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The ‘double mutant’ variant of coronavirus is likely to trigger an ‘intense second wave’. It is estimated that this mutated Covid variant is over 50% more transmissible and 60% more lethal.

Dr Vishal Rao



The biggest challenge of the Covid-19 resurgence has been the emergence of new virus variants across the globe. In the fall of 2020, the United Kingdom (UK) identified a fast-spreading variant called B.1.1.7 or VOC-20DEC-01 which has since been detected in many countries around the world. Experts believe it may potentially carry an increased risk of death compared to other variants. In South Africa, another variant called B.1.351 or VOC-20DEC-02, detected in early October 2020, shares some mutations with B.1.1.7. cases of this variant were reported in the US at the end of January 2021. In Brazil, a variant called P.1 or VUI-21JAN-01 was identified during routine screening at a Japanese airport in early January. This variant contains a set of additional mutations that may be able to escape natural antibodies. It was first detected in the US at the end of January 2021.


The Indian government in recent times announced a new coronavirus variant detected amid a new surge of Covid-19 cases across several states. This is a unique “double mutant” coronavirus variant with a combination of mutations not found anywhere in the world. However, it is still to be established if it increases infectivity or severity of Covid-19. Genome sequencing of a section of virus samples by a consortium of 10 labs across the country, called the Indian SARS-CoV-2 Consortium on Genomics (INSACOG), revealed two mutations, E484Q and L452R together, in at least 200 virus samples from Maharashtra, as well as a handful in Delhi, Punjab and Gujarat. 

Mutations in the virus per se are not surprising, but specific mutations that either help the virus evolve to thwart vaccines or the immune system or are linked to a spike in cases or disease severity, are a cause for concern. While the two mutations have been individually identified in other variants of SARS-CoV-2 globally and have been associated with a reduction in vaccine efficacy and infectivity, their combined effect and biological implication has not yet been fully comprehended. In the days ahead, the INSACOG will submit details of this variant to a global repository called GISAID and classify it as a ‘Variant of Concern’ (VOC) if required.

It is important to note that the ‘double mutant’ variant is likely to trigger an ‘intense second wave’. It is estimated that the virus is over 50% more transmissible and 60% more lethal, i.e., 1.6 deaths for every one death caused by the previous version of the virus.


We do not have any Genetic Surveillance system operational in India but it is undoubtedly the need of the hour. Whole viral genome sequencing allows for a better understanding of the virus transmission, including the knowledge of whether it is mutating and becoming a larger threat. In addition, genomics can help explain why people respond to Covid-19 in different ways, thereby helping us better protect those at greater risk. 

There is hence an acute need for employing genomics to help public health bodies respond faster to emerging outbreaks. Towards this effect, COG-UK and the Sanger Institute have raised 12.2 M pounds from the Testing Innovation Fund of the Department of Health and Social Care for creating a real-time surveillance system of emerging outbreaks. This system will be supported by new software being developed by the Sanger Institute and involving researchers from across the consortium’s network. Instead of relying on epidemiological exceedance, which “often requires a large number of cases to detect” outbreaks, genomics can help identify and respond to large clusters in an efficient and timely manner. For example, genome sequencing can show there are five identical SARS-CoV-2 viruses within one workplace on the same day, thereby suggesting the extent and severity of Covid-19 transmission happening in that workplace. If we didn’t have genomics we might know we had five cases, but we wouldn’t know if they were related and constituted an outbreak. It is possible that all five cases could be different, implying that they would have separate sources and do not represent a cluster. 

For a real-time surveillance system to be effective, the process of genomics sequencing would have to be expedited, which is what the COG-UK, the Sanger Institute and the consortium’s researchers are working on currently. The Department for Health and Social Care Testing Innovation Fund has backed the Welcome Sanger Institute and the Covid-19 Genomics UK (COG-UK) Consortium in expanding whole genome sequencing of positive SARS-CoV-2 virus samples to map the spread and evolution of CovidD-19. 

Notably, the 12.2M pounds funding will facilitate Sanger Institute to build a national real-time genomic surveillance system of Covid-19 by covering the cost of Whole Genome Analysis (WGA). The cost for WGA per sample in INR terms is Rs. 35000 + GST for 10X coverage and Rs 75000+GST for 30X coverage. 

A similar initiative must be spearheaded in India, that of establishing a Genetic Surveillance system to identify the ‘double mutant’ variant and protect the population from the greater risk of infection severity and mortality. 

The writer is Regional Director – Head & Neck Surgical Oncology and Robotic Surgery, Associate Dean – Academics, HCG Cancer Hospital, Bengaluru.

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Health & Wellness




Remote working that started as an effective solution to avert the pandemic’s rising cases, has now transformed into an entire workforce transition. Working on a presentation in comfortable clothes within the confines of home, no commute, and increased family time, the joy of remote working is limitless. However, working from home can also have some grave effects on one’s mental wellbeing. While some employees did attune well to the drastically altered business environment, others did find it challenging to prepare for this enormous transformation to their work-life balance. Functioning remotely has been even more stressful for leaders and managers, who had to acclimatise quickly to upholding a remote-working team. It is hard to adjust to novel ways of working, think tactically, and encourage people when you are feeling overwhelmed yourself. Trying to cope with these challenges can increase the risk of burnout, loneliness, and anxiety build-up.

Burnout has been hitting an all-time high with more than two-thirds of employees experiencing remote working burnout symptoms. This incursion has been affecting the overall well-being of the workforce. Burnout cannot be limited to simply being fatigued from your job, instead, prolonged exhaustion is known to cause a host of physical and mental conditions like high blood pressure, obesity, a low immune system, anxiety, depression, and in some cases cognitive decline. Alongside distant work, which socially detaches people, feeling isolated and depressed are additional components that also need to be considered. 

Below mentioned are a few strategies to nip remote-work burnout and the related isolation and anxiety in the bud before it gets too bad:

Never miss out on taking short breaks during working hours: To stay motivated and productive on task, make sure you freshen up your day with timely breaks. Get up from your chair, indulge in healthy snacking, sip onto teas or coffees, stretch when you start to feel cramped, or simply take a walk inside your home. A five-minute break every half an hour will give your mind some rest.

Setting realistic deadlines and sticking to them: Remember, the flexibility of working from home does not imply that you can start slacking off. It is necessary to set deadlines and work in a deliberate way to meet them. If you are unable to do this, it’s clear that you would end up working beyond regular working hours, increasing your possibility of potential burnout. At the same time, it is important to communicate if you feel you are burdened with work and under pressure. 

Communicate with colleagues regularly: Working in a closed home-office set-up, with no co-workers can make people feel lonely, particularly the outgoing ones who thrive on social interactions. However, work from home does not imply you must stop interacting with your colleagues, managers, and bosses. Stay in touch with your teammates through messaging, scheduling video calls, or simply by making a phone call. Discussing work, indulging in casual conversation, or cracking jokes will ease your stress and will help to avoid burnout.

Enjoy family time: For any remote worker it is important to disconnect from work at the end of the day and dedicate time to your loved ones. Live, laugh, love, to witness the wonders it can create for your morale and emotional and holistic well-being.

Dedicate time to mindfulness: It is crucial to dedicate time to mindful practices like meditation, yoga, or even napping. For instance, sitting in a quiet spot with your eyes shut for two minutes can be an exceptional way to relax your mind, evade stress, lower anxiety levels and temporarily turn off from work.

Striking the appropriate balance between work and personal life holds the key to how well you manage to tackle the challenges of burnout while working remotely. 

The writer is Mental & Emotional Wellbeing Coach & Founder – Let Us Talk.

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Health & Wellness


Dr Vishal Rao



Head and Neck cancers comprise nearly 30% of the overall cancer incidence in India, which is roughly about 10 lac cases per year. In other words, one out of every three cancers pertains to the head and neck region.

In the 70s and 80s, surgery was the main way of approaching every single subsite in head and neck cancers. As we moved closer towards the 21st century, there was a growing aversion for mutilating, cosmetically disfiguring, or functionally debilitating surgeries which triggered a trend in favour of chemoradiation, which delivered results on the back of an evidence-based approach.

A few years back, an incisive study found improved outcomes in key cancer types except the cases of laryngeal cancer. The study concluded that this adverse outcome was the result of indiscriminate use of chemoradiation and the expanded use of the non-surgical organ preservation approach. This prompted an ethical debate centred around the futility of organ preservation which is devoid of organ functionality. Any restoration is rendered deficient if not fruitless if the patient is ruthlessly deprived of functionality. Quality of life is as much about restoring the patients’ capabilities to earn livelihood and social respect as about saving their lives and vital organs.

Consequently, a paradigm shift ensued in favour of surgical organ preservation, which has two key weapons as the armamentarium: Laser and robotics. Both have brought down cancer to a level of daycare service. Laser technology has immensely helped in the treatment of early-stage laryngeal cancers where a patient is admitted in the morning, successfully cured, and discharged in the evening. Oncological clearance is hereby achieved without compromising on organ functionality.

In the case of advanced-stage cancers, robotics has dramatically improved outcomes. Surgeons have small eyes and big hands, while the robot has small hands and big eyes. That is the game-changer that helps the surgeon probe deeper into hitherto inaccessible areas with raccoon-like vision and precision. Technology has made the representation of reality way more interesting than the reality itself. Robots have taken site location, visualisation and human error mitigation to a whole new level. The haptic sensory feedback has made surgery discernibly fulfilling for the surgeon; it does not appear like a remote mechanism. It is an experience as intimate as what ensues through the use of human hands.

A catapulting effect has occurred in the last ten years through the bridging of technological advances with biological advances. Training is integral to this big leap. From medical school to practice, any new therapeutic procedures or breakthrough technologies tend to bring down surgical proficiencies unless they are consciously upped through continual training programs.

Robotics and lasers have an aspect of gamification and sophisticated technology that can be learnt and mastered with significantly shorter learning curves through standardised training programs. There is an acute need for bridging technological advances with biological advances. The game-changing technologies for the next decade include digital diagnostics, IoT and cloud, Ultra-fast scans, wearables, blockchain, digital therapies, Big Data, Nano Health, AI Health, Hackathons, System Learning and Robotics. And they will not work in isolation, but holistically based on purposeful crosstalk between them.

The writer is Regional Director – Head & Neck Surgical Oncology and Robotic Surgery, HCG Cancer Hospital Bengaluru.

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Health & Wellness


There have been tremendous advancements in the detection, management, and treatment of breast cancer, misinformation and misconceptions are everywhere, so it’s important to break those myths and know the facts.

Sudip Bagchi



According to the latest statistics from the WHO, 2.3 million women were diagnosed with breast cancer in 2020. Also, it is estimated that breast cancer is impacting over 2 million women each year. October is observed as Breast Cancer Awareness Month to raise awareness about the impact of breast cancer. While the occurrence of breast cancer rates is higher in developed regions of the world, trends reveal an upward trajectory in breast cancer rates in developing and underdeveloped geographies. However, there have been tremendous advancements in the detection, management, and treatment of breast cancer, misinformation and misconceptions are everywhere, so it’s important to break those myths and know the facts. 

MYTH: People with no family history of breast cancer, don’t get it. 

FACT: Family history of cancer may be important while determining the chances of breast cancer, however, breast cancer does occur in people with no family history of cancer.

It is a common belief that breast cancer is an inherited disease. However, it has been observed that only about 5% to 10% of breast cancers are hereditary. A vast majority of people who have breast cancer have no family history which is indicative of the fact that there are various factors as well, that contributes towards the development of breast malignancies. With increasing old, healthy breast cells can develop mutations on their own, finally developing into cancerous cells.

However, if someone in the family has breast cancer, it is an important risk factor that must be taken into account while screening for breast cancer. 

MYTH: Breast cancer affects only older women.

FACT: Younger women too can develop breast cancer, even men.

Although breast cancer is prevalent among women over the age of 50. It can, in fact, occur at any age and occur in men too, although it is extremely rare, it does happen. Males also contain breast tissue and if they experienced any growth or lump-like appearance in their chest area they must consult with a medical expert.

MYTH: Healthy weight, nutritious diet, regular exercise, and limiting alcohol can keep breast cancer at bay.

FACT: Although these behaviours can help lower breast cancer risk, they can’t completely eliminate it.

Factors responsible for breast cancer are outside our control and are nowhere related to a healthy lifestyle or diet. Although evidence exists that a healthy lifestyle encompassing a nutritious diet, regular exercise, and limited alcohol intake can help reduce breast cancer risk, they really don’t guarantee freedom from breast cancer. Sometimes after doing everything right people often succumb to breast cancer.

MYTH: Breast cancer always causes a lump you can feel.

FACT: Breast cancer might not cause a lump, especially when it first develops.

Most people believe that breast cancer always causes a lump or a tumour that can be felt during a breast self-examination. However, breast cancer does not necessarily, always cause a lump or perceivable clustering of tissues when in the initial stages. Sometimes cancer may affect the lymph nodes of the breast and cannot be felt in the form of lumps. 

Also, it must be clearly understood that any lump be it smooth or hard, movable or fixed, that can be felt through the skin needs to be checked out by a healthcare professional. Most of the lumps are benign (not cancerous), however, there is always a possibility that breast cancer may strike.

MYTH: Self breast examination is sufficient to find breast cancer early.

FACT: Although self breast examination is an important way to monitor changes in the breast, Mammography is the best early-detection tool that is available currently.

Breast self-examination is good practice to monitor changes in the breast, however, for women above the age of 40, it is highly recommended to get annual mammography screening done so as to detect cancer early when it is still within the duct which is called DCIS (Ductal Carcinoma In Situ). 

Usually on mammograms DCIS if detected it looks like a small cluster of calcifications with irregular shapes and sizes. Digital mammography systems enable the identification of micro-calcifications with high-quality images and hence improve the chances of early detection of breast cancer. But it’s important to pay attention to any changes in breasts by performing monthly breast self-exams and have a physical examination of your breasts by a health professional every year.

MYTH: Breast cancer cannot be treated.

FACT: Metastatic breast cancer can’t be cured, but it can be treated.

How the body performs with metastatic cancer relies on various factors including age, health, other conditions, and access to medical care. But about one-third of the people with this diagnosis have lived with it for a considerable duration of time. Various methods like radiation, chemotherapy, surgery, etc. are recommended based on the severity of cancer. 

The writer is President – Imaging and CLSS, Trivitron Healthcare.

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Health & Wellness


Hemant Sapra



The pandemic is not over yet and global experts predict the upcoming third wave to be more dangerous. The breakthrough we achieved by developing the vaccines of high efficacy certainly brings hope and optimism. Unfortunately, for everyone to get vaccinated and gain complete immunity against the Covid-19 would take a long time. So, let us not be complacent during this critical stage. Now, it is a crucial time to increase vigilance and to adhere to the safety measures without any lapse.


According to healthcare experts, the third wave of Covid-19 may hit India by the end of this year. The previous waves have renewed the panic amongst people, making them think harder on how to keep themselves safe from the virus. It is widely proven that selecting and proper using of right PPE can prevent you from the third wave of Covid-19 and even upcoming waves. So, wearing protective gear such as a face mask, face shield, gloves, kits etc., can protect you and those around you, even if you are fully vaccinated.

Stopping the spread starts with taking the right steps. As responsible manufacturers of personal protective equipment, it is our duty to provide the most accurate information to educate users with the right tools of safety.


Your face mask not only protects you but also helps protect those around you. One of the biggest challenges faced by users today is the quest to find the right mask.

Let us begin by understanding the difference between cotton masks, surgical masks and N95/FFP2 respirators. A cotton mask is a loose-fitted mask that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. A surgical mask is a 3-ply mask meant to be used by medical personnel during procedures. N95 or FFP2 respirators, on the other hand, are personal protective equipment that protects the wearer from airborne particles and aerosols from entering the respiratory system.

The first step in selecting the right face mask for any user is to look for the correct certification on its packaging. In India, ISI Marked FFP2 certification is the most important to look out for. N95 is an American Certification provided by NIOSH (certifying body based in the USA) which is the equivalent to the ISI FFP2 standard. Both these certifications claim 94/95% filtering efficiency, which is most suited for protection against coronavirus.

The next important criterion is the mask should completely seal the mouth and nose to prevent any air leakage. The nose clip should be flexible enough to take the shape of the nose and you should be able to breathe properly.

An N95 or FFP2 Mask is recommended to be used for 12 cumulative hours. The mask can be reused multiple times until 12 hours of usage is achieved. After use, it should be properly disposed-off in a closed bin by tearing off its loops or headband to prevent reuse. Please refrain from washing the mask as it destroys the filtering fabric thereby making it ineffective against coronavirus.

Face masks when used in combination with other personal protective gears, can provide the most effective protection from any of the waves of Covid-19.


We need to emphasise and promote practising safety protocols including social distancing, maintaining hand hygiene and wearing face masks even after getting vaccinated. Pandemic or not, face masks are here to stay and should consciously be made a part of our lives for the good health and safety of our loved ones.

Many started considering the third wave lightly and started showing utter disregard for the precautionary measures. Considering the speed of spread, we should not forget that the only way out is to obey the rules and wear the right certified PPEs. And most importantly, get vaccinated at the earliest since it reduces the possible complications in case you contract the virus. Encourage your friend and family also to take the vaccines without delay and to continue following the safety measure.

The writer is Co-founder and President, Global Marketing at KARAM Group and President of Safety Appliances Manufacturing Association (SAMA).

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Health & Wellness


Dr Lavindra Tomar



It has been increasingly witnessed in the elderly that they are more vulnerable to Covid-19, and this is compounded by the fact that they also have poor outcomes for survival. A higher risk has been associated with comorbid pre-existing medical conditions. The elderly with pre-existing arthritis and osteoporosis have progressed to debilitatingly painful symptomatology during the Covid era.

Sedentary lifestyles and poor exercise tolerability have increased the risks significantly with the deterioration of already pre-existing medical ailments. Reluctance for consultation due to lockdown restrictions, societal pressures to remain homebound to avoid Covid exposure, fear of affecting family members and re-allocation of resources in hospitals have all contributed immensely to the delay and initiation of timely management for arthritis and osteoporosis.

The Covid vaccine diplomacy along with the early vaccine hesitancy has also contributed to the fear of psychosis amongst both the educated and uneducated masses of the population.

Add to the above, surgical procedures and arthroplasty have been delayed in the management of arthritis.

The rescheduling of surgical replacements has presented now with multi-fold additional challenges in these times of the Covid pandemic. Poor chest compliance, lower exercise tolerance, thrombotic episodes, susceptibility to secondary infections, weak cardiac health have significantly increased risks in the elderly planned for elective surgery. The pre- Covid fit elderly population has now been graded as high-risk candidates for procedures.

Off-label use of drugs such as steroids, antivirals, DMARDs, immunomodulators, and plasma therapy for the management of Covid related illness has also had deleterious effects leading to a silent disaster-in-making. Significant alterations to an individual’s immune system, decreased glycaemic diabetic threshold, susceptibility to uncommon inflammation or infection including fungal and variability of inflammatory markers have confounded the clinician’s judgement. The diagnostic dilemma and unconventional treatment protocols have delayed the timely offer of surgery for the arthritic joint.

The contagious evolution of the Covid pandemic poses new challenges in the surgical management of joint arthritis. Personal observation suggests that there has been a 40% decline in replacement surgeries with additional delay in rescheduling of the planned surgeries. There is an urgent need to identify the crippling effects of arthritis and osteoporosis in the elderly to provide timely management.

The writer is Director & Unit Head, Department of Orthopaedics Max Super Specialty Hospital, Patparganj.

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Health & Wellness


Positively accepting the diagnosis through proper counselling can help overcome diabetes distress and lead to better outcomes.

Dr Arbinder Singal



A diagnosis like diabetes can bring with it some amount of distress because most of the time it comes as a shock to many people since the condition is asymptomatic. But a recent survey done on 250 people with diabetes by a team of psychologists at Fitterfly saw that 83% of people were willing to bring in desired behaviour changes to take charge of their health and bring down blood sugar levels. With proper counselling and education about the condition, about 70% of people felt motivated enough to stay on the prescribed course of treatment and attain healthy habits. This also shows that positively accepting the diagnosis through proper counselling can help overcome diabetes distress and lead to better outcomes. This is the first-ever diabetes distress survey done in India. 


While most of us don’t speak much about the psychological impact of diabetes, this kind of distress is genuine and overwhelming. Diabetes distress can also manifest in different ways :

Emotional distress: Making one angry, frustrated, guilty, or panicky

Physician distress: Unhappy with a physician due to lack of time spent or inability to express one’s fears and concerns 

Regimen distress: The continuous monitoring of blood sugar levels, diet watch and exercise, taking timely medication and more

Interpersonal distress: Problems between partners or limited involvement in family matters 

Diabetes distress has been associated with poor self-management and increasing levels of HbA1c. Many people give up too soon and stop taking insulin or oral medications. Uncontrolled diabetes distress can lead to diabetes burnout, with high sugar levels turning it into a life-threatening incident. While it is natural to feel distressed after a diagnosis, it isn’t advisable to deal with it alone. Sometimes one needs considerable help to overcome this feeling. 

It is critical to identify the signs of diabetes distress to reign control over the same. Here are a few signs that indicate diabetes distress: 

• Feeling angry about the diagnosis and frustrated about managing the same

• Worrying about not being capable of managing diabetes well 

• Being fearful about the complications or fearful of being dependent on medications 

• Avoiding going to appointments or checking blood sugars and being in denial 

• Making unhealthy food choices or indulging in emotional eating 

• Feeling alone, dejected or isolated


If you feel any of the above signs, get help immediately. Diabetes distress is not depression, but if ignored for long, it can lead to the same. In such a scenario, the consequences can be disastrous. Depression interferes with the ability to think clearly. It causes indecisiveness and the inability to perform tasks like taking the medications and meals on time, exercising, etc. Depression causes a rise in a stress hormone — cortisol, which interferes with glucose metabolism, increases insulin resistance, and causes accumulation of belly fat. It is ideal to get help before one reaches this stage. 


Pay attention to your feelings and act promptly: Rather than feeling frustrated, try to concentrate on the positives that can be controlled. Plan for a reversal if possible, or take control of your lifestyle choices to lessen the risks of complications.

Talk to other people who have diabetes: Alternatively, you can also check for support groups and share your struggles and coping strategies. Reaching out to people always has a positive impact on one’s mental well-being. 

Indulge in therapies that give you solace: Whether journaling your feelings or art therapy, or other hobbies that help you stay motivated, indulge in them to keep your mind agile and upbeat. 

Trust your near and dear ones: Most of the time, when you are in denial, you reject the support from your family and friends. But don’t, if you have trusted people around you, talk to them about your feelings (to relieve the stress) and don’t deny the help they extend to you, whether it is moral support or reminding you about your medications. 

Look for expert help: Sometimes, it gets overwhelming to counter diabetes distress all alone; in such a case, reaching out to an expert is an ideal solution. With DTx programs that promise highly personalised care and a holistic approach to diabetes, mental well-being is taken into consideration along with nutrition therapy and exercise plans for better outcomes. Fitterfly’s DTx diabetes care program – Diabefly focuses on psychological well-being for people with diabetes along with a proper nutrition plan and exercise regime. A proper psychological intervention can help one:  

• comply with the treatment plan

• adhere to diet and exercise routines 

• be timely with medication

• practice proper sleep hygiene

• positively control emotions and reduce stress levels 

• have a positive outlook 

• focus on healing and reducing risks of diabetes complications

Studies have also shown that better control over diabetes distress leads to better glycemic control and blood sugar levels. A positive mind is imperative in proper diabetes control and management.  

The writer is CEO & Co-founder, Fitterfly. 

Diabetes distress has been associated with poor self-management and increasing levels of HbA1c. Many people give up too soon and stop taking insulin or oral medications. Uncontrolled diabetes distress can lead to diabetes burnout, with high sugar levels turning it into a life-threatening incident. While it is natural to feel distressed after a diagnosis, it isn’t advisable to deal with it alone. Sometimes one needs considerable help to overcome this feeling.

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