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Steroids can cause mucormycosis, but it is a treatable condition



There is a recent scare around something known as the ‘black fungus’ and how it has complicated COVID-19 infections – whether this is true or not?

YES, it’s true. Is it always fatal? NO!

Mucormycosis is a treatable condition if checked and diagnosed well in time.

COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis, the black fungus. Recent reports suggest it is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. High index of suspicion, early diagnosis, and appropriate management can improve survival.

Black Fungus is a serious but rare fungal infection and mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. For e.g., uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection, is which can develop during the course of the illness or as a sequelae.

Doctors believe mucormycosis, which has an overall mortality rate of 50%, may be triggered using steroids, a life-saving treatment for severe and critically ill COVID-19 patients. How does this happen? Well, steroids reduce inflammation in the lungs for COVID-19 and help stop some of the damage that can happen when the immune system is working overtime to fight off the coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic COVID-19 patients. It is believed that this drop in immunity could be triggering these cases of mucormycosis.

Is it dangerous? While it is a serious condition if not detected in time, mucormycosis is treatable.

The Indian Council of Medical Research (ICMR) has released an advisory around “When to Suspect” mucormycosis. Enlisted below are the signs to watch out for:

  • Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone
  • One sided facial pain, numbness or swelling
  • Blackish discoloration over bridge of nose/palate
  • Toothache, loosening of teeth, jaw involvement
  • Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
  • Chest pain, pleural effusion, hemoptysis, worsening of respiratory symptoms

In case of any or all the above signs, please contact your clinician or nearest hospital immediately.

UIN: 262HP146R

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International travelers can get their Covishield shot preponed



In a mid-May report we had covered the news update that the gap between two doses of Covishield, had been revised to 12-16 weeks.

In a meeting on May 13th, 2021, based on the recommendation of COVID Working Group, the gap between two doses of Covishield vaccine was extended from 6-8 weeks to 12-16 weeks. According to a report by the Press Information Bureau of India, the COVID Working Group chaired by Dr N K Arora recommended extension of the gap between the first and second doses of Covishield vaccine to 12-16 weeks (after 84 days).

However, according to the recent update published on the MOHFW website, the Union Ministry of Health & Family Welfare has received several representations for allowing administration of second dose of Covishield for such persons who have only taken first dose of Covishield and are seeking to undertake international travel for educational purposes or employment opportunities or for part of India’s contingent for Tokyo Olympic games, but whose planned travel dates fall prior to completion of the currently mandated minimum interval of 84 days from the date of first dose.

For this category of citizens, the Government of India has released recommendations released by the Ministry of Health and Family Welfare (MOHFW), stating administration of second dose of Covishield vaccine can be revised to ‘after 28 days but before 84 days’ to persons intending to undertake international travel for education purpose, for joining employment in foreign countries and for India’s contingent to the Tokyo Olympics.

The communication further mentioned that this special dispensation will be available to the following category of travelers:

  1. Students traveling for education/admissions to foreign universities.
  2. International employment.
  3. Athletes, Sportspersons and accompanying staff of Indian contingent attending International Olympic Games to be held in Tokyo.

People who wish to avail this facility need to get in touch with their District Headquarters, wherein they can apply for the same after submitting required documents. Genuineness of the travel requirement and 28 days post the first dose of Covishield are the mandated requirements.

Currently, this facility shall be available to those who need to undertake international travel for these specified purposes in the period up to 31st August, 2021.

UIN: 303HP161R 

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Vandalur Zoo lioness dies of COVID-19



This news is true. Vandalur zoo is a zoo near the Tamil Nadu capital – Chennai. According to news reports, a 9-year-old lioness has died, and nine others tested positive for COVID-19 at the zoo, according to forest officials. Do animals get COVID-19? Is it transmissible to humans then? Yes and no! According to the Centre for Disease Control USA, recent experimental research shows that many mammals, including cats, dogs, bank voles, ferrets, fruit bats, hamsters, mink, pigs, rabbits, racoon dogs, tree shrews, and white-tailed deer can be infected with the virus.

Cats, ferrets, fruit bats, hamsters, racoon, dogs, and white-tailed deer can also spread the infection to other animals of the same species in laboratory settings. Several studies have also investigated non-human primates as models for human infection wherein the rhesus macaques, cynomolgus macaques, baboons, grivets, and common marmosets can become infected with SARS-CoV-2 and become sick in a laboratory setting.

Whether it spreads to humans from animals – the incidents are rare. Some coronaviruses that infect animals, can spread to people and then spread between people, but this is rare according to the reports published.

SARS-CoV-2 spreads easily from person to person. People who are physically near (within 6 feet) a person with COVID-19 or have direct contact with that person are at greatest risk of infection.   Currently, there is no evidence that animals play a significant role in spreading SARS-CoV-2 to people. Based on the available information to date, the risk of animals spreading COVID-19 to people is low. More studies are needed to understand if and how different animals could be affected by SARS-CoV-2.

SARS-CoV-2 has been reported in mink on farms in multiple countries including the United States. CDC is aware of reports of a strain of SARS-CoV-2 virus in mink in Denmark that was also present in the local human population. This strain, called “Cluster 5,” had not been seen before and was made up of five mutations. The World Health Organization (WHO) reported that as of November 2020, the Cluster 5 variant was no longer circulating in Denmark.

UIN: 296HP160R

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Vaccine cocktails: Safe to mix and match COVID-19 Vaccines



India has vaccinated close to 24 crores of its citizens as on 04th June 2021 according to data released by the Ministry of Health and Family Welfare. However, with the shortage of supplies during the second wave of the COVID-19 pandemic and the looming fear of the third wave, India needs quicker solutions to vaccinate maximum Indians in the shortest time possible. One such solution that has been adopted by several countries is mixing different COVID vaccines either to increase efficacy or to tackle the problem of vaccine shortage.

However, the Indian government said it won’t change its vaccine protocols till mixed vaccinations are backed by science. As of June 2021, Indians have the choice of 3 vaccines – Covishield, Covaxin and Sputnik V. While the gaps between two doses differ for different vaccines, individuals who have taken both doses of the vaccine they got, are considered fully vaccinated. However, according to recent report, scientists speculate that mixing and matching COVID vaccines might not only increase the efficacy of the vaccines, but also curb the shortage we are currently facing. This would mean that an individual vaccinated with Covishield in first dose, will have the option to choose either Covishield itself or Covaxin for the second dose. This is currently not applicable to Sputnik V, because according to reports and manufacturers of the Sputnik V vaccine, the two shots of the Sputnik V vaccine are different, and they work together to provide the immunity.

Across the globe, several countries have already started testing out ‘vaccine cocktails’ as these have come to be known as. They believe that if one vaccine is less effective against a variant, then one can get a booster shot that could have a higher efficacy against a variant.

In many European countries, including Germany, France, Sweden, Norway and Denmark, authorities are now advising younger people, who were previously given the AstraZeneca vaccine as a first dose, to take an alternative vaccine as their second vaccine jab.  Health officials in Canada are now advising Canadians to combine either the AstraZeneca-Oxford, Pfizer-BioNTech or Moderna shots interchangeably in certain situations. The National Advisory Committee on Immunization (NACI) updated its latest guidance and recommended that a first shot of the AstraZeneca vaccine can be followed by either Moderna or Pfizer.

If this works out, it will be a boon for a country like India because currently, the vaccine manufacturers in our country are struggling to live up to the demands of the vaccines. If vaccine cocktails work, the burden of meeting the demands will be divided amongst different vaccine manufacturers globally. Hence ensuring greater supply.

However, until further studies give evidence, it is currently not clear about the efficacy of vaccine cocktails. Not every vaccine can work when mixed, but researchers believe it can be done with those that share the same target – in the case of Coronaviruses, the spike protein.

India, at present, does not recommend mixing or matching of vaccines.

UIN: 297HP42IP

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Bodies of COVID 19 Victims Dumped in Ganga Can Spread Coronavirus



While the rest of the world was busy covering news updates on lack of crematoriums in India, we woke up to even more gut-wrenching news in the form of bodies dumped openly in the holy rivers Ganges and Yamuna last week. Because they were COVID corpses, this led to a concern whether the bodies could transmit COVID to the living. Experts suggest transmission is not possible from a dead COVID virus infected body to the living, but such actions have certainly polluted key sources of drinking water for many villages and localities along the rivers and this will adversely affect aquatic flora and fauna.

Therefore, the surge in bacterial infections may be significant, especially during and after the rainy season when the decomposed corpses buried in the riverbed sand will resurface due to erosion of the sand. Dr B.D. Tripathi, chairman of Malviya Ganga Research Centre at Benaras Hindu University (BHU) spoke on the subject in a recent interview, “If the dumping of bodies is not strictly stopped, the possible outbreak of other infectious diseases cannot be ruled out. Since the river Ganges at present has a low flow of water, the floating decomposed bodies will lead to an increase in organic load in its water, which will impact aquatic life. These decomposed corpses carry several harmful bacteria and fungi, which can be transmitted to human beings through carnivorous fishes, which the river hosts.

Dr. Tripathi further added, “It needs a great deal of research to conclude whether a dead body is infectious for COVID-19. So far, there is no evidence to show water transmits the virus. Air is the main route of its transmission. Respiratory droplets and aerosols in close contact can infect people.” However, he emphasized that the floating bodies will no doubt pollute the river, which may cause other health hazards.

According to Dr. Suneela Garg, Professor & Head, Community Medicine, Maulana Azad Medical College, New Delhi, “As of now there is no evidence that COVID-19 can be transmitted through water. However due to decomposition, there can be risk of gastrointestinal diseases and extremely foul-smelling water which is a public health hazard.”

Dr Arvind Mishra, ex-Assistant Director, Department of Fisheries, Uttar Pradesh, too ruled out the most-remote possibility of transmission through water, arguing that the bio-chemical process, which is required for the growth and multiplication of the virus, stops once an infected person dies. He added that there was no danger
of an outbreak of any zoonotic disease because carnivorous fishes were generally not eaten by people in the state. However, he also agreed that the water polluted by decomposing dead bodies would become unfit for drinking or any other activities.

UIN: 298HP78F

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Vaccinated individuals will die in 2 years



Earlier this week, a viral WhatsApp message claimed that Nobel laureate Luc Montagnier has said that all those who have been vaccinated for Covid-19 will die within two years.  A clip of Dr. Luc’s interview showed him say, “It’s unthinkable to vaccinate during a pandemic. They’re silent. It is the antibodies produced by the virus that enable the infection to become stronger. It is what we call antibody-dependent enhancement, which means antibodies favor a certain infection. The new variants are created by antibody-mediated selection due to the vaccination”. The video soon sent netizens into panic that all vaccinated people will die within 2 years. Neither is this claim correct nor is there evidence to prove Dr. Montagnier made the comments quoted in the social media posts, according to renowned news agency Reuters as well.

His actual comment about ADE is inaccurate and does not reflect real-world evidence. Further on, there is no evidence backing this claim that COVID-19 vaccines will kill people by causing antibody- dependent enhancement. Dr. Montagnier won the Nobel Prize for medicine in 2008 with fellow scientist Francoise Barre-Sinoussi for their work identifying the HIV virus.  

The 2-minute interview clip shows Montagnier claiming COVID-19 vaccines cause antibody dependent enhancement (ADE) – in other words, they cause worse disease than before. He says this is apparent by observing where “the curve of vaccination is followed by the curve of deaths”.

However, this is not correct – while the ADE was a concern initially contemplated by scientists creating COVID-19 vaccines, there have been no signs of cases happening during clinical trials or the roll-out. In fact, on the contrary, COVID-19 vaccines have been shown to save thousands of lives. England alone has estimated that the vaccines have averted more than 10,000 deaths up to the end of March 2021. Israel has seen similar results through their vaccination campaign which has been one of the fastest in the world.

The opening line of one of the WHO reports reads, “Vaccines are a critical tool in the battle against COVID-19, and getting vaccinated is one of the best ways to protect yourself and others from COVID-19”.  Still with some unverified information or misinformation circulated, people start questioning the efficacy of vaccines.

Responding to this claim, the verified Twitter handle of Press Information Bureau (PIB) tweeted that the WhatsApp forward is indeed fake news. Dr. Gagandeep Kang, virologist and professor at the Christian Medical College in Vellore also refuted this claim in a thread of tweets and specifically mentioned that massive vaccination being a mistake is a topic brought up with pseudo-scientific messy incorrect immunology. Further emphasizing this, she reiterated that we need to continue to study long term protection, and particularly study immune response in vaccine break through cases to understand what is happening with immunity and safety. But reassuringly, so far there is no signal.

UIN: 294HP41IP

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