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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.

UIN: 81HP30R

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Coronavirus

Dos and don’ts for vacay activities

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It is not a one size fits all when it comes to vacations or holidays because every family has a different demographic – some may have small kids who need to be taken to a washroom very often, some may have elderly who cannot sit too long during road trips. Therefore, every family should decide based on their own family size, needs and facilities. Traveling will inevitably lead to exposures to unvaccinated kids and adults. But the risk will be decided based on the extent of that exposure.

Masks reduce transmission and have been proven to be an effective tool with vaccination. Wearing a mask indoors and in public spaces further cuts down on risk considerably.

Before you travel:

  1. Get your RTPCR test done

While traveling:

  1. Wear a mask covering your nose and mouth at all times when you are in public places or around individuals that cannot maintain a safe distance of 6 feet away from you.
  2. Avoid crowds and stay at least 6 feet/2 meters from anyone who you do not know personally with their health history.
  3. Wash your hands often or use hand sanitizer (with at least 60% alcohol).

When you return from your vacation:

  1. If you see any signs of COVID, get tested and isolate yourself from other family members as well.
  2. Even if you test negative, stay home and self-quarantine for the full 7 days.
  3. If you don’t get tested, stay home and self-quarantine for 10 days after travel.
  4. Self-monitor for COVID-19 symptoms; isolate and get tested if you develop symptoms.

UIN: 407HP17G

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It hasn’t affected kids till now – it won’t affect them ever

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Schools reopening across the globe has brought about a sense of panic in some parents and a sense of confidence in others because vaccination for children is yet to come and unvaccinated children are both at direct risk for COVID as well as at risk of transmitting the virus to others.

According to the World Health Organisation (WHO), data suggests that children under the age of 18 years represent about 8.5% of reported cases, with relatively few deaths compared to other age groups and usually mild disease. However, cases of critical illness have been reported. As with adults, pre-existing medical conditions have been suggested as a risk factor for severe disease and intensive care admission in children. Further studies are underway to assess the risk of infection in children and to better understand transmission in this age group.

Although research has shown that children develop severe disease from COVID-19 far less commonly than adults, and therefore, the risk of death due to severity of COVID-19 is also much lower in children. However, they are not immune. There are reports of children dying due to COVID-19.  But even when children do not get seriously ill with COVID-19 or show symptoms, they can still transmit the virus to other children and adults. The rate of child-to-adult transmission of SARS-CoV-2 is roughly half the rate of adult-to-child transmission. So even when the risk is low for children, transmission to other unvaccinated kids and adults is still a serious concern.

UIN:406HP105F

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Coronavirus

Vaccination can help us tide over the third wave

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The  second wave is declining, although up to 30-40,000 daily new cases continue to be recorded. India is far from being a COVID-19 free nation. Moreover, the looming third wave and alerts released by different State heads to be prepared for a third wave or to make adequate arrangements for the third wave in terms of oxygen cylinders, beds, critical care wards, etc. has kept us all on our toes and inside homes for fear of expediting the arrival of the third wave.

Eminent virologist and retired professor (CMC Vellore), Dr. T Jacob John, in a recent media interview said if the Government can do justice to the vaccination, in terms of making it available in abundance and everywhere, even the unlikely probability of a third wave can be mitigated, adding that in other words, the third wave can be and must be prevented with vaccination. Dr. John also believes that the two strong waves of COVID-19 pandemic in India would have created high herd-immunity, which is why even a moderate level of vaccination will surely avert the third wave.

We should continue to follow physical distancing protocols and avoid crowding indoors or outdoors as much as possible.

UIN: 344HP186R

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Complete vaccinated individuals three times less likely to get COVID-19

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In what comes as more evidence to back completing the (two-dose or one-dose) mandated course for vaccinations for COVID-19, a recent update published by the Imperial College London has shown that people who have received both doses of their coronavirus vaccine are three times less likely to get infected with COVID-19. These results from the 13th round of the Imperial-led REACT-1 study, a major coronavirus monitoring programme, are based on swab tests taken by almost 100,000 people in England between 24 June and 12 July. 

According to their website, REACT (REal-time Assessment of Community Transmission) is a series of studies that are using home testing to improve the understanding of how the COVID-19 pandemic is progressing across England. This major research programme was commissioned by the Department of Health and Social Care (DHSC) and is being carried out by Imperial College London in partnership with Ipsos MORI and Imperial College Healthcare NHS Trust.

The analysis by Imperial College London and Ipsos MORI, which had almost 100,000 volunteers taking part in the study in England between June 24 and July 12, suggests that double vaccinated people are also less likely to pass on the virus to others. Results have also indicated that people who were fully vaccinated were less likely to be carriers of infection to pass the virus on to others, because they have a lower viral load on average and therefore shed less virus. 

In his statement to the Press post release of study results, the UK Vaccines Minister Mr. Nadhim Zahawi also stated, “these results show the positive impact of the vaccination program with those who are double jabbed three times less likely than unvaccinated people to get the virus and less likely to pass on this awful disease to those around them”.

It is important to note that no vaccine has 100% efficacy but benefits outweigh the risks and therefore vaccination is an important step towards curbing the pandemic. Vaccination however, must also be complemented by COVID appropriate behavior.

UIN 387HP217R

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Coronavirus

Breastfeeding post vaccination can kill your baby

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There isn’t any research to support this claim, and based on how vaccines work, there is no reason to believe that the vaccine could harm mom or baby. In fact studies support the fact that the vaccines are not excreted into the breast milk, but antibodies produced by mothers in response to the COVID-19 vaccine do — providing hope that breastfed babies might have some level of protection.

A report published in the journal Nature states that COVID-19 vaccines do not carry a risk of igniting an active infection and that they are extremely unlikely to cross into breast milk. The report further elaborates how the fragile messenger RNA used in the Pfizer–BioNTech and Moderna vaccines, is designed to break down so quickly that it should never leave the cells where it was injected. Therefore, it cannot get into the bloodstream and then the breast. In fact, experts believe none of the current vaccines will be excreted into breast milk.

The World Health Organisation (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) Guidance also recommends that mothers continue to breastfeed after vaccination. The Centre for Disease Control (CDC) and the UK Joint Committee on Vaccination and Immunisation issued statements shortly after the first vaccines were authorized in both countries recommending COVID-19 vaccination for breastfeeding women.

Australia’s Department of Health has indicated that breastfeeding women can get an approved COVID-19 vaccine and don’t need to stop breastfeeding before or after. 

Therefore, in conclusion, no safety concerns have been identified in lactating women who have been vaccinated. Women can continue to breastfeed pre and post COVID-19 vaccination.

 UIN: 400HP104F

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