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Subject: Biotech and Medical Sciences

  • [pib] Project ‘Isaac’

    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.

  • ‘Contact tracing’

    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.

  • Why need a 21-day lockdown period?

    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.

  • What is Hantavirus?

    China has reported the death of a person from Yunnan Province who tested positive for the Hantavirus.

    What is Hantavirus?

    • The Hantaviruses are a family of viruses spread mainly by rodents. It is contracted by humans from infected rodents.
    • Cases of the Hantavirus in humans occur mostly in rural areas where forests, fields and farms offer suitable habitat for infected rodents.
    • A person can get infected if he/she comes in contact with a rodent that carries the virus.
    • In the US and Canada, for instance, the Hantavirus carried by the deer mouse is responsible for the majority cases of the Hantavirus infection.
    • Like this, there are various other kinds of Hantaviruses that find hosts in rodents, like the white-footed mouse and the cotton rat among others that may lead to infections in humans if transmitted.

    Its origin

    • The Hantavirus is not novel and its first case dates back to 1993, according to the US Centre for Disease Control (CDC).
    • In the Americas, the family of viruses is known as ‘New World hantaviruses’.

    Symptoms

    • A person infected with the virus may show symptoms within the first to eighth week after they have been exposed to fresh urine, faeces or the saliva of infected rodents.
    • Symptoms may include fever, fatigue, muscle aches, headaches, chills and abdominal problems.
    • Four to ten after being infected, late symptoms of HPS may start to appear, which include coughing and shortness of breath.

    Mortality risk

    • It is the cause of Hantavirus pulmonary disease (HPS), a severe respiratory disease. The HPS can be fatal and has a mortality rate of 38 per cent.
    • It remains unclear whether human-to-human transmission of the virus is possible.
    • There have been no reports of human-to-human transmission of Hantavirus in the US.

  • Stages in a COVID-19 Pandemic

    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.

  • Can Vitamin C prevent or cure novel Coronavirus infection?

  • Time for a powerful display of humanity

    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.

     

  • Epidemics that have hit India since 1900

    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.

  • What is Herd Immunity?

    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.

  • 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.