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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The Power of Seva
If I were to ask you as to what differentiates the human species from other species, your response would probably be that humans are bipedal, have the power of language, are self-aware, can think, but what really differentiates us is our capacity to do “seva”, our ability to help others. Only the human species has this capacity for helping all life forms, which we call altruism, prosocial and philanthropic behaviour. But the essence is captured in the word ‘seva.’
Seva is a Sanskrit word meaning selfless service and is perhaps considered the most important part of our existence. It asks us to serve others with no expectation of outcome. A parallel western concept is volunteerism/help/service/community/social service, philanthropy, and the more contemporary and chic Corporate Social Responsibility and Institutional Social Responsibility.
Seva is a motivational state that a person possesses with the goal of increasing the welfare of another living being. While Seva, on the surface, seems to benefit others, it is actually the individuals engaged in Seva who also benefit. Seva is positively correlated with happiness, health, and well-being. People who did Seva showed greater satisfaction in life and exhibited reduced rates of depression and anxiety. So when you feel depressed, lonely, or anxious, go out and do seva. It could be working with animals, humans, the environment, etc. It is therapeutic and all-consuming and leaves no room for negativity.
While many of us feel drawn to helping others, our ego tends to drop in and voice our own thoughts. We use it to promote ourselves, our brands, and flaunt our service, which makes it counterproductive. Ego can also judge how we serve others. It may tell us that some types of service are more noble than others. “Oh, you help your neighbour once a week with her groceries? Well, I run events that serve 500 people.” “Oh, you help animals. Why don’t you help old people or children? “ This is not seva but the ego at work, because the aim of seva is to silence the ego, dissolve the ego, as all mental diseases emanate from the ego and its fears.
When we serve with the essence of seva in mind, we begin to see the myriad ways the ego, the source of all our troubles, is standing in front of the heart. When we transition from the head to the heart, then Seva becomes a practice of purification, a spiritual act. It is also in listening to the heart that we begin to understand that our innermost nature is a giving one. While the ego mind may tell us we need to focus on ourselves and even when we serve, it is when we shift into the spirit of seva that we realise we are naturally kind. In other words, we are naturally moved to serve others. It is when we do seva that we realise that all life is connected and working for others is the only path to mental fitness, wellness, and wellbeing and the royal road to spiritual growth.
The question you need to ask yourself for your happiness is, “Did you do Seva today?”
Dr Chavi Sharma Bhargava is the founder and CEO of Indic Center for Psychological Wellness and Holistic Health and Conversationists-Talking Cures.
Dr Vishali Gupta becomes first female Asian President of global Uveitis body
In a rare feat, a female ophthalmologist from Asia has become President of the International Uveitis Society Group and has been able to mark PGIMER at the global level. Uveitis is a field of medical science in which rare specialists are found and trained so far. The Daily Guardian had a one-on-one conversation with Dr Vishali Gupta on this and talked about the responsibilities she would have as president of this prestigious society.
What is this society all about? What is Uveitis?
The International Uveitis Study Group was formed in 1978 by a small number of clinicians who shared a common interest in Uveitis. Over the next almost 40 years, the group has increased in size to over 180 Uveitis specialists from all over the world.
What is uveitis?
Uveitis is the name given to inflammation inside the eye that, in some patients, can lead to blindness. It can affect one or both eyes, and the inflammation involves the uveal tract (iris, ciliary body, and choroid), although inflammation of adjacent tissues, such as vitreous humour, retina, and optic nerve also occurs. It could be due to an autoimmune disease and sees no age.
How long has the PGIMER been treating Uveitis, and how many experts does the department have?
PGIMER, under the stewardship of Dr Amod Gupta, has been working in the field of Uveitis since the 1990s. Then Dr Vishali Gupta, along with five experts, inducted Tuberculosis in Uveitis for the first time in the world. PGIMER has a special clinic for Uveitis patients, and these patients’ treatments are long, sometimes lifelong. Since PGIMER has Rheumatology, Microbiology, Research Scientists, and Pediatricians all under one roof, it is easy for the patients to get the best treatment. In the other sectors, it is not that easy.
Foods that can help you REDUCE headaches, migraine
Following a healthy diet can increase longevity, protect against disease, and improve your overall quality of life. Several nutrients in food promote health and protect your body from disease. The “Food as Medicine” concept generally refers to managing food and diet in an individual’s routine, with the aim of preventing, reducing symptoms of, or reversing a disease process. Research has shown that dietary habits can influence risk factors for disease. While certain foods can trigger and aggravate health conditions, others may offer significant medicinal and therapeutic advantages.
Headaches are a common occurrence that is encountered routinely by individuals. A study conducted by Biman K Ray in 2017 revealed that the one-year prevalence of migraine in an Indian population was found to be 14.12%. Headaches can be triggered by several small incidents that might not be considered significant. Sleepless nights, skipping breakfast, work pressure or stress, and excessive blue-screen exposure are all examples of irregular routines that can cause headaches. Migraine is a disabling primary headache disorder experienced predominantly by women and triggered by hormonal, emotional, physical, dietary, environmental, and medicinal factors.
In individuals, migraine triggers can include specific foods or types of foods. Eating a healthy diet can help prevent migraines and headaches. Alternatively, certain foods can decrease the frequency of migraine headaches or lessen the intensity of their symptoms. Though no definitive ‘migraine diet’ has been described,’ individuals may be able to reduce their migraines by monitoring the food that they eat.
Foods to avoid
Nuts and certain seeds: Tyramine, present in nuts and certain seeds, can induce headaches and migraines.
Cheese: Aged cheese consists of high levels of tyramine, which aggravates migraines and headaches.
Caffeine: According to clinical studies, drinking more than one to two cups of coffee per day can cause migraines in 14% of patients.
Chocolate: Chocolate is the most common migraine food trigger, and it has been epidemiologically linked to migraine attacks, so doctors typically advise migraine patients to avoid it.
Tomato-based products: They contain a high amount of histamine or tyramine that can aggravate migraines.
Avoid processed (packaged) foods: Nitrates and nitrites present in processed foods cause swelling of the blood vessels and can trigger migraines.
Foods to consume
Dark green leafy vegetables: Study published in BMJ Case report revealed that inclusion of leafy vegetables in meals can play pivotal role in relieving migraine or chronic headache .
Turmeric: Curcumin present in turmeric helps in relieving migraine frequency and duration.
Coriander: Consumption of coriander leads to a greater reduction in the duration, severity, and frequency of migraines.
Citron: It has reported several benefits in clinical trials however it also helps in reducing migraine intensity and duration.
Clinical trials of several herbal medicines indicate that various foods, through their multifactorial physiological influences, present potential options to improve migraine treatment.
The author is MD, Clinical Pharmacologist and Nutraceutical Physician, Founder and CEO IntelliMed Healthcare Suctions.
Active Covid cases have decreased, with 3,947 cases reported in the last 24 hours
According to Union Health Ministry data updated on Friday, India’s COVID-19 case tally increased by 3,947 in a day to 4,45,87,307, while active cases decreased to 39,583.
The death toll has risen to 5,28,629, with 18 more deaths, including nine fatalities reconciled by Kerala, according to data updated at 8 a.m.
According to the health ministry, active cases account for 0.09 per cent of total infections, while the national COVID-19 recovery rate has increased to 98.73 per cent.
The daily positivity rate was 1.23 per cent, with a weekly positivity rate of 1.44 per cent.
The number of active Covid cases fell by 1,167 in a single day, while the number of people who recovered from the disease rose to 4,40,19,095. The case fatality rate was calculated to be 1.19 per cent.
According to the ministry, the Nationwide Vaccination Drive has resulted in the administration of 218.52 crore total vaccine doses (94.84 crores second dose and 21.19 crore precaution dose).
Two deaths were reported in Maharashtra and West Bengal, and one each in Uttar Pradesh, Punjab, Karnataka, Haryana, and Chhattisgarh. Kerala has made amends for nine deaths.
On August 7, 2020, India’s COVID-19 case tally surpassed 20 lakh, followed by 30 lakh on August 23, 40 lakh on September 5, and 50 lakh on September 16. It surpassed 60 lakh on September 28, 70 lakh on October 11, 80 lakh on October 29, 90 lakh on November 20, and one crore on December 19.
Last year, the country passed the two crore mark on May 4 and the three crore mark on June 23. On January 25, this year, it surpassed the four-crore mark.
PREVENTION: HOW TO KEEP YOUR HEART HEALTHY AT AGE 40
An individual becomes more concerned about their health as they reach a certain age. As the most vital organ of the body, the heart requires extreme care as its chances of developing cardiac diseases increase with age.
Among older people, heart disease is the leading cause of morbidity. To reduce the risk of CVD in middle age, it is recommended to maintain or increase physical activity. Dr AnbuPandian, Medical Advisor, Agatsa, shared some tips to keep the heart healthy at 40 with us.
The most effective way to prevent heart disease at 40 is to adopt a healthy lifestyle. If you work nine hours in an office job, take short breaks every two hours. Taking the stairs instead of the lift, walking short distances instead of using a vehicle or public transportation. Exercise, meditate, swim, play basketball, dance, and do yoga—whatever you love.
Physical exercise has been shown to have a positive effect on heart health in comparison to sedentary lifestyles in various studies. A great quality of life is dependent on a healthy heart. Maintaining a regular exercise routine will keep the heart healthy for years to come.
Regular Heart Health Check-ups
A heart health check-up is essential at every stage of life, but becomes especially crucial after age 40. There are several factors that determine how often a person should get a check-up, including smoking, alcohol consumption, heart disease in the family, being overweight, and diabetes. Blood sugar and cholesterol levels should also be monitored closely. Heart diseases can be better treated if they are detected early. Once a person crosses the age of 40, a yearly checkup is mandatory. The physician may recommend more frequent check-ups if heart disease is detected.
As age increases, metabolism tends to decrease by 5 % every decade after 40. Hormonal imbalance and bone density are two other significant changes that the body registers while getting old. Increase the intake of fruits rich in Vitamin C. All citrus fruits, for that matter, have a bonus heart-healthy benefit. The best diet for preventing cardiac disease is one that is full of fruits and vegetables, whole grains, nuts, fish, poultry, and vegetable oils. Individuals who follow their dietary pattern have a 31% lower risk of heart disease than those who consume junk food.
Remote Monitoring Machines
Remote monitoring machines have been around for years but have gained significant prominence recently, thus resulting in high demand. Such devices are used on a daily basis to monitor diseases such as heart attacks, hypertension, and diabetes. These devices are very portable, user-friendly and capture patients’ health parameters via cables and sensors. These devices are cost-effective for patients because they reduce medical care costs and provide more timely intervention for chronic conditions. No one can slow down the ageing process. However, with proper care, one can be more fit, look younger, and lead a more energetic and active life. Life doesn’t end, but begins afresh again at 40!
The author is a Medical Advisor at Agatsa.
Why heart attacks are on the rise among women
Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.
Heart diseases are no longer a “men’s problem” and women too are equally prone to them. According to a recent report published by the National Family Health Survey, it was found that the overall prevalence of undiagnosed hypertension in women of the age group 15–49 years is 18.69% in India, which busts the myths that heat conditions are most prevalent among men.
Several other international studies have also indicated that heart ailments are now a leading cause of death among women, resulting in ten times more fatalities than breast cancer. Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.
Why are heart diseases going undetected in women? While ensuring the well-being of their loved ones, women in India tend to ignore their own needs and often neglect their health. For instance, if a woman has mild chest pain, she would rather ignore the symptoms and focus on managing the work/household chores rather than visiting a doctor. The patriarchal setup of our society also expects women to keep the well-being of others at the forefront rather than taking care of themselves, which results in late diagnosis and is one of the primary causes of increasing heart ailments among women in the country.
As the symptoms of a heart attack are different in both men and women, many women often don’t know if they have already suffered one or two heart attacks in the past until eventually, they visit a doctor. While in men, a heart attack usually results in extreme and sudden chest pain and breaking out in cold sweats, whereas in women, the symptoms are usually mild and heart attacks can be frequent and smaller. The symptoms in women can range from jaw pain to fatigue to pain in the neck and back to sweating or just heartburn, indicating the need for them to undergo regular health check-ups and take proactive measures to ensure overall well-being.
Which age group is most susceptible to heart attacks and what are the major concerns?
Women of the age group 45–55 years are at a high risk of experiencing a heart attack due to low levels of estrogen post menopause, work and family-related stress, loneliness, and lack of physical activity. More women in this age group may go undiagnosed and have atypical symptoms compared to men.
The second most affected age group is 60 years of age, where the biological deterioration makes both men and women more susceptible to heart attacks. High cholesterol, blood pressure, obesity, smoking, sedentary lifestyle, and diabetes are also some of the main concerns that make women more prone to cardiovascular diseases.
How can women take care of themselves and keep heart attacks at bay?
There are several steps that women can take to prevent heart ailments, such as:
- Educate yourself and increase awareness about the risk factors that can lead to blockages.
- Avoid smoking or the use of tobacco.
- Engage in physical activities like yoga, dancing, running, and walking for 30–45 minutes every day to maintain heart health and overcome obesity.
- Avoid junk food, aerated drinks and adopt a balanced diet. Healthy heart diets that include complex carbohydrates, legumes, fruits, vegetables, and less sugar, salt, and fat can have a positive impact on heart health.
Lastly, it is important to note that gender has nothing to do with heart attacks, and the condition affects both men and women equally. However, adopting a healthy lifestyle and undergoing regular health checkups can help you get the gift of good health.
The author is a Senior Consultant at Interventional
Cardiology, Aster CMI
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