Category: corona virus

Highly Contagious – Low Virulence?  Omicron-Covid-Variant


    If the initial data is correct, the Omicron-Variant of Covid is proving to  be of Highly Contagious –  Low Virulence.

     The Omicron variant is less likely to lead to less severe disease in people who have taken vaccines or had Covid-19 in the past, two studies from the UK have said.

Taken together with findings from South Africa – all three studies were released on Wednesday – there is now sound scientific basis to conclude the variant is less virulent than others, especially Delta, which caused a devastating outbreak in India last summer and sparked new waves in other countries.

The findings are the first encouraging scientific evidence linked to the variant of concern (VOC) discovered last month when it started tearing through parts of South Africa at a rate not seen with any other Sars-Cov-2 variant. Scientists soon discovered it was also the most resistant configuration of the coronavirus, leading to higher odds of repeat and vaccine breakthrough infections.

If the Omicron variant was to be as virulent, or more, than Delta, the implications would have been dire, although its high transmissibility and resistance still pose a threat.

“Our analysis shows evidence of a moderate reduction in the risk of hospitalisation associated with the Omicron variant compared with the Delta variant. However, this appears to be offset by the reduced efficacy of vaccines against infection with the Omicron variant. Given the high transmissibility of the Omicron virus, there remains the potential for health services to face increasing demand if Omicron cases continue to grow at the rate that has been seen in recent weeks,” said professor Neil Ferguson of Imperial College London, which released the analysis of Omicron and Delta cases in England.

Two UK studies, similar severity findings

The Imperial College study included all RT-PCR-confirmed Covid-19 cases recorded between December 1-14 in England. It found that Omicron cases have, on average, a 15-20% reduced risk of needing to visit a hospital (the lowest level of severity) and an approximately 40-45% reduced risk of a hospitalisation resulting in a stay of one or more nights.

It also found that a past infection offered approximately a 50-70% reduction in hospitalisation risk compared. All of these comparisons were made against risks of hospitalisation seen with the Delta variant.

The researchers estimate that in unvaccinated people being infected for the first time, the risk of hospitalisation may be lowered by 0-30%, suggesting the severity in completely immune-naive people may not be very different from those who had a Delta infection for the first time, without any vaccine.

The other UK study was from Scotland. Although based on a small number of hospitalisations, the study made similar findings: those with Omicron infections were 68% less likely to need hospitalisation compared to people infected with the Delta variant.

Both reports, as well as the South African study, are yet to be peer-reviewed.

The Imperial College researchers also said in their study that Omicron infections in people with vaccination may be even less likely to require ICU admission or lead to death when compared to Delta variant, “given that remaining immune protection against more severe outcomes of infection are expected to be much higher than those against milder endpoints”.

Need for vaccines, boosters

The detailed findings corroborate lab studies that show people with booster doses have a more adequate immune response to counter the Omicron variant. In their real-world analysis, the Scotland report found a 57% reduction in the risk of symptomatic infection in people who were infected with the VOC compared to those who just had two doses at least 25 weeks prior.

The detailed Imperial College findings made similar findings. For instance, people with two doses of the AstraZeneca vaccine (used in India as the Covishield vaccine), had a higher risk ratio of 0.37 than those with three doses of the same vaccine (0.21). These risk ratios mean two doses reduced the risk of hospitalisation by 63% while three doses cut it by 79%.

Crucially, the report added, people who took the AstraZeneca vaccine had a lower risk in needing to visit a hospital if infected by the Omicron variant when compared to the equivalent risk in the case of a Delta variant infection. In the case of Pfizer-BioNTech or Moderna vaccines, the likelihood of requiring a hospital visit – defined as the lowest level of severity – were similar between Omicron and Delta infections.

The report also stressed on the need to vaccinate the unvaccinated, especially those who did not have a past infection. “The proportion of unvaccinated individuals infected is likely to be substantially higher. In that context, our finding that a previous infection reduces the risk of any hospitalisation by approximately 50% and the risk of a hospital stay of 1+ days by 61% (before adjustments for under ascertainment of reinfections) is significant,” the report said.

  Most cases In India Asymptomatic

With reports of new cases surfacing, the overall number of Omicron cases in India has now reached 33. According to experts, the spread of the new variant is less concerning than that of Delta as the symptoms are mild. While this is partly because of the nature of this new variant, another reason might be the high rate of seropositivity of Indians, experts have said.

“India has the advantage of a very high rate of ‘seropositivity’ of 70, 80 per cent, and in big cities more than 90 per cent people already have antibodies,” Rakesh Mishra, former Director of CSIR-Centre for Cellular and Molecular Biology (CCMB) here, told PTI. Even if people get infected by Omicron, it will be very mild and mostly asymptomatic, Mishra said.

India’s Omicron tally rises to 33: Tracing Covid-19’s new variant in various states

A fresh wave of the pandemic may come even without Omicron, Mishra said referring to the fresh waves in Europe. Ruling out the possibility of a surge in hospitalisation, he said wearing the mask, maintaining social distancing and getting vaccinated remain the three major weapons against future waves.

All Omicron cases in India are mild and there has been no report of Omicron death in India and in any country of the world. The common symptoms are weakness, sore throat etc. Many Omicron patients of India have already recovered and tested negative for Covid.

Capital Delhi reported a new Omicron case on Saturday as a Zimbabwe-returnee tested positive. Reports said the patient only complained of weakness.

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0

 COVID-19 Vaccination  during Pregnancy; CDC data


Safety and Effectiveness of COVID-19 Vaccination during Pregnancy-

CDC released the first U.S. data on the safety of receiving an mRNA COVID-19 vaccine during pregnancy.

Evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy, although limited, has been growing. These data suggest that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy.

  • No safety concerns were found in animal studies: Studies in animals receiving a Moderna, Pfizer-BioNTech, or Johnson & Johnson (J&J)/Janssen COVID-19 vaccine before or during pregnancy found no safety concerns in pregnant animals or their babies.
  • No adverse pregnancy-related outcomes occurred in previous clinical trials that used the same vaccine platform as the J&J/Janssen COVID-19 vaccine: Vaccines that use the same viral vector have been given to pregnant people in all trimesters of pregnancy, including in a large-scale Ebola vaccination trial. No adverse pregnancy-related outcomes, including adverse outcomes affecting the baby, were associated with vaccination in these trials. Learn more about how viral vector vaccines work.

  • COVID-19 vaccines do not cause infection, including in pregnant people or their babies: None of the COVID-19 vaccines contain the live virus that causes COVID-19 so a COVID-19 vaccine cannot make anyone sick with COVID-19, including pregnant people or their babies.
  • Early data on the safety of receiving an mRNA COVID-19 vaccine (Moderna or Pfizer-BioNTech) during pregnancy are reassuring:
    • CDC released the first U.S. data on the safety of receiving an mRNA COVID-19 vaccine during pregnancy. The report analyzed data from three safety monitoring systems in place to gather information about COVID-19 vaccination during pregnancy. These early data did not find any safety concerns for pregnant people who were vaccinated or their babies.1
    • Another report looked at pregnant people enrolled in the v-safe pregnancy registry who were vaccinated before 20 weeks of pregnancy. Scientists did not find an increased risk for miscarriage among people who received an mRNA COVID-19 vaccine during pregnancy.2
    • Many pregnancies reported in these safety monitoring systems are ongoing. CDC will continue to follow people vaccinated during all trimesters of pregnancy to better understand effects on pregnancy and babies.
  • Early data suggest receiving an mRNA COVID-19 vaccine during pregnancy reduces the risk for infection: A recent study from Israel compared pregnant people who received an mRNA COVID-19 vaccine with those who did not. Scientists found that vaccination lowered the risk of infection from the virus that causes COVID-19.3
  • Vaccination of pregnant people builds antibodies that might protect their baby: When pregnant people receive an mRNA COVID-19 vaccine during pregnancy, their bodies build antibodies against COVID-19, similar to non-pregnant people. Antibodies made after a pregnant person received an mRNA COVID-19 vaccine were found in umbilical cord blood. This means COVID-19 vaccination during pregnancy might help protect babies against COVID-19. More data are needed to determine how these antibodies, similar to those produced with other vaccines, may provide protection to the baby.4

Additional clinical trials that study the safety of COVID-19 vaccines and how well they work in pregnant people are underway or planned. Vaccine manufacturers are also collecting and reviewing data from people in the completed clinical trials who received a vaccine and became pregnant.

Vaccine Side Effects

Side effects can occur after receiving any of the available COVID-19 vaccines, especially after the second dose for vaccines that require two doses. Pregnant people have not reported different side effects from non-pregnant people after vaccination with mRNA COVID-19 vaccines (Moderna and Pfizer-BioNTech vaccines). If you experience fever following vaccination you should take acetaminophen (Tylenol®) because fever—for any reason—has been associated with adverse pregnancy outcomes. Learn more at What to Expect after Getting a COVID-19 Vaccine.

Although rare, some people have had allergic reactions after receiving a COVID-19 vaccine. Talk with your healthcare provider if you have a history of allergic reaction to any other vaccine or injectable therapy (intramuscular, intravenous, or subcutaneous).

Key considerations you can discuss with your healthcare provider include:

  • The unknown risks of developing a severe allergic reaction
  • The benefits of vaccination

If you have an allergic reaction after receiving a COVID-19 vaccine during pregnancy, you can receive treatment for it.

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     Covid paradox: salary cut for doctors other paid at home

3

Challenges of Covid Vaccination-2021


If 2020 was consumed by Covid Virus ,  the next year 2021 will be  for Covid vaccination.

All over the world, billions of people are going to get vaccine.

Corona vaccination is one of the most anticipated events in every country. in coming weeks, multiple vaccines   are likely to get regulatory approval. 

    However, while making a good vaccine was the difficult part, earning  trust of public in vaccine is going to be another one. Especially the hurried development at Pandemic speed  and lack of awareness about safety issues will be areas of concern.

  The adverse events, which are unexpected medial problems that occur with drug treatments, are unavoidable part of any treatment, including vaccine science.

    The system need to be in place to identify  the causal relationship between vaccine agent and  the adverse event.  The objective criteria have to be in place to identify and treat, as the population to be vaccinated is also very large.

 The main hurdles equally challenging will be sourcing, distributing and giving the actual vaccination doses.

The preparation for mammoth exercise will also be a herculean task. It may take months to get ready to supply and build the chains and preparation for this need to begin now.

A systematic approach needs to be ready, so that the process of vaccination gets on smoothly and quickly, as soon as the doses are available. For example, the need for transport vehicles and the storage facilities for billions of doses at distant places will be one of challenges.

It will take mammoth number of healthcare workers, who will vaccinate people at different towns and cities.  

This exercise, if not done in a well-planned manner, could result in chaos.   The failure to set up a system will not only result in suboptimal vaccination but also non uniform supplies. Maintaining the cold chain will be crucial for effectiveness.

 People should get it based on needs rather than black marketing or money power.   The issues which look insignificant like the financial complexity among various stake holders or customer clearances need to be settled first, as they may become significant hurdles for smooth distribution.

    Most important would be to safeguard citizen’s faith in vaccine and clinical trials. As for the future science to develop, would   require people’s co-operation, faith and participation.

     Government regulators and Vaccine makers need to recognize the utmost importance of the communication about the true results of trials and effective communication with the public.  The misinformation and distrust should not  undermine the good work of medical science and advancements.

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     Covid paradox: salary cut for doctors other paid at home

Authorities mum on Adverse Event at Covid Vaccine Trial


Safety data of Covid Vaccine- need disclosure

   There are two important aspect of a successful vaccine,

1. Efficacy  for the prevention

2. Safety

       Given that the Covid vaccine is needed urgently and will be developed within a years’ time, some doubts about the safety aspect are natural. But safety can be assured, if the data about side effects is made public.

   All  the  companies  in a bid to rush their  vaccine into the market, are eager to  create an hype. But a caution need to be exercised against such hyping, especially when long term safety data is not available.

  Even the sparse details of the severe side effect,  that leak into the public domain, may be just tip of the iceberg, as far as long term safety data of a vaccine is concerned.

   All the side effects, mild or severe, need to be made known  and  in public domain, rather than exposed later after the use.

More than a month and a half after an adverse event occurred in a clinical trial in India of the AstraZeneca vaccine, the Central Drug Standard Control Organisation (CDSCO), the regulator for vaccine trials, has not issued any statement on the occurrence. It also did not respond to queries about whether it has completed its investigation to determine if the trial participant’s illness was related to the vaccine. Serum Institute, which is partnering the pharma MNC and Oxford University for producing the vaccine in India, has also refused to comment. This is in sharp contrast to AstraZeneca and Oxford University going public when one of the trial participants in the vaccine trial in the UK fell ill and halting the trial till an independent safety monitoring board and UK’s regulatory authority gave safety clearance. Information about the occurrence of the serious adverse event (SAE) during the vaccine trial in India came from the family of the trial participant, which has sent the company and the regulators a legal notice. Serum Institute merely stated that it would issue an official statement next week. AstraZeneca had issued a statement within days of the trial participant in UK falling ill and halted the trials across the world in the UK, Brazil and South Africa. The trial was resumed within a week after the independent safety review committee and national regulators gave clearance. The Indian Council of Medical Research is a co-sponsor of the trial along with Serum Institute.

According to the ICMR, it is for the DCGI to take a call on whether or not to halt the trial. The DCGI heads the CDSCO.

The 40-year-old trial participant, a business consultant with an MBA from New Zealand who says he took part in the trial deeming it his duty to help such an important venture, was administered the vaccine at SRMC on October 1. Eleven days later, he woke up with a severe headache, and progressively lost his memory, showed behaviour changes, became disoriented and was unable to talk or recognise his family members, according to the legal notice. As soon as he fell ill he was admitted to the ICU in SRMC.

“Though the legal notice we have served talks of a compensation of Rs 5 crore, our focus is not on monetary compensation. It was sent just last week, more than a month after the occurrence when we saw that none of the authorities was making the adverse event public. They ought to have warned other participants so that they could watch out for similar symptoms. We want to know why the occurrence of the adverse event has been kept under wraps and why the trial was not halted like it was done in the UK. Is an Indian life of less value than that of an UK citizen?” asked a close family friend who has been helping the family cope with the illness.

WHO says more data needed on AstraZeneca dose

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Neanderthal gene makes Covid more severe


What is Neanderthal gene

    Neanderthal-inherited genetic material is found in all non-African populations and was initially reported to comprise 1 to 4 percent of the genome. This fraction was later refined to 1.5 to 2.1 percent. It is estimated that 20 percent of Neanderthal DNA currently survives in modern humans.

Relation to severity of Covid

    Response to Covid infection varies from person to person. Some have severe covid infection, need ventilator and some remain unaffected. There is interest in the individual factors which influence the outcome of Covid infection. One such factor is the genetic predisposition.

     Covid-19 patients with a snippet of Neanderthal DNA that crossed into the human genome some 60,000 years ago run a higher risk of severe complications from the disease, researchers have reported.

People infected with the new coronavirus, for example, who carry the genetic coding bequeathed by our early human cousins are three times more likely to need mechanical ventilation, according to a study published Wednesday in Nature.

There are many reasons why some people with Covid-19 wind up in intensive care and others have only light symptoms, or none at all.

Advanced age, being a man, and pre-existing medical problems can all increase the odds of a serious outcome.

But genetic factors can also play a role, as the new findings makes clear.

“It is striking that the genetic heritage from Neanderthals has such tragic consequences during the current pandemic,” said co-author Svante Paabo, director of the department of genetics at the Max Planck Institute for Evolutionary Anthropology.

Recent research by the Covid-19 Host Genetics Initiative revealed that a genetic variant in a particular region of chromosome 3 — one of 23 chromosomes in the human genome — is associated with more severe forms of the disease.

That same region was known to harbour genetic code of Neanderthal origins, so Paabo and co-author Hugo Zeberg, also from Max Planck, decided to look for a link with Covid-19.

Unevenly distributed

They found that a Neanderthal individual from southern Europe carried an almost identical genetic segment, which spans some 50,000 so-called base pairs, the primary building blocks of DNA.

Tellingly, two Neanderthals found in southern Siberia, along with a specimen from another early human species that also wandered Eurasia, the Denisovans, did not carry the telltale snippet.

Modern humans and Neanderthals could have inherited the gene fragment from a common ancestor some half-million years ago, but it is far more likely to have entered the homo sapiens gene pool through more recent interbreeding, the researchers concluded.

The potentially dangerous string of Neanderthal DNA is not evenly distributed today across the globe, the study showed.

Some 16 percent of Europeans carry it, and about half the population across South Asia, with the highest proportion — 63 percent — found in Bangladesh.

This could help explain why individuals of Bangladeshi descent living in Britain are twice as likely to die from Covid-19 as the general population, the authors speculate.

Indian express-Article

In East Asia and Africa the gene variant is virtually absent.

About two percent of DNA in non-Africans across the globe originate with Neanderthals, earlier studies have shown.

Denisovan remnants are also widespread but more sporadic, comprising less than one percent of the DNA among Asians and Native Americans, and about five percent of aboriginal Australians and the people of Papua New Guinea.

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Covid Patients Remain Infectious for 9 days


Covid-19 patients can shed fragments of the virus that causes the infection for up to 83 days in their respiratory or stool samples but they are unlikely to be infectious for as long. According to a study published in The Lancet Microbe, one of world’s top medical journals, no live virus has been isolated from culture of the respiratory or stool sample beyond day nine of symptoms despite persistently high viral RNA loads. This means that a person affected by Covid-19 is infectious for nine days after developing disease symptoms though tests may find presence of the virus for nearly three months. The study conducted by researchers from UK and Italy involved systemic review and meta-analysis of 79 studies that focused on SARS-CoV-2, the virus which causes Covid-19. “The majority of studies included in our review were performed in patients who were admitted to hospital. Therefore, our findings may not apply to people with milder infection although these results suggest those with milder cases may clear the virus faster from their body. Additionally, the increasing deployment of treatments, such as dexamethasone, remdesivir as well as other antivirals and immunomodulators in clinical trials are likely to influence viral shedding in hospitalised patients. Further studies on viral shedding in this context are needed,” Dr Antonia Ho of MRC-University of Glasgow Centre for Virus Research, UK, who is one of the authors of the study, said.

article- times of india

                The Lancet Microbe study also suggests that people infected with SARS-CoV-2 are mostly likely to be highly infectious from symptom onset and the following five days. Therefore, the researchers said, it is important to self-isolate immediately after symptoms start. Understanding when patients are most likely to be infectious is of critical importance for informing effective public health measures to control the spread of SARS-CoV-2. The Lancet study looked at key factors involved in this: viral load (how the amount of the virus in the body changes throughout infection), viral RNA shedding (the length of time someone sheds viral genetic material (RNA), which does not necessarily indicate a person is infectious, as this is not necessarily able to replicate), and isolation of the live virus (a stronger indicator of a person’s infectiousness, as the live virus is isolated and tested to see if it can successfully replicate in the laboratory). The researchers found that the average length of time of viral RNA shedding into the upper respiratory tract, lower respiratory tract, stool and serum were 17 days, 14.6 days, 17.2 days and 16.6 days, respectively. The longest length of time that RNA shedding lasted was 83, 59, 35 and 60 days, respectively. “These findings suggest that in clinical practice, repeat PCR testing may not be needed to deem that a patient is no longer infectious, as this could remain positive for much longer and does not necessarily indicate they could pass on the virus to others. In patients with non-severe symptoms, their period of infectiousness could instead be counted as 10 days from symptom onset,” Dr Muge Cevik, the lead author of the study, said.

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     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Penal Servitude for Doctors, Nurses- Administrators Delight


                         Life for health care professionals like  doctors and nurses is hard in present era, right from getting into medical college, passing the exams, gaining experience, work under new imposed legal environment, with  over-regulation and under the moral burden of over-expectations of society. The benefit of these difficult situation is reaped to the maximum by administrators and overpowering medical industry.

            Despite working amid of a national emergency in Covid-times, the meagre salaries of hundreds of doctor and nurses are not paid for months in Hindu Rao Hospital, Delhi

         Ironically where doctors are punished for small genuine mistakes or even poor prognosis during  medical treatment, the blunders of health  administrators are taken as trivial issues.  More ruthlessness, cunningness or cruelty towards health care workers is possibly becoming an appreciated quality of health administrators.  Why no punishment for the administrators for such blunders?

     Consequently, with no support from society, to whom they serve, doctor and nurses gradually are pushed to a penal servitude. If this is regarded as normal in present era, anyone would wonder, what does slavery constitute?

   No salaries  for doctors for four months

The doctors alleged negligence and apathy on part of the government and said that they were unable to run their basic errands and accomplish their daily routine due to non-payment of salaries.

  Irked over non-payment of salaries for over four months in a row, doctors at Delhi’s Hindu Rao Hospital announced that beginning Saturday, October 10, they would stop attending to patients including those suffering from Covid-19. Hindu Rao Hospital, the largest municipal hospital in Delhi with 900 beds, is currently a dedicated Covid-19 facility.The doctors alleged negligence and apathy on part of the government and said that they were unable to run their basic errands and accomplish their daily routine due to being unpaid for months.Abhimanyu Sardana, President of the Resident Doctors’ Association (RDA) of the hospital, said that several letters and reminders had been sent to Delhi Chief Minister Arvind Kejriwal regarding the issue faced by the doctors, who are frontline warriors at the Covid-19 dedicated facility. “Don’t ignore the basic needs and rights of doctors,” wrote the RDA-Hindu Rao.

            Be it any circumstances like working without any facilities, poor infrastructure, non-availability of drugs, inhuman duties hours over 48-72 hours or poor pay, the administrators would say, “you are a doctor, it is your moral responsibility.”  Armchair preachers and administrators will always remind them of moral duties, but easily forget their own.

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2

Covid effect: Reasons for costly oxygen


 

Oxygen has been a essential lifesaving therapy for covid patients. As large numbers require oxygen for prolonged periods because of post covid lung damage, the requirement has increased manifold. So it is in short supply and there is no dearth of people want to monetize the need. There are multiple reasons of shortage.

 The Indian express explains

   The delay in transportation of oxygen to dealers, conversion into cylinders and supply to hospitals can get long if even a tiny link in the supply chain falters.  

As Covid-19 sweeps across the country, urban and rural areas alike face an unprecedented spike in oxygen use. Around 3-5 per cent (over 50,000) of active Covid-19 cases in India have lung tissues damaged enough by the virus to require external oxygen support.

Since March, medical oxygen demand has grown from 750-800 to over 2,500 metric tonnes, and now, hospitals are struggling.

The supply 

In an ideal scenario, it takes 3-5 days for oxygen to journey from a manufacturer to a patient’s bed. But delay in transportation to dealers, conversion into cylinders and supply to hospitals can take longer if even a tiny link in the supply chain falters.

India’s big oxygen manufacturers, such as Inox Air Products, Linde India, Goyal MG Gases, National oxygen, use cryogenic distillation technique to compress air, feed it into distillation columns and get liquid oxygen. It has 99.5 per cent purity. This process, an official from Inox said, can take two-and-half-days.

The liquid oxygen is filled into special cryogenic transport tankers that maintain -180 degree centigrade temperature to travel to smaller plants in hinterlands, where liquid oxygen is converted into gaseous form, fed into cylinders and transported to the final destination – hospitals.

India has the capacity to produce 6,900 metric ton of liquid oxygen daily, health secretary Rajesh Bhushan said in a media interaction. According to the All India Industrial Gases Manufacturers’ Association (AIIGMA), over 2,500 tonne is being directed towards hospitals, most consumed by coronavirus patients, and another 2,000-2,300 tonne is industrial requirement each day. So if India is not exhausting its capacity of 6,900 metric tonnes, why is oxygen suddenly a concern?

Logistics

Medical oxygen demand has grown threefold in six months. “The issue is not of supply, it is of transportation and storage,” says health secretary Dr Pradeep Vyas, Maharashtra, which produces one-fifth of India’s oxygen capacity.

As demand surges, logistics are falling short. India has roughly 1,200-1,500 tankers for transport. Before the pandemic, the tankers were enough, but now they are difficult to hire and cost more.

Inox is the biggest manufacturer of liquid oxygen in India, with capacity of 1,911 metric tonnes per day. It currently supplies 1,400 tonnes, and has 550 transport tanks and 600 drivers to supply to 800 hospitals across India. But this may soon fall short.

It can take 5-6 days, for instance, for oxygen to travel from Inox Pune plant to Osmanabad, where a dearth of oxygen has emerged. The Centre is now working to utilise nitrogen tankers to transport oxygen. In just Maharashtra, 10 more tankers have been roped in.

Then there is the problem of storing this huge quantity of oxygen, says Saket Tiku, president of AIIGMA. Most rural hospitals do not have oxygen tanks as the need never arose before. A critical Covid-19 patient can need 30-60 litres of oxygen in a minute. One cylinder can run out in 15 minutes to an hour, depending on oxygen directed to patients.

States are looking at alternatives, from buying extra dura and jumbo cylinders to installing oxygen tanks as buffer stock. Inox has got the contract to fix 64 jumbo tanks across Covid hospitals to store 4 lakh litres.

Several states have also begun construction of oxygen generation plants that convert air into oxygen, and provide 93.5 per cent purity. But this construction will take months. The AIIGMA states that across India, 500 oxygen plants are in the process of construction, of which two major ones will be in Pune (Maharashtra) and Modinagar (Gujarat).

The price rise

Oxygen is generally quite cheap, but suddenly it has become expensive. A cylinder that would earlier cost Rs 100-150 now costs Rs 500-700 for refilling. With this, hoarding has begun. Fearful of not getting a Covid bed in hospital, people are keeping oxygen cylinders at home.

Before the pandemic, it would cost Rs 1.5-2 to refill a cubic metre of oxygen. But the cost of logistics has risen, so now Delhi will find refilling costs Rs 10-15 per cubic metre, and Mumbai Rs 15 per cubic metre. The government has fixed the cost of refilling at Rs 17.49 per cubic metre.

Several private hospitals charge patients Rs 1,500-3,000 for oxygen per day. “Based on our analysis, oxygen cost cannot exceed Rs 300-400 per patient per day in a hospital,” said Dr Sudhakar Shinde, IAS officer in-charge of fixing price cap for hospitals.

The industrial sector is bearing the brunt too. Requirement for oxygen had dipped to 250 metric tonne per day in March after lockdown. As restrictions were lifted, industries restarted work. Now, the industrial requirement is at 2,00-2,500 metric tonne. But there is limited supply.

Madhya Pradesh relied on Maharashtra and Gujarat for oxygen – as supplies from these states reduced, it has turned to Chhattisgarh for supply. In some states like Maharashtra, only 20 per cent oxygen produced can be directed for industrial purposes, rest are reserved for medical use.

What government is doing

There is also the wastage of oxygen – mild cases who don’t need it are put on oxygen support, sometimes leakages are reported from oxygen pipelines. An expert committee under MoHFW has fixed oxygen supply to 40 litres in intensive care units and 15 litre per minute in normal ward per patient per minute.

It has advised to monitor patients on oxygen support daily, and only put those with oxygen saturation levels below 94 on oxygen support. As per the committee, 20 out of 100 patients turn symptomatic and three of them critical. This is the pool that may require oxygen.

In Numbers 

India’s per day oxygen production capacity: 6,900 metric tonne

Current requirement: Over 2,500 metric tonne

Oxygen Transport tankers: 1,200-1,500

Active Covid cases: 9.75 lakh

On oxygen: 5.8%

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0

Potential Ray of Hope: Highly effective coronavirus antibodies


        Identification of highly effective antibodies, will not only provide a passive immunity, but can be helpful in developing vaccine as well. This discovery may be a potential ray of hope against Covid war.

Highly effective coronavirus antibodies discovered may lead to passive Covid-19 vaccine

     BERLIN: Scientists have identified highly effective antibodies against the novel coronavirus, which they say can lead to the development of a passive vaccination for Covid-19. Unlike in active vaccination, passive vaccination involves the administration of ready-made antibodies, which are degraded after some time. However, the effect of a passive vaccination is almost immediate, whereas with an active vaccination it has to build up first, the researchers said. The research, published in the journal Cell, also shows that some SARSCoV-2 antibodies bind to tissue samples from various organs, which could potentially trigger undesired side effects. The scientists at the German Center for Neurodegenerative Diseases (DZNE) and Charite – Universitatsmedizin Berlin isolated almost 600 different antibodies from the blood of individuals who had overcome Covid-19, the disease triggered by SARS-CoV2. By means of laboratory tests, they were able to narrow this number down to a few antibodies that were particularly effective at binding to the virus.  Highly effective coronavirus antibodies identified, may lead to passive Covid-19 vaccine The researchers then produced these antibodies artificially using cell cultures. The so-called neutralising antibodies bind to the virus, as crystallographic analysis reveals, and thus prevent the pathogen from entering cells and reproducing, they said. In addition, virus recognition by antibodies helps immune cells to eliminate the pathogen. Studies in hamsters — which, like humans, are susceptible to infection by SARS-CoV-2 — confirmed the high efficacy of the selected antibodies. “If the antibodies were given after an infection, the hamsters developed mild disease symptoms at most. If the antibodies were applied preventively — before infection — the animals did not get sick,” said Jakob Kreye, coordinator of the research project. The researchers noted that treating infectious diseases with antibodies has a long history. For Covid-19, this approach is also being investigated through the administration of plasma derived from the blood of recovered patients. With the plasma, antibodies of donors are transferred, they said. “Ideally, the most effective antibody is produced in a controlled manner on an industrial scale and in constant quality. This is the goal we are pursuing,” said Momsen Reincke, first author of the research. “Three of our antibodies are particularly promising for clinical development,” explained Harald Pruss, a research group leader at the DZNE and also a senior physician at Charite – Universitatsmedizin Berlin. “Using these antibodies, we have started to develop a passive vaccination against SARS-CoV-2,” Pruss said. In addition to the treatment of patients, preventive protection of healthy individuals who have had contact with infected persons is also a potential application, the researchers said. How long the protection lasts will have to be investigated in clinical studies, they said. “This is because, unlike in active vaccination, passive vaccination involves the administration of ready-made antibodies, which are degraded after some time,” Pruss said. In general, the protection provided by a passive vaccination is less persistent than that provided by an active vaccination, the researchers said. “It would be best if both options were available so that a flexible response could be made depending on the situation,” Pruss added.

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Story of Moral slaves: How Doctors bear full brunt #Covid


              Struggling to become a doctor, slogging in wards to learn and earn degrees, work in inhuman conditions, listen to endless abuses, tolerate the false media criticism, dragged in courts for alleged negligence, work with fear of physical assaults, work without proper infrastructure and manpower, endangering their own lives, exploited by medical  industry and administrators, poorly paid and  still not respected.    Arm chair preachers would just say “yes, as a doctor, they should do it as moral duty.”

             The Indian Express has been wise enough and has been able to  express the situation to some extent, which is just tip of the iceberg.

             Low pay and long hours, doctors battle more than just Covid-19.

 Maharashtra estimates it needs 19,752 doctors, nurses and paramedics to fight Covid-19. As on September 15, 12,574 of the posts were vacant. Dr Rajesh Salagare is the only doctor at Raigad rural hospital since March. (Express photo by Tabassum Barnagarwala) Chest physician Dr Pravin Dumne has just done his rounds of the ICU at Osmanabad Civil Hospital and is now fielding queries from anxious relatives. Two hours into the PPE, he is drenched in sweat, with 22 hours more to go in his shift. Dumne has 150 Covid-19 patients under him. Since May, he hasn’t been able to take any break except for 12 days when he himself contracted the virus. Norms mandate one doctor per 10 ICU patients, Dumne is handling five times that. “There are times when multiple patients are critical and I can’t be everywhere. I feel helpless. We are losing lives,” he adds. As another relative complains about the lack of cleanliness in a ward, Dumne says, “I may quit government service once the pandemic is over.” Dumne isn’t the only one feeling the unequal load as coronavirus cases surge in Maharashtra, particularly its rural areas. The state estimates it needs 19,752 doctors, nurses and paramedics to fight Covid-19. As on September 15, 12,574 of the posts were vacant. Of the 1,700 Class I doctor posts (including specialists) the Public Health Department needs to fill, like Dumne’s, only 538 are filled. In May, Maharashtra was forced to ask Kerala for help. Forty specialist doctors came to Mumbai on a bus, to handle critical patient load until July. The shortage is even more intense in rural areas, where urgent advertisements by the government for specialists have yielded little response. In rural Nagpur, as many as 93.6% posts are vacant, followed by Thane at 79%. The last permanent posting in Osmanabad, an aspirational district under NITI Aayog, was three years ago. It needs 150 nurses and 40 doctors. The state government has been deputing Ayush doctors to civil hospitals. “Not all of them can handle serious patients,” Dumne points out. He and Dr Tanaji Lakal are the only two specialist doctors for Covid patients at Osmanabad Civil Hospital. Dumne was moved here from the PHC at Samudrawani village, following the pandemic. Dumne and Lakal alternate working for 24 hours continuously followed by one day off. In July, when Dumne got the coronavirus, he had to join back within 12 days, instead of the minimum 14. The number game In Raigad, 400 km away, Dr Rajesh Salagare has been the only doctor handling the entire rural hospital since March. The three other doctor posts at the hospital have been vacant since 2018. The previous night he was called for a delivery at 2 am; this morning, he was back on OPD duty at 9. “I am just an Ayush doctor. If something goes wrong, I will be held responsible,” he worries. It’s not just the long hours that deter doctors from rural duty. A government MBBS doctor in rural areas is paid Rs 60,000 per month and is expected to be on call 24 hours, their counterparts in Navi Mumbai get Rs 1.25 lakh, and in Mumbai and Thane, Rs 80,000 per month. Navi Mumbai, Thane and Mumbai mandate eight hours on Covid duty at a time, apart from providing hotel accommodation. As a chest physician, Dumne could earn up to Rs 2 lakh in urban areas, instead of the Rs 60,000 he gets now. His August salary came only a few days ago. The 100-bed Covid facility in Ratnagiri depends on Ayush doctors from nearby PHCs. One such doctor, who requested anonymity, says he sees over hundred suspected cases a day. He got his pending salary of Rs 40,000 for four months, till July, only a few days ago. “Everyone calls us corona warriors, but look at how we are treated.” Dr Pravin Dumne (in white) at Osmanabad Civil Hospital. (Express Photo: Tabassum Barnagarwala) An administrative officer at Ratnagiri Civil hospital, who is waiting for his pay since July, shows text messages exchanged with seniors. “If the government doesn’t respect us, why will a doctor want to work here?” he says. Ratnagiri Civil Surgeon Dr Ashok Bolde says the delay in salaries is on the part of the National Health Mission’s state office. Dr Sadhana Tayade, Director of the Directorate of Health Services, however, says, “Salaries are paid on time to doctors.” On why the poor response to advertisements, she says it is because “doctors are scared to work in Covid wards”. The government has begun tele-ICU services to plug the gap of specialists in rural hospitals of Bhiwandi, Aurangabad, Jalna and Solapur. Physicians in another city monitor ICU readings of patients in rural hospitals and call up on-duty doctors to direct treatment protocol. But tele-ICU has not reached every rural hospital, nor can it help everyone.          Next younger generation of aspiring doctors, who is  witnessing to the cruelty shown towards health staff, may be forced to think about their decisions to become doctors.

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