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Cardiac diseases on the rise post Covid, here’s what Experts suggest to improve heart health

by Pragati Singh
written by Pragati Singh

The incidence of Covid-recovered patients suffering from Cardiac illnesses such as sudden palpitation, chest discomfort, and even heart attack has increased substantially, particularly among young people. On the occasion of World Heart Day, Medically Speaking discussed the causes of such severe heart problems, early symptoms and possible treatments with a panel of esteemed experts that included: Padma Shri Dr Mohsin Wali, Senior Consultant, Internal Medicine from Sir Gangaram Hospital; Dr Mukesh Goel, Senior Consultant, Cardiothoracic Surgery from Apollo Hospitals; Padma Shri Dr Balbir Singh, Chairman of Cardiology from MAX Hospitals and Professor Rakesh Yadav, Professor of Cardiology from AIIMS.

Here are a few excerpts from the exclusive interview:

 

What is the significance of talking about heart diseases in the backdrop of the Covid-19 pandemic?

Dr Mohsin Wali: COVID has proven to be a poison for the heart, particularly the smaller blood vessels which reach every organ of our body. Involvement of the cardiovascular system in covid causing complications, acute as well as delayed, has been very well understood by now. Initially we were not aware about it.

We have learnt that Covid causes severe complications and in that conditions, whole system gets affected and these are the basic effects of the covid, almost all organs are involved and heart is one of the most important organ. And on the world heart day, my first message would be that in the covid background everyday should be will be world heart day because we are taking care of hearts especially of the youngsters.

 

Why do we have so many young Indians of their hearts such risk at the time of the covid-19, pandemic?

Dr Balbir Singh: Two things that happen with covid in young people: one was the involvement of the heart muscle which led to a condition called Myocarditis which has been associated with heart, failure and sudden deaths. Second was formation of clots within the arteries, which lead to heart attacks and unstable angina or acute coronary syndromes, which led to deaths. We cannot take Covid lightly. Even after six months of infection, I would say that keep yourself healthy, eat well, walk and keep yourself free. Don’t exercise too much, I would advise against heavy exercise after Covid illness. This is how you can take care of yourself after Covid illness.

 

Many believed Covid-19 affected the oxygen levels and lungs. How is it affecting the hearts?

Dr Mukesh Goel: We have a term nowadays, which we call long Covid which has many specific symptoms, feeling tired all the time, lack of energy, loss of appetite and even some depression also. When somebody is having a real cardiac issues, those symptoms can get mixed up with those long covid or post covid syndrome and it can be neglected. So I will just say that maybe we should not ignore these symptoms thinking that this must be a long covid or post covid syndrome should take it seriously.

 

What is the correlation between anxiety, panic and hypertension experienced otherwise and post Covid-19 and what can a patient or his family members do?

Prof Rakesh Yadav: If you see the statistic of post covid, about 50 to 70% are going to have some neurological problems like depression, anxiety, sleeplessness, tiredness, even a memory loss is there, they are unable to concentrate. Now second important thing is we are seeing autonomous dysfunction in plenty of patient which means their blood pressure will fluctuate, either it will come down or it will shoot and they have inappropriate increase in heart rate. So you will encounter lot of patients who says that, “Doctor if I walk little, my heart rate goes to 130 140,” which is a syndrome called POTS. We have seen patients who are on 2 or 3 hypertensives post Covid which needs to be stopped after the blood pressure drops below 100. Therefore, do not be happy if we stop hypertensive, it may be an indicator of an autonomous dysfunction. There is no direct correlation of anxiety with hypertension, however, hypertension is directly related to heart diseases. There is a lot of debate over cardiac screening post Covid after 3 to 6 months but we are seeing a lot of patients.

 

Heart diseases are killing over 17 million people worldwide, especially at rise among youngsters. What are the probable causes for this?

Dr Mohsin Wali: We were taught as students about young Coronary Artery Disease. But now, the diet patterns have changed and youngsters are more into junk foods, disturbed sleep patterns, excessive work load, stress and smoking are on the rise. Therefore, we are seeing changed patterns of Coronary Artery Disease in India. Furthermore, cases are more complicated now. We have to regulate our diet, sleep and stress and control hypertension and sugar and overall have a healthy lifestyle.

 

As head of Cardiology department, do you see cases of resuscitation worsen due to lack of knowledge?

Dr. Balbir Singh: CPR and the use of an automated external defibrillator must become a practise that everyone must learn. I believe that the training class should begin in schools, and that police officers should be engaged. Every human being should be aware that if someone collapses on the road, you must provide artificial respiration and pump his heart. I know there are AEDs (automated external defibrillators) in several malls and airports, but let me tell you that none of the security personnel in the malls or airports understands how to use them. It is a waste of money to install an AED without adequate training on how to utilize it. Having an AED everywhere is good but people at local levels should know how to use it and save lives around them because there is know way you can save a person suffering a sudden cardiac arrest without the basic knowledge. Therefore people must come forward to learn it.

 

What sort of lifestyle changes can a person need to ensure better health overall and ensue better cardiac health most importantly?

Dr. Mukesh Goel: as far as rise in incidents of heart disease in women is concerned, we were not much aware about it earlier. In fact even medical community has become more aware about looking and treating heart disease in women only in last decade or so. It was a common perception that women do not get heart disease much often.

But now we know why one in 25 women die of breast cancer and one in two will die of heart disease. As far as lifestyle changes is concerned, there is really no gender difference. If you are a man or a woman, the guidelines are same: Regular physical activities, keep a check on your diet, smoking should be avoided by both men and women, and check your blood pressure regularly.

 

Many believe that ayurvedic herbs have anti-inflammatory properties and can help those living with cardio issue. Would you agree with that statement?

Prof Rakesh Yadav: Any herb proven by science is accepted, but until that, I will not comment on it. Secondly, believe it or not, all our scientific medicines come from ancient herbs, may it be for diabetes or hypertension. So I’ll never blame Ayurveda for nothing. I know what will happen if I take an excessive dose of, let’s say an allopathic medicine for diabetes. I will suffer from hypoglycemia. Same goes with Ayurvedic medicines where people suffer from organ dysfunction due to excessive intake of Kadhas.

 

How do regular heart checkups reduce the risk of cardiovascular diseases?

Dr Mohsin Wali: Any checkup on a regular basis is beneficial. Routine checkup should be a part of everyone above the age of 25 which includes ECG, Electro-Cardiography, Sugar Screening, Blood Pressure Screening, Kidney Function, etc. After the age of 35, regular cardio checkup should be made mandatory. If one is a smoker, overweight or diabetic, these checkups must be taken frequently, at least once a year. Sometimes, diabetic patients do not have warning symptoms like chest pain so they are not aware about it. Dr Balbir Singh treats a lot of patients with Arrhythmias, which is also a cause of sudden death and is common among youngsters. Most importantly, if you have an abnormal symptom, like excessive sweating or even exhaustion, one should go for a cardiac checkup.

 

Many of the symptoms of cardiac issues are quite generic. What are the basic ones to watch out for?

Dr Balbir Singh: Foremost reason for such conditions is denial. For example if a person is facing difficulty with climbing stairs, they excuse it as weakness and think they cannot have a cardiac problem. This is a psychological problem that happens with everyone. These symptoms are so generic that these could be nothing or can be a serious heart ailment. The only way to distinguish is to get yourself tested without which you won’t be able to know. An ECG and a blood test will be sufficient to test it.

 

What are the alarming and more specific signs for these?

Dr Balbir Singh: There are two or three risk factors one should take care of. If one is a smoker, obese of diabetic, or has a family history of heart disease, one is under risk and should not take gas or acidity lightly, and ask for medical help. If 9 out of 10 get no signs of heart risks after tests, it is better than not getting tested at all.

 

Now let’s come to treatment which takes us to the real developments, which are happening when it comes to saving people’s lives. Of course, there was a time when major surgeries required stands, and of course, they were extremely expensive, but now things have changed completely. What’s the most recent news on the subject?

Dr Mohsin Wali: Things have improved. We used to treat cardiac attacks with morphine injection and giving oxygen. We can now map the diseased portion of the heart by doing echocardiograms, even by ECG’s. We were taught to map the area of the heart disease affected and then visualise it physically, by doing angiography. Beyond that, we have progressed to cardiac MRIs.

So these are the recent things we can implant: cardio, vascular, defibrillator, Walter devices, and very compact things like pacemakers. Initially we used to have only pacemakers, now we have defibrillators with portable, small and implantable cardioverters. So these are all the recent changes in the cardiac transplants that are extreme.

So maybe certain things we can do beyond that. Even if we can cut like a carpenter, that is a Rotablation. In one word, coronary revascularization. Heart muscle has tremendous capacity to recover, and that is why the doctors who treat the heart become very famous because they have to apply their minds to revive the muscle. Heart is an organ of the body that doesn’t go on leave. It beats from the last four months of intrauterine life until the last breath. It functions even when you are sleeping, driving, or having any activity. God made this muscle so strong and we poison it with sugar, smoking, alcohol and so many other stressful things. But we have to really save the heart and that us what the World Heart Day is for.

 

Take us to the latest investments in the Technological Sector that have been made in India and ehat more cam be invested in? How can our infrastructure be better prepared for a greater influx of patients?

Dr Balbir Singh: Covid has taught us many lessons about patients, their families, and doctors. So the doctors have taught us how to work hard and try to save more lives. It also taught us that if we work hard with the patients, we can get results. It has taught us in cardiology that innovations are helping patients. The one good thing that happened with COVID-19 was the media coverage. It brought the hospital into the view of people, who now realise how important hospital and medical health is. I used to give an example that a person will go to a restaurant and spend 5000 rupees, but he will not spend that 5,000 on getting his health check-up, which is a major disaster. So what has happened is that we have seen a 200% increase in health insurance following the Covid. That means people are now serious. The second thing that has happened is that these devices that have been just talked about are expensive. They are not cheap. Fortunately, we have not invested. India has not invested into making this technology. It is a difficult technology. We will have to ultimately get into this piece and build on who we are. These are important things, and we spend a lot of money on getting these devices, which means that we have to get to that level where we get our devices, which would be cheaper and more affordable for the world population.

 

What are the basic devices one can keep at home for regular home checkup as coming to hospital might be a risk for people? What would you say about their feasibility?

Dr Mukesh Goel: So basic devices that everyone should have at home is a blood pressure monitor, a blood sugar monitor, and earlier it was basically, I would not have recommended it, but now it has a pulse oximeter. So these three devices must be at everyone’s home. And if one is not hypertensive, and sugar is normal, I still recommend a weekly check of blood pressure, as well as a monthly check of blood sugar apart from the formal annual health check-up in a medical setting. That should be the minimum.

 

What would be your word of advise?

Prof Rakesh Yadav: If you want to make your heart healthy, make it happy too, because it is a happy and healthy heart that makes a good person. The second important thing is how to monitor your heart’s health. If you are asymptomatic, at least in your childhood, you should have one blood pressure check. After 20 years, you should have your blood pressure, sugar, and lipid profile checked. Then after 40 years, you get these three blood pressures, sugars, and lipid profile. If it is normal, repeat it after 5 years, and after 50, repeat it every two years. And after 60, repeat it every year. And after 70, every six months, if it is normal, it is good. But if it is abnormal, kindly seek advice from your doctor. Don’t ignore all of that. Don’t ignore your blood sugar. If you are hypertensive, by your blood pressure estimate, take your blood pressure at home. As doctor Goel suggests, if you are a diabetic, you must monitor your blood sugar levels on a regular basis. That is the most important thing to mention.

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ExclusivesInterviewsMental health

Identifying these risk factors at an early stage may help you prevent Alzheimer’s

by Pragati Singh
written by Pragati Singh

Alzheimer’s disease is the most commonly found Dementia or brain disorder that slowly impairs memory and thinking skills and finally the ability to carry out most basic tasks. It is the most common cause of memory loss among the elderly and interferes with their cognitive functioning making them completely dependent on others for help. As per a report published by ARDSI (Alzheimer’s and Related Disorders Society of India), nearly 7.6 million Indians might be suffering this disease.

Every year on September 21, World Alzheimer’s Day is observed to promote awareness and educate the public about Alzheimer’s disease and dementia. To discuss more about the theme and significance of this day along with the possible prevention of the disease and its relation with Covid, Medically Speaking invited a panel of experts that included: Dr Manjari Tripathi, Professor in Department of Neurology, AIIMS; Dr Manish Kandpal, Professor of Psychiatry, Ram Manohar Lohia Hospital; Dr Anand, Senior Director of Neurology, BKL Max Hospital; Dr Renu Vohra, Member Secretary, Alzheimer’s Related Disorder Society Delhi Chapter (ARDSI(DC)).

Here are a few excerpts from the interview:

Why do you think we need to focus on Alzheimer’s disease, it’s observation and awareness?

Dr Manjari Tripathi: As our life expectancy increases due to better medical facilities in our country, there is a disorder related to ageing known as Alzheimer’s Dementia. But a lot of knowledge for this disease is available in the western world. In India, any elderly who starts declining in memory is often taken as normal age related issue. However, if the memory decline is significant, a person cannot recollect what is going on. This is significant enough to impact his daily life and functioning and make the person dependent on others. Then it qualifies to be a disorder known as Alzheimer’s Dementia. There is a huge treatment and diagnostic gap for this disease in India. There also is a condition known as advanced Dementia, so when person is in late stages of the disease, that is when they consult a doctor, which is not what doctors, counsellors and psychologists want. We need people to come it early so there can be a maximization of impact of any intervention (medical or psycho-social). This is not happening which is why the awareness is needed and therefore this 21st September is celebrated as World Alzheimer’s Day and the theme for this year is ‘No Alzheimer’s, No Dementia’.

What are the early signs of Alzheimer’s that one needs to watch out for and can it affect a person before a certain age as well?

Dr Manish Kandpal: Diagnosis is done through history only, we have certain investigations to rule out early causes where memory is sailing. It is very important when people are getting issues with their day-to-day life. Recent memory is the first that gets affected. It is at later stages that the memory loss interferes with daily chores. Do not label yourself with Alzheimer’s or Dementia, but let a doctor investigate you. More than Alzheimer’s, we need to increase awareness among people not to self diagnose themselves when having problem with brain functioning.

What is the foremost sign to worry about and to refer to a counsellor?

Dr Renu Vohra: Patients do come at a later stage but we need to counsel them at that point also. The counselling is mainly done to the caregiver because they are equally important as caregiving to patients of Alzheimer’s and dementia needs flexibility and patience. There are two types of activities, Daily and Instrumental. Daily activities involve laundry, dressing, grooming and other personal activities. Instrumental activities involve shopping, household, finance, etc. The caregiver has to be keen on these activities of the patient on a daily basis because this is a disease which will slowly progress. Therefore the caregiver needs to make changes in their schedule as well. Take them out for a walk, make them do morning rituals so that they are not confused. Do not make them dependent on you completely.

What are the risk factors that can trigger Alzheimer’s that one can probably prevent?

Dr Anand: Alzheimer’s is a degenerative disease but there are contributory factors that we can take care of at early stages so that the progression speed and the impact of Alzheimer’s can be decreased. Burden of any comorbidity like Diabetes or Hypertension can impact the brain that is afflicted by Alzheimer’s. The gist of preventing or even delaying this disease is active involvement on Social and Physical activities.

If we start adopting these measures before hand to avoid mid-life crisis, can it be prevented?

Dr. Tripathi: For Alzheimer’s, there are two basic kind of risk factors, one is the non-modifiable risk factor and the other one is modifiable risk factor, which is within our hand which we can take care of to not get Alzheimer’s. The unmodifiable risk factors are ageing, which can’t be reversed. Second is pre-disposing genetics. Mutation causing chromosomes affect certain abnormal proteins that finally get deposited in Alzheimer’s patient’s brain. If you carry that gene as a result if a vertical heredity from your grandparents, then you’re at a very high risk.

Then there’s a modifiable gene which is not the causative gene but if it is presented it increases the risk which is known as APOE gene. Genetics is like a loaded gun trigger of which is in our environment on our lifestyle.

Not following a healthy routine, consuming junks food, unhealthy oils, having disturbed sleep patterns, not interacting socially with your surroundings and sitting on the couch watching TV all day, add up with blood pressure, insomnia, hypertension, obesity, diabetes and other diseases to contribute to such brain related diseases.

Q. Basically it’s a mix of genetics which are a ticking time-bomb, unhealthy lifestyle add up to it. According to a study conducted in California, pollution is a contributing factor to such diseases. When talking about the Indian metropolitans, especially the national capital, how can we protect ourselves and our elderly from this pollution to avoid this disease?

Dr. Manish Kandpal: A person living in Delhi could live medium or less because of air pollution, we have to make a certain balance. We have to adapt a healthy lifestyle like exercise and healthy foods. There are some fruits like tomatoes that are rich in antioxidants and hence help us to fight the side effects of air pollution. Apart from this there is something what we call Cognitive Stimulation in case of Dementia. You need to keep yourself busy in some sort of Cognitive exercise avoid cognitive reserve. People who are more socially active have lower chances of developing Dementia as compared to others.

How do you manage Alzheimer’s in times of Covid?

Dr. Renu Vohra: We on a helpline use to receive these calls from the care givers that earlier the main stream of therapy was making them socially active, taking them for walks and make them meet with relatives children and all. But all that have to stop during this time. They could not understand why is nobody visiting them and that made them even more confused. They can’t know the rationale around covid hence it was a difficult time for a care giver. We advised them to give them a social contacts on Facebook, Instagram, Whatsapp videos so that they can interact with people. Make sure that care giver as well as any person’s relative who comes to visit them should be fully vaccinated, wearing mask all the time because you know these people refuse to wear a mask. So make sure they visit an open place like in veranda. In certain cases, the main care giver was infected with covid. So, we told them they should never plan earlier and should not expect another either a friend or relative to take care of the patient at that time because they will not understand why suddenly my care taker has changed. Have a plan B.

What were the challenges you faced during this time and what will be you suggestion to the care givers during such difficult times?

Dr.Anand: covid has been and is devastating for people with Dementia. There have been maximum mortalities in nursing homes where people used to live.

In neurology and other facilities, we now have a term called Long-haul Covid that affects younger people also and they develop brain-fog like symptoms to which are advice is avoiding panic at all costs.

People with Dementia manifested these symptoms faster therefore it brought in new challenges for patients, doctors and the care-givers. Unfortunately, Alzheimer’s is not an individual’s disease and the one who got it does not even have an insight that he is suffering such a disease. He becomes a nuisance for the family and a responsibility. Covid has multiplied this problem several times more.

In consideration with Alzheimer’s what really the impact Covid has had on younger generation has it made few of them more susceptible?

Dr. Manjari Tripathi: As the COVID virus is very neurotrophic, so whether you like it or not, it’s going to affect the brain and the fact that during COVID many patients had hypoxia, i.e., their oxygen level fell. Many people, even after recovering from the Covid infection, will feel that they are not clear in their heads. They will feel as if they are not able to form memories, especially new memories for recent things. They may become aggressive, they may have negative emotions, and they might have depression. All these features are the manifestation of neuro Covid. There could be many reasons for it. It could be because of a neurotrophic virus, it could be because of hypoxia, it could be because of nutritional factors, and it could be because of Covid appetite goes down, and there are so many antibiotics and treatments a person is on. So the gut microbiota changes, which affects the memory. There are various mechanisms which are working here, so this must be discussed with the doctor. Medication for this, proper nutrition, and mindfulness and yoga should be done to impact the memory. It’s not dementia; it’s just an infection, but if it doesn’t improve, we’ll need to look into it.

What will be your suggestions for the people who see those early signs long haul Covid and might fear getting Alzheimer’s?

Dr Renu Vohra: We used to get calls from everywhere, not only during COVID but before also, with complaints like we are not forgetting things. We always told them that remembering that you have forgotten is not an issue, but the issue is when you don’t remember that you have forgotten something. In that case, we sent them to the memory centre at AIIMS and Ram Manohar hospital. The task of caregiving is very tough as they have to take care of everything right from taking baths to meals, and modesty should be kept in mind.

What about the treatment for Alzheimer’s and perhaps for further degeneration?

Dr. Manjari Tripathi: So there are several modalities of treatment. The first is, of course, pharmacological, so there are medicines available and very good medicines available in our country. We should start them as early as possible. Apart from that, each and every patient, as well as the caregiver, needs to be counselled about the disease so that that behaviour is taken as a part of the disease and you know, the elderly person should not be scolded or the caregiver shouldn’t get frustrated by those symptoms. For example, a patient can just have a harmless activity. You know, a harmless activity. Then we also need to take care of patients’ safety. We have to make sure if the memory is declining and they are losing their way, they must have a bracelet which is non-removable on which the patient’s name, address, and mobile number are written. This is very important because they have many patients who go out of the house and get lost, so safety is very important. There should not be any dangerous objects around them because they will have forgotten the use of objects and they can come to harm. Apart from that, it’s very essential that we put them in touch with an organisation like the Alzheimer’s Society of Delhi where there are volunteers, and who are these volunteers? These volunteers are rich in resilience because each one of them has had experience of either a spouse or a parent having dementia. They have first-hand knowledge of how to look after their spouse or parent and they enrich others’ experience by sharing it with others.

What about the oxygen therapy? Does it from early stages help Alzheimer’s?

Dr. Anand: There is no need to discuss this topic like this because there is nothing known as oxygen therapy for dementia. What was talked about was that COVID patients who had hypoxia in their brains may not function at that efficiency, so there is nothing known as oxygen therapy.

What will be your suggestions for those who are suffering from Alzheimer’s and don’t have much knowledge about?

Dr. Manjari Tripathi: So, you know, what we really need to do is be able to diagnose it early and also start the intervention modules early. It’s very important that the caregiver not be in denial. We still see a lot of families where the acceptance of Alzheimer’s as a diagnosis is not made, and if the acceptance is not made, they will not be able to fully intervene or usefully modify the life of the caregiver. board memory therapy, reminiscence therapy, by showing old photographs We still see this happening.

 

 

 

 

 

 

 

 

 

 

 

 

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corona vaccine
Interviews

Will be able to inoculate entire population by end of this year: NTAGI chief Dr NK Arora

by Vaishali Sharma
written by Vaishali Sharma

On Friday, India established a new milestone by administering more than 2 crore Covid-19 vaccinations in a single day. The country is the first in the world to reach such a large-scale vaccination target in one day.

Dr NK Arora, Chief of National Immunization Technical Advisory Group (NTAGI), praised the achievement saying, “I would like to congratulate India as a whole, as well as the citizens’ enthusiasm for immunisation. We know of nations like the United States and the United Kingdom that had large inventories of vaccines but individuals who were not ready to accept them. It’s happening at such a rapid speed that 1.37 lakh individuals may have already been vaccinated as we speak. This has been in the works since March 2020, and it will not be completed overnight.”

Taking into consideration the speed of vaccination, do you believe we are on the right track to vaccinate entire country by year end as previous government claims?

Dr NK Arora: People thought that it would take us 3 to 5 years to immunize the entire nation, but we achieved it. The reason behind this is that there are 4 to 5 sectors. Right from the beginning, there has been a philosophy of vaccine Atmanirbharta. Each and every vaccine administered in this country is Made In India and that is why we are not begging anyone else. Secondly, the preparation for rollout started in July when Corona vaccine centre planning was being done. Thirdly, we have a very expensive child immunization framework and infrastructure and this vaccination had been put on that. Fourthly, adults were being immunized for the first time and nobody was sure whether they will come up for vaccine or not. There was vaccine hesitancy even among the medical professionals for the first 6 to 8 weeks and there was a very proactive program to take care of that. Fifth, a major program for managing and keeping a record of this supply system was present.

Co-Win is a phenomenal platform and I believe country is very proud to have such digital platform for the management. Finally, we have a genomic surveillance program which is Cutting edge Technology, which is monitoring and picking up virus samples from all over the country to check how effective our vaccine is. I must recall here that we immunize 17 crore children every week under the Polio Immunisation Program, that is 2.5 crore children being immunized each day. If we can do that, we can do this also.

 

When can we expect children’s vaccination?

We are having meetings on prioritizing adults and children separately. We have 44 crore children below 18 years of age and 12 crore adolescents between the age of 12 to 17 years of age. From October onwards, we will prioritize those children who are likely to catch severe disease and possible unfortunate death. Healthy children do get infected just like adults but the possibility of severe infection and death is almost zero. Now schools are also opening, and once the parents, teachers and other adults are immunized, children will remain in a protective ring.

 

What is the status on the WHO approval on Covaxin?

Dr NK Arora: We should most probably get it by this week or the next week at maximum. Most of the paper work has been going on for quite some time and we have already provided the data for the safety of the vaccine and hope that it should be done as soon as possible and people might commute form October onwards.

 

Everyone is talking about the booster dose, what is the development on that front?

Dr NK Arora: In a meeting, we were just discussing about the efficacy of the vaccines and the vaccine tracker platform announced by the government last week. I would like to share that one dose is providing 97% protection from the virus, while two doses provide 98% efficacy and chances of hospitalization is reduced by 95%. Several parts of the country are conducting studies to see that it is not just the antibodies that provide protection because their decline is a natural process. We are looking at the ground situation and when the scientific evidence comes, we will start with the booster shots as well and we will also identify the subgroups that require special attention. We are regularly scanning through the scientific evidence of our country, not relying on data provided by USA or any other nation. We will work on this data only.

 

Indemnity was there regarding Pfizer and Moderna. Is that something that is under consideration or are we going to continue on the path of Atmanirbhar Bharat for the time being?

Dr NK Arora: We have our own DNA vaccine which is world’s first vaccine and we will have our own RNA vaccine by November most likely. Indemnity is a sticking issue but we have our own effective vaccines and the discussions are being carried out on our terms.

 

What would be your advice to the people this festive season?

Dr NK Arora: With folded hands, I would say that pandemic comes once in a century while festivals come each year. So we must have another year of discipline. Spend the days of festivities among your own family members which is safer. I may have been vaccinated but the virus can spread through me to others and similarly I could get infected too. Covid appropriate behaviour and social distancing does not only mean keeping an arm’s distance away from a person, but keeping away from the crowd. We have witnessed a spike during the festivities last time and hence I would really request that people celebrate festivals with discipline this year.

 

Would you second the claims on third wave or would you deny?

Dr NK Arora: 70 to 75 per cent of our population has already been infected will now. There will be a spike driven by lack of discipline. Whenever we have let our guards down, we will invite a surge. Fortunately, no new variant has come and it is a redeeming point. It will not be wise on our part to not be disciplined for the coming 6 to 8 weeks.

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Interviews

Explained by Experts: Why is Dengue D2 causing fatalities in Firozabad?

by Pragati Singh
written by Pragati Singh

As Uttar Pradesh managed to control Covid-19 cases, the state is now experiencing rising number of Dengue cases and the biggest concern of this is Firozabad, where 57 people, mostly children have died of the disease. According to a recent statement by the ICMR, the D2 strain is causing high number of cases and deaths in the state, which might also cause haemorrhaging that could be fatal.

To discuss the reason behind this fatality, Medically Speaking talked to a panel of experts that included: Dr Rommel Tickoo, Director of Internal Medicine from Max Hospital; Dr Ashutosh Biswas, Professor of Medicine from AIIMS; Dr Ajay Agarwal, Head of Department, Internal Medicine from Fortis Hospital and Dr Suranjit Chatterjee, Senior Consultant, Internal Medicine form Indraprastha Apollo Hospital.

 

Cases of Dengue are witnessed each year. Why are we talking about it particularly this year?

Dr Rommel Tickoo: We are currently in the midst of a pandemic, and we must contend with another virus, dengue fever, which can be fatal in certain individuals. There are a lot of patients in Firozabad, Uttar Pradesh, where a lot of people have died. Dengue fever is a mosquito-borne bone illness that is spread through mosquito bites. There are four strains, which means you may be infected four times in your lifetime, and each strain offers you lifetime immunity once you are infected. However, if you are infected with the second strain, you may get a serious illness.

The second issue is that all of these variants are quite deadly, with strains two and four being particularly harmful, and we are currently dealing with strain 2 (dengue virus strain 2), which is causing so many deaths in Firozabad. The majority of Dengue patients (75%) are asymptomatic or have a mild form of the disease. Only a few people get severe dengue, which can result in a plasma leak, multi-organ failure, or haemorrhage. It affects individuals who do not have access to medical treatment, and today, if it occurs in tiny towns or villages where sanitisation is a problem, it can result in such terrible consequences.

That is what occurred in Firozabad, and the issue is that we do not have a specific dengue treatment. So drink plenty of water, avoid painkillers, take paracetamol, and keep in touch with your doctor. So, if you catch it early on and have access to medical help, you won’t have any issues. If severe disease progression is diagnosed in time, then you won’t get into trouble.

 

Why is D2 strain causing brain haemorrhage and when does risk for the fatality?

Dr Ashutosh Biswas: yes, this is very important area to understand that there are three phases of dengue. First is the febrile phase, next three days are the critical phase and another three days recovery phase. 75% of the infected people don’t need to come to the hospital, they don’t need any treatment or any medications. But the rest of them really need hospitalisation, care or may be 5-10% of these people undergo severe manifestation. if we talk about 5% of the total infected people, symptomatic cases are very less. It is not necessary that only the second strain is virulent, other strains can also be dangerous if the person if infected second time.

 

What are the treatment for dengue?

Dr Suranjit Chatterjee: The platelet count is something we always think about, even if it isn’t as important.

It’s crucial to keep an eye on your blood’s thickness. Anyone who is in shock or has a low blood pressure should be taken seriously. As a result, the platelet count is low.

Firozabad residents, particularly young people, are suffering from haemoconcentration, shock, and liver failure. These are asymptomatic and not treatable. We’ve been treating Dengue fever for a long time, and only a small percentage of patients end up in the ICU. At least three of my patients have gone to the ICU in the previous five days, one of them was 15 years old, another was 21 years old, and the third was over 45 years old.

 

Why is dengue is affecting children more?

Dr Rommel Tickoo: Children don’t have that much great immunity against infections like these, specially viral infections. And the fact that children are mostly outdoors playing, they don’t have enough protection against mosquito bites.

 

Why are we all more focused on the platelet count? What are the other factors one should monitor if one gets dengue?

Dr Ashutosh Biswas: The platelet count isn’t important until it falls below 20,000 or even 10,000, at which point it must be transferred. Other variables that cause bleeding include coagulation factor. The second factor is a patient going into shock as a result of capillary leakage, which increases disease severity. The vessels get engaged in this stage, which is known as vasculopathy, and the bodily fluids leak out into the extra-vascular region of the body. The third crucial element to examine is organ involvement, with the liver and kidney being the most frequent organs affected.

 

Would you recommend that once someone recovers, they should continue monitoring their condition for a few days?

Dr Ajay Agarwal: We are seeing a lot of liver involvement with dengue fever. After most of the patients recover, they may have capillary leaks still, may have high blood pressure, hypertension and the fluids accumulate in the lungs and abdomen. It is important that once the patient is discharged, he stays at home and gets adequate hydration, and must report back to the hospital if symptoms like breathlessness, giddiness or hypertension are experienced. If patient is undergoing domestic care, they should be well educated about the disease. Only getting the platelets count done will not help, other factors like organ involvement must be checked.

 

How do you see planning the spike in cases in the coming few days?

Dr Suranjit Chatterjee: Very few cases of Dengue last year but this year, the numbers have increased again due to the heavy rains and waterlogging in the city. Therefore, we again have a potential of Dengue epidemic which have wreaked havoc in the previous years. Hence, we must be very careful as citizens and the government because though the cases are at an all-time low this time, but there is a possibility that Covid might come back to Delhi since the other parts of the country are experiencing spike in cases and many countries in the world are now suffering from the third wave. Covid along with Dengue will prove to be very dangerous for the healthcare infrastructure of our country.

 

Speaking about dengue in relation to covid, is it possible that people are misunderstanding the symptoms of dengue with covid? What will you suggest in that?

Dr Rommel Tickoo: It is quite difficult to identify the problem by Symptoms in early 4-5 days as all of them are quite similar and people are coming with symptoms like fever cold cough which is common in Flu, Covid and Dengue. Until and unless they have running nose and heavy breathing, you probably think that it is Covid but talking about current situation where many Covid and Dengue cases are coming at the same time, what I will suggest is to get tested for Covid and dangue both at the same time if you have those symptoms. But in Delhi there is no Covid that much there is flu, which is a self-limiting disease and gets better in 6-7 days which doesn’t need hospitalization. Our focus should be more on Dengue right now.

 

There is no vaccine for Dengue, does that make the conversation more pertinent and requires people to be even more vigilant?

Dr Ashutosh Biswas: Around 10 to 15 countries have vaccines for Dengue but they are not much effective due to which the Indian government is not much confident about using them in the country. Therefore we need to be more careful about Dengue because we do have vaccines for Covid. We have been witnessing Dengue for years now and it is very difficult to fight against mosquitoes. If someone experiences warning signs of Dengue like abdomen pain, vomiting, low urination and confusion, they must be cautious.

 

What are the precautions of the disease?

Dr Ajay Agarwal: Prevent water logging around the house, water bodies should be sprinkled over by Kerosene so that mosquito breeding is stopped. Wear full sleeves when going out and keep the house mosquito free through mosquito repellents.

 

Patients have a fear of catching Covid if they visit hospital for Dengue. What is your suggestion to them?

Dr Suranjit Chatterjee: If there is a need to come to the hospital, they must come because many cases of strokes and heart diseases were seen last year where patients feared coming to the hospital and ended up losing their lives to it. Dengue patients do not necessarily require hospitalization but if the symptoms are severe, they must visit because Covid may not kill you but Dengue might if you are in shock or there is multi-organ failure. It is all need based.

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Covid News and UpdatesInterviews

Analyzing state-specific data eligible to avoid third wave: Dr Samiran Panda, ICMR Scientist

by Vaishali Sharma
written by Vaishali Sharma

“We need to look at where the second wave was descending since an increase will almost definitely be noticed from there, which may be regarded an early sign of the third wave. However, this necessitates a thorough examination of state-specific data,” claims top scientist of the Indian Council for Medical Research (ICMR), Dr Samiran Panda.

In an interview with Medically Speaking, Dr Panda talked about the possible threats of the third wave and increasing number of daily cases in India amid the festive season.

Everyone wants to know whether the third wave is going to hit or not? And if it does, what does it mean for the common people and when will it arrive or is it already here?

Dr Samiran Panda: Short answer to this is that yes there is a possibility of the third wave hitting us. The question, however can be broken down to smaller parts and should be asked at state level because India does not have a uniform state-wise vulnerability. Many states in India did not get affected as severely as Maharashtra, Kerala or Delhi. 80% of the recorded infections were recorded by only 10 states and people there developed good immunity against the infection. Thus, the possibility of third wave hitting strong in these states is lower compared to other states. These states also had quick vaccination which boosted their immunity fairly. State-level data should be analyzed on the terms of the intensity of first and second wave and the vaccination.

 

We are seeing 60 % to 70 % of daily cases coming from Kerala. Would you say that third wave has arrived there already?

Dr Samiran Panda: We realized that around 44% of the individuals in Kerala, particularly from the areas participating in the 4th round of the Sero-survey had presence of antibodies in them which means that they were also exposed to the infection. Looking at the other side of this, 56% of the people were not infected which means that Kerala was successful in containing the infection. Hence, we are not surprised on the fact that Kerala is experiencing surge of infection.

We need to look at where the second wave was descending since an increase will almost definitely be noticed from there, which may be regarded an early sign of the third wave. However, this necessitates a thorough examination of state-specific data.

 

Which states are at a higher risk of entering the third wave?

Dr Samiran Panda : Infections might happen to anyone even after the vaccination but will not push us to the severe stage of the disease. In a particular state vaccination has again good coverage then people will still get infected if they do not observe covid appropriate behaviour. Vaccine against Covid-19 in India are not infection preventing vaccines, they are disease modifying vaccines. Hospitalization or need of oxygens or even unfortunate event of deaths will be less in those states where 50-60% of the people have been vaccinated.

 

Would you say there is a tentative time line for the upcoming third wave, or would you say that it is not inevitable?

Dr Samiran Panda : Virus needs an opportunity where suspectable people come in contact with infected individuals and in the situation that the population density is very high.

 

We saw a surge in cases last time after the festivals like Holi and people went out to places like Kullu-Manali. Would you say that this time too the third wave would be experienced after festivals like Ganesh Chaturthi?

Dr Samiran Panda: If the height of the wave is in the question, I would still expect the height of this wave to be lower than the second because we did not have vaccinations happening back then.

If the population density increases during festivals with Covid appropriate behavior not being followed, we can always expect rise in cases. We must not forget our health is in our own hands.

Recorded number of infections and recorded number of symptomatic infections where more people are going to hospital requiring oxygen are two different things. Second scenario where the number of advanced stages of disease are at a large, is a scenario which can be considered as a wave and we do not want that.

 

Is it possible to avoid it?

Dr Samiran Panda: Each state needs to look into the epidemiology of the infection. It is possible to avoid the rise in cases through the state-specific data analysis.

We have seen a new variant emerge known as “C.1.2 and MU” which could be a variant of concern and as reports suggest many vaccines may not be as effective on it. Is there any real danger of it spreading in India?

Dr Samiran Panda: while delta was spreading, we looked into the magnitude of its spread. We realized that all the variants were neutralized by the ……  collected by the vaccine recipient which is a good thing. Talking about the variants from other countries, we need to have a surveillance which could happen at three levels: at the airports, at the state level and at the district level.

As yet we have not recorded this new variant. Any new variant is identified as variant of interest or variant under investigation. As far as India is concerned, C.1.2 has not made an entry into the nation. If it results in large number of cases and deaths are being reported due to the new variant, it will be identified as a variant of concern.

NCDC is the focal institution that will conduct this genomic surveillance which sees whether the new variants are appearing or not.

 

There are certain variants like the Delta Plus on which the vaccines are not effective. What does this mean for our country?

Dr Samiran Panda: Any variant that gets identified as the variant of concern must be tested against the serum collected from a vaccine recipient and see if the serum is able to neutralize the new variant. Many laboratory experiments have shown that the vaccines made in India have been able to handle the variants called Delta or Delta Plus.

 

Since we are talking about the various mutation of covid, the possible third wave is stressing people. If it comes, will it be as effective as second wave or will it not be considering the number of cases in the second wave, immunity building etc.?

Dr Samiran Panda: If the third wave occurs, then, according to the models which we studied at ICMR, the third wave should not reach the heights as we had seen in the second wave, which is a good thing, but we should not let our guard down because, post vaccination, it’s possible for us to get infected. We won’t get to the severe point of the disease, but others can get infected, which is not good.

Is there any fear regarding increase in covid cases as children have better immunity but the can be carriers?

Dr Samiran Panda: Although children got infected but it is not clear whether they got it from school or not. And according to a National Sero-survey we saw that 55 percent of the children were already exposed and infected because they had presence of antibodies during the survey. So what can be done to avoid further spread is that before or during the opening of schools the parents and the school staff should get fully vaccinated and all the required precautions should be taken. Moreover, people should know that preventing children going from school is like robbing their life opportunities from them because they are the future of the country.

There are few reports about the booster shots, many countries started it already. What do you think about it whether India needs a booster shot?

Dr Samiran Panda: In India, we turned out to be lucky to have Covaxin and Covishield and many people have achieved natural immunity through natural infection. It does not make any sense to talk about booster dose as many eligible and prioritised groups of Indians are receiving vaccines and preferably two doses.

In the case of these present variants, it is all dependent on discussion related to neutralizing antibodies. But we must not forget that it’s just not about neutralizing antibodies after vaccination or post infection which matters. There is another arm of immunity, which is called cell-mediated immunity, and we are not measuring them.

I would say let’s not panic, and let us get fully vaccinated and then see what is the scientific data is telling us. For India, booster dose should not be the centre of discussion.

What would you tell the audience about the safety majors one should take as we are also approaching the festive season?

Dr Samiran Panda: If we celebrate a little low key so may be can celebrate better in coming years. So my appeal to everyone is get vaccinated keep the covid appropriate behaviour and so by doing this we can win this war against Covid-19 in India. So all of this is in your hand. Stay home and stay safe.

 

 

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Effects of Covid-19 on Mental Health
InterviewsMental health

Alleviating Parents’ Anxiety with Reopening of Schools

by Pragati Singh
written by Pragati Singh

 

Parents are becoming increasingly concerned about the prospect of a third wave, as numerous states mandate school reopenings. Parents’ fears and anxieties about their children’s safety are palpable, and many argue that authorities should wait until the vaccine is ready for youngsters. Learning to control anxiety and accept uncertainty are vital skills for anybody, but they’re especially critical for parents in this circumstance. Medically Speaking spoke with a few specialists about how to deal with this anxiety and what the best course of action is in this circumstance.

Shweta Sharma, Clinical Psychologist and Founder of Mansa Foundation says, “The children are utterly stranded and dissatisfied. Anxiety disorders are far more prevalent among youngsters, and parents are experiencing mixed emotions as they are both frightened and happy that their children will soon be able to return to the real world.”

She further said, “In such instances, we recommend that they communicate with the youngster in a nice manner so that they understand and do not feel compelled to wear the mask all the time. Hugs and physical touch are widespread among teenagers. Only a pleasant interaction with the parents would assist in this instance.”

Dr Prakamya Singal, Psychiatrist from Safdarjung Hospital observed, “It is very legitimate and natural for parents, children, teachers, and school people as well to have all these anxieties because these are unprecedented times, and no one can really ever be sure as to what is going to happen next. I think one of the most important things that needs to be at the center of all of this is an open and honest dialogue between all of the stakeholders.”

“I think we can also have a shift in the way that we are perceiving the situation. Having a unimodal view where we’re only looking at the harms of reopening schools is going to lead us to make probably not so wise decisions. Opening up schools right now might be a risky venture, but then there are also a lot of disadvantages to having our children locked up in their houses. Teenage is a critical stage where the mind needs to develop emotional quotient. Children need to learn how to be able to read others’ faces. This is what schooling and education is about,” she added.

Dr Sharma said, “We’re concentrating on different activities where public spaces are available, and we’re really going with the kids just to change the setting. So, what exactly is the problem with schools? There is an option. You are not required to send them on a regular basis. You don’t have to send them on alternate days. You should send them at least two or three times a week, if not more.

However, those adjustments are necessary for their psychological well-being. Because anxiety and depression in youngsters are already at an all-time high. They’re irritable. They are coming with the issues. The problem is also affecting parents. Especially with that age bracket, that interpersonal bond is already strained. So, in my judgement, if we are going to explore it, and with all the safeguards in place, I believe the government should applaud this initiative.”

Analysing the move of the government and the impact of online classes on children, Dr. Amrita Dass, Founder of ICS Institute for career studies says, “It has a significant negative impact on students because, while epidemic classes and, to some extent, virtual co-curricular activities are possible, they are insufficient for a student’s all-round development, and it is through all-round development that they develop employability skills, as well as opportunities for leadership, creativity, and teamwork. There are also many students who do not have access to online classes because many schools do not offer them, and some schools that do offer them have students with poor internet access. As a result, there are students who have completely missed out, and they are looking forward to returning to school and getting back into the excitement of teaching and co-curricular activities. There has been a great deal of worry and tension about the future, particularly since the board examinations were cancelled. They were unconcerned about the cancellation, but they were concerned about the future of higher education.”

Dr Dass added, “There’s another essential point to consider. Nobody is talking about the impact on preschool and kindergarten children. Younger children require experiences that cannot be duplicated online for their social and mental development. We should help them in small groups, with parents volunteering. In terms of emotional, social, and linguistic development, these children have suffered the most. Parents are not adequately prepared to provide the type of education that nursery and KG children require.”

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InterviewsMental healthPediatrics News

Next 6 to 8 weeks is a period to assess the impact of reopening schools, it’s a dynamic situation: Experts

by Vaishali Sharma
written by Vaishali Sharma

In several areas, schools have reopened with rigorous coronavirus precautions in place. Students will now physically attend classes in states such as Delhi, Uttar Pradesh, Madhya Pradesh, Rajasthan, and Tamil Nadu. In light of the pandemic, precautionary measures such as physical separation, staggered lunch breaks, obligatory masks for instructors and children, and the use of sanitizers have been implemented. Still, parents are apprehensive about sending their children to school.

In a conversation with Medically Speaking, a parent put forth his concern regarding the reopening of schools saying, “Experts foresee a third wave, but how can parents expect their children, who are most likely in elementary school or even high school, to send their children to such a situation? When it comes to third wave, the school faculties are also a little sceptical.”

He said, “What assurance do you have that the SOPs will be followed in the schools? How can I expect a nursery child to maintain social distance or a KG child to ensure that his or her tiffin is not shared with anyone? There is no transportation provided by any of the schools, which causes a great deal of hardship for parents. What about that?”

Dr Smita Malhotra, Senior Consultant, Pediatrics from Apollo Hospital, answers, “Let us also keep in mind that everything must be viewed in context. We can’t pick and choose which of our fears to deal with. You’ve all seen the images from when we first launched tourist destinations like Manali, when restaurants were completely booked. We are up and about when we have to enjoy it, but we are anxious when it comes to school. Everyone is attending meetings, parties, and get-togethers to celebrate festivals. In life, there is always a risk-benefit ratio that must be considered. Currently, the statistics are constantly low. So if not now, then when? This is the moment when we must go outside; it is an opportunity for us to witness what occurs. It’s always a dynamic scenario, where we can always close back down if there’s a surge.”

“As we all know, children are susceptible to a variety of anxiety disorders, it is quite tough to persuade them to follow the procedures, and they must attend school for 6-7 hours, which is an extremely long period of time. We need to come up with some ways that are both practical and offer a reasonable level of safety. For example, if we have to instruct them to wear a mask at least when they are in class with each other and not on the playground, where they may be separated, they must wear a mask that covers their nose and mouth,” said Dr Krishnan Chugh, Principal Director, HOD, Pediatrics from Fortis, Gurgaon.

He added, “After each period, we need to give them a 10-minute break so they may remove their mask, take a big breath, put it back on, and return to class. The other is that there should not be as many children in the class as there were previously, which implies that if a class previously had 40 desks, we should now limit it to 20 or even less.”

According to Dr Chugh, “India is a massive nation. What is true in Delhi may not be true in Kerala, where the second wave is still ongoing. We will have a solid notion of what needs be done till Diwali when we open schools while keeping our children secure. The schools should thereafter be shut for at least 3 to 4 weeks to assess the impact of the Diwali celebrations, and then reopened if no spike is seen.”

While talking about whether the schools should start offline classes for 6th standard onwards, Dr Malhotra explained, “I believe we should reopen because we are seeing a lot of youngsters with a variety of health problems as a result of being locked indoors for over a year and a half. We’ve seen a lot of kids with psychiatric difficulties, weight issues, and stomach concerns that aren’t caused by anything organic. They have a lot of problems, so they need to go on with their life, and I believe that youngsters, as we all know, have the lesser sickness and that the people around them are fully vaccinated.”

In contrast to this, Dr Shuchin Bajaj, Founder of Ujala Cygnus Group of Hospitals mentions, “Since everything else has reopened, we’ve already passed the deadline for reopening. We’ve already seen that children in Delhi have a nearly 60% sero positivity rate, so we’re confident that they’ll have a mild disease. However, as you pointed out, everyone around these children, whether teachers, sports staff, or parents, needs to be vaccinated as soon as possible, because the pre- and post-covid eras will be very different. We need to educate kids how to follow covid protocols once they enter school.”

In assurance to the parents’ anxiety, Dr Bajaj said, “Unfortunately, we are overlooking the fact that the great majority of Indians do not have access to all of these resources, resulting in a significant digital gap. We are overlooking all of the students who do not have access to phones or other digital gadgets in order to attend class. We’re overlooking those who only have one smartphone at home and their father to take it to work. I simply want to comfort parents who are worried that if their children can carry the virus home, so can you.”

“If you don’t go out, if you don’t work, if you stay at home all the time, it’s reasonable to expect your children to do the same, but if you go to the office, to parties, and then expect your children to stay at home because there’s a risk of them contracting the virus, that’s completely unreasonable. Even if you are concerned, rest assured that all schools will make it voluntary for you. It is not mandatory for you to send your children to offline lessons, but please enable children who require a physical environment, are developing psychological difficulties, are obese, or are losing confidence to do so,” he added.

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Interviews

IIT-AIIMS collaborate to develop new innovation in radiology; no contact treatment now possible

by Vaishali Sharma
written by Vaishali Sharma

The All India Institute of Medical Sciences (AIIMS) has jointly developed a telerobotic ultrasound system in collaboration with IIT Delhi and Addverb Technologies.

The research collaboration between IIT Delhi and AIIMS allows remote ultrasound access through a robotic arm to reduce the contact between Radiologists and anyone who is possible infected by Covid-19.

The research team at AIIMS was led by Chandrashekhara, while Chetan Arora and Subir Kumar Saha led the IIT team. The lead contributor for the research was Suvayan Nandi from Addverb Technologies along with Dr Kritika Ranganathan from AIIMS and Deepak Raina, a PhD Scholar from IIT Delhi.

 

Tell us about your innovation, what is it about?

Dr. Chandrashekhar – Ultrasound, as you may know, is a commonly used modality that is quick, accurate, and can be used to diagnose problems right away. It is one of the most commonly used modalities in the emergency room. The doctor stays in close contact with the patient for a longer period of time while performing the ultrasound which was not a huge problem until the world was hit by the covid-19 pandemic. We noticed that close proximity between the patients and healthcare workers tends to increase the possibility of infection among healthcare workers. Then we went to IIT Delhi to see if there was a robotic system that could assist us in conducting this ultrasound remotely. What we can do is have a separate seat from the patient and control a robotic arm that is placed right next to the patient, with probe connected to the robotic arm. The images will be sent to us via Wi-Fi so that we can interpret them. First advantage of it being the less human contact there is, the lower the risk of infection or cross infection, and we’ll be saving a lot of PPE kits. We can also do the tele-robotic ultrasound doesn’t quite distinctly if you can extrapolate this same concept to other places.

What is this robotic arm? How does it function? What is the distance between the radiologist and the patient? Does it affect the efficacy of the results?

Dr. Chetan Arora– One of the other key requirements for ultrasound at this time is that the doctor must stand by the patient’s side. This requirement arises because the doctor is required to hold the probe on the patient. Otherwise, it is much easier to move this picture from one building to another via the internet. Now the probe is now being held by the robotic arm rather than the doctor. Now the doctor is standing in the next room, which is a safe distance from the covid, but we can expand into new buildings and cities in the future. The doctor has received a haptic device which sends the commands of the movements that the doctor makes to the robotic arm on the patient’s side.

In this case, however, pressure feedback is also a critical factor which is applied in the same measure by the robotic arm as by the doctor. And just like you do a regular diagnosis by looking at the screen and the image, the same way you can do it. So the key issue here is one manipulating an arm while sitting at a distance and the other transferring this pressure and force feedback both ways. So, from the patient to the doctor and the doctor to the patient.

What was the Genesis of the idea? When did the research work on it?

Dr Kritika Ranganathan – Although the idea has previously occurred to us in relation to distance ultrasound, particularly in a country like India, where a large portion of the population lives in rural areas and lacks access to health care. And, as we previously stated, who does the ultrasound is a critical component. A CT- Scan and an MRI is carried out by a technician, unlike an ultrasound, which must be operated by a specialist. Genesis of the idea came from Covid.

Every time there was a call from the covid ward, the radiologist had to wear a PPE kit, do the check-up and come back. This entailed long duration of waits for Covid patients and a lot of PPE kits being consumed.

Our first set of clinical tests was not carried out on patients but on normal people The first step is to ensure that there is no difference in the type of ultrasound that we can get from a handheld ultrasound probe versus our robotic ultrasound probe in terms of the type of diagnosis we can get.

In addition is that I think credit to Addverb and IIT Delhi. I think the technology then we saw the technology of the kind of dexterity the provides us is hugely different from what was available previously.

Tell us a little bit about adverb Technologies. What’s the role you played? How was the whole experience of building this Innovative robotic arm?

Suvayan Nandi – Addverb Technologies is the Robotics and automation company and we started in the year 2016. It was started with 6 people and now we have more than 500 employees. Mr. S.K. Saha and Mr. Chetan came to us with this idea of developing a telerobotic arm in collaboration with AIIMS. We took this opportunity to start the project under our CSR activity. We donated this robot and we were responsible for developing the first prototype and all the development, assembly and manufacturing was done in our plant only.

 

What was your experience in for this project?

Deepak Raina – It was an amazing experience, especially given the kind of team that we have. We have doctors from AIIMS,. We have professors from IIT Delhi with continuously giving us idea about how to add up Innovations into the system, and how to make this physical. Whenever there are certain challenges. It becomes quite challenging to ensure the safety of the human as well. So, this was a quite interesting experience for me as I was a PhD student and it was also my research project.

There are various components that are merged into the system. You need to ensure that there is a proper positioning and orientation of the probe, proper pressure is applied and that too in a remote setting. The quality of the system and the ultrasound imaging is comparable to the conventional technique. Overall you overcome all the challenges and maybe made this system operational and hopefully with more effectively we will turn it into a clinical product and bring it into the moment.

 

What is the next step or the goal that you have in mind?

Dr. Chandrashekhar– Well, we are at a stage where we have developed the Prototype. We have conducted trial on around 20 volunteers, but some refinement, adjustments and improvements are needed from the technological point of view, so that it can be used over the patients. And if we can refine the technology, then maybe the next step is to shift to the robotic system to AIIMS and conduct the ultrasound examination over the patients. Supposing if a patient comes at night in an emergency and the doctor is not available, we can set up a robotic system there and interpret the images sitting at home or maybe office. We want to expand this technology to the rural areas as well.

Speaking of the rural setup, how feasible is it? What is the eventual costing you consider for this?

Dr Chetan Arora- The ultimate goal is that this is a multi-purpose technology that we can potentially apply it in remote areas also.

The expertise of the person doing the ultrasound is extremely important. So this means that with a device like this, which is a high-tech ultrasound device, we can actually make an expert available anywhere in the rural areas.

 

What is the tentative cost line you are looking at?

Dr. Chetan – I assure you that the cost is going to be much lesser. For example, when we talk about the current surgical robots, even the basic surgical robot will start from few crores. On the other hand, the kind of cost that were expecting for a robotic arm like this is a few lakhs. That’s the order of the difference that we are looking at. So we are aware about the cost implication and this is going to be a low-cost device.

 

It is a first of it’s kind innovation. Is it happening elsewhere in the world?

Prof. Subir Kumar Saha – Similar attempts have been made elsewhere in the world. Typically a robot follows a command without caring about who or what comes in between, which is called position control. Second aspect is to get a proper quality of the images. You have to have appropriate force to be applied on the body which is called force control. So, here the challenge is to implement force and position together on the robot.

 

How difficult is it for radiologists to adapt to this technology?

Dr. Kritika Rangarajan – To start it off, we actually practice this on pillows and tended to be a little more resistant to trying anything on even volunteers, although we had that consent and ethical clearance for it. But we did soon realized that required reorientation of our minds and practice a little bit before we could actually go ahead and use it. Radiologist tend to be overburdened with whatever clinical work they already have. To expect them to adapt to a new setting is a little difficult, but having said that this is a problem with all robotic devices and odd new technologies around the world. Every form of robotic surgery, the Da Vinci robot, for example, has a mandatory training period and you cannot go ahead and use it without that training period. We have to enforce something of that sort.

 

 

Would the level of comfort a patient has with a doctor remain the same with the robotic arm?

Suvayan Nandi – The robot has a sensor in it, which can get the feedback on how much pressure is being applied on the patient. So we already keep it under check that it is less than 20 Newton so that it doesn’t hurt the patient. Apart from that as a part of what we call as a safety, we have a foot pedal with the doctor and then we have an emergency button with the patient. So whenever he feels any discomfort, any one of them can disengage it and can stop the robot.

 

Is there any message you want to give to the people?

Deepak Raina – Well, I think as our prime minister also keeps mentioning that Covid like scenario also comes with lot of opportunities and I think our project is basically a good example of that that how we made use of that opportunity and came up with a system which was actually and to do that study the development up to a level where we also did the volunteer trials at the AIIMS. I think we have we have done justice to whatever opportunity has been given to us.

 

Have you started the trials on the patients in AIIMS and if not then what is the tentative timeline you are looking at?

Dr Chandrashekhar – The robot will be shifted to adverb to further modify and adjust some refinements. As soon as it is over, we will shift it to AIIMS and the trial will start soon. Our goal is to bring health care to people rather than having them travel long distances to us for certain investigations, and we plan to do so using tele-robotic technology so that even the common people can access the expert opinion.

 

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InterviewsPediatrics News

Immunity of Children sufficient to fight third wave?

by Vaishali Sharma
written by Vaishali Sharma

As the number of Delta variant cases rises, health officials throughout the world are concerned, and are pushing health organizations to release revised COVID guidelines. The variant affects not just adults, but also children, according to reports. Because the majority of children have not yet had their COVID vaccinations, they are more likely to catch the virus, develop symptoms, and transmit it to others.

To talk about the same, we had a panel of experts on our special segment: Dr Smita Malhotra, Senior Consultant, Pediatrics and Gastroenterology, Apollo Hospital; Dr Shyam Kukreja, HOD, Pediatrics, Max Hospital; Dr Amit Gupta, Neonatologist and Pediatrician, Motherhood Hospital; Dr Rajeev Seth, Senior Pediatrician, Chairman, IPSCAN; Dr Naveen Bajaj, Senior Consultant, Neonatologist, Deep Hospital.

Below are a few excerpts from the interview:

 

Recent reports suggest that Covid in a child could be as worrying as in an adult. How worrying is this situation?

Dr. Rajeev Seth: We’ve witnessed two waves so far. The children were less affected in both rounds. As you can see from wave one, the majority of the youngsters were asymptomatic, and only a few cases were reported. More children were afflicted during this period because the disease’s effect was proportionately larger in the overall population, and children were also seen with a wide range of mild, moderate, and severe illnesses caused by covid. Mild infections may have gone unnoticed, while moderate infections may have caused breathing difficulties and decreased oxygen saturation, and severe infections may have resulted in multisystem inflammatory illness, requiring hospitalisation. Those extreme cases are now insignificant in comparison. In general, it is assumed that children who have a strong immune system and do not suffer from any serious illnesses have a robust immune system. Right now, it is critical that we take excellent care of our children. Except for one that we knew about from Zydus Cadila, none of the vaccinations have been authorised for children. For 12-18 it will take about another few months before it is available for children above 12 years.

In terms of diet, nutrition, and general well-being, adults must look after the child. Because the majority of the children have been confined indoors, they are at risk for behavioural and emotional problems. When the time comes, vaccination will be the most important component in achieving complete immunity. However, most studies suggest that approximately 60-67 percent of youngsters have antibodies, indicating that they had either a mild or moderate illness. Most professional organisations were keeping an eye on the disease’s varied patterns as it progressed. It’s becoming increasingly obvious that we don’t need to be so afraid. However, we must be prepared in the event of a significant third wave. Both secondary and tertiary care establishments have resources accessible for referrals. As a result, we must modernise the healthcare sector to provide secondary and tertiary treatment for children with covid.

 

There was a report by MHA which came out saying that our infrastructure is not enough to take care of children in case they get severe Covid infection. What is your overall assessment and how are pediatrician planning to deal with the upcoming third wave of Covid?

Dr. Shyam Kukreja: There are three questions that we have here,

  1. Is third wave really imminent?
  2. If it comes how children are going to be affected? Are they going to be affected in a different way as compare to what was happened in first and second wave?
  3. If the third wave comes, are we prepared for it?

 

If you take a big group of children, for example, there are 100 cases of covid infection in adults, which means 15 of them are in trouble. They require oxygen, hospitalisation, and specialized treatment. In a group of 100 children infected with Covid, less than 1% will experience difficulties, but our denominator is so large that even 1% will be a significant amount. Therefore, I think we have to be prepared for lot of counseling of parents because 99% are going to be ordinary mild cases.

 

Are we prepared? What about severe cases? Are our ICU’s prepared as far as the infrastructure is concerned ?

 Dr. Shyam Kukreja : Due to the large number of people, any infrastructure might fail. But I believe that now everyone is ready. It should, in my opinion, be much better controlled.

 

Do you think infrastructure wise India is where it should be?

Dr. Smrita Malhotra : Yes we have children who are severly affected who need tertiary care like Pediatric ICU including the elite specialty that they are under. Obviously we lack such facilities as of now. But rising up to the challenge, one may say that there will be a coordinated effort with the tertiary care centres, nursing homes, coordinating efforts between the referring pediatricians and the tertiary care center doctors.

 

Maternity hospitals have refused to take in Covid patients at all. What do the people who want to continue consulting the doctor in these hospitals do?

Dr. Amit Gupta: Majority of these hospitals are preparing for the next wave. Like in the second wave they were not taking covid patients initially, but have started taking them in now. Our infrastructure is getting ready for it. We are not anticipating any major thing as sir previously said most likely its not going to happen but these small hospitals are taking in mothers who are covid positive, separating them, taking all universal precautions just to keep them.

 

Depending on the immunity of the children, many of them already have antibody. Do you think that’s enough to fight covid third wave?

Dr. Naveen Bajaj: Talking about new born specially and said that new born are much more protected than the older children because of the factor that receptor for this virus to enter into a cell are relative the less in those kids, specially in new born and they have an immunity which is better for there particular spike protein so that particular immunity is better. Infants gain immunity from breastmilk itself which is known to transfer antibodies from mother to the baby. So it is very important that all the newborns should be breastfed exclusively and must continue till 2-3 years of age.

 

Talking about the immunity in children, is there anything parents can do?

Dr Shyam Kukreja: Children generally have good immunity. That’s why pediatricians have been out of work in the last two phases. Children have good innate immunity as they keep on having common colds and getting cross immunity. Because of that, children don’t smoke and they have immature lungs, so they already have so much immunity. Apart from that, breast milk is the best for babies till the age of 2 yrs.

 

Should we be prepared for the mutation in the virus affecting children or should we be so much dependent on the immunity of children?

Dr Smita Malhotra: It is a fact that children have good immunity, but there is one more fact which I have seen is that they come with a lot of weight gain, lack of sleep, as they are spending more time on their phones and TV screens. They are not going out to play, which is causing an epidemic of obesity along with this covid pandemic. So children don’t need some immunity building food, but normal food, which includes a wide range of different coloured foods and vegetables. Avoiding junk food is really important for good health. And as far as the preparation for mutation is concerned, it might cause problems in critical cases, like we had seen in the second wave, where we had MISC. When they had MISC, they needed more care as they have cardiac issues and they get affected, for which we needed pediatric Echoes. Unfortunately, we lack, but apart from that, we can take care of ourselves as we have an adequate amount of oxygen, medication, and ventilators.

 

What about emergency cases Dr. Gupta? Fortunately the numbers are low but there are cases unfortunately, which require further care.

Dr Amit Gupta: All the district hospitals and PMO recently had a meeting where they are trying to coordinate and trying to come up with solutions. We are trying to build ICU’s. If God forbid this third wave to happen, then we are most probably really for it.

 

Talking about jabs for healthy children, as the vaccination for children is being said to come by 2022, don’t you think it’s too late considering the third wave?

Dr Naveen Bajaj: Yes, we have to wait as it is a scientific approach to make sure that the vaccine doesn’t have any side-effects on growing children. We have other things as an alternative to this, like everyone in the family should get vaccinated and children should get other vaccinations, such as vaccinations for flue, etc, so that they don’t catch other infections which will affect their immunity and make them more prone to covid infection.

 

Why is it like children have good immunity but they are at risk of being carriers?

Dr Rajeev Seth: Children are prone to being carriers, as this was also seen in the first wave and second wave. For this, children need to take the proper vaccines at the proper time. They need to be in touch with their pediatricians because it is not like that all other diseases have gone because of covid. So proper care and vaccination are very important till the time we have the covid vaccine in place.

 

What would you say to the worried parents at this time?

Dr Shyam Kukreja: The Covid vaccine will come in due course, as we are seeing data in adults so that we will be more sure with children, but there is one thing that parents should get their kids vaccinated for other diseases as they are more deadly in children than covid.

 

Is like that the children below the age of 13 have even better immunity that they don’t need vaccine at all?

Dr Amit Gupta: Yes, they have very very good immunity, but parents need to create a cocoon effect around them by getting vaccinated. Especially mothers who are feeding their kids need to take extra care.

 

We talked about importance of vaccine, breast feeding, but what would you give for a final advice to the viewers ?

Dr Naveen Bajaj: Those who are breast feeding should continue that, skin to skin contact is very helpful for kids so don’t isolate them for a bit. Make them wear mask. That’s all.

 

 

 

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