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.

Advantages-Disadvantage of being a doctor

     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

   Medical-Consumer protection Act- Pros and Cons

REEL HEROES Vs REAL HEROES


The old adage  “All that glitters is not Gold” is particularly relevant  in current era of media domination where media  projection shapes the perception and may defy  the  reality.  Media has dominated our lives and can sway the  opinion formation of masses.  Written media, television, social media  can collectively influence the mass opinion.

Society, in general, needs to be wise  enough  to realize the importance   of  getting  rid of  these blinders in  real life . One such factor that causes an illusional mist in the  thoughts of masses is projection in films. They create a mirage of illusional glitter wherein  there is blurring of real life from the reel life of heroes. The larger-than-life unreal persona of the celebrities on screen looks too charming and sometimes becomes undeniable and dominates mind of masses. The super-human characters played out in films appear to be real. The problem arises when the imaginary characters of the reel life stories are emulated in real life. Individuals as projected character fill in  peoples’ imagination and are perceived as real and   becomes ingrained in mind. The naivety of masses to perceive the projected character as real one  goes beyond a reasonable thought process and imagination.

These roles played in films are  not  really act of   inspiration  in real life  as  the actual purpose accomplished in the end of a movie  is entertainment of society and business for themselves. A recent  candid  admission  by the actor Mr Irrfan Khan  that film stars should  not be role models  was impressive (Hindustan times) .

   At the best, a particular projected character  (and  not individual acting star) may be a  role model. An actor or super star, is simply doing his work of “acting” in  the end. This work of acting may bring an entertainment of few hours at the most.

One  cannot stray away from the wisdom to  choose between what we consume merely for our entertainment and  what we believe or face in real life. One needs to differentiate between rationale truth behind the celebrity gimmicks in the media and exaggerated sensationalism. Sensation created merely for a commercial successful venture should not be allowed to overpower the judgments of real life.

But the problem starts, when these false perceptions created merely   by a projected  glimmer    takes the shimmer  away from the real worthy. The real  professionals and people who are worthy of glory become invisible behind  the glittery mist, a haze, which is unreal and unhelpful in real life.

   A  soldier contributes to our society much more in real terms. Even a junior doctor saves many lives in a  day in emergencies as compared to work of a superstar in films.  A teacher, nurse or scientist have contribution which is more fruitful to our generation. Also the scientists, who contribute immensely and bring about the  real change in our lives. Their contribution is huge to our society and much more than doing just acting on screen. The reel actor merely imitates the real life lived and actual work done by real heroes like soldier, doctor or teacher. Someone who only acts and  behaves like one, is respected and paid thousand times or more than the real one. In reality, people need  more than mere entertainment and reel role models and actors in their real lives.

Compare the trivial  amount of  remuneration, fame  and respect the real worker  gets  as compared to the film stars, who merely imitate their actions. Reel projection for purpose  of entertainment is more easier to enact and more profitable  than actual performance  in real life.  It is easier to become a reel hero, as it requires little hard work or just connections to get an opportunity.  Some one can be a reel hero just  by  dynastic factor  easily. Hard work is definitely required but that may or may not be prerequisite.

Even good films  may raise some social problem, which everyone knows already and offer no practical solution in reality. Therefore what good it brings to the public, beyond entertainment, is any body’s guess. The persona, actors usually  project on screen, may actually be far from his or her real personality. In most of cases, what he does in movies and reel life, is actually away from  possibility of real life . But strangely in present era, people lose sight of what is mere perception. It is clearly a story, tale, a drama, a myth and is not the real identity of the people, we see on-screen.

In present era, real contributions by people, who are saviours of human life and  the real heroes, remain unappreciated. People are so besotted by  fame and money that they fail to appreciate the sacrifices made by real heroes. Filmy super hero  just imitates  a doctor, soldier,  dacoit or a street hooligan and just pretends to be one on the screen.

But there are  real life heroes that exist around us. Doctors awake at night saving lives every minute or soldier in freezing cold are worthy  of more respect and are real heroes.  And it is up to the society  to look beyond the superficial and reel story, and focus on the real life actors. There has to be an true effort to make, respect and appreciate  real heroes.

Point to  ponder  is that whether society needs people  just  acting like   doctors,  soldiers  and not the  actual and real ones, who saves lives. Does Society need  only  entertainment, because respect  which is paid to someone who is  just  an   actor, is  not extended to real doctors, soldiers or other altruistic professions.

 A reel hero who acts like a soldier, is famous  and richer and than the  actual soldier, who dies unnamed and in penury.   Children of today’s times will strive  to become, who is worshiped and paid respect  by society and  therefore will prefer  to become reel heroes.

A  society truly needs the real people, who work and act for them, more than just entertainment. It will need total change in attitude of people to deconstruct the perceptions, which are based on mere projections and are away from reality.

It is time to recreate and worship real heroes, who have become invisible behind the glittery mist.

Society needs to envisage the bigger real picture, and should not be mistaken for another projected story.

The perception of the projection will decide, what does the   society actually  need- or desire-or deserve , “Reel Heroes or Real Heroes”.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

  21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Medical-Consumer protection Act- Pros and Cons

History & Evolution of Vaccination


Before the first vaccinations, in the sense of using cowpox to inoculate people against smallpox, people have been inoculated in China and elsewhere, before being copied in the west, by using smallpox, called Variolation.

Variolation was the method of inoculation first used to immunize individuals against smallpox (Variola) with material taken from a patient or a recently variolated individual, in the hope that a mild, but protective, infection would result.

   The procedure was most commonly carried out by inserting/rubbing powdered smallpox scabs or fluid from pustules into superficial scratches made in the skin. 

    The earliest hints of the practice of variolation for smallpox in China come during the 10th century. The Chinese also practiced the oldest documented use of variolation, which comes from Wan Quan’s (1499–1582) Douzhen Xinfa  of 1549. They implemented a method of “nasal insufflation” administered by blowing powdered smallpox material, usually scabs, up the nostrils.

   Various insufflation techniques have been recorded throughout the sixteenth and seventeenth centuries within China. Two reports on the Chinese practice of inoculation were received by the Royal Society in London in 1700; one by Martin Lister who received a report by an employee of the East India Company stationed in China and another by Clopton Havers. In France, Voltaire reports that the Chinese have practiced variolation “these hundred years”.

     In 1796, Edward Jenner, a doctor in Berkeley in Gloucestershire, England, tested a common theory that a person who had contracted cowpox would be immune from smallpox. To test the theory, he took cowpox vesicles from a milkmaid named Sarah Nelmes with which he infected an eight-year-old boy named James Phipps, and two months later he inoculated the boy with smallpox, and smallpox did not develop.

   In 1798, Jenner published An Inquiry into the Causes and Effects of the Variolae Vacciniae which created widespread interest. He distinguished ‘true’ and ‘spurious’ cowpox (which did not give the desired effect) and developed an “arm-to-arm” method of propagating the vaccine from the vaccinated individual’s pustule. Early attempts at confirmation were confounded by contamination with smallpox, but despite controversy within the medical profession and religious opposition to the use of animal material, by 1801 his report was translated into six languages and over 100,000 people were vaccinated. The term vaccination was coined in 1800 by the surgeon Richard Dunning in his text Some observations on vaccination.

   In 1802, the Scottish physician Helenus Scott vaccinated dozens of children in  Mumbai (previous Bombay) against smallpox using Jenner’s cowpox vaccine. In the same year Scott penned a letter to the editor in the Bombay Courier, declaring that “We have it now in our power to communicate the benefits of this important discovery to every part of India, perhaps to China and the whole eastern world”.  Subsequently, vaccination became firmly established in British India. A vaccination campaign was started in the new British colony of Ceylon in 1803.

    By 1807 the British had vaccinated more than a million Indians and Sri Lankans against smallpox. Also in 1803 the Spanish Balmis Expedition launched the first transcontinental effort to vaccinate people against smallpox. Following a smallpox epidemic in 1816 the Kingdom of Nepal ordered smallpox vaccine and requested the English veterinarian William Moorcroft to help in launching a vaccination campaign. In the same year a law was passed in Sweden to require the vaccination of children against smallpox by the age of two. Prussia briefly introduced compulsory vaccination in 1810 and again in the 1920s, but decided against a compulsory vaccination law in 1829.

    A law on compulsory smallpox vaccination was introduced in the Province of Hanover in the 1820s. In 1826, in Kragujevac,  future prince Mihailo of Serbia was the first person to be vaccinated against smallpox in the principality of Serbia. 

    Following a smallpox epidemic in 1837 that caused 40,000 deaths, the British government initiated a concentrated vaccination policy, starting with the Vaccination Act of 1840, which provided for universal vaccination and prohibited Variolation.

    The Vaccination Act 1853 introduced compulsory smallpox vaccination in England and Wales.

    The law followed a severe outbreak of smallpox in 1851 and 1852. It provided that the poor law authorities would continue to dispense vaccination to all free of charge, but that records were to be kept on vaccinated children by the network of births registrars. It was accepted at the time, that voluntary vaccination had not reduced smallpox mortality, but the Vaccination Act 1853 was so badly implemented that it had little impact on the number of children vaccinated in England and Wales.

In the United States of America compulsory vaccination laws were upheld in the 1905 landmark case Jacobson v. Massachusetts by the Supreme Court of the United States. The Supreme Court ruled that laws could require vaccination to protect the public from dangerous communicable diseases. However, in practice the United States had the lowest rate of vaccination among industrialized nations in the early 20th century.

    Compulsory vaccination laws began to be enforced in the United States after World War II. In 1959 the World Health Organization (WHO) called for the eradication of smallpox worldwide, as smallpox was still endemic in 33 countries.

     In the 1960s six to eight children died each year in the United States from vaccination-related complications. According to the WHO there were in 1966 about 100 million cases of smallpox worldwide, causing an estimated two million deaths.

     In the 1970s there was such a small risk of contracting smallpox that the United States Public Health Service recommended for routine smallpox vaccination to be ended.

   By 1974 the WHO smallpox vaccination program had confined smallpox to parts of Pakistan, India, Bangladesh, Ethiopia and Somalia.

     In 1977 the WHO recorded the last case of smallpox infection acquired outside a laboratory in Somalia. In 1980 the WHO officially declared the world free of smallpox.

   In 1974 the WHO adopted the goal of universal vaccination by 1990 to protect children against six preventable infectious diseases: measles, poliomyelitis, diphtheria, whooping cough, tetanus, and tuberculosis.

    In the 1980s only 20 to 40% of children in developing countries were vaccinated against these six diseases. In wealthy nations the number of measles cases had dropped dramatically after the introduction of the measles vaccine in 1963. WHO figures demonstrate that in many countries a decline in measles vaccination leads to a resurgence in measles cases. Measles are so contagious that public health experts believe a vaccination rate of 100% is needed to control the disease.  Despite decades of mass vaccination polio remains a threat in India, Nigeria, Somalia, Niger, Afghanistan, Bangladesh and Indonesia.

   By 2006 global health experts concluded that the eradication of polio was only possible if the supply of drinking water and sanitation facilities were improved in slums. The deployment of a combined DPT vaccine against diphtheria, pertussis (whooping cough), and tetanus in the 1950s was considered a major advancement for public health. But in the course of vaccination campaigns that spanned decades, DPT vaccines became associated with high incidences of side effects. Despite improved DPT vaccines coming onto the market in the 1990s, DPT vaccines became the focus of anti-vaccination campaigns in wealthy nations. As immunization rates decreased, outbreaks of pertussis increased in many countries.

      In 2000, the Global Alliance for Vaccines and Immunization was established to strengthen routine vaccinations and introduce new and under-used vaccines in countries with a per capita GDP of under US$1000.

     Advantages-Disadvantage of being a doctor

     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

 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 ModernaPfizer-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.

     Advantages-Disadvantage of being a doctor

     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

New book: ‘The Real Issues’ through ‘fictional narratives’


“AT THE HORIZON OF LIFE AND DEATH”

Find it on Amazon :

Description

         This book comprises of stories that capture the pivotal moments in the treatment trajectory of the critical patients facing death.  The times that force the doctor to confront the saddest moments, while battling a terrifying, unbeatable foe, the death monster alongside families’ fears, gloom, indecisiveness, dilemmas about future and saviour’s own predicaments intertwined with medico-legal intricacies and consequent complex emotional interactions.  

        The situations depict ‘the real issues’ through ‘fictional narratives’. 

       The stories reflect life of a doctor in the present era, amidst sick patients in an imposed legal milieu, a mystic journey, an arcane odyssey punctuated with pain and pleasure in the narrow and uncertain lanes at the horizon of life and death, carrying the burden of various vicissitudes like consumerism, legalities, unpredictable course of diseases, mistrust and blame for poor outcomes.   

        The narratives try to unmask the eternal latent vulnerability that is intrinsic in doctor’s work, which is exploited by media, law industry and even celebrities to sensationalize and sell their news and shows. The vulnerability turns more evil as the delineating cleft that separates doctors from the invisible overpowering medical industry is not shown, thus ensuring to sustain the prejudice with its dangerous bias towards health care workers. 

        One negative news story through a ‘portrayal effect’ generates unbridgeable gap in doctor -patient relationship, painful burden of mistrust loaded on doctors, that would heal only if millions of unfettered, unprejudiced, unbiased facts are clearly projected. 

           The book tries to highlight a seemingly illogical and contrary nature of the conflict; the doctors are finding themselves increasingly being engaged into. The dense mazes of consumerism, extensive communication, documentation, unrealistic expectations, negative media insinuations, legal complexities are demoralizing to doctors and certainly counterproductive for patients.

         The futile discords emanate frequently, that are mundane in reality when compared to the actual disease and the real point of intention which is ‘The Treatment of the Patient’.

         But is this what the patients actually need? Does the entanglement of doctors in such a maze help the patients in real sense?

        The author felt morally compelled and attempted to find answers, embedded in a journey that was wondrous and inspirational, but with horrifying moments as well.

        Has the decision to treat human fragility become a mistake in present era?  No reward, if you win the match of life and death but sword hanging; if  one were to lose?     

       Patient will need to decide someday, whether to be a consumer or just remain a patient. 

       Being a consumer may be an overall loss-making deal for the patient.

Disclaimer

   The stories are fictional, but the depiction of the problems to the doctors, nurses and patients are real, based on day to day routine incidents. The episodes do not pertain to any single particular person, patient, doctor, nurse, hospital and organization. All the characters, names and dialogues in the book are figment of imagination of the author and similarity to any person, any situation or organization may be co-incidental.

            The stories are not against any law, word of courts, profession, any government or any organizational set up or rules of any country. They depict the problems commonly faced by doctors in performing their duties hence are likely to affect the patient directly.

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.

     Advantages-Disadvantage of being a doctor

     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

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.

     Advantages-Disadvantage of being a doctor

     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

Admin Apathy- Kerala Doctors to Protest State’s ‘lack of concern’


         Doctors and nurses are now  getting out of their own self-imposed moral enslavement. Rather they are now forced to do so, as their lives and deteriorating working environment are becoming impossible to be in. One cannot burn himself in a furnace for eternity, for the well-being of others, especially if others are not concerned.

      The incidents at few places are just a tip of the iceberg. Covid has helped doctors to bring forth their plight. Doctors and nurses not paid for months in some Delhi Hospitals.  Doctors openly ridiculed and scolded by Administrators for no fault of theirs. Even a doctor lynched by mob in Assam and many assaulted at other places. Hospitals vandalized indicate that there is danger lurking for doctors everywhere. Most sad part is that, there are no firm administrative hands to deal with the menace.

     Clearly Well being of doctors and nurses is not being taken care of. They are being used as dispensable disposables. Such system, which is based on exploitation of the health workers, is becoming fast unsustainable. If apathy towards their genuine problems continues, negative attitude towards doctor and nurses persists,  it will kill the empathy towards patients as well.

 Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

Government doctors in Kerala to boycott additional duties

    The Kerala Government Medical Officers’ Association (KGMOA) has declared that government doctors will stay away from all additional duties from Thursday, in protest against the government’s apparent lack of concern about the plight of health-care workers who are overworked and fatigued, fighting on the front lines for the past nine months.

  The KGMOA has, however, made it clear that while declaring non-cooperation, COVID-19 care and disease containment activities will not be disrupted.

In a statement issued here, the KGMOA said that apart from ignoring the KGMOA’s repeated demand for deploying additional human resources in COVID-19 care activities, the government’s decision to take away the leave given to health-care workers after continuous COVID-19 duty was something that defied all principles of fairness. This was totally unacceptable, the KGMOA said here.

   Advantages-Disadvantage of being a doctor

   25 factors- why health care is expensive

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   21 occupational risks to doctors and nurses

   Covid paradox: salary cut for doctors other paid at home

Are Doctor & Nurses Dispensable Disposables?


 

It is surprising that  doctors and nurses, who can save many lives, have to put their own lives at risk for the want of proper PPE’s. The cost of PPE’s is not more than few hundred rupees.  Even such a cheap facility is not available to the saviors for their own protection. Such episodes are not only  painful to the medical fraternity but also expose the hypocritical  attitude of the administrators as well as  the insensitive approach of society towards health care workers, although everyone expects doctors and nurses to be sensitive towards every one. Such incidents demoralizes and causes deep discouragement to the front line doctor and nurses, but sadly remains a routine business for administrators. The pain of being  treated like a dispensable disposables remains as  a deep hurt within.

10 govt docs, 70 private nurses have quit in Telangana over safety, hospital infra.   (Times of India)

 

At least 10 senior resident doctors deputed on Covid-19 duty at government hospitals and 70 nurses in private facilities have quit their jobs, with most citing poor protective gear to combat the virus as a reason.

While the senior residents said they were dejected with the poor state-of affairs at hospitals and the looming threat of contracting the infection, some individual doctors and nurses took a break from the profession, until the pandemic, gets over. These doctors are from the Osmania Medical College (OMC) and Mahatma Gandhi Memorial (MGM) hospital Warangal among other government hospitals. So far, 300 doctors and other medical personnel in the government sector alone have contracted the virus, with worries of sub-standard protective gear and long working hours, forcing doctors to even go on strike. Some senior resident doctors deputed from the OMC to the Chest Hospital never reported for duty, while others served for one or two months before putting in their papers. “The problem is not just that there was a threat of infection and we didn’t get proper personal protection equipment (PPE) kits, it seemed like a waste of effort. Even if a patient was dying in front of me, I could do nothing at all,” said one of the senior resident doctor who had resigned from the OMC .

“We didn’t have staff, we didn’t have the infrastructure, we didn’t have proper PPE kits or any other provision required. It seemed like a futile effort,” he said. Despite the guilt of having resigned in the middle of an ongoing pandemic, the doctors said that their presence or absence hardly made any difference to the situation. Authorities ignored repeated complaints It was like there is everything wrong, but no one was there to take responsibility. I felt bad about resigning but after over a month of working and making repeated requests for additional doctors and nurses, there was no difference. It was just a blame game,” another doctor told TOI. From the medicine department at Osmania General Hospital (OGH), six senior residents have resigned, while few others have resigned at the MGM hospital, said Dr Mahesh Kumar, president, Healthcare Reforms Doctors Association (HRDA). “At the beginning of the pandemic, there was a lot of issues with PPE kits and infrastructure and despite repeated representations they were not sorted out. Most of the residents resigned in the first two months of the pandemic, discouraged by the situation and fearing for their personal safety,” he added. Apart from doctors, 70 nurses who are at the frontline have gone missing from work too. “A least 30 of these nurses went missing from a single corporate hospital. Currently, there is a huge shortage of nurses as most are reluctant to do Covid-19 duties,” said Laxman Rudavath, president, Nursing Officers Association of Telangana.

 

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