Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Tap to read more: https://www.civilsdaily.com/news/convalescent-plasma-therapy-2/

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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:

PCR Test for Diagnosis of the COVID-19

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

[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

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

[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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

‘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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

What are human challenge trials, and why are they controversial?

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Human Challenge Trial

Mains level : Ethical issue involved in HCT

As laboratories around the world race to develop a vaccine for the novel coronavirus, many people have volunteered to take part in a controversial testing method called human challenge trials (HCT).

A number of challenging ethical issues are raised by the ongoing COVID-19 pandemic. It has invoked a clash between the medical ethics and disaster ethics which deals with situations in which a crisis has led to a large number of people needing medical help.

How vaccines are usually developed?

  • In most regulatory regimes, vaccines take several years to develop, and their development typically proceeds through three phases of clinical trials.
  • In Phase 1, small groups of people receive the trial vaccine.
  • During Phase 2, the clinical study is expanded and the vaccine is given to people who have characteristics (such as age and physical health) similar to those for whom the new vaccine is intended.
  • In Phase 3, the vaccine is given to several thousand people and tested for efficacy and safety. During this phase, participants either receive the vaccine or a placebo.

Human Challenge Trials and its Benefits

  • Under HCT, participants of both the vaccine group and placebo group upon consent are deliberately exposed to the infection – thus are “challenged” by the disease organism.
  • Proponents of the method believe that such trials could save valuable time in developing a Covid-19 vaccine, as researchers would not have to wait for participants to contract the infection under real-world conditions.
  • Controlled HCT of SARS-CoV-2 vaccine candidates could accelerate the testing and potential rollout of efficacious vaccines.
  • By replacing conventional Phase 3 testing of vaccine candidates, such trials may subtract many months from the licensure process, making efficacious vaccines available more quickly.
  • Such testing would also require significantly less number of people than regular Phase 3 trials, which require thousands of volunteers.

Human challenge trials: The ethical concerns

  • While HCT is not new, they are usually carried out in developing medications for diseases which are considered less lethal and have been better understood by scientists over the years, such as malaria.
  • HCT appears to be in conflict with the guiding principle in medicine to do no harm.
  • Critics have questioned undertaking such trials for Covid-19, a potentially deadly disease for even those who are less at risk, and which researchers are still in the early stages of studying.

Issue of Informed consent

  • It is essential that challenge studies be conducted within an ethical framework in which truly informed consent is given.
  • When conducted, human challenge studies should be undertaken with abundant forethought, caution, and oversight.
  • The value of the information to be gained should clearly justify the risks to human subjects.
  • Information to be gained should clearly justify the risks to human subjects.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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?

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

[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.

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.

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

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

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

 

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.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

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.

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.

Epidemic vs. Pandemic

  • A simple way to know the difference between an epidemic and a pandemic is to remember the “P” in the pandemic, which means a pandemic has a passport. A pandemic is an epidemic that travels.

Epidemic vs. Endemic

  • An epidemic is actively spreading; new cases of the disease substantially exceed what is expected.
  • More broadly, it’s used to describe any problem that’s out of control, such as “the opioid epidemic.”
  • An epidemic is often localized to a region, but the number of those infected in that region is significantly higher than normal.
  • For example, when COVID-19 was limited to Wuhan, China, it was an epidemic. The geographical spread turned it into a pandemic.
  • Endemics, on the other hand, are a constant presence in a specific location.
  • Malaria is endemic to parts of Africa. Ice is endemic to Antarctica.

Endemic vs. Outbreak

  • Going one step farther, an endemic can lead to an outbreak, and an outbreak can happen anywhere.
  • Last summer’s dengue fever outbreak in Hawaii is as an example. Dengue fever is endemic to certain regions of Africa, Central and South America, and the Caribbean. Mosquitoes in these areas carry dengue fever and transmit it from person to person.
  • But in 2019 there was an outbreak of dengue fever in Hawaii, where the disease is not endemic. It’s believed an infected person visited the Big Island and was bitten by mosquitoes there.
  • The insects then transferred the disease to other individuals they bit, which created an outbreak.

You can see why it’s so easy to confuse these terms. They’re all related to one another and there’s a natural ebb and flow between them as treatments become available and measures for control are put in place — or as flare-ups occur and disease begins to spread.

Coronavirus – Disease, Medical Sciences Involved & Preventive Measures

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.

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.

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.

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.

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.

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.

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.

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.

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.

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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