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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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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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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