According to the Government of India Delhi reports 3419 new COVID19 cases in last 24 hours with 4916 recoveries and 77 deaths deaths in last 24 hours.
The total cases Delhi has reported is 5,89,544 with a total number of recoveries of 5,53,292. The total Death rate recorded is 9574 from the time of the outbreak.
The National Consumer Dispute Redressel Commission(NCDRC) has dismissed a case of negligence agasint Medanta hospital in Gurugram .The complaint was on the basis of conducting the surgery for replacement of the infected Aneurysm of the arch of Aorta with ’24 mm Dacron branched Arch Graft’.
The court has pronounced about no negligence involved during the treatment and death of a patient .The patient who died after the three years of treatment, he was from Amritsar and undergone for Arch replacement. The wife of patient who is doctor alleged that doctor has not provided the nature of the disease and a surgery to be performed.
Exclusive interview with Professor K. Srinath,President, Public Health Foundation of India the vaccine will help to save lives reduce transmission , but not throw out the virus from this planet.
Q. Do you think vaccination is the only solution to save people from COVID-19?
A. I do not think it is the only solution but it will be part of the solution. We will require a combination of public health measures over 2021 to see Covid-19 fade away by 2022. We will still need to wear masks for most of next year, avoid super spreader events and follow the norms of hand hygiene and physical distancing to the extent possible. I believe that, with these measures, the virus will change to a less virulent form and pose less of a threat to life even it co-exists with us as many other viruses do. Otherwise, it cannot survive as a species if it keeps ravaging its host species. That is the survival logic of evolutionary biology. In the meanwhile, a safe and effective vaccine will help to save the lives of the most vulnerable persons, such as the elderly, persons with co-morbid health conditions, healthcare providers and other essential workers who are frequently exposed to symptomatic or asymptomatic persons infected with the virus. The vaccine will help to save lives, not throw out the virus from this planet.
Q. How break the chain could be a solution to reduce COVID-19 cases?
A. We must recognise that the systemic vaccines which are administered by intramuscular injection are not yet proven to prevent a person being infected by the virus. They only help the body to mount a strong defence against the virus and prevent a serious disease and death, if infection does occur. Whether an immunised person who acquires the natural virus from an infected person will harbour the virus in the nose or throat for some time and whether that can be the source of infection to another person is unknown at present. It is possible that by preventing a serious symptomatic disease and quickly fighting off the virus in the body, the period of viral replication will be cut short and the immunised person may not be transmitting the virus to others for long. That will help to reduce transmission. However, current scientific evidence does not provide proof that an immunised person will not get infected at all and will not transmit to others even for a short while if infected. Vaccine will save lives, will probably reduce transmission but not completely break the transmission chain.
Q. Who should get the vaccine first?
A. Health workers, other essential workers, elderly persons and persons with pre-existing health disorders (co-morbidities) are the persons who are at the risk of severe infection either because of high levels of viral exposure or lowered immunity due to age and underlying health conditions. They should receive the vaccine first. The challenge lies in identifying persons with co-morbidities. In large cities, many of them would have already been identified, though there too persons in slums and low income communities may have been missed out by the health services which do not routinely screen for these disorders. In smaller towns and villages, the proportion of undiagnosed persons with these disorders would be higher. Since these co-morbidities occur at least a decade earlier in the Indian population compared to the western populations, we should offer the vaccine to all persons above the age of 50 years initially, apart from the essential workers, if adequate vaccine stocks are available.
Q. Do you think India is well prepared for mass vaccination? What kind of geographic strategy India should follow?
A. I do not know what the plans are but believe that the vaccination will occur in stages. That should help in efficiently planning the rollout and managing the logistics. It would be appropriate and efficient to start with the cities which have high crowd density and move outward to smaller towns and villages. These urban areas will also have more persons with co-morbidities and higher age groups. If there are hot spots emerging with high rates of new infection in any area, they too will need to be accorded priority. Within this broad framework, all states should be covered.
Q. Mass vaccination in a densely populated country like India requires how many phases?
A. It depends on the availability of the vaccine and the health workforce needed to administer it. I expect multiple phases of rollout. Broadly the first phase will cover essential workers and persons at high risk of severe disease. The next phase would cover the other age groups at risk sequentially, going down decade by decade and also expanding the definition of essentiality. The third phase would cover the remaining, as a supplement to the routine immunisation programme. Each of these broad phases can have sub-phases. The rollout can be modified by changing dynamics of the epidemic. If the transmission, hospitalisation and death rates drop markedly due to other factors, the urgency of the immunisation drive may ease and we can wait for newer vaccines to arrive with better profiles of protection, safety, logistics and cost. Mass immunisation may not be a required strategy then. This has been an evolving epidemic and our strategy too must be adaptive.
Q.When do you think India will be free from COVID-19?
A. I cannot crystal gaze and predict with assured confidence, because of the multiple variables involved in viral behaviour, human behaviour, speed of scientific progress and nature of governance at state, national and global levels. However, 2021 should be better than 2020, in gaining control. If we provide a strong and steady response, at all levels of society, we should be able to overcome the epidemic by the middle of next year. The virus itself is unlikely to go away, even if it becomes less virulent. So, we need to maintain vigil till the next winter too passes. I expect that we will be able to celebrate our 75th year of freedom in 2022, without the shadow of Covid19 looming over us. Our freedom struggle took strength, resolve and sacrifice to gain independence. Our battle against Covid-19 too will require those qualities of confidence, commitment and resilience.
Drugmakers Zydus Cadila said it has received the approval from the Drugs Controller General of India (DCGI) to start phase 3 clinical trials with its biological therapy PegiHep in COVID-19 patients’ company is going to start phase 3 trials with PegiHep soon. The trials will start in December in the start it will be conducted on 250 patients across 20-25centres in India.The company is going to start further trials a similar phase 2 in Mexico and the US Food and Drug Administration (USFDA) to start the Investigational New Drug(IND) application for Pegylated Interferon alpha-2b in order to initiate appropriate clinical trials in US.
By Anjan Trikha
It was in the month of March that meetings were being conducted in different health organizations in India and many hospitals to formulate plans to tackle the CORONA disease regarding which there was a paucity of information other than that available from studies from China, anecdotal stories on the social media and the newspapers. It was a mystery disease with hardly any scientific details regarding its course, treatment modalities that work and the long-term effects. Over the past 8 months or so we are wiser and have some answers to the first two issues only; the post-recovery effects of the disease are still a mystery. In the months of April and May, we were many times criticized for spending exchequers money on the preparations that were carried out for setting up dedicated COVID heath care facilities.
However, the months of June and thereafter proved the health care policy makers correct- there was a huge surge in number of infected patients and the hospitals started getting full, both with mild and severe disease. The requirement of critical care beds increased in a geometric progression and became tough for doctors to deal with so many patients.
What did we as health care givers do right?
Preparedness plus wait and watch mantra that every health institution was instructed to follow was proven to be correct. Deferment of routine surgeries, procedures and hospital admissions were also justified. There was a time when all these actions were strongly criticized. The political will to fight the pandemic was a great help – cross political party bickering’s notwithstanding. One needed to realize the difference in Indian population’s demographic details as compared to that of developed nations from where all the scientific and non-scientific information was coming. Policies had to be made for managing an unknown disease at the community level with data from the developed world! As a country we did so reasonably well.
One must appreciate the tenacity of the Indian health care system that whatever was available at the start of the epidemic was supposedly and optimally utilized. Antiviral medications used for other viral diseases, with no scientific evidence for efficacy against the coronavirus, formulations from the alternate systems of medicines – namely homeopathy and Ayurveda – were all used. The government officially promoted the use of immunity-boosting concoctions made from popular herbs and spices. The latter was widely accepted among the citizens of our country. One really does not know if they worked but the end result is that we in India have a low mortality rate. This was also attributed to the Asian genes, the immunity provided by the efficient vaccination program of the country for children and even the widespread unhygienic conditions where the poor citizens live and have high immunity to virus infections.
During the initial days of the pandemic two scientific words became household names in India- ventilators and Personal Protection Equipment (PPE). The first came in from the West due to the acute shortage of such devices in those countries and lead to innovations like ‘Y’ connections that could be used to run multiple ventilators in series from a single source of oxygen and mechanized devices to press breathing bags that could push oxygen into the patient’s lungs. All such innovations were never found to be useful and were hardly used. The second word PPE was a wonderful word for the safety of healthcare workers. Fortunately, both of these issues (availability of ventilators and PPEs ) were managed reasonably well by the government.
The pandemic is not over yet, and we need to channelize our efforts to improve the health care delivery systems that would provide best possible benefit to our citizens. The commissioning of greater number of ICU beds and availability of vaccine are being considered as the “saviours” of the human race at present. Vaccine availability is surely something that everyone is looking forward to but only time would tell us the impact it has on the disease prevention and /or decreasing the symptoms of the disease. Most pharmaceuticals are likely to get emergency use authorization of vaccines for limiting the spread of COVID virus. The safety of these vaccines in children, old persons and child bearing women is still awaited. The efficacy and the logistical problems in vaccinating more than a billion people in India spread over different temperature zones is still to be ascertained.
Of late older patients and those with comorbidities suffering from COVID are dying in larger numbers. Therefore at present commissioning of more number of ICU beds is one of the most important thing that the authorities are working on. Availability of larger number of such beds may sound to be very comforting but we are missing a very important component of intensive care – the health care staff to manage the intensive care gadgets and the critically ill patients. The government has totally missed on policies to promote training of various categories of health workers in management of critically ill patients. In good intensive care units a nurse patient ratio of 1:1 is mandatory at all times. Further these nurses are specially trained to work in intensive care units. It is common knowledge that during pandemics such ratios cannot be maintained; but in a country like India such ratios were never present even during non pandemic times. There had always been a huge shortage in trained nursing officers in India and the pandemic has further highlighted this shortcoming in our critical care system. Further with more hospital beds being converted to ICU beds with cardiac monitors and ventilators the nursing care is going to be substandard. A fear of contracting the disease and decrease in efficiency of work after donning into personal protective equipment adds to this problem. Other than nurses, there is an acute shortage of physiotherapists, technicians and sanitary workers for working in COVID intensive care units. All these persons too suffer from the same problems – decreased efficiency of work after donning and fear of contracting COVID infection.
Special programmes and training should be initiated
The government has to initiate programmes with incentives for such health care workers to enrol for specialized training in COVID critical care areas – both for adult and paediatric sick patients. Same should be true for doctors too. It is common knowledge that resident staff or junior doctors are one of the most essential part of the hospitals in all countries. In the present time there is need for incentive based short training courses for young doctors to work in intensive care areas. It is possible to channelize interns and doctors from other specialties for duties in COVID areas but practically this is very difficult and leads to suboptimal care unless they have received a “crash course” in intensive care. During the 1965 war with Pakistan the Indian army started enrolling young men at all junior levels – including young officers as ‘emergency commission’. Something similar is required at the present time. Many hospitals in the ‘gulf region’ have brought out advertisements offering extra salaries for persons willing to work in COVID areas. Public and private hospitals in India should be doing something similar. If extra salaries cannot be given in government hospitals something else has to be thought off – an extra 5 marks in the competitive exams for young graduate doctors, an extra increment for government employees or giving preferences for paramedical staff for permanent government jobs in their areas.
It is common knowledge that majority of persons – about 85% – who get infected with the CORONA virus could be manged easily in their homes. It is the rest 15% who need hospitalization and out of these about 5% would need admission to critical care. But even this small 15 and 5 % numbers would mean a large number of the Indian population.
It is difficult to start new health care units in a pandemic, though some of them in the form of COVID care centres have been set up to cater to stable patients without any complications, the majority of the sick patients would require admission to existing COVID designated hospitals. The Government would surely be able to procure/ buy cardiac monitors, ventilators and all other machines required to provide care for sick patients, but the need is of efficient, trained manpower who is willing to work in stress full conditions where there is a potential to get infected with the dreaded disease. Lateral thinking and innovative ideas are needed at the present time .
The writer is Dr.Anjan Trikha, Department of Anesthesiology, Pain Medicine and Critical CareChairman, Clinical Managerial Group
JPNTC Designated COVID HospitalAIIMS New Delhi
NewDelhi: The Indian Institute of Public Health, Hyderabad, a constituent unit of the Public Health Foundation of India in collaboration with CBM India, organisation in disability-inclusive development and Humanity & Inclusion has conducted a study on the impact of Covid-19 on persona with disabilities in India. The study had a sample size of 403, of which 60% were male and 40% female. The respondents had different impairments with the following stats- 51.6% with physical impairment, 16.1% with visual impairment, 19% with intellectual impairment, and 9.2% with speech and hearing impairment.
The study was conducted across 14 states in India- Chhattisgarh, Madhya Pradesh, Uttar Pradesh, Bihar, Jharkhand, Odisha, Delhi, Uttarakhand, Assam, Meghalaya, Andhra Pradesh, Tamil Nadu, Telangana, and Maharashtra.
Prof GVS Murthy, Director, IIPH Hyderabad, lead author of the study said, “People with disability suffered significantly more than the rest of the population in accessing health and rehabilitation care during the COVID lockdown. We need to be adequately prepared so that we do not comprise the health needs of people with disabilities as the country has committed itself to the goal of Universal Health Care as part of SDGs.”
Dr. Sara Varughese, Managing Trustee, CBM India, adds “Lockdown had a negative psychological impact on these differently-abled and one of the most common reason stated was economic difficulties. Many faced difficulties in even accessing basic necessities. Incomes were compromised and even withdrawing their money from their bank accounts was a challenge. Another major concern that was raised was the needs of Persons with disability was not taken into consideration while developing the guidelines on Covid-19 response.”
Mr. Raju Palanchoke, Acting Regional Director at Humanity & Inclusion said “In times of crisis like COVID-19, we should not forget that persons with disabilities are diverse and have unique needs based on their disability and circumstances. We must recognize the differences and support them to take appropriate steps. Together, we can work towards and encouraging an enabling environment where persons with disabilities actively participate, lead and enjoy their rights”.
Highlights of the Study:
Ø The lockdown posed a major difficulty in accessing medicines due to travel restrictions in their region-
o 42.5%, i.e., two out of every five people with disability reported that lockdown had made it difficult for them to access routine medical care
o Among those with a pre-existing medical condition (12.7%), 58% stated facing difficulty in accessing routine medical care
o Nearly a quarter reported difficulty in getting their medications while 28% reported postponing their scheduled medical appointments because of the lockdown
Ø More than half the respondents perceived that continuous lockdown would have a deleterious effect on their health-
o 35% reported the need of out-patient services at hospitals/clinics during lockdown of whom more 55% had difficulty in accessing out-patient services
o 16.6% stated that they needed emergency medical care during the lockdown among whom 45% had difficulty in accessing the services
o Of the 35.7% needing medicines during the lockdown, nearly half (46%) stated that they faced problems in accessing the same
o 58% of those who needed regular blood pressure monitoring could not get it done during the lockdown
o A third of those who stated needing regular blood sugar estimations expressed their lack of access to such a service
o 5.2% of respondents with disability stated that they needed a surgical procedure of whom 47.6% could not attend for the same due to the lock-down
o Among the 17% needing rehabilitation services, 59.4% failed to access the same
Ø Many faced difficulties in accessing basic necessities-
o For a third (34.3%) drinking water supplies were affected
o A third (33.1%) also mentioned that their pensions were affected
o 45.7% of persons with disabilities were forced to borrow money during the lockdown mainly for livelihood
o 84.7% had to borrow or request for support for food to cope with financial crisis
o 18.2% reported that loans were advanced by inclusive cooperative societies
#WhoGetsItFirst | India with more than one vaccine manufacturer in the country receives protection against the Covid-19 when a vaccine becomes available. . . . Watch the whole discussion on #NewsX Youtube. https://youtube.com/watch?
On coronavirus latest Updates AIIMS Delhi Director Dr Randeep Guleria said “In the beginning, the vaccine won’t be available in sufficient doses to give to everyone. We need a priority list to see that we vaccinate those who’ve high chances of dying due to Covid. Elderly, people with comorbidities & front line workers should be vaccinated 1st.”
Many govt health officials have given a statement on preparation for vaccination Director AIIMS , Delhi said “Work is going on at war-footing both at centre & state level for vaccine distribution plan in terms of maintaining cold chain, having appropriate storehouses available, developing strategy, training vaccinators & availability of syringes”
However, on trials and authorisation Dr Guleria added “In India, we now have vaccines which are in their final trial stage. Hopeful that by the end of this month or early next month we should get emergency use authorisation from Indian regulatory authorities to start giving the vaccine to public.”
After Chennai volunteer’s claims on Serum Institute of India’s clinical trials and side effects from vaccines during the trials, he further added ” There is good data available that the vaccines are very safe. Safety & efficacy of vaccine not compromised at all. 70,000-80,000 volunteers given the vaccine, no significant serious adverse effects seen. Data shows that in the short term vaccine is safe.”
In an interview with The Medically Speaking, scientific and medical Experts Dr Randeep Guleria who is Director at AIIMS ( DELHI) , Pawanexh Kohli, founding CEO of India’s National Centre for Cold-Chain Development (NCCD), Dr Lalit Kant, former HoD, Epidemiology and Communicable Diseases, and Dr Satyajit Rath, Scientist at IISER, Pune, spoke about the vaccines developed by Pfizer and authorised by UK today and Moderna who is going to apply for the emergency license soon.But whether India is ready to receive such vaccines.
Q. WHY WOULD THE PFIZER AND MODERNA VACCINES PROVE TO BE DIFFICULT FOR INDIA?
“It is not any more difficult in India than everywhere else,” said Pawanexh Kohli. According to the experts, the vaccines produced by both Moderna and Pfizer are mRNA vaccines. If approved, these would be the first mRNA vaccines approved for use in humans. Although it is easy to maintain the temperature of these vaccines, if or when they are exposed to higher temperatures, they will lose their potency. “The long haul will be done with dry ice and insulated boxes,” Kohli added. It should be noted that the vaccine, at -70° Celsius, will require thousands of specialised insulated boxes designed for dry ice capability.
Dr Lalit Kant elaborated, “There are three issues that countries like India would need to tackle. The first is its availability, as most of the doses to be produced in 2020 have already been purchased by some countries, notably the US and the UK. Second, its shipping and storage require ultralow temperatures (Pfizer’s requires -80°C), and putting in place an appropriate cold chain would be a major challenge. And, third, we are still unsure about the long-term safety of the vaccines and the duration of protection. The Pfizer vaccine does not use a preservative and there are chances of contamination of unused vaccines.”
DO WE HAVE ENOUGH PREPARATIONS TO ACCEPT THE CHALLENGE OF THE DELIVERY OF THESE VACCINES?
Dr Randeep Guleria of AIIMS pointed out, “The -70° Celsius storage requirement will be a challenge for India, especially maintaining a cold chain in rural areas.”
However, Dr Kant said, “I do not think India needs to go for vaccines that have such complex cold chain requirements. There would be other vaccines available which would not have such stringent cold chain requirements. The cost is another issue. It has been learnt the US has agreed to buy 100 million doses of Pfizer’s vaccine for up to $1.95 billion.”
“I think the BioNTech (Pfizer) and the Moderna Covid-19 vaccine candidates will be almost impossible to implement on any substantial scale in India in their current state since they require storage at -70°, which is impractical in Indian vaccination situations,” said Dr Satyajit Rath too, adding, “There are efforts being made to test if these vaccine candidates can work at higher storage temperatures, and there are also efforts being made to develop cheap low-maintenance ultra-cold storage methods. However, the outcomes remain uncertain. At the moment, as matters stand, I do not see any realistic actual modalities in place to implement this category of Covid-19 vaccines in India.”
WHAT CAN BE DONE IN THIS CASE?
Pawanexh Kohli said, “For -70°C, no dispersed facilities are available for cryogenic storage and these must be managed by the regular replenishment of dry ice at key nodal locations. Their subsequent movement would be at 2-8°C and done like all others. Otherwise, the option of flying or railroading them in insulated boxes with dry-ice can also happen. However, the vaccine supply is not to be planned for long-term storage but for regular evacuation and distribution. Using existing assets for this emergent need will be the most timely and efficient deployment for the purpose now.”
“The Moderna vaccine is at -20°C, which is the same as ice cream. That can be done easily and will still be at 2-8 °C at the last mile in regular reefer trucks. Keeping other vaccines at 2 to 8 °C is the same as we do with fresh produce, with last-mile storage the same as the other, in regular reefer trucks. At the delivery centre, they will need small fridges with active cooling—grid or solar-powered or backed with small DG sets. Also, temperature monitors with data loggers, and the syringes, which we may run short of! Vaccine givers are also required—people have to be organised if the plan is to do it at a mass scale and quickly,” he added.
Britain has Pfizer’s COVID-19 vaccine on Wednesday announced about the approval before the approval of the United States and Europe. Britain has become the West’s first country to formally announce the authorization of COVID-19 vaccine.
“This vaccine (Pfizer-BioNTech COVID-19 vaccine) has only been approved because those strict tests have been done and complied with. Everyone can be absolutely confident that no corners whatsoever have been cut.” the statement by UK’s medicine regulator MHRA chief Dr June Raine
“Britain has become first country to get vaccine for COVID-19 and will World gets first vaccine that will start the rollout procedure early next week.” she added
According to the official statement given by the Chief Medical officer of BioNTech said “We’ve regulatory submissions on a rolling basis not only in EU but also in countries like Canada & Australia.We’ve applied at USFDA for emergency use authorization of our vaccine in the US. We’re expecting decisions by mid-December.”