it.

We now have a protocol that Remdesivir is not to be given to everyone who tests positive. Only after doctors look at test results, symptoms and comorbidities of a patient, it can be given. Remdesivir isn’t a ‘Ram baan’; it only decreases the viral load in people who need it.

A lesser percentage of people require hospitalisation. Hospital beds should be utilised judiciously and responsibly. This responsibility rests on all of us.


If you have any symptoms like body ache, cold, cough, indigestion and vomiting, I have one important message: get yourself tested for Covid-19. It is the most important thing.

In case you are positive, see a doctor and get his opinion. Do not panic; Covid-19 is common now. It is a problem that can be solved, provided you get medical help at an early stage and follow the doctor’s instructions.

There is a possibility that you may be asymptomatic. Doctors will tell you to stay at home, isolate yourself, wear a mask and check your oxygen saturation every six hours.

If your O2 saturation is above 94%, there is no problem. But if it is falling after exercise, you need to call a doctor. It’s important you get the right treatment at the right time.

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Medically Speaking

This isn’t a second wave, but a tsunami: Experts on Covid surge

Planning in advance and ensuring stocks of oxygen, Remdesivir could have prevented such a rise in the number of new cases, say doctors.

Shalini Bhardwaj



The daily spikes in Covid-19 cases have left many wondering where India went wrong. Did people stop following Covid-appropriate behavior, or did the government make a mistake by not planning for a second wave, which had been observed in the West and was likely to hit India next? Eminent doctors Dr Nita Radhakrishnan, HoD, Pediatric Hematology-Oncology, SSPHPGTI, Noida, Dr Shuchin Bajaj, founder and director of Ujala Cygnus hospitals, Dr Avinash Bhondve, former president, IMA Maharashtra, and Dr Prachi Jain, ENT specialist, Alchemist Hospital, speak to The Sunday Guardian about their views on what is causing the deadly second wave of Covid-19 in India.

Q: What exactly went wrong that has left India so vulnerable to a second wave of Covid-19 with multiple mutations?

Dr Shuchin Bajaj: Till around February, we were all congratulating ourselves and patting our backs for being the only one among the top five affected countries that had not seen a second wave. We were attributing it to our natural immunity and other factors. The WHO, in fact, wrote a paper saying it was due to the mass behaviour of Indians and the government enforcing monetary penalties for not wearing masks. But it was not the correct way to think. We work in the hinterland, in rural areas and semi-rural areas and we saw that nobody was wearing masks there, whether at election rallies or celebrations or at the farmers’ movement. So I think it is the virus’ behaviour, as has been seen repeatedly in various countries, where it goes away and comes back viciously as a second wave. This is exactly what happened a century ago with the Spanish flu as well. The second wave was much deadlier and wider in scope. Unfortunately, although we knew about this behaviour, that this was happening in Western countries and we were about three or four months behind them, we did not take it seriously enough. We did not realise that it would affect us as well. We went about merrily, attending weddings and parties, and now it has come back with a vengeance. It is like a tsunami now, it is no longer a wave. The numbers are shooting up rapidly and we are seeing so many mutant variants of concern that I think there are a few tough months ahead of us.

Q: What do we blame for India’s latest Covid crisis?

Dr Avinash Bhondve: As Dr Bajaj rightly said, in the month of December and January, all the people, including the Government of India, thought that this corona wave has come down and is almost gone. But we had been expecting a second wave in November and December. Fortunately, the numbers came down that time. However, in the great return, it was found that there was a new strain and there were a lot of patients who were affected rather rapidly—30 times faster than the previous virus. They did immediate genome sequencing and found out that there is a new mutant. We asked the government to take great precautions. Flights from Great Britain were stopped but genome sequencing of all those who came, which had been advised, was not done in full capacity. A few hundred were examined but there was more than that. At the same time, we got strains from Brazil and South Africa and even after that very few samples were tested. Then it was declared that a new strain was found in Amravati. Towards the end of January, the numbers were coming down but it never touched the baseline, so it was clear that the second wave was bound to come in a few days and it happened in February when the numbers started rising again. It was absurdly speedy and the government should have informed all the people that this is the speed at which the numbers are increasing. The government is saying that it happened because of people not following Covid-appropriate behaviour but they did not do that even in the months of September October or January or even today. So that was not the main reason, also since the numbers were increasing more in Maharashtra and Kerala. It was quite clear that there was some Covid strain or mutant which had been ignored. The early preventive measures which had been advised came out on 25 March, when the previous year’s highest point was crossed and it was announced that there are at least two mutants.  By the double mutant, it was said that 18% to 20% people in Maharashtra were affected then, but today, as per the latest report, around 61% are affected. So, for all these things precautions should have been taken in February, especially contact tracing, which was advised but not done. Many who were asymptomatic or mildly symptomatic were not diagnosed so they spread the infection as carriers. They were people travelling for business, in local trains and buses, and all this became the main reason for the spread of the new mutants.

Secondly, when the vaccinations began in January, it was so slow that at some places there was only one centre open or only open for four days a week. So many people, even doctors and health workers, avoided taking it because of their work. The government never came out with an open statement saying the vaccines are safe. It was never announced officially. It was also expected that new vaccines would come, which would be better. These were things which the government never planned. Even planning ahead for hospital beds. In Maharashtra, all those Covid centres or jumbo Covid centres where 500 to 1000 people used to be accommodated were closed. The doctors were sent back as they had been taken on a contract basis. There was no planning or expectations about future events. Then, when the numbers started increasing, they never accepted it as the second wave, and were then taken aback with its speed.

Right now, the healthcare system in Maharashtra has totally collapsed. There is absolutely no place, even for simple isolation beds. Oxygen beds and ventilators and the ICU are really out of the question. Even Remdesivir is not available. Around 5% of the infected people may require Remdesivir. So if there are 50,000 patients per day, you require that amount. But it was not planned which is why Remdesivir is falling short now. It is the same for oxygen. Even worse is the state at crematoriums where people are waiting for hours to perform the last rites of their relatives. It is happening for not listening to experts or those who have been studying pandemics.

Q: How are children getting affected by Covid-19? Especially children who already have diseases like cancer and have low immunity levels.

Dr Nita Radhakrishnan: Globally, there has been big concern from the beginning about how this infection is going to affect immune-compromised patients. In many situations, it was found that cancer patients were more susceptible and died of the infection more. Then later on, we saw that the overall mortality was much higher in adult cancer patients than in children. For children with cancer, mortality is definitely higher than among the normal population, but it is not very high either. There are a couple of reasons. One, cancer patients are kept isolated anyway. Their families know the importance of hand hygiene and protection and not going out to crowded places. These things have been there even before the pandemic started. So, in a way, these children were protected. But I agree with the previous speakers on the statement that we have been very lax as a community. The government issuing a challan for not wearing a mask will never be a solution. It has to come from all of us. We have to decide as a group that we will wear masks till our immunity is at a level which is good enough to tackle the infection. Till the time that doesn’t happen, these children, including cancer patients, are going to be highly susceptible to the disease.

Q: How is Sputnik V different from Covishield? What is its composition?

Dr Prachi Jain: All these vaccines are basically aimed at different components of the virus. Some vaccines use mRNA, some use the whole protein, some use the spike protein. In the case of Sputnik V, which is roughly 91.6% efficient, it is a little different from Covishield. In this, different components have been used but the efficacy has been around 90%.

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Medically Speaking


Shalini Bhardwaj



In a virtual press conference, three senior members of the national Covid-19 task force, Niti Aayog member V.K. Paul, ICMR Director General Balram Bhargava and AIIMS Delhi director Randeep Guleria, presented data pertinent to the ongoing Covid wave.

Dr Bhargava said there is no difference between the first wave and the second wave and the data showed that over 70% of patients in hospitals in both waves of the infection are above 40 years of age, indicating that seniors are still at higher risk. “Older population continues to be more vulnerable to be admitted in the hospital in the current wave,” Bhargava said while sharing the data.

There is no difference in the percentage of deaths between the first wave and second wave from the data we have,” the ICMR DG added, as per ANI reports.

The statistics presented also outlined that there is a higher need for supplemental oxygen — over 54% in hospitalised patients during the second wave. However, it also showed a decrease in the demand for ventilators, which has come down during the second wave, with only 27.8% of those admitted in hospitals needing it, as compared to over 37% who required it during the first wave.

He also said that more cases of breathlessness are being reported during this wave, while in the last wave, symptoms like dry cough, joint pain, headaches were more prevalent.

The ICMR DG also listed three main reasons for the higher transmissibility of Covid-19: laxity, Covid-inappropriate behaviour and various unidentified mutations. “We have had a tremendous amount of laxity, Covid-19-inappropriate behaviour and various unidentified mutations. Of them, some are of concern — the UK, Brazilian and South African variants, which have been demonstrated to have higher transmissibility,” he said. He also added that a double mutant has been found in India but its higher transmissibility has not been established.

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Medically Speaking


Shalini Bhardwaj



In an interview on Monday, AIIMS Director Dr Randeep Guleria briefed the public on the importance of drug management during the ongoing pandemic, which has sparked concerns about shortages of medicines like Remdesivir.

“As far as drug management is concerned, there are two aspects – one is drugs and the other is the timing of drugs,” he said, warning that, “Giving a cocktail of drugs can also be more harmful.”

He also spoke about treating Covid-19 through drugs, steroids and CT scans. However, he advised against the use of Remdesivir for people recovering at home. “Studies have shown that Remdesivir is not a magic bullet and it is not reducing mortality. We may use it as we don’t have an antiviral drug. It’s of no use if given early to asymptomatic individuals/ones with mild symptoms. Also of no use, if given late,” he said.

“The majority of patients will improve with just symptomatic treatment. It’s only when you have moderate patients who are admitted that we need to look at steroids and other antiviral drugs (like Remedesivir) by following protocols and rationally give treatment,” he added.

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Variants, inappropriate behaviour, Covid fatigue have led to a surge: Top doctors

The ongoing coronavirus surge is not really a sudden, one-off incident. About 100 years ago, there was a similar pandemic, healthcare experts tell The Sunday Guardian in an exclusive interview.

Shalini Bhardwaj



Top doctors and healthcare experts Dr Rakesh Mishra, director of CSIR-CCMB, Dr Padma Srivastava, senior neurologist from All Indian Institute of Medical Sciences, and Dr S.K. Sarin, director of ILBS, told this paper why they think India is witnessing a massive surge in Covid-19 cases now and how this surge can be controlled. Excerpts:

Q. What explains the sudden surge in Covid-19?

Dr Rakesh Mishra: The most logical reason for the surge in Covid cases is that 2-3 months ago, things were in control, but gradually we started to become careless and common people thought that coronavirus is now gone and normal life can be resumed. We are seeing the consequence of that carelessness. When the number of cases rise, it picks up like a chain reaction. Political activities, farmers’ protests, marriage parties, local trains, schools reopening, restaurant opening, bars opening, malls opening and all such things mean lots of exposure to people in public and these things led to the sudden increase in cases. Also, over a period of time, more variants have emerged and this has affected a large number of people.

Q: In Punjab, we are seeing a lot of people been infected by the UK variant?

Dr Rakesh Mishra: You can actually link that very nicely if you see the data of the UK variant. It means that these are the travellers who initially came from the UK and then participated in some activity where a large number of people came together and then they went to smaller cities and villages and started to spread the virus. But the reason for spreading is only one which is when people are not careful. When people are in close proximity without protection to an infected person, who is also not protected, this is bound to happen. It doesn’t matter which variant it is.

Q. What would you like to say about the sudden surge?

Dr Padma Srivastava: Again, as Dr Mishra said, it is not really sudden. About 100 years ago, there was a very similar pandemic. There was also a second wave which was steeper and worse and then a third wave and then probably, it just vanished. So, what we are seeing today is not an unexpected development. What has happened now, as professor Mishra said, is the presence of variants. To add to it is Covid-inappropriate behavior, which may be due to Covid fatigue as well as overconfidence following the arrival of Covid vaccines. So, people threw caution to the wind at a time when mutants were present and active. Historically, we are going to hit waves and waves again. And for safety, vaccination and Covid-appropriate behaviour are the best bet.

Q: The situation in India is worsening, what are the steps we should all take now?

Dr S.K. Sarin: First, we have to accept that we have a difficult situation and we are actually having more infections now than we anticipated. This is likely to probably overshoot last year’s numbers; so first, we have to accept that we are down in the dumps, we are in trouble and, therefore, if we accept that, then certainly, we have to manage at least this wave of severe and rapidly spreading infection and then, the second step would be to think about how we can prevent a subsequent wave and not let these waves keep on coming and disturbing our economy and lives.

As Dr Mishra and Dr Padma have already said, in my opinion, this was anticipated even in January when things opened up very rapidly. We had the first mutant coming and the UK variant had come or at least was detected at that time and from then on, everyone knew that like in UK, in three months, it would lead to a major proportion of people getting infected. We are not doing as many sequencing as we should for the virus types, but it is anticipated that in a few weeks, this may become a major problem of viral variants infecting Indians. Of course, other variants are there; the virus has a life cycle of about 12-16 weeks until the time it has a major mutation.

So while they are occurring, we should be aware of mutants coming and infecting the population in different cities where it was not there. What is worrying is that we had opened up almost all our transport systems and our offices back in January thinking that the virus has gone away; also, we thought that now that the vaccine has arrived, all of us will be vaccinated soon. These two things have probably help the spread of the virus now. The worry now is the number of deaths piling up in the next 2 to 4 weeks’ time when the infection becomes deeper and more and more people get infected. I think the situation is difficult, but all of us have a collective responsibility.

Q: How can we check such waves?

Dr Rakesh Mishra: Genome sequencing let you explore the aspects of the virus–what kind of changes it is acquiring and if there is any particular area where a particular variant is increasing in number. We have to keep in mind that we are only generating the mutants by allowing the virus groups to spread across a large number of people and mutations are a natural process of any life form. Genome sequencing provides valuable information which gives us some hints about what might be happening, but to control the spread of the virus, we all have to be extremely careful and behave in a Covid-appropriate manner.

Q: Do you think lockdown is one of the useful options?

Dr S.K. Sarin: Once you finish two to four weeks of lockdown, people tend to think that the virus has gone and they start doing multiple times the level of activities they did earlier; so lockdown sometimes is not a very positive way of managing such things.

As Dr Padma said we have to get things like hospitals, ICU beds, drugs, protocols and healthcare workers in order; however, testing and tracing has to be as strict as possible. Lockdown has to be self imposed–you have to see that you actually lock yourself down compared to others to stop the transmission of the virus. The virus is like a villain, it will go away and then show up again and again.

We need to vaccinate our population faster; we have just done 7% vaccination of our population which is much less, especially with respect to areas where the virus is spreading fast like in Maharashtra or maybe Karnataka and Delhi. I think the age bar should be removed and mass vaccination is required as fast as possible. In the history of medicine, there has never been an occasion when the whole world has to be vaccinated and that too fast. So, there are challenges, challenges of making vaccines available, challenges of side effects, challenges of getting people to vaccinate and most importantly, getting people to accept a vaccine. Having said that, through the media, it is very important for us to communicate that there are two types of vaccines available: one is your mask and the second is the available vaccine and we have to employ both of them. Get your shot, do not be hesitant because there are advantages of getting a vaccine. Some people say he got two shots of vaccines, still he got infection, so what is the use of getting vaccination? But it is important to understand that if someone got vaccine shots and even then that person got infected, the infection will be milder. The severity of the disease is reduced as also the severity or possibility of transmitting the virus to others.

The other advantage of vaccines is that you will have antibodies which will at least last for six months to a year; but that should not make you abandon all the Covid-appropriate behavior. Also, once you have a vaccine, you can become and work like a frontline worker. No doctor, nurse, or healthcare worker should work if they have not received both doses of the vaccine. In fact, if there is a possibility, there is a support, we should test the immunization because vaccination is not equal to immunization; immunization means we have a high level of protective antibodies; we have not come to that stage yet. If you are over cautious that a certain vaccine may have side effects, we will lose more lives. Take whichever vaccine is available; they’re safe as millions have taken them.

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