दुनियाभर में कोरोना वायरस का संक्रमण काफी तेजी से फैल रहा है। कई जगहों पर तो संक्रमण के मामले नहीं के बराबर आ रहे थे, लेकिन अब एक बार फिर उन जगहों पर संक्रमण की रफ्तार बढ़ गई है। इस वायरस से दुनियाभर में अब तक तीन करोड़ 57 लाख से भी अधिक लोग संक्रमित हो चुके हैं जबकि 10 लाख 45 हजार से अधिक लोगों की मौत हो चुकी है। इस बीच विश्व स्वास्थ्य संगठन ने कोरोना के संक्रमण को लेकर एक डराने वाला खुलासा किया है। संगठन लीडर्स की एक विशेष बैठक में कहा गया है कि हो सकता है कि दुनिया में हर 10 में से एक व्यक्ति कोरोना वायरस से संक्रमित हुआ हो। मीडिया रिपोर्ट्स के मुताबिक, संगठन के एक वरिष्ठ अधिकारी का कहना है कि इसका मतलब है दुनिया की कुल आबादी का एक हिस्सा खतरे में है।
स्विट्जरलैंड के जेनेवा स्थित विश्व स्वास्थ्य संगठन के मुख्यालय में हुई बैठक में संगठन ने कहा कि कोरोना संक्रमण का असली आंकड़ा 80 करोड़ के करीब हो सकता है जबकि अभी तक करीब साढ़े तीन करोड़ लोगों के ही संक्रमित होने की पुष्टि हुई है। कई विशेषज्ञ भी पहले से ही ये कह रहे हैं कि संक्रमण के पुष्ट मामलों की अपेक्षा संक्रमण का असली आंकड़ा कहीं अधिक हो सकता है।
कोरोना वायरस के संक्रमण का पहला मामला पिछले साल चीन के वुहान में दर्ज किया गया था और तब से लेकर अब तक 10 महीने का वक्त बीत चुका है, लेकिन कोरोना का संक्रमण घटने के बजाए बढ़ता ही जा रहा है। कुछ देशों में इसे रोकने के लिए कई तरह के प्रतिबंध लगाए गए थे, लेकिन अब समय के साथ उसमें ढील दी गई है, जिसका नतीजा ये है कि महामारी की दूसरी लहर देखने को मिल रही है और संक्रमण की रफ्तार में काफी तेजी आ गई है।
कोरोना के संक्रमण से सबसे ज्यादा प्रभावित देशों की सूची में अमेरिका शीर्ष पर बना हुआ है। वहां 76 लाख 79 हजार से अधिक लोग कोरोना वायरस से संक्रमित हो चुके हैं जबकि मरने वालों का आंकड़ा दो लाख के पार है। वहीं भारत की अगर बात करें तो यहां भी संक्रमितों की संख्या 66 लाख 85 हजार से अधिक हो गई है जबकि मृतकों की संख्या एक लाख के पार है और यह संख्या दिन-ब-दिन बढ़ती ही जा रही है। हालांकि सुखद बात ये है कि यहां संक्रमण से ठीक होने वालों की संख्या भी तेजी से बढ़ रही है। यहां अब तक 56 लाख से अधिक लोग इस वायरस से ठीक हो चुके हैं।
कोरोना वायरस से निपटने के लिए वैक्सीन बनाने का काम तेजी से चल रहा है। उम्मीद जताई जा रही है कि अगले साल भारत को वैक्सीन मिल जाएगी। हाल ही में केंद्रीय स्वास्थ्य मंत्री डॉ. हर्षवर्धन ने कहा है कि सरकार का लक्ष्य है कि अगले साल जुलाई तक 20-25 करोड़ नागरिकों को कोरोना का टीका लग जाए और इसके लिए वैक्सीन की 40-50 करोड़ डोज हासिल करने की योजना बनाई जा रही है।
हालांकि जब तक वैक्सीन नहीं आ जाती है, तब तक लोगों को बेहद ही संभल कर रहने की जरूरत है। वैज्ञानिकों और विशेषज्ञों द्वारा कोरोना से बचने के लिए बताए गए नियमों का पालन करें, जिसमें समय-समय पर हाथों को साबुन-पानी से धोना, मास्क पहनना और सामाजिक दूरी आदि शामिल हैं
Artificial immune boosting may not be the right strategy to fight against
COVID-19. Staying calm, maintaining social distancing and hygiene and using
protective gear will help us in the long run.
The human immune system (inherited from gazillions of its
preceding species in evolution)
consists of a rather well-endowed immune
response network. A network composed
of cells (neutrophils, eosinophils, T cells,
B cells, macrophages, and other cells)
and non-cellular molecules (cytokines,
leukotrienes, enzymes, etc.) form a
formidable resistance, which intensely
and strategically defend the wonderful
bulwark that the human body is. This
network however is useful and wonderful
so long as it starts and ends on cue and
does not overstay its welcome or overdo
what is expected of it. In other words,
balance is the key.
“Immune boosting” would therefore
mean artificially getting it all excited and
ready to fight. Fight it must but only when
it is necessary against a defined adversary,
as much and as long as it requires to
reinstate a desired state of health.
Not
The Myth of
Immune-Boosters
Artificial immune boosting may not be the right strategy to fight against
COVID-19. Staying calm, maintaining social distancing and hygiene and using
protective gear will help us in the long run.
more. Not less. This well-orchestrated
response by a disciplined battalion of the
immune army requires a band of welltrained scouts, elite strategists, and some
seriously effective mobilisation of foot
soldiers (granulocytes), mounted soldiers
(antibody-dependant cell cytotoxicity),
archers (inflammatory mediators and
their receptors), powerful cannons
(histamine, bradykinin), missiles
(IL-6, IL-1, TNF-α, IFN-γ, chemokines),
and target-locked nukes (antibodies).
This arsenal in the immune repertoire (as
is apparent from the analogies) must be
kept under check. If not, tremendous and
uncontrolled bombardment by its own
defence system shall devastate the body’s
ramparts (auto-immune response).
We do not want that to happen under
any circumstances because that will be
disastrous!
Now, to define "boosting" we revisit
the original task, that of keeping the
body in a state of preparedness but not
draw first blood. Thus, (i) a "well-oiled"
group of scouts (cells that are part of
the first line of defence in our innate
immune network and generally shoot
from the hips but do manage to come
back with useful information about a
novel enemy) must be maintained such
that even if an insidious attack is able to
breach the body’s security system, it will
not be allowed to penetrate too deep;
(ii) the level of co-ordination among
this network of immune players (innate
and acquired immunity, long-term and
short-term immunity, memory-directed
immune stratification and new game plan
against an unforeseen intruder) must be
clear and specific such that no confusion
(usually created by an intruder to set off
false alarms) maybe unduly provoked.
Thus, no immunosuppressant, no
immunedepletion to red herring signals
staged by sneaky pathogenic microbes
maybe unduly evoked; and (iii) when the
time comes, action is swift and lethal and
cleanly eliminates the intruder.
At last we come to the main point
of this long prologue—SARS-CoV-2 and
its pet scourge COVID-19. SARS-CoV-2
enters the human cell via a membranebound enzyme angiotensin converting
enzyme 2 (ACE-2) and a transmembrane
serene protease 2 that its spike protein
combines efficiently with to initiate a
smooth endocytosis reaction and the
viral payload gains unobstructed entry
into the cell. The receptor-binding spike
making up its corona is the key to the host
cell’s aforementioned lock. The dropletborne virus enters through the lung
and quickly infiltrates circulation via its
chosen portal and spreads systemically.
ACE-2 being a blood pressure
regulator, for the host humans, COVID-19
that may start with all the hallmarks of
pneumonia, quickly and silently takes
over multiple organs entering their
cells via the endothelial lining of blood
vessels, all of which express its chosen
receptor protein. And all hell breaks
loose! A severe “cytokine storm” starting
with low levels of IFN-γand high levels
of IL-6, TNF-α, IL-1β, CCL2, CCL3, CCL5 in
huge amounts like a tsunami of powerful
missiles by the body’s own defence
system completely overwhelms the
immune system. This is what kills us—a
total failure of our espionage system
(scout cells), all the trained commandos,
the diplomats, the strategists, and the
entire security is breached and arson
of the main weapon’s manufacturing
units of the body leads to mayhem.
Complete immune depletion due to
foolish and explosive squandering of
precious defensive resources turns into
our own nemesis. And a final fatal blow
jeopardises the thing called life from the
poor human host.
Thus, immune boosting, I feel,
maybe accomplished simply by leading
a balanced life—good nutrition
(building, repairing and maintaining
all the important faculties of the body
and not just the immune system since
it is not an isolated one), optimum and
enjoyable activities (moderate exercise
such as walking, swimming, yoga,
pranayam and intellectually or creatively
stimulating tasks that generate the
happy 'hormones') and sufficient and
quality sleep (that recharges, replenishes
and regenerates the expenditure in the
aforementioned enterprises).
Ayurvedic knowledge (curcumin
in turmeric, fisetin in apple and
strawberry, piperine in black pepper,
etc.), local and seasonal food (raw
fruits and coloured vegetables high in
flavonoids, phenolic compounds rich
in anti-oxidants), clean lifestyle sans
the redundant practices (avoiding
nothing but excess), and effective
armament (of offensive attack against
the infectious agents) supplemented
by western medicine (antiviral drugs
such as avifavir, ritonavir, remdesivir,
and others like hydroxychloroquine
and azithromycine combination
therapy, convalescent plasma therapy,
intravenous immunoglobulin (IVIG)
by recombinant DNA technology and
support from ventilator, extracorporeal
membrane oxygenation (ECMO) and
excellent supportive care) may yet save
us even if that wicked and troublesome
rogue virus the SARS-CoV-2 manages to
gain entry. A vaccine (such as Moderna’s
mRNA1273 or Oxford University’s
ChAdOx1, which are in various stages of
clinical trial) may take long to come and
offer a shield against COVID-19.
And while we are at it, may I warn
against frivolous advertisements
claiming immune boosting because
there is nothing to gain from a “boosted”
immunity other than expediting and
intensifying a pro-inflammatory disease
like COVID-19. We do not want our
immunity to be unnecessarily boosted.
We want it to stay calm and in a state
of preparedness so that it will not be
fooled and respond to provocation and
spend itself unnecessarily. We want the
casualties of war (immune maintenance
and immune surveillance circuits) to
be efficiently replenished, replaced and
regenerated and rejuvenated to remain
healthy and balanced. We want capacity
to generate and maintain a diverse
immune weaponry, not necessarily in
a state of preparedness but skilled and
fit and there in case they are called into
action. And most importantly, we want
the regulatory mechanisms to remain
alert and effective such that even if we
need to go into a well-thought-out war
(innate and acquired immunity including
but not limited to inflammation and
T and B cell-mediated cytotoxicity
or humoral response, the designated
cells with very specific and specialised
immune functions, signalling peptides,
receptors that regulate intercellular
cross-talk, etc.) they are efficiently
regulated and brought down to normal
levels when it is over.
Thus, balance is the key to a healthy
ability to mount anti-viral immunity,
rather than “boosting” it. I’d say, stay
calm, stay safe, and stay alert, but
most importantly, stay clean (social
distancing, protective gear, hygiene) and
“immune boosting” or not, we shall be
able to keep the COVID-19 at bay.
Dr Ena Ray Banerjee is Professor, Dept of
Zoology, University of Calcutta, Immunology and
Regenerative Medicine Research Unit, Translational
Outcomes Research. Email: erb@caluniv.ac.in
With the announcement of COVAXIN
by Bharat Biotech and ZyCov-D
Vaccine by Zydus Cadila the proverbial
silver line in the dark clouds of COVID-19
appears at the horizon.
The nod given by the Drug
Controller General of
India CDSCO (The Central
Drugs Standard Control
Organisation) for the
conduct of the human trial
for the vaccines marks the
beginning of the end.
More than 140
candidate vaccines are
under various stages
of development. One of the leading
candidates is AZD1222 developed by
Jenner Institute of University of Oxford
and licensed to AstraZeneca BritishSwedish multinational pharmaceutical
and biopharmaceutical company
headquartered in Cambridge, England.
Parallelly, Indian institutions have
also engaged in R&D for the development
of vaccines in India. With the primary
scientific inputs coming from ICMR’s
Pune-based institution National
Institute of Virology and Hyderabadbased CSIR institution
Centre for Cellular and
Molecular Biology, six
Indian companies are
working on a vaccine for
COVID-19.
IIT Mandi develops 98%
efficient face masks from
waste plastic bottles at
nearly one tenth the cost . Researchers at Indian Institute of
Technology (IIT) Mandi developed
high-efficiency face masks out of waste plastic bottles. The PET bottles were
successfully converted into a nanofibre
membrane. This membrane can be
layered with nylon on both sides to create
the mask. Research scholars Ashish
Kakoria and Sheshang Singh Chandel
produced the mask under the guidance
of Prof Sumit Sinha Ray. The nanofibre
membrane is 250 times thinner than
a human hair and can remove minute
particles with 98% efficiency.
18 Sims speculum vaginal double ended ISS Medium: 1
19 Uterine sound graduated: 1
20 Cheatle’s forcep: 1
21 Vaccine carrier: 2
22 Ice pack box: 8
23 Sponge holder: 2 + 2 (D)
24 Plain Forceps: 5
25 Tooth Forceps: 2
26 Needle Holder: 2
27 Suture needle straight: 10
28 Suture needle curved: 10
29 Kidney tray: 4
30 Artery Forceps, straight: 5 + 5 (D)
31 Dressing Forceps (spring type): 1
32 Cord cutting Scissors, Blunt, curved on flat: 1
33 Clinical Thermometer oral and rectal: 1
34 Talquist Hb scale 1
35 Stethoscope: 1
36 Foetoscope: 1
37 Hub cutter and Needle destroyer: 1
38 Ambu Bag (Pediatric size) with Baby mask: 1
39 Suction Machine: 1D
40 Oxygen Administration Equipment:1
41 Tracking bag and tickler box (Immunization): 1D
42 Measuring tape: 1
43 I/V Stand:1
Source: Field survey
C. Physical Performance vis-à-vis Equipments
The data on physical performance of Sub Centres in Mahendergarh with respect to equipments have been presented in table-3. A glance at the table shows that none of the Sub Centres in district Mahendergarh had a 6 litre capacity deep Basin, Kelly’s hemostat, straight Forceps, Suture straight needles, Suture curved needles, Oxygen Administration Equipment and a I/V Stand. The sub centres at Deroli Ahir, Majra Kalan, Jatwas, Duloth Ahir, Atali and Beri did not have equipments mentioned at sr. no. 16, 19, 11, 11, 18 and 21 respectively out of a total of 43 equipments required in a Sub Centre as per IPHS guidelines.
The data on physical performance of Sub Centres in Sirsa with respect to equipments have been presented in table 4. A glance at the table shows that availability / non availability of equipments shows almost a uniform pattern across various Sub Centres. None of the SCs in district Sirsa had a 6 litre capacity deep Basin, Kelly’s hemostat straight Forceps, a Sterilizer, Surgical Scissors straight, Sims speculum vaginal double ended ISS Medium, Suture straight needles, Suture curved needles, Oxygen Administration Equipment, Talquist Hb scale, Foetoscope and a Suction Machine. The sub centres at Pohrka, Khari Surera, Jivan Nagar, Nuhian wali, Chormar and Kalanwali Village did not have 12 equipments each out of a total of 43 equipments required in a Sub Centre as per IPHS guidelines.
Conclusion
The findings of the paper shows that the sub-centres of district Mahendergarh are good in term of human resources but they are in poor condition in the terms of building and equipments as per the IPHS. The sub-centres of District Sirsa are in poor condition in all terms i.e. human resources, building infrastructure and equipments. Sub-Health Centre (Sub-centre) is the most peripheral and first point of contact between the primary health care system and the community providing all the primary health care services. The success of NHM would depend largely on the proper functioning of Sub-centres providing services of acceptable standard to the people. So, the government should ensure the human resources, building infrastructure and equipment facilities at the grass root level for the better implementation of health policies.
COVID-19: Cuba offers UK salutary lesson in ‘shoe-leather’ epidemiology:
Cuba’s successful containment of COVID-19 through door-to-door screening of every home in the country, shows how ‘shoe-leather’ epidemiology could have averted the dramatic failure of the UK’s response to the pandemic. In Cuba there have been 2,173 confirmed cases and 83 deaths, with no reported deaths throughout the first week in June.
The term ‘shoe leather’ epidemiology, where much of the work is carried out on foot in the community, was first demonstrated during the Soho cholera epidemic in 1854.
Writing in the Journal of the Royal Society of Medicine, Professor John Ashton describes how, when China first reported the emerging epidemic in Wuhan in January 2020, Cuba promptly drew up a cross-government contingency plan. When the first cases of the virus were confirmed in the country among three tourists from Italy on 11 March, the plan was immediately put into action.
Screening was carried out in Cuba by tens of thousands of family doctors, nurses and medical students on foot, with testing, tracing and quarantining of suspected cases in state-run isolation centres for 14 days.
Prof Ashton said: “Cuba has long been renowned for its ability to turn in world beating health statistics while continuing to struggle economically. With a health system grounded in public health and primary care, the country invests heavily in producing health workers who are primarily trained to work in the community. Their efforts with COVID-19 have been outstanding.”
He added: “Cuba was one of the first countries to send health workers to support the control of the epidemic in Wuhan, back in January, just one example of its unrivalled commitment to international solidarity in humanitarian disasters.”
Shoe leather epidemiology in the age of COVID: lessons from Cuba (DOI: 10.1177/0141076820938582) by John Ashton is published the Journal of the Royal Society of Medicine
The failure of the UK government to follow the advice of the World Health Organization to ‘Test, Test, Test’ for COVID-19 has cost the country dear. Having been slow to treat the pandemic with due urgency once the initial Public Health Emergency of International Concern had been called at the end of January, the country of John Snow and the Broad Street pump was left playing an embarrassing and fatal game of catch-up as the disease spread.
For those trained in the proud tradition of UK public health, this disaster has proved all the more galling in its neglect of the basic lessons of 1854 and the Soho cholera epidemic, when shoe leather epidemiology first demonstrated its worth. It was from walking the streets from house to house and business to business that Snow was able to demonstrate the concentration of cases among those drinking water from the street pump and persuaded the select vestry to remove the pump handle.
This very practical and local approach to public health provided the leit motif for its effective practice for generations until the disastrous reorganisation of the National Health Service, and with it public health, in England in 2013. The creation of a flawed agency, Public Health England, with its unremitting centralisation and undermining of local and regional public health, paved the way for the dramatic failure of response to COVID-19 in 2020. The inability to undertake large-scale testing for the coronavirus and to follow through with contact tracing, triaging, isolation and treatment followed as light follows day. Local capacity of the skilled workforce and local knowledge was run down and along with it the ability to mobilise the rich network of laboratory assets. Over-dependence on prominent London figures, institutions and laboratories, together with fly-by-night private sector contractors operating from anonymous call centres, were no substitute for hands-on experience with local knowledge and established networks of collaboration. The result was chaos and incompetence.
Comparison with one country that has performed exceptionally in response to the emergency illustrates what might have been possible had we not seemed hellbent on destroying a functioning public health system and had instead played to national strengths in primary care. Cuba has long been renowned for its ability to turn in world beating health statistics while continuing to struggle economically. With a health system grounded in public health and primary care, the country invests heavily in producing health workers who are primarily trained to work in the community, with only a small proportion going on to specialise in hospital medicine. Their efforts with COVID-19 have been outstanding.
When China first reported that a new coronavirus had been identified as the cause of the emerging epidemic in Wuhan in January 2020, Cuba promptly drew up a cross-government contingency plan and was ready to act. The first cases were confirmed among three tourists from the high disease incidence area of Lombardy in Italy on 11 March, the same day that World Health Organization declared that COVID-19 qualified as a pandemic, the patients were immediately hospitalised and the plan put into action. Tens of thousands of family doctors, nurses and medical students screened all homes in the country for cases on foot, with testing, tracing and quarantining suspected cases in state-run isolation centres for 14 days. The epidemic was soon contained after a total of 2173 confirmed cases and 83 deaths with no reported deaths throughout the first week in June. In addition, Cuba had been one of the first countries to send health workers to support the control of the epidemic in Wuhan, back in January, just one example of its unrivalled commitment to international solidarity in humanitarian disasters.
As the pandemic in the UK enters a new phase and we wait to see whether there will be a second and third wave, as happened in the Spanish flu of 1918–1920, or whether it just disappears as happened with its close relative SARS in 2003, the time for reflection has already begun. Let us hope that we can put to one side the Little England mentality that has been so much in evidence in the handling of COVID-19 and be willing to learn from others who still understand and value the ‘shoe leather epidemiology’ that was invented in Broad Street 170 years ago!
