Prime Minister Narendra Modi to visit the Pune-based Serum Institute of India on November 28.Serum Institute of India(SII)has partnered with AstraZeneca and the Oxford University for COVID-19 vaccine.
Serum Institute of India’s Ceo , Adar Poonawala is in U.K he will be coming back tomorrow.
After the visit of PM Narendra Modi, the Ambassadors and High Commissioners from around 100 countries are also going to visit SII on December 4.
According to the data given by the Union Ministry of Health and Family Welfare, 60.50% of 524 case fatalities reported in the last 24hrs are reported from Delhi, Maharashtra, West Bengal, Haryana, Punjab & UP are the states who are reporting the maximum number of COVID-19 positive cases and deaths.
India has reported 44,479 new cases in 24 hours. The positivity case in Delhi has comedown in 3 weeks.The Government of Delhi has decided not to open schools till vaccine comes.
“The positivity rate in Delhi has come down to 8.5% in the last 3 weeks. A vaccine will hopefully soon be out. Until we are completely assured of the situation is in control, no schools will reopen.” Said Satyendar Jain, Delhi Health Minister
Rajasthan Health Minister Dr Raghu Sharma tested COVID-19 positive , despite being tested positive he visited the COVID-19 wards of RUHS Hospital yesterday.Now, he has been admitted for treatment of coronavirus at RUHS Hospital.
Rajasthan has been witnessing spike in coronavirus cases and to tackle the spike in cases Rajasthan government has also imposed the night curfew on Saturday in Jaipur , Jodhpur, Kota, Bikaner , Udaipur , Ajmer , Alwar and Bhilwara.
Rajasthan government has also increased the fine of Rs 200 t0 500 for not wearing mask.
It is the first case of an international transfer of a COVID pneumonia patient on Extracorporeal Membrane Oxygenation (ECMO) machine
A 37-year-old critically ill Covid pneumonia patient on ECMO machine from transferred from Nepal to Delhi hospital. The patient was plummeting rapidly despite 100% ventilator support due to COVID pneumonia with extensive Lung involvement (ARDS). He was put on a ventilator support in Nepal but continued to be sick.
The patient was kept on ECMO or Extracorporeal Membrane Oxygenation is a life support machine replacing heart and/or lung functions. The machine pumps blood from the patient’s body to an artificial lung (oxygenator) that adds oxygen to it and removes carbon dioxide. Elaborating on the condition of the patient, Dr. Kewal Krishan, Director, Heart Transplant & Ventricular Assist Devices, Department of Cardiovascular Surgery, Max Hospital, said, “The patient from Uttarakhand was in Katmandu, Nepal for a business trip. He had been complaining of fever for over a month and was initially treated at home. After 3-4 days, however, he developed difficulty in breathing and was diagnosed with COVID-19. He was admitted in a hospital in Kathmandu, but his oxygen saturation levels kept dropping despite mechanical ventilation. That’s when we were contacted by the patient’s family and flew down to Kathmandu and put him on VV ECMO support.”
“Patient had extensive pneumonia in both the lungs despite being on ventilator with 100% support, that’s when we decided to put him on ECMO. ECMO is a procedure that has been well established in the western world but still in a nascent stage in our country. We are privileged that this facility is available with us. With this, we can save the lives of people who are on ventilator and not improving. One of its major advantages is that it acts as an artificial lung outside the body and protects the patient from ventilator related complications.” Said Dr. Vivek Nangia, Principal Director & Chief of Pulmonology (Cluster 1), Max Super Speciality Hospital, Saket
According to the Government of Delhi total cases reported in 24 hours are 6,224 and total death rate is 109.Total COVID-19 cases reported from the time of outbreak is 5,40,541 and active cases are 38,501.
After Delhi Maharashtra reports the maximum cases in India .In 24 hours Maharashtra reported 5,439 new COVID-19 cases and 30 deaths in 24 hours.
According to the sources – Delay in approval from State Health Secretariat and clearance from Hospital Ethics Committee have been long pending, which led to the termination of SPUTNIK V trial.
By Dr Subhrajyoti Bhowmick
World Health Organization defines telemedicine as, “The delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities.”
On March 25th, 2020, The Ministry of Health and Family Welfare issued the Telemedicine Practice Guidelines, 2020 under the Indian Medical Council Act, 1956 and which superseded the Indian Medical Council (Professional, Conduct, Etiquette and ethics regulation, 2002)
Telemedicine aims to enhance healthcare service and access to all. The guidelines are meant for Registered Medical Practitioners ( RMP) under the IMC Act 1956. The guidelines cover norms and standards of the RMP to consult patients via telemedicine. Telemedicine includes all channels of communication with the patient that leverage Information Technology platforms, including Voice, Audio, Text & Digital Data exchange.
Guidelines of telemedicine in India begin when an RMP is well positioned to decide whether a technology-based consultation is sufficient or an in-person review is needed. Practitioner shall exercise proper discretion and not compromise on the quality of care. Seven elements need to be considered before beginning any telemedicine consultation.
Seven Elements are considered before any telemedicine consultation is carried out and they are Context, Identification of RMP and Patient, Mode of Communication, Consent, Type of Consultation, Patient Evaluation and Patient Management.
Process for consultation between patient and RMP at the beginning of a Telemedicine Consultation for the first Consult includes Patient identification and consent, Quick assessment, Exchange of Information for Patient Evaluation and finally Patient Management.
An RMP may use any telemedicine tool suitable for carrying out technology-based patient consultation e.g. telephone, video, devices connected over LAN, WAN, Internet, mobile or landline phones, Chat Platforms like WhatsApp, Facebook Messenger etc., or Mobile App or internet based digital platforms for telemedicine or data transmission systems like Skype/ email/ fax etc.
Telemedicine applications are of four types as mode of communication, timing of the information transmitted, purpose of the consultation and interaction between the individuals involved—be it RMP-to-patient / caregiver, or RMP to RMP.
Multiple technologies can be used to deliver telemedicine consultation. There are 3 primary modes: Video, Audio, or Text(chat, messaging, email, fax etc.) Each one of these technology systems has their respective strengths, weaknesses and contexts, in which, they may be appropriate or inadequate to deliver a proper diagnosis.
It is therefore important to understand the strengths, benefits as well as limitations of different technologies. Broadly, though telemedicine consultation provides safety to the RMP from contagious conditions, it cannot replace physical examination that may require palpation, percussion or auscultation; that requires physical touch and feel. Newer technologies may improve this drawback.
Each technology comes with its own set of strengths and limitations.
The Video mode of telemedicine, Apps, video on chat platforms, facetime etc are closest to an in-person consult. Real time interaction, patient identification is easier, RMP can see the patient and discuss with the caregiver, visual cues can be perceived and inspection of patient can be carried out. The limitations of Video format is it is dependent on high quality internet connection at both ends, or else it may lead to a sub optimal exchange of information, since there is a possibility of abuse/ misuse, ensuring privacy of patients in video consults is extremely important
The audio platforms on phone, VOIP, Apps have the strength of convenience and speed, unlimited reach, suitable for urgent cases, no separate infrastructure required and privacy is ensured while the limitations are that non-verbal cues can be missed, this format is not suitable for conditions that require a visual inspection (e.g. skin, eye or tongue examination) or physical touch also patient identification can be an issue with imposters representing the actual patient.
Text- technologies as specialized chat based, telemedicine smartphone apps, SMS, Websites, messaging systems e.g. WhatsApp, Google, Hangouts, FB Messenger have the strength of being convenient and quick, where documentation and identification may be an integral feature of the platform, this mode is suitable for urgent cases, or follow-ups, second opinions provided RMP has enough context from other sources, Separate infrastructure is not required and it can be real time. The technology has its limitations as apart from the visual and physical touch, text-based interactions also miss the verbal cues, it is difficult to establish rapport with the patient and one cannot be sure of identity of the doctor or the patient.
ASYNCHRO-NOUS technology as e-mail, fax, recordings have the strength of Convenience and easy to document with no specific app or download requirement, images, data, reports can be readily shared, no separate infrastructure is required and finally it is more useful when accompanied with test reports and follow up and second opinions. But the technology has its limitations as it is not real time interaction, only a one-way context is available, relying solely on the articulation by the patient, patient identification is document based only and difficult to confirm, non-verbal cues are missed and there may be delays as the RMP may not go through the e-mail immediately.
Among the advantages for patients who benefit through telemedicine are lower costs, improved access to healthcare, preventive care and convenience. The benefits for health care providers include reduced overhead expenses, additional revenue stream, less exposure to illness and infections and patient satisfaction.
Disadvantages for patients do not include Insurance coverage, Protecting medical data and care delays. Disadvantages for health care providers are licensing issues, technological concerns and inability to examine patients.
The writer is a Dr Subhrojyoti Bhowmick,MD, Clinical director, Peerless Hospital
British – Swedish Drugmaker AstraZeneca said Its covid vaccine for coronavirus which developed along with the University of Oxford could be around 90% effective under one dosing regimen.
According to Professor Andrew Pollard, Director of the Oxford Vaccine Trial, said ‘These findings show that we have an effective vaccine that will save many lives. Excitingly, we’ve found that one of our dosing regimens maybe around 90% effective and if this dosing regimen is used, more people could be vaccinated with a planned vaccine supply. Today’s announcement is only possible thanks to the many volunteers in our trial, and the hard-working and talented team of researchers based around the world.’
Serum Insititute CEO Adar Poonawala has tweeted on Covisheild vaccine efficiency he said by a tweet that he is delighted to hear that”I am delighted to hear that Covishield, a low-cost, logistically manageable & soon to be widely available, COVID-19 vaccine, will offer protection up to 90% in one type of dosage regime and 62% in the other dosage regime. Further details on this, will be provided this evening.”
Britain could give permission to Pfizer – BioNTech’s COVID-19 vaccine approval in this week by December 1.
According to the governmnet’s sources, British regulators to start appraisal of the vaccine prepared by Pfizer Inc and BioNtech SE, , the National Health Service had been to be radey to administer vaccine by December 1.But U.K Department authorities have not commented yet whtaht when they are going to first when first vaccination woule start.
However, U.S.Food and Drug Administration said on Friday the FDA would meed on December 10 to discuss whether to authorise the vaccine.
World Health Organisation (WHO) has issued a recommendation on the use of remdesivir in hospitalized patients. The recommendations are released by WHO on 20 November.
According to the statement released by WHO which on the basis of controlled 4 trials from over 7000 patients.
“Work on this began on 15 October when the WHO Solidarity Trial published its interim results. Data reviewed by the panel included results from this trial, as well as 3 other randomized controlled trials. In all, data from over 7000 patients across the 4 trials were considered.” Statement released by WHO
“The evidence suggested no important effect on mortality, need for mechanical ventilation, time to clinical improvement, and other patient-important outcomes” it added
The advice is a setback for Gilead’s drug, which grabbed worldwide attention as an effective treatment for COVID-19 patients, but its use was always under controversy.