Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Responding to the new COVID-19 sub-variants
Note4Students
From UPSC perspective, the following things are important :
Prelims level: COVID-19 subvariants
Mains level: Continuous tracking of virus variants is challenging due to the unpredictable nature of genetic changes.
Central idea
Dr. Chandrakant Lahariya discusses the emergence of the JN.1 sub-variant of SARS-CoV-2, highlighting its classification as a Variant of Interest (VoI). He emphasizes the need for ongoing genomic sequencing and data tracking while reassuring that, as of now, there’s no evidence of increased severity or immune escape. The central idea is to approach COVID-19 like any respiratory illness, maintaining standard preventive measures and avoiding unnecessary concerns.
Key Highlights:
- Dr. Chandrakant Lahariya, a medical doctor with extensive WHO experience, addresses the emergence of the JN.1 sub-variant of the Omicron variant of SARS-CoV-2.
- Over 1,000 subvariants have been reported since the novel coronavirus outbreak in 2019.
- The designation of JN.1 as a Variant of Interest (VoI) prompts increased genomic sequencing for monitoring.
Key Challenges:
- Continuous tracking of virus variants is challenging due to the unpredictable nature of genetic changes.
- Distinguishing between inconsequential and significant genetic alterations requires careful assessment by international agencies and experts.
Key Terms:
- SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus-2.
- VoI: Variant of Interest.
- VoC: Variant of Concern.
- Hybrid Immunity: Combined immunity from natural infection and vaccination.
Key Phrases:
- “Silent wave”: JN.1 circulated without causing a significant increase in reported or clinical cases.
- “Genetic material changes”: Variants and subvariants result from alterations in the virus’s genetic structure.
Key Quotes:
- “Designating a variant as VoI does not automatically mean there is a reason to worry.”
- “JN.1 is not a new virus but a sub-variant of BA.2.86, itself a subvariant of Omicron.”
- “There is no scientific evidence to support having a fourth shot of COVID-19 vaccines.”
Key Statements:
- WHO declared the end of the COVID-19 pandemic in May 2023 but emphasized the need for ongoing virus and variant tracking.
- JN.1, as a VoI, requires heightened genomic sequencing and data tracking but doesn’t indicate an immediate cause for concern.
Key Examples and References:
- JN.1 is a subvariant of BA.2.86, part of the Omicron variant of SARS-CoV-2.
- Waste-water surveillance in some Indian cities suggested JN.1 circulated widely without a significant increase in reported cases.
Key Facts:
- Since 2019, more than 1,000 subvariants and recombinant sub-lineages of SARS-CoV-2 have been reported.
- Immunologically, current evidence supports continued protection from COVID-19 vaccines against subvariants.
Key Data:
- Average daily deaths due to respiratory diseases and tuberculosis in India are 50 to 60 times higher than COVID-19 deaths.
Critical Analysis:
- Dr. Lahariya emphasizes the need for nuanced government responses, responsible citizen behavior, and clear science communication.
- The spike in COVID-19 cases may be due to increased testing, and deaths attributed to COVID-19 might be incidental in already sick individuals.
Way Forward:
- Handle SARS-CoV-2 like any other respiratory illness, focusing on standard public health measures.
- Individual and community levels should maintain routine activities, and school closure should not be considered in response to a COVID-19 case surge.
- Continuous surveillance, waste-water monitoring, and improved health facility services are essential for effective response.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
New COVID Variant ‘JN.1’
Note4Students
From UPSC perspective, the following things are important :
Prelims level: JN.1 Variant
Mains level: Not Much
Central Idea
- Following the detection of the JN.1 COVID-19 variant, Karnataka announced that senior citizens are advised to wear masks.
- The JN.1 variant was identified in Kerala and in a traveler from Singapore to Tamil Nadu, with additional cases found in Goa.
Understanding the JN.1 Variant
- Variant Lineage: JN.1 is a sub-variant of BA.2.86, also known as Pirola, first detected in the United States in September and globally as early as January.
- Mutation Characteristics: While JN.1 has only one additional mutation on the spike protein compared to Pirola, its high number of spike protein mutations has drawn attention of researchers.
Potential Impact of JN.1
- Transmission and Severity: Currently, there is no evidence suggesting that JN.1 causes more severe symptoms or spreads faster than other circulating variants.
- WHO Assessment: Both Pirola and JN.1 have been effectively neutralized by serum from infected and vaccinated individuals, according to the WHO Technical Advisory Group on COVID-19 Vaccine Composition.
Global Spread and Current Concerns
- Increasing Cases: A rise in cases caused by Pirola and JN.1 has been observed globally, including in the USA, Europe, Singapore, and China.
- WHO Data: JN.1 accounted for a significant proportion of COVID-19 sequences in the GISAID database and a notable percentage of variants in the United States.
- Singapore’s Situation: Singapore reported a surge in COVID-19 cases, predominantly JN.1, with increased hospitalizations among older individuals.
Vaccination and Immunity in India
- Hospitalization Risk: Data from Singapore indicates higher hospitalization risks for those who received their last COVID-19 vaccine dose over a year ago.
- Indian Immunity Levels: Doctors suggests that widespread vaccination and exposure to COVID-19 have likely resulted in substantial immunity in India, reducing the need for updated vaccines.
- Consistent Precautions: Experts recommend standard protective measures against respiratory viruses, including masking in crowded and enclosed spaces, staying in well-ventilated areas, and frequent hand washing.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Nipah breaks out again in Kerala
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Nipah Virus
Mains level: NA
Central Idea
- The reappearance of Nipah infection in Kerala, with two confirmed deaths and two individuals under treatment, has raised concerns about this lethal viral disease.
- Nipah, while not as contagious as COVID-19, is significantly more deadly, with a case fatality rate ranging from 40% to 75%.
What is Nipah Virus Infection?
- Nipah is a zoonotic disease, meaning it is transmitted to humans through infected animals or contaminated food.
- Direct person-to-person transmission through close contact with an infected individual is also possible.
- Symptoms include fever, headache, cough, sore throat, difficulty in breathing, and vomiting.
- In severe cases, Nipah infection can progress to disorientation, drowsiness, seizures, and encephalitis (brain swelling), ultimately leading to coma and death.
Transmission of Nipah Virus
- Historical Outbreaks: The Nipah virus was first reported in Malaysia (1998) and Singapore (1999), deriving its name from a Malaysian village where it was first isolated. The primary mode of transmission from animals to humans is through the consumption of contaminated food. This can occur via the consumption of raw date palm sap or fruit contaminated with saliva or urine from infected bats.
- Animal Host Reservoir: Fruit bats, commonly known as flying foxes, are the known hosts of the virus. They transmit it to other animals like pigs, dogs, cats, goats, horses, and sheep. Human infection usually occurs through direct contact with these animals or the consumption of food contaminated by their saliva or urine. Human-to-human transmission is also documented, particularly in families and healthcare settings.
Nipah Virus Spread and Mortality
- Slow Spread: Unlike the rapid transmission of SARS-CoV-2, the Nipah virus spreads more slowly. However, its high mortality rate is a significant concern.
- High Mortality: During outbreaks, Nipah has shown a mortality rate as high as 68-75%. For example, in the 2001 Siliguri outbreak, 45 of the 66 infected individuals succumbed to the virus. Similarly, during the 2018 Kerala outbreak, 17 of the 18 confirmed patients died.
- Localized Outbreaks: Notably, Nipah outbreaks have remained localized and were contained relatively quickly. The virus’s limited infectiousness and low human-to-human transmission contribute to this containment.
- Reproductive Number (R0): Studies indicate an R0 of about 0.48 for Nipah outbreaks, signifying a slow rate of transmission within the population. An R0 value below one suggests that an infected person does not infect more than one other individual, leading to a relatively rapid end to the outbreak.
- High Death Rates Limit Transmission: The virus’s high death rates also play a role in restricting its transmission.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Metagenome Sequencing and Pathogen Surveillance
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Metagenomics
Mains level: NA
Central Idea
- Genome sequencing technologies played a crucial role in identifying the causative agent of the COVID pandemic.
- This approach, known as metagenomics, revolutionized pathogen identification and surveillance, enabling rapid response to emerging threats.
Metagenomics and COVID-19
- Unprecedented Scale: Scientists rapidly applied genome sequencing to identify SARS-CoV-2, making it one of the most sequenced organisms in history.
- Break from Tradition: Instead of traditional microbiological methods, patient samples were directly subjected to genome sequencing, expediting virus identification.
- Global Genome Surveillance: The success of genome sequencing led to the development of technologies like CovidSeq assay and spurred national and international SARS-CoV-2 genome surveillance initiatives.
What is Genome Sequencing?
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Application in Pathogen Surveillance
- Genome Surveillance Technologies: Several technologies based on genome sequencing, such as the CovidSeq assay, were developed for SARS-CoV-2 detection.
- GISAID Repository: GISAID became a repository for global genome-sequence data, reflecting high-throughput genome surveillance activities.
- India’s Initiatives: India initiated a national genome-sequencing and surveillance program for SARS-CoV-2, fostering national-level efforts.
Nigerian Study and Metagenomic Sequencing
- Application of Metagenomics: Nigerian scientists employed metagenomic sequencing to study pathogen surveillance in three cohorts of patients.
- Versatile Approach: The study identified 13 distinct viruses among the cohorts and aided in detecting co-infections and undiagnosed conditions.
- Diagnostic Power: Metagenomics helped link symptoms to pesticide poisoning in some cases, showcasing its diagnostic potential.
Diverse Applications and Future Prospects
- Expanding to Other Pathogens: Genome sequencing technologies are being applied to detect other pathogens like Zika, dengue, lumpy skin disease, and drug-resistant tuberculosis.
- Environmental Surveillance: Genome surveillance is being extended to diverse sources, such as wastewater, air, soil, and animals, aiding in early detection and response strategies.
- Mainstay for Pathogen Defense: The speed, accuracy, and adaptability of genome sequencing make it a cornerstone for future pathogen detection, surveillance, and response.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
India joins Centralised Laboratory Network (CLN)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Centralised Laboratory Network (CLN)
Mains level: Not Much
Central Idea
- India has recently become a member of the Centralized Laboratory Network (CLN), which is a part of the Coalition for Epidemic Preparedness Innovations (CEPI).
Centralised Laboratory Network (CLN)
- CLN consists of 15 partner facilities in 13 countries and aims to test vaccines for use during pandemics and epidemic disease outbreaks.
- It focuses on testing vaccines for pandemic and epidemic disease outbreaks.
- It is part of the Coalition for Epidemic Preparedness Innovations (CEPI).
- The network aims to standardize testing methods and materials.
New members of the CLN
- Indian Council of Medical Research-National Institute of Virology (ICMR-NIV) joins CLN.
- Institute Pasteur de Dakar (IPD) from Senegal is a new member.
- KAVI Institute of Clinical Research (KAVI ICR) and University of Nairobi Institute of Tropical and Infectious Diseases (UNITID) from Kenya join CLN.
- Synexa Life Sciences from South Africa becomes a member.
- Uganda Virus Research Institute (UVRI) from Uganda is also a new member.
Objectives of the CEPI-funded network
- The CEPI-funded network aims to identify promising vaccine candidates rapidly and accurately.
- The network focuses on emerging infectious diseases.
- The goal is to support sustainable regional outbreak preparedness infrastructure.
CEPI-Funded Network Objectives
- The CEPI-funded network, which includes CLN, has the primary objective of identifying the most promising vaccine candidates rapidly and accurately against emerging infectious diseases.
- In addition to vaccine testing, the expanded network also aims to support the development of sustainable regional outbreak preparedness infrastructure.
- By working collaboratively and sharing standardized methods and materials, the network enhances global preparedness for potential disease outbreaks.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Moving Beyond COVID-19: Need for Contextual Understanding
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NA
Mains level: Lessons learned form COVID-19 pandemic and the future of Health governance
Central Idea
- COVID-19 has transitioned from a population-level challenge to more of an individual health concern, and it is time for India to shift gears and apply the lessons learned from the pandemic.
WHO Announcements on COVID-19
- On January 30, 2020, COVID-19 was announced as a public health emergency of international concern.
- On May 5, 2023, WHO declared that COVID-19 was no longer a public health emergency of international concern.
Issues of misinformation during the second wave of COVID-19 in India
- False claims about a third wave affecting children: In April-May 2021, there was a COVID-19 misinformation blitzkrieg that a third wave in India would affect children, leading to children being repeatedly asked to wear masks and deprived of schooling and learning.
- Lack of scientific evidence: School closure and making masks mandatory for schoolchildren had their origin in nearly identical challenges of actions not being supported by scientific evidence.
- Influencers’ impact on public discourse: Social media influencers, not necessarily subject experts, were shaping the public discourse, which was not effectively addressed by governments.
- Disparate viewpoints: Disparate viewpoints existed among experts and influencers living in India and abroad, with the latter making more definitive and stronger arguments for school closure and mask wearing for children in India.
- Failure to consider local context: The sub-groups of super-specialists and those staying abroad failed to factor in the local context while coming up with their opinions.
- Dogmatic stands of self-proclaimed experts: Self-proclaimed experts and influencers have adopted a dogmatic stand and have been selectively and conveniently using emerging evidence and published literature to support their stand, often misguiding gullible followers.
- COVID-foreverers: A group of disparate individuals and social media groups keep insisting on the enforcement of restrictions such as universal masking at ‘the drop of the hat’, often on frivolous grounds.
What lessons were learned from the COVID-19 pandemic?
- The importance of preparedness: The pandemic highlighted the importance of being prepared for future outbreaks and the need for robust public health infrastructure.
- The role of misinformation: The pandemic showed how misinformation can spread rapidly and have serious consequences, highlighting the need for better education and awareness to combat misinformation.
- The importance of local context: The pandemic demonstrated the importance of factoring in local context when making policy decisions, as different regions and countries may face different challenges and require different interventions.
- The danger of dogmatic thinking: The pandemic showed how dogmatic thinking can be dangerous, and the need for an open-minded and evidence-based approach to decision-making.
- The importance of nuance and context in epidemiology: The pandemic highlighted the need for nuanced understanding of epidemiology, and the importance of taking into account the broader context when interpreting scientific studies.
- The need for a shift in focus: With COVID-19 transitioning from a population-level challenge to more of an individual health concern, there is a need to shift the focus from COVID-19 fixation to tackling other pressing health challenges.
- The importance of integrating COVID-19 response with general health services: The pandemic showed the need for integration of COVID-19 response with general health services, and the importance of a balanced approach to public health.
Way forward
- Formal training courses on the principles and practice of epidemiology should be offered by the government to prepare India for more nuanced responses to outbreaks and epidemics and to curb misinformation.
- The government needs to integrate the COVID-19 response to general health services.
- India’s response to surges, outbreaks, and epidemics (of any infectious disease and not just COVID-19) should be guided by a nuanced understanding of epidemiology and not unduly derailed by social media influencers.
- Schools should not be closed for a COVID-19 uptick, and wearing masks in order to attend school should never again be made mandatory, as children were never at risk from moderate to severe COVID-19.
- It is time to drop the COVID-19 fixation and move on to tackle other more pressing health challenges in the country.
Conclusion
- The COVID-19 pandemic has presented numerous challenges and lessons for India and the world. The issues of misinformation and lack of context-based policy interventions have been major obstacles in effectively tackling the pandemic. It is time to apply the lessons learned and shift focus to other pressing health challenges while being prepared to respond to future outbreaks and epidemics with a nuanced understanding of epidemiology.
Mains Question
Q. During the COVID-19 pandemic, how did misinformation pose a significant challenge? Discuss what lessons have we learned from it?
Also Read:
| Covid is no longer an Emergency: what changes? |
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
FDA approves first vaccine for Respiratory Syncytial Virus
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Respiratory Syncytial Virus, F Protein
Mains level: NA
The Food and Drug Administration (FDA) has approved the first vaccine ‘Arexvy’ for respiratory syncytial virus (RSV) to lower respiratory tract disease in people older than 60 years.
What is Respiratory Syncytial Virus?
- Respiratory Syncytial Virus (RSV) is a common respiratory virus that can cause illness in people of all ages.
- It is the most common cause of lower respiratory tract infections in infants and young children, and it can also affect older adults and people with weakened immune systems.
- RSV is highly contagious and spreads through droplets when an infected person coughs or sneezes, or by touching a surface contaminated with the virus and then touching one’s face.
- Symptoms of RSV can range from mild to severe, including runny nose, coughing, sneezing, fever, wheezing, and difficulty breathing.
- In severe cases, it can lead to pneumonia, bronchiolitis, or death.
Identification of Protein F
- In 2013, Barney Graham and other scientists identified the key protein, protein F, responsible for the RSV virus to infect human cells.
- The protein, introduced in humans, elicited neutralizing antibodies against the virus.
Approval and Efficacy of Arexvy
- The FDA has approved Arexvy, the first RSV vaccine to be approved anywhere in the world, manufactured by GSK.
- The approval was based on a phase-3 trial carried out on nearly 25,000 participants.
- It showed a single dose of the vaccine reduced the risk of developing lower respiratory tract disease caused by the RSV virus by 82.6% and severe disease by 94.1% in people older than 60 years.
- The vaccine will be available for older adults in the U.S. before the 2023-2024 RSV season.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Omicron evolved strategies to evade T Cell Immunity
Note4Students
From UPSC perspective, the following things are important :
Prelims level: T Cell Immunity
Mains level: Covid resurgence
Central idea: The SARS-CoV-2 virus has the ability to evade CD8 T cells, which are important in reducing the viral load and clearing the infection by detecting and killing infected cells.
What is the news?
- A recent study has revealed that the SARS-CoV-2 virus has the ability to modulate MHC I expression in host cells.
- MHC I is crucial in alerting the immune system to virally infected cells.
- The virus has evolved multiple strategies to inhibit MHC I expression, which is not seen in the case of the influenza virus.
What is T Cell Immunity?
- Like B cells, which produce antibodies, T cells are central players in the immune response to viral infection.
- For your immune system to fight off any kind of invader, such as a virus, you need a kind of white blood cell called a B cell, which makes antibodies, and a similar-looking white blood cell called a T cell.
- T cells can play different roles altogether.
- They can act as “killer cells”, attacking cells which have been infected with a virus or another kind of pathogen, or they can act as “helper cells” by supporting B cells to produce antibodies.
How do they function?
- Alongside antibodies, the immune system produces a battalion of T cells that can target viruses.
- Some of these, known as killer T cells (or CD8+T cells), seek out and destroy cells that are infected with the virus.
- Others, called helper T cells (or CD4+T cells) are important for various immune functions, including stimulating the production of antibodies and killer T cells.
- T cells do not prevent infection, because they kick into action only after a virus has infiltrated the body. But they are important for clearing an infection that has already started.
- In the case of COVID-19, killer T cells could mean the difference between a mild infection and a severe one that requires hospital treatment.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Marburg Virus
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Marburg Virus
Mains level: Rise in zoonotic diseases
Central idea: Equatorial Guinea has confirmed its first-ever outbreak of Marburg virus disease.
Where is Equatorial Guinea located?
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Marburg Virus
- The Marburg virus is a highly dangerous pathogen that targets several organs and reduces the body’s ability to function on its own.
- Depending on the strain and case management, the fatality rates for the virus range from 24% to 88%.
Transmission and Prevention
- The natural carrier of the Marburg virus is the African fruit bat, which carries the virus but does not fall sick from it.
- Human-to-human transmission occurs through contact with blood or other bodily fluids.
- Rehydration treatment to alleviate symptoms can improve the chances of survival.
Its outbreaks
- The virus has caused simultaneous outbreaks of disease in laboratories in Marburg, Germany and Belgrade, Serbia in 1967, resulting in seven deaths.
- During an outbreak in Angola in 2004, the virus killed 90% of the 252 people who were infected, and in Ghana last year, two people died of Marburg.
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What is Immune Imprinting?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Immune Imprinting
Mains level: NA
A slew of recent studies has shown that a phenomenon in our bodies, called immune imprinting, might be making new boosters vaccines far less effective than expected for coronavirus infection.
What is Immune Imprinting?
- Immune imprinting is a tendency of the body to repeat its immune response based on the first variant it encountered.
- Our body does this through infection or vaccination — when it comes across a newer or slightly different variant of the same pathogen.
- The phenomenon was first observed in 1947, when scientists noted that “people who had previously had flu, and were then vaccinated against the current circulating strain, produced antibodies against the first strain.
- At the time, it was termed the ‘original antigenic sin’ but today, it’s commonly known as imprinting.
How imprinting works for immune system?
- Imprinting acts as a database for the immune system, helping it put up a better response to repeat infections.
- After our body is exposed to a virus for the first time, it produces memory B cells that circulate in the bloodstream and quickly produce antibodies whenever the same strain of the virus infects again.
- The problem occurs when a similar, not identical, variant of the virus is encountered by the body.
- In such cases, the immune system, rather than generating new B cells, activates memory B cells.
- This in turn produce antibodies that bind to features found in both the old and new strains, known as cross-reactive antibodies.
Are the booster doses completely useless?
- These cross-reactive antibodies do offer some protection against the new strain,.
- However they are not as effective as the ones produced by the B cells when the body first came across the original virus.
How to circumvent immune imprinting?
- Currently, several ongoing studies are trying to find a way to deal with imprinting.
- Some scientists have said nasal vaccines might be better at preventing infections than injected ones.
- They believe the mucous membranes would create stronger protection, despite carrying some imprint of past exposure.
- Researchers are also trying to find if spacing out coronavirus vaccine shots on an annual basis, could help with the problem of imprinting.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Tomato Flu cases found in India
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Tomato Flu
Mains level: Not Much
With cases of tomato flu reported from at least four states — Kerala, Tamil Nadu, Haryana, and Odisha — the Union Health Ministry has issued a set of guidelines on prevention, testing, and treatment of the infection.
Researchers believe that it is a different clinical presentation of hand-foot-and mouth disease (HFMD) caused by a group of enteroviruses (viruses transmitted through the intestine).
What is Tomato Flu?
- Tomato flu or tomato fever is characterized by fever, joint pain, and red, tomato-like rashes usually seen in children below the age of five years.
- This is accompanied by other symptoms of viral fevers such as diarrhoea, dehydration, nausea and vomiting, and fatigue.
- This was thought to be an aftereffect of dengue and chikungunya that is commonly seen in Kerala.
- However, researchers now believe that it is HFMD caused by enteroviruses like Coxsackievirus A-6 and A-16.
Is it very uncommon?
- Tomato flu could be an after-effect of chikungunya or dengue fever in children rather than a viral infection.
- It could also be a new variant of the viral hand, foot, and mouth disease, a common infectious disease targeting mostly children aged 1–5 years and immunocompromised adults.
- HFMD is not a new infection, we have read about it in our textbooks. It is reported from time to time across the country, but it is not very common.
Why is the infection spreading now?
- There actually are more cases or because we are more vigilant about viral infections and testing after Covid-19.
- Since the disease is self-limiting, doctors do not usually test for it.
- There are so many viral infections in children, but we cannot — and there is no need to — test for each and every one of it.
Which pathogen is causing it now? And how is the clinical presentation different?
- The current HFMD cases are mainly caused by Coxsackievirus A-6 and A-16.
- Another pathogen — Enterovirus71 — that also causes the disease is not very prevalent now, according to her.
- This is good because the pathogen was known to lead to severe neurologic symptoms, including fatal encephalitis (brain inflammation).
- In almost all cases, say 99.9% cases, the disease is self-limiting.
- But, in a small number of cases it can lead to CNS (central nervous system) complications.
Is there a treatment for the infection?
- There is no specific treatment or vaccine available for the disease.
- Those with the infection are treated symptomatically, such as prescription of paracetamol for fever.
How can the infection be prevented?
- As it happens mainly in children, the Centre’s advisory focuses on preventions in these age groups.
- As per the advisory, anyone suspected to have the infection should remain in isolation for five to seven days after the onset of the symptoms.
- It states that children must be educated about the infection and asked not to hug or touch other children with fever or rashes.
- The children should be encouraged to maintain hygiene, stop thumb or finger sucking, and use a handkerchief for a running nose, the advisory states.
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What is Langya Virus?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Langya virus
Mains level: Zoonotic Diseases
A new virus, Langya henipavirus, is suspected to have caused infections in 35 people in China’s Shandong and Henan provinces over roughly a two-year period to 2021.
Langya Virus
- It’s related to Hendra and Nipah viruses, which cause disease in humans.
- However, there’s much we don’t know about the new virus – known as LayV for short – including whether it spreads from human to human.
How sick are people getting?
- Symptoms reported appeared to be mostly mild – fever, fatigue, cough, loss of appetite, muscle aches, nausea and headache – although we don’t know how long the patients were unwell.
- A smaller proportion had potentially more serious complications, including pneumonia, and abnormalities in liver and kidney function.
- However, the severity of these abnormalities, the need for hospitalization, and whether any cases were fatal were not reported.
Where did this virus come from?
- The authors also investigated whether domestic or wild animals may have been the source of the virus.
- Although they found a small number of goats and dogs that may have been infected with the virus in the past, there was more direct evidence a significant proportion of wild shrews were harbouring the virus.
- This suggests humans may have caught the virus from wild shrews.
Does this virus actually cause this disease?
- The researchers used a modern technique known as metagenomic analysis to find this new virus.
- Researchers sequence all genetic material then discard the “known” sequences (for example, human DNA) to look for “unknown” sequences that might represent a new virus.
- This raises the question about how scientists can tell whether a particular virus causes the disease.
- Researchers used “Koch’s Postulates” to determine whether a particular micro-organism causes disease:
- it must be found in people with the disease and not in well people
- it must be able to be isolated from people with the disease
- the isolate from people with the disease must cause the disease if given to a healthy person (or animal)
- it must be able to be re-isolated from the healthy person after they become ill.
What can we learn from related viruses?
- This new virus appears to be a close cousin of two other viruses that are significant in humans: Nipah virus and Hendra virus.
- This family of viruses was the inspiration for the fictional MEV-1 virus in the film Contagion.
- Hendra virus was first reported in Queensland in 1994, when it caused the deaths of 14 horses and the trainer Vic Rail.
- Nipah virus is more significant globally, with outbreaks frequently reported in Bangladesh.
What lies ahead?
- Little is known about this new virus, and the currently reported cases are likely to be the tip of the iceberg.
- At this stage, there is no indication the virus can spread from human to human.
- Further work is required to determine how severe the infection can be, how it spreads, and how widespread it might be in China and the region.
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Monkeypox is ‘Public Health Emergency’
Note4Students
From UPSC perspective, the following things are important :
Prelims level: PHEIC, Monkeypox
Mains level: Rise in zoonotic diseases
The World Health Organization’s Director-General has declared monkeypox a public health emergency of international concern (PHEIC) July 23, 2022.
What is PHEIC?
Definition: Under the International Health Regulations (IHR), a public health emergency is defined as “an extraordinary event which is determined, as provided in these Regulations: to constitute a public health risk to other States through the international spread of disease; and to potentially require a coordinated international response”.
What criteria does the WHO follow to declare PHEIC?
- PHEIC is declared in the event of some “serious public health events” that may endanger international public health.
- The responsibility of declaring an event as an emergency lies with the Director-General of the WHO and requires the convening of a committee of members.
Implications of a PHEIC being declared
The PHEIC is the highest level of alert the global health body can issue.
- There are some implications of declaring a PHEIC for the host country.
- Only polio and SARS-CoV-2 were ongoing PHEIC prior to monkeypox.
- Declaring a PHEIC may lead to restrictions on travel and trade.
Back2Basics: Monkeypox
- The monkeypox virus is an orthopoxvirus, which is a genus of viruses that also includes the variola virus, which causes smallpox, and vaccinia virus, which was used in the smallpox vaccine.
- It causes symptoms similar to smallpox, although they are less severe.
- While vaccination eradicated smallpox worldwide in 1980, monkeypox continues to occur in a swathe of countries in Central and West Africa, and has on occasion showed up elsewhere.
- According to the WHO, two distinct clade are identified: the West African clade and the Congo Basin clade, also known as the Central African clade.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is Black Death?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Black Death
Mains level: NA
In a study published in the Science journal, researchers have claimed that the bubonic plague was originated in modern day northern Kyrgyzstan around 1338-1339 – nearly 7-8 years before it ravaged large parts of the world.
What is Black Death?
- The term Black Death refers to the bubonic plague that spread across Western Asia, Northern Africa, Middle East and Europe in 1346-53.
- Most scholars agree that the Black Death, which killed millions, was caused by bacterium Yersinia pestis and was spread by fleas that were carried by rodent hosts.
- The microorganism Y. pestis spread to human populations, who at some point transmitted it to others either through the vector of a human flea or directly through the respiratory system.
Why this plague was called the Black Death?
- It is commonly believed that the term Black Death gets its name from the black marks that appeared on some of the plague victims’ bodies.
- In the 14th century, the epidemic was referred to as the ‘great pestilence’ or ‘great death’, due to the demographic havoc that it caused.
- The world black also carried a dark, gloomy emotional tone, due to the sheer amount of deaths generated by the plague.
Why is the new discovery significant?
- The geographical origin point of the plague has been debated for centuries.
- Some historians have argued that the plague originated in China, and spread across Europe by Italian merchants who first entered the continent in trading caravans through Crimea.
- Another story argues that Mongol army hurled plague-infested bodies into the city during the siege of Caffa (Crimea) and led to the spread of the disease.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is INSACOG?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: INSACOG
Mains level: NA
The PM has announced that the Indian SARS-CoV-2 Genomics Consortium (INSACOG) would be extended to India’s neighbouring countries.
What is INSACOG?
- INSACOG was established in December 2020 as a joint initiative of the Union Health Ministry of Health and Department of Biotechnology (DBT).
- It aims to expand the whole-genome sequencing of SARS-CoV-2, the coronavirus that causes the Covid-19 disease, across India with the aim of understanding how the virus spreads and evolves.
- It functions under the Ministry of Science and Technology with the Council for Scientific & Industrial Research (CSIR) and Indian Council of Medical Research (ICMR).
Composition of INSACOG
- INSACOG started out with the participation of 10 national research laboratories of the central government, and gradually expanded to a network of 38 labs.
- It now includes private labs operating on a hub-and-spoke model.
- These works to monitor genomic variations in SARS-CoV-2 by a sentinel sequencing effort which is facilitated by the National Centre for Disease Control (NCDC).
- It now involves the Central Surveillance Unit (CSU) under the central government’s Integrated Disease Surveillance Programme (IDSP).
Working of the INSACOG
- The data from the genome sequencing laboratories is analysed as per the field data trends to study the linkages, if any, between the genomic variants and epidemiological trends.
- INSACOG helps to understand super spreader events and outbreaks, and strengthen public health interventions across the country to help break chains of transmission.
- Linking this data with IDSP data and the patient’s symptoms helps to better understand viral infection dynamics, and trends of morbidity and mortality.
- The data can be linked with host genomics, immunology, clinical outcomes, and risk factors for a more comprehensive outlook.
- Sequencing assumes added significance as the incidence of reinfections and vaccine breakthroughs increases.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Settling India’s COVID-19 mortality data
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Not much
Mains level: Paper 2- Covid-19 mortality data
Context
Over the last year, the World Health Organization (WHO) has been busy, in an unprecedented effort, to calculate the global death toll from COVID-19.
Revision of Covid-19 death toll by WHO
- Globally from an estimated six million reported deaths, WHO now estimates these deaths to be closer to almost triple the number.
- The new estimates also take into account formerly uncounted deaths, but also deaths resulting from the impact of COVID-19.
- For example, millions who could not access care, i.e., diagnosis or treatment due to COVID-19 restrictions or from COVID-19 cases overwhelming health services.
- India’s stand: India is in serious disagreement with the WHO-prepared COVID-19 mortality estimates.
- The argument being made by India’s health establishment through a public clarification is that this is an overestimation, and the methodology employed is incorrect.
India’s Covid response
- India’s COVID-19 response has been replete with delays and denials.
- For instance, for the longest time that India’s COVID-19 number rose, the health establishment continued to insist that community transmission was not under way.
- It took months and several lakh cases before they agreed that COVID-19 was finally in community transmission.
- The devastation of the second wave showed how unprepared we were to combat the deadly Delta variant.
- By the time the wave subsided, India’s population was devastated, and helpless, seeing dignity neither in disease nor in death.
Conclusion
The figures ratchet up not only issues of administrative but also moral accountability for governments that they have been previously side stepped.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Recombinant Variants of SARS-CoV-2
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Recombination vs Mutation in viruses
Mains level: Severity of COVID
The World Health Organization (WHO) has flagged the emergence of a new variant of the SARS-CoV-2 virus — the XE recombinant.
How are variants created?
- SARS-CoV-2, the virus that causes COVID-19, is an RNA virus which evolves by accumulating genetic errors in its genome.
- These errors are produced when the virus infects a person and makes copies of itself inside the host’s cells.
- These errors (otherwise called mutations) are therefore a by-product of replication of SARS-CoV-2 inside the cell and may be carried forward as the virus continues to infect people.
- When viruses having a specific set of errors or mutations infect a number of people, this forms a cluster of infections descending from a common parental virus genome and is known as a lineage or a variant of the virus.
Who name these variants?
- The PANGO network, an open global consortium of researchers from across the world, provides a system for naming different lineages of SARS-CoV-2.
- Pangolin was developed to implement the dynamic nomenclature of SARS-CoV-2 lineages, known as the Pango nomenclature.
- These variants or lineages are widely followed by epidemiologists for tracking the evolution of SARS-CoV-2.
What is a recombinant variant?
- Apart from the errors in the virus genome, another process through which a virus increases its genetic diversity is recombination.
- Recombination occurs when, in extremely rare situations, two different lineages of the virus co-infect the same cell in the host and exchange fragments of their individual genomes.
- This generates a descendent variant having mutations that occurred in both the original lineages of the virus.
- Recombination of lineages happens in a variety of other viruses, including those that cause influenza, as well as other coronaviruses.
- Such recombination events occur typically in situations where two or more lineages of SARS-CoV-2 may be co-circulating in a certain region during the same time period.
- This co-circulation of lineages provides an opportunity for recombination to occur between these two lineages of SARS-CoV-2.
How many recombinant viruses have been detected?
- While recombination events are not frequently observed for the SARS-CoV-2 virus, multiple recombinant lineages have been designated during the pandemic.
- The recombinant lineages are annotated by PANGO with an ‘X’ followed by an alphabet which indicates the order of discovery.
- Some previously detected and designated lineages include XA, a recombinant of B.1.1.7 (Alpha) and B.1.177 detected in the U.K., lineage XB detected in the U.S., and lineage XC detected in Japan, which is a recombinant of B.1.1.7 (Alpha) and AY.29 sublineage of Delta.
- Three new recombinant lineages of SARS-CoV-2 have been recently designated by the PANGO network and are being monitored — XD, XE, and XF.
- Although currently present in a very low proportion of genomes in the U.K., early data from the country show evidence of community transmission of XF.
Are recombinant variants more deadly?
- Although recombination has been detected in SARS-CoV-2, it has not yet impacted public health in a unique way.
- There is little evidence to suggest that recombinant lineages have a varied clinical outcome compared to the currently dominant Omicron variant.
- It is certain at this point in time that more data will be needed to ascertain the impact of these lineages on the epidemiology of COVID-19.
What are the methods through which recombinants are identified?
- Identifying and tracking recombinant lineages for SARS-CoV-2 is a challenging task.
- This would require specialised tools and the availability of primary (or raw) data for genome sequences as similar variant combinations could also arise from inadvertent errors in sequencing or analysis as well as contamination of sequencing experiments.
- A cluster of recombinant genomes can be designated a lineage name by the PANGO network if it can be confirmed that samples in the cluster have a common origin and descend from two individual lineages of SARS-CoV-2.
- Additionally, there should be at least 5 genomes in the public domain belonging to the cluster, indicating an ongoing transmission of the lineage.
- Furthermore, screening the sequencing data of these samples should show no signs of contamination and meet the definition of a recombinant.
Way ahead
- Since recombinations are extremely rare occurrences, it is unclear how and why the viruses recombine.
- It is, therefore, important to track the recombination of SARS-CoV-2 lineages because it may lead to the generation of a viral lineage that is better at infecting people or transmitting from host to host.
- Monitoring circulating SARS-CoV-2 genomes for evidence of recombination will help gain a better understanding of the ongoing evolution of SARS-CoV-2.
- It will also provide information if a more “concerning” variant of the virus were to emerge.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is T-Cell Immunity?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: T-Cell Immunity
Mains level: Long term health impact of COVID
A new study from Wuhan has studied the role of T-Cell Immunity against prolonged and sever COVID-19.
What are T-Cells?
- Like B cells, which produce antibodies, T cells are central players in the immune response to viral infection.
- For your immune system to fight off any kind of invader, such as a virus, you need a kind of white blood cell called a B cell, which makes antibodies, and a similar-looking white blood cell called a T cell.
- T cells can play different roles altogether.
- They can act as “killer cells”, attacking cells which have been infected with a virus or another kind of pathogen, or they can act as “helper cells” by supporting B cells to produce antibodies.
How do they function?
- Alongside antibodies, the immune system produces a battalion of T cells that can target viruses.
- Some of these, known as killer T cells (or CD8+ T cells), seek out and destroy cells that are infected with the virus.
- Others, called helper T cells (or CD4+ T cells) are important for various immune functions, including stimulating the production of antibodies and killer T cells.
- T cells do not prevent infection, because they kick into action only after a virus has infiltrated the body. But they are important for clearing an infection that has already started.
- In the case of COVID-19, killer T cells could mean the difference between a mild infection and a severe one that requires hospital treatment.
What did the latest research find?
- The researchers found that neutralising antibodies were detectable even 12 months after infection in “most individuals”.
- It remained stable 6-12 months after initial infection in people younger than 60 years.
- The researchers found that “multifunctional T cell responses were detected for all SARS-CoV-2 viral proteins tested”.
- And most importantly, the magnitude of T cell responses did not show any difference immaterial of how severe the disease was.
- While the ability of antibodies to neutralise was nearly absent against the Beta variant, it was reduced in the case of the Delta variant.
Neutralizing antibodies
- SARS-CoV-2-specific neutralising antibody and T cell responses were retained 12 months after initial infection.
- Neutralising antibodies to the D614G, Beta, and Delta were reduced compared with those for the original strain, and were diminished in general.
- Memory T cell responses to the original strain were not disrupted by new variants.
- The findings show that robust antibody and T cell immunity against SARS-CoV-2 is present in majority of recovered patients 12 months after moderate-to-critical infection.
Robustness of antibodies
- The study reveals the durability and robustness of the T cell responses against variants, including Delta, even after one year of infection.
- Most importantly, the robust and longstanding T cell responses were seen in people who have not been reinfected or vaccinated.
- This would mean even in the absence of vaccination, a person who has been infected by the virus even one year ago would have robust immune responses.
- It would offer protection against disease progressing to a severe form requiring hospitalization.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
NeoCov Coronavirus found in Bats
Note4Students
From UPSC perspective, the following things are important :
Prelims level: NeoCoV
Mains level: Not Much
NeoCov coronavirus found in bats may pose threat to humans in the future, scientists caution.
Coronavirus: A quick backgrounder
- Coronaviruses are a large family of viruses that are known to infect animals and humans.
- They are largely categorized into four genera — alpha, beta, gamma, and delta.
- Broadly speaking, alpha and beta coronaviruses commonly infect mammals such as bats and humans, while Gamma and Delta mainly infect birds.
Infecting humans: Through ‘Zoonotic Spillover’
- While animals, including bats, are generally considered as the reservoirs of coronaviruses, rarely spillover events could occur.
- It is possible for viruses that infect animals to jump to humans, a process which is known as zoonotic spillover.
- Many major infectious diseases, including COVID-19, is widely thought to be a result of spillover.
COVID-19 Pandemic
- SARS-CoV-2, the coronavirus responsible for the COVID-19 pandemic, belongs to the genus of beta coronavirus.
- It is in fact the 7th type of coronavirus known to infect and cause severe disease in humans.
How does it affect humans?
- How a coronavirus latches onto special receptors on host cells depends on a key part of the virus known as its receptor-binding domain.
- The differences in the receptor-binding domain of coronaviruses are therefore what determine the type of host receptor the virus will use and thus the host that it will be able to infect.
- There are currently 4 well-characterized receptors for coronaviruses, including ACE2, which is used by SARS-CoV and SARS-CoV-2, and DPP4 used by MERS-CoV.
What is NeoCoV?
- NeoCoV is a bat coronavirus that was first identified in 2011.
- It was identified in a species of bats known as Neoromicia, which is where the name NeoCoV was derived from.
- Commonly known as aloe bats, this species is distributed in the Afro-Malagasy region.
- NeoCoV shares an 85% similarity to MERS-CoV in the genome sequence, making it the closest known relative of MERS-CoV.
Does NeoCoV infect humans and cause high mortality?
- It is important to note that inherently, NeoCoV cannot interact with human receptors, implying that in its current form the virus cannot infect humans.
- NeoCoV does not infect humans yet and has thus not caused any deaths.
What does the preprint say and why is it important?
- The study reports that despite their similarity, MERS-CoV and NeoCoV use different receptors to infect cells.
- The bat coronavirus NeoCoV was found to use bat ACE2 receptors for efficiently entering cells.
- The interaction between NeoCoV and bat ACE2 receptors is different from what is seen in other coronaviruses that utilize ACE2.
- However, specific mutations artificially created in the receptor-binding domain of NeoCoV can enhance its efficiency to interact with human ACE2 receptors.
- These mutations have not yet been seen in NeoCov isolates from natural settings.
Conclusion
- SARS-CoV-2 is not the first coronavirus to infect humans and cause large disease outbreaks, nor is it likely to be the last.
- The study highlights that through further adaptation, coronaviruses like NeoCoV or other related viruses could potentially gain the ability to infect humans.
Way forward
- To prevent future outbreaks, it will thus be important to monitor this family of viruses for potential zoonosis while continuing research efforts on understanding the complex receptor usage of different coronaviruses.
- Genomic surveillance of human and animal viruses is, therefore, the key to understanding the spectrum of viruses, and possibly provides early warning to potential spillover events.
Try this question from CSP 2021:
Q. The term ACE2′ is talked about in the context of:
(a) genes introduced in the genetically modified plants
(b) development of India’s own satellite navigation system
(c) radio collars for wildlife tracking
(d) spread of viral diseases
Post your answers here.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is Antimicrobial Resistance (AMR)?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Anti-Microbial Resistance
Mains level: Overdose of anti-biotics
The Global Research on Antimicrobial Resistance (GRAM) report published in The Lancet provides the most comprehensive estimate of the global impact of Antimicrobial Resistance (AMR) so far.
What is AMR?
- Antimicrobial resistance (AMR or AR) is the ability of a microbe to resist the effects of medication that once could successfully treat the microbe
- Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.
- A growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective.
- It leads to higher medical costs, prolonged hospital stays, and increased mortality.
How does it occur?
- Antibiotics are medicines used to prevent and treat bacterial infections.
- Antibiotic resistance occurs when bacteria change in response to the use of these medicines.
- Bacteria, not humans or animals, become antibiotic-resistant.
- These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.
What did the GRAM report find?
- AMR is a leading cause of death globally, higher than HIV/AIDS or malaria.
- As many as 4.95 million deaths may be associated with bacterial AMR in 2019.
- Lower respiratory tract infections accounted for more than 1.5 million deaths associated with resistance in 2019, making it the most common infectious syndrome.
The six leading pathogens for deaths associated with resistance were:
- Escherichia coli (E. Coli)
- Staphylococcus aureus
- Klebsiella pneumonia
- Streptococcus pneumonia
- Acinetobacter baumannii
- Pseudomonas aeruginosa
What are the implications of this study?
- Common infections such as lower respiratory tract infections, bloodstream infections, and intra-abdominal infections are now killing hundreds of thousands of people every.
- This includes historically treatable illnesses, such as pneumonia, hospital-acquired infections, and foodborne ailments.
Way forward
- Doctors recommend greater action to monitor and control infections, globally, nationally and within individual hospitals.
- Access to vaccines, clean water and sanitation ought to be expanded.
- The use of antibiotics unrelated to treating human disease, such as in food and animal production must be “optimised” and finally they recommend being “more thoughtful”.
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Omisure: India’s first RT-PCR kit to identify Omicron strain
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Gene sequencing, RTPCR
Mains level: COVID diagnosis
Omisure — India’s first home-grown testing kit has recently received approval from the Drugs Controller General of India.
About Omisure
- Omisure is an omicron detecting RT-PCR kit developed by the Mumbai-based Tata Medical and Diagnostics Ltd (TATA MD) in partnership with the Indian Council of Medical Research (ICMR).
- It can differentiate the omicron strain of the novel coronavirus from the delta, alpha and the other variants in under four hours.
- It can diagnose this variant in a single step
How does it work?
- This new kit can identify the Omicron variant by targeting two regions of the S or the spike gene.
- This gene codes for the spike protein, which helps the novel coronavirus enter and infect human cells.
- The S, the Enveloped (E), and Nucleocapsid (N) genes are some of the targets of conventional RT-PCR tests.
- When it detects these genes, a patient sample is labelled positive. As omicron bears heavy mutations in the S gene, the RT-PCR can sometimes miss it.
- The absence of S gene likely indicates omicron’s presence.
- This is called S gene dropout or S gene target failure — and is one of the targets of Omisure.
How does Omisure compare with gene sequencing?
- Gene sequencing reads the order of nucleotides, which are the building blocks of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA).
- Despite being considered the gold standard, sequencing has a few limitations.
- It is slow, expensive and complicated. It is a multi-step process.
- It begins with extracting the virus’ RNA from patient samples, converting it into DNA, amplifying or multiplying it through RT-PCR before finally sending it for gene sequencing.
- This entire process can take as many as three days.
Back2Basics:
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Traditional vaccines just as effective, say US Scientists
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Types of vaccines
Mains level: Effectiveness of various vaccines against COVID
Vaccines like Biological E’s Corbevax and Bharat Biotech’s Covaxin that are made by traditional methods are “just as effective” as the latest mRNA technology-based vaccines a/c to US scientists.
What are Vaccines?
- A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease.
- It typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins.
Types of Vaccines
There are several types of vaccines, including:
- Inactivated vaccines
- Live-attenuated vaccines
- Messenger RNA (mRNA) vaccines
- Subunit, recombinant, polysaccharide, and conjugate vaccines
- Viral vector vaccines
[1] Inactivated vaccines
- Inactivated vaccines use the killed version of the germ that causes a disease.
- Inactivated vaccines usually don’t provide immunity (protection) that’s as strong as live vaccines.
- So you may need several doses over time (booster shots) in order to get ongoing immunity against diseases.
- Inactivated vaccines are used to protect against: Hepatitis A, Flu (shot only), Polio (shot only), Rabies etc.
[2] Live-attenuated vaccines
- Live vaccines use a weakened (or attenuated) form of the germ that causes a disease.
- Because these vaccines are so similar to natural infection that they help prevent, they create a strong and long-lasting immune response.
- Just 1 or 2 doses of most live vaccines can give you a lifetime of protection against a germ and the disease it causes.
- They need to be kept cool in refrigerated conditions.
- Live vaccines are used to protect against Measles, mumps, rubella (MMR), Rotavirus, Smallpox, Chickenpox, Yellow fever
[3] Messenger RNA vaccines
- Researchers have been studying and working with mRNA vaccines for decades and this technology was used to make some of the COVID-19 vaccines.
- mRNA vaccines make proteins in order to trigger an immune response.
- mRNA vaccines have several benefits compared to other types of vaccines, including shorter manufacturing times and, because they do not contain a live virus, no risk of causing disease in the person getting vaccinated.
How does mRNA vaccine work?
- The mRNA vaccines function differently from traditional vaccines.
- Traditional vaccines stimulate an antibody response by injecting a human with antigens.
- mRNA vaccines inject a fragment of the RNA sequence of a virus directly into the cells, which then stimulate an adaptive immune response mRNA fragment is a specific piece of the virus that carries instructions to build the antigen of the virus.
- An advantage of RNA vaccines is that they stimulate cellular immunity.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is Omicron Variant?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: COVID mutation
Mains level: Not Much
A new lineage of SARS-CoV-2 has been designated as a Variant of Concern (VoC) by the World Health Organization (WHO) and has been named Omicron.
Behind the name: Omicron
- The WHO has been using Greek letters to refer to the most widely prevalent coronavirus variants, which otherwise carry long scientific names.
- It had already used 12 letters of the Greek alphabet before the newest variant emerged in South Africa this week.
- After Mu, the 12th named after a Greek letter, WHO selected the name Omicron, instead of Nu or Xi, the two letters between Mu and Omicron.
- The WHO said Nu could have been confused with the word ‘new’ while Xi was not picked up following a convention.
Why is the Omicron variant interesting?
- The Omicron variant is interesting due to the fact that it has a large number of mutations compared to other prevalent variants circulating across the world.
- This includes 32 mutations in the spike protein.
- Many of these mutations lie in the receptor-binding domain of the spike protein, a key part of the protein required for binding to the human receptor proteins for entry into the cell.
- It can thus play an important role in recognition by antibodies generated due to a previous infection or by vaccines.
What do spike mutations do?
- Many of the mutations in the spike protein have been previously suggested to cause resistance to antibodies as well as increased transmission.
- Thus, there is a possibility that this variant could be more likely to re-infect people who have developed immunity against previous variants of the virus.
- The behavior of the virus is not yet accurately predictable based on the evidence on individual mutations.
Does the variant result in vaccine breakthrough infections?
- Some of the initial individuals identified to be infected with the variant have been vaccinated for COVID-19 and therefore the variant can indeed cause vaccine breakthrough infections.
- This should not be of concern, since the prevalent variants of concern including Delta have been shown to cause breakthrough infections.
- Whether the variant causes more breakthrough infections than Delta is not currently known.
How can we be prepared for the variant?
- Enhanced surveillance and genome sequencing efforts are essential to detect and track the prevalence of the Omicron variant.
- Rapid sharing of genome sequences of the virus and the epidemiological data linked with it to publicly available databases will help in developing a better understanding of the variant.
- Existing public health and social measures need to be strengthened to control and prevent transmission.
- Enhancing vaccination coverage across different regions along with access to testing, therapeutics and support will be essential for combating the new variant.
- Equitable access to vaccines would be key to controlling the Omicron variant, and slowing down the emergence of any future variants.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is Hybrid Immunity?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Hybrid immunity
Mains level: Not Much
A study has shown that a combination of natural infection with a single dose of vaccine provides greater immunity than either natural infection without vaccination or full vaccination in individuals.
What is the new study?
- People without prior infection but fully vaccinated with the Pfizer or AstraZeneca vaccine showed a decline in neutralising antibodies over a period of three to seven months.
- But the decline was much less in vaccinated people with prior infection.
- People with hybrid immunity had a higher and more durable neutralising antibody response.
- The hybrid immunity offers stronger protection than just infection or full vaccination alone.
What is Hybrid Immunity?
- It is natural immunity from an infection combined with the immunity provided by the vaccine.
- The immunological advantage from hybrid immunity arises mostly from memory B cells.
What are memory B cells?
- In immunology, a memory B cell (MBC) is a type of B lymphocyte that forms part of the adaptive immune system.
- B lymphocytes are the cells of the immune system that make antibodies to invade pathogens like viruses.
- They form memory cells that remember the same pathogen for faster antibody production in future infections.
How do they assist hybrid immunity?
- While the bulk of antibodies after infection or vaccination decline after a short while, the memory B cells get triggered on subsequent infection or vaccination.
- The memory B cells triggered by infection and those triggered by vaccination have different responses to viruses.
- Infection and vaccination expose the spike protein to the immune system in vastly different ways.
- After full vaccination, antibodies produced by natural infection continued to grow in potency and their breadth against variants for a year after infection.
- Unlike after vaccination, the memory B cells formed after natural infection are more likely to make antibodies that block immune-evading variants.
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West Nile Virus outbreak in Russia
Note4Students
From UPSC perspective, the following things are important :
Prelims level: West Nile Virus
Mains level: NA
Russia warned of a possible increase in West Nile virus infections this autumn as mild temperatures and heavy precipitation create favorable conditions for the mosquitos that carry it.
West Nile virus (WNV)
- WNV is mainly transmitted through mosquito bites and can lead to fatal neurological diseases in humans, although most people infected never develop any symptoms.
- Cases of WNV occur during mosquito season, which starts in the summer and continues through fall.
Its origin
- Originally from Africa, the WNV has spread to Europe, Asia, and North America.
- It was first isolated in a woman in the West Nile district of Uganda in 1937.
- It was identified in birds in the Nile delta region in 1953.
- Before 1997, WNV was not considered pathogenic for birds.
- Human infections attributable to WNV have been reported in many countries for over 50 years.
Symptoms
- Infected persons usually have no symptoms or mild symptoms.
- Some of the symptoms include fever, headache, body aches, skin rash, and swollen lymph glands.
- They can last a few days to several weeks and usually, go away on their own.
- Prolonged illness may cause inflammation of the brain, called encephalitis, or inflammation of the tissue that surrounds the brain and spinal cord, called meningitis.
Treatment
- There is no vaccine against the virus in humans although one exists for horses, the WHO says.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is Monkey B virus?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Monkey B Virus
Mains level: Zoonotic Diseases
China has reported the first human death case with the Monkey B virus (BV).
What is Monkey B virus?
- The virus, initially isolated in 1932, is an alphaherpesvirus enzootic in macaques of the genus Macaca.
- B virus is the only identified old-world-monkey herpes virus that displays severe pathogenicity in humans.
Answer this question from our AWE initiative:
How is it transmitted?
- The infection can be transmitted via direct contact and exchange of bodily secretions of monkeys and has a fatality rate of 70 per cent to 80 per cent.
- According to the Centre for Disease Control and Prevention, Macaque monkeys commonly have this virus, and it can be found in their saliva, feces, urine, or brain or spinal cord tissue.
- The virus may also be found in cells coming from an infected monkey in a lab. B virus can survive for hours on surfaces, particularly when moist.
When can a human get infected with B virus?
- Humans can get infected if they are bitten or scratched by an infected monkey.
Symptoms
- Symptoms typically start within one month of being exposed to B virus but could appear in as little as three to seven days.
- The first indications of B virus infection are typically flu-like symptoms such as fever and chills, muscle ache, fatigue and headache.
- Following this, a person may develop small blisters in the wound or area on the body that came in contact with the monkey.
- Some other symptoms of the infection include shortness of breath, nausea and vomiting, abdominal pain and hiccups.
- As the disease progresses, the virus spreads to and causes inflammation (swelling) of the brain and spinal cord, leading to neurologic and inflammatory symptoms.
Is there a vaccine against B virus?
- Currently, there are no vaccines that can protect against B virus infection.
Who are at higher risk for infection?
- The virus might pose a potential threat to laboratory workers, veterinarians, and others who may be exposed to monkeys or their specimens.
- To date, only one case has been documented of an infected person spreading the B virus to another person.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is UV-C technology?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: UV technology for disinfection
Mains level: Not Much
The Union Ministry for Science and Technology has informed that Ultraviolet-C or UV-C Disinfection Technology will soon be installed in Parliament for the mitigation of airborne transmission of SARS-COV-2.
UV-C air duct disinfection system
- The UV-C air duct disinfection system was developed by CSIR-CSIO (Central Scientific Instruments Organisation).
- The system is designed to fit into any existing air-ducts and the virucidal dosages using UV-C intensity and residence time can be optimized according to the existing space.
- The release adds that the virus is deactivated in any aerosol particles by the calibrated levels of UV-C light. It can be used in auditoriums, malls, educational Institutions, AC buses, and railways.
What is Ultraviolet (UV)?
- Ultraviolet (UV) is a type of light or radiation naturally emitted by the Sun. It covers a wavelength range of 100-400 nm. The human visible light ranges from 380–700 nm.
- UV is divided into three bands: UV-C (100-280 nm), UV-B (280-315 nm) and UV-A (315-400 nm).
- UV-A and UV-B rays from the Sun are transmitted through our atmosphere and all UV-C is filtered by the ozone layer.
- UV-B rays can only reach the outer layer of our skin or epidermis and can cause sunburns and are also associated with skin cancer.
- UV-A rays can penetrate the middle layer of your skin or the dermis and can cause ageing of skin cells and indirect damage to cells’ DNA.
- UV-C radiation from man-made sources has been known to cause skin burns and eye injuries.
So, can UV-C kill coronavirus?
- UV-C radiation (wavelength around 254 nm) has been used for decades to disinfect the air in hospitals, laboratories, and also in water treatment.
- But these conventional germicidal treatments are done in unoccupied rooms as they can cause health problems.
- It can destroy the outer protein coating of the SARS-Coronavirus.
Is it safe for humans?
- The device is specifically developed to disinfect non-living things.
- UV-C radiation used in this device could be harmful to the skin and eyes of living beings.
Answer this PYQ in the comment box:
Q.What is the role of ultraviolet (UV) radiation in the water purification systems?
- It inactivates/kills the harmful microorganisms in water.
- It removes all the undesirable odours from the water.
- It quickens the sedimentation of solid particles, removes turbidity and improves the clarity of water.
Which of the statements given above is/are correct? (CSP 2010)
(a) 1 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Covid-19 Delta-plus Variant
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Delta plus variant
Mains level: COVID
The Maharashtra government has tightened the Covid-19 unlocking process in the wake of a rise in cases of the Delta Plus variant.
What is Delta Plus?
- A variant that has emerged as a new threat, especially in India, Delta Plus (B.1.617.2.1/(AY.1) is a new mutant strain of the Delta variant of SARS-CoV-2.
- It is technically the next generation of SARS-COV-2.
- The Delta variant that was first detected in India eventually became a huge problem for the whole world.
- However, the Delta Plus variant, at present, is limited to smaller areas in the country. This mutant of Delta was first detected in Europe in March 2021, but it came to light on June 13.
- Although it is still under investigation, experts believe that the Delta Plus variant has increased transmissibility.
What is known so far?
- The new Delta plus variant has been formed due to a mutation in the Delta or B.1.617.2 variant.
- Delta Plus (AY.1) is resistant to monoclonal antibodies cocktail.
- Since it’s a new variant, its severity is still unknown.
- 63 genomes of Delta (B.1.617.2) with the new K417N mutation have been identified by the GISAID (global science initiative) so far.
- The mutation is in the spike protein of SARS-COV-2, which helps the virus enter and infect the human cells.
- People reported symptoms like headaches, sore throats, runny noses, and fever.
Are COVID-19 vaccines effective against the Delta Plus variant?
- Medical experts say it is too early to predict the effectiveness of the existing vaccines on the new variant.
- A detailed study would be required to establish any effect of the mutant on the immune system.
- However, Union Health Ministry says that both Indian vaccines — Covishield and Covaxin are effective against the Delta variant.
- There is fear that this new variant Delta Plus may spark the third wave of COVID-19, but there is a very low incidence of such cases, so there is no certainty.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is Gain-of-Function Research?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Gain-of-function research
Mains level: Bio-engineering and associated threats
With the re-emergence of the Wuhan lab-leak origin theory, questions are also being raised on what gain-of-function research is, and whether the benefits of conducting such research outweigh the risks of pathogens escaping from labs.
What is gain-of-function research?
- In virology, gain-of-function research involves deliberately altering an organism in the lab, altering a gene, or introducing a mutation in a pathogen to study its transmissibility, virulence and immunogenicity.
- It is believed that this allows researchers to study potential therapies, vaccine possibilities and ways to control the disease better in future.
- Gain-of-function research involves manipulations that make certain pathogenic microbes more deadly or more transmissible.
- This is done by genetically engineering the virus and by allowing them to grow in different growth mediums, a technique called as serial passage.
Antithesis to this theory
- There is also ‘loss-of-function’ research, which involves inactivating mutations, resulting in a significant loss of original function, or no function to the pathogen.
- When mutations occur, they alter the structure of the virus that is being studied, resulting in altered functions. Some of these significant mutations might weaken the virus or enhance its function.
Associated risks
- Some forms of gain-of-function research reportedly carry inherent biosafety and biosecurity risks and are thus referred to as ‘dual-use research of concern’ (DURC).
- This indicates that while the research may result in benefits for humanity, there is also the potential to cause harm — accidental or deliberate escape of these altered pathogens from labs may cause even pandemics.
Essential component of vaccine development
- The current medical countermeasures are often insufficient largely because of resistance mechanisms that lead to ‘escape mutants’, i.e., drug-resistant strains.
- There is, hence, a continual need to develop new antiviral drugs and additional options, such as immunotherapy, based on neutralizing monoclonal antibodies.
- Ultimately, gain-of-function studies, which enhance viral yield and immunogenicity, are required for vaccine development.
What is the situation in India?
- In India, all activities related to genetically engineered organisms or cells and hazardous microorganisms and products are regulated as per the “Manufacture, Use, Import, Export and Storage of Hazardous Microorganisms/Genetically Engineered Organisms or Cells Rules, 1989”.
- Last year, the Department of Biotechnology issued guidelines for the establishment of containment facilities, called ‘Biosafety labs’, at levels two and three.
- The notification provides operational guidance on the containment of biohazards and levels of biosafety that all institutions involved in research, development and handling of these microorganisms must comply with.
Should research continue?
- Scientists have differing opinions on the issue, particularly since the emergence of the COVID-19 pandemic.
- While those on the side of gain-of-function research say that it makes science and governments battle-ready for future pandemics, there have been a rising number of calls to suspend such research.
- Proponents of gain-of-function research believe that “nature is the ultimate bioterrorist and we need to do all we can to stay one step ahead”.
- Some researchers thinks it is time to stop such research.
- Science policymakers “must wrestle with defining the rare instances in which the benefits of experiments that enhance a virus’s capacity to survive and flourish in human hosts outweigh any risks.
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Bring genomic sequencing into the pandemic fight
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Variants of coronavirus
Mains level: Paper 3- Importance of genomic sequencing in dealing with the pandemic
The article highlights the importance of genomic sequencing in dealing effectively with the pandemic and suggest the scaling up of genomic sequencing.
Why genomic sequencing is important
- An effective COVID-19 pandemic response requires, inter alia, keeping track of emerging variants and then conducting further studies about their transmissibility, immune escape and potential to cause severe disease.
- The success of the United States and the United Kingdom in containing the virus also goes to scaled-up genomic sequencing, tracking the emerging variants and using that evidence for timely actions.
- The data from genomic sequencing has both policy and operational implications.
- Our scientific knowledge and understanding about emerging strains is going to be the key to deploy public health interventions (vaccines included) to fight the pandemic.
- The emerging variants — with early evidence of higher transmissibility, immune escape and breakthrough infections — demand continuous re-thinking and re-strategising of the pandemic response by every country.
Insufficient genomic sequencing in India
- Though the procedural steps such as setting up the Indian SARS-CoV2 Genomic Consortia, or INSACOG have been taken, the sequencing has remained at a very low level of a few thousand cases only.
- The challenge of insufficient genomic sequencing is further compounded by slow pace of data sharing.
Steps need to be taken
- 1) Scale-up genomic sequencing: India needs to scale up genomic sequencing, across all States.
- More genomic sequencing is needed from large urban agglomerations.
- A national-level analysis of collated genomic sequencing data should be done on a regular basis and findings shared publicly.
- 2) Research on vaccine effectiveness: The Indian government needs to invest and support more scientific and operational research on vaccine effectiveness.
- Rethink vaccine policy: There are early indications of immune escape and reduced vaccine effectiveness against the Delta variant (especially after one-shot).
- These are the questions that experts need to deliberate and come up with the answers.
Consider the question “What is genomic sequencing and how it could help in dealing with the Covid-19 pandemic? Suggest the steps India need to take to use genomic sequencing in curbing the pandemic.”
Conclusion
As India prepares for the third wave, increasing genomic sequencing and use of scientific evidence for decision making are not a choice but an absolute essential.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Indian SARS-CoV-2 Genomic Consortia (INSACOG)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Indian SARS-CoV-2 Genomic Consortia (INSACOG)
Mains level: Not Much
In early March, members of the Indian SARS-CoV-2 Genomic Consortia (INSACOG), an advisory group to the Central government, warned of a new and contagious form of the novel coronavirus.
What is INSACOG?
- INSACOG is a consortium of 10 labs across the country tasked with scanning COVID-19 samples from swathes of patients and flagging the presence of variants that were known to have spiked transmission internationally.
- It has also been tasked with checking whether certain combinations of mutations were becoming more widespread in India.
- Some of these labs had begun scanning for mutations in April 2020 itself, but it was not a pan-India effort.
- The institutes involved were laboratories of the Department of Biotechnology, the CSIR, the ICMR, and the Ministry of Health & Family Welfare (MoHFW).
- The National Centre for Disease Control (NCDC) under the MoHFW was tasked with coordinating the collection of samples from the States as well correlating disease with the mutations.
- The work began in January by sequencing samples of people who had a history of travel from the United Kingdom and a proportion of positive samples in the community.
What are the findings?
- The “foreign” variants identified were primarily the B.1.1.7 (first identified in the United Kingdom) and the B.1.351 (first found in South Africa) and a small number of P2 variants (from Brazil).
- However, some labs flagged the growing presence of variants identified in India that were clubbed into a family of inter-related variants called B.1.617, also known as the ‘double mutant’ variant.
- It was primarily due to two mutations — E484Q and L452R — on the spike protein.
- The B.1.617 family was marked as an international ‘variant of concern’ after it was linked to a recent spike in cases in the UK.
- INSACOG labs also found that the B.1.1.7 variant, which is marked by increased infectivity, is distinctly more prevalent in several northern and central Indian States in comparison to southern States.
Beyond identifying patterns, why is genome sequencing useful?
- The purpose of genome sequencing is to understand the role of certain mutations in increasing the virus’s infectivity.
- Some mutations have also been linked to immune escape, or the virus’s ability to evade antibodies, and this has consequences for vaccines.
- Labs across the world, including many in India, have been studying if the vaccines developed so far are effective against such mutant strains of the virus.
- They do this by extracting the virus from COVID-19-positive samples and growing enough of it. Then, blood serum from people who are vaccinated, and thereby have antibodies, is drawn.
- Using different probes, scientists determine how much of the antibodies thus extracted are required to kill a portion of the cultured virus.
- In general, the antibodies generated after vaccination — and this was true of Covaxin, Covishield, Pfizer and Moderna jabs — were able to neutralize variants.
- Antibody levels are not the only markers of protection and there is a parallel network of cellular immunity that plays a critical role in how vaccines activate immunity.
- The current evidence for most COVID-19 vaccines is that they have almost 75% to 90% efficacy in protecting against disease but less so in preventing re-infection and transmission.
Challenges faced by INSACOG
- Given that the novel coronavirus is spreading, mutating, and showing geographical variations, the aim of the group was to sequence at least 5% of the samples.
- For many reasons, this has so far been only around 1%, primarily due to a shortage of funds and insufficient reagents and tools necessary to scale up the process.
- While some of these issues, the INSACOG, in spite of being peopled by expert scientists, is ultimately an advisory group to the Central government and part of its communication structure.
- Warnings about emerging variants were not made public with sufficient urgency and the sharing of datasets, even within constituent groups of the INSACOG, was less than ideal.
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ICMR drops Plasma Therapy for COVID-19
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Convalescent Plasma Therapy
Mains level: Not Much
The use of convalescent plasma has been dropped from the recommended treatment guidelines for COVID-19, according to an advisory from the Indian Council of Medical Research (ICMR).
Q.What is convalescent plasma therapy and what are the issues involved in its adoption?
Convalescent Plasma Therapy
- The therapy seeks to make use of the antibodies developed in the recovered patient against the coronavirus.
- The whole blood or plasma from such people is taken, and the plasma is then injected into critically ill patients so that the antibodies are transferred and boost their fight against the virus.
- A COVID-19 patient usually develops primary immunity against the virus in 10-14 days.
- Therefore, if the plasma is injected at an early stage, it can possibly help fight the virus and prevent severe illness.
How often has it been used in the past?
- This therapy is no new wonder. It has been used several times.
- The US used plasma of recovered patients to treat patients of Spanish flu (1918-1920).
- In 2014, the WHO released guidelines to treat Ebola patients with convalescent whole blood and plasma.
- In 2015, plasma was used for treating MERS patients.
How is it done?
- The process to infuse plasma in a patient can be completed quickly.
- It only requires standard blood collection practices and extraction of plasma.
- If whole blood is donated (350-450 ml), a blood fractionation process is used to separate the plasma.
- Otherwise, a special machine called aphaeresis machine can be used to extract the plasma directly from the donor.
- While blood is indeed extracted from the donor, the aphaeresis machine separates and extracts the plasma using a plasma kit, and the remaining blood components are returned into the donor’s body.
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Mucormycosis infection in COVID-19 patients
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Mucormycosis
Mains level: Post covid hazards
Hospitals across the country have started to report a number of cases of Mucormycosis, an invasive fungal infection affecting patients who have recently recovered from COVID-19.
What is Mucormycosis?
- Mucormycosis is an aggressive and invasive fungal infection caused by a group of moulds called micromycetes.
- It can affect various organs but is currently manifesting as invasive rhino-orbito-cerebral disease, crawling through the sinus and working its way to the brain, affecting the ear, nose, throat, and mouth.
- While it is not contagious, it can cause a lot of damage internally and can be fatal if not detected early.
- It is an old disease; perhaps new and concerning is the sudden increase in the invasive form of the sinus variant, which involves the orbit, and at times the brain, leading to blindness, stroke or death.
What causes the disease?
- Diabetes mellitus is the most common underlying cause, followed by haematological malignancies and solid-organ transplants.
- Diabetes mellitus was reported in 54% to 76% of cases, according to a report.
- What seems to be triggering Mucormycosis in patients post COVID-19 is indiscriminate use of a high dose of steroids in COVID-19 patients, sometimes even in minimally symptomatic patients.
- This leads to spikes in the sugar level among diabetics, which, in turn, renders them vulnerable.
Symptoms
- The symptoms to watch out for are a stuffy nose, bloody, blackish, or brown discharge from the nose etc.
- Other symptoms include blackish discolouration of the skin, swelling or numbness around the cheek, one-sided facial pain, toothache or jaw pain, drooping of the eyelids or eyelid swelling, double vision, redness of eyes, and sudden decrease in vision.
Treatment
- The mainline of treatment is an anti-fungal drug called amphotericin B, which is given over an extended period of time under the strict observation of a physician.
- Rational use of steroids is necessary, and constant monitoring of sugar levels and resorting to insulin use to control these levels if required is essential.
- Surgery to remove the fungus growth might also be warranted.
Preventive measures
- It is important to keep blood sugar levels under control and ensure that appropriate calibration of oral drugs or insulin is done from time to time.
- Further, recognising the symptoms and seeking treatment early if there are two or three symptoms at a time is key.
- Like most illnesses, if detected early, Mucormycosis can be cured.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
2-DG: DRDO’s new oral drug for Covid-19
Note4Students
From UPSC perspective, the following things are important :
Prelims level: 2DG
Mains level: COVID-19 Treatment
Defence Minister has released the first batch of the indigenously developed anti-Covid-19 drug, 2-deoxy-D-glucose or ‘2-DG’.
What is the news?
- The Drugs Controller General of India (DCGI) had cleared the formulation on May 1 for emergency use as an adjunct therapy in moderate to severe Covid-19 patients.
What is 2-DG?
- 2-DG has been developed by the Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, a lab of the DRDO in collaboration with Hyderabad-based pharma company Dr Reddy’s Laboratories (DRL).
- The 2-DG anti-Covid drug is expected to reduce dependence on medical oxygen in Covid-19 infected patients.
- The pseudo glucose molecule in the drug stops the virus in the tracts.
- Hence, it has been prescribed for Coronavirus infected patients requiring critical medical oxygen.
How does it work?
- Clinical trial data show that the molecule helps in faster recovery of patients hospitalized with Covid-19, and reduces their dependence on supplemental oxygen.
- The drug accumulates in virus-infected cells, and prevents the growth of the virus by stopping viral synthesis and energy production.
- Its selective accumulation in virally-infected cells makes this drug unique.
Advantages
- 2-DG being a generic molecule and an analogue of glucose, it can be easily produced and made available in large quantities.
- The drug is available in powder form in a sachet, and can be taken orally after dissolving in water.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
A WTO waiver on patents won’t help us against covid
Note4Students
From UPSC perspective, the following things are important :
Prelims level: TRIPS
Mains level: Paper 2- Option to waiver from IP rights for vaccine production
There has been growing clamour across the world for waiver of intellectual property protection for Covid-19 vaccines under TRIPS. The article suggests alternatives to achieve the desired production of vaccines without setting the precedent for a waiver.
Waiver from TRIPS
- Last October, India and South Africa moved a motion at the WTO asking its council on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to provide a waiver on intellectual property protection for pharmaceutical patents.
- Many developing countries have since supported the joint move.
- While most advanced countries, home to the world’s major pharmaceutical companies, have opposed it.
- Nobel economist Joseph Stiglitz, along with activist Lori Wallach, penned an opinion piece making a case for such a waiver.
Voluntary licensing
- Alternative to waiver could be voluntary licensing arrangements between pharmaceutical companies and countries that wish to make vaccine doses for their own use.
- This is exactly what has occurred in India’s case, with a licensing agreement between AstraZeneca and Serum Institute of India.
- The recent difficulties with this arrangement are a result of India diverting some doses intended for export (or for Covax) to its domestic vaccination drive.
- But India will soon begin making other important global vaccines under similar licence arrangements, and a waiver would do nothing to speed up this process.
Compulsory licensing
- In the event that India needs to ramp up production more than is feasible via licences from global manufacturers, there is another alternative available, which is ‘compulsory licensing’.
- Such an approach would not permit the export of vaccine doses made under a compulsory licence.
- This approach should be taken by any developing country, if, for some reason, global pharmaceutical companies are unwilling to license a life-saving vaccine for domestic manufacture and distribution in that nation.
Why TRIPS waiver won’t help
- India’s limiting factors are a shortage of raw materials and low production capacity, neither of which would be cured with the supposed magic bullet of a WTO waiver.
- Not only would a WTO waiver not do anything to address the real bottlenecks that constrain the global production and distribution of vaccines, it would also set a bad precedent.
- It is true that governments, including the US and others, have significantly subsidized or incentivized in other ways the research and development activities of private pharmaceutical companies that now hold patents for major covid vaccines.
- Yet, these governments required the ingenuity of private enterprise to invent these vaccines.
Consider the question “What are the legal provisions to ensure the accessibility of life-saving drugs in the country?”
Conclusion
While it may seem appealing, a WTO waiver on intellectual property protection is an inappropriate priority. It’s a distraction from the heavy lifting needed to create the capacity to fight the scourge of covid.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Supreme Court must oversee vaccination to protect the right to life
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Article 32
Mains level: Paper 3- Vaccination of Covid-19
The article highlights the role the Supre Court can play in universal vaccination in India.
Why Supreme Court needs to step in
- Amid raging debate over the vaccination strategy, the role the Supreme Court of India can play to safeguard the right to life guaranteed under Article 21, for which it is duty-bound to exercise jurisdiction under Article 32 needs consideration.
- In this regard, universal vaccination is a glimmer of hope.
- The Supreme Court of India can facilitate speed and deeper penetration of universal vaccination, which is now commonly accepted as the only possible solution to the pandemic in the long run.
Issue of patent of vaccine
- It is time to question patents claimed by vaccines that have been developed with aid from the state in research and development.
- These patents, if established, must be immediately acquired with just and adequate compensation and made accessible to all manufacturers.
- This was done for medicines for AIDS and it can be done again under the Patents Act.
- The Court can also issue mandamus to undertake this exercise on an emergency basis.
- Thereafter, all pharmaceutical companies with Good Manufacturing Practices (GMP) as per the Drugs and Cosmetics Act must be allowed to manufacture vaccines at a pre-approved price of cost + 6 per cent return on investment.
- States can also be directed to incentivise the setting up of new manufacturing facilities as a possible third wave, periodic booster doses and the need for ancillary vaccines make it a long-term phenomenon.
- All this has to be ensured in addition to the free import of vaccines approved by advanced nations.
Free for all
- The availability of all the vaccines, whether indigenous or imported, must be free for all the recipients to be paid by GoI.
- The vaccines can be distributed to states on a pro-rata basis as per population and price adjusted as part of general revenue sharing in GST.
Vaccine administration
- The vaccine administration needs to be ramped up both in state and private facilities.
- For vaccine hesitancy, we need to incentivise the vaccination through a direct deposit of Rs 500 in Jan Dhan accounts for each vaccinated member of BPL families.
- This vaccination can be made compulsory for identifiable categories of persons from MGNREGA beneficiaries to Aadhaar Card holders to income-tax payers to bank account holders to driving-licence holders.
- There must be a strict penalty to be recovered from those who do not get vaccinated without medical reasons.
- Private efforts can be made eligible for reimbursement of cost.
Conclusion
The Supreme Court can steer us, with greater emphasis on the right to life. The pandemic may leave nothing and nobody behind to bicker about.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Understanding the Ct value in a Covid-19 test
Note4Students
From UPSC perspective, the following things are important :
Prelims level: RT-PCR Test
Mains level: Paper 2- Ct value in RT-PCR test
Recently, the Maharashtra government sought clarity from the Indian Council of Medical Research (ICMR) on the threshold Ct value to treat a person Covid-negative.
What is Ct value
- Short for cycle threshold, Ct is a value that emerges during RT-PCR tests.
- In an RT-PCR test, RNA is extracted from the swab collected from the patient.
- It is then converted into DNA, which is then amplified.
- Amplification refers to the process of creating multiple copies of the genetic material — in this case, DNA.
- Amplification takes place through a series of cycles — one copy becomes two, two becomes four, and so on.
- Put simply, the Ct value refers to the number of cycles after which the virus can be detected.
- The lower the Ct value, the higher the viral load — because the virus has been spotted after fewer cycles.
Why Ct value is important
- According to the ICMR, a patient is considered Covid-positive if the Ct value is below 35.
- If the benchmark were to be lowered to 24 — the value mentioned in Maharashtra’s letter — it would mean that Ct values in the range 25-34 would not be considered positive.
- A benchmark of 35, therefore, means that more patients would be considered positive than we would get if the benchmark were 24.
- The ICMR has said lowering Ct threshold parameter may lead to missing several infectious persons.
Does Ct score indicate the severity of disease
- A small study published in the Indian Journal of Medical Microbiology in January this year found that there was no correlation between Ct values and severity of disease or mortality in patients with Covid-19 disease.
- It found that the time since the onset of symptoms has a stronger relationship with Ct values as compared to the severity of the disease.
- The Ct value tells us about the viral load in the throat and not in the lungs.
- The Ct value does not correlate with severity – only with infectivity.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Undermining vaccination for all
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Not much
Mains level: Paper 2- Issues with vaccination strategy
The article highlights the issues with the new vaccine strategy adopted by the government.
Revamped vaccine strategy
- With the second Covid-19 wave reaching catastrophic proportions, the Government of India has acted by unveiling a completely revamped vaccine strategy.
- Two key elements are the hallmark of this new strategy, which will be implemented from May 1.
- First, the vaccination drive has now been extended to the entire adult population, namely, to those above 18 years.
- Second, vaccine manufacturers have been given the freedom to sell 50% of their vaccine production to State governments and private hospitals.
- A third element of the vaccine strategy, which was not announced formally, is a grant of ₹45 billion to the two vaccine manufacturers, the Serum Institute of India (SII) and Bharat Biotech, to boost their capacities.
Issues with the new vaccine strategy
1) Control over the market for vaccine
- The central government has given up its control over the market for vaccines, a key feature of the vaccine roll-out plans thus far.
- This issue assumes further significance since the Government of India is well aware about the significance of vaccinating every citizen in the country; “none of us will be safe until everyone is safe”.
- It is, therefore, vitally important that public health authorities in the country take an objective view of the realities of the country before adopting strategies for vaccine availability.
2) Vaccine export
- The phased roll-out of the government’s ambitious vaccination drive, beginning with health-care and frontline workers in January was in sync with the availability of vaccines in the country.
- But, given that India too saw a degree of “vaccine-scepticism”, the Government of India found itself in a situation where it could promise exports of vaccines to 95 countries, mostly in Africa and Asia.
- As of April 26, these countries have received more than 66.4 million doses of vaccines from India.
- Until now, nearly 142 million vaccine doses have been administered in the country, the third highest in the world.
- However, in terms of population share, less than 2% has received both vaccine doses, while less than 9% has received one dose.
- But there is one worrying facet, which is that a demand-supply mismatch has begun to appear as the coverage of the vaccine-eligible population expanded.
- The largest supplier, SII, gave two explanations for its inability to meet its commitments.
- The first was that the United States Government had restricted exports of vaccine culture and other essential materials.
- Second, the company complained that it lacked the financial capacity to expand its production, requesting a grant of ₹30 billion from the government.
3) Onus on the States
- Central government have allowed vaccine producers to sell 50% of their production directly to State governments and private hospitals.
- The central government would continue to support vaccination for people above 45 years, and health-care workers and frontline workers.
- The new strategy shifts the onus onto the State governments, which have to take decisions regarding free vaccination for people above 18 years.
- The government has not fixed the vaccine prices and has allowed the producers to pre-declare the prices they would charge from the State governments and private hospitals, a sharp departure from the extant strategy.
- New policy fragments the market into three layers namely, central government procurement, State government procurement and the private hospitals.
- This layering of the market would allow the producers to charge high prices from the State governments and private hospitals.
- The new strategy would shift the burden of vaccination of the young population, namely, those between 18-44 years, entirely on the State governments.
- This implies that the vaccination of a significant section of the population depends on the financial health of each State government, resulting in inequitable access to vaccines across States.
4) Public money given for expanding production capacity
- In view of the advance of ₹45 billion made by the Government of India to the two vaccine producers in India for expanding their production capacities decision to deregulate the vaccine market raises serious questions.
- This question is more pertinent in India, where access to affordable vaccines is critical for ensuring “vaccination for all”.
Way forward
- Rather than allowing duopoly in the vaccine market, the government should have ensured a competitive market for vaccines.
- One positive step that the government has taken in this direction is to increase production of Bharat Biotech’s vaccine through the involvement of three public sector undertakings, including Haffkine Institute.
- There is a need for more open licensing of this vaccine to scale up production.
Conclusion
There can be no alternative to vaccination for all if we want to overcome the Covid and to ensure that government needs to rethink its new strategy.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Complexities of herd immunity
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Herd immunity
Mains level: Paper 2- Herd immunity and issues related to it
What is herd immunity
- The herd immunity concept is based on lowering the number of susceptible individuals.
- If sufficient individuals in the population are immune either through vaccination or a prior exposure, then the number of susceptible individuals drops.
- For example, if the immune population is 70%, then the susceptible population is 30%.
Does herd immunity really protect from subsequent waves?
- The number of daily cases depends on three factors: The number of infectious people in the population, the number of susceptible individuals, and the rate of transmission of the virus.
- The rate of transmission is dependent on the nature of the virus and the extent of contact between individuals.
- So, if the rate of transmission increases due to change in social behaviour and increased contact then even with a large percentage of the immune population, a significant number of daily cases can result.
- The “herd immunity” number is not a static number but it changes depending on the rate of transmission of the virus and the extent of virus present.
Estimating exposures in metro cities
- Serosurveys indicated that Covid had touched 56% of population in Delhi by January; 75% in some slums Mumbai in November, and about 30% in Bengaluru in November.
- The population touched by Covid can also be estimated by the Infection Fatality Rate (IFR).
- This is the total number of deaths divided by the total people infected. In India, the estimate is 0.08%.
- So this number can be used to back-calculate the number of infections based on the number of deaths in the different cities.
- The table given below shows the number of people exposed to Covid in some metros until January 31 using the method above.
What are the reasons behind the recent surge
- The reasons behind the recent surge are not fully understood.
- The one factor that is not in doubt, however, is that interaction and contact with the population has increased since February.
- Such increased contact increased the virus in circulation and led to increased cases in the susceptible population.
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Understanding infections after Covid-19 vaccination
Note4Students
From UPSC perspective, the following things are important :
Prelims level: How vaccine works
Mains level: Paper 2- Breakthrough infections
Breakthrough infections
- There have been several cases of Covid-19 vaccinated people, even those who have received both doses, testing positive for the virus.
- Such cases are referred to as “breakthrough” infections, indicating that the virus has been able to break through the defences created by the vaccine.
- Such cases have led to some doubts being expressed about the effectiveness of the vaccine, and contributed to the already prevailing vaccine hesitancy.
- However, vaccines protect not against the infection, but against moderate or severe disease and hospitalisation.
- It typically takes about two weeks for the body to build immunity after being vaccinated.
- So, the chances of a person falling sick during this period are as high — or as low — as the chances for any person who has not been vaccinated.
- Also, those in the priority list of vaccination, such as healthcare workers and frontline workers, have been prone to getting infected due to prolonged occupational exposure to the virus
Full protection not possible
- It is very well understood that no vaccine offers 100% protection from any disease.
- However, according to the Centers for Disease Prevention and Control (CDC) in the United States, vaccinated people are much less likely to get sick, but it is never entirely ruled out.
- Then there is the emergence of new variants of the virus.
- Some variants of the virus are able to evade the human immune response, and therefore have a greater chance to break through the defences created through the vaccine.
Breakthrough cases in India
- Among 10.03 crore people who had taken only the first dose of Covishield vaccina, 17,145 had got infected.
- That translates into a 0.02% prevalence.
- Among the 1.57 crore people who received the second dose as well, 5,014, or about 0.03%, had got infected later.
- About 1.1 crore doses of Covaxin have been administered until now.
- Of the 93.56 lakh who took only the first dose, so far 4,208 have got the infection.
- That is about 0.04% of the total.
- Among the 17.37 lakh who have taken the second shot, only 695 had been infected, again 0.04%.
Challenges
- “Given the scope of the pandemic, there’s a huge amount of virus in the world right now, meaning a huge opportunity for mutations to develop and spread.
- That is going to be a challenge for the developers of vaccines.
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Emergency use nod for Virafin
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Type 1 interferons
Mains level: Paper 2- Emergency use approval of Virafin
About the drug
- It is used in treating people with chronic hepatitis B and C.
- The Drug Controller General of India (DCGI) granted emergency use approval for pharma major Zydus Cadila’s antiviral drug ‘Virafin’, to treat moderate COVID-19 disease in adults.
- When administered early on during COVID, Virafin will help patients recover faster and avoid much of the complications.
- It significantly reduces viral load when given early on and can help in better disease management.
Findings of the clinical trials
- A single dose subcutaneous regimen of the antiviral Virafin [a pegylated interferon alpha-2b (PegIFN)] will make the treatment more convenient for the patients.
- When administered early on during COVID, Virafin will help patients recover faster and avoid much of the complications.
- In the phase-3 trials, the drug was able to achieve “better clinical improvement in the patients suffering from COVID-19”.
- A “higher proportion (91.15%) of patients administered the drug were RT-PCR negative by day seven as it ensures faster viral clearance”.
- The drug reduced the duration for supplemental oxygen to 56 hours from 84 hours in moderate COVID-19 patients.
How the drug works
- Type I interferons are the body’s first line of defence against many viral infections.
- In old people, the ability to produce interferon alpha in response to viral infections gets reduced, which might be the reason for higher mortality.
- The drug when administered early during the disease can replace this deficiency and help in the recovery process.
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How & why of oxygen therapy
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Epithelial cell
Mains level: Paper 2-Oxygen requirement in covid patients
How Covid-19 leads to shortness of breath?
- Shortness of breath occurs because of the way Covid-19 affects the patient’s respiratory system.
- When a person inhales, the tiny air sacs in the lungs — alveoli — expand to capture this oxygen, which is then transferred to blood vessels and transported through the rest of the body.
- Respiratory epithelial cells line the respiratory tract.
- Their primary function is to protect the airway tract from pathogens and infections, and also facilitate gas exchange.
- And the SARS-CoV-2 coronavirus can infect these epithelial cells.
- To fight such infection, the body’s immune system releases cells that trigger inflammation.
- When this inflammatory immune response continues, it impedes the regular transfer of oxygen in the lungs.
- Simultaneously, fluids too build up.
- Both these factors combined make it difficult to breathe.
- Low levels of oxygen triggered by Covid-19 are inflammatory markers, which include elevated white blood cell counts and neutrophil counts.
Does a patient always show Covid symptoms when their oxygen levels drop?
- No.
- According to the FAQs on Covid-19 from AIIMS e-ICUS, sudden deaths have been reported at presentation to the emergency department, as well as in hospital.
- AIIMS has said that the reasons that have been proposed include a sudden cardiac event, preceding “silent hypoxia” that went unnoticed, or due to a thrombotic complication such as pulmonary thromboembolism.
- In silent hypoxia, patients have extremely low blood oxygen levels, yet do not show signs of breathlessness.
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A missing science pillar in the COVID response
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Not much
Mains level: Paper 2- Covid response based on data and science
The article deals with the emerging trends from the surge in Covid cases and suggests a data-driven policy approach followed by a national vaccination program to deal with the challenge.
Surge in Covid cases
- Recently, there has been a sharp increase in new cases and deaths from the disease.
- Maharashtra seems to be particularly affected, but nearly all States are reporting increases.
- The epidemiology of COVID-19 is poorly understood.
- But some early understanding of the transmission of the virus can enable a more effective science-driven response.
Variant of virus could be behind the spread
- The surge is probably driven by variants from the original, as variants worldwide comprise much of the current wave.
- Evolutionary theory would expect SARS-CoV-2, the virus that causes COVID-19, to mutate to become more transmissible.
- However, the expected concomitant decrease in lethality has not yet been documented.
- Anecdotal reports that the current surge is occurring more in younger adults and accompanied by unusual symptoms also support the idea that variants are responsible.
- Direct evidence is needed from genetic sequencing of the virus.
No herd immunity
- Various serosurveys have consistently found that half or more of tested urban populations have antibodies to the virus.
- However, this high level of infection is not the same as a markedly reduced level of transmission, which is what is required for herd immunity.
- Notions of herd immunity do not fully capture the fact that for largely unknown reasons, viral transmission is cyclical.
- Much of the infection in India might well be mild, with less durable immune protection than induced by vaccination.
- Asymptomatic infection is more commonly reported in Indian serosurveys, exceeding 90% in some, in contrast to high-income countries, where about one-third of infections report as asymptomatic.
- Milder infection might well also correlate with lower severity of clinical illness, helping to explain the Indian paradox of widespread transmission but with low mortality rates.
Policy must be data-driven
- Theories or mathematical models are hugely uncertain, particularly early on in the epidemic.
- A better understanding of the unique patterns of Indian viral transmission has a few pillars, which can be achieved quickly.
- First, collection of anonymised demographic and risk details like age, sex, travel, contact with other COVID-19 patients, existing chronic conditions, current smoking on all positive cases on a central website in each State remains a priority.
- Second, greatly expanded sequencing of the viral genome is needed from many parts of India, which can be achieved by re-programming sequencing capacity in Indian academic and commercial laboratories.
- Third, far better reporting of COVID-19 deaths is needed.
- Daily or weekly reporting of the total death counts by age and sex by each municipality would help track if there is a spike in presumed COVID-19 deaths.
- Fourth, the Indian Council of Medical Research’s national serosurvey had design limitations such that it probably underestimated the true national prevalence.
- A far larger and better set of serial surveys is required.
- Finally, we need to understand better why some populations are not affected.
Counter the inequality in vaccination
- Affluent and connected urban elites of India are vaccinating quickly, but the poorer and less educated Indians are being left behind.
- Vaccination campaigns need to reach the poor adults over age 45, without having to prove anything other than approximate age.
- Follow-up studies among the vaccinated can establish the durability of protection, and, ideally, reduction in transmission.
- Similarly, India must capture and report data on who is vaccinated, including by education or wealth levels.
- The poor cannot be left in the dark.
Prepare for future pandemics through adult vaccination plan
- COVID-19 could well turn into a seasonal challenge and thus, the central government should actively consider launching a national adult vaccination programme.
- The Disease Control Priorities Project estimates an adult national programme would cost about ₹250 per Indian per year to cover routine annual flu vaccination, five-yearly pneumococcal vaccines, HPV vaccines for adolescent girls and tetanus for expectant mothers.
- Per year, vaccines for one billion adults might save about 200,000 lives from the targeted diseases.
- Indeed, we might already be in the era where major zoonotic diseases are not once-a-century events, but once a decade.
- Thus, adult and child vaccination programmes are essential to prepare for future pandemics.
Conclusion
The resurgence of COVID-19 presents a major challenge for governments, yet the best hope is to rapidly expand epidemiological evidence, share it with the public and build confidence that the vaccination programme will benefit all Indians.
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What changes after COVID-19 vaccination?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Vaccine for COVID
Mains level: Vaccination challenges for coronavirus
As the vaccination drive gains momentum, questions have emerged about appropriate behaviour after being vaccinated.
What does being vaccinated mean?
- Being fully vaccinated means a period of two weeks or more following the receipt of the second dose in a two-dose series, or two weeks or more following the receipt of a single-dose vaccine.
- In India, currently, both vaccines being used — Covishield and Covaxin — follow a two-dose regimen.
- Typically, the immune response takes a while to build up after a vaccine shot.
- After the first jab of a two-dose vaccine, a good immune response kicks in within about two weeks. It is the second dose that boosts the immune response.
Is the COVID threat averted?
- It is still unclear how long immunity lasts from the vaccines at hand now.
- Whether or not the immune response is durable, how it performs with the passage of time, and how long it lasts can be found out only by monitoring people who have already been vaccinated over a period.
- If the vaccinated individual is still carrying the virus, the vaccine may provide immunity from severe disease for him or her, but the individual could still transmit the virus.
What changes after you get a vaccine shot?
- After vaccination, one risk of severe disease from COVID-19 goes down dramatically.
- There is not enough evidence yet of vaccine response for some age groups, and vaccines are in short supply in the community.
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Why do Viruses mutate?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Virus mutation
Mains level: Vaccination challenges for coronavirus
SARS-CoV-2 variants have emerged independently in several countries, and research published over the past week indicates that the virus is changing more quickly than was once believed.
Try this PYQ:
Q.H1N1 virus is sometimes mentioned in the news with reference to which one of the following diseases?
(a) AIDS
(b) Bird flu
(c) Dengue
(d) Swine flu
Mutation of Virus
- Mutation, an alteration in the genetic material (the genome) of a cell of a living organism or of a virus that is more or less permanent and that can be transmitted to the cell’s or the virus’s descendants.
- Like all life, viruses carry a genetic code in the form of nucleic acids — either DNA or RNA.
- When cells multiply, the DNA within them replicates as well, to make copies for the new cells.
- During replication, random errors are introduced into the new DNA, much like spelling errors when we write.
- While the errors in DNA virus genomes can be corrected by the error-correcting function of cells in which they replicate, there are no enzymes in cells to correct RNA errors.
- Therefore, RNA viruses accumulate more genetic changes (mutations) than DNA viruses.
Effect of mutation on the virus
- Evolution requires not just mutations, but also selection.
- While most mutations are deleterious to the virus, if some allow a selective advantage — say better infectivity, transmission, or escape from immunity — then the new viruses out-compete the older ones in a population.
- The mutations can be synonymous (silent) or non-synonymous (non-silent); the latter also changes an amino acid (protein building block) at that position in the coded protein.
Mutations in COVID
- As of January 26, about 29,000 infections are attributed to UK variants from 63 countries, many due to local transmission.
Why is it harmful?
- Viruses with mutations within the receptor-binding domain (RBD) of the Spike protein have the most potential to evade antibodies that develop as a result of natural infection or vaccination.
- The RBD binds the cellular receptor allowing the virus to infect cells, and anti-RBD antibodies neutralize the virus.
- Such mutations were recently found in variant viruses that emerged in the UK, South Africa and Brazil.
Testing of mutation
- Indirect tests are done in laboratories to assess if an emerging variant might escape antibodies developed after natural infection or vaccination.
- Serum (the blood components that contain antibodies) from recovered patients or vaccinated people, and antibodies are known to neutralize the original virus, are tested.
- Serial dilutions of the serum or antibodies are separately mixed with a fixed amount of the original and variant viruses, and the mixture is added to cells in culture.
- After a period of incubation, cells are washed and stained. Cells infected and killed by viruses multiplying within them appear as clear zones (plaques) on a dark background.
- The effectiveness of serum or antibody is expressed as an inhibitory concentration (IC) or plaque reduction neutralisation titer (PRNT) value.
- The IC50 or PRNT50 value is the reciprocal dilution of serum or antibody that neutralises 50 per cent viruses in the sample.
India’s response
- Only the UK variant viruses have so far been reported from India — and that too, in travellers.
- There is no reported local transmission, but considering its increased infectivity, this is likely to happen.
- The evidence so far suggests that current vaccines would still protect against the UK variant, even if with reduced efficacy.
- The evidence at this time, though of concern, does not indicate that current vaccines are failing.
- But this has to be watched carefully, and all efforts made to limit transmission between people, which drives mutations and the emergence of variants.
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What is Herd Immunity?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Serological surveys
Mains level: Herd immunity and related health concerns
The initial findings of the fifth round of serological survey conducted in Delhi suggest that over 56 percent of the people have developed antibodies against Covid-19 implying achievement of herd immunity.
Herd Immunity
- Herd immunity is when a large number of people are vaccinated against a disease, lowering the chances of others being infected by it.
- When a sufficient percentage of a population is vaccinated, it slows the spread of disease.
- It is also referred to as community immunity or herd protection.
- The decline of disease incidence is greater than the proportion of individuals immunized because vaccination reduces the spread of an infectious agent by reducing the amount and/or duration of pathogen shedding by vaccines, retarding transmission.
- The approach requires those exposed to the virus to build natural immunity and stop the human-to-human transmission. This will subsequently halt its spread.
Sero-surveys in Delhi
- The results of the latest serosurvey in Delhi have led researchers and experts to surmise that a large section of the city’s population has already developed antibodies against Covid-19.
- The presence of antibodies among a large percentage of the population could be a reason for the decline in the daily number of Covid-19 cases.
- As more people are able to resist infection, it will help to break the chain of transmission of the virus.
- Five serological surveys have been carried out in Delhi so far, including the present one, which was conducted in January.
- The survey conducted by NCDC in July last year suggested the presence of antibodies in 23 percent of those surveyed.
- In August, the survey conducted by the Delhi government showed 29.1 percent had antibodies.
The relevance of such surveys
- Carrying out repeated serological surveillance on the same population gives an idea of how the disease is behaving.
- It is always good to have surveillance regularly to understand the trends.
- Having robust surveillance is always beneficial, it may not be too close, but it may help us in giving an idea, even of the natural history of the disease.
What do the data suggest about herd immunity?
- Many researchers believe that if 60 percent or more of the population has developed antibodies against Covid-19, there is a possibility of acquiring herd immunity.
- In Delhi, it is quite indicative, as the number of cases is also going down. This shows that we are moving closer towards acquiring herd immunity.
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Covid-19 vaccine policy
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Vaccines for Covid-19
Mains level: Paper 2- Challenges in vaccination for Covid-19
The article explains the challenge in the vaccination program for the Covid-19 vaccine.
Issue of lack of data about the vaccine
- In the COVID vaccine roll out, there is no clear data for either of the two vaccines proposed for use in the programme.
- We do not know if they provide protection for life, for a year or six months, its efficacy among the elderly or the very sick or in stopping new infections.
- Getting such data requires at least three years and cannot be obtained in a few months.
Guidelines for implementing vaccine programme
- Given these limitations, the government has drawn up strategic guidelines for implementing an vaccine programme covering 30 crore people by July.
- The guidelines draw upon the knowledge of running national campaigns acquired over three decades of implementing the Universal Immunisation Programme.
- These guidelines detail the skills, roles and responsibilities of the required human resources, logistics for delivering vaccines at point of use, physical infrastructure, monitoring systems based on digital platforms and feedback systems for reporting adverse events.
- The approach involves 19 departments, donor organisations and NGOs at the national, state, district and block level.
- The guidelines also mention the priority criteria — caregivers, front line workers of the departments of health, defence, municipalities and transportation; persons above the age of 50 and those below 50 having diabetes, hypertension, cancers and lung diseases.
Issues with the guidelines
- Of the 28,932 cold chain points, half are in the five southern states, Maharashtra and Gujarat.
- Combined with poor human resources — doctors, nurses, pharmacists — a weak private sector, poor safety and hygiene standards, frequent power outages, poor infrastructure, the capacity to implement with the expected speed, quality and accuracy is daunting.
- The immunisation can disrupt routine health service delivery — antenatal care, national programmes like those pertaining to TB or other immunisation drives.
- While data for the above-50-year-olds is available in the electoral rolls, line listing of the under 50s with comorbidities can be challenging.
- Not only are urban-rural variations substantial, but urban areas have weak public health infrastructure and a multiple number of private providers due to the poor implementation of the Clinical Establishment Act, 2010.
- Patient tracking can be problematic.
- The non-availability of efficacy data could also impact the procurement and supply of vaccines, result in huge wastage, and can introduce scope for errors and duplication.
Way forward
- Central to the success of the roll out will be the confidence of the people in the vaccines.
- Coming out of this messy situation is necessary and one option — as adopted for the polio eradication programme — is to establish an independent team of experts under the aegis of the WHO to ensure the safety of the vaccine.
- This will create confidence in the community and international authorities as well.
Conclusion
it is important to understand that vaccination is an incomplete solution to ending the epidemic, since the virus is mutating. Adopting safe behaviour is.
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What is Molnupiravir?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Molnupiravir
Mains level: Vaccine for covid
A new drug called Molnupiravir has been shown to stop the transmission of SARS-CoV-2 in 24 hours.
Must read:
Molnupiravir
- Molnupiravir is an experimental antiviral drug which is orally active and was developed for the treatment of influenza.
- It is a drug of the synthetic nucleoside derivative N4-hydroxycytidine, and exerts its antiviral action through introduction of copying errors during viral RNA replication.
- Molnupiravir is being developed by the biotechnology firm Ridgeback Biotherapeutics in collaboration with pharmaceutical firm Merck.
- The research team repurposed MK-4482/EIDD-2801 against SARS-CoV-2 and tested it on ferrets.
- This is the first demonstration of an orally available drug to rapidly block SARS-CoV-2 transmission and it can be a game-changer.
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What is mRNA vaccine?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: mRNA
Mains level: Vaccination challenges for coronavirus
The Moderna and Pfizer vaccines which recently announced their success use the same technology, based on messenger RNA, or mRNA.
Try this PYQ first:
Q.‘RNA interference (RNAi)’ technology has gained popularity in the last few years. Why?
- It is used in developing gene silencing therapies.
- It can be used in developing therapies for the treatment of cancer.
- It can be used to develop hormone replacement therapies.
- It can be used to produce crop plants that are resistant to viral pathogens.
Select the correct answer using the code given below:
(a) 1, 2 and 4
(b) 2 and 3
(c) 1 and 3
(d) 1 and 4 only
What is mRNA?
- Messenger RNA (mRNA) is a single-stranded RNA (Ribo Nucleic Acid) molecule that is complementary to one of the DNA strands of a gene.
- The mRNA is an RNA version of the gene that leaves the cell nucleus and moves to the cytoplasm where proteins are made.
- During protein synthesis, an organelle called a ribosome moves along the mRNA, reads its base sequence, and uses the genetic code to translate each three-base triplet, or codon, into its corresponding amino acid.
What is the mRNA vaccine?
- Such vaccines make use of the messenger RNA molecules that tell the body’s cells what proteins to build.
- The mRNA, in this case, is coded to tell the cells to recreate the spike protein of the coronavirus SARS-CoV-2, which causes Covid-19.
- It is the spike protein — which appears as spikes on the surface of the coronavirus — that initiates the process of infection; it allows the virus to penetrate cells, after which it goes on to replicate.
- A coronavirus vaccine based on mRNA, once injected into the body, will instruct the body’s cells to create copies of the spike protein.
- In turn, this is expected to prompt the immune cells to create antibodies to fight it.
- These antibodies will remain in the blood and fight the real virus if and when it infects the human body.
Back2Basics: Ribo Nucleic Acid (RNA)
- RNA is an important biological macromolecule that is present in all biological cells.
- It is principally involved in the synthesis of proteins, carrying the messenger instructions from DNA, which itself contains the genetic instructions required for the development and maintenance of life.
- In some viruses, RNA, rather than DNA, carries genetic information.
- The type of RNA dictates the function that this molecule will have within the cell.
- Aside from the coding region of messenger RNA (mRNA) molecules that will be translated into proteins, other cellular RNA elements are involved in different processes.
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Kawasaki Disease
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Kawasaki Disease
Mains level: NA
Children in the world over have shown to be affected by either Kawasaki Disease (KD) since the reopening of schools.
Try this PYQ:
Q.H1N1 virus is sometimes mentioned in the news with reference to which one of the following diseases?
(a) AIDS
(b) Bird flu
(c) Dengue
(d) Swine flu
What is Kawasaki Disease?
- Kawasaki disease is an illness that causes blood vessels to become inflamed, almost always in young children.
- Its cause is yet unknown. It is one of the leading causes of heart disease in kids.
- But doctors can treat it if they find it early. Most children recover without any problems.
Symptoms
Kawasaki disease comes on fast, and symptoms show up in phases. Signs of the first phase of Kawasaki disease include:
- High fever that lasts more than 5 days
- Swelling and redness in hands and bottoms of feet
- Red eyes
- Swollen glands, especially in the neck
- Irritated throat, mouth, and lips
In the second phase, symptoms include:
- Joint pain
- Stomach trouble, such as diarrhoea and vomiting
- Peeling skin on hands and feet
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What is the D614G mutation in coronavirus?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: D614G mutation
Mains level: Not Much
While novel coronavirus is undergoing many mutations, one particular mutation called D614G, according to a study, has become the dominant variant in the global COVID-19 pandemic.
Try this PYQ:
Q.Which one of the following statements is not correct?
(a) Hepatitis B virus is transmitted much like HIV.
(b) Hepatitis B, unlike Hepatitis C, does not have a vaccine.
(c) Globally, the number of people infected with Hepatitis B and C viruses is several times more than those infected with HIV.
(d) Some of those infected with Hepatitis B and C viruses do not show the symptoms for many years.
D614G mutation
- When the virus enters an individual’s body, it aims at creating copies of itself. When it makes an error in this copying process, we get a mutation.
- In this case, the virus replaced the aspartic acid (D) in the 614th position of the amino acid with glycine (G). Hence the mutation is called the D614G.
- This mutated form of the virus was first identified in China and then in Europe. Later it spread to other countries like the U.S. and Canada and was eventually reported in India.
Threats posed
- This particular mutation aids the virus in attaching more efficiently with the ACE2 receptor in the human host, thereby making it more successful in entering a human body than its predecessors.
- D614G show increased infectivity but it also displayed greater ability at attaching itself to the cell walls inside an individual’s nose and throat, increasing the viral load.
How prevalent is it in India?
- A study (reveals that the D614G was one of the most prevalent spike mutations even during the initial phase of the pandemic.
- Since then, D614G mutation’s ‘relative abundance’ has increased over time to 70% and above, in most states except Delhi.
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Debate over Plasma Therapy’s efficacy
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Plasma therapy
Mains level: Efficacy of the plasma therapy
Recently published findings on convalescent plasma therapy on Covid-19 patients have triggered a debate over its efficacy.
Plasma Therapy
- Plasma is the liquid part of the blood. Convalescent plasma, extracted from the blood of patients recovering from an infection, is a source of antibodies against the infection.
- The therapy involves using their plasma to help others recover. For Covid-19, this has been one of the treatment options.
- The donor would have to be a documented case of Covid-19 and healthy for 28 days since the last symptoms.
How is it done?
- The process to infuse plasma in a patient can be completed quickly.
- It only requires standard blood collection practices, and extraction of plasma.
- If whole blood is donated (350-450 ml), a blood fractionation process is used to separate the plasma.
- Otherwise, a special machine called aphaeresis machine can be used to extract the plasma directly from the donor.
- While blood is indeed extracted from the donor, the aphaeresis machine separates and extracts the plasma using a plasma kit, and the remaining blood components are returned into the donor’s body.
WHO’s guidelines
- WHO guidelines in 2014 mandate a donor’s permission before extracting plasma.
- Plasma from only recovered patients must be taken, and donation must be done from people not infected with HIV, hepatitis, syphilis, or any infectious disease.
- If whole blood is collected, the plasma is separated by sedimentation or centrifugation, then injected in the patient.
- If plasma needs to be collected again from the same person, it must be done after 12 weeks of the first donation for males and 16 weeks for females, the WHO guidelines state.
What has happened to spark the debate?
- An ICMR study has found convalescent plasma was not associated with a reduction in progression to severe Covid-19 or all-cause mortality.
- While the use of this therapy seemed to improve the resolution of shortness of breath and fatigue in patients with moderate Covid-19, this did not translate into a reduction in 28-day mortality or progression to severe disease.
- Progression to severe disease or death at 28 days after enrolment occurred in 44 (19%) of the participants in the intervention arm as compared to 41 (18%) in the control arm.
What happens if ICMR does remove the therapy from its guidelines?
- The authorisation of convalescent plasma as a treatment for Covid-19 in India has led to questionable practices such as calls for donors on social media, and the sale of convalescent plasma on the black market.
- The ICMR has been cautious because of the trial findings.
- However, those guidelines are not necessarily binding and it is too early to dismiss convalescent plasma therapy. But there are other issues.
- The therapy involves resource-intensive processes such as plasmapheresis, plasma storage, and measurement of neutralizing antibodies.
Way ahead
- This is a new virus, and around the world, the evidence is still emerging on the best therapeutic options.
- Covid care is individualized care. Use of the right medication on the right patient does work.
- Some of the therapies can be continued on compassionate grounds.
- However, the potential harms of the non-immune components of convalescent plasma should be rigorously investigated.
- Only donor plasma with detectable titers of neutralizing antibodies should be given to trial participants, to ensure that the potential for benefit exists for all intervention arm patients.
Try this question:
Q.What is convalescent plasma therapy? Discuss its efficacy and limitations for COVID-19 treatment.
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E-VIN network to handle COVID-19 vaccine supply
Note4Students
From UPSC perspective, the following things are important :
Prelims level: EVIN network
Mains level: Vaccination challenges for coronavirus
The eVIN network, which can track the latest vaccine stock position; the temperature at storage facility; geo-tag health centres; and maintain facility-level dashboard, is being repurposed for the delivery of the COVID-19 vaccine.
Try this question from CSP 2016:
Q.‘Mission Indradhanush’ launched by the Government of India pertains to:
(a) Immunization of children and pregnant women
(b) Construction of smart cities across the country
(c) India’s own search for the Earth-like planets in outer space
(d) New Educational Policy
What is eVIN network?
- The eVIN is an innovative technological solution aimed at strengthening immunization supply chain systems across the country.
- This is being implemented under the National Health Mission (NHM) by the Ministry of Health and Family Welfare.
- It aims to provide real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in the country.
- This system has been used during the COVID pandemic for ensuring the continuation of the essential immunization services and protecting our children and pregnant mothers against vaccine-preventable diseases.
Components of eVIN
- eVIN combines state-of-the-art technology, a strong IT infrastructure and trained human resource to enable real-time monitoring of stock and storage temperature of the vaccines kept in multiple locations across the country.
- At present, 23,507 cold chain points across 585 districts of 22 States and 2 UTs routinely use the eVIN technology for efficient vaccine logistics management.
Benefits of eVIN
- It has helped create a big data architecture that generates actionable analytics encouraging data-driven decision-making and consumption-based planning.
- It helps in maintaining optimum stocks of vaccines leading to cost savings. Vaccine availability at all times has increased to 99% in most health centres in India.
- While instances of stock-outs have reduced by 80%, the time taken to replenish stocks has also decreased by more than half, on an average.
- This has ensured that every child who reaches the immunization session site is immunized, and not turned back due to unavailability of vaccines.
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Cat Que Virus
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Cat Que Virus
Mains level: Not Much
In a study published in the Indian Journal of Medical Research, scientists have noted the presence of antibodies against the Cat Que virus (CQV) in two human serum samples.
Try this PYQ:
Q.Which one of the following statements is not correct?
(a) Hepatitis B virus is transmitted much like HIV.
(b) Hepatitis B, unlike Hepatitis C, does not have a vaccine.
(c) Globally, the number of people infected with Hepatitis B and C viruses is several times more than those infected with HIV.
(d) Some of those infected with Hepatitis B and C viruses do not show the symptoms for many years.
What is the Cat Que Virus?
- For CQV, domestic pigs are considered to be the primary mammalian hosts.
- Antibodies against the virus indicate that the virus has formed a “natural cycle” in the local area and has the ability to spread in pigs and other animal populations through mosquitoes.
- CQV belongs to the Simbu serogroup and infects both humans and economically important livestock species.
- It was first isolated in 2004 from mosquitoes during the surveillance of arbovirus activity in northern Vietnam.
- In this study, researchers reported a CQV strain (SC0806), which was isolated from mosquito samples collected in China in 2006 and 2008.
Impact on humans
- Humans can get infected through mosquitoes as well.
- In the study, scientists note that because of positivity in human serum samples and the replication capability of CQV in mosquitoes, there is only a “possible disease-causing potential” of CQV in the Indian scenario.
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What is Next Generation Sequencing (NGS)?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: PCR, Genome Sequencing, NGS
Mains level: Genome Sequencing Applications
- To speed up testing as well as improve the accuracy of testing COVID-19, the CSIR is working on developing “mega labs” where large machines, called Next Generation Sequencing machines (NGS), will be used for sequencing human genomes.
- It is repurposed to sequence 1,500-3,000 viral genomes at a go for detecting the SARS-CoV-2 novel coronavirus.
Try this PYQ:
What is Cas9 protein that is often mentioned in news? (CSP 2018)
(a) A molecular scissors used in targeted gene editing
(b) A biosensor used in the accurate detection of pathogens in patients
(c) A gene that makes plants pest-resistant
(d) A herbicidal substance synthesized in genetically modified crops
What is NGS?
- DNA sequencing is the process of determining the nucleic acid sequence – the order of nucleotides in DNA.
- It includes any method or technology that is used to determine the order of the four bases: adenine, guanine, cytosine, and thymine.
- The advent of rapid DNA sequencing methods has greatly accelerated biological and medical research and discovery.
- Next-generation sequencing (NGS), also known as high-throughput sequencing, is the catch-all term used to describe a number of different modern sequencing technologies.
- These technologies allow for sequencing of DNA and RNA much more quickly and cheaply than the previously used Sanger sequencing, and as such revolutionized the study of genomics and molecular biology.
Benefits
- The genome sequencing machines can substantially detect the possible presence of the virus even in several instances where the traditional RT-PCR tests miss out on them.
- This is primarily because the RT-PCR test identifies the SARS-CoV-2 virus by exploring only specific sections of the virus.
- Having an edge, the genome method can read a bigger chunk of the virus genome and thereby provide more certainty that the virus in question is indeed the particular coronavirus of interest.
- It can also trace the evolutionary history of the virus and track mutations more reliably.
Back2Basics:
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[pib] E-Sanjeevani Tele-Medicine Platform
Note4Students
From UPSC perspective, the following things are important :
Prelims level: E-Sanjeevani
Mains level: Telemedicine and its effectiveness
1.5 lakh teleconsultations were recently completed on the “eSanjeevani” and “eSanjeevani OPD” tele-medicine.
Why Telemedicine?
Telemedicine can increase the efficiency of care delivery, reduce expenses of caring for patients or transporting to another location, and can even keep patients out of the hospital.
E-Sanjeevani Platform
- E-Sanjeevani is a platform-independent, browser-based application facilitating both doctor-to-doctor and patient-to-doctor tele-consultations.
- It provides the ease of accessing the health records at the comforts of one’s home.
- The application is based on invite-system which restricts it to the actual beneficiaries of the application.
- It has a user-friendly interface which facilitates both tech-savvy and novice doctors/users in the rural and urban environment to access the application.
- This eSanjeevani platform has enabled two types of telemedicine services viz. Doctor-to-Doctor (eSanjeevani) and Patient-to-Doctor (eSanjeevani OPD) Tele-consultations.
- The former is being implemented under the Ayushman Bharat Health and Wellness Centre (AB-HWCs) programme.
Services included:
The telemedicine platform hosts speciality OPDs which include:
- Gynaecology, Psychiatry, Dermatology, ENT, Ophthalmology, antiretroviral therapy (ART) for the AIDS/HIV patients, Non-Communicable Disease (NCD) etc
With inputs from:
https://www.cdac.in/index.aspx?id=hi_pr_eSanjeevani
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is Itolizumab, newly cleared for Covid?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Itolizumab
Mains level: NA
The Drug Controller General of India recently approved Itolizumab as a novel biologic therapy for restricted emergency use.
Various drugs in news these days are:
1) Remdesivir: Ebola
2) Lopinavir: HIV
3) Hydroxychloroquine: Malaria
What is Itolizumab?
- Itolizumab is an existing drug used for psoriasis, a chronic skin disease involving unregulated growth of some skin cells that develop into red patches mostly on knees and elbows, but also on some other parts of the body.
- The drug, developed by Bengaluru-based Biocon, was approved in 2013.
- It is a monoclonal antibody which is used to treat acute psoriasis.
Why it is being used for COVD-19?
- The coronavirus has been observed to induce an overreaction of the immune system, generating a large number of cytokines that can cause severe damage to the lungs and other organs.
- Itolizumab is safe and efficient in preventing cardio-renal complications in Covid-19 patients who also have acute respiratory distress.
What are monoclonal antibodies?
- Monoclonal antibodies are proteins cloned in the lab to mimic antibodies produced by the immune system to counter infection.
- They have their genesis in serum, the colourless constituent of blood that contains antibodies.
- These proteins bind to an antigen, the fragment of an infectious virus in the case of SARS-CoV-2, and either destroy it or block its action.
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Vitamin D and its health benefits
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Vitamin D
Mains level: NA
There have been considerable discussions in scientific circles on the importance of vitamin D in these days of the COVID-19 pandemic.
Try this question from CSP 2017:
Q.Regular intake of fresh fruits and vegetables is recommended in the diet since they are a good source of antioxidants. How do antioxidants help a person maintain health and promote longevity?
(a) They activate the enzymes necessary for vitamin synthesis in the body and help prevent vitamin deficiency.
(b) They prevent excessive oxidation of carbohydrates, fats and proteins in the body and help avoid unnecessary wastage of energy.
(c) They neutralize the free radicals produced in the body during metabolism.
(d) They activate certain genes in the cells of the body and help delay the ageing process.
Vitamin D and its prevalence
- It is produced when sunlight (or artificial light, particularly in the ultraviolet region of 190-400 nm wavelength) falls on the skin.
- Light triggers a chemical reaction to a cholesterol-based molecule and converts it into calcidiol in the liver and into calcitriol in the kidney.
- It is these two molecules that are physiologically active.
- Since sunlight is important for the generation of vitamin D, tropical countries have an advantage over the northern countries.
- India, being a tropical country, one would expect naturally derived vitamin D levels to be good.
Why Vitamin D is important?
- Vitamin D deficiency can affect COVID-19 high-risk patients, particularly those who are diabetic, have heart conditions, pneumonia, obesity and those who smoke.
- It is also associated with infections in the respiratory tract and lung injury.
- Besides, vitamin D is known to help in having the right amount of calcium in the bones, catalyse the process of protecting cell membranes from damage, preventing the inflammation of tissues.
- Moreover, it helps stop tissues from forming fibres and weakening bones from becoming brittle, leading to osteoporosis.
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What is T Cells Immunity?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: T-Cells Immunity
Mains level: Coronovirus outbreak and associated medical research
A recent study has shown that people unexposed to and not infected with novel coronavirus may still exhibit T cell responses specific to this virus. It is thought that Coronavirus specific T cell responses seen in healthy people might arise from memory T cells derived from exposure to ‘common cold’ coronaviruses.
Try this question from CSP 2010:
Q. Widespread resistance of malaria parasite to drugs like chloroquine has prompted attempts to develop a malaria vaccine to combat malaria. Why is it difficult to develop an effective malaria vaccine?
(a) Malaria is caused by several species of Plasmodium
(b) Man does not develop immunity to malaria during natural infection
(c) Vaccines can be developed only against bacteria
(d) Man is only an intermediate host and not the definitive host
What are T Cells?
- T Cells also called T lymphocyte, type of leukocyte (white blood cell) that is an essential part of the immune system.
- T cells are one of two primary types of lymphocytes—B cells being the second type—that determine the specificity of the immune response to antigens (foreign substances) in the body.
- T cells originate in the bone marrow and mature in the thymus.
Why are they called memory cells?
- In the thymus, T cells multiply and differentiate into helper, regulatory, or cytotoxic T cells or become memory T cells.
- They are then sent to peripheral tissues or circulate in the blood or lymphatic system.
- Once stimulated by the appropriate antigen, helper T cells secrete chemical messengers called cytokines, which stimulate the differentiation of B cells into plasma cells (antibody-producing cells).
How do they control immunity?
- Regulatory T cells act to control immune reactions, hence their name.
- Cytotoxic T cells, which are activated by various cytokines, bind to and kill infected cells and cancer cells.
- Because the body contains millions of T and B cells, many of which carry unique receptors, it can respond to virtually any antigen.
Vaccination outcomes on T cells
- There is a possibility that pre-existing T cell memory might influence vaccination outcomes.
- Pre-existing immunity could help elicit better immune responses against novel coronavirus, and these responses can manifest faster.
- Meanwhile, pre-existing immunity could be mistaken as an enhanced efficacy of the vaccine in eliciting immune responses.
- This could be particularly confusing in Phase-1 trials where the vaccine is tested on a small group of healthy participants.
Its drawbacks
- The pre-existing immunity can reduce the immune responses that the vaccine causes through a mechanism called the “original antigenic sin”.
- It can also lead to antibody-mediated disease enhancement, where antibodies present at sub-neutralizing concentrations can actually augment virus infection and cause more severe disease.
- This was seen in the case of chikungunya and dengue.
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AarogyaPath Platform for the Healthcare Supply Chain
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Aarogyapath platform
Mains level: Not Much
AarogyaPath Platform has been recently launched to provide real-time availability of critical healthcare supplies.
Possible prelims question:
Q. The AarogyaPath platform recently seen in news is related to:
Options: a) Tracking of COVID patients/ b) Emergency ambulances service/c) Supply-chain solutions of healthcare facilities/ d)E-com portal for generic medicines …
Aarogyapath platform
- The information platform named AarogyaPath with a vision of providing a path which leads one on a journey towards Aarogya (healthy life) has been developed by the CSIR.
- During the present national health emergency arising out of the COVID-19 pandemic, wherein there is a severe disruption in the supply chain, the ability to produce and deliver the critical items may be compromised due to a variety of reasons.
- The platform would serve manufacturers, suppliers and customers.
- CSIR expects AarogyaPath to become the national healthcare information platform of choice in the years to come.
- It would fill a critical gap in last-mile delivery of patient care within India through improved availability and affordability of healthcare supplies.
Its significance
- This platform provides single-point availability of key healthcare goods that can be helpful to customers in tackling a number of routinely experienced issues.
- These issues include dependence on limited suppliers, time-consuming processes to identify good quality products, limited access to suppliers who can supply standardized products at reasonable prices within desired timelines, lack of awareness about the latest product launches, etc.
- It also helps manufacturers and suppliers to reach a wide network of customers efficiently, overcoming gaps in connectivity between them and potential demand centres like nearby pathological laboratories, medical stores, hospitals, etc.
- It will also create opportunities for business expansion due to an expanded slate of buyers and visibility of new requirements for products.
- Over time, analytics from this platform is expected to generate early signals to manufacturers on overcapacity as well as on looming shortages.
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Debate over a homoeo drug – Arsenicum album 30
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Arsenicum album 30
Mains level: Clinical trials and ethical issues involved in treating covid
A homoeopathic drug, Arsenicum album 30, has become a subject of debate after several states and AYUSH Ministry recommended it for prophylactic (preventive) use against Covid-19.
Practice question:
Q. The furore over the usage of several medicines has created an chaos in treating COVID. Critically comment.
Arsenicum album 30
- Arsenicum album is made by heating arsenic with distilled water, a process repeated several times over three days. The drug has less than 1% arsenic.
- A small bottle with one course costs Rs 20-30.
- Arsenicum album is considered to correct inflammation in the body. It takes care of diarrhoea, cough and cold.
- It is used commonly by homoeopaths to treat anxiety, restlessness, cold, ulcerations, burning pains. It is taken in powder form or as a tablet.
- The health hazards of arsenic contamination in water are well known: long-term exposure to the metal can cause skin cancer, pulmonary and cardiovascular diseases.
- It has been recommended against COVID by the state governments in Rajasthan, Karnataka, Tamil Nadu, Andhra Pradesh and Kerala.
The Covid-19 context
- Arsenicum album 30 could be taken as prophylactic medicine against Coronavirus infections.
- It is only “possible prevention” against flu.
- The AYUSH Ministry recommended taking the medicine for three days on an empty stomach and repeating the dose after a month if an outbreak continues locally.
Issues with such medicines
- The WHO neither has any guidelines nor any effective evidence on using Arsenicum album as a Covid-19 treatment.
- The debate stems from the fact that there is no scientific evidence that the drug works against Covid-19, a fact stressed not only by medical scientists but also by some homoeopathic practitioners themselves.
- There have been reports about people flocking to homoeopathic clinics to buy Arsenicum album, sometimes at triple the cost.
- Even local chemists have started stocking this medicine.
- Self-medication can prove harmful as prevention or cure for COVID-19.
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What is the FAITH’ Trial?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: FAITH and Solidarity Trials
Mains level: Clinical trials and ethical issues involved
With the number of COVID-19 patients rising in India, a pharma company has announced a new randomized study to test the combined efficacy of two antiviral drugs under the ‘FAITH Trials’.
Misleading names: One may get confused over the names given to these clinical trials. The name ‘FAITH’ and ‘Solidarity’ appear more like a judicial trial or some Human Rights violation related trials. UPSC can knock such areas in prelims.
FAITH Trials
- The two drugs: Favipiravir and Umifenovir will be tried as a potential COVID-19 treatment strategy.
- This new combination clinical trial will be called FAITH – (FA vipiravir plus Um I fenovir (efficacy and safety) Trial in Indian Hospital setting).
- The two antiviral drugs have different mechanisms of action, and their combination may demonstrate improved treatment efficacy by effectively tackling high viral loads in patients during the early stages of the disease.
- This trial offers a comprehensive antiviral cover on pre-entry and post-entry life-cycle of the SARS-CoV-2 virus.
Dosages under the trial
- Patients taking the drug will receive Faviprivir 1800 mg bid and Umifenovir 800 mg bid on Day 1.
- Thereafter, they will receive Faviprivir 800mg bid and Unifenovir 800mg bid for the remaining course of treatment.
- Duration of treatment will be 14 days and patients will be discharged after clinical cure and two consecutive negative tests.
- While one group will be receiving Favipiravir and Umifenovir (with standard supportive care), the other group will receive Favipiravir along with standard supportive care.
Other trials in news: The Solidarity Trial
- “Solidarity” is an international initiative for clinical trials launched by the WHO, along with partners, to help find an effective treatment for Covid-19.
- It was originally supposed to look at four drugs or drug combinations: Remdesivir, HCQ, Ritonavir/Lopinavir and Lopinavir/Ritonavir/Interferon beta 1a.
- Now with HCQ trial enrolment stalled for at least the next few weeks, the Solidarity trial will proceed with the other three arms.
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[pib] Kangra Tea and its medicinal properties against the coronavirus
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Kangra Tea
Mains level: Not Much
The chemicals in Kangra tea are found to be effective in boosting immunity as they can block coronavirus activity better than anti-HIV drugs.
It would be no surprise to expect a question based on worldwide tea production:
Q. Among the following, which one is the largest exporter of rice in the world in the last five years? (CSP 2019)
(a) China
(b) India
(c) Myanmar
(d) Vietnam
Kangra Tea
- Kangra tea is a tea from the Kangra district in Himachal Pradesh, India.
- Both black tea and green tea have been produced in the Kangra Valley since the mid-19th century.
- After a feasibility survey in 1848 showed the area of being suitable for tea plantation, a Chinese variety of Camellia sinensis was planted across the region.
- Kangra tea is known for its unique colour and flavour.
- The unique characteristics of the tea are attributed to the geographical properties of the region.
- Kangra tea was given the Geographical Indication status in 2005. Tea was first grown in the Kangra region in the mid-19th century.
Benefits of Kangra Tea
- Using computer-based models, the scientists screened 65 bioactive chemicals or polyphenols that could bind to a specific viral protein more efficiently than commercially available anti-HIV drugs approved for treating COVID-19 patients.
- These chemicals might block the activity of the viral protein that helps the virus to thrive inside human cells.
Back2Basics: Lopinavir/ Ritonavir
- Lopinavir/ritonavir (LPV/r), sold under the brand name Kaletra among others, is a fixed-dose combination medication for the treatment and prevention of HIV/AIDS.
- It combines lopinavir with a low dose of ritonavir.
- It is generally recommended for use with other antiretrovirals.
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‘Agappe Chitra Magna’ kit for COVID diagnosis
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Agappe Chitra Magna
Mains level: COVID diagnosis and treatment
Agappe Chitra Magna, a magnetic nanoparticles-based RNA extraction kit has been commercially launched.
The peculiarity of the name ‘Agappe Chitra Magna’ creates a possibility of a prelims question. One may confuse it with any sort of Artform.
Agappe Chitra Magna (ACM) Kit
- The ACM kit is developed by the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) and manufactured by Kochi-based Agappe Diagnostics Ltd.,
- It uses innovative technology for isolating RNA using magnetic nanoparticles to capture the RNA from the patient sample.
- The magnetic nanoparticles beads bind to the viral RNA and, when exposed to a magnetic field, give a highly purified and concentrated RNA.
- As the sensitivity of the detection method is dependent on getting an adequate quantity of viral RNA, this innovation enhances the chances of identifying positive cases.
- The commercial launch of the kit is a major step to make India self-reliant in detecting COVID-19 and can help increase the rate of testing and bring down its costs, a crucial step for combating the pandemic.
Significance of the kit
- The commercial launch of the kit is a major step to make India self-reliant in detecting COVID-19 and can help increase the rate of testing and bring down its costs, a crucial step for combating the pandemic.
- The RNA isolation kit will reduce the dependence on imported kits and make COVID testing more cost-effective.
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Indigenous antibody test: COVID Kavach ELISA
Note4Students
From UPSC perspective, the following things are important :
Prelims level: ELISA Test, Antigen, Antibodies
Mains level: Not Much
Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV) at Pune has developed and validated the indigenous IgG ELISA test “COVID KAVACH ELISA” for antibody detection for COVID-19.
Our thumb rule suggests that the ELISA test is being used only for the diagnosis of HIV infection. Right?
But the ELISA test is a broader term to diagnose antibody-antigen interaction after certain virus infection to a person. UPSC can test your basic knowledge of core biology with a question based on this concept.
What is ELISA test?
- ELISA (enzyme-linked immunosorbent assay) is a plate-based assay technique designed for detecting and quantifying substances such as peptides, proteins, antibodies and hormones.
- Other names, such as enzyme immunoassay (EIA), are also used to describe the same technology.
- In an ELISA, an antigen must be immobilized on a solid surface and then complexed with an antibody that is linked to an enzyme.
- Detection is accomplished by assessing the conjugated enzyme activity via incubation with a substrate to produce a measurable product.
- The most crucial element of the detection strategy is a highly specific antibody-antigen interaction.
What are antibodies?
- An antibody is a large, Y-shaped protein produced mainly by plasma cells that are used by the immune system to neutralize pathogens such as pathogenic bacteria and viruses.
- There are five immunoglobulin classes (isotypes) of antibody molecules found in serum: IgG, IgM, IgA, IgE and IgD.
- They are distinguished by the type of heavy chain they contain.
Application of ELISA
- Presence of antigen or the presence of antibody in a sample can be evaluated
- Determination of serum antibody concentrations in a virus test
- Used in the food industry when detecting potential food allergens
- Applied in disease outbreaks- tracking the spread of disease e.g. HIV, bird flu, common, colds, cholera, STD etc
Significance
- Robust antibody tests are critical for surveillance to understand the proportion of the population exposed to infection.
- The test will have the advantage of testing 90 samples together in a single run of 2.5 hours.
- Moreover, ELISA based testing is easily possible even at the district level as the ELISA kit has an inactivated virus.
- There are also minimal bio-safety and bio-security requirements as compared to the real-time RT-PCR test.
- The test has the advantage of having much higher sensitivity and specificity as compared to the several rapid test kits which have recently flooded the Indian market.
Limitations
- Since the ELISA test is based on the detection of antibodies, it can only help in knowing if the person has been previously infected by a coronavirus.
- It takes one-three weeks for the antibodies to develop in response to infection.
- So, if a person who has been recently infected by the virus is tested during the window period (the time taken to develop antibodies) the result will turn out to be negative.
- But a repeat test after a couple of weeks will indicate the true infection status.
How it is different from the PCR test?
- While the RT-PCR, which detects the RNA of the coronavirus, enables detection of current infection, it will not be useful if the testing is carried out days after the infection clears as the virus will no longer be present.
- However, antibodies developed in response to the coronavirus infection will be present in the blood for a longer duration and hence the ELISA test can help detect past infection.
- The maximum time the antibodies will be present in the body is not known for coronavirus.
Back2Basics: Reverse Transcriptase – Polymerase Chain Reaction (PCR) Test
- It uses a technique that creates copies of a segment of DNA. ‘Polymerase’ refers to the enzymes that make the copies of DNA.
- Kary Mullis, the American biochemist who invented the PCR technique, was awarded the Nobel Prize for Chemistry in 1993.
- The ‘chain reaction’ is how the DNA fragments are copied, exponentially — one is copied into two, the two are copied into four, and so on.
- However, SARS-COV-2 is a virus made of RNA, which needs to be converted into DNA. For this, the technique includes a process called reverse transcription.
- A ‘reverse transcriptase’ enzyme converts the RNA into DNA. Copies of the DNA are then made and amplified.
- A fluorescent DNA binding dye called the “probe” shows the presence of the virus. The test also distinguishes SARS-COV-2 from other viruses.
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How Remdesivir tricks coronavirus?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Remdesivir
Mains level: Coronovirus and the hunt for its vaccine
A new research has found how Remdesivir treats coronavirus and described the exact mechanism of interaction between the virus and the drug. Remdesivir is an experimental antiviral made by American pharmaceutical firm Gilead Sciences that was first developed to treat Ebola.
DNA/RNA related terminologies, Genes and Genomes, etc. always find their way in UPSC Prelims. Most recent one was-
With reference to the recent developments in science, which one of the following statements is not correct? (CSP 2019)
(a) Functional chromosomes can be created by joining segments of DNA taken from cells of different species.
(b) Pieces of artificial functional DNA can be created in Iaboratories.
(c) A piece of DNA taken out from an animal cell can be made to replicate outside a living cell in a laboratory.
(d) Cells taken out from plants and animals can be made to undergo cell division in laboratory petri dishes.
How Remdesivir kills coronavirus?
- Remdesivir is designed to obstruct the stage of replication, when the virus creates copies of itself, followed endlessly by the copies creating copies of themselves.
How does replication take place?
- Once the virus enters the human cell, it releases its genetic material, which is then copied using the body’s existing mechanism.
- At every stage of infection, various human proteins, virus proteins, and their interactions come into play.
- At the replication stage, the key viral protein at play is an enzyme called RdRp (an enzyme is a kind of protein that speeds up chemical reactions within a cell).
- It is RdRp that makes the copies, by processing components of the RNA of the virus.
- University of Alberta researchers called it the “engine” of the virus in a paper last week, in which they described the action of Remdesivir against this “engine”.
- In scientific literature, such an enzyme is called a polymerase (the p is RdRp stands for polymerase) or a replica.
- In any case, this is the enzyme that is targeted by Remdesivir.
And how exactly does Remdesivir target this enzyme?
- In order to replicate, the virus processes raw material from the virus RNA, broken down by another enzyme with that specific function.
- When a patient is given Remdesivir — the inhibitor — it mimics some of this material and gets incorporated in the replication site.
- With Remdesivir replacing the material it needs, the virus fails to replicate further.
- These coronavirus polymerases are sloppy and they get fooled, so the inhibitor gets incorporated many times and the virus can no longer replicate.
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Plasma therapy is no silver bullet
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Convalescent plasma therapy.
Mains level: Paper 3- What is plasma therapy and issues involved in its adoption.
The article discusses the issues with convalescent plasma therapy. The therapy has been in the news as a cure to Covid-19. The lack of conclusive evidence is a major issue. There are certain risks involved in large scale adoption. All such issues are dealt with in detail here.
Importance of scientific research in dealing with Covid-19
- The COVID-19 pandemic has posed unprecedented challenges to governments, health professionals and the general public at large, around the world.
- Every response, administrative, social, economic or medical is being subjected to intense public scrutiny, as it rightly should be in the spirit of mature democracy.
- Scientific research in medicine is the only means to overcome novel and complex diseases such as COVID-19 and that too thrives on the same spirit of debate and criticism.
- Difficulty in establishing protocols: The difference is that the standards of evidence required, to generate consensus and arrive at the most optimal protocols, are far more rigorous and time-taking than in most other walks of life.
Issues with plasma therapy
- The convalescent plasma therapy, that is being currently studied by the Indian Council of Medical Research, through open-label, randomised controlled trial to evaluate it for both safety and efficacy.
- The problem with the therapy is of the lack of established protocols.
- What is involved in therapy? The therapy involves infusing patients suffering from COVID-19 with plasma from recovered patients.
- In theory, the antibodies of the recovered person may help that patient’s immune system fight the virus.
- While showing great promise, it is a line of treatment that is yet to be validated for efficacy and safety and cannot be deployed widely without caution.
- The current evidence to conclude anything about the true benefits of this therapy is very thin.
- Till date, there have been only three published case series for convalescent plasma in COVID-19 with a cumulative of 19 patients.
- Given the very small number of patients involved in these studies and a publication bias in medicine, we cannot conclude the therapy will work on all patients all the time or even believe that the convalescent plasma was the only reason for their improvement.
- The most important principle in medical ethics is “do no harm”.
- The transfusion of convalescent plasma is also not without risks, which range from mild reactions like fever, itching, to life-threatening allergic reactions and lung injury.
- To recommend a therapy without studying it thoroughly with robust scientific methods may cause more harm than good.
- Further, convalescent plasma therapy requires intensive resources, healthy COVID-19 survivors to donate, a blood bank with proper machinery and trained personnel to remove plasma, equipment to store it and testing facilities to make sure it has an adequate amount of antibodies.
Need for the Randomised Controlled Trials (RCT)
- To say with certainty whether a drug is truly effective or not, the gold standard in medicine is to conduct a randomised controlled trial.
- In RCT half the patients get the experimental drug and the other half do not.
- Only if patients in the first half show substantial improvement over those in the second half, it indicates the drug is beneficial.
Exploring other options and focusing on health infrastructure
- Too much focus on one approach can take away the focus from other important therapeutic modalities like the use of oxygen therapy, antivirals, and antibiotics for complicated hospital courses.
- To overcome the pandemic comprehensively, we should focus on strengthening health systems at all levels, including referral systems, supply chain, logistics and inventory management.
- We need to work on protecting our healthcare workers, improving prevention methods, promoting cough etiquettes, effective quarantining and accurate testing.
A direct question based on the therapy like- “What is convalescent plasma therapy and what are the issues involved in its adoption?” can be asked by the UPSC.
Conclusion
Even these times of collective uncertainty are no reason to lower scientific temper. Science should be driven by reason and evidence with hope as a catalyst but not by either fear or populism. Pushing one or the other therapy without evidence or caution can only set back our larger fight against COVID-19.
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Mobile Virology Research and Diagnostics Laboratory (MVRDL)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: BSL ratings
Mains level: Not Much
The Defence Research and Development Organisation (DRDO) has developed a mobile virology research lab.
We can expect a prelim question on BSL ratings as the term is widely appearing in news these days.
About the MVRDL
- The MVRDL is the combination of a bio-safety level (BSL)-3 lab and a BSL-2 lab and was set up in a record time of 15 days.
- It can process 1,000-2,000 samples a day.
- The mobile lab will be helpful in carrying out a diagnosis of COVID-19 and in virus-culturing for drug screening, convalescent plasma-derived therapy, comprehensive immune profiling of patients towards vaccine etc.
What are Biosafety Level (BSL) Ratings?
- A BSL is a set of biocontainment precautions required to isolate dangerous biological agents in an enclosed laboratory facility.
- The levels of containment range from the lowest biosafety level 1 (BSL-1) to the highest at level 4 (BSL-4).
- BSL-1 is suitable for work with well-characterized agents which do not cause disease in healthy humans.
- BSL- 2 is suitable for work involving agents of the moderate potential hazard to personnel and the environment.
- BSL-3 is appropriate for work involving microbes which can cause serious and potentially lethal disease via the inhalation route.
- BSL-4 is the highest level of biosafety precautions and is appropriate for work with agents that could easily be aerosol-transmitted within the laboratory and cause severe to fatal disease in humans for which there are no available vaccines or treatments.
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What is Post-intensive Care Syndrome (PICS)?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: PICS
Mains level: Mental health concerns raised by the COVID-19 pandemic
- Various news reports in recent weeks have pointed out that for some COVID-19 patients who needed intensive care, the journey to recovery is a long one.
- After leaving the ICU, they may suffer from what is known as post-intensive care syndrome (PICS), which can happen to any person who has been in the ICU.
Infectious disease outbreaks, like the current Coronavirus (COVID-19), can be scary and can affect our mental health. This pandemic is going to leave a bigger trauma for those who had lost their dear ones as well those who recovered.
What is PICS?
- PICS comprise impairment in cognition, psychological health and physical function of a person who has been in the ICU.
- Further, such patients may experience neuromuscular weakness, which can manifest itself in the form of poor mobility and recurrent falls.
- The psychological disability may arise in a person in the form of depression, anxiety and post-traumatic stress disorder (PTSD).
Its symptoms
- The most common PICS symptoms are generalized weakness, fatigue, decreased mobility, anxious or depressed mood, sexual dysfunction, sleep disturbances and cognitive issues.
- These symptoms may last for a few months or many years after recovery, the authors of the aforementioned article note.
- Patients who develop this may take at least a year to fully recover, until which time they may have difficulty in carrying out everyday tasks such as grooming, dressing, feeding, bathing and walking.
What causes PICS?
- A combination of factors can affect aspects of an ICU survivor’s life.
- PICS may be induced if a person was on prolonged mechanical ventilation, experienced sepsis, multiple organ failure and a prolonged duration of “bed-restore deep sedation”.
Treatment
- It is recommended that to avoid PICS, patients’ use of deep sedation is limited and early mobility is encouraged, along with giving them “aggressive” physical and occupational therapy.
- Further, patients should be given the lowest dose of pain medications when possible and should be put on lung or cardiovascular rehabilitation treatments along with treatments for depression, anxiety and PTSD.
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What is pooled testing, recommended by the ICMR?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Pooled testing
Mains level: Intensive measures required for the containment the ongoing pandemic
The Indian Council of Medical Research (ICMR) has issued an advisory for using pooled samples for testing of COVID-19 in order to increase the number of tests conducted by laboratories across the country.
COVID-19 containment measures are pacing up across the country. However, it is argued that we are lagging in the number of tests to be carried out. With certain limitations, pooled testing promises an edge over individual testings of suspected patients.
What is pooled testing?
- In a pooled testing algorithm, samples of multiple individuals are put together in a tube and screened through the PCR test.
- In case the pooled test turns out to be positive, individual samples are tested, which is referred to as pool de-convolution.
- If there’s no positive result, all individual samples in the pool are regarded as negative, resulting in substantial cost savings.
What the ICMR has recommended?
- ICMR has advised that while more than two samples can be pooled together, the number should not exceed five samples to avoid sample dilution, which can lead to false negatives.
- This method can be used in areas where the prevalence of COVID-19 is low, which means a positivity rate of less than two per cent.
- In areas with a positivity rate between two to five per cent, sample pooling of PCR screening may be considered in a community survey of surveillance among asymptomatic individuals.
- Samples of individuals with known contact with confirmed cases or healthcare workers should not be included in the pooled samples.
- Also, ICMR has said pooling of sample is not recommended in areas or population with positivity rates of over five per cent.
Benefits of pooled testing
- Using this method, substantial costs and testing kits are saved.
- For instance, if a pooled sample consists of the samples of five individuals and it tests negative, the cost of four testing kits is saved and more number of people are covered with fewer resources.
- Significantly, pooled screening can also help in tracking down the asymptomatic cases of the disease, thereby tracking community transmission.
- But in case the sample tests positive, all individuals need to be tested separately.
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What is Contact Tracing Technology?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Contact Tracing Technology
Mains level: ‘Contact tracing’ and its significance to control disease outbreaks
Global technology giants Apple and Google have announced that they are partnering on developing contact tracing technology to help governments and health authorities tackle the novel coronavirus pandemic.
What did tech-giants announce?
- Contact tracing is considered essential for bringing epidemics under control and is expected to help governments in relaxing lockdown orders.
- The tech companies announced that they would build a comprehensive solution that includes application programming interfaces (APIs) and operating system-level technology to assist in enabling contact tracing.
What is contact tracing?
- The WHO defines contact tracing as the process of identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission.
- Via contact tracing, people who have come into contact with a person carrying a disease are alerted and identified.
Importance of contact tracing
- Identifying people at the onset of symptoms and promptly isolating them reduces exposure to other persons, preventing subsequent EVD (Ebola Virus Disease) infections.
- Additionally, prompt isolation and admission of the symptomatic person to a treatment facility decreases the delay to supportive treatment, which improves the likelihood of survival.
How will the new technology by Google and Apple work?
- Google and Apple are the developers of the Android and iOS platforms respectively, which together power most of the world’s smartphones.
- Both companies will release application programming interfaces (APIs) that would enable interoperability between Android and iOS devices using apps from public health authorities.
- The official apps will be available for users to download via their respective app stores, as per the press release.
- When this step is realized, phone-based matching via official apps will help alert people if they have come in contact with someone diagnosed with COVID-19.
Actual working
- For this to work, COVID-19 patients would have to declare their status to the respective apps voluntarily.
- Following this, all people whose Android/iOS smartphones were detected nearby such patients, would get notified.
- This means the user will be notified even if he/she was around a stranger who has tested positive for the disease.
Issues with contact tracing
- Privacy, transparency, and consent are of utmost importance in this effort.
- The tech giants should look forward to building this functionality in consultation with interested stakeholders.
Note: How is our Aarogya Setu app different from the technology mentioned in the newscard?
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Covid-19 Quarantine Alert System (CQAS)
The Department of Telecommunications (DoT) has shared a Standard Operating Procedure (SOP) with all telecom service providers regarding the application called COVID-19 Quarantine Alert System (CQAS).
- CQAS collects phone data, including the device’s location, on a common secured platform and alerts the local agencies in case of a violation by COVID patients under watch or in isolation.
Quarantine Alert System (CQAS)
- Developed By: The DoT and the Centre for Development of Telematics (C-DOT), in coordination with telecom service providers, have developed and tested the application.
- Working: The CQAS prepares a list of mobile numbers, segregates them on the basis of telecom service providers, and the location data provided by the telecom companies are run on the application to create geo-fencing.
- Geo-fencing is a location-based service in which an app or other software uses GPS, RFID, Wi-Fi or cellular data to trigger a pre-programmed action when a mobile device or RFID tag enters or exits a virtual boundary set up around a geographical location, known as a geofence.
- Geo-fencing will only work if the quarantined person has a mobile phone from Airtel, Vodafone-Idea or Reliance Jio, as “BSNL/MTNL” do not support location-based services. BSNL and MTNL are government-owned.
- The location information is received periodically over a secure network for the authorised cases with “due protection of the data received”.
- The System triggers e-mails and SMS alerts to an authorised government agency if a person has jumped quarantine or escaped from isolation, based on the person’s mobile phone’s cell tower location. The “geo-fencing” is accurate by up to 300 m.
Use of Powers under the Indian Telegraph Act, 1885
- The Centre is using powers under the Indian Telegraph Act to “fetch information” from telecom companies every 15 minutes to track COVID-19 cases across the country.
- The States have been asked to seek the approval of their Home Secretaries under the provisions of Section 5(2) of the Indian Telegraph Act, 1885, for the specified mobile phone numbers to request the DoT to provide information by email or SMS in case of violation of “geo-fencing”.
- Section 5(2) authorises State or Centre to access information of a user’s phone data in case of “occurrence of any public emergency or in the interest of the public safety.”
Protection of Data
- As per the SOP, the phone number should be deleted from the system after the period for which location monitoring required is over and the data would be deleted four weeks from thereon.
- The data collected shall be used only for the purpose of Health Management in the context of COVID-19 and is strictly not for any other purposes. Any violation in this regard would attract penal provisions under the relevant laws.
Centre for Development of Telematics
- C-DOT was established in August 1984 as an autonomous Telecom R&D Centre of DoT.
- It is a registered society under the Societies Registration Act, 1860.
- It is a registered ‘public-funded research institution’ with the Department of Scientific and Industrial Research, Ministry of Science & Technology.
Global Positioning System
- The Global Positioning System is a Global Navigation Satellite System (GNSS), used to determine the ground position of an object.
- It is a US-owned utility that provides users with Positioning, Navigation, and Timing (PNT) services.
Radio-Frequency Identification
- Radio-Frequency Identification (RFID) is the use of radio waves to read and capture information stored on a tag attached to an object.
- A tag can be read from up to several feet away and does not need to be within the direct line-of-sight of the reader to be tracked.
Wi-Fi
- Wi-Fi is the name of a wireless networking technology that uses radio waves to provide wireless high-speed Internet and network connections.
- WiFi network enables a connection between two or more devices wirelessly for data sharing purposes.
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Private: Soap, Sanitizer and Coronavirus
Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Sodium Hypochlorite as Coronavirus disinfectant
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Sodium hypochlorite, Bleaching Powder
Mains level: Coronovirus outbreak and its mitigation
In Uttar Pradesh, migrant workers travelling to their home states, or their belongings, were sprayed with a disinfectant, apparently to sanitise them. The chemical in the spray was a sodium hypochlorite solution.
Sodium hypochlorite
- Sodium hypochlorite is commonly used as a bleaching agent, and also to sanitise swimming pools.
- As a common bleaching agent, sodium hypochlorite is used for a variety of cleaning and disinfecting purposes.
- It releases chlorine, which is a disinfectant. Large quantities of chlorine can be harmful.
- The concentration of the chemical in the solution varies according to the purpose it is meant for.
- A normal household bleach usually is a 2-10% sodium hypochlorite solution.
- At a much lower 0.25-0.5%, this chemical is used to treat skin wounds like cuts or scrapes. An even weaker solution (0.05%) is sometimes used as a handwash.
Note: The common bleaching powder is chemically referred to as Calcium hypochlorite and not Sodium hypochlorite.
Is the chemical safe?
- Sodium hypochlorite is corrosive and is meant largely to clean hard surfaces.
- It is not recommended to be used on human beings, certainly not as a spray or shower. Even a 0.05% solution could be very harmful for the eyes.
- A 1% solution can cause damage to the skin of anyone who comes in contact with it.
- If it gets inside the body, it can cause serious harm to lungs.
Does the chemical get rid of the novel coronavirus?
- The WHO recommends homemade bleach solutions of about 2-10% concentration to clean hard surfaces to clear them of any presence of the novel coronavirus.
- Cleaning hard surfaces with this solution can disinfect them not just from novel coronavirus but also help prevent flu, food born illnesses, and more.
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Convalescent Plasma Therapy
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Convalescent Plasma Therapy
Mains level: Coronovirus outbreak and its mitigation
With no specific treatment available for novel coronavirus disease and a vaccine at least a year away, the US Food and Drug Administration (FDA) has approved use of blood plasma from recovered patients to treat severely critical COVID-19 patients.
Convalescent Plasma Therapy
- The therapy seeks to make use of the antibodies developed in the recovered patient against the coronavirus.
- The whole blood or plasma from such people is taken, and the plasma is then injected in critically ill patients so that the antibodies are transferred and boost their fight against the virus.
- A COVID-19 patient usually develops primary immunity against the virus in 10-14 days.
- Therefore, if the plasma is injected at an early stage, it can possibly help fight the virus and prevent severe illness.
How often has it been used in the past?
- This therapy is no new wonder. It has been used several times.
- The US used plasma of recovered patients to treat patients of Spanish flu (1918-1920).
- In 2014, the WHO released guidelines to treat Ebola patients with convalescent whole blood and plasma.
- In 2015, plasma was used for treating MERS patients.
How is it done?
- The process to infuse plasma in a patient can be completed quickly.
- It only requires standard blood collection practices, and extraction of plasma.
- If whole blood is donated (350-450 ml), a blood fractionation process is used to separate the plasma.
- Otherwise, a special machine called aphaeresis machine can be used to extract the plasma directly from the donor.
- While blood is indeed extracted from the donor, the aphaeresis machine separates and extracts the plasma using a plasma kit, and the remaining blood components are returned into the donor’s body.
WHO’s guidelines
- WHO guidelines in 2014 mandate a donor’s permission before extracting plasma.
- Plasma from only recovered patients must be taken, and donation must be done from people not infected with HIV, hepatitis, syphilis, or any infectious disease.
- If whole blood is collected, the plasma is separated by sedimentation or centrifugation, then injected in the patient.
- If plasma needs to be collected again from the same person, it must be done after 12 weeks of the first donation for males and 16 weeks for females, the WHO guidelines state.
How optimistic is the latest move?
- COVID-19 does not have a specific treatment, only supportive care— including antiviral drugs, oxygen supply in mild cases and extracorporeal membrane oxygenation.
- Plasma can be infused into two kinds of COVID-19 patients— those with a severe illness, or individuals at a higher risk of getting the virus.
- However, that while plasma transfers immunity from one person to another, it is not known if it can save lives in COVID-19 infection.
- The treatment could be effective for patients in the age group 40-60, but may be less effective for people aged beyond 60 years.
Can it be done in India?
- India has facilities for removing 500 ml of plasma from a donor using aphaeresis.
- For this experimental therapy to be tried out, the Drug Controller General of India will first have to grant blood banks approval for removal of plasma from recovered COVID-19 patients.
- The procedure is simple and can be done in India, but it is important to control the risk of infection during transfusion, and the patient’s acceptance is required.
- It’s like a vaccine. It will engulf the virus and kill it. But it is easier said than done. We may need a series of approvals which India has never done before.
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Schedule H1 drugs
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Schedule H1 drugs
Mains level: Coronovirus outbreak and its mitigation
Hydroxychloroquine is now a schedule H1 drug and can be sold on prescription only.
What are Schedule H1 drugs?
- The sale of the Hydroxychloroquine drug from now on should be in accordance with the conditions for sale of drugs specified in Schedule H1 to the Drugs and Cosmetics Rules, 1945.
- In exercise of the powers conferred by Section 26B of the Drugs and Cosmetics Act, 1940 (23 of 1940), the Central Government can direct that sale by retail of any drug.
Why such move?
- The Central Government is satisfied that the drug ‘Hydroxychloroquine’ is essential to meet the requirements of emergency arising due to pandemic COVID-19.
- And in the public interest, it is necessary to regulate and restrict the sale and distribution of the drug ‘Hydroxychloroquine’ and preparation based thereon for preventing their misuse.
Hydroxychloroquine
- Hydroxychloroquine is used to prevent or treat malaria infections caused by mosquito bites.
- It does not work against certain types of malaria (chloroquine-resistant).
Pls take a note-
- Hydroxychloroquine and a related drug, chloroquine, are currently under study as possible treatments for COVID-19.
- These drugs have not yet been approved for this use.
- Do not use these medications to treat COVID-19 unless your doctor recommends that you do so.
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Indian Scientists’ Response to CoViD-19 (ISRC) Group
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Indian Scientists’ Response to CoViD-19 (ISRC)
Mains level: Not Much
Several Indian scientists have come together to form a Google group to address some of the concerns that the COVID-19 outbreak has thrown up.
Indian Scientists’ Response to CoViD-19 (ISRC)
- It is a voluntary group of scientists who regularly discuss the rapidly evolving situation with its dire need for science communication.
- With nearly 200 members, the group has scientists from institutions such as the NCBS, the IISc, the TIFR, the IITs, the IISERs and many others.
- The group aims to study existing and available data to bring out analyses that will support the Central, State and local governments in carrying out their tasks.
Self-assigned tasks
- Several working groups have been formed by scientists.
- They include one on hoax busting to address disinformation spreading with respect to the coronavirus and one on science popularization to develop material that explains concepts such as home quarantine.
- Other groups work on resources in Indian languages, mathematical models and apps.
Why such a group?
- The scientific community has realized their social and democratic responsibility in the current situation, both in terms of analysing the situation and reaching out to the public.
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Serological test for COVID-19
Note4Students
From UPSC perspective, the following things are important :
Prelims level: COVID 19 diagnosis
Mains level: Coronovirus outbreak and its mitigation
The ICMR invited bids for an estimated 10 lakh antibody kits (for serological tests) for the diagnosis of COVID-19.
What are serological tests?
- Viral infections are mainly identified by two kinds of tests– genetic and serological.
- Genetic tests can identify infections that are active but cannot be used to detect past infections.
- To trace how infections like the novel coronavirus have spread so far, it is important to detect people who contracted the disease in the past and have recovered.
- This is what serological tests seek to determine.
How are the two different?
- The genetic test is conducted on a swab collected from the back of the throat, a liquid sample from the lower respiratory tract, or a simple saliva sample.
- For SARS-COV-2, the virus’s RNA is first converted into DNA.
- By a process called polymerase chain reaction (PCR), DNA fragments in the sample are copied exponentially — one is copied into two, the two are copied into four, and so on.
- Unlike genetic tests, which look for RNA in swab samples, serological tests work on antibodies in blood samples. Hence, they are also called ‘antibody tests’.
How serological tests work?
- Antibodies, or protective proteins produced by the immune system to neutralize pathogens such as bacteria and viruses, are present in one’s bloodstream for a considerable period of time after the infection has gone.
- To disable a pathogen, the antibody latches to a unique protein molecule on pathogen’s surface, called an antigen.
- Serological tests use antigen molecules to detect the presence of antibodies relevant to the infection.
- Generally, a blood sample is placed in a test tube that is lined with antigens on the inside. If the relevant antibodies are present, they latch on to the antigens.
- Such tests are relatively inexpensive, and can display results within a few minutes.
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[pib] Project ‘Isaac’
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Project 'Isaac'
Mains level: Not Much
IIT, Gandhinagar has launched Project Isaac to engage its students in creative projects to enhance their critical skills while they are confined to their homes because of Coronavirus.
Project ‘Isaac’
- The project is inspired by Sir Isaac Newton, who was similarly sent home by Trinity College, Cambridge, because of the Great Plague of London in 1665.
- During this year, Newton, then a 22-year-old college student developed some of his most profound discoveries, including early calculus, as well as his theories of optics and gravity.
- As part of the project, four different competitions are being organized by IIT, Gandhinagar to cultivate new skills among students regarding writing, painting, coding, music, creative expression, and so on.
- Students can take part in competitions online.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
‘Contact tracing’
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Not Much
Mains level: ‘Contact tracing’ and its significance to control disease outbreaks
As the number of coronavirus cases in India increases, authorities in different states are relying on contact tracing, a concept in epidemiology that involves tracing the number of people an infected person comes in contact with.
The idea behind contact tracing is to stop the outbreak by breaking the transmission chains.
What is Contact Tracing?
- Contact tracing is not a novel concept and has been used as a method to track cases of the Ebola virus in Africa.
- It is one of the methods of detecting an outbreak and the number of infected people.
- In 2014, when the first Ebola cases began to be reported in Sierra Leone, a contact tracing mechanism was devised.
- According to the Centre for Disease Control (CDC), the system in the district was able to identify 13 Ebola cases, which would have been overlooked otherwise.
Various steps involved
According to WHO contact tracing can be broken down into three steps:
1) Contact identification:
- This involves identifying the contacts of the infected person by asking about the person’s activities and those of people around them since the onset of illness.
- In the case of the first positive COVID-19 patient from Chandigarh for instance, a chain of 119 people was traced directly or indirectly to the patient.
2) Contact listing:
- This means listing all those people who came in contact with the infected person.
- Efforts should be made to identify every listed contact and to inform them of their contact status, what it means, the actions that will follow, and the importance of receiving early care if they develop symptoms.
- In some areas across India, authorities are releasing lists of those who are quarantined and are identifying their houses by putting quarantine posters in front of their houses.
3) Contact follow-up:
- This step involves regular follow-ups with all the contacts to monitor for symptoms and test for signs of infection.
Limitations of Contact Tracing
- Since everyone has many contacts, contact tracing is useful when there are only a few cases.
- At this point, in many countries, we have so many cases that everyone would be contacted. This is essentially the lockdown — everybody isolates.
- However, while a fifth of the world’s population is currently isolated and under lockdown, it may not be feasible to trace contacts of all the infected patients given the scale of the current outbreak.
Way forward
- While contact tracing is an important step during a disease outbreak, it is insufficient alone in controlling it, requiring other interventions.
- Rapid and effective contact tracing can reduce the initial number of cases, which would make the outbreak easier to control overall.
- Effective contact tracing and isolation could contribute to reducing the overall size of an outbreak or bringing it under control over a longer time period.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Why need a 21-day lockdown period?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: COVID 19
Mains level: Coronovirus outbreak and its mitigation
Amid diverse opinions on nationwide lockdown, there is a public health/epidemiological significance to the 21-day lockdown period announced by PM.
What led PM to impose 21-day lockdown?
- It seems that rich scientific data has fed this decision to announce a 21-day lockdown period.
- In fact, 21-day quarantines have been discussed elaborately in the context of Ebola and the calculations are based on the estimated incubation period of the virus in a human host.
- The 21-day quarantine value is derived from interpretations of outbreak data, past and present, public health experts said.
Median incubation period
- In epidemiological terms, the logic is that we have arrived at an incubation period of 14 days.
- Give another week for the residual infection to die out, for the tail end, to be entirely safe, and you arrive at 21 days.
- This being a new coronavirus, they have estimated that the median incubation period (the time between the entry of the virus to the onset of symptoms/ disease) falls within this period.
Significance
- This is the most effective way of preventing the spread of the infection from those already infected into the community.
- In fact, for infections that are transmitted in this manner, this is the one thing to prevent the rapid spread of infection within the community.
- The lockdown or quarantine also creates some breathing space — to convince people of the seriousness of the situation and build positive public opinion, carry out disinfection of all buildings, vehicles and surfaces, and allows hospitals to prepare themselves for the next phase of operations.
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Welcome Policy On APIs, Devices
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Not much.
Mains level: Paper 3- Incentive package to promote the API production in India.
Context
It is most welcome that the Centre has announced a `14,000-crore incentive package to boost the manufacture of drugs, especially active pharmaceutical ingredients (API).
What should be the immediate policy focus?
- Focus on protective gear: The immediate policy focus must be to swiftly overcome shortages of critical protective gear like gowns and face masks, diverting production lines if required.
- We also need to anticipate and step-up production of vital devices like ventilators.
- Provisions in the package: What is proposed now are industrial parks for bulk drugs and APIs, together with a policy for multi-year fiscal benefits. And ditto for parks for the manufacture of medical devices and attendant fiscal incentives.
- The state governments need to identify 1,000 acres for the parks that are well-integrated with knowledge centres and nationally accredited labs.
What additions need to be made in the package?
- Public-private partnership: In tandem, the pharmaceuticals package issued on Saturday needs to be followed through, with a forward-looking public-private partnership, to avoid import-dependency in this critical sector.
- What is envisaged is a set of schemes to reap economies of scale and ready availability of inputs in the production of APIs and medical devices via the cluster approach.
How India became uncompetitive in API?
- Policy rigidities and price controls: APIs are, of course, bulk drugs that provide medicines with their therapeutic value, and it is unfortunate that since circa 1995, India has become steadily uncompetitive in API production, thanks to a panoply of policy rigidities such as onerous price controls.
- Export competition from China: Opaque export competition from China has been game-changing indeed: APIs for most medicines are mostly imported.
- This needs to change, fast. We do need to competitively and efficiently boost output of pharmaceuticals right across the value chain.
Conclusion
The government must understand that manufacture by itself is not enough. The policy must ensure competition and quality, keep prices down.
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Stages in a COVID-19 Pandemic
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Various stages of a pandemic
Mains level: Coronovirus outbreak and its mitigation
Over the past few weeks, India has been dreading the possibility that the novel coronavirus outbreak will move to the stage of community transmission.
What are the stages of a pandemic?
Stage I
- In the first stage of a disease epidemic that eventually takes the form of a pandemic sweeping the globe, cases are imported into a country in which the infection did not originate.
- An infection whose spread is contained within the boundaries of one or a few countries is obviously not a pandemic.
Stage II
- The second stage is when the virus starts being transmitted locally.
- Local transmission means that the source of the infection is from within a particular area and the trajectory the virus has taken from one person to the next is clearly established.
Stage III
- The third stage is that of community transmission. It is usually localised.
- According to the WHO community transmission is evidenced by the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples.
- In layman terms, it means that the virus is now circulating in the community, and can infect people with no history either of travel to affected areas or of contact with an infected person.
- If and when community transmission happens, there might arise the need for a full lockdown because in that situation it is theoretically possible for every person, regardless of where they are from and who they have been in contact with, to spread the disease.
Stage IV
- There is also a fourth stage in every pandemic. It is when the disease, COVID-19 in this case, becomes endemic in some countries.
- The Indian government’s containment plan takes this possibility into account.
- Among diseases that are currently endemic in India — meaning they occur round the year across the country — are malaria and dengue.
How does categorising an outbreak in this manner help?
- The stages of a pandemic are uniform the world over.
- This is so because, in today’s interconnected world, it is important to have a standardised phraseology that conveys the same thing to every person around the world, and helps countries prepare better.
- The categorization helps countries take specific actions that are necessary to target just that particular scenario.
- For example, India imposed travel restrictions to China from very early on as the cases they were all imported from China.
- Later, as cases started being imported from other European countries, flight and visa restrictions were put in place for those countries.
- India has now shut itself to individuals coming from all countries — this is because the virus is now confirmed as circulating in at least 177 countries and territories.
Worldwide, in which stage is the COVID-19 pandemic now?
- The pandemic has spread to nearly every country on the planet. In most, though, it is in the stage of either imported cases or local transmission.
- Among the countries where community transmission seems to be operating are China, Italy, Iran, South Korea and Japan.
- China adopted a graded approach in dealing with the infection but the epicentre, Hubei, was in a state of complete lockdown at the peak of the infection.
- It something that Italy has now effected in a bid to stop the virus from wreaking more havoc, given the country’s ageing population.
How long before India enters community transmission?
- It is totally unpredictable. Some doctors perceive that community transmission is inevitable; other experts feel it may have already happened.
- There are some reports of one strain having less mortality. If indeed a milder strain has come to India, it could change the course of the epidemic.
- There is another theory that all the various viruses circulating in South Asia and the generally lower levels of hygiene may give us some immunity.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Can Vitamin C prevent or cure novel Coronavirus infection?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Vitamin C
Mains level: Coronovirus outbreak and its mitigation
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
The strategy of ‘Shelter in Place’
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Janata curfew
Mains level: Social distancing and its significance
What is the news: As India observed a “janata curfew” from 7 am to 9 pm on 22nd March refraining from making any non-essential movements, they are implementing a version of what is referred to, most commonly in the United States, as a “shelter in place” order.
What exactly is a “Shelter in Place”?
- In the context of the US, it is not a precise legal term, and its meaning and implications vary.
- It conveys the broad idea of a set of restrictions being put into place, but follows not set definition.
- Broadly, “shelter in place” orders everywhere social distancing, which is the key to “flattening the curve”, that is, spreading out the incidence of infection over a longer time so that healthcare systems are not overwhelmed.
- Ultimately, the intent of the protocols is to decide what people should and shouldn’t do based on a particular threat to the public.
Indian concept of self-imposed curfew
- There is no exact definition of a “Janata curfew” — the PM has laid down guidelines for what Indians should not do, and authorities have taken steps to ensure compliance through appeals, advisories, and executive action such as invoking prohibitory orders.
- In the cities, traders’ associations and housing societies have voluntarily put curbs on themselves in response to the PM’s call.
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Time for a powerful display of humanity
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Not much.
Mains level: Paper 2- India is unprepared for dealing with pandemics.
Context
India is unprepared for dealing with the outbreak of coronavirus.
Is India really faring better than the other countries?
- 45 days for first 100,000: Globally, it took roughly 45 days for the first 100,000 cases. It is likely to take nine days for the next 100,000.
- Death count: The global death count is now doubling every nine days and stands at 8,248, with 207,518 confirmed cases.
- That is how epidemics work — they gather steam as infected individuals go on to infect even more people. Confirmed cases in India, as of today stand at 169.
- It is much lower than in small countries such as Iceland (around 250). Could this really be the case that we have fared better than everyone else?
- Probably India is not performing better: Testing in India remains abysmally low. Only about 10 in a million people in India have been tested, compared to say nearly 120 in a million in Thailand or 40 per million in Vietnam.
- Why testing in not being done in India? The stated explanation is that the limited number of test kits are being conserved for when they are truly needed but when is the need greater than right now?
- There are probably shortages even in being able to procure adequate supplies given that many countries are seeking to buy the limited stocks.
- Importance of testing: Testing is the most important thing we could be doing right now.
- As the Director-General of the World Health Organization, said recently about the need for more testing, “You cannot fight a fire blindfolded.”
Avoiding undercounting
- Timely identification is essential to prevent secondary infection: We need to identify coronavirus-infected patients in a timely manner in order to increase our chances of preventing secondary infections.
- There is no shame in saying that we have far more cases than what we have detected so far.
- K.’s admitted undercounting: Even the United Kingdom, which has a far better health system than India, has admitted that it is probably undercounting its true infections by a factor of 12, and is likely have about 10,000 cases.
- Is it possible that India with 20 times their population has only 169 cases?
- Preparedness to deal with a higher number of cases: If widespread testing were to commence in India, the number of confirmed cases would likely climb to the thousands very quickly. This is something we have to be prepared for without panic or fear-mongering.
- Positive action: This is how epidemics move and the real numbers should spur us into positive action.
- Strict measures by the government: At some stage, it is possible that the government may have to put in place very strict measures on quarantining and closures, much like what China had to do to control the epidemic in Wuhan.
How prepared is India?
- There is not an easy answer to how worst things could go.
- Mutation or sensitivity of virus: If we escape the worst, either because this virus mutates to a less virulent form or because there is something about its temperature or geographical sensitivity that we know nothing about, then we should count our blessings.
- Viruses do mutate and generally to be less lethal.
- Projection from Europe: If the projections from Europe are applicable in India, our ‘namastes’ and clean hands notwithstanding, the prevalence in India would be upwards of 20%.
- In other words, we should expect to see about 200-300 million cases of COVID-19 infections and about four and eight million severe cases of the kind that are flooding hospitals in Italy and Spain at the moment.
- More importantly, these cases are projected to appear in just a two to the four-month window.
- In the current scenario, we are not ready.
- India has somewhere between 70,000 and 100,000 intensive care unit beds and probably a smaller number of ventilators.
- That is simply inadequate.
- What should be done? The next two weeks should be spent on planning for large, temporary hospitals that can accommodate such numbers. If we are lucky, we will not need them.
Unprepared for pandemics
- Catastrophic event with highest probability-Pandemic: This all sounds doomsday-like. But we have known for decades now that of all catastrophic events to befall humanity, between an asteroid hit and a nuclear war, a disease pandemic has always been the highest on our list of impact and probability.
- Not enough changes in preparedness: There were some changes after the Severe Acute Respiratory Syndrome (SARS) but not nearly enough.
- Pandemic preparedness always took a backseat to the crisis of the moment.
- And in fairness, there is truly no amount of preparation that can fully mitigate such an occurrence.
Conclusion
Things are about to get a lot worse. Let us hope that this brings out the best in us, and not the worst. Whether we know this or not, these events are just a dress rehearsal for the more challenging events such as climate change that are likely to be with us this century. And if we take care of each other, we will survive both these challenges with our humanity intact.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Epidemics that have hit India since 1900
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Various diseases mentioned and their vaccines
Mains level: Epidemics and their containment
India has witnessed widespread illnesses and virus outbreaks in parts of the country, including the SARS outbreak between 2002 and 2004. However, statistics show that they were nowhere as widespread as the COVID-19 that has now reached almost every part of the country and almost every country in the world.
What is an Epidemic?
- The WHO defines epidemics as “the occurrence in a community or region of cases of an illness, specific health-related behaviour, or other health-related events clearly in excess of normal expectancy.
- The community or region and the period in which the cases occur are specified precisely.
- The number of cases indicating the presence of an epidemic varies according to the agent, size, and type of population exposed, previous experience or lack of exposure to the disease, and time and place of occurrence.
- Epidemics are characterized by the rapid spread of the specific disease across a large number of people within a short period of time.
Epidemics in India
- Many Indian citizens born at the start of the 21st century have not fully witnessed or experienced circumstances surrounding the mass outbreak of epidemics.
- This is not to say however, that as a nation, India is completely unfamiliar with dealing with epidemics and public health crises, some with exceptional success such as:
1915-1926 — Encephalitis lethargica
- Encephalitis lethargica, also known as ‘lethargic encephalitis’ was a type of epidemic encephalitis that spread around the world between 1915 and 1926.
- The disease was characterized by increasing languor, apathy, drowsiness and lethargy and by 1919, had spread across Europe, the US, Canada, Central America and India.
- It was also called encephalitis A and Economo encephalitis or disease.
- Approximately 1.5 million people are believed to have died due to this disease.
1918-1920 — Spanish flu
- This epidemic was a viral infectious disease caused due to a deadly strain of avian influenza.
- The spread of this virus was largely due to World War I which caused mass mobilization of troops whose travels helped spread this infectious disease.
- In India, approximately 10-20 million people died due to the Spanish flu that was brought to the region a century ago, by Indian soldiers who were part of the war.
1961–1975 — Cholera pandemic
- Vibrio cholerae, one type of bacterium, has caused seven cholera pandemics since 1817.
- In 1961, the El Tor strain of the Vibrio cholerae bacterium caused the seventh cholera pandemic when it was identified as having emerged in Makassar, Indonesia.
- In a span of less than five years, the virus spread to other parts of Southeast Asia and South Asia, having reached Bangladesh in 1963 and India in 1964.
1974 — Smallpox epidemic
- According to WHO, smallpox was officially eradicated in 1980. The infectious disease was caused by either of the two virus variants Variola major and Variola minor.
- Although the origins of the disease are unknown, it appears to have existed in the 3rd century BCE.
- This disease has a history of occurring in outbreaks around the world and it is not clear when it was first observed in India. India was free of smallpox by March 1977.
1994 — Plague in Surat
- In September 1994, pneumonic plague hit Surat, causing people to flee the city in large numbers. Rumours and misinformation led to people hoarding essential supplies and widespread panic.
- This mass migration contributed to the spread of the disease to other parts of the country. Within weeks, reports emerged of at least 1,000 cases of patients afflicted with the disease and 50 deaths.
2002-2004 — SARS
- SARS was the first severe and readily transmissible new disease to have emerged in the 21st century.
- In April 2003, India recorded its first case of SARS, severe acute respiratory syndrome, that was traced to Foshan, China.
- Similar to COVID-19, the causative agent of SARS was a type of coronavirus, named SARS CoV that was known for its frequent mutations and spread through close person-to-person contact and through coughing and sneezing by infected people.
2014-2015 — Swine flu outbreak
- In the last few months of 2014, reports emerged of the outbreak of the H1N1 virus, one type of influenza virus, with states like Gujarat, Rajasthan, Delhi, Maharashtra and Telangana being the worst affected.
- By March 2015, according to India’s Health Ministry, approximately 33,000 cases had been reported across the country and 2,000 people had died.
2018 — Nipah virus outbreak
- In May 2018, a viral infection attributed to fruit bats was traced in the state of Kerala, caused by the Nipah virus that had caused illness and deaths.
- The spread of the outbreak remained largely within the state of Kerala, due to efforts by the local government and various community leaders who worked in collaboration to prevent its spread even inside the state.
- Between May and June 2018, at least 17 people died of Nipah virus and by June, the outbreak was declared to have been completely contained.
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What is Herd Immunity?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Herd Immunity
Mains level: Coronovirus outbreak and its mitigation
As Europe was declared the epicentre of the novel coronavirus outbreak last week, Britain announced a different strategy to tackle the situation. Officials said that Britain would contain the spread of the virus but would not suppress it completely to build up a degree of ‘herd immunity’.
Herd Immunity
- Herd immunity is when a large number of people are vaccinated against a disease, lowering the chances of others being infected by it.
- When a sufficient percentage of a population is vaccinated, it slows the spread of disease.
- It is also referred to as community immunity or herd protection.
- The decline of disease incidence is greater than the proportion of individuals immunized because vaccination reduces the spread of an infectious agent by reducing the amount and/or duration of pathogen shedding by vaccines, retarding transmission.
- The approach requires those exposed to the virus to build natural immunity and stop the human-to-human transmission. This will subsequently halt its spread.
Can it work?
- Globally, this strategy has been criticized.
- COVID-19 is a new virus to which no one has immunity. More people are susceptible to infection.
- The goal seems to have been delaying urgent action to allow an epidemic to infect large numbers of people.
- To combat COVID-19, there is an urgent need to implement social distancing and closure policies.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Social Distancing and Flattening the Curve
The last two days, a number of states in India have enforced measures aimed at reducing public gatherings. This is called “social distancing”.
How does social distancing work?
- To stem the speed of the coronavirus spread so that healthcare systems can handle the influx, experts are advising people to avoid mass gatherings.
- Offices, schools, concerts, conferences, sports events, weddings, and the like have been shut or cancelled around the world, including in a number of Indian states.
- An advisory by the US Centers for Disease Control recommends social distancing measures such as: reducing the frequency of large gatherings and limiting the number of attendees; limiting inter-school interactions; and considering distance or e-learning in some settings.
What is the objective of such restrictions?
- Compared to deadlier diseases such as bird flu, or H5N1, coronavirus is not as fatal —which ironically also makes it more difficult to contain.
- With milder symptoms, the infected are more likely to be active and still spreading the virus.
- For example, more than half the cases aboard a cruise ship that has docked in California did not exhibit any symptoms.
- In a briefing on March 11, WHO officials said, “Action must be taken to prevent transmission at the community level to reduce the epidemic to manageable clusters.”
- The main question for governments is to reduce the impact of the virus by flattening the trajectory of cases from a sharp bell curve to an elongated speed-bump-like curve.
- This is being called “flattening the curve”. How does ‘flattening the curve’ help?
- Limiting community transmission is the best way to flatten the curve.
What was the curve like in China?
- The numbers show that the virus spread within Hubei exponentially but plateaued in other provinces.
- Some say it’s because many of these countries learnt from the 2003 SARS epidemic.
- Just as Chinese provinces outside of Hubei effectively stemmed the spread in February, three other countries —South Korea, Italy, and Iran — were not able to flatten the curve.
Flattening The Curve
- In epidemiology, the idea of slowing a virus’ spread so that fewer people need to seek treatment at any given time is known as “flattening the curve.”
- It explains why so many countries are implementing “social distancing” guidelines — including a “lockdown” order that affects 1.3 billion people in India, even though COVID-19 outbreaks in various places might not yet seem severe.
What is the curve?
- The “curve” researchers are talking about refers to the projected number of people who will contract COVID-19 over a period of time.
- To be clear, this is not a hard prediction of how many people will definitely be infected, but a theoretical number that’s used to model the virus’ spread. Here’s what one looks like:
- The curve takes on different shapes, depending on the virus’s infection rate.
- It could be a steep curve, in which the virus spreads exponentially (that is, case counts keep doubling at a consistent rate), and the total number of cases skyrockets to its peak within a few weeks.
- Infection curves with a steep rise also have a steep fall; after the virus infects pretty much everyone who can be infected, case numbers begin to drop exponentially, too.
- The faster the infection curve rises, the quicker the local health care system gets overloaded beyond its capacity to treat people.
- As we’re seeing in Maharashtra or Ahmedabad, more and more new patients may be forced to go without ICU beds, and more and more hospitals may run out of the basic supplies they need to respond to the outbreak.
- A flatter curve, on the other hand, assumes the same number of people ultimately get infected, but over a longer period of time.
- A slower infection rate means a less stressed health care system, fewer hospital visits on any given day and fewer sick people being turned away.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
What is a Pandemic and various other terms?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Not Much
Mains level: Coronovirus outbreak
What is the news: The World Health Organization (WHO) has declared the COVID-19 outbreak a pandemic.
What is a pandemic?
- Simply put, a pandemic is a measure of the spread of a disease.
- When a new disease spreads over a vast geographical area covering several countries and continents, and most people do not have immunity against it, the outbreak is termed a pandemic.
- It implies a higher level of concern than an epidemic, which the US Centers for Disease and Control Prevention (CDC) define as the spread of a disease in a localised area or country.
- There is no fixed number of cases or deaths that determine when an outbreak becomes a pandemic.
- The Ebola virus, which killed thousands in West Africa, is an epidemic as it is yet to mark its presence on other continents.
- Other outbreaks caused by coronaviruses such as MERS (2012) and SARS (2002), which spread to 27 and 26 countries respectively, were not labelled pandemics because they were eventually contained.
Which outbreaks have been declared pandemics in the past?
- A major example is the Spanish flu outbreak of 1918, which killed between 20-50 million.
- Cholera pandemics have been declared multiple times between 1817 and 1975.
- In 1968, a pandemic was declared for H3N2 that caused about a million deaths.
- The last pandemic declared by the WHO was in 2009, for H1N1.
Does the declaration change the approach to the disease?
- Describing the situation as pandemic does not change WHO’s assessment of the risk posed by the virus. However, the categorization as a pandemic can lead to more government attention.
- The categorization by WHO indicates the risk of disease for countries to take preventive measures.
- It will help improve funding by international organisations to combat coronavirus.
Difference Between Endemic, Epidemic, Outbreak and Pandemic:
- AN EPIDEMIC is a disease that affects a large number of people within a community, population, or region.
- A PANDEMIC is an epidemic that’s spread over multiple countries or continents.
- ENDEMIC is something that belongs to a particular people or country.
- AN OUTBREAK is a greater-than-anticipated increase in the number of endemic cases. It can also be a single case in a new area. If it’s not quickly controlled, an outbreak can become an epidemic.
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Genome sequencing of Coronavirus
Note4Students
From UPSC perspective, the following things are important :
Prelims level: COVID 19
Mains level: Global pandemics and their mitiagtion strategies
Scientists across the world are trying to develop a line of treatment and a possible vaccine for COVID-19. However, with the most optimistic timelines we don’t see a line of treatment or vaccine arriving before next year.
Genome sequencing of Coronavirus
- A global effort is on to collect and analyse the genetic composition of the new virus, which would be key to developing a cure and a vaccine.
- Genome sequence is the unique code of genetic material of any organism, and determines the characteristic of any organism.
- Whole genome sequencing is the process of determining the complete DNA sequence of an organism’s genome at a single time.
- The gene composition of novel coronavirus, for instance, is different from that of the influenza virus. Every organism has a unique genome sequence.
- Laboratories in various countries have been isolating and sharing the genome sequences of the virus on an international platform.
Why are so many genome sequences being isolated?
- When viruses multiply, or reproduce, there is a copying mechanism that transfers the gene information to the next generation.
- However, no copying mechanism is perfect. When the virus multiplies, there will be small changes, which are called mutations.
- These mutations accumulate over time, and after prolonged periods, are responsible for evolution into new organisms.
- Within a single reproduction, the changes are extremely minor. More than 95 per cent of the gene structure remains the same.
How it helps scientists?
- However, the small changes that occur are crucial to understanding the nature and behaviour of the organism.
- In this case, for example, the small changes could provide scientists with information about the origin, transmission, and impact of the virus on the patient.
- It could also hold clues to the differing effects the virus could have on patients with different health parameters.
How many genome sequences are required?
- India has far fewer positive cases compared to China, South Korea, Iran, Italy, or even the US.
- Patients who have been infected with the virus in similar conditions are unlikely to show any significant changes in the genome sequences.
- Patients with existing medical conditions could be other candidates from where genome sequences of this virus could be isolated.
- This could help scientists to look for clues to possible impact of virus amidst those existing medical conditions.
Currently, what is the most effective medication?
- As of now, there is none such. Right now, drugs are being repurposed, meaning old drugs for similar diseases are being checked for their efficacy against COVID-19.
- These drugs, if they work, will require clinical trials, and then can be made widely available for people.
- In most cases, symptomatic treatment for fever, body ache, and cough will be sufficient. More severe cases will require oxygen and respiratory support.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
N95 Mask
Note4Students
From UPSC perspective, the following things are important :
Prelims level: N95 Masks
Mains level: Coronovirus outbreak
In a new mandate to curb unnecessary demand, the Maharashtra Food and Drug Administration said that chemists cannot sell N95 masks without a doctor’s prescription. The FDA also warned that serious action would be taken against those who are found selling masks at high prices or hoarding them.
Why such a move?
- Personal Protective Equipment (PPE) kits and N95 masks are being sold at very high prices in medical shops. The State has received many complaints about the same.
- It has also been found that many are making bulk purchases and hording PPE kits and N95 masks.
- Since the COVID-19 outbreak in China, shortage of PPE gear and masks has been reported from across the world.
- While the Indian government has currently banned exports of N95 masks, the manufacturers are focussed on making other surgical marks to get good returns from exports.
N95 mask
- A disposable N95 mask (respirator) is a safety device that covers the nose and mouth and helps protect the wearer from breathing in some hazardous substances.
- An N95 respirator is designed to achieve a very close facial fit and very efficient filtration of airborne particles.
- The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95 percent of very small (0.3 micron) test particles.
- If properly fitted, the filtration capabilities of N95 respirators exceed those of face masks. However, even a properly fitted N95 respirator does not completely eliminate the risk of illness or death.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Private: Rare Disease
Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Explained: One Health Concept
Note4Students
From UPSC perspective, the following things are important :
Prelims level: One Health Concept
Mains level: Strategies to curb rising incidences of zoonotic diseases
The concept of ‘One Health’ is gaining importance as most of the contagious diseases affecting humans are zoonotic (animal to man origin) in nature. It can be effectively implemented for reducing incidence of emerging zoonotic threats like COVID-19.
The One Health concept
- The World Organization of Animal Health, commonly known as OIE (an abbreviation of its French title), summarizes the One Health concept.
- It says that as “human health and animal health are interdependent and bound to the health of the ecosystems in which they exist”.
- Circa 400 BC, Hippocrates in his treatise On Airs, Waters and Places had urged physicians that all aspects of patients’ lives need to be considered including their environment; disease was a result of imbalance between man and environment.
- So One Health is not a new concept, though it is of late that it has been formalized in health governance systems.
Why accept this model?
- Of the contagious diseases affecting humans, more than 65% are of zoonotic or animal to man origin.
- One Health model is a globally accepted model for research on epidemiology, diagnosis and control of zoonotic diseases.
- One Health model facilitates interdisciplinary approach in disease control so as to control emerging and existing zoonotic threats.
- Increasing stress on animals due to loss of their habitat would increase scope of zoonotic diseases.
Why corona is so deadly?
- Current outbreak of COVID-19 still could not find out the actual source of virus.
- Even though genomics of the virus has been published ambiguity still exists whether it was from bats, snakes, pangolin, etc.
Frequent Outbreaks of Zoonotic Diseases
- Not so long ago, the widespread prevalence of avian influenza in poultry, or bird flu as it commonly became known, created nationwide panic resulting in the culling of millions of poultry birds.
- It was concern for human health that prompted the extreme reaction and subsequent establishment of protocols; containment of avian influenza is managed quite effectively now.
- Similarly in 2003, SARS or Severe Acute Respiratory Syndrome emanated suddenly in China and vanished soon.
Followed by hues and panic
- These outbreaks culminated emergency response that included extreme measures like travel bans and restrictions.
- In both cases, panic spread much faster than the virus.
- Besides drawing a response from governments, these events also brought forth the hitherto forgotten philosophy of One Health.
- This idea recognizes inter-connectivity among human health, the health of animals, and the environment.
Why rise in zoonotic outbreaks?
- As human populations expand, it results in greater contact with domestic and wild animals, providing more opportunities for diseases to pass from one to the other.
- Climate change, deforestation and intensive farming further disrupt environment characteristics, while increased trade and travel result in closer and more frequent interaction, thus increasing the possibility of transmission of diseases.
Need for a robust animal health system
- Private sector presence in veterinary services is close to being nonexistent.
- Unlike a physician, a veterinarian is always on a house call on account of the logistic challenge of transporting livestock to the hospital, unless they are domestic pets.
- There could not be a stronger case for reinventing the entire animal husbandry sector to be able to reach every livestock farmer, not only for disease treatment but for prevention and surveillance to minimize the threat to human health.
- Early detection at animal source can prevent disease transmission to humans and introduction of pathogens into the food chain. So a robust animal health system is the first and a crucial step in human health.
Conclusion
- Developing countries like India have a much greater stake in strong One Health systems on account of agricultural systems resulting in uncomfortably close proximity of animals and humans.
- This builds a strong case for strengthening veterinary institutions and services.
- Further delay may pave way for emergence of new communicable diseases.
Way Forward
- The most effective and economical approach is to control zoonotic pathogens at their animal source.
- It calls not only for close collaboration at local, regional and global levels among veterinary, health and environmental governance, but also for greater investment in animal health infrastructure.
- Need of the hour is to scale up such a model across the country and to establish meaningful research collaborations across the world.
- Health, veterinary, agriculture and life science research institutions and universities can play a lead role.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Private: Convalescent Plasma Therapy
China has developed convalescent plasma to treat patients who are infected with the novel coronavirus (COVID-19), according to the China National Biotec Group.
- As the disease develops, the body has already begun developing antibodies against the virus.
- Antibodies in the plasma bind to the virus and prevent them from entering the cells. People who have recovered from COVID-19 disease would have antibodies against the virus.
- Infusing the antibodies to critically ill patients is expected to improve the chances of survival.
- The plasma that is transfused contains the antibodies.
- The company had collected plasma from some recovered patients to prepare therapeutic products including convalescent plasma and immune globulin.
- This is not the first time that plasma from recovered patients has been used to treat people infected with certain viruses for which drugs are not available.
- When Ebola struck Guinea, Sierra Leone, and Liberia in 2014, the World Health Organization prioritised the evaluation of treatment with convalescent plasma derived from patients who have recovered from the disease.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Remdesivir: Under-trail vaccine against Coronavirus
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Remdesivir
Mains level: Coronovirus outbreak
The Wuhan Institute of Virology at Wuhan, China has filed for a patent on Remdesivir, an antiviral experimental drug from the US which may help treat the novel coronavirus (nCoV-2019).
Remdesivir
- It is an experimental drug and has not yet been licensed or approved anywhere globally. It has not been demonstrated to be safe or effective for any use.
- It is currently being developed for the treatment of Ebola virus infection.
- Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro.
- Chloroquine is a “widely used” anti-malarial and autoimmune disease medicine that has recently come to light as a potential antiviral drug.
Can Remdesivir treat coronavirus?
- Significantly, Remdesivir has demonstrated in vivo (experimentation using a whole living organism) and in vitro (activity performed in a controlled environment) activity in animal models against viral pathogens that cause MERS and SARS.
- Even so, the use of the experimental drug has been allowed only as an emergency treatment, which can be administered in the absence of any other approved treatment options.
- These two diseases are also caused by coronaviruses structurally similar to the nCoV-2019.
- Additionally, limited clinical data is available from the emergency administration of Remdesivir in patients with Ebola.
- Even so, it is yet to be seen if Remdesivir and chloroquine can be effective against the novel coronavirus in humans.
How can the novel coronavirus infection be treated?
- As of now, there is no known treatment for the novel coronavirus, and an appropriate antiviral drug is required for this.
- Ideally, a vaccine against the infection can also prove to be effective, but such a development does not seem to be in the offing for at least three-four months.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
[op-ed of the day] A sneeze, a global cold and testing times for China
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Not much.
Mains level: Paper 2- Dealing with outbreaks of infectious disease.
Context
The World Health Organization (WHO) has declared the coronavirus outbreak a global emergency, as the outbreak continues to spread outside China.
Coronavirus outbreak and Chinese response
- What is coronavirus? Normally, coronavirus is a large family of viruses that are often the source of respiratory infections, including the common cold.
- A small number of common infecting virus: Most of the viruses are common among animals and only a small number of them infect humans.
- Mutation of animal base virus: Sometimes, an animal-based coronavirus mutates and successfully finds a human host.
- Dangers of rapid urbanisation: Rapid urbanisation that forces animals and humans into closer proximity (as in the “wet market” in Wuhan) creates a perfect petri dish from where such zoonotic outbreaks can originate.
Concern for India
- Reported case in Nepal and cause of concern for India: For India, the most critical is cases being reported in Nepal since India and Nepal share an open border though so far.
- All tests undertaken in India have been negative.
- A tweet by the Ministry of Health and Family Welfare on January 30 said that one positive case of a novel coronavirus patient
Understanding the new virus
- The possible mode of transmission: According to the World Health Organization, during previous outbreaks due to other coronavirus, human-to-human transmission occurred through droplets, contact and fomites (objects or materials which are likely to carry infection, such as clothes, utensils, and furniture).
- This suggests that the transmission mode of the 2019-nCoV can be identical.
- The transmission even in incubation period: More significant is the new understanding that the virus is contagious even during incubation, that is even before a patient exhibits any symptoms.
- This characteristic amplifies
Experience from the past outbreaks
- Comparison with SARS: Comparisons are being drawn the Severe Acute Respiratory Syndrome) outbreak in 2002-03.
- Zoonotic case: SARS is also a zoonotic case, part of the coronavirus family with clues pointing to horseshoe bats in China as the likely source.
- Late reporting by China in SARS:
- The first incidents were reported in Guangdong province in November 2002 but WHO was officially informed only after three months.
- Different response this time: Comparison with SARS: Comparisons are being drawn the Severe Acute Respiratory Syndrome) outbreak in 2002-03.
- Zoonotic case: SARS is also a zoonotic case, part of the coronavirus family with clues pointing to horseshoe bats in China as the likely source.
- Late reporting by China in SARS: The first incidents were reported in Guangdong province in November 2002 but WHO was officially informed only after three months.
- Different response this time: This time around, the Chinese government has been more open but the question being asked is whether it has been open enough?
- The difference in time to develop vaccine: For SARS, it took 20 months from the genome sequencing to the first human vaccine trials; for the 2019-nCoV, authorities in the U.S. are working on a deadline of 90 days.
Lessons from Kerala in Nipah outbreak
- Managing an outbreak with few casualties: Kerala managed to curtail the Nipah outbreak with few casualties.
- Nipah is also zoonotic and made the jump from fruit bats to humans.
- Though there were 17 deaths in India, effective quarantine measures by local authorities prevented the spread.
- Infectious disease on the rise: Infectious diseases including those of the zoonotic variety are on the rise in India.
- In addition, regions in India suffer from seasonal outbreaks of dengue, malaria and influenza strains.
- The nation-wide disease surveillance programme needs to be strengthened.
Conclusion
India should brace itself for the possible outbreak of infectious diseases and frame policies to deal with such outbreaks in fast and effective ways.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Why China has emerged as the epicentre of global outbreaks of disease?
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Zoonotic diseases
Mains level: Threats posed by coronavirus outbreak
Several deadly new viruses in recent years have emerged in China — Severe Acute Respiratory Syndrome (SARS), bird flu, and now the novel Coronavirus (nCOV).
Zoonotic infections
- Closely packed stalls in busy marketplaces, the Chinese taste for exotic meats, and the high population density of cities create the conditions for the spread of zoonotic infections.
- The reason could lie in the busy food markets dotting cities across the country — where fruits, vegetables, hairy crabs and butchered meat are often sold next to bamboo rats, snakes, turtles, and palm civets.
- The relationship between zoonotic pathogens and global pandemics are not new.
- The WHO estimates that globally, about a billion cases of illness and millions of deaths occur every year from zoonoses, i.e, diseases and infections naturally transmitted between people and vertebrate animals.
- Some 60% of emerging infectious diseases globally are zoonoses. Of the over 30 new human pathogens detected over the last three decades, 75% originated in animals.
Major cause: Animal markets
- In animal markets, there are greater chances of transmission of a virus from animals to humans, and its mutation to adapt to the human body.
- It has happened wherever in the world there is unregulated mixing of humans and animals, either wild or domesticated.
- The official referred to the Ebola outbreak in Africa there it was wild chimpanzees who had the disease. It came into humans after these were killed and consumed.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Corona Virus
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Coronavirus, Pneumonia
Mains level: Underlying threats and India's preparedness against the virus
Chinese scientists have confirmed can spread between human beings.
Corona Virus
- Corona viruses are large family of viruses, which cause illnesses to people and also circulate in animals including camels, cats and bats.
- They cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome.
- 2019-nCoV is a new strain that has not been previously identified in humans.
- Much remains to be understood about the new coronavirus, which was first identified in China earlier this month.
- Not enough is known about 2019-nCoV to draw definitive conclusions about how it is transmitted, clinical features of disease, or the extent to which it has spread. The source also remains unknown.
Why is it called the Wuhan Virus?
- The first cases emerged in Wuhan in central China’s Hubei province.
- On December 31 last year, authorities confirmed that a large number of patients with unexplained pneumonia were admitted in hospitals in the city.
Symptoms of infection
- According to the WHO, common signs include fever, cough, and shortness of breath. Serious infections can lead to pneumonia, kidney failure, and death.
- Although human-to-human transmission has now been confirmed, the WHO says animals are the outbreak’s likely primary source. It is not known yet which animals are responsible.
- To prevent the spread of all respiratory infections, the WHO in general asks people to cover their mouths and noses when coughing or sneezing, and to frequently wash their hands.
- Direct contact with farm or wild animals should be avoided — similar outbreaks in the past, like the Severe Acute Respiratory Syndrome (SARS) emerged from markets where people were in contact with live animals.
Why is there concern around the world?
- People see a similarity with the SARS outbreak that infected over 8,000 people and killed around 775 in more than 35 countries worldwide in 2002-03.
- SARS too, was caused by a mystery coronavirus, and started in China.
- The source of the virus remained unknown for 15 years, until Chinese scientists in 2017 traced it back to a colony of horseshoe bats living in remote cave in Yunnan province.
- The virus was carried by civet cats which are sold in markets in China.
- Fears that SARS could reappear and memories of China misleading the rest of the world on the extent and seriousness of the outbreak have not gone away.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
[pib] Novel Corona Virus (nCoV)
Note4Students
From UPSC perspective, the following things are important :
Prelims level: nCoV
Mains level: Not Much
The Union Ministry of Health and Family Welfare has been closely monitoring the situation after the reports of 41 confirmed cases of novel Corona virus (nCoV) including one death from Wuhan, China, 2020.
About Novel Corona Virus
- Corona viruses are large family of viruses, which cause illnesses to people and also circulate in animals including camels, cats and bats.
- They cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome.
- 2019-nCoV is a new strain that has not been previously identified in humans.
- Much remains to be understood about the new coronavirus, which was first identified in China earlier this month.
- Not enough is known about 2019-nCoV to draw definitive conclusions about how it is transmitted, clinical features of disease, or the extent to which it has spread. The source also remains unknown.
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Coronavirus – Disease, Medical Sciences Involved & Preventive Measures
Coronavirus
Note4Students
From UPSC perspective, the following things are important :
Prelims level: Coronavirus, Pneumonia
Mains level: NA
A new virus has been identified by Chinese researchers which is responsible for a new pneumonia-like illness.
Coronavirus
- Coronaviruses are a specific family of viruses, with some of them causing less-severe damage, such as the common cold, and others causing respiratory and intestinal diseases.
- A coronavirus has many “regularly arranged” protrusions on its surface, because of which the entire virus particle looks like an emperor’s crown, hence the name “coronavirus”.
- Apart from human beings, coronaviruses can affect mammals including pigs, cattle, cats, dogs, martens, camels, hedgehogs and some birds.
- So far, there are four known disease-causing coronaviruses, among which the best known are the SARS coronavirus and the Middle East Respiratory Syndrome (MERS) coronavirus, both of which can cause severe respiratory diseases.
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