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Public Screening is not Reliable

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  • Yes, this is true. One‐time screening in apparently healthy people is likely to miss people who are infected. It is still not proven though if combined screenings, repeated symptom assessment, or rapid laboratory tests are useful.
  • A recent report published in the Cochrane Review1 included two modelling studies one of which reports that symptom screening at travel hubs, such as airports, may slightly slow but not stop the importation of infected cases. The second modelling study reported very low‐certainty evidence that screening of healthcare workers in emergency departments using laboratory tests may reduce transmission to patients and other healthcare workers   
  • With these well-known screening techniques, a high extent of affected people might be missed and proceed to contaminate others, and healthy people might be false-positive, requiring corroborative testing and conceivably prompting the isolation of these people.
  • The study thus concluded that the poor sensitivity of existing approaches point to the need for greater emphasis on other ways that may prevent transmission such as face coverings, physical distancing, quarantine, and adequate personal protective equipment for frontline workers.
  • Therefore, because screening can miss people who are infected, public health measures such as face coverings, physical distancing, and quarantine for those who are apparently healthy, continue to be very important.

Source:
Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD013718. 

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Coronavirus

Is there a possibility of reinfection in COVID patients?

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Yes, there is possibility of reinfection in COVID-19 patients. In September 2020, Health Patrol had published that the Coronavirus has been seen to recur in patients from some countries. In continuation of this discussion, recent reports further indicate that there are confirmed cases of reinfection from different parts of India viz Bengaluru, Hyderabad and Mumbai.1,2,3 Researchers from the Government Institute of Medical Sciences, Greater Noida, and the Institute of Genomics and Integrative Biology (IGIB), New Delhi, recently uploaded a preprint paper4 confirming two cases of reinfection from India.

A recent study5 published in the journal Lancet Infectious Diseases also found evidence of reinfection and reported that COVID-19 patients might develop more severe symptoms in case of reinfection. The study based its observations on the case of a 25-year old American man who got reinfected, with the second infection resulting in hospitalization with oxygen support. As researchers accumulate more examples of reinfection, they should be able to sort out these possibilities, as per an October 2020 report published in the journal Nature.6 The Indian Council of Medical Research (ICMR) also calls for sustained caution against COVID-19 and pointed out that any negligence could lead to reinfection. Previous exposure to SARS-CoV-2 might not guarantee total immunity in all cases. Thus, all individuals, whether previously diagnosed with COVID-19 or not, should take identical precautions to avoid infection with SARS-CoV-2.7

Source:

1.https://theprint.in/health/two-confirmed-covid-19-reinfections-in-telangana-increase-concerns-about-immunity/489589/
2.https://science.thewire.in/health/mumbai-resident-doctor-covid-19-positive-reinfection/
3.https://www.thehindu.com/news/national/karnataka/bengaluru-reports-first-case-of-covid-19-reinfection/article32532841.ece
4.https://osf.io/4fmrg/
5.Lancet Inf. Dis. 2020; https://doi.org/10.1016/ S1473-3099(20)30783-0
6.Nature. 2020;585;168-69.
7.Lancet Inf. Dis. 2020; https://doi.org/10.1016/ S1473-3099(20)30764-7

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Coronavirus

Fruits and vegetables do not spread Coronavirus

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SARS-CoV-2 is primarily transmitted from person to person through respiratory droplets that are either inhaled directly or enter the mouth, nose, or eyes by contaminated hands. There is no current evidence that SARS-CoV-2 is transmitted through food consumption.1 According to the latest evidence, the presence of coronavirus in the sewer has been confirmed, but there is no evidence that it is transmitted through sewage or contaminated drinking water. Also, SARS-COV-2 transmission through food, food packages, and food handlers has not been identified as a risk factor for the disease.2 

 However, it is advisable3 to strictly follow some rules to effectively prevent any chances of transmission through food or water.

  1. Always practice good hand hygiene once you get home from grocery shopping or restaurant take-away.
  2. Rinse off fruits and vegetables thoroughly with water before consumption.
  3. Do not share dinnerware or cutlery with others.
  4. Transfer take-away food into your own containers. Heat the food before consumption.
  5. At the store, maintain at least 6 feet of distance between yourself and other shoppers.
  6. Avoid shaking hands, hugs, or other physical contact.
  7. Wear plastic disposable gloves to touch any surfaces like grocery carts or basket handles.
  8. Avoid touching your face while at the store or driving back from the store until you can reach home and wash your hands and face thoroughly.
  9. Use sanitizers wherever possible.

Stay at home if you have symptoms such as fever or cough. Wearing a mask may help prevent transmission to others at home.

Masking and washing your hands frequently and maintaining distance between yourself and others are the best ways to prevent illness.

Recent studies4,5 have shown that SARS-CoV-2 may remain infectious on surfaces or objects from a few hours to days, and therefore, after unpacking fruits and vegetables, groceries, or take-away food, wash your hands with soap and water for at least 40-60 seconds, or use hand sanitizer for effective prevention of transmission.

Source:
1.JAMA. 2020;323(19):1982.
2.AMB Express. 2020;10(1):92.
3.JAMA. 2020;323(15):1516.
4.Am J Respir Crit Care Med. 2020;202(5):P15-P16.
5.Food Control. 2021;121:107661.

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Coronavirus

People with blood type O may have lower risk of COVID infection

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People with blood type ‘O’ may have lower risk of COVID infection and this has been recently researched. Two studies1,2 published in the October 2020 edition of journal Blood Advances have reported that people with blood group ‘O’ may indeed have a lower risk of COVID-19 infection and reduced likelihood of severe outcomes, including organ complications, if they do get sick. Based on their findings, the two studies concluded that COVID-19 patients with blood group A or AB are at increased risk for requiring mechanical ventilation vs those with blood group O or B. COVID-19 patients with blood group A or AB appear to exhibit a greater disease severity than patients with blood group O or B and that Blood group O is associated with a decreased risk for contracting SARS-CoV-2 infection.

A Danish study1 compared the health registry data from more than 473,000 individuals tested for COVID-19 to data from a control group of more than 2.2 million people from the general population. Among the COVID-19 positive, they found fewer people with blood type O and more people with A, B, and AB types. These study results from the Danish population also suggest that people with blood types A, B, or AB may be more likely to be infected with COVID-19 than people with type O.

Further analysis of the reports elaborates how blood groups A and AB are associated with an increased risk of severe clinical outcomes of COVID-19 infection and therefore, people with blood groups A or AB appear to exhibit greater COVID-19 disease severity than people with blood groups O or B.3 Similarly, researchers examined data from 95 critically ill COVID-19 patients hospitalized in Vancouver, Canada and found that patients with blood groups A or AB were more likely to require mechanical ventilation. These results suggested that they had greater rates of lung injury from COVID-19. They also found more patients with blood group A and AB required dialysis for kidney failure. Furthermore, critically ill COVID-19 patients with blood group A or AB are associated with an increased risk for requiring mechanical ventilation, CRRT, and prolonged ICU length of stay compared with patients with blood groups O or B. In conclusion, these findings suggest that patients in these two blood groups may also have an increased risk of organ dysfunction or failure due to COVID-19 than people with blood types O or B.

Source:
1.Blood Adv. 2020; 4 (20): 4990-93
2.Blood Adv. 2020; 4 (20): 4981-89
3.Clin Epidemiol. 2020;12:875-81

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Coronavirus

Does Vitamin D protect against the Coronavirus?

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Vitamin D3, also known as the ‘Sunshine Vitamin’ has gained increased interest over the past couple of years due to its role in the general well-being in bone health. This vitamin is produced in the skin through the action of UVB radiation reaching 7-dehydrocholesterol in the skin, followed by a thermal reaction.1 Vitamin D has many mechanisms by which it reduces the risk of microbial infection and death. It enhances cellular innate immunity partly through the induction of antimicrobial peptides, which exhibit direct antimicrobial activities against a spectrum of microbes, including Gram-positive and Gram-negative bacteria, enveloped and nonenveloped viruses, and fungi.1

As per a study published in the renowned journal Lancet2, Vitamin D also enhances cellular immunity, in part by reducing the cytokine storm induced by the innate immune system. The innate immune system generates both pro-inflammatory and anti-inflammatory cytokines in response to viral and bacterial infections, as observed in COVID-19 patients.2 

It is also important to note that serum vitamin D [25(OH)D] concentrations tend to decrease with age3, which may be important for COVID-19 because there is an increase seen in case-fatality rates as age progresses.4 It is known that vitamin D stimulates innate immunity and modulates acquired immunity,5 explaining at least in part how vitamin D may fight against acute respiratory infections. Moreover, a former director of the Center for Disease Control and Prevention (CDC), Dr. Tom Frieden, proposed using vitamin D to combat the COVID-19 pandemic.6

Some retrospective studies7 have also demonstrated a correlation between vitamin D status and COVID-19 severity and mortality and several other studies8 demonstrated the role of vitamin D in reducing the risk of acute viral respiratory tract infections and pneumonia.

In conclusion, there is evidence that Vitamin D can protect against the Coronavirus. Vitamin D deficiency is an easily modifiable risk factor of respiratory infections and should be actively corrected through supplements. Given how Vitamin D deficiency is very common across the globe, especially during the ‘cold’ season owing to a lack of sunlight exposure, and given that containment at home would prevent sunlight exposure for many people worldwide, even in spring/summer, researchers believe that Vitamin D supplementation should be encouraged, at least in any individual with risk factors of Vitamin D deficiency (e.g. obesity, old age, dark skin, wearing covering clothes, no sunshine exposure).9 

Source:

1.Expert Opin. Biol. Ther. 2007;7:1449–61.
2.Lancet. 2020 doi: 10.1016/S0140-6736(20)30183-5.
3.Orv. Hetil. 2011;152:1272–77.
4.Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41:145–51.
5.J Intern Med. 2018;284:145–162.
6.https://www.foxnews.com/opinion/former-cdc-chief-tom-frieden-coronavirus-risk-may-be-reduced-with-vitamin-d
7.Nutrients. 2020; 12(4): 988.
8.J Infect Public Health. 2020; 13(10): 1373–80
9.J Glob Antimicrob Resist. 2020; 22: 133–34.

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Coronavirus

Extreme fatigue persists even post-COVID-19 recovery

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With COVID-19, evidence is mounting that some people who have had relatively mild symptoms at home may also have a prolonged illness. It is estimated that nearly 75% of patients complain of prolonged signs and symptoms for weeks or months after making a full recovery (testing COVID negative).5 Long haulers, as they are being called, can experience mild to severe symptoms. Support groups on social networking sites have a lot of long-haulers, comprising COVID-19 survivors, who talk about and discuss the struggle to get out of bed, or to work for more than a few minutes or hours at a time, making this a real problem with COVID-19 survivors.

Overwhelming fatigue, palpitations, muscle aches, pins and needles and many more symptoms are being reported as after-effects of the virus. Over the past nine months, an increasing number of people have reported crippling exhaustion and malaise after having the virus.1 Professor Paul Garner2, of The Infectious Diseases Division at Liverpool School of Tropical Medicine, described his experience of COVID-19 as a roller coaster of ill health, extreme emotions, and utter exhaustion. A recent study published in Journal of American Medical Association found that in patients who had recovered from COVID-19, 87.4% reported persistence of at least 1 symptom, particularly fatigue and dyspnea.3 Post-viral fatigue was also seen in a quarter of those infected with the original severe acute respiratory syndrome (SARS) virus in Hong Kong in 20034 which makes it important to understand the post-COVID-19 fatigue. Evidence from previous coronavirus outbreaks, especially the SARS epidemic, suggests that these effects can last for years.1

A study3 from Rome with people post-COVID-19 recovery found that 53% had reported fatigue and 43% had shortness of breath an average of 2 months after their symptoms started. Similarly, a report6 from China showed that 25% had abnormal lung function after 3 months, and that 16% were still fatigued.

Speaking on the subject, eminent clinician and Past President of the Indian Medical Association, Dr. KK Aggarwal mentioned that while cytokine fatigue occurs in the first 9 days and continues up to 28 days, fatigue from COVID-19 is being seen to last for up to 3 months leading to signs of Chronic Fatigue Syndrome, which is a severely debilitating condition. He further added that this could start with the first signs and symptoms of COVID-19 or right after the patient recovers and could be due to prolonged exacerbation of symptoms after physical, cognitive or orthostatic exertion or stress e.g. unrefreshing sleep after sleeping for many hours. calculations, reasoning short memory, spatial disorientation are also some of the signs. Worsening of symptoms after maintaining an upright posture can also be seen in these patients. Details can be accessed on https://www.facebook.com/watch/?v=898525210554041 When it comes to treating chronic fatigue, the emphasis previously has been on effective treatment of the underlying disease, with the understanding that tackling the root cause would help ease the fatigue. However, for most viral infections, there is no specific treatment, and because COVID-19 is so new, research is still underway in its prevention and treatment.

Source:

1.Nature 2020;585, 339-41.
2.https://blogs.bmj.com/bmj/2020/05/05/paul-garner-people-who-have-a-more-protracted-illness-need-3.help-to-understand-and-cope-with-the-constantly-shifting-bizarre-symptoms/
4.JAMA. 2020;324(6):603-05.
5.Arch Intern Med. 2009;169(22):2142-2147.
6.https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/coronavirus-symptoms-why-7.breathlessness-and-fatigue-are-two-most-post-covid-common-symptoms/photostory/78632446.cms
8.EClinicalMedicine 2020;25, 100463.

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