Vol.4 | Issue No.14 - NIRT
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2021|Vol
.4|I
ssueNo.
14
05 April 2021 | Vol.4 | #14
NEWS BULLETIN A weekly publication from NIRT Library
COVID-19 vaccination:
A year with the coronavirus: lessons and Here’s how to find
challenges vaccination centres on
Google Maps,
In the over one year since the pandemic began, the response
has evolved. A look at what we have learnt so far, and the
MapMyIndia
challenges that remain. COVID-19 vaccination: For those who
are still searching for the closest
Written by Dr Shahid Jameel | New Delhi |
vaccination centre, both Google Maps
Updated: April 5, 2021 8:13:20 am
and MapMyIndia have this information.
Here's how to find a vaccination centre
Family and friends often call to know which of the two Covid-
close to your home on Google Maps.
19 vaccines available in India is better. My advice to take
whichever is easily available is met with apprehensions about By: Tech Desk | New Delhi |
adverse effects of vaccines. This is symptomatic of the past year, Updated: April 6, 2021 8:24:24 am
a year full of half-truths, false claims and often outright lies that
became more viral than the virus itself. While it has been a COVID-19 vaccinations are now
remarkable year for science and the value it brought to society, available to all Indian citizens above
there is little understanding of the scientific method, which relies the age of 45. The
on data and evidence. government opened vaccinations for
all in this age group and above from
Our understanding of diseases and the germs that cause them April 1. Those who wish to get
has advanced by leaps and bounds starting in the mid-20th vaccinated can always pre-register
century. Yet, the initial human response to a disease outbreak on the Cowin portal or on the Aarogya
has changed little. In his essay, What Pandemic Novels Teach Us, Setu app and get an appointment.
novelist and Nobel laureate Orhan Pamuk reminds us that
“People have always responded to epidemics by spreading If you are still searching for the closest
rumor and false information and portraying the disease as vaccination centre,
foreign, brought in with malicious intent.” Comparing Covid-19 both Google Maps and MapMyIndia
to historical outbreaks of plague and cholera, he says, “There is have this information. Follow these
an overabundance of similarities. Throughout human and literary steps on how to find the one closest to
history, what makes pandemics alike is not the mere your home.
commonality of germs and viruses but that our initial response
Continued in page no.7
has always been the same.”
In the past, rumours and false information were controlling the pandemic by letting its population
driven by not understanding a disease, but the get infected to reach herd immunity. Despite an
new age tools of modern communications now excellent healthcare system, Sweden registered
aid that spread. As with old plagues, rumours and 15 to 20 per cent mortality in April and May 2020,
accusations based on nationalist and religious forcing it to abandon this strategy.
identities, fueled through social media, have
impacted how Covid-19 unfolded in India and The nature of pandemics
other parts of the world. Through the ages, the Pandemics are caused by infectious agents but
most common rumours were about who carried spread by humans. The control, therefore,
the disease and from where. The disease is always depends as much on how humans behave as on
foreign, either brought with malicious intent or due medical intervention. When the populace trusts
to the incompetence of others to contain it in a policy makers, it follows advice. Trust comes from
foreign land. The Romans blamed Christians for transparency and clear and honest
their practices that angered the Roman gods and communication, all found wanting over the past
brought the Antonine plague of smallpox in 165- year. For example, there is overwhelming
180 AD. In the early days of the HIV/AIDS epidemic evidence that masks prevent infection and save
in the 1980s, preachers and televangelists blamed lives. In data from 200 countries, Covid-19
it on the “perverted lifestyles” of homosexuals and mortality was 100-fold lower in countries that
concluded that “AIDS is God’s punishment”. Still implemented mask wearing within 15 days of first
others argued that the HIV/AIDS virus came about case detection compared to those that took 60
due to voodoo practices or that it came from days or more to do so. Then why don’t people
outer space or was a bioweapon created in a CIA wear masks or wear them properly. The same goes
lab. In 2020, contrary to overwhelming scientific for avoiding crowded places, known to spread
evidence that the Covid-19 virus was first infection.
transmitted from bats to humans and then from
People’s choices reflect the relative costs of illness
person to person, many still assert it was produced
and its avoidance to them. If this private cost of
in a Chinese lab.
illness is low, or the private cost of avoiding illness
Denial has been another early response to disease is high, people have little incentive to follow
outbreaks. Governments have distorted facts and preventive measures. It is hard to convince
manipulated data to first deny the disease and someone who has no food security to wear a
then cherry pick data to not reveal its full extent. mask. It is impossible for the poor to practice
This is always done in ‘public interest’. The denial ‘social distancing’ while trying to earn a living or
by South Africa’s President Thabo Mbeki (1999- within their crowded dwellings. The essentially
2008) that AIDS was caused by a virus, and the economic nature of individual decisions, and the
failure to provide available medicines to infected role of behaviour and economics in epidemiology
people caused hundreds of thousands of determines the societal impact of a pandemic.
preventable deaths and new infections there. The One of the biggest gaps in the global response to
continued denial of Covid-19 as a problem at the the pandemic is the understandable reliance on
highest levels of the US government during the technological solutions, with insufficient attention
early part of the pandemic led to a grave situation to communications, human behaviour and social
in the world’s most technologically advanced networks.
nation. The country is now reeling with over 31
Though microbes infect royals and commoners
million cases and 568,000 deaths. With almost 13
alike, pandemics are unequal in their impact. The
million cases and over 330,000 deaths, Brazil also
“Spanish Flu” of 1918-20claimed about 50 million
owes the devastation to early denial by its
lives of which 12 to 18 million are thought to be
leadership. Sweden ignored guidance and tried
from India, which was under colonial rule. The
mortality rate in Britain was 0.47 per cent, for experience and the dedication of healthcare
Europeans living in India it was 0.83 per cent, but workers. By early February 2021 the Indian Medical
for Indians it was 2 per cent. Even among Indians, Association reported the loss of 734 doctors to
lower castes and upper castes showed 6.1 per Covid-19.
cent and 1.9 per cent mortality, respectively. In
South Africa under apartheid 32 per cent of the Could India have done better? There have been
white population was infected with 0.8 per cent suggestions that India lost valuable preparatory
mortality; 46 per cent of blacks were infected with time in February and March 2020. Some others
3 per cent mortality. differ on the timing of the lockdown. Still others
think the government relied more on
Poverty and unequal access to healthcare administrative inputs than on scientific advice.
creates such disparities. Covid-19 may not be very These discussions are not just academic. An
different in this respect. While the overall life analysis will help us to be better prepared in future.
expectancy in USA fell by one year in the first half
of 2020, for the black population it declined by 2.7 India now has about 12.5 million cases that are
years in the same period. The life expectancy gap globally the third highest, and about 164,000
between black and white Americans is now at six reported deaths. After reaching a peak in mid-
years, the widest it has been since 1998. September, there was a steady decline till mid-
Considering its very large informal workforce and February 2021, but cases are again on the rise
poor healthcare infrastructure, India is unlikely to again with 1.01 lakh cases reported on April 4,
fare any better when reliable data becomes 2021, which is close to the peak of 97,894 cases on
available. September 16, 2020. The daily rate of infection,
which was steady at about 0.1 per cent for a few
The pandemic in India months has now increased to about 0.6 per cent.
But the mortality rate is still low and steady. With
When India went into a lockdown on March 25, over 90 per cent new cases coming from only ten
2020, there were 525 confirmed cases and 11 states, what is driving this second wave?
deaths due to Covid-19. When the lockdown Seroprevalence studies have shown protective
ended 68 days later on 31st May 2020, India antibodies in 35 to 40 per cent people in major
reported 190,609 cases and 5,408 deaths. cities and 10 to 20 per cent in rural areas. The
immunity being non-uniform there are pockets of
While millions of livelihoods were lost and a serious
susceptible people in cities as well as villages.
migrant and economic crisis emerged, India did
manage to “flatten the curve”. Active cases that In Maharashtra for example, which is reporting
were increasing at a rate of about 15 per cent in over 60 per cent of India’s cases at this time, about
early April came down to about 4 per cent when 25 per cent of these cases are coming from the
the lockdown was lifted. This allowed healthcare Vidarbha region that was largely spared in the first
and ancillary capacity to be built, which saved wave, but 10 per cent cases are also coming from
lives. What also saved lives was the service and the Pune region that already showed high
shared experience of physicians and healthcare antibody seroprevalence.
workers. Even in the absence of any specific
treatments, open sharing of clinical experience Rapidly falling cases over five months and a
and protocols allowed ICU admissions and relatively low rate of mortality have also led to a
mortality rates to decrease with time. Besides low private cost of illness, which contributes to low
increasing capacity, a flatter pandemic curve compliance with masks and distancing. Emerging
also saved lives due to accumulated clinical mutants and variant viruses have also been
NIRT Library News Bulletin
3
suggested as driving this surge. Variants of Israel, where over 75 per cent of people above 60
concern, including those that have contributed to years of age have received both doses of a mRNA
increased spread in UK, South Africa and Brazil, as vaccine. For this age group, new positive cases
well as home-grown variant viruses are and hospitalizations in Israel have decreased to
increasingly being found in India. It remains to be near baseline levels. The USA, which has the
seen if these are linked to the present surge highest load of Covid-19 cases has also
committed itself to a vigorous vaccine rollout. The
Curbing a pandemic with vaccines new President promised 100 million vaccine doses
For the first time in the history of human infectious in his first 100 days; 121 million doses have already
diseases, a vaccine is being deployed to curb a been administered in two months. Covid rates
pandemic. Developments in science and have flattened or declined in all four countries
technology over the past two decades made it where enough vaccines have been deployed to
possible to know the genetic sequence of the new cover at least 25 per cent of the population; these
virus within one week of its emergence. To include Israel, UAE, Maldives and Seychelles.
compare, it took over 80 years to decipher the full
genetic sequence of the 1918 pandemic flu virus. However, vaccine access and equity have been
It took over four months to establish the causative a challenge. A small group of countries have
agent for the 2002-03 SARS outbreak. access to 60 per cent of the vaccines. The
European Union has refused to share vaccines
The availability of genetic sequences of SARS- manufactured there with COVAX, a global
CoV2 in early January started a race to develop consortium set up to supply vaccines to low and
Covid-19 vaccines. Moderna, a ten-year-old middle income countries (LMICs). In light of such
company, developed a vaccine based on the vaccine nationalism, India’s vaccine diplomacy
novel mRNA platform and started its clinical has been a breath of fresh air. Called “Vaccine
testing only 63 days after the sequence became Maitri”, it has supplied over 65 million vaccine
available. A similar vaccine invented at a young doses to 72 LMICs. This includes vaccine gifts as
German company called BioNTech and licensed well as commercial partnerships.
to Pfizer, was the first to get approval on
December 11, 2020, well within 12 months of the India’s vaccine challenges and the way forward
discovery of the new disease and nine months India’s vaccination plan, also based on the above
since it was declared a pandemic. Vaccines three-point principle, is to vaccinate 300 million
typically require years to develop, but in 2020, people in the first tranche. This includes 10 million
scientists produced safe and effective vaccines healthcare workers, 20 million frontline workers
against Covid-19 in record time. There are and 270 million people above 60 years of age and
currently 78 vaccines undergoing clinical testing those younger but with significant comorbidities.
on humans, of which 13 have received From April 1, 2021 everyone 45 years of age or
conditional or full approval. older is also eligible for vaccination. About 76
million doses have been administered till now.
A pandemic vaccine must do three things. First, it
should be used to protect healthcare and other India was already a vaccine manufacturing
frontline workers. Second, it should decrease powerhouse before the arrival of this pandemic. It
mortality. And finally, it must be deployed widely supplied over 60 per cent of global childhood
to end the pandemic. Most estimates suggest that vaccines, including up to 90 per cent of the
about 65 to 70 per cent of the population would world’s measles vaccines. It produced about 3
require infection or vaccination to reach ‘herd billion vaccine doses annually, of which about 1
immunity’. Crucial evidence of this comes from billion was used domestically and the remaining 2
NIRT Library News Bulletin
4
billion exported. Two Covid-19 vaccines have partnership with the Hyderabad-based Dr.
received Emergency Use Authorization (EUA) in Reddy’s Labs. A protein nanoparticle vaccine
India and several others are being tested. To developed by Novavax (USA) reported an
vaccinate 300 million Indians in the first phase efficacy of 96 per cent in USA but only 49 per cent
would require two things – 600 million vaccine in South Africa due to the circulation of a variant
doses and a high rate of vaccine administration. virus. Though it also has a manufacturing
Since January 16, when vaccination started in agreement of over 1.5 billion doses with SII, this has
India, about one million doses on an average not yet been approved in any other country. If
have been administered daily, but in the past two Covishield could be approved in India without
weeks the daily rate has increased to around two bridging trials and Covaxin without efficacy data,
million doses. Still, only 4.8 per cent and 0.7 per at least two other vaccines can also receive EUA
cent of Indians have received one or both to boost the supply chain.
vaccine doses, respectively. At this rate, it would
take nine months to fully vaccinate 20 per cent of On any given day, India has 40,000 to 45,000
India (~ 275 million people) with two doses. The vaccine administration points. With about 2 million
challenge, therefore, is to increase the rate of daily vaccinations, these are delivering on
vaccine administration. This requires increase in average about 50 doses daily, which is half of the
vaccine supply, more administration points and planned 100 doses per site per day. With 74.2
convincing people willing to take the vaccines. million registrations so far, of which almost 55 per
cent are walk-ins, the problem appears to be both
With only two vaccines approved in India – capacity and vaccine hesitancy. The capacity
Covishield from Serum Institute of India (SII) can increase with more vaccination points,
and Covaxin from Bharat Biotech India Limited especially in rural areas, and with increased
(BBIL), is there enough supply? Though India was vaccine supply discussed above. Vaccine
to have access to 500 million doses of Covishield hesitancy is fuelled by multiple factors that all
and about 300 million doses of the Covaxin, there point to poor communication, mixed messaging
appear to be supply issues to honour both and the inability to effectively counter false
domestic and international commitments. Data information. For example, recent reports of blood
shows that so far Covaxin accounts for less than 10 clots and a pause in use of the
per cent of administered vaccine doses. This Oxford/AstraZeneca vaccine (the same as
lopsided supply is problematic, especially when Covishield) by a number of European countries
media reports suggest that SII is not able to meet has created fear in India, where this vaccine has
the local and export demand for Covishield. been used in over 90 per cent vaccinations.
Though the European Medicines Agency and
The Indian regulator should consider approving at World Health Organization have found no links
least two other vaccines that have finished between blood clots and the vaccine, time and
efficacy trials and are approved elsewhere, and effective communication will be required to repair
have partnerships with Indian vaccine companies. the damage.
The Johnson & Johnson single-dose vaccine
showed an efficacy of up to 72 per cent and has Science and the future
received EUA in Bahrain, EU and USA. The The global response to Covid-19 reveals the
company has a partnership with the Hyderabad- power of science and partnerships. Within days of
based Biologicals E. Russia’s Sputnik V vaccine its notification, viruses were isolated from patients
reported an efficacy of 91.6 per cent and and characterized, which paved the way for
received EUA in Russia and several Asian, African developing diagnostic tests, vaccines and
and Latin American countries. This has a therapies. With almost one million SARS-CoV-2
NIRT Library News Bulletin
5
genomic sequences publicly available by now, it duration of vaccine-mediated protection may be
allows scientists to model its evolution and gauged from studies following natural infection.
movement across the globe. Multiple vaccines Neutralizing antibodies wane off in about 3 to 5
were developed, tested and approved within a months but cell-mediated immune response lasts
year. This is remarkable considering that in 2003 it longer. Infection by other endemic human
took 20 months for the SARS vaccine to reach coronaviruses may also offer some protection.
testing. Over 1100 diagnostic tests have been Modelling studies by researchers at Harvard
developed and evaluated, 24 different University have suggested various scenarios –
treatments are in use with various levels of annual winter outbreaks if immunity lasts less than
efficacy, and more than 110,000 publications on 40 weeks; outbreaks every other year if immunity is
Covid-19 are openly accessible. This remarkable longer than 100 weeks; winter outbreaks if
speed and collaboration have created societal transmission is seasonal; or elimination by 2024 if
value for science and saved lives. there is cross-protection from exposure to
endemic coronaviruses. While these models have
However, the scientific process remains poorly assumed seasonal variation like in influenza
understood. The blood clots scare shows how viruses, which is driven by genetic drift, SARS-CoV-
association is confused with causality. The US 2 is genetically much more stable. As we have
Centers for Disease Control and Prevention (CDC) already seen, pandemic waves remain difficult to
reports that 1 person in 1000 randomly develop predict.
blood clots every year. If a blood clot will be
associated with a new vaccine within one month Emerging viral variants have added to the
of vaccination, let us divide this number by 12. The complexity. At least three widely circulating
incidence is 0.08 per 1000 people per month. The variant lineages – called the UK (B.1.1.7), South
European Union reported 30 cases of blood clots African (B.1.351) and Brazil (P.1) lineages have
after vaccinating 5 million people, which works emerged with variable consequences. Trials have
out to be 0.006, i.e., 13 times less than random already shown compromised efficacy of existing
chance. Another way to establish causality is to vaccines against viruses of the South African and
compare the incidence of blood clots in people Brazil lineages, prompting vaccine companies to
who blindly and randomly received the vaccine go back to the drawing board. With increasing
versus those who got a placebo. This was done in vaccine coverage globally, there would be fewer
phase 3 trials. The incidence of blood clots in both opportunities for transmission and this will reduce
vaccine and placebo groups was rare and not the virulence or disease-causing potential of SARS-
statistically different. This is the scientific method. CoV2. Increasing vaccine coverage would also
Everything else is scaremongering. lead to evolutionary pressure on the virus to
develop vaccine-escape mutants, which are
How will the pandemic play out this year and in observed for other viruses following widespread
the future? That will depend on vaccine vaccination.
availability, coverage and duration of protection.
Models of global vaccine manufacturing and
capacity show that Covid-19 vaccines sufficient
to cover all those vulnerable and at risk would only
be available by mid-2022 and for everyone by
mid- to late-2023. There is also a problem of
unequal access. The poorest countries may only
be able to achieve 20 per cent coverage through
vaccines provided by the COVAX partnership. The
NIRT Library News Bulletin
6
Currently, there are five known cases, all of them
women under 60, who developed blood clots.
One of them even died and another suffered a
brain haemorrhage. The side effects surfaced 7-10
Netherlands temporarily days after receiving the AstraZeneca dose.
suspends AstraZeneca Covid Two weeks ago the EMA had determined that the
vaccine AstraZeneca vaccine was “safe and effective”,
but added it could not definitively rule out the
The Medicines Evaluation Board has advised people possibility of increased risk of blood clots as a side
to seek immediate medical attention if a vaccine effect.
beneficiary develops symptoms three days after
receiving a jab. Euronews reported that several countries
including Italy, Austria and the Balitc region
By: Express Web Desk | New Delhi
resumed the vaccine rollout across all age groups
Updated: April 5, 2021 1:17:14 pm
after temporarily halting the drive. France has
restricted its use to people 55 and above, while
Sweden and Finland for those 65 and above.
In Spain, vaccinations were reserved for people
between 55-65, but now have been extended to
include essential workers who are 65 and above.
The vaccination drive continues to remain
suspended in Norway and Denmark.
In the UK, the Medicines and Healthcare products
Regulatory Agency had identified 30 cases of
blood clots in people who received the
The Netherlands has halted the administration of vaccination. However, they stressed that the
AstraZeneca vaccine to people of all age groups benefits outweigh the low risks. An estimated 18
till April 7 amid reports of a few beneficiaries million doses of AstraZeneca have been
developing blood clots after inoculation, administered in the UK.
according to Aljazeera. In an official statement on
April 2, the Netherlands Health Minister wrote to
the House of Representatives that he is suspending
the vaccination pending a further assessment by Continued from page no.1
the European Medicines Agency (EMA). A report
by EMA is awaited sometime next week.
How to search for vaccination centre near
In response, AstraZeneca released a statement your home on Google Maps
this afternoon saying it was working with Duth
authorities. “Authorities in the UK, European Union, Open Google Maps on your desktop browser. Or
the World Health Organization have concluded you can also open the app on
that the benefits of using our vaccine to protect your iOS or Android device.
people from this virus significantly outweigh the Simply type Covid 19 vaccination centre and the
risks across all adult age groups,” it said. relevant results will appear. Make sure that
location access is turned on for Google Maps. If
NIRT Library News Bulletin
7
location access is turned off, it will not be able to The MapMyIndia Move app also lets users search
show the centres close to where you are located. for vaccination centres. The map can also be
The results for the hospitals or clinics, which are seen on the CoWin portal.
listed as COVID-19 vaccination centres, also
come with some information. For instance, Just open the Move app or
Google Maps will shows whether appointment is Maps.MapMyIndia.com. You will see Vaccination
required at the centre, and that it is limited to Centres as an option in the search box. Tap on it.
certain patients. The centres nearest to your location will appear.
Make sure you have given the app or the website
The search query also says that citizens should location access to ensure correct information.
check with the centre or register in advance.
People are also advised to keep government IDs Remember, it is best to take an appointment
ready for registration. The results also add that the before going to a location for vaccination as
vaccine is available to citizens above 45 years of there maybe queues. Further many places require
age. an appointment in advance, before one can go
and get vaccinated.
Google is relying on the Ministry of Health and
Family Welfare, Government of India for this data
about vaccination centres. Here’s how to register on cowin.gov.in or Aarogya
Setu app. There is no CoWIN app on Play Store for
How to search for vaccination centre near your registration
home on MapMyIndia
First open Aarogya Setu or Cowin.gov.in
website and enter your mobile number, followed
NIRT Library News Bulletin
8
by the one-time password which will come to your The “Book Appointment for Vaccination” page
registered mobile number. Tap on the verify will open. Enter relevant details such as State,
button after entering the OTP. District, Pincode, and click on Search button.
In Aarogya Setu app, go to the CoWin tab, and A list of vaccination centres will appear
tap on the Vaccination tab. depending on your location. You can choose one
of them and then see the vaccination dates
A registration page will appear where you will available at these centres.
need to enter the photo ID type, number, full
name, gender and age. Acceptable IDs are Book the date and slot most convenient to you.
Driving License, Aadhaar Card, passport, etc. Don’t forget to tap or click on “Confirm” once you
have finalised the date.
After the registration process is complete, the
system will display account details. One person An ‘appointment successful’ page should also
can add four more people linked to the same appear. Save those details.
mobile number.
Once the names are registered, a column called
Action will appear. Tap on it and you will see
calendar icon. Click on it to schedule an
appointment.
NIRT Library News Bulletin
9for expansion of production specific to J&J’s
vaccine doses, Emergent added.
“The $23 million will be used for the purchase of
biologics manufacturing equipment specific to
US puts J&J in charge of plant
Johnson & Johnson’s COVID-19 vaccine for the
that botched Covid-19 vaccine, potential expansion of manufacturing of that bulk
drug substance into a third suite of Emergent’s
removes AstraZeneca Baltimore Bayview facility,” the company said.
By: Reuters | Updated: April 5, 2021 10:41:12 am
The Department of Health and Human Services
J&J said it was "assuming full responsibility" of the
facilitated the move, the health official said in an
Emergent BioSolutions facility in Baltimore,
email, asking not to be named due to the
reiterating that it will deliver 100 million doses to
sensitivity of the matter.
the government by the end of May.
AstraZeneca, whose vaccine has not been
The United States has put Johnson and Johnson in
approved in the United States, said it will work with
charge of a plant that ruined 15 million doses of
President Joe Biden’s administration to find an
its COVID-19 vaccine and has stopped British
alternative site to produce its vaccine.
drugmaker AstraZeneca Plc from using the facility,
a senior health official said on Saturday. White House officials did not immediately respond
to a request for comment.
J&J said it was “assuming full responsibility” of the
Emergent BioSolutions facility in Baltimore, The development, first reported by The New York
reiterating that it will deliver 100 million doses to the Times, further hampers AstraZeneca’s efforts in the
government by the end of May. United States. The government has criticized the
drugmaker for using outdated data in the results
In a separate statement late Sunday, Emergent
of its vaccine trial. It later revised its study.
said it expects to align with the US government
and AstraZeneca to ramp down manufacturing Workers at the Emergent BioSolutions plant several
for AstraZeneca’s COVID-19 vaccine at its weeks ago conflated ingredients for the J&J and
Baltimore plant. AstraZeneca vaccines, the Times said earlier in the
week. J&J said at the time the ruined batch had
not advanced to the fill-and-finish stage.
The government’s move to have the facility make
only the J&J single-dose vaccine is meant to avoid
future mix-ups, the Times said, citing two senior
federal health officials.
The top US infectious disease doctor told Reuters
on Thursday the country may not need
AstraZeneca’s vaccine even if it wins approval.
The Department of Health and Human Services The United States has loan deals to send Mexico
and Canada roughly 4 million doses of the
has also increased Emergent’s order by $23 million
AstraZeneca vaccine, made at its US facility.
NIRT Library News Bulletin
10patients reported in the city, 11 of them were
identified as Myanmar citizens.
Ruili is a key transit point for Yunnan province,
China reports biggest daily which has struggled to monitor its rugged 4,000 km
(2,500-mile) border with Laos, Myanmar and
COVID-19 case jump in over 2 Vietnam for illegal immigration amid a wave of
months unauthorised crossings last year by people seeking
a haven from the pandemic.
Local authorities have also begun a vaccination
drive in Ruili in a bid to contain COVID-19 and Local authorities have also begun a vaccination
build up herd immunity in the city. drive in Ruili in a bid to contain COVID-19 and
build up herd immunity in the city.
By: Reuters | April 5, 2021 9:34:14 am
The number of new asymptomatic cases, which
China reported its biggest daily jump in
China does not classify as confirmed cases, stood
new COVID-19 cases in more than two months, as
at 18, matching the total from a day earlier.The
a city on the border with Myanmar in
total number of confirmed COVID-19 cases in
southwestern Yunnan province accounted for all
mainland China now stands at 90,305, while the
new local cases. Ruili’s local government put
death toll remains unchanged at 4,636.
residents in its urban area under home quarantine,
launched a massive testing drive and began
restricting people from leaving and entering the
city from last week after reporting COVID-19
patients.
Preventing crowding very, very
difficult… Need strategies on
what to do despite people not
following Covid norms: AIIMS
chief
By: Express News Service | New Delhi |
Updated: April 5, 2021 9:06:09 am
The city accounted for all of the 15 new local As India grapples with a second wave of Covid-19
cases reported on April 4. The total number of new cases, Dr Guleria has been central to the country’s
COVID-19 infections, including imported infections disease response. As head of clinical research
originating from overseas, stood at 32, marking the group of the national Covid-19 task force, he is
highest total since Jan. 31.Genetic analysis of the instrumental in framing treatment policies.
cases discovered in Ruili suggest the new local
infections stem from viruses imported from The AIIMS chief says vaccination will open up but
Myanmar, state media reported. Of the new “gradually”, advises caution over theories
NIRT Library News Bulletin
11regarding re-infection, addresses the “Bihar grandparents or people with comorbidities… So I
paradox” when polls did not see a surge, and says think it’s too early to say that the mortality is less.
approvals for vaccination in children must be fast-
tracked. The session was moderated by Principal AMITABH SINHA: I understand that we might not
Correspondent Kaunain Sheriff M. have the full details yet, but what is the best
explanation for the five-month slowdown in cases
KAUNAIN SHERIFF M: India is witnessing a second starting mid-September?
wave of Covid-19. How do you read the new One possibility is the link between people showing
numbers? Covid-appropriate behaviour and an aggressive
I think the numbers are worrying… Firstly, this wave containment strategy. Secondly, in some areas, a
is much steeper than what we have seen in the lot of people got the infection and therefore
past. It has taken much less time to cross the developed immunity, breaking the chain of
80,000 cases per day mark this time. Secondly, the transmission. That may have contributed to a
degree of fear or panic that was there when we decrease in cases as well… Now, people said that
had crossed the 80,000-mark last time does not there is good herd immunity in Mumbai, Pune,
seem to exist today. There is no Covid-appropriate because a large number of people got infected
behaviour. Despite the numbers crossing the in these cities (in the first wave). But these cities are
80,000-mark, people are planning holidays, hotels still seeing a surge. We therefore need more
are full at all hill stations. So that is worrying. We epidemiological and genome sequencing data.
don’t have data which suggests that we have a Another possibility that led to the decline earlier
good degree of immunity. A majority of our could be that people developed some degree of
population is susceptible and we are also seeing immunity but the virus itself evolved over a period
new variants of the virus now, which we know can of time and now it has developed some degree
be more infectious. They can also develop of ‘immune escape’. Plus, there were still a large
‘immune escape’, which may allow some degree number of people who were susceptible. The
of reinfections. combination has led to the resurgence that we
are seeing right now.
KAUNAIN SHERIFF M: Are we seeing a significant
difference in the transmissibility and severity of the AMITABH SINHA: Do we have any understanding
disease now? of what could be the proportion of reinfections
We are definitely seeing more transmission. The now?
curve is much steeper and it could be related to That is a difficult question and it is something for
the fact that the virus is more infectious, it is which we urgently need to get data on. The issue
spreading more and we are also allowing it to here is that we know that almost 30-40% of people
spread because of our lack of Covid-appropriate may have asymptomatic infection. These people
behaviour. may have never got tested. They had the
immunity at that point in time, and therefore, they
The second issue is regarding mortality. The data were responsible for bringing the cases down. But
currently is not that strong. There is a feeling that now they may have got the infection again,
this second wave may cause less mortality, but we which we think is the first infection. But actually, it
need to be very careful when we interpret that. may be a reinfection, right?
Currently, the rise in cases is in the younger age
group where we know the mortality is less. We also Our sero surveillance data suggested that at the
know that people in the younger age group will national level, only around 20% people had
take this infection home to their parents or antibodies. In some cities, that figure stood at
more than 50% in some population dense areas.
NIRT Library News Bulletin
12Yet, we are seeing a surge in these areas, where monitored closely over the next few years through
the immunity was believed to be high. That is why characterization of viruses from infected people.
we need to really look at it very critically to know Increased genomic sequencing will also allow us
if the cause for the surge is only related to lack of to catch variants that spread faster or cause more
Covid-appropriate behaviour, is it related to some severe outcomes well in time.
variation in the virus, or is it related to some other
factors. Science has shown the way by fast-tracking
Covid-19 vaccines. We must do more by way of
better communications and building trust to
assure the public that the vaccines are safe and
effective. For the first time in the history of human
disease, we have the historic opportunity to end a
pandemic through vaccines.
A year with the coronavirus: Epilogue
lessons and challenges Unlike old plagues and pandemics, the fear today
is fed more by our understanding of disease than
In the over one year since the pandemic began, of the unknown. “Fear, like the thought of dying,
the response has evolved. A look at what we makes us feel alone, but the recognition that we
have learnt so far, and the challenges that are all experiencing a similar anguish draws us out
remain. of our loneliness,” says Pamuk. He further adds,
“We are no longer mortified by our fear; we
Written by Dr Shahid Jameel | New Delhi | discover a humility in it that encourages mutual
Updated: April 5, 2021 8:13:20 am understanding”.
Family and friends often call to know which of the “Historically, pandemics have forced humans to
two Covid-19 vaccines available in India is better. break with the past and imagine their world anew.
My advice to take whichever is easily available is This one is no different. It is a portal, a gateway
met with apprehensions about adverse effects of between one world and the next. We can choose
vaccines. This is symptomatic of the past year, a to walk through it, dragging the carcasses of our
year full of half-truths, false claims and often prejudice and hatred, our avarice, our data banks
outright lies that became more viral than the virus and dead ideas, our dead rivers and smoky skies
itself. While it has been a remarkable year for behind us,” says author Arundhati Roy, adding,
science and the value it brought to society, there “And in the midst of this terrible despair, it offers us
is little understanding of the scientific method, a chance to rethink the doomsday machine we
which relies on data and evidence. have built for ourselves. Nothing could be worse
than a return to normality.”
As India approaches one year of its lockdown, I
review the year gone by and attempt some We are at an inflection point in our shared history.
cautious crystal gazing into what lies ahead. Will we learn from it for a better future?
However, since this will involve changing the virus-
cell binding interface, it may also lead to less fit
and less virulent viruses. These scenarios should be
NIRT Library News Bulletin
13other states for trying to cover their “failures” in
containing the pandemic by making “deplorable”
attempts through “irresponsible” statements to
distract attention and spreading panic among
Centre increases vaccine people.
supply to Maharashtra, Tope He also said that Chief Minister Uddhav Thackeray
says ‘not enough’ is also going to demand 40 lakh vaccine doses per
week in his meeting with Prime Minister Narendra
Maharashtra Health Minister Rajesh Tope Modi.
claimed that despite having double the
Amid a huge surge in active coronavirus cases,
population of Gujarat and active coronavirus
Maharashtra is staring at a shortage of both beds
cases, Maharashtra was not getting the priority in
and vaccines. With the state estimated to record
getting vaccine doses.
around 60,000 new cases daily for the next few
By: Express Web Desk | Mumbai, New Delhi | days, a bed shortage may just be 7-10 days away.
April 8, 2021 2:45:40 pm The state is opening more Covid care centres in
rural areas and roping in private hospital beds. It is
The Centre has decided to send a stock of 17 lakh also vaccinating more than 4 lakh people per
vaccines to Maharashtra. However, state Health day. But its stock of over 13 lakh doses will last just
Minister Rajesh Tope believes this will not be three days.
enough considering the rising cases in
Maharashtra and the shortage of vaccines. On Wednesday, Tope had said people had to be
turned away from various vaccination centres.
Addressing a press conference, Tope claimed Amid the shortage, Tope also demanded the
that despite having double the population of Centre allow vaccination of the 20-40 age group.
Gujarat and active coronavirus cases,
Maharashtra was not getting the priority in getting The Centre has said Maharashtra could reach 11
vaccine doses. Earlier, the Centre had promised lakh active Covid-19 cases by April 30 if the surge
7.43 lakh vaccines to Maharashtra. continues uncontrolled and no restrictions are put
in place.
“We are questioning why there is discrimination
against Maharashtra. Even this is less because we
need 40 lakh vaccine doses a week and 17 lakh
doses are not enough,” ANI quoted him as saying.
Tope further asked the Centre to not politicise the
issue and support Maharashtra at this juncture.
“We want the Centre to support us at this juncture, Controlling TB: Combating
not oppose us. We are not pulling a political stunt, tobacco and
and request him (Harsh Vardhan) to not politicise
this issue either,” Tope said. tuberculosis together
His statement was in response to Union Health April 1, 2021 2:24 PM
Minister Harsh Vardhan remark yesterday, where
he had lashed out at Maharashtra and some
NIRT Library News Bulletin
14Tuberculosis is a major cause of ill health, the Against Tuberculosis and Lung Disease (The Union)
leading cause of death from a single infectious – allowing for the coordination of national
agent in the developing world programmes of both tuberculosis and tobacco
control together. Further, the toolkit provides pre-
By Dr Vikas Maurya, tested public service announcement, ‘Cough’ in
Tuberculosis is a major cause of ill health, the 17 national and regional languages. ‘Cough’ is
leading cause of death from a single infectious the first-ever campaign highlighting the link
agent in the developing world. Tobacco, between TB and tobacco use and was rated as
particularly smoking is recognized by the medical one of the highest in terms of potential
community as a major public health hazard. It effectiveness for TB prevention and treatment.
affects all part and organs of the body apart from
the respiratory system which is predominantly The mechanism behind association between
affected. smoking and pulmonary tuberculosis seems to be
biological. Smoking tobacco causes changes in
This harmful socio-economic factor was less the structural and functional changes in the
thought of as a contributor to the morbidity and respiratory system and also affects the alveolar
mortality of tuberculosis but since the publication immune cells. The occurrence of tuberculosis is
of first ever review article on association between thought to be linked to altered immune response,
smoking tobacco and tuberculosis in 2002 decrease in immune cells and/or other
(Maurya V et al) in International Journal of mechanisms. All of these factors, in combination,
Tuberculosis and Lung diseases, many such studies may contribute to increased susceptibility of an
and articles have published in last two decades individual to tuberculosis infection and
showing a strong association between smoking occurrence of the disease.
tobacco and tuberculosis infection and disease.
Not only pulmonary tuberculosis but It is therefore recommended to combat tobacco
extrapulmonary tuberculosis has also been linked and tuberculosis together which will help in
to smoking tobacco. Similarly, studies have found decreasing tuberculosis incidence and mortality
increase incidence of positive tuberculin skin test and adopt following principles which are widely
in smokers. Even passive smoking has been linked accepted and developed (WHO). These are:
to increased incidence of pulmonary tuberculosis.
To control tobacco consumption all over the
As per WHO, smoking substantially increases the world, including those areas where people are at
risk of tuberculosis and death from tuberculosis. It risk of tuberculosis infection.
increases the risk of tuberculosis disease by more
than two and a half time. It’s a risk factor for To cross train tuberculosis and tobacco control
tuberculosis, independent of alcohol use and health workers
other socioeconomic risk factors. More than 20%
To register tuberculosis patients’ tobacco, use and
of global TB incidence may be attributable to
offer them counselling and treatment.
smoking. And controlling the tobacco epidemic
will help control the TB epidemic. In this respect,
To promote and enforce smoke-free policies,
one can have a look at the ‘End Tobacco to
particularly where tuberculosis services are
Eliminate TB: Communication Toolkit’, launched
delivered.
by public health organisation Vital Strategies in
collaboration with the National Tuberculosis To integrate brief tobacco control interventions
Elimination Programme (NTEP) of Ministry of Health into tuberculosis control programme activities
and Family Welfare and The International Union
NIRT Library News Bulletin
15To promote smoking cessation practices and six – and the baby were too young to
understand, but Keitu knew enough to be afraid.
(The author is Director and Head, Department of
Pulmonology & Sleep Disorders, Fortis Hospital, She had watched her father waste away for
Shalimar Bagh, Delhi. The article is for informational seven months, even though he took all his
purposes only. Please consult experts and medical medicine before he died. His skin had turned
professionals before starting any therapy or orange; at the end he was too weak to respond
medication. Views expressed are personal and do to her silly songs or whispers of “I love you” as he
not reflect the official position or policy of the gasped for breath on his thin mat. Keitu chanted
Financial Express Online.) quietly to the children during their difficult walk,
“Be brave, be brave, be brave.”
Sustainable solutions for
children and adolescents at risk
of drug-resistant tuberculosis
Project Update30 March 2021 An MSF nurse assessing a nine-year-old patient with
extensively drug-resistant tuberculosis and extra-
They walked in single file through the narrow pulmonary tuberculosis at MSF's independent clinic in
Mumbai. India, March 2021.
alleyways winding away from their tin shack in
Cape Town towards the health centre. Eleven- Keitu was right to be afraid. Half a million people
year-old Keitu carried her baby brother on her become sick with DR-TB each year and the
back as their mother was too frail and could disease is often ruinous for families. Not only is DR-
barely manage on her own. Keitu kept a close TB potentially fatal, households often incur
eye on her two other little brothers as well. They
catastrophic costs when a member of the family
had been acting out since their father died of falls ill. Unfortunately, the current global
drug-resistant tuberculosis (DR-TB) several approach to DR-TB does very little to address the
months earlier, and they were grumpy from not disease in a family-friendly way.
having eaten anything but porridge in the last
three days. Although the World Health Organization (WHO)
recommends that all household contacts of
The nurse working in the health centre had people living with DR-TB be assessed as quickly
begged them to come in. Keitu’s mother had possible after someone in the family is diagnosed
been diagnosed with DR-TB as well and, since
with the disease, poorly resourced programmes
the family all breathed the same air within their can do little more than make lists of the contacts
one-room dwelling, there was a chance the who might have been exposed.
children might have it too. The boys – aged four
NIRT Library News Bulletin
16Outdated and ineffective methods of screening with a daily injection, even though there are
for DR-TB mean that many people who are sick more effective oral options. These injections are
are simply missed. This problem is especially not only extremely painful, but also put their
significant among children since many cannot hearing at risk, a devastating complication for a
produce the sputum needed to diagnose DR-TB. developing child.
Instead, children have to undergo gastric
washing, an intrusive and painful procedure in Médecins Sans Frontières (MSF) is addressing
which a long tube is placed down a child’s nose these family issues in our projects in South Africa
into their stomach to try and suck out any sputum and India. Through our ‘post-exposure
they may have swallowed, to confirm if they protocols’, we are actively seeking out people
have TB. who may have contracted DR-TB and screening
all children and adolescents in a household
Globally, very few household contacts are where someone has been newly diagnosed. We
offered access to preventive treatments after are piloting the use of stool samples, rather than
exposure, even though this is recommended by gastric washing, to test whether children have TB
the WHO and reduces the risk of developing DR- in both hospital and community settings.
TB by 90 per cent. If a sick child is found, they are
often taken from their family and held in a MSF always provides treatment free of charge
hospital for months to receive treatment, and addresses the socioeconomic needs of the
disrupting family bonds, and normal school and families we serve through transportation support
social activities. and food parcels, and by working with partner
organisations to address other social needs
A 10-year-old extensively drug-resistant tuberculosis
survivor is screened for malnutrition at MSF independent
In one project in South Africa, MSF is giving
clinic in Mumbai. India, March 2021.
children and adolescents, who have been
In many places, children are not able to access exposed to DR-TB, but not yet sick, preventive
the most effective medications, including newer treatments to dramatically decrease their
drugs like bedaquiline and delamanid, because chances of developing DR-TB. By actively
they were not included in studies of these looking for the disease in exposed children, we
lifesaving treatments. Instead, they are given are finding those who are infected much earlier,
old, often toxic, medications, which come as allowing us to treat most of them in a community
adult-sized tablets that have to be cut, crushed setting.
and mixed before they can be given to children.
In the worst instances, children are still treated
NIRT Library News Bulletin
17In South Africa, all children receive injectable- regimen with dispersible tablets, which his
free treatments, and in both South Africa and mother gave him each day with yoghurt. In spite
India, MSF has introduced child-friendly of their challenges, the family began to heal and
formulations of some of the most commonly used hope returned to their home.
medications. We have also ensured that children
in the places where we work have access to While MSF’s work has benefitted hundreds of
new, highly-effective TB drugs, including children and families, there are tens of thousands
bedaquiline and delamanid, and that they can in need of such innovative approaches. Keitu
be treated with shorter regimens. and her family faced a challenging journey, as
do thousands of families grappling with DR-TB.
MSF also provides them with nutritional support Stakeholder commitment and far greater
and have developed family-friendly counselling resources are desperately needed to rapidly
programmes to ensure their mental wellbeing is increase the scope of these child-friendly
supported while they are receiving treatment. initiatives. This is the only way to ensure that
families like Keitu’s face a less frightening future
when one of them becomes sick with DR-TB.
So: https://www.msf.org/solutions-young-people-risk-
drug-resistant-tuberculosis
MSF nurses sealing gastric lavage samples to be sent to a
tuberculosis laboratory for diagnosis. India, March 2021.
In Mumbai, India, between January 2016 and India’s tuberculosis goal: A race
mid-March 2021, our team initiated 69 patients
under the age of 18 on treatment. And in the against time!
Khayeltisha and Eshowe projects in South Africa By EH News Bureau On Apr 1, 2021
between2013 and mid-March, almost 100
With current pandemic testing our resilience of
children and adolescents received all-oral
undeterred efforts towards our vision of TB free India, the
therapy with newer drugs.
country is driving for its mission amidst all challenges
through systematic efforts. Dr Vandana Dabla,
Fortunately for Keitu, a family-centred approach
Voluntary Health Services, Accelerating Sustainability of
was offered to them at the clinic. She, the baby, Public Health Systems in India to Prevent, Detect, and
and her six-year-old brother were found to be Respond to Infectious Disease Outbreaks and Other
well and were started on preventive therapy. Her Public Health Emergencies Project and Dr K S
four-year-old brother had been losing weight Sachdeva, Deputy Director General and Head, Central
and his chest X-ray was abnormal. He was TB Division, Ministry of Health & Family Welfare share
started on treatment for DR-TB after a stool some insights on the relentless efforts and strategies to
sample was collected and the disease was realise TB free vision of India, when the country
accounts for a quarter of global TB case burden and
confirmed. He was able to get an all-oral
NIRT Library News Bulletin
18faced with an unavoidable health challenge of global The pandemic, inciting the national lockdown
pandemic certainly challenged the continuity of efforts,
however the immediate action plan was put into
In India, tuberculosis is more than a disease! The force to continue the treatment services. Efforts
country accounts for a quarter of global TB case have been made to deliver uninterrupted services
burden, with its 2.64 million population affected by to already Notified TB patients. Systematic
this disease and documenting 16 per cent monitoring of service delivery cascade from early
mortality. While the country also shares the highest case detection to treatment; and strengthening
international burden of Drug-resistant TB (DR-TB) the online monitoring through NIKSHAY/ Nikshay
cases (27 per cent); it remains as a public health Aushadhi.
threat with only one-third infected patients get
enrolled for DR-TB treatment. The innovative service delivery models were
outlined and applied to district and sub-district
Nonetheless, the current pandemic is also testing levels, with the collaborative efforts from
our resilience of undeterred efforts, eliminating this community organisations, development partners
disease is equally challenging as eliminating its and stakeholders. Home delivery of anti-
stigma. With social stigma and its common risk tuberculosis treatment (ATT) drugs from Primary
factors like immunocompromised population, Health institutions were arranged, with focused
undernourishment, alcoholism, diabetes etc., has attention to uninterrupted ATT Quarantined /
made the eradication more of a fighting task. Isolated TB patients. Special facilities were drawn
However, recalling TB management timelines, towards collection and transportation of priority
India is undoubtedly driving for its mission amidst samples from TB patients. A regular counselling
all challenges. Penetrating services to the smallest schedule was drafted and followed for the on-
districts, a well implemented state level planning treatment TB patients to ensure adherence and
and strategically designed national policies are monitoring. The efforts ensured minimum 72 per
giving every hope to achieve our ambitious aim to cent TB treatment coverage with 84 per cent
eradicate it from the country by 2025. treatment success rate.
India, with its progressive approach, invested its India has come a long way in its approach
efforts in a systematic national strategic plan. It towards tuberculosis management. It’s assuming
finalised and released the operational guidelines an enormous amount of strategic inter-sectoral
for TB services across Health & Wellness centers; collaborative attempts, consistently. Its coherent
implemented “Single Window Services” for all co- endeavour supports the country’s enthusiasm to
infected patients of TB and HIV infection; and mirror the United Nations Sustainable
launched TB Preventive Therapy among Development Goals for healthcare. Although
vulnerable population, in addition to inclusion of challenging in the dynamic phase of public health
private sector engagement to avoid missing any threat, the country is putting its best efforts possible
links in successful management of disease. to attain its TB elimination goal with defined
Moreover, to address the gender-specific strategies, integrated efforts of parallel health
challenges in accessing the TB services, a services and community and stakeholder’s
proactive approach is adopted in 2019 for participation.
gender-specific interventions in TB prevention,
diagnosis and treatment. Further, the research is So: https://www.expresshealthcare.in/blogs/guest-blogs-
being promoted among the species and healthcare/indias-tuberculosis-goal-a-race-against-
phytochemical extraction from medicinal plants time/427974/
for anti-TB drug development.
NIRT Library News Bulletin
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