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Shoes can spread Coronavirus



Proposed Expert: Dr. DR Rai, MAMS, FCGP, IBMS
Internal Medicine Specialist, Hon. Prof. of College of Medical Practitioners, Kota

In October 2020, Health Patrol had carried a report stating that lift and other touch surfaces are potential spread points for the Coronavirus1 which prompted one of our readers to ask if shoes too could spread the Coronavirus. While shoes do carry the virus as has been shown by various studies, there is no evidence yet that the virus can be transmitted by shoes.

A 2020 study published in the Journal of Hospital Infections2 reported that the shoes of healthcare workers and the floor represent hotspots.  A Singapore-based study found a swab sampling from the surface of a shoe front tested positive, while all other PPE samples tested negative. According to the study, the risk of transmission from contaminated footwear is likely low, as evidenced by negative results in the anteroom and clean corridor.3 Consistent with this, a Wuhan-based research team found that half of the samples taken from the soles of shoes of ICU staff were positive.4 Furthermore, all the samples from the pharmacy floor were positive; as patients do not have access to the pharmacy, this implies that the virus may be tracked around on the floor through the shoes of healthcare workers.4 However, there are no reports till date of the Coronavirus being transmitted by wearing shoes that may have been worn by infected individuals. Further reports are awaited.

The WHO5 also says that the likelihood of COVID-19 being spread on shoes and infecting individuals is very low. However, as a precautionary measure, particularly in homes where infants and small children crawl or play on floors, consider leaving your shoes at the entrance of your home. This will help prevent contact with dirt or any waste that could be carried on the soles of shoes.

Frequency of cleaning can be increased for identified contamination hotspots, and disposable shoe covers or disinfection for the soles of shoes may be incorporated into contamination control measures.


2. Zhang DX. J Hosp Infect. 2020; 105(3): 577–579.doi: 10.1016/j.jhin.2020.05.001
3. Ong SW, et al. JAMA. 2020; 323(16):1610-12. doi: 10.1001/jama.2020.3227.
4. Guo ZD, et al. Emerg Infect Dis. 2020;26(7):1583-91. doi: 10.3201/eid2607.200885.


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Fact Check

An apple a day keeps the doctor away



It has been an age old saying that an apple a day keeps the doctor away, but is it really true that an apple can avoid doctor visits altogether? Research shows an apple a day may not keep the doctor away, but it is a healthy choice anyway.

While apples have been shown to improve health and adding them to your diet is a wise step in the right direction, it still remains to be seen if they’re the be-all and end-all of all health troubles. Studies show that eating more apples could be associated with a lower risk of several chronic conditions such as heart ailments.

A study of close to 20,000 adults found that consuming higher amounts of white-fleshed fruits and vegetables, including apples, was linked to a lower risk of stroke which can be attributed to flavonoids, which are compounds found in apples that have been shown to reduce inflammation and protect heart health. Apples are also loaded with soluble fiber, which may help reduce blood pressure and cholesterol levels, both of which are risk factors for heart disease.

Apples contain several compounds that may help prevent cancer formation – a comprehensive review of more than 40 studies reported that consuming a higher amount of apples was associated with a decreased risk of developing lung cancer. Similarly, another study reported that apple consumption is linked to a lower colorectal cancer risk.

Apples have also been linked to several other health benefits that could help keep the doctor away and these include weight loss due to their fiber content, improved bone health, higher brain function, prevention of asthma and reduced risk of diabetes. Studies also show that eating apples could help reduce oxidative stress, prevent mental decline, and slow signs of aging.

 UIN: 213HP117R

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Vaccinated people cannot carry or spread the virus



There have been speculations if vaccination will ensure complete immunity or not. Initial fears were that even vaccinated people could carry and spread coronavirus; however, CDC has confirmed that a new study suggests that vaccinated people may also be far less at risk for transmitting COVID-19 and not just being protected from serious symptoms. In a media interview, the Director of CDC, Dr. Rochelle Walensky has said that vaccinated people do not carry the virus — they don’t get sick and that this has not just been seen in clinical trials, but also in real-world data.

The study, published earlier this week, is the CDC’s first analysis of how well the current vaccines on the market work among frontline works that are at a higher risk of exposure to the virus. These findings are encouraging as there have been reports of a lot of people not going for vaccinations or hesitating for a wide range of reasons including the rumored side effects, the actual side effects, efficacy, etc.

For the CDC report, researchers collected data from nearly 4,000 frontline workers from across the USA and analyzed the original coronavirus strain vaccines as well as the more contagious variants. After a single dose of either the Pfizer-BioNTech or Moderna vaccine, participants’ risk of infection was reduced by 80%. After the second dose, their risk was reduced by 90%, similar to what scientists saw in clinical trials, which showed a two-dose vaccine efficacy rate of around 95%. Therefore, as of now, the results are encouraging and support the fact that vaccinated people are not carriers, nor can they spread the virus.

Although the risk that fully vaccinated people could become infected with COVID-19 is low, any fully vaccinated person who experiences symptoms consistent with COVID-19 should isolate themselves from others, be clinically evaluated for COVID-19, and tested for SARS-CoV-2 if indicated, according to the CDC. The symptomatic fully vaccinated person should inform their healthcare provider of their vaccination status at the time of presentation to care. Fully vaccinated people with no COVID-like symptoms do not need to quarantine or be tested following an exposure to someone with suspected or confirmed COVID-19, as their risk of infection is low. Fully vaccinated people who do not quarantine should still monitor for symptoms of COVID-19 for 14 days following an exposure. If they experience symptoms, they should isolate themselves from others, be clinically evaluated for COVID-19, including SARS-CoV-2 testing, if indicated, and inform their health care provider of their vaccination status at the time of presentation to care.

UIN: 207HP112R

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Nitazoxanide improve COVID symptoms



A number of drugs have been tested and experimented with, in the treatment of COVID-19. One of these includes Nitazoxanide, which inhibits replication of a broad range of respiratory viruses in cell cultures, including SARS-CoV-2. Currently, two phase 3 trials for prevention of COVID-19 are being initiated in high-risk populations, including elderly residents of long-term care facilities and healthcare workers.

In addition to the prevention studies, a third trial for early treatment of COVID-19 is planned.  Another multicenter, randomized, double-blind phase 3 study was initiated by Romark, a pharmaceutical firm in August 2020 for treatment of people aged 12 years and older with fever and respiratory symptoms consistent with COVID-19. Efficacy analyses will examine those participants who have laboratory-confirmed SARS-CoV-2 infection. 

Nitazoxanide is a US-FDA approved antiprotozoal drug, which is reported to also exert broad-spectrum antiviral activity against various viral infections. It has revealed good in vitro activity against SARS-CoV-2 in cell culture assays, suggesting role in COVID-19. It displays the potential to boost host innate immune responses and thereby tackle the life-threatening cytokine storm. Possibilities of improving lung, as well as multiple organ damage and providing value addition to COVID-19 patients with comorbidities, are other important facets of the drug. 

A January 2021 study reports Nitazoxanide proposes great potential for repurposing against COVID-19. The potential of nitazoxanide to inhibit the inflammatory cytokine storm while simultaneously stimulating innate immune responses presents great promise to prevent ARDS. The ability to protect the lung, avert associated multiple organ damage, and the beneficial effects in COVID-19 patients with comorbidities confirm the potential of nitazoxanide in COVID-19.

Current strategy is to enhance bioavailability to increase the efficacy at possibly lower doses. Furthermore, research hypothesizes that directing the drug in high concentration to the target site following oral administration could be achieved by lymphatic targeting of oral particulate carrier. Scientists are hopeful that the targets Nitazoxanide attacks are involved in the pathogenesis of COVID-19; therefore, it be one of the promising new alternatives to COVID-19 therapy.

It is important to note here that no one drug has been declared as the treatment of COVID-19. Across the globe, scientists and clinicians are working hard to come up with a fail-safe treatment protocol for COVID-19. Until that happens, it is advisable to follow all social distancing and hygiene protocols as always.

UIN: 198HP34IP

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Fact Check

Cannabis can be used as a medicine



The cannabis plant and its derivatives have been exploited for centuries for recreational and medicinal purposes, with millions of regular users around the world. The recreational use of cannabis is reflective of its neuropsychiatric effects, such as euphoria, light-headedness and the feeling of anxiety vanishing into thin air. However, research now shows how cannabis appears to have an emerging therapeutic role, especially in chronic disease and as an adjunct to cancer treatment. 

Cannabis is derived from the cannabis plant, Cannabis sativa. It is mainly used as charas, hashish, ganja and bhang. In India, Bhang is not restricted under the Narcotics Act. 

The Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985 has defined cannabis as below:

“(iii) “cannabis (hemp)” means-

  1. charas, that is, the separated resin, in whatever form, whether crude or purified, obtained from the cannabis plant and also includes concentrated preparation and resin known as hashish oil or liquid hashish;
  2. ganja, that is, the flowering or fruiting tops of the cannabis plant (excluding the seeds and leaves when not accompanied by the tops), by whatever name they may be known or designated; and
  3. any mixture, with or without any neutral material, of any of the above forms of cannabis or any drink prepared therefrom;”

Bhang is prepared from the leaves (and seeds) of the cannabis plant. Hence, it is not covered under the NDPS Act, 1985, which bans the production and sale of cannabis resin and flowers, but permits use of leaves and seeds. Mixing of bhang with any part of flowering tops or the resin produced from the cannabis plants, however, is a punishable offence under relevant provisions of the NDPS Act, 1985.

Research shows cannabis leaves-based drugs were found to be effective in alleviating pain and other symptoms in cancer patients after chemo- and radiotherapy in a pilot study conducted in 2018 by Central Council For Research in Ayurvedic Sciences (CCRAS), a research body under the Ministry of AYUSH in collaboration with the Gujarat Ayurved University, Jamnagar on cancer patients undergoing treatment at the Tata Memorial Hospital in Mumbai.

Further to this pilot study, another study is proposed to be conducted at AIIMS this year to examine and validate the efficacy of cannabis in reducing side-effects in patients suffering from breast and cervix cancer. 

Meanwhile, the Council of Scientific and Industrial Research – Indian Institute of Integrative Medicine (CSIR – IIIM) in collaboration with Bombay Hemp Company (BOHECO) is also working towards research to develop cost-effective cannabis based drugs for treatment of pain in cancer, epilepsy and sickle cell anaemia, while cannabis is being cultivated at the Jammu-based Indian Institute of Integrative Medicine (IIIM) research station which has obtained licence from the state government to grow it to study its medicinal properties so that drugs can be developed for the Indian population.

IIIM Director Ram Vishwakarma said they are in talks with the Drug Controller General of India’s office to acquire approval for conducting trials to see the utility of cannabis as medicine in India. 

UIN: 202HP33IP

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Microwaving food kills the Coronavirus



Most of us use microwaves to warm food especially since it is advisable to heat the food to kill the coronavirus—more so people ordering take-aways.  However, there is no definitive response to this yet. So, the answer is still a work in progress.

As of now, what we do know about the virus is that for many types of food, the safe minimum cooking temperature is 165°F (74°C). However, this may be lower for some food types. Studies have looked at temperatures that can kill SARS-CoV-2, the virus that causes COVID-19, in both laboratory media and on N95 respirators. They found that a temperature of 70°C (158°F) could kill the virus. The amount of time needed to achieve this varied by surface.

Health Patrol also carried out a detailed report on surface contamination and how long the virus can survive on various types of surfaces. Let us focus on the microwaving aspect of this contamination.

Microwaves work by producing radio waves that are transmitted into the device at a specific frequency. These waves are absorbed by water molecules in the food, causing them to vibrate rapidly. These rapid vibrations produce the heat that cooks the food.According to the Centers for Disease Control and Prevention (CDC), microwaves can be used to disinfect materials that are microwave-safe. A home microwave may completely kill germs within 60 seconds to 5 minutes. However, the total amount of time that this may take depends on the specific type of germ but whether that amount of power and time can effectively kill SARS-CoV-2 or not, is not confirmed at this time.

Unlike bacteria, viruses cannot grow (replicate) inside of food. In simple terms, they are parasites that need a living host cell in order to make more of themselves. Studies have evaluated how long SARS-CoV-2 can be found on various surfaces, including some common food packaging materials:

  • plastic: between 3 to 7 days
  • cardboard: up to 24 hours
  • glass: up to 4 days
  • paper: up to 4 days

According to the CDC, no cases of COVID-19 have been reported due to handling of food or food packaging. The FDA also agrees—according to them, there is no epidemiological evidence of food or food packaging as the source of SARS-CoV-2 transmission to humans. Furthermore, transmission has not been attributed to food products or packaging through national and international surveillance systems.

While disinfecting foods or food packaging is unnecessary, always wash your hands after handling these items and before eating.

UIN: 193HP102R

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