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Rinsing the nose with saline protects against the coronavirus

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It is well known now that the nasal mucosa represents a vulnerable area for coronavirus to colonize for its abundant blood vessels, mucinous glands and serous glands which create a humid environment. As reported earlier, angiotensin converting enzyme-2 (ACE2) expression was found in the basal layer of the nonkeratinizing squamous epithelium in nasal mucosa, indicating that coronavirus may infect nasal mucosa cells if basal layer is exposed due to nasal mucosa barrier breakdown.1 It has been seen that human coronavirus causes disruption of the ciliated epithelium and ciliary dyskinesia which can impair mucociliary clearance. Damage to the respiratory epithelium, due to coronavirus infection, may occur without overt clinical symptoms.2 Therefore, it is mandatory to pay attention to the protection of upper respiratory tract and mucosa.

Nasal rinsing is often recommended as an additional non-pharmacological preventive strategy to clean the nasal cavities by removing antigens, inflammatory mediators, and microorganisms such as bacteria and viruses; in particular, nasal rinsing can reduce the viral load in the nasal cavities. The data supporting nasal rinsing for coronaviruses may not be aplenty, but there are few studies on the use of saline nasal irrigation  as preventive strategy of upper respiratory tract infections (URTIs).

For e.g., Slapak et al.3 showed that the use of nasal rinsing three times daily for 8 weeks, reduced URTI episodes more than the control group without treatment, with a consistent improvement in symptoms, medication consumption, reported illness, school absence, and complication rate. Similarly, Tano and Tano4 suggested that a daily nasal spray with saline can prevent nasal symptoms of common cold in a population of otherwise healthy adults.

Recently, Ramalingam et al.5 conducted a pilot, randomized controlled trial of nasal rinsing and gargling versus standard care, in healthy adults within 48 hours of URTI onset to assess recruitment, acceptability, symptom duration, and viral shedding of a large number of viruses such as rhinovirus, enterovirus, influenza A virus, and coronavirus. At the end of the study, the authors showed that in the intervention arm, duration of illness was lower by 1.9 days, over-the-counter medications use by 36%, transmission within household contacts by 35% and viral shedding by ⩾0.5 log10/day. When individuals infected with similar viruses (rhinovirus, coronavirus, enterovirus, and influenza virus) were compared, 30% more individuals had reduction in viral shedding by ⩾0.5 log10 per day in the intervention arm.

Studies have thus indicated that nasal rinsing plays a defensing role in improving the innate antiviral immunity of the nasal mucosa cells, for e.g., another study suggested that epithelial, fibroblast, and hepatic cells have enhanced antiviral activity in the presence of increasing concentrations of sodium chloride even in the case of infection with a coronavirus.6.

Nasal rinsing is inexpensive and can be performed at home. It is rarely accompanied by adverse effects, although the use of hypertonic solutions can lead to the irritation of nasal mucosa and a greater sensation of burning in some cases.7 It is also known to cure sinusitis and migraine related symptoms that are commonly associated with with the common cold.

  1. Yan Y, Chen H, Chen L, et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019. Dermatol Ther. 2020; DOI: 10.1111/dth.13310.
  2. Chilvers MA, McKean M, Rutman A, et al. The effects of coronavirus on human nasal ciliated respiratory epithelium. Eur Resp J 2001;18(6):965–70.
  3. Slapak I, Skoupá J, Strnad P, et al. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch of Otolaryngol–Head & Neck Surg 2008;134(1):67–74.
  4. Tano L, Tano K. A daily nasal spray with saline prevents symptoms of rhinitis. Acta Oto-Laryngologica 2004;124(9):1059–62.
  5. Ramalingam S, Graham C, Dove J, et al. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Scientific Reports 2019;9(1):1015.
  6. Ramalingam S, Cai B, Wong J, et al. Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels. Sci. Rep 2018;8(1):13630.
  7. Casale M, Moffa A, Cassano M, et al. Saline nasal irrigations for chronic rhinosinusitis: From everyday practice to evidence-based medicine. An update. Int J Immunopath and Pharmacol2018;32:2058738418802676.

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Coronavirus

Everyone can benefit from a probiotic

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Probiotics are live microorganisms that can be consumed through foods such as curd/yoghurt and through supplemental forms. Studies show that the balance or imbalance of bacteria in your digestive system is linked to overall health and disease and probiotics promote a healthy balance of gut bacteria. They are used in managing and treating a variety of disease states. They are live microorganisms that are known to help improve gut health and include benefits for weight loss, digestive health, immune function and more.

However, current research suggests that probiotic supplements may not benefit everyone and should not be prescribed as a one-size-fits-all supplement. However, when taken in moderation according to your clinician’s advice, probiotics have a plethora of benefits reported in literature. Recent researches point out that changes in the gut microbiota would lead to a systemic inflammation that in different ways would reach the CNS modulating inflammatory pathways and especially the microglia, which could influence responses to treatments. Probiotics have therefore shown antidepressant responses and anti-inflammatory effects.

Studies also show probiotics promote mental flexibility and alleviate stress in healthy older adults, along with causing changes in gut microbiota. The probiotics exert their beneficial effects through modulation of host immune responses, maintain gut homeostasis and produce interferon thereby suppressing the virus induced cytokine storm.

Studies have also shown probiotics could significantly decrease the serum levels of high-sensitivity C-reactive protein and interleukin-6 and increase the serum albumin levels, upper arm circumference, and triceps skinfold thickness in patients undergoing peritoneal dialysis. 

What’s more – Probiotics may potentially have a beneficial role in preventing COVID-19. A recent study quotes, “The efficacy of probiotics has been studied previously on several respiratory tract viral infections. Probiotics comprise living microbes that upon oral administration benefit human health by reshaping the composition of gut microbiota. The close kinship of the gastrointestinal and respiratory tract suggests why the dysfunction of one may incite illness in others. The emerging studies suggest the capability of probiotics to regulate immune responses in the respiratory system.”

However, some studies showed that bacterial overgrowth in the small intestine related to probiotic use can lead to bloating, gas, and other adverse side effects. Additionally, some studies show that probiotic treatment following a course of antibiotics may delay the natural reconstitution of normal gut bacteria.

Therefore, it is recommended that you get a health checkup done starting from consulting your family physician who will advise if you need probiotic supplementation or not.

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Fully vaccinated individuals have lower travel risk but can be carriers

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While the debate for vaccinations continues across the globe, there is good news for those who have gotten vaccinated. Vaccination reduces risk of infection about 15-20 days after the dosing is complete. According to the new guidelines issued by the Centre for Disease Control (CDC), US, it is okay to travel domestically if you are fully vaccinated. Which means, you have completed the two doses of the two-dose vaccines or one dose of the J&J vaccine. Or as the CDC puts it’s, “you’re considered fully vaccinated 2 weeks after you receive the last required dose of the COVID-19 vaccine”.

While the US has issued statements that fully vaccinated domestic travelers don’t need to be tested before or after traveling unless their destination requires it, in India the rules for entering different states by air need to be checked well in time because a lot of states mandate a negative RT-PCR test for entry requirements. The Ministry of Health and Family Welfare in India has issued guidelines for International Travel and so has the Ministry of Civil Aviation for domestic travel on 30th March 2021. The DGCA has stated that surveillance across the airports in India will now be increased to ensure all COVID-19 protection protocols are taken into account.

On 13th April 2021, the Indian Railways has also confirmed that in view of the COVID-19 pandemic and related hygiene issues, they have also stopped service of cooked food and replaced the same with Ready to Eat (RTE) meals in trains. In addition, they have ensured that the COVID-19 related protective items such as masks, sanitizers, gloves etc. and takeaway bedroll kits/items, are available for sale through Multi-Purpose Stalls at Stations.

However, as is recommended, even fully vaccinated travelers should still follow the recommendations for traveling safely, including wearing a mask over your nose and mouth, staying 6 feet away from others and avoiding crowds, washing your hands often or using hand sanitizer, self-monitoring for COVID-19 symptoms after traveling, and isolate and get tested if symptoms develop

It is still very important to stay cautious and avoid potential exposures to the coronavirus whenever possible during travel, mainly because vaccination drives are still ongoing, and it is not recommended to travel unguarded since a lot of COVID-19 patients remain asymptomatic and can continue to spread the virus to other unvaccinated people. Also, no vaccine is a 100% fail safe yet, so a very small fraction of fully vaccinated people may still be at risk because emerging variants of the virus add a measure of uncertainty.

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Real-world data shows 90% efficacy of Pfizer-BioNTech and Moderna COVID-19 vaccines

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Pfizer-BioNTech and ModernaCOVID-19 vaccines are messenger RNA (mRNA) vaccines but are not available in India yet. These COVID-19 vaccines have been shown to be effective in preventing symptomatic SARS-CoV-2 infection in randomized placebo-controlled Phase III trials.

A new study has shown that the Pfizer-BioNTech and Moderna-NIAID vaccines are effective at preventing infections in the real world. According to the CDC, the authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.

 This study has been published March 29 in Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention (CDC) in the USA. Study analysts have seen that the two-dose vaccine regimen was 90% effective at preventing infections 2 weeks after receiving the second dose.

This new study restores faith in the COVID-19 vaccines and has shown to be highly effective at preventing symptomatic and asymptomatic infections in real-world settings. As per the study results, this data is similar to those from earlier phase 3 clinical trials published in the journal New England Journal of Medicine, which found an efficacy of more than 90% for both the Pfizer-BioNTech and Moderna-NIAID vaccines. This is encouraging news for everyone across the globe because real-world effectiveness is often conservative and therefore, lower due to a number of factors.

Dr. James H. Conway, a pediatric infectious disease specialist at the University of Wisconsin-Madison, said what we really care about is a vaccine’s effectiveness — its real-world potential. He further added that such studies are not only proving how effective the vaccines can be for the studies and research data, but also show the true power of vaccines for real-world COVID-19 pandemic. Therefore, results published in the recent report from the CDC reassure that the vaccines are working as well as they are hoped to, in curbing the pandemic and in turn, stopping the spread of the virus.

Get vaccinated today!!

Read about the vaccination registration procedure here. For details about the type of vaccine and the dosing schedule, read here.

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Sputnik V submitted for DGCI approval for emergency use authorization

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On 13th April 2021, the Drug Controller General of India (DCGI) has approved the Sputnik V COVID-19 vaccine for emergency use.  After Covishield, developed by Oxford University-AstraZeneca and manufactured by the Serum Institute of India (SII), and Bharat Biotech’s Covaxin, this will be the third vaccine against the novel coronavirus that has been granted emergency use authorization in India.

India is the 60th country to approve Sputnik V—the rollout for which is likely to begin by end of April or early May.Currently, the Sputnik V will be imported before the local production kicks in. It is hoped that this emergency approval of Sputnik V will strengthen the government efforts to scale up vaccination, as India is battling the second wave of the pandemic with close to 1.4 lac cases reported on 12th April 2021.

India is also the leading production hub for Sputnik V, since its parent manufacturer company has reached agreements with the leading pharmaceutical companies in India such as Gland Pharma, Hetero Biopharma, Panacea Biotec, Stelis Biopharma, Virchow Biotech aimed at production of more than 850 million doses per year, sufficient to vaccinate more than 425 million people around the world.

The vaccine Sputnik V ranks second among coronavirus vaccines globally in terms of the number of approvals issued by government regulators and has an efficacy of 91.6%. It has shown encouraging results in protection against severe cases of COVID-19 as demonstrated by the data published in one of the leading medical journals The Lancet.

Sputnik V uses two different vectors (adenovirus 26 and adenovirus 5) for the two shots in a course of vaccination, providing immunity with a longer duration than vaccines using the same delivery mechanism for both shots.The safety, efficacy and lack of negative long-term effects of adenoviral vaccines have been proven by more than 250 clinical studies over two decades. There are no strong allergies caused by Sputnik V and with a storage temperature of 2-8 degrees Celsius, the vaccine can be stored in conventional refrigerators without the need to invest in additional cold-chain infrastructure.

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37 vaccinated doctors are Covid-19 positive at Delhi’s Sir Gangaram Hospital

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Delhi recorded 7,437 fresh COVID-19 cases on April 8 — the highest single-day surge this year – with 24 more people dying due to the coronavirus infection, taking the death toll to 11,157, according to the Delhi Health Department. In what makes the situation worse, at least 37 doctors of Delhi’s Sir Gangaram Hospital have tested positive for coronavirus, as per the hospital sources on Thursday, 08th April 2021. These doctors had received both doses of COVID-19 vaccination during the first phase of the vaccination drive that was launched on 16th January 2021, thereby cautioning vaccinated individuals to be as cautious as ever to prevent the COVID-19 infection.

The hospital sources have confirmed that a majority of the COVID-19 positive doctors currently have mild symptoms – out of which, 32 doctors are in home isolation and 5 are admitted in the hospital.

Sir Ganga Ram Hospital in New Delhi has been at the forefront of the war against the pandemic that has crippled normal life for more than a year now. Here’s wishing all Corona Warriors a speedy recovery from Health Patrol!

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