Amid rise in H3N2 cases, living with a virus

The Indian Express | 1 week ago | 19-03-2023 | 12:45 pm

1.30 pm, Basement OPD, Fortis Hospital, Vasant Kunj: There’s a crowd of mothers, trying to calm their restless children in the crook of their arms. They all have varying degrees of fever, cough and stuffy nose, suspected to be suffering from the influenza virus that’s raging through our cities. Dr Manoj Sharma, senior consultant, Internal Medicine, is taking a small break after seeing patients non-stop through the morning. As soon as he resumes his consultation, a 30-year-old woman complains about high fever and is almost convinced it is Covid. He calms her down, saying all she needs to do is take standard medication for fever (Paracetamol), wear a mask and follow hand hygiene. He asks her to wait for three days for the fever to subside and report any breathing abnormalities or other complications that might arise even on Day 5.“The new strain of the influenza virus, H3N2, has regular flu symptoms like cough, congestion in throat, respiratory tract and lungs, sore throat, fever, headache, chills, body ache and fatigue. So we are asking patients to wear masks in order to prevent transmission and giving them symptomatic treatment,” says he. A senior patient, who has been waiting eagerly for his turn, complains of having extreme coughing bouts that make him retch. Dr Sharma advises him to take a flu vaccine shot. “The manifestation of the virus is severe in the elderly. Existing flu shots are not updated to counter this strain of the virus but if you have had a flu shot earlier, there could be some partial protection. Of course, if you take the flu shot now, it may not work in the current wave as your body would require four to six weeks to develop immunity. But we should all take the flu shots annually and those living with co-morbidities like diabetes and cardiac issues, should actually go for the pneumonia shot each year,” says he. The IMA has also stated that this virus usually preys on individuals below the age of 15 years or above 50 years of age. So vaccines are a must for both age groups.In between patients. Dr Sharma says that H3N2 is not new. “There was an outbreak in 1968-69 and caused a pandemic just like Covid did this time. It resulted in about four 4 million deaths as well. It remains in the community and whenever the community becomes more vulnerable, it resurfaces. Over a period of time, antigenic variations happen in every virus. The same happened with the influenza virus, which has been categorised into the A,B,C,D types. H3N2 is a sub-type of influenza A,” says he. “It’s not like there’s a resurgence of influenza. It’s just that Covid protocols and a collective preventive behaviour kept us away from it. Now with a less than calibrated social exposure, we have just encouraged the virus to circulate more. Besides, most of us have had Covid, which has compromised our immunity shield. That’s why we are susceptible to not just this strain but other viruses floating about. That’s why people are complaining of relapses because immunity against one kind of virus doesn’t mean you are protected against others,” he adds. Ninety per cent of people are reporting a lingering cough for three to four weeks, indicating how the body defences have weakened and are slowing down recovery.Do H3N2 patients require antiviral therapy? “Not at all. Only the elderly, the immuno-compromised, pregnant women, diabetics, those suffering from heart, lung and kidney disease need to be watched for such interventions. If the symptoms are mild, we don’t even go for testing. There’s no need to create unnecessary panic,” he adds. But what worries him more is the city’s pollution. “Pollutants scrape the respiratory lining of our lungs and alter it. The flu season will ebb but we will be perennially prone to contracting viral and bacterial infection. So we have to develop a new preventive social behaviour in a post-Covid world,” he says.

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Why 2020-2030 has the makings of a lost decade for the global economyPremium Story

The Indian Express | 12 hours ago | 29-03-2023 | 12:45 pm

The Indian Express

12 hours ago | 29-03-2023 | 12:45 pm

ExplainSpeaking-Economy is a weekly newsletter by Udit Misra, delivered in your inbox every Monday morning. Click here to subscribeDear Readers,From the perspective of the global economy, the year 2023 started off on a mildly optimistic note. As top policymakers and CEOs met in Davos, there was a sense that the global economy might be able to dodge the chances of a recession in 2023. The IMF’s World Economic Outlook in January provided a salutary stamp to that notion. However, the recent collapses in the banking sector had yet again ratcheted up the apprehensions of a recession.In this context, a new research publication by the World Bank, titled “Falling Long-Term Growth Prospects”, argues that the current decade (2020-2030) “could be a lost decade in the making—not just for some countries or regions as has occurred in the past—but for the whole world.”Simply put, the World Bank has found that the overlapping crises of the past few years — Covid-19 pandemic, Russia’s invasion of Ukraine and the resultant spike in inflation as well as monetary tightening — have ended a span of nearly three decades of sustained economic growth.“Starting in 1990, productivity surged, incomes rose, and inflation fell. Within a generation, about one out of four developing economies leaped to high-income status. Today nearly all the economic forces that drove economic progress are in retreat,” writes David Malpass, President, The World Bank Group.He further warns that without a big and broad policy push to rejuvenate it, the global average potential GDP growth rate—the theoretical growth rate an economy can sustain over the medium term based on investment and productivity rates without risking excess inflation— is expected to fall to a three-decade low of 2.2% a year between now and 2030, down from 2.6% in 2011-21 and 3.5% during the first decade of this century.The important thing to understand here is that while the report talks about global growth slowdown, the main hurt will be felt by emerging economies such as India. “A persistent and broad-based decline in long-term growth prospects imperils the ability of emerging market and developing economies (EMDEs) to combat poverty, tackle climate change, and meet other key development objectives,” states the World Bank.The World Bank report recounts a 2015 research request by Kaushik Basu, the World Bank Group’s Chief Economist at the time, to assess the long-term growth prospects of emerging market and developing economies (EMDEs).While the World Bank came up with a preliminary study (titled “Slowdown in Emerging Markets: Rough Patch or Prolonged Weakness?”), the latest publication provides “a definitive answer” to the question. And the answer is: These economies are in the midst of a prolonged period of weakness.Look at the data for actual GDP growth and per capita GDP growth in the two tables (A.1 and A.3) below. It shows a broad-based decline over the past two decades whether a country belongs to EMDEs or the middle-income countries (MICs) or the low-income countries (LICs).The World Bank has looked at a whole set of fundamental drivers that determine economic growth and found that all of them have been losing power. The six charts below capture the weakness.These fundamental drivers include things like capital accumulation (through investment growth), labour force growth, and the growth of total factor productivity (which is the part of economic growth that results from more efficient use of inputs and which is often the result of technological changes) etc.Not surprisingly then, the potential growth rate is expected to decelerate further (see Table A.3).What about India?Even though India has also lost its growth momentum over the past two decades, it is and will likely remain a global leader when it comes to growth rates. India falls under the South Asia Region (SAR), which is expected to be fastest growing among emerging market and developing economies (EMDEs) for the remainder of this decade. To be sure, India accounts for three-fourths of the SAR output. SAR includes countries like Afghanistan, Pakistan, Sri Lanka, Nepal and Bangladesh etc.“Economic activity in the South Asia region (SAR) rebounded strongly from the recession caused by the COVID-19 pandemic, expanding by 7.9 percent in 2021 after a drop of 4.5 percent in 2020. Output in the region is on track to grow by about 6.0 percent a year between 2022 and 2030, faster than the 2010s annual average of 5.5 percent and only moderately slower than growth in the 2000s,” states World Bank.According to the World Bank, if all countries make a strong push, potential global GDP growth can be boosted by 0.7 percentage point—to an annual average rate of 2.9%; this would be faster than the preceding decade (when the global economy grew by 2.6%) but still slower than the first decade of 2000s (when the growth clocked 3.5% per annum).There are six priority interventions suggested by the report: incentivise investments into the economy, boost labour force participation rates (especially for women), cut trade costs, capitalise on service exports, improve global cooperation, ensure that fiscal policies and monetary policies don’t run against each other (for instance, government expenditures raising deficits at a time when central banks are trying to contain inflation).Until next week,Udit

In UK hearing, Boris Johnson fights for his political career, says ‘I did not lie’ about lockdown parties

The Indian Express | 6 days ago | 23-03-2023 | 12:45 pm

The Indian Express

6 days ago | 23-03-2023 | 12:45 pm

A combative Boris Johnson fought for his political career on Wednesday, as the former British prime minister said “hand on heart” he did not lie to parliament over Covid-19 lockdown parties at a hearing with lawmakers.Parliament’s Committee of Privileges is investigating whether Johnson, who was ousted from Downing Street in September, intentionally or recklessly misled the House of Commons in a series of statements, where he said no rules were broken in the gatherings. If the committee finds Johnson deliberately misled lawmakers, then he could be suspended. Any suspension longer than 10 days could prompt an election to remove him from his parliamentary seat and end his political career.The former leader, who considered an audacious bid for a second stint as prime minister last year, launched a lengthy defence at the hearing, saying statements he made to parliament had been done in good faith.“I’m here to say to you, hand on heart, that I did not lie to the House,” said Johnson, who has accused the committee of bias. “When those statements were made, they were made in good faith and on the basis of what I honestly knew and believed at the time.”The so-called partygate scandal contributed to the ultimate downfall of Johnson, after months of reports that he, alongside other senior government figures, had been present at alcohol-fuelled gatherings in Downing Street during 2020 and 2021 when much of the rest of Britain was forced to stay at home.Johnson was fined by police for attending an event to celebrate his birthday in Downing Street in June 2020, making him the first prime minister found to have broken the law while in office. Some 126 fines were issued over the gatherings.The outcry and repeated accusations of lying over the parties and allegations that a Conservative lawmaker had drunkenly groped two men eventually prompted the resignations of most of his top team of government ministers, including the current prime minister, Rishi Sunak, who was among those fined.Thanking staffHarriet Harman, the chair of the committee, said it would consider the evidence Johnson had given and may take further evidence in due course. It is expected to report its findings later in the year. She stressed the importance of ministers telling the truth, saying this went to the heart of the way Britain’s parliamentary system functions.At the start of the hearing, Johnson was made to swear an oath to tell the truth on a bible before giving his evidence. He said the inquiry had not found any evidence he deliberately misled parliament and said he was banned by the committee from publishing a “large number of extracts” he relied on in his defence.Asked about events in May, November, and December 2020 when he was pictured talking to colleagues who were drinking, Johnson said some meetings were “essential” to the functioning of government. He said his presence at events was necessary to thank staff for their hard work.“People who say that we were partying in lockdown simply do not know what they are talking about,” he said, crossly. He said he was “shocked” to be fined and “amazed” by the number of other fines issued.“I think what happened basically, was that on a few evenings, events did simply go on for too long and I can’t apologise for that enough,” he said.Britain had one of the highest coronavirus death tolls in the world with more than 1,75,000 deaths by the time Johnson said he would step down as prime minister.The campaign group Covid-19 Bereaved Families for Justice UK said that Wednesday was “a new low” for Johnson and said it was “painful to watch him pull his usual tricks of deflection, self-pity and blaming everyone but himself”.Johnson accepted he had inadvertently misled parliament but had believed what he had said when he spoke.“I didn’t think that those events were an issue. Nobody had previously raised them with me as being things that I ought to be concerned about,” Johnson said. “Call me obtuse or oblivious, but they did not seem to me to be in conflict with the rules.”

Amid Covid, H3N2 rise, how India can help build global resiliencePremium Story

The Indian Express | 6 days ago | 23-03-2023 | 12:45 pm

The Indian Express

6 days ago | 23-03-2023 | 12:45 pm

The recent rise in Covid-19 cases reminds us that the pandemic is not yet over. It has added some more concern to the ongoing influenza outbreaks. On the global stage, countries and a range of institutions are negotiating the “pandemic treaty” — a global accord on pandemic prevention, preparedness and response.As is reasonably well known now, the Covid XBB 1.16 variant seems to be fuelling the surge, nearly a three-fold rise in cases over the last fortnight. So far, it has not caused any mortality in India. With more than 6,000 currently active cases, 76 samples of XBB 1.16 have tested positive from eight states, the most so far from Karnataka and Maharashtra. XBB.1.5 has been reported from 38 countries and declared a variant of interest (VOI) by the WHO. It is expected to emerge as a dominant strain in the UK and Europe and is rapidly spreading in the US as well. Even individuals who had received three or four doses of an mRNA vaccine (such as Moderna or Pfizer), plus suffered a BA.5 infection, were not immune to this variant. There is no evidence of any potential change in severity though. The growth advantage of XBB 1.16 is nearly one-and-a-half times of XBB.1.5, making it a rather aggressive variant, and with immune escape properties too.Another potential worry from Israel is the identification of a combination of the BA.1 (Omicron) and infectious BA.2 variants. The virus was detected in the parents of an infant boy, in whom two viruses linked up and exchanged genetic materials. The current test positivity rate is 10 per cent, a worrying metric by all accounts.This current landscape of Covid-19 is layered with a huge surge of H3N2 Influenza A cases, with at least nine reported deaths. Influenza B has also been identified. Both these are seasonal influenzas, driving up the hospital — including intensive care — admissions. Much like Covid-19, the high-risk groups are pregnant women, the elderly and those with chronic medical conditions and immunosuppressive conditions. Healthcare workers are at particularly high risk of getting affected and in turn spread to vulnerable persons.The limitations of the International Health Regulations (IHR) 2005 were exposed during the Covid-19 pandemic — both in countries not reporting in time and the international agencies not responding adequately. Local, national and global governance is increasingly being recognised as an important determinant of the emergence and re-emergence of diseases of animal origin. To re-emphasise, both Covid-19 and the influenza viruses have animal origins — “spill over” in technical jargon — when a virus is able to overcome several barriers to “jump” and become feasible in another species.It is in this context that the World Health Assembly set off a global process in December 2021, at its second-ever special session, to draft and negotiate a convention agreement to strengthen pandemic prevention, preparedness and response. An intergovernmental negotiating body (INB) that includes WHO’s 194 countries is steering this process. At the same time, more than 300 amendments to the IHR are also being discussed. The World Health Assembly in 2024 is expected to ratify these, ushering in a “comprehensive, complementary and synergistic set of global health agreements”. The WHO Director-General referred to this initiative as a once-in-a-generation opportunity to strengthen the global health architecture to protect and promote the well-being of all people.The G20 group of countries, with the Indian presidency, has a significant role to play. This is particularly so in light of the One Health Mission that India is working on and is expected to be rolled out in the near future. The G20 is already engaged with One Health (OH) issues and pandemic preparedness is one of the current focus areas.India, representing the Global South, is expected to play a role in integrating equity considerations in the ongoing negotiations. Scholars have enunciated three key equity considerations. First, the appropriate use, recognition, and protection of indigenous knowledge, which has traditionally recognised the interconnectedness of human, non-human and ecosystem health. Second, the substantive and equitable inclusion of women and minority groups, including racial, ethnic and sexual minorities – traditionally under-represented groups in treaty design and implementation. Third, the use of health equity impact and gender-based analysis to identify and develop mitigation plans for the potentially inequitable impact of epidemics.On the domestic front, the tasks include promoting the establishment of OH infrastructure. This will need an integrated OH surveillance system, building and nurturing partnerships to connect and share data on infectious pathogens in wildlife, companion animals, livestock, humans, the environment, and related risk factors. India will also need to build OH capacity and pandemic preparedness monitoring and assessment into the state and district governance architecture that will draw upon an inter-/ transdisciplinary OH evaluation framework and methodology, including metrics for measuring success.The writer is chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi and co-investigator at the UKRI-GCRF One Health Poultry Hub

Woman fails to recognise her father after Covid-19 infection; can the virus lead to face blindness?

The Indian Express | 1 week ago | 22-03-2023 | 12:45 pm

The Indian Express

1 week ago | 22-03-2023 | 12:45 pm

When Annie (name changed), a 28-year-old customer service representative and portrait painter, caught Covid-19 infection, she experienced symptoms such as high-grade fever, coughing fits that led to fainting due to lack of oxygen, tightness in the chest, shortness of breath, diarrhoea, and loss of smell and taste. However, three weeks after symptom onset, she felt well enough to start working from home before seeing her symptoms return four weeks later.According to a study, published in the journal Cortex, she noticed disorientation and that “something was off with faces”. “These deficits caused her primary care provider to send her to seek care in an Emergency Department (ED). At the ED, a CT scan revealed no active bleeds in her brain, and she was discharged,” it added.However, in June 2020, when spending time with her family for the first time since contracting Covid-19, Annie noticed that she was unable to recognise her father or visually distinguish him from her uncle. “My dad’s voice came out of a stranger’s face,” she told the researchers. Sharing that she is now relying heavily on people’s voices for identification purposes, Annie said that she was previously able to draw a face and only look at a reference photo every 15–30 min, she now depends on photographs while drawing.“Faces are like water in my head,” she said, sharing that she is now relying heavily on people’s voices for identification purposes. In the case study, Annie scored poorly on all four facial recognition tests used to diagnose prosopagnosia, or face blindness. She also reported to told that, since her COVID-19 infection, she has experienced “substantial” deficits in her navigation abilities, which frequently co-occur with prosopagnosia, the study authors wrote.To explore whether other people experienced similar problems, the researchers surveyed 54 individuals who had long Covid about their neuropsychological abilities. A majority of them reported a decline in visual recognition and navigation abilities, the authors added. They said that these findings indicate that Covid-19 may cause severe and selective neuropsychological impairments “similar to deficits seen following brain damage,” and that these problems are not uncommon among patients with long Covid.What is face blindness?Face blindness, also known as prosopagnosia, is a neurological condition that affects a person’s ability to recognise faces. “It is a disorder of face perception where the brain has difficulty recognising and distinguishing between faces, even those of people the person knows well,” said Dr Ravindra Srivastava, Head of the Department and Senior Consultant, Neurosurgery, Primus Super Speciality Hospital, New Delhi.Agreeing, Dr Pavan Pai, Consultant Interventional Neurologist, Wockhardt Hospitals, Mira Road, said that it is a neurological disorder that requires timely medical attention.SymptomsAccording to Dr Pai, the main symptom is that one fails to recognise faces even of people they tend to know. “Other signs can be the inability to recognize emotions on one’s face, not being able to know the gender or age of people, and not being able to recognise cars, animals, one’s gender, and characters in the film,” he said, adding that these symptoms can lead to problems in day-to-day life.What is it caused by?While the exact cause of face blindness is not fully understood, it is thought to be related to abnormalities in the brain’s fusiform gyrus, which is responsible for face recognition, Dr Srivastava said. “In some cases, it can be present from birth, while in others it may be the result of a brain injury or neurological disorder. More importantly, it is recognized that when Rt. fusiform gyrus was involved, it causes facial blindness.”Dr Pai added that this condition also runs in families. “Moreover, brain damage, stroke, head injury, Alzheimer’s disease, and even encephalitis which is the inflammation of the brain can lead to this problem,” he said.Link between Covid-19 and face blindnessAcknowledging the recent study on the same, the experts noted that more research is needed to confirm the relationship between Covid-19 and face blindness. “The exact link between COVID-19 and face blindness is not yet fully understood. However, it is thought to be related to the virus’s impact on the brain and nervous system. COVID-19 has been associated with a range of neurological symptoms, and it is thought that the virus may be able to cross the blood-brain barrier and directly affect the brain. More research is needed to understand the mechanisms behind this potential link,” Dr Srivastava elucidated.Agreeing, Dr Pai said that Covid-19 can impact one’s cognitive and perceptual abilities, causing face blindness. “One should be aware of it,” he said.How to cope?Here are some ways to cope with face blindness, as suggested by Dr Srivastava.*Do tell people about the condition before you meet them.*Ask people you are close to for help in identifying others.*Ask people to introduce themselves.*When you greet them, use people’s voices or body language to tell them apart.*Make a note of distinctive features about a person, such as hairstyles, jewellery, or accessories.*Use name tags or write down the names of colleagues and where they sit at work.📣 For more lifestyle news, follow us on Instagram | Twitter | Facebook and don’t miss out on the latest updates!

Ayurvedic drug Ayush 64 well-tolerated and safe for use in Covid-19 patients: Study

The Indian Express | 1 week ago | 22-03-2023 | 12:45 pm

The Indian Express

1 week ago | 22-03-2023 | 12:45 pm

The poly-herbal Ayurvedic drug Ayush 64 that was repurposed for use during the Covid-19 pandemic has been found to be well-tolerated and safe, a new study in the PLOS One journal has said.The study published on March 16 said the drug, in combination with the standard of care (SOC), hastened recovery, reduced hospitalisation, and improved health among Covid-19 cases. It is significant as only a few drug trials from Ayurveda or other alternative systems have broken into the domain of modern medicine publications in journals with high impact factors. Rajesh Kotecha, secretary of the Union Ministry of Ayush, told The Indian Express that the study was a great model reflecting a systematic approach by modern medicine doctors, epidemiologists, pulmonologists, basic science researchers, ethics experts from a host of institutions like the Council for Scientific and Industrial Research (CSIR), Department of Biotechnology (DBT), Ayurveda scientists and doctors.The Central Council of Research in Ayurvedic Sciences (CCRAS), under the Ayush ministry, funded the study. The drug was repurposed for Covid-19 based on the recommendations of the interdisciplinary Ayush R&D task force chaired by Prof Bhushan Patwardhan, former vice-chairman of the University Grants Commission (UGC).Initially developed to treat malaria, Ayush 64 was found helpful in treating mild respiratory tract infections. Each 500 mg tablet contained aqueous extracts (100 mg each) of Alstonia scholaris (bark), Picrorhiza kurroa (rhizome), Swertia chirata (whole plant) and Caesalpinia crista (200 mg seed powder).According to the study, Ayush 64 was well-tolerated and found safe over 12 weeks of use in treating mild to moderate symptomatic patients of Covid-19. Kotecha said to reduce the burden on the hospital-based healthcare delivery system during the second wave of Covid-19, the Ayush ministry conducted a community-based study of Ayush 64 in asymptomatic, mild to moderate Covid-19 patients in home isolation. “More than 64,000 participants enrolled for the study and 96 per cent of them clinically recovered after administering Ayush 64 for 20 days. These research studies have been published in indexed medical journals with good impact factors such as Frontiers in Public Health, Complementary Therapies in Medicine, and PLOS One, among others,” he said.When contacted, Dr Patwardhan said this was a well-planned randomised multi-centre clinical trial conforming to good clinical practices. “In a way, this is a historical study which can serve as a role model for transdisciplinary research integrating a standard of care and ayurveda,” Dr Patwardhan said.Pune-based rheumatologist Dr Arvind Chopra, national clinical coordinator of the CCRAS-CSIR project for Covid-19 drug trials, said that the drug trial was unprecedented in several ways, especially in the domain of alternative medicinal systems. The study showed no participants progressed to severe Covid-19 or required intensive care. “Getting published in PLOS One, one of the most credible medical journals in the world, was an uphill task. Several journal referees critically reviewed the trial report and data on primary efficacy was reanalysed by journal experts before being accepted,” Dr Chopra added.Meanwhile, data from the Indian Medicines Pharmaceutical Corporation Limited (IMPCL), the public sector manufacturing unit of the Ayush ministry, showed that in 2021-22, Ayush 64 worth more than Rs 28 crore was sold. According to Ayush ministry officials, good sales were reported from 46 other industries where the technology was transferred.

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