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We have to watch out for mutations of the virus: Dr Shahid Jameel

Virologist Dr Shahid Jameel discusses the parameters for an effective vaccine against the coronavirus pandemic and how to prepare for a large-scale vaccination drive.

Shalini Bhardwaj



In an exclusive Interview with The Daily Guardian, Dr Shahid Jameel, Virologist and Director of Trivedi School of Biosciences at Ashoka University, talks about how to judge the efficacy of a Covid-19 vaccine, how India needs to plan for the vaccination drive and whether the novel coronavirus is likely to mutate in the near future. Excerpts:

Q. What would you say about the companies claiming the efficacy of their vaccines only through press releases?

A. Press releases are quick ways for companies to make their achievements public, but they are geared more towards shareholders and financial markets. A factual position can only be judged when the scientific details of a trial are published in a peer-reviewed publication. We should wait for those. At this time, the percentage of efficacy is not important and should not be used to compare different vaccines. All this means is that vaccines based on the viral spike protein will work to protect against disease, and sometimes against infection as well.

Q. What kind of a vaccine should be given to the people?

A. A vaccine that has been proven to be safe and has good efficacy. This is the reason why human clinical trials are done in stages – Phase 1 for safety in small numbers of volunteers; Phase 2 for safety and immunogenicity in larger numbers of volunteers; and Phase 3 for safety and efficacy in very large numbers of volunteers with gender, racial and age diversity.

Q. How much efficacy should that vaccine have before being approved for people?

A. It depends upon how infectious a virus is. In this case, the WHO and US FDA have set a benchmark of 70% efficacy before a vaccine candidate will be considered for approval.

Q. Why have there been errors with the AstraZeneca vaccine?

A. I cannot answer that. All I know is what the company has said. Errors happen, but what is important is how transparently they are addressed. I am sure the regulators in all countries that want to license this vaccine will look at the data very carefully.

Q. How does India need to plan ahead for successful vaccination?

A. India’s plan should include the following. Firstly, who should get the vaccine first? The primary aim should be to use the vaccine to protect frontline workers (healthcare, sanitation, essential services), reduce mortality (elderly and those with comorbidities) and control the pandemic.

Secondly, to work out the storage-transfer-delivery logistics down to the last detail. India has a lot of experience with the polio vaccine but that was an oral vaccine not an injectable one. India also has a lot of experience with childhood and maternal vaccines, but we have never delivered such large amounts of a vaccine during a pandemic.

Thirdly, the current capacity is to deliver 1.5 million doses per month, or 18 million doses per year. The Health Minister stated that 250 million Indians would be vaccinated in 2021. That means 500 million doses. At current staff strength, it would take more than two years. Therefore, we must increase trained staff.

Fourthly, should we vaccinate those in high priority groups (e.g. healthcare workers) who have already been infected? This would make little sense and waste precious doses. If we decide not to, then there should be an inexpensive test to find out those who already have antibodies. Today the test costs as much as one vaccine dose. That cost has to be factored in.

Lastly, make the plan available for public scrutiny and comment. This will increase trust in the vaccination programme.

Q. What are the parameters which need to be considered for emergency approval of vaccines?

A. Emergency Use Approval looks primarily at safety in large and diverse populations and also a reasonable level of efficacy.

Q. For how long will these vaccines work?

A. We don’t know the answer to this simply because vaccine trial follow-ups have not been done for long enough. Extrapolating from natural infection, neutralising antibodies wane off in about six months, but that does not mean loss of protection since there are T cells and memory recall responses. Even natural infection has not been followed long enough after recovery to fully answer this question. But, going by other endemic coronaviruses, protection may last up to a year or more.

Q. Do you think this virus can mutate? If it does, what is likely to happen?

A. Every virus mutates and so does this one. RNA viruses mutate faster than DNA viruses. However, compared to other RNA viruses, coronaviruses have the lowest rate of mutation. With over 224,000 SARS-CoV2 genomes sequenced by now, mutations in the spike protein neutralizing domain have not been seen. So, that’s good from the vaccine perspective. But this region has no selection pressure on it to change. Once vaccines are deployed in a big way, such mutations will arise. We would have to watch out for that.

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Medically Speaking




If you are one of those people who can’t start their day without a cup of hot coffee, we have some good news for you. New research has found that drinking higher amounts of coffee can make you less likely to develop Alzheimer’s disease.

The findings of this research were published in the ‘Frontiers in Aging Neuroscience Journal’. As part of the Australian Imaging, Biomarkers and Lifestyle Study of Ageing, researchers from Edith Cowan University (ECU) investigated whether coffee intake affected the rate of cognitive decline of more than 200 Australians over a decade.

Lead investigator Dr Samantha Gardener said that the results showed an association between coffee and several important markers related to Alzheimer’s disease.

“We found participants with no memory impairments and with higher coffee consumption at the start of the study had a lower risk of transitioning to mild cognitive impairment – which often precedes Alzheimer’s disease – or developing Alzheimer’s disease over the course of the study,” she said.

Drinking more coffee gave positive results in relation to certain domains of cognitive function, specifically executive function which includes planning, self-control, and attention.

Higher coffee intake also seemed to be linked to slowing the accumulation of the amyloid protein in the brain, a key factor in the development of Alzheimer’s disease.

Dr Gardener said that although further research was needed, the study was encouraging as it indicated drinking coffee could be an easy way to help delay the onset of Alzheimer’s disease.

“It’s a simple thing that people can change,” she said.

It could be particularly useful for people who are at risk of cognitive decline but haven’t developed any symptoms.

“We might be able to develop some clear guidelines people can follow in middle age and hopefully it could then have a lasting effect,” she said.

If you only have allowed yourself one cup of coffee a day, the study indicated you might be better off treating yourself to an extra cup, although a maximum number of cups per day that provided a beneficial effect was not able to be established from the current study.

“If the average cup of coffee made at home is 240g, increasing to two cups a day could potentially lower cognitive decline by eight per cent after 18 months,” Dr Gardener said.“It could also see a five per cent decrease in amyloid accumulation in the brain over the same time period,” she added.

In Alzheimer’s disease, the amyloid clump together forming plaques that are toxic to the brain.

The study was unable to differentiate between caffeinated and decaffeinated coffee, nor the benefits or consequences of how it was prepared (brewing method, the presence of milk and/or sugar etc).

Dr Gardener said that the relationship between coffee and brain function was worth pursuing.“We need to evaluate whether coffee intake could one day be recommended as a lifestyle factor aimed at delaying the onset of Alzheimer’s disease,” she said.

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Pairing fasting with exercise can boost health outcomes



A new study has found that exercising intensely at the start of a fast may help maximise the health benefits of temporarily foregoing food.

The findings of the study were published in the journal ‘Medicine & Science in Sports & Exercise’. “We really wanted to see if we could change the metabolism during the fast through exercise, especially how quickly the body enters ketosis and makes ketones,” said BYU PhD student Landon Deru, who helped design the study for his thesis.

Ketosis occurs when the body runs out of glucose — its first, preferred fuel — and begins breaking down stored fat for energy, producing chemicals called ketones as a byproduct. In addition to being a healthy energy source for the brain and heart, ketones combat diseases like diabetes, cancer, Parkinson’s and Alzheimer’s.

For the study, the researchers asked 20 healthy adults to complete two 36-hour fasts while staying hydrated. Each fast began after a standardised meal, the first fast starting without exercise and the other with a challenging treadmill workout. Every two hours while awake, the subjects completed hunger and mood assessments and recorded their levels of B-hydroxybutyrate (BHB), a ketone-like chemical.

Exercise made a big difference: when participants exercised, they reached ketosis on average three and a half hours earlier in the fast and produced 43 per cent more BHB. The theory is that the initial exercise burns through a substantial amount of the body’s glucose, prompting a quicker transition to ketosis. Without exercise, the participants hit ketosis about 20 to 24 hours into the fast.

“For me, the toughest time for fasting is that period between 20 and 24 hours, so if I can do something to stop fasting before 24 hours and get the same health outcomes, that’s beneficial. Or if I do fast for my usual 24 hours but start with exercise, I’ll get even more benefits,” said study co-author Bruce Bailey, a BYU exercise science professor.

There are a few caveats to the proposed strategy, however.

“If you carb load or eat a huge meal before you fast, you may not reach ketosis for days, even if you do exercise, so you should eat moderately before fasting,” Bailey said.

“We also don’t know the ideal frequency for fasting. There are definitely certain people who shouldn’t fast, such as those with Type 1 diabetes, and obviously, it’s detrimental to fast 24/7. But for most people it’s perfectly safe and healthy to fast once or even twice a week for 24 or more hours,” Bailey added.

The study, which required participants to run on a treadmill for an average of 45 to 50 minutes, also didn’t establish an ideal amount or type of exercise for every person. Overall, though, the researchers believe the more energy a person can burn, the better.

“You can get a pretty good estimation of how many calories you’re burning in most exercises, and the more carbohydrates you burn off (without overdoing it or injuring yourself), the better you set the stage for starting ketosis early in your fast,” Deru said.

Also important to note is that, according to the participants’ reports, exercise didn’t seem to aggravate hunger or affect moods during the fast.

“Everyone’s going to be a little grumpier when they fast, but we found that you aren’t going to feel worse with the intervention of exercise — with exercise, you can get these extra benefits and be the exact same amount of grumpy as you would be if you didn’t exercise,” concluded Deru.

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Managing and controlling chronic obstructive pulmonary disease (COPD) is always important, and especially given the pandemic in the backdrop individuals living with a chronic lung disease are at a higher risk of severe illness and complications from COVID-19. However, misinformation about COVID-19 has made it hard for people with chronic conditions to determine how to stay safe.

Here is what you should know. Patients with COPD are highly susceptible from respiratory exacerbations from viral respiratory tract infections. So, when the COVID pandemic took us by storm, these patients were said to be more at risk of COVID-19 pneumonia or COVID-19-related mortality. However, with the more than 20 months into the pandemic, researchers are yet to establish the adverse COVID-19 outcomes in COPD patients. Having said that, in our clinical experience, a diagnosis of COPD significantly increases the odds in patients with COVID. Therefore, it is important for all COPD patients be considered a high-risk group and advised preventative measures and aggressive treatment for COVID-19 including vaccination.

There are a few things you can do. The best way to avoid illness, regardless of age or health status, is avoiding exposure to the virus. This becomes even pressing for individuals living with COPD. Stringent adherence to the safety precautions is vital. This means staying home as much as possible and avoiding potential exposure to the virus. When in public, maintain social distance of at least six feet from people and wear a N-95 mask. Also, wash your hands often and clean, then disinfect frequently touched surfaces.

Also, vaccination is key. Vaccines are developed to help a person’s immune system recognize and protect the body against certain infections. Vaccination can help in building immunity and in controlling severe disease if infected with COVID. Apart from this, continue controller medications for COPD to maintain lung health. Don’t delay important visits or ignore flare-ups or new symptoms. COPD complications can become serious if left untreated. Moreover, taking medication correctly is a major component in successfully controlling chronic lung diseases. Nebulized therapy continues to be a safe and effective way to take inhaled medications at home during the pandemic.

Above all, eating a healthy diet and drinking plenty of water can also help to support the body and remove excess mucus from the lungs. Add more Vitamin C and adequate proteins to your diet, along with moderate exercise as tolerated. Avoid crowded places and don’t forget to wear a mask while venturing out. Remember, if you develop symptoms of COVID-19, call your doctor who will advise what to do.

The author is a consultant-Pulmonologist & Sleep Medicine Expert, Hiranandani Hospital, Vashi-A Fortis Network Hospital.

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How often do you feel lethargic or feel exhausted? Can you barely make it up the stairs without getting winded even though you’re physically fit? If so, you might be lacking in iron.

Although many people don’t think of iron as being a nutrient, but it is an extremely important mineral for our body. Iron helps to transport oxygen throughout our body. It is an important component of hemoglobin, the substance in red blood cells that carries oxygen from your lungs to transport it throughout your body. Hemoglobin represents about two-thirds of the body’s iron. If you don’t have enough iron, your body can’t make enough healthy oxygen-carrying red blood cells. A lack of red blood cells is called iron deficiency anemia.


Iron deficiency that results in anemia has been a major public health burden in India. The incidence of anemia is as much as 53.2 percent among women and 21.7% among men. Iron deficiency occurs when the body lacks adequate iron, which is essential to make haemoglobin, the protein in red blood cells enabling them to transfer oxygen around the body. Without enough oxygen in your blood, you may feel tired, weak, and experience shortness of breath. Your doctor will find out why your iron is low. Usually, you can treat iron deficiency anemia with supplements. Once your iron levels go up, you should start to feel better.

Some symptoms include: Fatigue or weakness; pale or yellow skin; hortness of breath; dizziness or lightheadedness; headaches; fast or irregular heartbeat; chest pain; cold feet and hands; brittle, cracked nails, spoon-shaped nails, hair loss, cracks near the side of your mouth, Pica (cravings for things that aren’t food, like dirt, starch, clay, or ice); sore and swollen tongue and restless legs syndrome (an urge to move your legs while you’re in bed)

How Much Iron Do You Need?

This depends on your age, gender, and overall health. Infants and toddlers need more iron than adults, in general, because their bodies are growing so quickly. In childhood, boys and girls need the same amount of iron — 10 milligrams daily from ages 4 to 8, and 8 mg daily from ages 9 to 13.

Women need more iron because they lose blood each month during their period. That’s why women from ages 19 to 50 need to get 18 mg of iron each day, while men the same age can get away with just 8 mg.

Moreover, you might need more iron, either from dietary sources or from an iron supplement, if you: are pregnant or breastfeeding; have kidney failure (especially if you are undergoing dialysis, which can remove iron from the body) have an ulcer, which can cause blood loss; have a gastrointestinal disorder that prevents your body from absorbing iron normally (such as celiac disease, Crohn’s disease, or ulcerative colitis); take too many antacids, which can prevent your body from absorbing iron; have had weight loss (bariatric) surgery; work out a lot (intense exercise can destroy red blood cells)

If you are a vegetarian or vegan, you may also need to take an iron supplement, because the body doesn’t absorb the type of iron found in plants as well as it absorbs the iron from meat.


You can easily supplement your child’s Iron needs through diet by including the below-mentioned food items: various kinds of meat like beef, lamb, pork, liver, chicken, turkey; legumes like chickpeas, lentils, dried peas, beans; vegetables like spinach, green peas, broccoli, brussel sprouts. Other food items such as Eggs, Fish, Grains and Cereals

By ensuring that children, women, and all adults consume Iron-rich food, you can guarantee healthy and normal growth.

The author is the Director of Haematology & BMT Dept., Fortis Hospital Mulund

Iron deficiency that results in anemia has been a major public health burden in India. The incidence of anemia is as much as 53.2 percent among women and 21.7% among men. Iron deficiency occurs when the body lacks adequate iron, which is essential to make haemoglobin, the protein in red blood cells enabling them to transfer oxygen around the body.

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According to a study, professional rugby players are more likely to show signs of poor mental health, such as depression and anxiety compared to amateur ones and non-contact athletes.

The research has been published in the journal ‘Sports Medicine’. The retired elite rugby players in the study suffered more concussions during their playing days than those in other groups and the researchers said this could be linked to their poor mental health later in life.

Players who had suffered five or more concussions were almost twice as likely to report signs of depression, anxiety and irritability compared with players with fewer concussions. These players were also more likely to struggle with feelings of covert anger.

Signs of depression and irritability were also more common in the rugby players who had suffered three or more concussions in their playing career. One in two players with three or more concussions experienced these signs of poor mental health compared to one in three players who had suffered less than three concussions.

The retired elite rugby union and league players, who all played in the UK, were compared to amateur rugby players and non-contact athletes, such as cricketers and runners. The scientists said further research is needed to explore if there is a direct neurobiological connection between repeated concussions and longer-term psychological health and to investigate any possible links with the development of neurodegenerative disease. Lead author, Dr Karen Hind from the Department of Sport and Exercise Sciences, at Durham University, said, “Our study shows that elite level rugby players disclosed more adverse mental health issues following retirement from the sport, compared to those who had played amateur level rugby, or a non-contact sport. This was particularly the case for those players who had experienced three or more concussions.”

There were no differences in alcohol scores between the retired sports groups or in relation to concussion history. However, the study did find that the former professional rugby players were more likely (1.8 to 2.9 times more likely) to suffer from sleep disruption compared to the amateur rugby players and non-contact athletes.

One in five former elite rugby players said they would not seek help from anyone if they had a problem or were upset.

The researchers acknowledged that forced retirement due to injury also played a part in players’ well-being post-retirement.

They also stressed that while this study does not conclude cause and effect; the findings are important for player welfare and added to a growing body of evidence on the impact of repeated concussions.

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According to research at UC San Francisco, it was found out that while the common heart condition is triggered by caffeine, sleep deprivation and sleeping on the left side, alcohol is the only one that was associated with heart arrhythmia (improper beating of the heart, whether irregular, too fast or too slow).

The study has been published in the ‘JAMA Cardiology Journal’. The authors concluded that people might be able to reduce their risk of atrial fibrillation (AF) by avoiding certain triggers.

Researchers were surprised to find that although most of the things that participants thought would be related to their AF were not, those in the intervention group still experienced less arrhythmia than the people in a comparison group that was not self-monitoring.

“This suggests that those personalized assessments revealed actionable results,” said lead author Gregory Marcus, MD, professor of medicine in the Division of Cardiology at UCSF.

“Although caffeine was the most commonly selected trigger for testing, we found no evidence of a near-term relationship between caffeine consumption and atrial fibrillation. In contrast, alcohol consumption most consistently exhibited heightened risks of atrial fibrillation,” he added.

Atrial fibrillation contributed to more than 150,000 deaths in the United States each year, reported the federal Centers for Disease Control and Prevention, with the death rate on the rise for more than 20 years.

To learn more about what patients felt was especially important to study about the disease, researchers held a brainstorming session in 2014. Patients said researching individual triggers for AF was their top priority, giving rise to the I-STOP-AFib study, which enabled individuals to test any presumed AF trigger. About 450 people participated, more than half of whom (58 per cent) were men, and the overwhelming majority of who were white (92 per cent).

Participants in the randomized clinical trial utilized a mobile electrocardiogram recording device along with a phone app to log potential triggers like drinking alcohol and caffeine, sleeping on the left side or not getting enough sleep, eating a large meal, a cold drink, or sticking to a particular diet, engaging in exercise, or anything else they thought was relevant to their AF.

Although participants were most likely to select caffeine as a trigger, there was no association with AF. Recent research from UCSF has similarly failed to demonstrate a relationship between caffeine and arrhythmias — on the contrary, investigators found it may have a protective effect.

The new study demonstrated that consumption of alcohol was the only trigger that consistently resulted in significantly more self-reported AF episodes.

The individualized testing method, known as n-of-1, did not validate participant-selected triggers for AF. But trial participants did report fewer AF episodes than those in the control group, and the data suggest that behaviours like avoiding alcohol could lessen the chances of having an AF episode.

“This completely remote, siteless, mobile-app based study will hopefully pave the way for many investigators and patients to conduct similar personalized “n-of-1” experiments that can provide clinically relevant information specific to the individual,” said Marcus.

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