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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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Coronavirus

Steam Inhalation for a week kills Coronavirus?

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The common misconception is that steam inhalation is beneficial in preventing and treating respiratory tract symptoms. Social media and home-made tutorials from unverified sources have a role in misleading patients, caregivers and most important parents of young children into practising this dangerous habit.1 A social media forward doing the rounds claims steam inhalation kills the Coronavirus because at different temperatures, the virus behaves differently and is ultimately weakened and dies. This is NOT TRUE.

As per a Cochrane Review2, while steam inhalation is traditionally used as a home remedy for common colds and upper respiratory tract infections, the evidence base of the practice is weak, with unproven theories that the steam loosens mucus, opens nasal passages, and reduces mucosal inflammation, or that the heat inhibits replication of viruses.This review found evidence to be equivocal but that it did lead to symptom relief in the common cold. However, overall it found that evidence supporting steam inhalation in the treatment of the common cold was inadequate to recommend it for routine clinical practice.

Whilst none of the trials in the review2 found steam inhalation to cause a worsening of respiratory symptoms, steam inhalation has been associated with other complications, most notably scald injuries. 

The National Institute for Clinical Excellent (NICE) currently recommends3 that steam inhalation may be used as a symptomatic remedy, which may “theoretically help congested mucus drain better and heat may destroy the cold virus, as it does in vitro”. An observational study conducted by Mahajan et al. also concluded that steam can be permitted as an adjunct to social distancing, sanitizers and masks and PPE for effective precaution as well as cure in COVID-19; but this study warrants further extended randomized controlled trials to see the effect of steam on larger groups of patients or healthcare staff.

It is important to note that steam inhalation has been a hazard to children as well. Resulting scalds can ultimately lead to hospital admission, surgery, and life-long disfigurement. Brewster et al. reported that the Burns Centre at Birmingham Children’s Hospital, Birmingham, UK, received a 30-fold increase in the number of scalds directly resulting from steam inhalation. The article published in The Lancet, further emphasized that parental education is paramount to preventing these injuries. Steam inhalation should be actively discouraged and parents should be taught about alternative treatments for their child.

Source:

1.Brewster CT, et al. Lancet. 2020;395(10238):1690. https://doi.org/10.1016/S0140-6736(20)31144-2
2.Singh M, et al. Cochrane Database Syst Rev. 2017; 2017CD001728
3.NHS Clinical Knowledge; 2016. What self-care advice should i give to someone with the common cold? [Internet]. Summaries. Available from: https://cks.nice.org.uk/common-cold#!scenario.
4.Mahajan HN. July 2020 Indian Medical Gazette. https://www.researchgate.net/publication/343262923_Indian_Medical_Gazette_Use_of_Steam_as_Adjuvant-treatment_in_Covid-19_Patients_An_Observational_Study

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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

UV Germicidal lamp is useful for Covid-19

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In the fight against the coronavirus disease 2019 (COVID-19) pandemic, an old weapon has re-emerged.1 Ultraviolet C (UVC) radiation is a known disinfectant for air, water, and nonporous surfaces and has effectively been used for decades to reduce the spread of bacteria, such as tuberculosis. For this reason, UVC lamps are often called “germicidal” lamps.2 In the current pandemic, with disinfection and sanitization being the primary modes of prevention against the Coronaviruses, UV lamps have generated newfound interest for all of us. However, the reports are still not confirmatory as to whether it can be assumed that UV germicidal lamps are useful for COVID-19 or not.

According to a recent FDA report, UVC radiation has been shown to destroy the outer protein coating of the SARS-CoV-1 Coronavirus, which is a different virus from the current SARS-CoV-2 virus. Destruction of this outer protein coating inactivates the virus. Therefore, it is being assumed that UVC radiation may also be effective in inactivating the SARS-CoV-2 virus. However, currently there is limited published data about the wavelength, dose, and duration of UVC radiation required to inactivate the SARS-CoV-2 virus.

Theoretically, UVB and UVA radiations are expected to be less effective than UVC radiation at inactivating the SARS-CoV-2 coronavirus. But, in an August 2020 report, the FDA has elaborated upon the possibility of UVB and UVA in the inactivation of the SARS viruses.2

“UVB: There is some evidence that UVB radiation is effective at inactivating other SARS viruses (not SARS-CoV-2). However, it is less effective than UVC at doing so and is more hazardous to humans than UVC radiation because UVB radiation can penetrate deeper into the skin and eye. UVB is known to cause DNA damage and is a risk factor in developing skin cancer and cataracts.

UVA: UVA radiation is less hazardous than UVB radiation but is also significantly (approximately 1000 times) less effective than either UVB or UVC radiation at inactivating other SARS viruses. UVA is also implicated in skin aging and risk of skin cancer.”

The airborne antimicrobial potential of UVC ultraviolet light has long been established; but its widespread use in public settings is limited as conventional UVC light sources are a health hazard being both carcinogenic and cataractogenic.4

By contrast, we have previously shown that far-UVC light (207–222 nm) efficiently inactivates bacteria without harm to exposed mammalian skin. This is because, due to its strong absorbance in biological materials, far-UVC light cannot penetrate even the outer (nonliving) layers of human skin or eye; however, because bacteria and viruses are of micrometer or smaller dimensions, far-UVC can penetrate and inactivate them.4

Disinfection with far-UVC lamps remains largely experimental but could have an intrinsic advantage. Initial evidence suggests that far-UVC light does not penetrate beyond the outer dead layer of skin cells or the liquid film on eyes in healthy people.3,4 Thus, it cannot cause skin cancer or cataracts, like UVA and UVB. It also seems not to cause temporary skin burns and eye damage (“welder’s flash”) like standard UVC. This presumably depends on the intensity of exposure; whether intense exposure to destroy pathogens on the hands, for example, would be safe is unknown.

However, doctors may need some convincing to accept that some kinds of UV light may be safe to human eyes. “I would like to see more research on longer term exposure before I am convinced,” said Karl Linden, a professor of environmental engineering at the University of Colorado in Boulder, CO, USA. If it can be proven safe at the incidental exposure involved, far-UVC light might prove ideal for disinfecting spaces that always have people in them, like a 24-hour market; they could perhaps also be used to provide constant disinfection in hospitals.1 UV light is also being used to disinfect and re-use hospital face masks.5 In conclusion, the effectiveness of UVC lamps in inactivating the SARS-CoV-2 virus is unknown because there is limited published data about the wavelength, dose, and duration of UVC radiation required to inactivate the SARS-CoV-2 virus. It is important to recognize that, generally, UVC cannot inactivate a virus or bacterium if it is not directly exposed to UVC. In other words, the virus or bacterium will not be inactivated if it is covered by dust or soil, embedded in porous surface or on the underside of a surface. Therefore, until further reports emerge on the efficacy of UV lamps against the Coronaviruses, standard precautions should be taken including wearing masks, social distancing, cleaning and disinfection of all surfaces in contact.

Source:

1.Engineering (Beijing). 2020; 6(8): 851–53.
2.https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/uv-lights-and-lamps-ultraviolet-c-radiation-disinfection-and-coronavirus
3.Radiat Res. 2017;187:493–501.
4.Sci Rep. 2018;8:2752.
5.Engineering 2020;6(6):593–6.

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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

Mortality is very high in Indians due to COVID-19 and the disease is fatal

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This rumor was based on a few social media forwards that stated that there is no hope if you have contracted the novel coronavirus and that the disease is mostly fatal. This is not true. COVID-19 may not have a cure yet, but it is definitely a manageable disease. India’s COVID-19 recovery rate currently stands at 88.63%.  The total positive cases are less than 7.5 lakh and comprise just 9.85% of active cases. Less than 50,000 new cases have been recorded in the last 24 hours.1

An October 2020 report (dated 20th October 2020), showed that while the global case fatality rate (CFR) stood at 2.97% as on date, India is the only country with the highest recoveries and continues to have one of the lowest fatality rates globally. The fatality rate in India is 1.52%, said the Union Health Ministry in a release issued earlier today (20th October 2020).1

Speaking on the subject, eminent physician and cardiologist and Past President of the Indian Medical Association, Dr. KK Aggarwal mentioned that mortality of symptomatic cases of the coronavirus is 1% and if you include asymptomatic cases as well, the mortality is 0.3%. Therefore, the disease is treatable and not always fatal.

Source:

Press Information Bureau, Ministry of Health and Family Welfare Press release, 20th October.
World Report (The Lancet) 2020;396(10252):657

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