Explained Ideas: Why the govt must vaccinate every Indian for free

Government's Covid vaccine policy is a maze of confusion that could doom India’s future prospects, write Shashi Tharoor and Salman Anees Soz.

COVID-19 has unleashed a devastating second wave in India. In their opinion piece in The Indian Express, Shashi Tharoor and Salman Anees Soz of the Indian National Congress, state that the government has proven woefully unprepared for this crisis and warn against the government’s recently announced vaccine policy.

“We can blame hubris or incompetence or a combination thereof for India’s unfolding tragedy. However, it should now be everyone’s goal to shorten the duration of the broader crisis, which won’t remain restricted to this second wave,” they write.

They say a humanitarian and economic catastrophe looms. In this regard, they call the government’s vaccine policy unconscionable and potentially disastrous.

“It will likely create confusion, limit vaccination coverage, breed inequality, and prolong the duration of the crisis,” they state. “Better alternatives are available, which can help save both lives and livelihoods.”

What should be the goals of a vaccination policy during a global pandemic?

“We believe a good policy will seek to achieve maximum coverage, as close to universalisation as possible and do so as quickly and cost-effectively as possible. We should also account for the institutional capacity to implement such a policy. Given that the pandemic disproportionately impacts poor and low-income families, it is vitally important that the policy also be equitable,” they write. At the current rate, they believe, it may take India two years to vaccinate 75 per cent of the population. The government’s vaccine policy could make things considerably worse as they believe it is “fatally flawed on almost all counts”.

What can be an alternative way to vaccination?

In most major countries, vaccines are being given free to all residents. “In that most capitalist of nations, the United States, even billionaires are getting free vaccines. Not just that, undocumented workers are also part of the free vaccine programme. The easiest way to ensure maximum coverage is to offer vaccines for free to everyone. As such, they propose that all vaccine procurement in India be done by the Union government. Identifying manufacturers, negotiating prices, scheduling deliveries, and executing payments should be handled by the central government. The Centre should also devise a transparent formula for distributing vaccines to individual states, they argue.

Won’t this be costly? No, they say. “The cost of a prolonged crisis will be far more devastating to the economy. In 2020-21, the crisis probably cost us close to Rs 8 trillion in economic output,” they write.in

https://indianexpress.com/article/explained/india-coronavirus-vaccine-shashi-tharoor-salman-anees-soz-7293278/

Explained: Why has the EU initiated legal action against AstraZeneca?

AstraZeneca started delivery of vaccines to the EU in February and under its contract with the bloc, it promised to deliver about 300 million doses by the end of June. However, in mid-March, the company announced a shortfall in vaccine shipment meant for the EU.

AstraZeneca noted in its statement that half of the EU's supply in the second quarter and about 10 million doses in the first quarter were due to be sourced from the company’s international supply chain.

On Monday, the European Commission (EC) initiated legal action against AstraZeneca over the shortfall in the company’s supply of vaccines to the European Union (EU), which has been a contentious issue between the two for a few weeks now.

Earlier in March, several European countries had temporarily paused the use of the vaccine after reports of blood clots emerged. However, the European regulatory body said that the known benefits of the vaccine outweigh the potential risks.

So, why has the EC launched legal action against AstraZeneca?

Dispute between the EC and the Anglo-Swedish company have been ongoing for a few weeks now. AstraZeneca started delivery of vaccines to the EU in February and under its contract with the bloc, it promised to deliver about 300 million doses by the end of June. However, in mid-March, the company announced a shortfall in vaccine shipment meant for the EU. It said that it would deliver 100 million doses in the first half of 2021, of which 30 million doses would be delivered in the first quarter.

The company cited a lower-than-expected output from the production process as one of the reasons for the shortfall and said that it would compensate by sourcing vaccines from its international supply network. Significantly, AstraZeneca noted in its statement that half of the EU’s supply in the second quarter and about 10 million doses in the first quarter were due to be sourced from the company’s international supply chain.

According to Euro News, in terms of absolute number of vaccinations, the UK is leading in Europe and is “way ahead of the rest of Europe”, with over 46 million vaccinations. Germany, Turkey and France follow with 25 million, 21 million and 19 million doses, respectively. As per a Reuters report, the delays in delivery of the AstraZeneca vaccine are slowing down the EU’s vaccination drive since the bloc was mainly relying on this vaccine. However, after repeated cuts in the supplies, it is now mainly relying on the vaccine developed by Pfizer-BioNTech.

What has AstraZeneca said in response to the legal action?

In response to the EC’s decision, the company has said that it is about to deliver about 50 million doses to European countries by the end of April. “AstraZeneca has fully complied with the Advance Purchase Agreement with the European Commission and will strongly defend itself in court. We believe any litigation is without merit and we welcome this opportunity to resolve this dispute as soon as possible,” the company said in a statement.

Does the Serum Institute of India have a role to play in this?

The Serum Institute of India (SII), which is the largest vaccine manufacturer in the world, is one of the sites where the Oxford-AstraZeneca vaccine for COVID-19 is being manufactured, which will be used in India and other countries around the world. Earlier in January, when the vaccine received Emergency Use Authorisation (EUA) from India, AstraZeneca said in a statement, “The approval in India is an important milestone as it will enable to supply India but also a large number of countries around the world.” This also includes low and middle-income countries, to which vaccines are being supplied under the COVAX program.

In June 2020, the company reached a licensing agreement with SII to supply one billion doses of the vaccine to low and middle-income countries, with a commitment to provide about 400 million doses “before the end of 2020” under the COVAX program.

The program is led by the vaccine alliance GAVI, the World Health Organisation (WHO) and the Coalition for Epidemic Preparedness Innovations (CEPI) in partnership with UNICEF, vaccine manufacturers and the World Bank, among others. The aim is to ensure equitable distribution of COVID-19 vaccines globally in what is being called the largest vaccine procurement and supply operation in history.

In late February, Ghana became the first country in the world to receive a shipment of coronavirus vaccines under the COVAX program. About 600,000 doses of the Oxford-AstraZeneca vaccine, manufactured by SII, were sent to Accra in Ghana on February 23.

However, deliveries of the vaccine manufactured by SII meant for countries participating in COVAX were delayed from March onwards after India banned the exports to meet domestic demand. Critics of the government said that India’s vaccine diplomacy hurt its own domestic needs. As of March-end, COVAX had been supplied with 28 million doses of Covishield (the variant of the Oxford-AstraZeneca vaccine made by SII).

As of April 27, India has exported doses of both Covishield and Covaxin to over 95 countries, including Bangladesh, Bhutan, Brazil, Sri Lanka, the UK and Syria. These 95 countries do not include the 27-member countries of the EU and it is not clear to what extent India’s ban of exports of vaccines has impacted AstraZeneca’s supply chain to the EU.

https://indianexpress.com/article/explained/explained-why-has-the-eu-initiated-legal-action-against-astrazeneca-7291254/

New research: How SARS coronaviruses use host cells to produce proteins and replicate

Notably, coronaviruses other than SARS-CoV (which causes SARS) and SARS-CoV-2 (which causes Covid-19) do not use this mechanism, the researchers said.

Coronaviruses that cause harmless colds in humans were discovered more than 50 years ago.

Coronavirus researchers have discovered how SARS viruses enhance the production of viral proteins in infected cells, so that many new copies of the virus can be generated. Notably, coronaviruses other than SARS-CoV (which causes SARS) and SARS-CoV-2 (which causes Covid-19) do not use this mechanism, the researchers said. This may therefore provide a possible explanation for the much higher pathogenicity of the SARS viruses, they report in the EMBO Journal.

Coronaviruses that cause harmless colds in humans were discovered more than 50 years ago. When it emerged in 2002-03, the SARS coronavirus was the first coronavirus found to cause severe pneumonia in infected people. From comparisons of the RNA genomes of innocuous coronaviruses with those of the SARS coronavirus, researchers identified a region that only occurred in the latter, and was called the “SARS-unique domain” (SUD). Such genomic regions and their protein products might be linked to the extraordinary pathogenicity of SARS coronavirus and its cousin, SARS-CoV-2, they said.

The research groups involved in the new study showed that the SUD proteins of these two viruses interact with a human protein called Paip-1, which is involved in the first steps of protein synthesis. Together with Paip-1 and other proteins in human cells, SUD apparently binds to the ribosomes, the molecular machines that are responsible for protein synthesis in cells. This would lead to an enhancement of the production of all proteins, both those of the host cell and those of the virus. However, in cells infected with SARS-CoV or SARS-CoV-2, the messenger RNA molecules that code for host proteins are selectively destroyed by a viral protein named Nsp1. As a result of this complicated process, the infected cell predominantly produces viral proteins, so that many new copies of the virus can be created.

A research group led by Albrecht von Brunn of Ludwig Maximilian University of Munich discovered the interaction between the proteins SUD and Paip-1 several years ago. “Being an experienced coronavirologist, I knew that one has to inspect the special regions of the SARS genome when trying to understand this virus,” he said in a statement released by Ludwig Maximilian University.

A research group led by Professor Rolf Hilgenfeld of the University of Lübeck, meanwhile, had already elucidated the three-dimensional structure of the SUD protein some years previously. The two research groups teamed up. Dr Jian Lei in Hilgenfeld’s group, a group leader at Sichuan University in Chengdu (China), meanwhile, crystallised the complex formed by SUD and Paip-1 and determining its three-dimensional structure by X-ray crystallography. And co-first author Dr Yue “Lizzy” Ma-Lauer of von Brunn’s group characterised the complex of the two proteins and its function using a variety of cell-biological and biophysical methods, Ludwig Maximilian University said in the statement

“Interaction studies of this kind between coronavirus proteins and proteins of the infected human cell will help us understand how the viruses change key functions of the cell to their own benefit,” the university quoted Hilgenfeld as saying.

https://indianexpress.com/article/explained/explained-how-sars-coronaviruses-use-host-cells-to-produce-proteins-and-replicate-7291676/

Explained: The Ct value in a Covid-19 test

The cycle threshold value emerges in RT-PCR tests for the coronavirus, and determines whether a person is positive for Covid-19 or not. To what extent does it correlate with viral load and disease severity?

 

Among various scientific terms that the Covid-19 pandemic has made part of the public vocabulary, one is the ‘Ct value’ in RT-PCR tests for determining whether a patient is positive for Covid-19.

 

This was the subject of a recent request sent by the Maharashtra government to the Indian Council of Medical Research (ICMR). The state sought clarity whether it was advisable to treat a person as Covid-negative if the Ct value is more than 24 and the person is asymptomatic. State officials said various ICMR documents had mentioned different Ct values and there were divergent views even among Niti Aayog and the National Centre for Disease Control.

 

Days later, the ICMR DG wrote back to the state Health Secretary that ICMR has taken inputs from virology laboratories across the country to arrive at a single Ct value cut-off. All patients with a Ct value less than 35 may be considered as positive while those with a Ct value above 35 may be considered as negative, ICMR said.

 

 But what is Ct value?

Short for cycle threshold, Ct is a value that emerges during RT-PCR tests, the gold standard for detection of the SARS-CoV-2 coronavirus. In an RT-PCR test, RNA is extracted from the swab collected from the patient. It is then converted into DNA, which is then amplified. Amplification refers to the process of creating multiple copies of the genetic material — in this case, DNA. This improves the ability of the test to detect the presence of virus. Amplification takes place through a series of cycles — one copy becomes two, two becomes four, and so on — and it is after multiple cycles that a detectable amount of virus is produced.

According to the ICMR advisory, the Ct value of an RT-PCR reaction is the number of cycles at which fluorescence of the PCR product is detectable over and above the background signal. Put simply, the Ct value refers to the number of cycles after which the virus can be detected. If a higher number of cycles is required, it implies that the virus went undetected when the number of cycles was lower. The lower the Ct value, the higher the viral load — because the virus has been spotted after fewer cycles.

 

Why is it important?

To put that in context, let us look at the ICMR advisory and Maharashtra’s letter to ICMR. According to the ICMR, a patient is considered Covid-positive if the Ct value is below 35. In other words, if the virus is detectable after 35 cycles or earlier, then the patient is considered positive. If the benchmark were to be lowered to 24 — the value mentioned in Maharashtra’s letter — it would mean that Ct values in the range 25-34 would not be considered positive. A benchmark of 35, therefore, means that more patients would be considered positive than we would get if the benchmark were 24. The ICMR has said lowering Ct threshold parameter may lead to missing several infectious persons.

 

One can think of Ct value as a measure of transmission potential, said leading virologist Dr Shahid Jameel. “So if there is more virus in my throat and nose, I will transmit it better,” said Dr Jameel, who is Director of the Trivedi School of Biosciences at Ashoka University.

 

What is the significance of the ICMR threshold of 35?

Globally, the accepted cut-off for Ct value for Covid-19 ranges between 35 and 40, depending on instructions from the respective manufacturers of testing equipment. The ICMR has arrived at the Ct value of 35 based on laboratory experiences and inputs taken from several virology labs.

There was no new advisory, but ICMR informed the Maharashtra government that it was not advisable to use a lower cycle threshold parameter as it would lead to missing several infectious persons and increase disease transmission, Dr Balram Bhargava, DG of ICMR, has said.

 

Is there any correlation between a Ct value and severity of disease?

No. Although Ct value is inversely correlated with viral load, It does not have any bearing on the severity of the disease, experts have said. A patient can have a low Ct value, which means her viral load is high enough to be detected rapidly, but she may still be asymptomatic.

 

A small study published in the Indian Journal of Medical Microbiology in January this year found that there was no correlation between Ct values and severity of disease or mortality in patients with Covid-19 disease. It found that the time since the onset of symptoms has a stronger relationship with Ct values as compared to the severity of the disease.

 

The Ct value tells us about the viral load in the throat and not in the lungs, said Dr Parikshit Prayag, consultant for infectious diseases at Deenanath Mangeshkar Hospital, Pune. “The Ct value does not correlate with severity – only with infectivity. In the first report I do not really look at the Ct value, but for follow -up of patients in the hospital, I do consider the Ct value, as then I can decide whether to transfer the patient to the non-Covid building or not. From the infectivity point of view, it can matter, not severity,” Dr Prayag said.

 

Does a high Ct value always mean a low viral load?

While that may be the obvious inference, some experts stress that some patients can have a high Ct value and yet have a very significant level of Covid-19 infection, and vice versa. Many factors are important in interpreting an RT-PCR test, and the results may also depend on the method of specimen collection and time from infection to collection and to analysis.

 

An ICMR advisory in August last year noted that Ct values depend on how the sample has been collected. A poorly collected sample may reflect inappropriate Ct values. Besides, Ct values are also determined by the technical competence of the person performing the test, calibration of the equipment, and the analytical skills of the interpreters.

 

Again, Ct values may differ between nasal and oropharyngeal specimens collected from the same individual. The temperature of transportation, as well as the time taken from collection to receipt in the lab, can also adversely impact Ct values.

https://indianexpress.com/article/explained/explained-the-ct-value-in-a-covid-test-7291682/

Don’t ignore any symptoms

Dipak Kumar Singh tells you what can be done if your RT-PCR Test throws up a false negative report.

The second wave of COVID-19 has affected almost everybody. People are in panic mode and don’t know what to do and where to go. With no beds in the hospitals for severe patients, let alone the mild cases, here are a few things that one can do.

Don’t ignore any symptom, specially fever and/or sore throat. Mass awareness is essential at this point. Most of the cases turn critical only because of ignoring of early warning signs and delay in start of treatment.

Don’t wait for RT-PCR report to start treatment if above symptoms are there.

Start the treatment even if you have been tested RT-PCR negative, but you have above symptoms. Those having other symptoms like loss of smell/taste should also start medication.

Completely avoid raw, sour and cold food. Eat only home cooked hot fresh food. A to Z tablet is sufficient to meet your Vitamin C needs. There is no need to rush for lemon/orange for Vitamin C.

As soon as above symptoms arise, or when asymptomatic patients test positive and unless you have some special medical condition, start the following medication immediately:

• Azithral 500mg once daily×5 days
• Doxy 100mg bd × 5 days
• Ivermectin 12mg once daily for 3 days ( if weight more than 50 kg. If weight is less than 50 kg then take Ivermectin 6 mg once daily for 3 days)
• Zincovit (not be taken in the night)
• Zincovit and A to Z once daily for 30 days
• Dolopar 650 mg SoS if fever more than 100°
• D3 60K once in a week empty stomach for eight weeks
• Pantocid 40 once daily empty stomach
• Drink four-five litres of water daily spreading over whole day. Don’t take more than one- two glass at a time. The kidney patient should regulate water intake as per doctor’s advice. The intake of water helps not only in managing body temperature but also in preventing blood thickening.
• Gargle at least twice with hot water, salt preferably and a pinch of turmeric.

• Steam inhalation at least twice with hot water and put sendha salt in it.
• Do breathing exercises which increases lungs capacity and helps to maintain oxygen level. Do these exercises:

Sit straight and inhale/exhale slowly but deeply, inhaling in 5 seconds and exhaling in 5 seconds).

Anulom/vilom at least 25 times.

Lie on your stomach, keep right hand under right chest, left hand under left chest, keep elbows stretched, chin on the bed and take deep breath. Do it as many times as possible.

Take any vessel with narrow mouth, half fill it, take a straw, one end in your mouth and one end in the water and blow hard with full breath so that bubbles are created.

If fever continues for five days or more or if CRP / ESR value is high, then not later than 6th day get HRCT (THORAX)/ digital x -ray/ x-ray ( depending on the facility available) done, because the likelihood is that your lungs has been effected.

Most important don’t panic. COVID-19 can be managed with home isolation or at a normal COVID facility, without necessarily having ICU/ventilator facility.

The writer is Principal Secretary, Environment, Forest and Climate Change, Bihar

(Disclaimer: The writer is not a certified doctor. This is for reference purpose only. If you have any special medical condition, consult your physician)

https://www.dailypioneer.com/2021/pioneer-health/don---t-ignore-any-symptoms.html

Australia to send oxygen, ventilators, PPE to India as part of immediate support package

Australia will send oxygen, ventilators and personal protective equipment to India as part of an immediate support package to the country which is battling with the latest surge of the COVID-19 cases, Health Minister Greg Hunt said on Monday.

The federal government was in the process of considering what it could send to help, the Australian Broadcasting Corporation news channel quoted Hunt as saying.

"India is literally gasping for oxygen," the federal health minister said.

“And while we can assist with the national medical stockpile, their particular request is for assistance with regards to the physical supply of oxygen. That will be one of the things we are looking at, in particular with the states,” the minister said.

The federal government also confirmed to send oxygen, ventilators and personal protective equipment to India as part of an immediate support package to be announced on Tuesday, according to the report.

However, Australia would not send vaccines.

Hunt further said: ''We are in a strong position on that front because we don't need them at this point in time. We will still keep a reserve, but if they can be of assistance (they will be donated)."

The National Security Committee of Cabinet is set to meet on Tuesday to discuss any assistance for India, as well as any extra steps that may need to be taken to minimise the risk of infections spreading to Australia.

The government was also considering banning all flights from India following the massive spike of coronavirus cases in the country.

The Cabinet meeting will discuss temporarily halting all repatriation flights out of India.

The move could affect thousands of people, including Australian cricketers currently playing in the Indian Premier League in India.

Foreign Affairs Minister Marise Payne, Australia's ambassador to India Barry O'Farrell and officials from the Health Department, the Department of Foreign Affairs and Trade, and the Department of Home Affairs were holding discussions over recent days on how to deal with the emerging situation.

India is struggling with a second wave of the pandemic with more than 3,00,000 daily new coronavirus cases being reported in the past few days, and hospitals in several states are reeling under a shortage of medical oxygen and beds.

India's tally on Monday climbed to 1,73,13,163 while active cases crossed the 28-lakh mark, with 3,52,991 people testing positive for coronavirus infection in a day, the highest so far, the Health Ministry said.

The death toll rose to 1,95,123 with a record 2,812 new fatalities, it said.

https://www.dailypioneer.com/2021/top-stories/australia-to-send-oxygen--ventilators--ppe-to-india-as-part-of-immediate-support-package.html

AstraZeneca denies breaching EU vaccine contract

British-Swedish pharmaceutical giant AstraZeneca on Monday denied having breached its contract to supply the European Union with 300 million doses of its Covid-19 vaccine.

"AstraZeneca has fully complied with the Advance Purchase Agreement with the European Commission and will strongly defend itself in court," the company said in a written statement published shortly after the EU executive branch announced that it was taking legal action against AstraZeneca over alleged breaches of its Covid-19 vaccine supply contract, the dpa news agency reported.

"We believe any litigation is without merit and we welcome this opportunity to resolve this dispute as soon as possible," the statement added.

The company said that it expects to deliver 50 million doses to European countries by the end of April, in line with its forecast.

"Vaccines are difficult to manufacture, as evidenced by the supply challenges several companies are facing in Europe and around the world," AstraZeneca said.

Earlier in the day, the spokesperson of the European Commission, Stefan De Keersmaecker, had said: "The company (AstraZeneca) has not been in a position to come up with a reliable strategy to ensure the timely delivery of doses.

"We want to make sure that there is a speedy delivery of a sufficient number of doses that European citizens are entitled to, and which have been promised on the basis of the contract."

https://www.dailypioneer.com/2021/trending-news/astrazeneca-denies-breaching-eu-vaccine-contract.html

GMCH to start daily virtual interaction of Covid patients with their kin from today

The intention is to bring down the possible stress level of admitted patients and help them feel closer to their loved ones.

The Government Medical College and Hospital, Sector 32, has taken an initiative to arrange daily virtual interaction of COVID patients with their relatives through video calls. The intention is to bring down the possible stress level of admitted patients and help them feel closer to their loved ones. Tablets and smart phones have been arranged and the facility has already been introduced for patients in the Sector 48 hospital. A similar facility will be started for admitted patients in the Sector 32 hospital from April 23.

 

The existing system of daily briefing to attendants/relatives of the admitted COVID patients, which is done between 11.00 am and 01.00 pm will continue without any change.

UT Administrator V P Singh Badnore has said that regular checks on the food being provided to patients must be ensured and also to have variation in food items.

 

In another initiative, GMCH 32, with the assistance of the Chandigarh Housing Board, has started video interaction with COVID patients in home isolation within the jurisdiction of South Zone and some part of the East Zone. The areas are: Sectors 32 to 46, Sectors 49 to 63, Attawa, Kajheri, Burail, Palsora, Badheri, Shahpur, Buterala, Dadumajra and Maloya, Sector 48, Grain Market and Nizampur in East Zone.

 

The interaction of the doctors with the patients in home isolation will reduce the possible anxiety level and will also provide a sense of security and patients in home isolation may avoid unnecessary travel to GMCH. The patients in home isolation from the above areas may interact with the doctors on video calling at the following numbers: 7657977814-815.

 

Adviser Parida has said that to ensure availability of required medicines and support staff, advance actions are needed to take care of the possible delays in the supply chain. The stock of required medicines for COVID- related issues is being monitored and advance supply orders are being placed for sufficient quantity. A screening committee has also been constituted, which will provide a wait-list of qualified/suitable support which can be deployed with brief in-house training. There are sufficient arrangements in the facility of Level-1, Level-2 and Level-3 with sufficient availability of oxygen and required medicines. The patients are being discharged and also being shifted from one level facility to the other based on the requirement and the prescribed protocol.

https://indianexpress.com/article/cities/chandigarh/gmch-to-start-daily-virtual-interaction-of-covid-patients-with-their-kin-from-today-7285468/

Pfizer to offer vaccine to govt at ‘not-for-profit’ rate

The company's statement comes amid speculations that the US drug giant may sell its vaccines in open market now that the government has allowed vaccine-makers the option of setting their own prices for states and private hospitals.

 

Pfizer plans to provide its Covid-19 vaccine to India at a “not-for-profit” price, according to the company.

 

The company’s statement comes amid speculations that the US drug giant may sell its vaccines in open market now that the government has allowed vaccine-makers the option of setting their own prices for states and private hospitals.

 

“For India, Pfizer has offered a not-for-profit price for its vaccine for the Government immunization program. We continue to be in discussions with the Government and remain committed to make our vaccine available for deployment in India’s immunization program,” a Pfizer spokesperson stated.

 

While Pfizer was the first company to seek emergency approval in India for its vaccine with BioNTech, its application was rejected because it had not conducted local trials of the vaccine here. However, amid a surge in cases, the government reversed its earlier policy on foreign vaccines that had not been tested in India.

 

This was in part due to a shortage of vaccines and a slow ramp-up in production of existing Covid-19 vaccines in the country.

 

According to SII CEO Adar Poonawalla, the government’s decision to allow companies to set their own prices for Covid-19 vaccines in open market was a move to attract more foreign vaccines.

 

The Indian Express on April 21 reported that Pfizer had decided not to engage in the practice of selling its vaccines in the “open market” route.

 

“During the current pandemic situation worldwide, Pfizer has maintained that its priority would be to exclusively support governments through supply of its vaccine only to governments for their immunization programs. This would be our approach in India as well,” the company’s spokesperson stated in a statement on Thursday. “Further, in all our agreements, Pfizer has adopted a distinct pricing structure for high, middle, and low/lower-middle-income countries consistent with our commitment to work towards equitable and affordable access for our Covid-19 vaccine for people around the world.”

 

At this stage, it is unclear what not-for-profit rate Pfizer has offered to the government for its vaccine.

 

In the first few stages of the country’s Covid-19 vaccination programme, the government had negotiated a procurement price of around Rs 150 per dose for SII’s Covishield. The vaccines provided through this programme to priority groups were free for those who received jabs at government facilities and capped at Rs 250 a dose at private hospitals.

Poonawalla had earlier said in an interview to a TV news channel that SII was making a profit at Rs 150 per dose, but that the profits were not enough for it to invest back into capacity expansion.

 

“By opening it up to the private (hospitals) and the states to procure separately above Rs 150 was also a move to encourage the foreign manufacturers to come here. How are we going to get foreign vaccines in India if they have to sell at Rs 150?” he said on Wednesday in an interview to CNBC TV-18.

 

The SII has set a price of Rs 400 per dose of Covishield for states and Rs 600 per dose for private hospitals — higher than the prices negotiated for the AstraZeneca-Oxford vaccine in other international markets. The Pune firm is manufacturing the vaccine on a licence from the Swedish-British company.

 

Other vaccines that are expected to be available in the country for the open market include Covaxin and Sputnik V.

https://indianexpress.com/article/india/pfizer-to-offer-corona-vaccine-to-govt-at-not-for-profit-rate-7285331/

PGIMER Dean advises judicious and rational use of Remdesivir, Tocilizumab

With Remdesivir and Tocilizumab cited as the ultimate cure for the Covid-19 patients, the PGIMER on Thursday gave details of the usage of drugs in the patients and emphasised on its rational use.

In a statement,  Prof. GD Puri, Dean (Academic) & Head,  Dept. of Anaesthesia & Intensive Care, PGIMER  said Remdesivir is an antiviral drug and it was the first drug to be approved by FDA USA for treatment of covid 19.

Various studies have found that Remdesivir given in patients of moderate covid 19 disease (Covid 19 patients developing hypoxia at room air), reduces the duration of hospitalization, only if started within the first 8 days of symptom onset.

He said it doesn't have any effect in reducing mortality and it is not effective in patients requiring high oxygen support or ventilation. "So, if it has to be rationally used, use it within the first  7 to 8 days, in patients developing room air hypoxia (oxygen saturation < 94%)," he said in the statement.

The Dean said it is not likely to be beneficial after 10 days, in patients already on ventilator. It is also not indicated in patients with raised liver enzymes. It has a potential to worsen renal functions and may cause arrhythmia, so needs to be used with caution and under monitoring. There are very limited indications for using Remdesivir and a very narrow therapeutic window, so it should be judiciously used.

Prof Puri said the only medicine with definite effect on reducing mortality in critically ill patients is steroids (dexamethasone), which is beneficial only when covid positive patients develop hypoxia at room air. Use of steroids in patients not having room air hypoxia is associated with increased risk of mortality. So steroids have to be used under medical supervision, judiciously.

He said Tocilizumab  is a strong immune system suppressant and is indicated to control "cytokine storms" rapidly. Its use has to be guided by the clinical condition of the patient. Since it can increase the incidence of secondary bacterial infections in the patients, it should be used only after ruling out significant bacterial or fungal infections.  Various studies have not shown any mortality benefit in critically ill patients.

"In case it is not available, good supportive care, steroids and ventilation may be tried. Off label use of any other experimental agent should only be exercised under trial setting. Only after obtaining permission from requisite authorities and informed consent from patients and relatives," he added.

https://www.dailypioneer.com/2021/state-editions/pgimer-dean-advises-judicious-and-rational-use-of-remdesivir--tocilizumab.html

Haryana launches ‘Covid Emergency Loan Scheme’

To ensure uninterrupted flow of vital medical supplies to fight the Covid-19 pandemic in the State, Haryana Government on Thursday announced “Haryana Covid Emergency Loan Scheme” for new and old entrepreneurs supplying medicines, oxygen and other medical facilities to Covid-19 patients.

For this, the State Government has set up a fund of Rs 500 crore.

The State Cabinet meeting held under the chairmanship of Chief Minister Manohar Lal Khattar gave approval to launch the scheme.

“Under the scheme, Haryana Government will help businessmen, presently working in the state, to increase their current production or to set up new units to meet various requirements to tackle Covid-19 pandemic. The scheme will come into effect from the date of notification and will remain in effect across the state,” said Chief Minister Manohar Lal while talking to the mediapersons after the cabinet meeting.

He said that during the Covid-19 pandemic, the already functioning units which provide oxygen, beds, ventilators etc. will be helped to increase their production.

This scheme will also provide a guarantee to entrepreneurs to buy additional production for six months, for which rate contracts will also be fixed. In addition, the interest on the loan taken by the bank will be borne by the State Government for one year.

The newly notified entrepreneurs will also get the benefit of this scheme in setting up new units. Under this, the State Government will provide loan guarantee to the bank for setting up such units in government hospitals or designated places, Khattar said.

Under the scheme, a committee will be formed, which will review all types of matters related to it and will revise the scheme as required from time to time. For this, the applicant will have to apply to the notified bank and the application will be forwarded to the Haryana Government for its recommendation.

POLICY FOR SALE OF SHOPS OR HOUSES BY MUNICIPAL BODIES APPROVED

To encourage monetization of locked properties of the municipal bodies, Haryana Government has made a policy for sale of shops or houses by Municipal Bodies, where possessions of such properties are with entities other than the Municipal Bodies or its predecessor for a period of 20 years.

The Chief Minister said that the municipal bodies find managing such properties difficult, particularly in view of the fact that the ownership of such properties have, in several cases, changed hands on numerous occasions and the municipal bodies lack authentic documentation in this regard. Further, several Municipal Bodies are unable to even recover the rentals of such properties, he said.

On a careful consideration, it was decided to transfer the ownership of these properties to such persons who are currently in justified possession of these properties, he said.

As per the policy, where the entire structure constructed by the municipal body or its predecessor raised on the land and the land is to be transferred to a single occupier base rate would be the chargeable price.

The government also approved ‘Policy for transfer of Municipal Lands by charging consideration.’  This policy would apply on the categories of properties or persons, where due to exigencies or otherwise, no approach road is available to the land owned by private individuals or entities.

‘HARIHAR’ POLICY APPROVED

The government has approved “HARIHAR” (Homeless Abandoned and Surrendered Children Rehabilitation Initiative Haryana) policy aimed at providing employment, educational and financial benefits to abandoned and surrendered children who have completed the age of 18 years from the child care institutions of the state and were abandoned before the age of 5 years or surrendered before the age of 1 year.

Some of the features of the policy include providing jobs on compassionate grounds and economically weaker section (EWS) status to abandoned and surrendered children, free school and higher education including technical education ,skill development and industrial training and after care stay, rehabilitation and financial assistance upto the age of 25 years or marriage, whichever is earlier and one time interest free loan for purchase of a house in Haryana.

The benefits and eligibility of this policy would be eligible to Abandoned and Surrendered children upto the age of 25 years.

https://www.dailypioneer.com/2021/state-editions/haryana-launches----covid-emergency-loan-scheme---.html

Covid death rate goes up from .5% to .7%

India’s death rate is showing a steady rise, going up from .5 per cent to nearly .7 per cent. It means from an earlier count of five deaths per thousand patients, now seven patients out of 1,000 are succumbing to the virus. On Wednesday, the country reported record

2,101 deaths against record 3,15,478 cases reported during 24 hours.

This is the first time India has reported more than 3 lakh Covid positive in 24 hours. The surge was driven by Maharashtra, Uttar Pradesh, Delhi and Karnataka. Several others States, like Madhya Pradesh. Rajasthan, Bihar, West Bengal, and Chhattisgarh, Haryana, Punjab, are also trying to catch up with the worst-affected States.

The health authorities in Maharashtra went into a tizzy, as the daily deaths shot to 568, while the State recorded 67,468 infections — the second-highest since the outbreak of the pandemic in March last year.

Uttar Pradesh reported 187 deaths, Delhi 249, Gujarat 125, Karnataka 116, Chhattisgarh 193, Madhya Pradesh 75, and Rajasthan 62.

In the worst-affected Maharashtra, a day after the pandemic claimed a record 519 and left as many as 62,097 people infected, the Covid-19 wreaked havoc again. The infections recorded on Wednesday are the second-highest record number of cases. Earlier, the State had recorded an all-time high of 68,631 infections on Sunday, while there were 67,123 infections on Saturday.

With 568 deaths, the total number of deaths in the state climbed from 61,343 to 61,911. Similarly, with 67,468 infections, the total caseload crossed the 40 lakh mark, as the number of cases in the State increased from  39,60,359 to 40,27,827.

 In Uttar Pradesh, amid the cry of the paucity of medicine and oxygen the second wave of the corona saw 33,214 fresh cases and the highest ever 187 deaths in the past 24 hours.

Lucknow continued to be the hotspot with 5,902 fresh cases and 21 deaths. At least 2,269 people were discharged while in Varanasi reported 2,564 fresh cases and 12 deaths. Praygraj recorded 1,828 cases and 6 deaths and 1,811 fresh cases were reported in Kanpur.

The whole of Uttar Pradesh was gripped with panic as almost all “mohallas” across the State are reporting fresh cases and deaths due to Covid. The scarcity of oxygen cylinders and life-saving drugs has further complicated the scenario.

Many private nursing homes have put up notices asking people to take away their relatives as there is a scarcity of oxygen. In many hospitals relatives have been asked to bring oxygen cylinders. Nitin Sharma bought an oxygen cylinder at Rs 16,000. “I cannot see my father dying in front of my eyes,” he said as he wheeled in the oxygen cylinder inside a private hospital.

In Kerala, with the number of new Covid-19 patients reaching 22,414 on Wednesday, Kerala emerged as the epicenter of the dreaded pandemic in South India. The State also saw 22 deaths during the last 24 hours. This was disclosed by Chief Minister Pinarayi Vijayan in his media briefing late Wednesday evening. The Chief Minister said the situation was grave in the State and asked the people to avoid crowding, closed space, and close contact.

As the number of new cases shot up in the State, a new battle has emerged between Kerala and the Centre with the Opposition Congress declaring its support to the CPI(M)-led Government. Vijayan said though the State had informed the Centre about the vaccine shortage in Kerala, the Centre is yet to respond to its plea.

Tamil Nadu diagnosed 11,681 new Covid-19 cases on Wednesday while the death toll increased to 53, according to a release by the Directorate of Public Health and Preventive Medicine. Chennai alone accounted for 3,750 patients on Wednesday while Chengalpattu registered 947 cases.

But Dr Jayanti, head, multi-specialty Covid hospitals told the media on Wednesday that there was no need for the people to get upset with the increasing number of Covid patients.

“We are fully prepared to meet any kind of emergencies. The State has enough stock of vaccines as well as oxygen cylinders,” said Dr Jayanti.

https://www.dailypioneer.com/2021/page1/covid-death-rate-goes-up-from--5--to--7-.html

0.03% vaccinated get reinfected

For Covaxin, only 0.04% afflicted with coronavirus again after 2nd dose

The Union Health Ministry on Wednesday pointed out that more than 21,000 people tested positive for Covid-19 after taking the first dose of either Covishield or Covaxin, manufactured by Bharat Biotech and Serum Institute of India (SII) while over 5,500 contracted the infection after taking the second dose.

“And the data are not at all worrisome”, said Dr Balram Bhargava, ICMR chief, at a routine Press conference here.

“Around 0.04 per cent of 17,37,178 individuals, who received the second dose of Covaxin, were positive for Covid-19, while 0.03 per cent of 1,57,32,754 people, who took the second dose of Covishield, contracted the infection,” he said.

Bhargava who presented the data said vaccines reduce the risk of infection and prevent death and severe infection.   “After vaccination, if one gets infection then it is known as breakthrough infection,” he said.

So far, 1.1 crore doses of Covaxin have been administered. Out of which 93 lakh received the first dose and out of that 4,208 (0.04 per cent) people got the infection which is four per 10,000 individuals.  About 17,37,178 people received the second dose of which only 695 (0.04 per cent) tested positive for Covid-19, Bhargava said.

Of Covishield, 11.6 crore doses have been given. Ten crore received the first dose and 17,145 i.e. 2 per 10,000 people contracted the infection. About 1,57,32,754 individuals took the second dose of Covishield and of that 5,014 (0.03 per cent) got infected. Two to four per 10,000 breakthrough infections have occurred, a very small number. This was mainly healthcare workers prone to more occupational hazards, he said.

5,709 people contracted the infection after the second dose of either of the two vaccines. “This is a very small number and not at all worrisome, “ he said.

NITI Aayog Member (Health) VK Paul noted that there is a risk even after taking vaccination so “we stress people to follow Covid appropriate behaviour even after taking the vaccination”.

Amid oxygen shortage in the country, Union Health Secretary Rajesh Bhushan said 7,500 metric tonnes of oxygen is being produced in the country per day and 6,600 metric tonnes is being supplied to the States for medical use.

“We have issued instructions that, leaving a few industries, the supply of industries will be restricted so that more and more oxygen can be made available for medical use. We have allocated 6,600 MT out of 7,500 MT to States,” he said.

https://www.dailypioneer.com/2021/page1/0-03--vaccinated-get-reinfected.html

Covid vax 'safe' in people with high-risk allergies: Study

Severe allergic reactions to Covid-19 vaccines remain exceedingly rare, thus people with high-risk allergy histories can safely take the jabs, according to a study of 65,000 people.

Individuals with severe allergies to foods, oral drugs, latex, bee stings or venom can safely receive the Covid-19 vaccines, stated the experts led by allergists at Massachusetts General Hospital (MGH) in the US.

"Our main goal is to enable as many individuals as possible to receive a Covid-19 vaccine safely and avoid unnecessary vaccine hesitancy due to a lack of knowledge around allergic reactions to vaccines," said lead author Aleena Banerji, clinical director of the Allergy and Clinical Immunology Unit at MGH.

However, people with a recent severe allergic reaction to polyethylene glycol (PEG) -- an ingredient in the vaccines -- should see an allergist before getting the jabs, they recommended. The findings are published in the Journal of Allergy and Clinical Immunology: In Practice.

The study examined possible allergic reactions to Covid vaccinations in more than 65,000 people who have become fully vaccinated, with the Pfizer-BioNTech and Moderna Covid vaccines. PEG is the common excipient in both the mRNA Covid vaccines, whereas polysorbate 80 is the excipient in the Janssen Covid-19 vaccine.

The US Centers for Disease Control and Prevention described the rate of anaphylaxis after receipt of the mRNA Covid-19 vaccines as 4.5 cases per million doses administered, with 89 per cent occurring within the 15- to 30-minute observation period. However, Polysorbate 80 caused anaphylaxis is extremely rare.

If a person is allergic to PEG, he or she should not receive an mRNA Covid-19 vaccine, instead speak to the physician about receiving the Janssen Covid-19 vaccine, the team suggested. On the other hand, if you are allergic to polysorbate 80, you should not receive the Janssen vaccine and instead speak to your physician about receiving the mRNA Covid-19 vaccines.

The CDC, has since April 13, placed the Janssen vaccine on "pause" while investigating adverse events of thrombocytopenia and central venous thrombosis.

https://www.dailypioneer.com/2021/pioneer-health/covid-vax--safe--in-people-with-high-risk-allergies--study.html

New COVID-19 vaccine may provide protection against existing, future strains, scientists say

A new experimental COVID-19 vaccine has shown promising results in early animal testing, according to researchers who say the preventive may provide protection against existing and future strains of the novel coronavirus, and cost about USD 1 per dose.

The vaccine developed by researchers, including those from the University of Virginia (UVA) in the US, prevented pigs from being becoming ill with a pig model coronavirus, porcine epidemic diarrhea virus (PEDV).

PEDV infects pigs, causing diarrhea, vomiting, and high fever, and has been a large burden on pig farmers around the world.

The new vaccine approach might one day open the door to a universal vaccine for coronaviruses, including coronaviruses that previously threatened pandemics or perhaps even coronaviruses that cause some cases of the common cold, the researchers said.

According to the researchers, the vaccine offers several advantages that could overcome major obstacles to global vaccination efforts.

It would be easy to store and transport, even in remote areas of the world, and could be produced in mass quantities using existing vaccine-manufacturing factories, they said.

"Our new platform offers a new route to rapidly-produce vaccines at very low cost that can be manufactured in existing facilities around the world, which should be particularly helpful for pandemic response," said Steven L. Zeichner from UVA.

Described in the journal PNAS, the vaccine-production platform involves synthesising DNA that directs the production of a piece of the virus which can instruct the immune system to mount a protective immune response against the virus.

"Killed whole-cell vaccines are currently in widespread use to protect against deadly diseases like cholera and pertussis. Factories in many low-to-middle-income countries around the world are making hundreds of millions of doses of those vaccines per year now, for a USD 1 per dose or less," Zeichner said.

"It may be possible to adapt those factories to make this new vaccine. Since the technology is very similar, the cost should be similar too," he added.

The vaccine takes an unusual approach in that it targets a part of the spike protein of the virus, the "viral fusion peptide," that is essentially universal among coronaviruses.

The spike protein helps the virus to enter the human cells.

The fusion peptide has not been observed to differ at all in the many genetic sequences of SARS-CoV-2 that have been obtained from thousands of patients around the world during the pandemic.

The resaerchers made two vaccines, one designed to protect against COVID-19, and another designed to protect against PEDV.

PEDV and the virus that causes COVID-19 are both coronaviruses, but they are distant relatives.

PEDV and SARS-CoV-2, like all coronaviruses, share several of the amino acids that constitute the fusion peptide.

The researchers observed that both the vaccine against PEDV and the vaccine against SARS-CoV-2 protected the pigs against illness caused by PEDV.

The vaccines did not prevent infection, but they protected the pigs from developing severe symptoms, much like the observations made when primates were tested with candidate COVID-19 vaccines.

The vaccines also primed the immune system of the pigs to mount a much more vigorous immune response to the infection, the researchers said.

If both the PEDV and the COVID-19 vaccines protected the pigs against disease caused by PEDV and primed the immune system to fight the disease, it is reasonable to think that the COVID-19 vaccine would also protect people against severe COVID-19 disease, they said.

https://www.dailypioneer.com/2021/pioneer-health/new-covid-19-vaccine-may-provide-protection-against-existing--future-strains--scientists-say.html

Explained: Assessing Covid reinfection risks for the young

The authors say that despite previous infection and the presence of antibodies, vaccination is still necessary to boost immune responses, prevent reinfection, reduce transmission, and that young people should take up the vaccine wherever possible.

A past Covid-19 infection does not completely protect against reinfection in young people, according to a new observational study published in The Lancet Respiratory Medicine.

The study was among more than 3,000 healthy members of the US Marines Corps, most of whom were in the age group 18-20. Of 2,346 Marines followed long enough for this analysis of reinfection rate, 189 were seropositive and 2,247 were seronegative at the start of the study, between May and November 2020. Around 10% of participants who were previously infected with SARS-CoV-2 (19 out of 189) became reinfected, compared with new infections in 50% (1,079 out of 2,247) of participants who had not previously been infected.

 

Implications beyond cohort

The authors say that despite previous infection and the presence of antibodies, vaccination is still necessary to boost immune responses, prevent reinfection, reduce transmission, and that young people should take up the vaccine wherever possible.

 

Although the study was in young, fit, mostly male Marine recruits, the authors believe that the risk of reinfection found in their study will apply to many young people, but that the exact rates of reinfections will not be applicable elsewhere. This is owing to the crowded living conditions on a military base and close personal contact required for basic training likely contributing to a higher overall infection rate than seen elsewhere.

 

For example, a study of 4 million people in Denmark also found that the risk of infection was five times higher in people who had not before had Covid-19. Only 0.65% of people who had Covid-19 during Denmark’s first wave tested positive again during the second wave, compared with 3.3% of people who tested positive after initially being negative. In addition, a preprint study including British healthcare workers found that those who had been not previously infected had a five times higher risk of being infected than people who had a past infection.

 

Antibodies & viral load

To understand why reinfections occurred in the study of Marine recruits, the authors studied the reinfected and not infected participants’ antibody responses. They found that, among the seropositive group, participants who became reinfected had lower antibody levels against the SARS-CoV-2 virus than those who did not become reinfected. In addition, in the seropositive group, neutralising antibodies were less common.

 

Comparing new infections between seropositive and seronegative participants, the authors found that viral load in reinfected seropositive recruits was on average only 10 times lower than in infected seronegative participants, which could mean that some reinfected individuals could still have a capacity to transmit infection, but the authors note that this will need further investigation.

https://indianexpress.com/article/explained/assessing-covid-reinfection-risks-for-the-young-7275502/

Dry mouth and covid tongue: Coronavirus symptoms you must not ignore

Research has shown that other than the common organs, ACE2 or angiotensin-converting enzyme 2 exists in various oral mucosal tissues, so, the oral cavity is considered a potential route for the entry of the COVID-19 virus, said Dr Samrat Shah, consultant internist at Bhatia Hospital, Mumbai

As the Covid-19 pandemic continues to cause unprecedented damage to lives across the world, scientists are still learning about the various symptoms of the viral infection. Of late, there have been cases where patients have experienced newer symptoms after being infected with the coronavirus. The latest report by the National Institute of Health mentions that about half of the patients have these symptoms.

 

One of them is dry mouth, also known as Xerostomia, which could be the initial presentation of COVID 19. Patients may develop this condition even a few days ahead of fever, sore throat, or other known or associated symptoms.

 

“In a dry mouth, the body is unable to produce saliva which protects the mouth from bad bacteria, other pathogens and aids the process of digestion. The patient may feel dryness or stickiness in the mouth and the saliva may become thicker. As per studies, Xerostomia happens when the virus attacks the oral linings and muscle fibres,” said Dr Samrat Shah, consultant internist at Bhatia Hospital, Mumbai.

 

The other most common causes of dry mouth include drugs, type 1 diabetes, hyperthyroidism, autoimmune diseases, renal failure, vitamin deficiencies, and other viral infections. However, in recent times, there have been a number of cases of dry mouth related to COVID-19, which has caught the attention of researchers.

 

“Research has shown that other than the common organs, ACE2 or angiotensin-converting enzyme 2 exists in various oral mucosal tissues, so, the oral cavity is considered a potential route for the entry of the COVID-19 virus. ACE2 is a protein that provides the entry point for the coronavirus to hook into and infect a wide range of human cells,” mentioned Dr Shah.

Like dry mouth, another symptom of dry tongue — now also known as COVID tongue — is a manifestation when the body fails to produce saliva that protects your mouth from bad bacteria. COVID tongue is often accompanied by a change to the tongue’s sensation, as well as muscle pain while chewing due to persistent ulcers. In this condition, the tongue may start to appear white and patchy. However, in many cases, this disorder is due to alterations in the quality of saliva, while the quantity of saliva does not vary much.

 

People who have developed dry mouth or dry tongue may also find it difficult to chew food and speak. The ACE2 receptors are mostly observed in the tongue and floor of the mouth, among other areas.

 

Studies have shown that these receptors are also present in salivary gland cells which are believed as one of the first SARS-CoV-2 target cells. Since xerostomia could occur before the common symptoms are noticed, it is possible to use this condition for early diagnosis, treatment, and isolation of the individual thereby preventing further transmission.

 

Some of the other reasons that researchers have suggested for the occurrence of xerostomia in COVID-19 is the consumption of numerous medicines and diverse pharmacological groups. “The most common medications in patients with COVID-19 include antiviral agents (remdesivir), hydroxychloroquine, anti-HIV medications (ritonavir, lopinavir) and interferons. Overall, these medications are the most frequent reasons for xerostomia,” said Dr Shah.

 Dry mouth condition needs to be closely monitored.

However, as mentioned earlier, the signs of xerostomia in COVID-19 patients usually occur before other symptoms. This means it is possible to initiate treatment faster. This could reduce the possibility of the need for medicines that could generate xerostomia. However, in some cases, studies have also shown that the signs of xerostomia began simultaneously or a little after the incidence of COVID-19 symptoms.

 

For now, it’s important to know that COVID is not merely a respiratory infection. Besides lungs, it also affects blood vessels and other body organs, hence it can manifest in symptoms which even experts had no idea about.

https://indianexpress.com/article/lifestyle/health/dry-mouth-new-covid-symptoms-prevention-antibiotics-7274665/