A recent survey conducted by CSIR (Council of Scientific Industrial Research), Government of India, has revealed that smokers and vegetarians are less likely to contract Covid-19 infection. The survey suggested smoking may be protective, despite Covid-19 being a respiratory disease, due to its role in increasing the mucous production that may be acting as the first line of defense among the smoking population. It indicated that vegetarian food rich in fiber may have a role to play in providing immunity against COVID-19 due to its anti-inflammatory properties by modification of gut microbiota.

The pan India survey was conducted by an eminent team of 140 doctors and research scientists to study the presence of antibodies against SARS-CoV-2, the virus that causes Covid-19, and their neutralization capability to infer possible risk factors for infection. The study assessed 10,427 adult individuals working in more than 40 CSIR laboratories and centers in urban and semi-urban settings spread across and their family members. These people voluntarily participated in the study.

Earlier, two studies from France and similar reports from Italy, New York, and China reported lower Covid infection rates among smokers. A study by America’s Centers for Disease Control and Prevention (CDC), which examined over 7,000 people who tested positive for COVID-19, also vindicated the above findings. Interestingly, the study found that only 1.3 percent of survey participants were smokers, compared to the CDC report that 14 percent of all Americans smoke.

Similarly, UCL (University College London) academics that looked at 28 papers across the UK, China, US, and France found the proportions of smokers among hospital patients were ‘lower than expected. One of its studies showed that in the UK the proportion of smokers among COVID-19 patients was just five percent, a third of the national rate of 14.4 percent. Another found in France the rate being four times lower (7.1% vs 32% among all population). In China, a study noted that only 3.8 percent of patients were smokers – despite more than half of the population regularly smoking cigarettes.

In a separate study by Jin-jin Zhang to understand the influence of smoking behavior on the susceptibility to Coronavirus observed that only 9 (6.4%) patients had a history of smoking, and 7 of them were past smokers. The study found that smoking populations were less likely to be infected with SARS-CoV-2. These findings were also confirmed by a French study of public health data that showed people who smoke, were 80% less likely to fall prey to COVID-19 than non-smokers of the same age and sex.

The Council of Scientific & Industrial Research (CSIR), known for its cutting-edge R&D knowledge base in diverse S&T areas, is a contemporary R&D organization. Having a pan-India presence, CSIR has a dynamic network of 40 national laboratories, 39 outreach centers, 3 Innovation Complexes, and 5 units. CSIR’s R&D expertise and experience are embodied in about 4600 active scientists supported by about 8000 scientific and technical personnel.

CSIR covers a wide spectrum of science and technology – from radio and space physics, oceanography, geophysics, chemicals, drugs, genomics, biotechnology, and nanotechnology to mining, aeronautics, instrumentation, environmental engineering, and information technology. It provides significant technological intervention in many areas with regard to societal efforts which include environment, health, drinking water, food, housing, energy, farm and non-farm sectors. Further, CSIR’s role in S&T human resource development is noteworthy.

CSIR is ranked at 84th among 4851 institutions worldwide and is the only Indian organization among the top 100 global institutions, according to the Scimago Institutions Ranking World Report 2014. CSIR holds the 17th rank in Asia and leads the country at the first position.

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New Delhi: The infectious rage of COVID-19 doesn’t seem to cease. So, the feasible solution turns out to prevent and coexist with this. Of several preventive public health measures being practised ever since its outbreak, wearing the mask is supposed to be the most effective, feasible and affordable measure, which needs public attention and adaptation.

Considering the essence of wearing a mask, and making this message wide-spread to bring behaviour change, HEAL Foundation — a healthcare advocacy group in association with ICCIDD organised the largest 2^nd India Healthcare e-SUMMIT on 6^th August 2020 with a special session on the Science of Mask — linking ancient wisdom with modern science. The session covered wide-range of topics on mask wherein eminent Educationist & Padma Awardee, Dr Pushpesh Pant elaborated on the history of mask and its connections with India’s cultural heritage.

Also, ‘Independence from Coronavirus Movement’ via “MASK is MUST” campaign was launched by the HEAL Foundation. This campaign has started at the right time, which may be instrumental in breaking the infection chain and bringing behaviour change amongst the masses.Introducing a nationwide campaign ‘Mask is Must’ as a single point intervention to prevent the surge of COVID-19 and its undeterred rage in India, Dr Swadeep Srivastava, Founder, HEAL Foundation appealed the people to follow ‘Mask-Wearing’ religiously as it has certain benefits.

Elaborating on the essence of wearing a mask and the scientific reasons behind it, Prof K Srinath Reddy, President, Public Health Foundation of India (PHFI) & Padma Awardee, said, “It is imperative to wear a mask as the COVID-19 virus enters the body through two main gateways — nose and mouth. And mask covers both. By wearing a mask one can prevent infection. If we speak loudly we discharge more virus in the air, but when we sneeze or cough, we discharge over 2 hundred million viruses, which increase the chances of more people getting infected.”

“Also, wearing mask protects you from getting infected from others and the vice-versa. These are the scientific reasons behind wearing a mask. Alone hand washing and mask-wearing reduces 60% chances of infection. Mask wearing campaign is a very much required initiative in this crucial time as such campaigns are supposed to bring behaviour change amongst masses”, added Prof Reddy.

Linking ancient wisdom to modern science and the essence of the mask, Dr Chandrakant S Pandav, President, ICCIDD & Leading Global Health Expert, said, “Mask is quintessential to stay safe from any infection and especially from COVID-19 as this is the part of our culture. And our honorary PM has set a new paradigm of being the public health practitioner. Mask in some form or the other and hand washing has been the part of our ancient culture. ‘Mask is Must’ to fight the COVID-19 infection.”

“However, to stay integrated and healthy, we have to follow 3M’s — ‘Mantra Jaap’, ‘Meditation’ and ‘Music’. And I am thankful to our honourable PM for recognising the ancient wisdom of Yoga and declaring 21^st June as ‘World Yoga Day’. Mask plays a vital role in protecting you from infection. We should pledge to ‘Ask for Mask’ to bring behaviour change in our society, which is very important to fight this pandemic”, added Dr Pandav.

On attuning with ‘Making of the Mask — Tender, Loving, Care’ Prof Sheetal Vij, Premium Faculty Member, World Peace University, Pune, said, “Masks have been used since antiquity for both ceremonial as well as practical purposes. In the pre-pandemic, the mask for me was just a normal thing to protect your face, but now, it has become essential. In ancient time it was used for ceremonial purposes, however, in 2020, it has turned out as a healer.”

At the end of the last session of 2^nd India Healthcare e-SUMMIT, recognising the contribution of ‘Real-Life’ Heroes who worked relentlessly to serve the community in need during COVID-19 crisis, HEAL Foundation in association with ICCIDD conferred COVID Hero Award 2020 to eight individuals from different sections of society for their exemplary deeds.The session was moderated by Mr Rajeev Mehrotra, Trustee & Secretary, Foundation for Universal Responsibility of HH The Dalai Lama.

Alo read: COVID TO STAY IN INDIA : LIFE TO CONTINUE IN NEW NORMAL

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In India, COVID-19 pandemic has turned several people jobless and many more are working with 50-75% of their salary.  So, the economic impact of COVID-19 on a common man has been huge, mainly disruptive. Further, there is this fear factor among’st all-have I got exposed to the deadly virus?  Am I immune to the infection? Am I in the asymptomatic phase of the infection? Whether can I go out for work?  If I go out for work, am I exposing my family members to the risk of COVID-19 infection?  By hearing the news of continuous increase in the rate of COVID-19 infections every day, the major question that arises in the mind of a common man is, are we in the stage of community transmission of the infection? All these questions have caused mental distress too.

Antibody screening to fight against COVID-19 infection:

As per WHO, the community transmission is evidenced by the inability to relate confirmed cases through chains of transmission for a larger number of cases and with increasing number of   COVID-19 positive tests, as we are experiencing now.  Majority of the positive cases do not have any concreate evidence of how they got infection in the current lock-down situation.  For all these questions, antibody screening assays can prove to be a silver lining and will help to develop confidence among the public to fight against COVID-19 infection.

Antibody screening assays for COVID-19 infection are easy to perform and operator friendly. These tests use blood/serum samples. The sample collection for antibody testing is easy, unlike the complication involved with respiratory track fluid samples collection, as shown in the television channels and social media, for the RT-PCR or antigen-based assays. The antibody tests are designed to detect whether people have been previously infected with COVID-19 virus and have developed antibodies to it or not.  It helps to differentiate the common cold infection from COVID-19 infection to certain extend, when the testing is done after 5 – 8 days of symptoms onset.

Recent studies also concluded that Anti-SARS-CoV2 antibodies provide some level of protection or immunity from getting the viral infection again.  The presence of antibodies especially IgG antibodies in the blood, in a common man without any clinical symptoms, helps in allaying the fear and anxiety especially in health care workers, office employees, front line workers, corona warriors, etc.,as they continue to work or resume back. Antibody test results, if used in conjunction with clinical history, patient’s symptoms along with other diagnostic tests like RT-PCR or antigen tests, may be helpful to establish the diagnosis of COVID-19 infection and enable to provide effective treatment to those infected.

The most common type of antibody tests currently in use are ELISA (enzyme-linked immuno-sorbent assay) and CLIA (chemiluminescence immunoassay) tests. Both are laboratory-based tests performed in blood samples and measure the antibody levels.  While performing the antibody tests, it is very important to understand the specificity of the test.  If the antibody test method lacks good specificity, it may provide false results.

Those people with false positive results may increase the risk of getting infection and pave way for continued transmission of infection to others.  Ortho Clinical Diagnostics launched VITROS Anti-SARS-CoV2 Total antibody and VITROS Anti-SARS-CoV2 IgG antibody screening assays,based on CLIA method,with 100% clinical specificity and no cross-reactivity with other respiratory track viral infections.  These tests are available in most of the clinical laboratories and hospitals in India.

Also Read: FIVE IMMUNITY BOOSTING HERBS TO KEEP DISEASES AT BAY

Dr. K. Cheirmaraj
National Manager – Technical Support
Ortho Clinical Diagnostics, India

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Cytokine storm appears to be common in severe cases of COVID-19. This is an umbrella term wherein a massive release of cytokines; i.e. immune proteins that may lead to multi-organ involvement. This uncontrolled reaction can occur in a variety of conditions, including infections, organ damage and autoimmune disorders. Cytokine Storm can be life-threatening and may require urgent intervention. Early studies suggest that up to 67% of hospitalized COVID-19 patients may present with additional organ dysfunction syndromes, other than lungs that may be induced by a high level of circulating cytokines. ^[1]

Dr Rajesh Pandey, Intensivist, BLK, Delhi says “According to Chinese researchers with much experience of managing COVID-19 patients, Continuous Renal Replacement Therapy (CRRT) is not justrenal support, but also helps in curbing the cytokine storm and multi-organ support in critically ill patients. ^[5] In situations where patients may not be able to sustain rapid changes in body fluid balance and metabolic fluctuations and in situations where other extra corporeal therapies are required like invasive ventilator support, continuous RRT can be used as an integrated system and are preferred over parallel systems, as was highlighted by a small retrospective study in COVID-19 patients requiring invasive mechanical ventilation, where CRRT was associated with a significant reduction in mortality (74.6% Vs. 54.5% p=0.032) than those treated without CRRT. ^[6] “

Given that many of COVID-19 patients may have multiorgan dysfunction or failure CRRT might be a better option for patients on multiple extracorporeal therapies. “As per the recommendation of American Society of Nephrology and in the COVID-19 pandemic scenario, the CRRT maybe one of the preferred modalities, especially for those who have hemodynamic instability. CRRT is a blood purification therapy applied for 24 hours a day. At present, among the other therapies being used, CRRT is beneficial to maintain volume balance, hemodynamic stability andto improve the clearance efficiency ofmiddle-sized molecules such as cytokines especially when used with adsorptive filters which can help with improved clearance of cytokines from circulation”,^[7] said Dr Deepak Govil, Intensivist, Medanta.

He further added, “One such adsorptive filter available in India is Oxiris, which amidst COVID-19 pandemic crisis has also received emergency use authorization from the US Food and Drug Administration (FDA) for COVID-19 treatment, moreover the use of this filter can provide multiple blood purification therapies simultaneously, including cytokine removal or/and CRRT.”

In addition to the above-mentioned benefits, Chinese researchers recommend CRRT treatment should also be used in other non-renal indications, especially to control cytokine storm, appropriate early intervention should be made when ARDS, right heart failure and capacity overload occurs at the initial stage, CRRT should be activated to implement three-level management capacity to better support cardiopulmonary function. ^[8] Overall, along with ventilators the hospitals should also plan and manage adequate supply for dialysis equipment and associated supplies not only for outpatient use but also critically ill patients in intensive care units.

References:

1. Ronco C, Reis T, De Rosa S. Coronavirus epidemic and extracorporeal therapies in intensive care: si Vis pacem para bellum [published online ahead of print, 2020 Mar 13]. Blood Purif. 2020; 1–4. doi:10.1159/000507039

2. https://www.asn-online.org/ntds/resources/Webcast_2020_04_21_AKI!NOW.mp4

3. Chinese Medical Association, Expert consensus on the Application of Special Blood purification Technology in severe COVID-19 Pneumonia Branch of Nephrology, Chinese Medical Association Professional Committee of Nephrology, Chinese Research Hospital Association

4. Yi Yang*, Jia Shi*, Shuwang Ge et al. Effect of continuous renal replacement therapy on all cause mortality in COVID-19 patients undergoing invasive mechanical ventilation: a retrospective cohort study. https://doi.org/10.1101/2020.03.16.20036780

5. Chinese Medical Association, Expert consensus on the Application of Special Blood purification Technology in severe COVID-19 Pneumonia Branch of Nephrology, Chinese Medical Association Professional Committee of Nephrology, Chinese Research Hospital Association

6. Chinese Medical Association, Expert consensus on the Application of Special Blood purification Technology in severe COVID-19 Pneumonia Branch of Nephrology, Chinese Medical Association Professional Committee of Nephrology, Chinese Research Hospital Association.

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