Saturday, March 21, 2020



Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

Corona viruses have same weighjt as other viruses

Covid-19 virus is physically larger and heavier than other known respiratory viruses. So while Covid-19 infects hosts via mucus droplets, its infectious range is lower relative to other viruses because its mass limits how far it can travel before succumbing to gravity. Coronaviruses can only travel about one to two meters, less than seven feet, before they start falling to the ground. Compare that to much more infectious viruses like measles or chickenpox, both of which are much lighter and able to remain airborne on tiny dust particles.

Only this virus has a unique link to bats

While scientists suspect that Covid-19 may have initially jumped from bats to humans, bats seem to be uniquely able to harbor many other viruses that cause serious human disease: Ebola, Marburg, Rabies, Hendra and Nipah.

As recently as 2017, a research study that tested bats in Kenya identified several novel coronaviruses that had genomic sequences closely related to human coronaviruses.

There are strains of the new coronavirus are spreading around the world

World Health Organization insists that “there is no evidence that the virus has been changing”.
Viruses do mutate especially RNA viruses like SARS-CoV-2. When a person is infected with the coronavirus, it replicates in their respiratory tract. Every time it does, around half a dozen genetic mutations occur, says Ian Jones at the University of Reading, UK.

When Xiaolu Tang at Peking University in Beijing and colleagues studied the viral genome taken from 103 cases, they found common mutations at two locations on the genome. The team identified two types of the virus based on differences in the genome at these two regions: 72 were considered to be the “L-type” and 29 were classed “S-type”.

A separate analysis by the team suggests that the L-type was derived from the older S-type. The first strain is likely to have emerged around the time the virus jumped from animals to humans. The second emerged soon after that, says the team. Both are involved in the current global outbreak. The fact that the L-type is more prevalent suggests that it is “more aggressive” than the S-type, the team say.

One reason coronaviruses mutate so rapidly is that they possess the longest genomes of all known RNA viruses. With more sections in their genome, there are more potential errors when the virus copies itself.

At age 20 I need not worry

A review of more than 4,000 U.S. patients who were diagnosed with novel coronavirus infection (COVID-19) shows that an unexpected 20% of deaths occurred among adults aged 20-64 years, and 20% of those hospitalized were aged 20-44 years.

The expectation has been that people over 65 are most vulnerable to COVID-19 infection, but this study indicates that, at least in the United States, a significant number of patients under 45 can land in the hospital and can even die of the disease.

To assess rates of hospitalization, admission to an ICU, and death among patients with COVID-19 by age group, the Centers for Disease Control and Prevention analyzed 4,226 COVID-19 cases in the United States that were reported between Feb. 12 and March 16. [CDC COVID-19 Response Team. MMWR Morb Mortal Wkly Rep. 2020 Mar 18.

Drink water every 15 minutes

One post, copied and pasted by multiple Facebook accounts, quotes a "Japanese doctor" who recommends drinking water every 15 minutes to flush out any virus that might have entered the mouth. A version in Arabic has been shared more than 250,000 times.
Professor Trudie Lang at the University of Oxford says there is "no biological mechanism" that would support the idea that you can just wash a respiratory virus down into your stomach and kill it.
Infections like coronaviruses enter the body via the respiratory tract when you breathe in.

However, staying hydrated is generally good medical advice but not to flush the virus.

Drinkable silver

Unlike iron or zinc, silver is not a metal that has any function in the human body.
The use of colloidal silver was promoted on US televangelist Jim Bakker's show. Colloidal silver is tiny particles of the metal suspended in liquid. A guest on the show claimed the solution kills some strains of coronavirus within 12 hours (while admitting it hadn't yet been tested on Covid-19).
Proponents claim it can treat all kinds of health conditions, act as an antiseptic, and state it helps the immune system. Silver is used in bandages applied to wounds.

There's clear advice from the US health authorities that there's no evidence this type of silver solution is effective for any health condition. More importantly, it could cause serious side effects including kidney damage, seizures and argyria - a condition that makes your skin turn blue.

Vodka can used as habd saniriser

No,   vodka only contains 40% alcohol. You need minimum 60% alcohol.

Drink MMS

YouTuber Jordan Sather, has been claiming that a "miracle mineral supplement", called MMS, can "wipe out" coronavirus.
It contains chlorine dioxide - a bleaching agent.
In January he tweeted that, "not only is chlorine dioxide (aka MMS) an effective cancer cell killer, it can wipe out coronavirus too".

Last year, the US Food and Drug Administration warned about the dangers to health of drinking MMS. Health authorities in other countries have also issued alerts about it. The FDA says it "is not aware of any research showing that these products are safe or effective for treating any illness". It warns that drinking them can cause nausea, vomiting, diarrhoea and symptoms of severe dehydration.

Once available in the private labs in India the covid 19 test will be very costly

No. ICMR may cap price of each coronavirus test at Rs 4,500-Rs 5,000 for private labs.

You can get escaped by disobeying government directions in India

The Lucknow police lodged an FIR against Bollywood singer Kanika Kapoor for alleged negligence in compliance of necessary directives to safeguard against the spread of deadly Coronavirus disease post her return from London earlier this month. She tested covid-19 positive on Friday and left a chain of VIPs behind who had either put themselves on self-isolation or earmarked for monitoring by the administration.
Lucknow Commissioner of Police, Sujeet Pandey confirmed that an FIR was lodged at Sarojini Nagar police station under Indian Penal Code section 188, 269, 270 on the complaint of Chief Medical Officer, Lucknow.
188: 188. Disobedience to order duly promulgated by public servant.
Section 269:- Negligent act likely to spread infection of disease dangerous to life
Section 270:- Malignant act likely to spread infection of disease dangerous to life

"Coronavirus is not in my area, so I can go out."

You don’t know it’s not in your area.  All etsts are not being done so we don’t have an accurate idea of how many people – or what areas – have truly been affected.
Individuals can shed the virus for up to 2 weeks before they get sick.

Our situation could be similar to Italy and Germany where there is a shortage of ventilators for critically ill patients.

Coronavirus is just like the flu – it’ll all be ok.

The two viruses are different in ways that are significant and dangerous.
Flu has a vaccine; COVID-19 does not.
Flu has established treatments; COVID-19 does not.

Hydroxychloroquine  and Azithromycin have no role in in COVID 19

Hydroxychloroquine (200 mg three times per day for 10 days) plus Azithromycin 500 mg once daily for ten days

Both chloroquine and hydroxychloroquine have been reported to inhibit SARS-CoV-2 in vitro, although hydroxychloroquine appears to have more potent antiviral activity [1].

Chloroquine is included in treatment guidelines from China's National Health Commission and was reportedly associated with reduced progression of disease and decreased duration of symptoms [2,3].  However, primary data supporting these claims have not been published [4].

In an open-label study of 36 patients with COVID-19, use of hydroxychloroquine (200 mg three times per day for 10 days) was associated with a higher rate of undetectable SARS-CoV-2 RNA on nasopharyngeal specimens at day 6 compared with no specific treatment (70 versus 12.5 percent) [5].

In this study, the use of azithromycin in combination with hydroxychloroquine appeared to have additional benefit, but there are methodologic concerns about the control groups for the study, and the biologic basis for using azithromycin in this setting is unclear.

Despite the limited clinical data, given the relative safety of short-term use of hydroxychloroquine (with or without azithromycin), the lack of known effective interventions, and the in vitro antiviral activity, some clinicians think it is reasonable to use one or both of these agents in hospitalized patients with severe or risk for severe infection, particularly if they are not eligible for other clinical trials.

1.         Yao X, Ye F, Zhang M, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020.
2.         Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020; 14:72.
3.         Colson P, Rolain JM, Lagier JC, et al. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents 2020; :105932.
4.         Cortegiani A, Ingoglia G, Ippolito M, et al. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care 2020.
5.         Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 DOI:10.1016/j.ijantimicag.2020.105949.

The Marseille Study
The European Union Clinical Trials Register shows that the Marseille study was accepted on 5th March by the National Medicines Safety Agency (ANSM). It could include up to 25 COVID-19 positive patients, comprising five aged 12–17 years, 10 aged 18–64 years, and 10 more aged 65 years or over.

Unblinded study showed a strong reduction in viral load with hydroxychloroquine.

After 6 days, the percentage of patients testing positive for COVID-19 who received hydroxychloroquine fell to 25% versus 90% for those who did not receive the treatment (a group of untreated COVID-19 patients from Nice and Avignon).

In addition, comparing untreated patients, those receiving hydroxychloroquine and those given hydroxychloroquine plus the antibiotic azithromycin, the results showed there was "a spectacular reduction in the number of positive cases" with the combination therapy.

At 6 days, among patients given combination therapy, the percentage of cases still carrying SRAS-CoV-2 was no more than 5%.

Azithromycin was added because it is known to be effective against complications from bacterial lung disease but also because it has been shown to be effective in the laboratory against a large number of viruses, the infectious disease specialist explained.

More detailed results of the study have been submitted for publication in the International Journal of Antimicrobial Agents.

Christian Perronne, head of infectious diseases, University Hospital Raymond Poincaré, Garches, Paris

"I really believe in hydroxychloroquine. It is a drug I find rather fascinating, that has been used for decades. There have been positive results in an in vitro study and a preliminary Chinese study in 100 patients which showed that hydroxychloroquine reduced the viral load, the symptoms lasted for less time, and they are not as severe. This could reduce the number of carriers, which I find interesting from an epidemiological perspective.

"I think from an ethical point of view, we should suggest it to all patients with severe disease who are hospitalised, under surveillance and on short treatment, paying attention to drug interactions, especially with drugs that prolong the QT interval.

Afterwards, in terms of adverse effects, at increased doses, it is possible that patients will have pain or fever, but it seems that the treatment is effective at lower doses, according to the Chinese data. In any case, the adverse effects of this compound are not dangerous."

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