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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How Covid-19 could bring adverse complications for pregnant women
Assessing 2,471 women in the third trimester of their pregnancy, close to their delivery, researchers found “significant differences” for symptomatic covid positive patients including higher rates of gestational diabetes, lower white blood cell counts, and heavier bleeding during delivery, whilst respiratory complications were witnessed in their babies.
The peer-reviewed findings were published in The Journal of Maternal-Fetal and Neonatal Medicine. The study finds an increased risk of poorer outcomes for the newborns and symptomatic women with COVID-19, which adds further weight to the argument for pregnant women to be vaccinated for the virus.
Thankfully in the group of patients — which included 172 Covid positive women (56 of whom were symptomatic)– monitored at the Mayanei Hayeshua Medical Center in Israel, only one person needed mechanical ventilation, and there were no maternal deaths.
They show, lead Dr Elior Eliasi stated that COVID-19 in the third trimester of pregnancy “has clinical implications, albeit at lower rates than expected once asymptomatic patients are taken into account.”
The analysis found that there was no significant increase in cesarean delivery in women, who were COVID-19 positive and the incidence of preterm deliveries was not significantly different among the three groups (healthy, covid positive asymptomatic, covid positive symptomatic). Most pregnancy and delivery outcomes were similar between COVID-19-positive and -negative parturients (a woman about to give birth; in labour).
Dr Eliasi said, “However, There were significant differences between the COVID-19-positive and healthy controls included higher rates of GDM (gestational diabetes), low lymphocyte counts (white blood cell count) which were significantly lower, postpartum hemorrhage (bleeding during birth), and neonatal respiratory complications.”
“Our findings support the importance of vaccinating all pregnant women at all stages of pregnancy,” he added.
The study looked at births at the hospital between 26 March and 30 September 2020. A total of 93 per cent of women admitted to the labour ward during this period were negative for COVID-19. Of the COVID-19-positive patients, 67 per cent were asymptomatic.
On average the increase risk of incidence of adverse outcomes was 13.8 per cent higher for asymptomatic covid patients and 19.6 per cent higher for those symptomatic.
“More data is now needed to better delineate the differences between pregnancy outcomes seen in certain populations, potentially related to different viral characteristics (subtypes, viral load), patient epigenetics, or other factors. Additionally, the effects of maternal infection on the fetus both in terms of symptomatic maternal illness and vertical viral transmission remain to be further investigated,” the authors stated.
Limitations of this study include it being retrospective; whilst another is that the sample includes a relatively healthy population admitted to just a single community hospital. “Therefore,” the authors stated their findings, “may not be generalizable to all populations.”
STUDY DETERMINES SENSE OF SMELL IS BODY’S MOST RAPID WARNING SYSTEM
Researchers at Karolinska Institutet in Sweden have been able to study what happens in the brain when the central nervous system judges a smell to represent danger.
The study indicated that negative smells associated with unpleasantness or unease are processed earlier than positive smells and trigger a physical avoidance response. The findings of the study were published in the journal ‘Proceedings of the National Academy of Sciences’. The ability to detect and react to the smell of a potential threat is a precondition of our and other mammals’ survival.
“The human avoidance response to unpleasant smells associated with danger has long been seen as a conscious cognitive process, but our study shows for the first time that it’s unconscious and extremely rapid,” said the study’s first author Behzad Iravani, a researcher at the Department of Clinical Neuroscience, Karolinska Institutet.
The olfactory organ takes up about five per cent of the human brain and enables us to distinguish between many million different smells. A large proportion of these smells are associated with a threat to our health and survival, such as that of chemicals and rotten food. Odour signals reach the brain within 100 to 150 milliseconds after being inhaled through the nose.
The survival of living organisms depends on their ability to avoid danger and seek rewards. In humans, the olfactory sense seems particularly important for detecting and reacting to potentially harmful stimuli.
It has long been a mystery just which neural mechanisms are involved in the conversion of an unpleasant smell into avoidance behaviour in humans. One reason for this is the lack of non-invasive methods of measuring signals from the olfactory bulb, the first part of the rhinencephalon (literally “nose brain”) with direct (monosynaptic) connections to the important central parts of the nervous system that helps us detect and remember threatening and dangerous situations and substances.
Researchers at Karolinska Institutet have developed a method that for the first time has made it possible to measure signals from the human olfactory bulb, which processes smells and in turn, can transmits signals to parts of the brain that control movement and avoidance behaviour.
Their results are based on three experiments in which participants were asked to rate their experience of six different smells while the electrophysiological activity of the olfactory bulb when responding to each of the smells was measured.
“The results suggest that our sense of smell is important to our ability to detect dangers in our vicinity, and much of this ability is more unconscious than our response to danger mediated by our senses of vision and hearing,” said the study’s last author Johan Lundstrom, associate professor, Department of Clinical Neuroscience, Karolinska Institutet.
BRIEF COUNSELLING BY DOCTOR CAN PRODUCE USEFUL REDUCTIONS IN DRINKING
WASHINGTON : A recent study found the alcohol-targeted brief interventions when delivered in medical settings, can produce useful reductions in drinking.
Published in the scientific journal ‘Addiction’, the findings suggest that structured, one-to-one, short conversations about drinking, designed to motivate changes in risky behaviour, when delivered in doctors’ offices and similar medical settings, might produce small but useful reductions in drinking.
Alcohol-targeted brief interventions yielded small beneficial effects on alcohol use, equivalent to a reduction in 1 drinking day per month. Interestingly, the findings were inconclusive for brief interventions delivered in the emergency department/trauma centres but were effective when delivered in other general medical settings (e.g., a primary care clinic).
There was limited evidence regarding the effects of drug-targeted brief interventions on drug use. Lead author Emily Tanner-Smith comments: “A reduction of one drinking day per month may not sound like much, but small individual reductions can add up to a substantial reduction in population-level harms. Given their brevity, low cost, and minimal clinician effort, brief interventions may be a promising way to reduce alcohol use, one patient at a time.”
Study finds Covid-19 related parenting stress impacts eating habits of children
Researchers found that stress resulting from uncertainty about the job and financial security was associated with psychological distress, while concerns over family safety and stability led to anxiety
A new study has found that the stress experienced by parents during the Coronavirus pandemic has a negative impact the eating habits of children. The findings were published in the journal Current Psychology.
When stay-at-home mandates were ordered and the school went virtual at the onset of the pandemic, many parents suddenly had to juggle multiple roles such as caregiver, employee and educator. Leslie Frankel, associate professor of human development and family studies, said all those responsibilities took a toll on parents’ mental health, and in turn, what and how much their children were consuming.
Previous research has shown that stress, in general, is known to have a negative impact on parent-child feeding interactions, but new findings reveal COVID-19 only magnified the problem.
“These parents do not have the time, energy or emotional capacity to engage in optimal feeding behaviours, so they resort to maladaptive feeding behaviours such as using food as a reward or pressuring their kids to eat,” said Frankel, the study’s lead author and expert in parent-child relationships. “As a result, their children are not able to self-regulate what or how much food they are putting into their bodies, which could have harmful consequences in the long run.”
Frankel and study co-authors Caroline Bena Kuno, a doctoral student in the UH College of Education and UH Honors College student Ritu Sampige, surveyed 119 mothers and fathers of children ages two to seven between April and June 2020.
The researchers analysed two different types of COVID-related parenting stress and found that stress resulting from uncertainty about the job and financial security was associated with psychological distress, while concerns over family safety and stability led to anxiety. The mothers surveyed reported experiencing higher levels of stress and anxiety compared to fathers who participated in the study.
“The stress doesn’t just go away. Many parents are still feeling uneasy and a parent who is overwhelmed and experiencing symptoms of depression and anxiety may not pay attention to or acknowledge their children’s cues of hunger and fullness,” Frankel explained.
To ensure children are optimising their eating habits in the event of another public health emergency or natural disaster, the research team says policymakers or non-profit organizations interested in improving outcomes for children and parents should provide support systems to help parents manage their daily stressors.
OSTEOPOROSIS: THE SILENT DISEASE
Osteoporosis is a disorder in which the density of bone decreases, causing it to lose strength and become brittle. Osteoporosis causes unusually porous, collapsible bone, similar to that of a sponge. The skeleton is weakened by this condition, which leads to frequent fractures (breaks) in the bones. A normal bone is made up of protein, collagen, and calcium and they all contribute to its strength. Osteoporosis-affected bones can shatter (fracture) even with small traumas that would not usually cause a bone to break. Although osteoporosis-related fractures can occur in nearly every skeletal bone, they are most commonly found in the spine, hips, ribs, and wrists.
Symptoms of osteoporosis- there are no indicating symptoms hence the title ‘The Silent Disease’. But one can look out for the following indications; height loss (getting shorter by an inch or more), change in postures, asthma (smaller lung capacity due to compressed lung capacity), fractures in bones, lower- back discomfort.
Some of the factors that increase the risk of developing osteoporosis are:
1. Gender: Women have a higher chance of having osteoporosis as they have smaller bones and lower peak bone mass compared to men. Men still are at risk particularly after the age of 70.
2. Age: Bone loss accelerates as you become older, but new bone formation slows. The bones may deteriorate over time, increasing the chances of developing osteoporosis.
3. Size of the body: Slender, thin-boned women and men are more likely to develop osteoporosis than larger-boned women and men because they have less bone to lose.
4. Race: Osteoporosis is more prevalent among Caucasian and Asian women. African-American and Hispanic women, on the other hand too face this. In fact, after a hip fracture, African-American women are more likely to die than white women.
5. Genetics: Researchers have shown that if one of your parents has had an osteoporosis or hip fracture, your chance of developing osteoporosis and fractures may be increased.
6. Hormonal changes: Certain hormone deficiencies might raise your risk of getting osteoporosis. As an example: After menopause, women’s estrogen levels drop. Low estrogen levels caused by an atypical lack of monthly cycles in premenopausal women owing to hormone abnormalities or high amounts of physical exercise. Men’s testosterone levels are low. Men who have diseases that induce low testosterone are at risk for osteoporosis.
7. Diet: A diet deficient in calcium and vitamin D might raise the chances of developing osteoporosis and fractures. Excessive dieting or a lack of protein may also raise the risk of bone loss and osteoporosis.
8. Lifestyle: Low levels of physical activity and lengthy periods of inactivity can both contribute to accelerated bone loss. They also put you in poor physical shape, increasing your chances of falling and fracturing a bone. Chronic excessive alcohol use is a substantial risk factor for osteoporosis. According to research, smoking is also a risk factor for osteoporosis and fracture.
Treatment for Osteoporosis includes proper nutrition, changes in your way of life, exercise, fall avoidance is important in order to avoid fractures, medications.
DIAGNOSIS FOR OSTEOPOROSIS
Before any problems arise, your healthcare practitioner might schedule a test to provide you with information about your bone health. Dual-energy X-ray absorptiometry (DEXA or DXA) scans are other names for bone mineral density (BMD) examinations. These X-rays utilize extremely small quantities of radiation to evaluate the strength of the bones in the spine, hip, and wrist. Regular X-rays will only reveal osteoporosis if the illness has progressed significantly. Women over the age of 65 should undergo a bone density test. For women who have osteoporosis risk factors, a DEXA scan may be performed sooner. Men over the age of 70, as well as younger men with risk factors, should get a bone density test.
When you have osteoporosis, it’s critical to avoid fractures since they can lead to other medical issues. When your health care practitioner tailors a programme to your specific needs, exercise can help avoid fractures caused by falls and increase bone strength. Before beginning any fitness programme, speak with your doctor or physical therapist if you have osteoporosis or bone loss. Furthermore, avoiding falls helps to avoid fractures. Falls raise your chances of breaking a bone in your hip, wrist, spine, or other skeleton.
This author is a Lead Consultant – Orthopedics & Joints Surgery, Aster RV Hospital
RESEARCH: INTERMITTENT FASTING WORKS FOR WEIGHT LOSS, HEALTH CHANGES
According to a new study review led by University of Illinois Chicago researchers, intermittent fasting can produce clinically significant weight loss as well as improve metabolic health in individuals with obesity.
The findings of the study were published in the journal Annual Review of Nutrition. “We noted that intermittent fasting is not better than regular dieting; both produce the same amount of weight loss and similar changes in blood pressure, cholesterol and inflammation,” said Krista Varady, professor of nutrition at the UIC College of Applied Health Sciences and author of “Cardiometabolic Benefits of Intermittent Fasting.”
According to the analysis published in the Annual Review of Nutrition, all forms of fasting reviewed produced mild to moderate weight loss, 1 to 8 percent from baseline weight, which represents results that are similar to that of more traditional, calorie-restrictive diets.
Intermittent fasting regimens may also benefit health by decreasing blood pressure and insulin resistance, and in some cases, cholesterol and triglyceride levels are also lowered. Other health benefits, such as improved appetite regulation and positive changes in the gut microbiome, have also been demonstrated.
The review looked at over 25 research studies involving three types of intermittent fasting: alternate-day fasting, which typically involves a feast day alternated with a fast day where 500 calories are consumed in one meal, 5:2 diet—a modified version of alternate-day fasting that involves five feast days and two fast days per week, time-restricted eating—which confines eating to a specified number of hours per day usually four to 10 hours with no calorie restrictions during the eating period.
Various studies of time-restricted eating show participants with obesity losing an average of 3 percent of their body weight, regardless of the time of the eating window.
Studies showed alternate day fasting resulted in weight loss of 3% to 8% of body weight over three to eight weeks, with results peaking at 12 weeks. Individuals on alternate day fasting typically do not overeat or binge on feast days, which results in mild to moderate weight loss, according to the review.
Studies for the 5:2 diet showed similar results to alternate-day fasting, which surprised the study’s reviewers. The subjects who participate in the 5:2 diet fast much less frequently than alternate-day fasting participants do, but the results of weight loss results are similar.
Weight loss in both the alternate day and 5:2 fasting are comparable to more traditional daily calorie-restrictive diets. And, both fasting diets showed individuals were able to maintain an average of 7% weight loss for a year.
“You’re fooling your body into eating a little bit less and that’s why people are losing weight,” Varady said.
Varady added the review set out to debunk some myths regarding intermittent fasting. Intermittent fasting does not negatively affect metabolism, nor does it cause disordered eating, according to the studies reviewed.
“Fasting people are worried about feeling lethargic and not being able to concentrate. Even though you are not eating, it won’t affect your energy,” Varady said. “A lot of people experience a boost of energy on fasting days. Don’t worry, you won’t feel crappy. You may even feel better.”
The study review includes a summary of practical considerations for those who may want to try intermittent fasting. Among the considerations are:
Adjustment time—side effects such as headaches, dizziness, and constipation subside after one to two weeks of fasting. Increased water intake can help alleviate headaches caused by dehydration during this time.
Exercise—moderate to high-intensity endurance or resistance training during food abstention can be done, and some study participants reported having more energy on fast days. However, studies recommend those following alternate day fasting eat their fasting day meal after exercise.
Diet during fasting—there are no specific recommendations for food consumption during intermittent fasting, but eating fruits, vegetables, and whole grains can help boost fibre intake and help relieve constipation that sometimes accompanies fasting.
Alcohol and caffeine—for those using an alternate day or 5:2 fasting plan, alcohol is not recommended on fast days as the limited calories should be used on healthy foods that provide nutrition.
There are several groups who should not intermittent fast, according to the studies. Those individuals include: those who are pregnant or lactating, children who are under 12, those with a history of disordered eating, those with a body mass index, or BMI, less than 18.5, shift workers—studies have shown they may struggle with fasting regimens because of shifting work schedules, and those who need to take the medication with food at regimented times.
“People love intermittent fasting because it’s easy. People need to find diets that they can stick to long term. It’s definitely effective for weight loss and it’s gained popularity because there are no special foods or apps necessary. You can also combine it with other diets, like Keto,” Varady said.
It’s definitely effective for weight loss and it has gained popularity because there are no special foods or apps necessary. You can also combine it with other diets, like Keto.
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