(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)
Often times, in the post-COVID world, with science/health reporting picking up since the pandemic, health writing becomes all about telling a story in detail, it’s about laying it all bare, explaining the nuances, capturing the latest research and interpreting it for a burgeoning group of readers of science and health articles. There is no doubt that the consumption of such content has seen an uptick since the pandemic; people actively seeking out information on health and a healthy lifestyle, new variants of COVID circulating, what it means for them, what are the advances in terms of therapeutics and vaccinations. The Hindu also takes its explainers seriously, adding explainers on current issues from time to time. This past week has been no different.
Sridhar Sivasubbu and Vinod Scaria this time tell you to listen to your gut – it may be telling you something about your heart. They focus on researchers identifying a link with variants of a gene cluster in organisms involved in metabolising an amino-sugar molecule called N-acetylgalactosamine. The organisms with this gene cluster had more individuals with specific genetic variants in the ABO blood group locus (a locus is a place on a chromosome where a gene is located). Genetic variants in ABO blood group loci, and consequently ABO blood groups, have been previously associated with a number of cardiometabolic traits, including lipid levels and blocks in blood vessels. More recently, scientists have also unearthed links with the risk of severe COVID-19 infections. It suggests that the association of ABO and risk for cardiovascular disorders could in part be modulated through the microbiome.
This, for all intents and purposes, must be instinctive, but then the situation, given the shocking neglect the area faces, is such that it demands an explainer. Siddesh Zadey, Aimen Perween Afsar and Maithili K. write about how why access to essential surgery is important. Global surgery focuses on equitable access to emergency and essential surgery. While it predominantly focuses on low- and middle-income countries (LMICs), it also prioritises access disparities and under-served populations in high-income countries (HICs). These “surgeries” include essential and emergency surgeries such as surgery, obstetrics, trauma, and anaesthesia (SOTA). Despite small differences, there is largely a consensus across multiple international groups on about thirty or so procedures that fall under the umbrella of emergency and essential surgery.
Taking on the current issue in the field of anti-microbial resistance, based on the statistics that were released in India, last week, Bindu Shajan Perappadan talks to Sumit Ray, and Abdul Ghafur to find out: Are antibiotics over-prescribed in India? The answer too, is that antibiotics are being misused and overused in India, and that a cap on inappropriate use of antibiotics is the need of the hour. The latter further elaborated, in another explainer, about how innovative entrepreneurship has the power to turn the tide against antimicrobial resistance, even in India. The crux of the problem isn’t about cutting down on necessary treatments; it’s about fine-tuning them. The aim is to prescribe antibiotics only when absolutely needed and in the right doses. This careful management is vital to keep current antibiotics working and to make sure that new ones remain effective for longer. Yet, in India, a significant hurdle is that most hospitals don’t have enough trained specialists to put such careful antibiotic use into practice. This calls for innovative service models that can provide the needed guidance and support for hospitals to start and keep up effective antibiotic stewardship and infection control measures.
In order to understand the reasons behind the U.K. junior doctors’ strike for better pay, Saumya Kalia does a deep dive. Recently U.K. junior doctors’ held their longest-ever walkout/ ‘historic’ strike for better pay. “A crippling cost-of-living crisis, burnout and well below inflation pay rises risk driving hard-working doctors out of their profession at a time when we need them more than ever,” the British Medical Association said, highlighting that this would have a cascading effect on the U.K.’s health services. Pay has been reduced by more than a quarter since 2008, and the BMA has asked for a 35% pay increase. Health Secretary Victoria Atkins on January 9 said this is “simply unaffordable”.
For more clarity on the new rules to ensure quality in the pharma sector, this is the go-to story: The Health Ministry issues revised rules to ensure quality in the pharma sector. The crux of the matter is this: The Ministry of Health and Family Welfare late last week notified revised rules under Schedule M of the Drugs and Cosmetics Rules, 1945. The revision aims to ensure that the pharma sector recommits to the manufacture of safe, effective, and high-quality drugs in compliance with international quality standards, thus benefiting both patients and industry. This is a response to the backlash India has been receiving over reports of substandard medicine being exported from India. To read further, tarry at the link.
Parth Sharma and Vaishnavi Jayakumar provide the long history of medical care on Indian Railways, whether care is adequate, and whether passengers are safe while travelling on trains.
Here’s our weekly update on COVID-19, going beyond the usual statistics:
Rajeev Jayadevan dwells on a crucial aspect that requires a great deal of attention, an issue that cannot be simply wished away, even as we encounter yet another wave of COVID, albeit mild - long COVID. Researchers from the Amsterdam University Medical Center have discovered an important mechanism responsible for fatigue in people with Long COVID. They show that essentially it is an energy availability problem within the muscles, rather than hypoxia due to clots blocking tiny blood vessels as previously thought. The results were published in Nature Communications on January 4, 2024. The commonest symptom, anecdotally, and with empirical evidence, is extreme tiredness or fatigue that is worse after even mild exertion. For instance, walking a few steps might result in the same level of fatigue as climbing six flights of stairs, necessitating an immediate rest afterwards. Researchers discovered both structural and functional damage to muscles in Long COVID, likely from a deranged immune response. The cause of tiredness was identified as muscle cells not receiving sufficient energy from mitochondria. As the author explains, “This is somewhat like using an old mobile phone with a weak battery and low charge, where even a brief conversation triggers a complete shutdown. Similarly, even a slight exertion led to excessive fatigue in the muscle cells.”
There is yet another vaccine that seems effective against COVID-19, this one, homegrown. A heat-tolerant vaccine developed by the Indian Institute of Science (IISc) researchers is said to be effective against all current strains of SARS-CoV-2 besides having the potential to be quickly adapted for future variants as well. Given that other vaccines are in short supply in the country, and given the potential for waning immunity, every announcement about the availability of a vaccine is welcomed with joy. More so, because of its very nature: According to IISc., the RS2 antigen can also be stored at room temperature for a month without the need for cold storage, unlike many vaccines in the market which require mandatory cold storage. This would make the distribution and storage of these vaccine candidates much more economical.
For other regular updates on COVID-19, on the JN.1 variant, do see below:
January 15:India logs 375 new COVID-19 cases
January 12: Number of cases crosses 1,000 mark
Concerned over deaths among those with comorbidities, Karnataka to monitor patients through tele-ICUs
Last rites of COVID victims can be done in all crematoria in Karnataka, says Health Department
Credit for T.N.’s effectiveness in tackling COVID-19 goes to every Minster: Health minister
There is finally some good news from Tuberculosis reporting in India, hopefully, it will set the trend for the future, what with targets looming large. R. Prasad notes that India has achieved a record TB notification in 2023. In 2022, India had notified 24,22,121 TB cases, which the India TB Report 2023 remarked as a “milestone year for TB surveillance efforts in India, with a record high notification”. The number of TB cases notified in the public sector in 2023 stood at 16,99,119 while the number of TB cases notified by the private sector was 8,38,116. Whereas the TB notification by the public sector reached 93% of the target, it was 89% in the case of the private sector.
Did you know, with pooled procurement, drugs cost 82% less? For the first time, a private entity — the National Cancer Grid — has been able to replicate the model and hammer down the cost of high-value, high-volume cancer and supportive care medicines through a pilot pooled procurement programme. The pooled procurement of 40 drugs by 23 cancer centres resulted in savings of Rs. 13.2 billion (Rs. 1,320 crores), according to a paper published in 2023 in the Bulletin of the World Health Organization. Besides anticancer drugs, the list of medicines included antibiotics, antifungals, antiemetics and growth factors. The drugs included both generic and patented medicines, and the participating cancer centres — small, mid-size and large-volume — included both private and public cancer hospitals from across the country. Certainly, lessons in this for the larger health community in the country.
Talking about prevention, a strange sort of clarification issued by the Health Ministry had journalists wondering last week. It said, in a release, that it was staunching rumours that the Ministry had begun HPV vaccination for adolescent girls in the country; it had not. After analysing the data available in this country threadbare, the National Technical Advisory Group on Immunisation recommended the vaccine’s inclusion in the government’s universal immunisation programme. This would involve a one-time catch-up shot for nine to 14-year-old adolescent girls, followed by a routine introduction at nine years. One story we intend to stay on…
Chennai-based senior diabetologist V. Seshiah recently advocated the use of metformin, an anti-diabetes drug, from the 8th week of pregnancy to prevent gestational diabetes. When foetal insulin secretion begins changes happen in maternal metabolism, says Dr. Seshiah. “Hyperglycaemia causes non-communicable diseases in later life and so gestational diabetes is the mother of NCDs. Transgenerational transmission of diabetes should be avoided,” he adds. Read on, here, for further information.
In international news, we hear that Oxford scientists have launched the first human vaccine trials for Nipah virus. The trials of the ChAdOx1 NipahB vaccine, consisting of 51 people aged 18 to 55, will be led by the Oxford Vaccine Group. As we saw last year, Nipah virus is spread by a variety of fruit bats that can be devastating in around 75% of cases, the researchers said. Outbreaks have occurred in countries in Asia, including Singapore, Malaysia, Bangladesh and India, with a recent one in Kerala in September last year.
States are constantly concerned about cleaning up rivers flowing through them, the Cooum in Chennai, or the Yamuna in Delhi, the length of the Ganga, and several such. Elaborate plans are laid, particularly after bad monsoon years to tidy up and remove encroachments that impede the flow, but most of them come to nought. In this context, it is interesting to learn that Europe’s problems are similar too: Bosnian river’s floating waste dump threatens health, tourism. People, and their waste disposal habits, are after all not that disimilar across the world, then!
Tailpiece
If you believe that the secrets of the past hold the key to the future, then you’ve got it right, in this case at least. DNA from ancient Europeans reveals surprising multiple sclerosis origins, we learnt recently. DNA obtained from the bones and teeth of ancient Europeans who lived up to 34,000 years ago is providing insight into the origin of the often-disabling neurological disease multiple sclerosis, finding that genetic variants that now increase its risk once served to protect people from animal-borne diseases.
The researchers identified a pivotal migration event about 5,000 years ago at the start of the Bronze Age when livestock herders called the Yamnaya people moved into Western Europe from an area that includes modern Ukraine and southern Russia.
Scientists have finally filled in the remaining 8% of the human DNA. They carried genetic traits that at the time were beneficial, protective against infections that could arise from their sheep and cattle. As sanitary conditions improved over the millennia, these same variants increased MS risk. This helps explain, the researchers said, why Northern Europeans have the world’s highest MS prevalence, double that of Southern Europeans.
From the Health page
If you have a few extra moments to spare, take your pick from below:
A.S. Jayanth says private practice of government doctors in Kerala is under the lens again.
I-STEM to launch Samavesha project on January 16 at IISc Bengaluru to connect researchers with labs and equipment.
Work on India’s first Integrated Ayush Wellness Centre initiated.
For an overview of the regional content published across bureaus:
Delhi
Nikhil M. Babu reports: Action against four doctors for turning away accident victim in New Delhi.
Bihar
Amit Bhelari on the midnight surprise inspection of Tejashwi Yadav that exposed government hospital.
Jammu
Hirra Azmat explains how a Jammu CSIR lab found cannabis plant compound has antibiotic effects.
Karnataka
Belagavi doctors perform rare heart surgery to save pregnant woman.
Rishikesh Bahadur Desai follows up on the issue: Maharashtra opens service centres in Belagavi to enrol beneficiaries for health insurance scheme.
Sathish G.T. reports: Girl’s death in Karnataka owing to Kyasanur Forest Disease intensifies need for vaccine.
Maharashtra’s Phule health scheme centres in Belagavi closed.
Ambulance services launched for tribal hamlets around Bandipur.
Kerala
Kerala ASHA workers on the warpath seeking release of pending allowances.
Kerala’s Kudumbashree campaign to join palliative care.
Alappuzha district panchayat forms 500-member palliative care team.
Tamil Nadu
8.35 lakh workers in 711 factories to be screened for NCDs in a month: Tamil Nadu Health Minister.
Serena Josephine M. reports: Chennai had highest number of users of 108 ambulance network in 2023.
Tamil Nadu to retain GoI tagline of Arogyam Paramam Dhanam in rebranding exercise of HWCs.
R. Krishnamoorthy reports that work begins on the ₹90-crore cancer care centre in Tiruppur.
8,84,551 families newly added as beneficiaries under CM’s Comprehensive Health Insurance Scheme: T.N. Health Minister.
S. P. Saravanan reports: 45 tribal hamlets in Erode to get smart study and tele-medicine centres.
Wilson Thomas reports on the fever camps being conducted in Coimbatore district to combat dengue.
Organ donations increased 14% in Tamil Nadu in 2023.
T.N. government announces schemes to improve safety, health, and livelihood of residents in Manali-Ennore area.
Telangana
Siddharth Kumar Singh says Telangana is fighting surge in spurious drug trade; doctors sound alarm.
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