(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.)
In the world of healthcare, déjà vus are quite common. While wisdom indicates that one learns from one’s mistakes to improve, and step ahead, that is easier said than done. As a result, mistakes are often made, just as they are in any other sector, but only, in health care, the costs of not learning from previous errors are sometimes, incalculably high. During the initial months of COVID-19, as it became evident later, China was being secretive with regard to sharing information about the SARS-CoV-2 virus. The tardiness of China in sharing crucial information, it was argued by experts around the world, could’ve caused expensive, critical gaps in knowledge that would have had an impact on the outcomes of the pandemic, and lives lost. Last week, we reported that the World Health Organization has asked China for more data on respiratory illness outbreaks. The United Nations body said that northern China had reported an increase in “influenza-like illness” since mid-October when compared to the same period in the previous three years, the WHO said. “WHO has made an official request to China for detailed information on an increase in respiratory illnesses and reported clusters of pneumonia in children,” it said in a statement on November 23. But there was no public comment on this from China.
China’s National Health Commission told reporters last week that the respiratory illness spike was due to the lifting of COVID-19 restrictions and the circulation of known pathogens, namely influenza and common bacterial infections that affect children, including mycoplasma pneumonia. A day after WHO flagged the issue, it clarified after a virtual meeting with the Chinese authorities that China reported no unusual, novel pathogens in respiratory illness surge.
The scare turned out to be a false alarm, as far as an epidemic goes, but brought back fears again. Health cannot afford to be shrouded in mystery or mysticism, particularly because in a globalised world, there are no secluded corners. Sharing information for the benefit of the various nations is not only appreciable, but also imperative, to closely monitor, and predict future pandemics, in an effort to prevent it.
Meanwhile, India’s Health Ministry maintained that it would be closely monitoring an outbreak of H9N2 and clusters of respiratory illness in children in China, while asserting that the country was prepared to meet any health emergency. Bindu Shajan Perappadan further reports: “The overall risk assessment by WHO indicates a low probability of human to human spread and low case fatality rate among human cases of H9N2 reported to WHO so far,” it said. According to a senior Health Ministry official, India is embarking on a One Health approach to adopt a holistic and integrated roadmap towards addressing such public health issues.
“There has also been a significant strengthening of health infrastructure, especially since the COVID-19 pandemic. PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) is developing capacities of health systems and institutions across the continuum of care at all levels,” he said. Also, the Centre has asked States to watch cases of respiratory illness, as part of regular surveillance stepped up.
News about COVID-19 is never far behind. WHO announced last week that it will work on strategies to integrate COVID-19 vaccines with routine immunisation. If anything, this indicates the world has moved into the phase of living with COVID-19. Its officials began deliberating strategies for member countries to transition from the use of COVID-19 vaccines under Emergency Use Authorisation (EUA) to full Marketing Authorisation (MA). “Even though the acute phase of the COVID-19 pandemic is over, the virus is still circulating. We need to make sure people continue to stay protected from existing and future variants. For this, it is crucial that the regulatory authorities of member states are better equipped to take considered decisions to grant long-term authorisation to COVID-19 vaccines, and introduce them in national immunisation programmes as per requirements,” Poonam Khetrapal Singh, Regional Director, WHO South-East Asia said.
Here’s some good news from the COVID-therapy front. I write about this small triumph which will bring huge relief for people struggling with peculiar long COVID sequelae - anosmia (or the loss/distortion of smells). For the study, 54 patients were treated with a stellate ganglion block, which includes injecting anaesthetic directly into the nerves on one side of the neck to stimulate the nervous system, guided by a CT. The stellate ganglia are nerves on either side of the neck that are part of the autonomic nervous system, which regulates involuntary processes including heart rate, blood pressure, breathing and digestion. They deliver certain signals to the head, neck, arms and a portion of the upper chest. At the follow-up after the injection, one week later, 59% of patients reported improvement in symptoms. Of this, 82% reported significant progressive improvement by one month post-procedure. At three months, there was a mean 49% improvement in symptoms (range 10% to 100%) among the 22 patients.
Meanwhile, a Lancet study concluded that high-dose COVID-19 treatment was less effective in India than in Europe. A higher dose of the steroid drug, dexamethasone, may have less beneficial effects for COVID-19 patients in India as compared with those in Europe, according to a study published in The Lancet Regional Health - Southeast Asia journal. The team, including researchers from Copenhagen University Hospital - Rigshospitalet, Denmark found that a bigger dose of dexamethasone (12 mg) did not seem to be as good as the usual dose (6 mg) for COVID-19 patients in India. This was seen through survival rates and how well people were doing after 90 and 180 days, they said, though admitting that this might be a chance finding, if more evidence was not mined in support of the theory.
Continuing our coverage of evictions in hospitals in the Gaza Strip, do read these stories: Two premature babies died before evacuation from Gaza, according to the UN, and a doctor at Gaza’s Al-Shifa hospital says their director was arrested by Israel.
In other follow-ups, continuing to watch the availability of TB drugs in India, R. Prasad writes that eight months on, States wait for 3HP TB preventive drug, the shorter drug regimen involving once-weekly isoniazid-rifapentine for 12 weeks for members of the household where patients with TB live. The 3HP regimen has been associated with a higher completion rate in all subgroups — adults with HIV, adults without HIV, and children and adolescents. According to the 2021 Guidelines for Programmatic Management of Tuberculosis Preventive Treatment in India, the use of the shorter regimen was associated with “at least 20% greater treatment completion rate (82% vs 61%)”. The costs of this treatment are also cheaper to current alternatives.
Keeping on the infectious diseases track, here is more news about the mpox outbreak in the Congo with the U.N. confirming for the first time, the sexual mode spread of the infection. “This is the first definitive proof of sexual transmission of monkeypox in Africa,” Oyewale Tomori, a Nigerian virologist who sits on several WHO advisory groups, said. “The idea that this kind of transmission could not be happening here has now been debunked.” Mpox has been endemic in parts of central and west Africa for decades, where it mostly jumped into humans from infected rodents and caused limited outbreaks.
As we announce the news of Indian Immunologicals launching measles and rubella vaccine for children, here is also a detailed explainer on whether India is really lagging behind in measles vaccination, as the WHO and CDC report pointed out a week ago. The report said measles cases in 2022 have increased by 18%, and deaths by 43% globally, compared to 2021. In response, the Ministry said: “The recent reports based on data released by WHO-CDC are not based on facts and don’t reflect the true picture. The catch-up vaccination age for the administration of Measles Containing Vaccine (MCV) has been increased from 15 months/2 years to 5 years. All unvaccinated/partially vaccinated children with missed/due doses of vaccines will be vaccinated.”
In the week where COP28 gets underway in Dubai, it will be impossible to ignore this important piece by Rajeev Sadanandan and Pranay Lal on recognising the impact of climate change on health. India’s inadequate health systems make our population particularly vulnerable to the impact of climate risks on health. Climate change affects health directly, causing more sickness and death. In more indirect ways, it affects nutrition, reduces working hours, and increases climate-induced stress.
One estimate suggests that if global temperature were to rise by 2°C, many parts of India would become uninhabitable. All nations during the Paris Agreement agreed to cap the rise in temperature at 1.5°C. Clearly, we have failed. The year 2023 saw the highest temperatures and heat waves in recorded history. The situation is likely to worsen for the planet. Climate emergencies — extreme heat, cyclones, floods — are expected to occur with increasing regularity. These will interfere with food security and livelihoods and sharpen health challenges. The double burden of morbidity that India faces from communicable and non-communicable diseases will be worsened by climate change. It could facilitate the growth of vectors, the authors argue.
Moving on, here is more good news, a rare thing for the rare diseases sector. Generic drugs to treat four rare diseases were launched last week. The Union Health Ministry has made available generic drugs to support the care and treatment of four ailments: Tyrosinemia-Type 1, Gauchers Disease, Wilson’s Disease, and the Dravet-Lennox Gastaut Syndrome. This means that the cost of these drugs will be slashed by anywhere between 60 and 100 times of their current market value. There are plans to extend this to other rare diseases too, and this will help patients and their families immensely.
People keep feeding the ayurveda mill more grist. Here is a follow-up on the Patanjali controversy: Patanjali defends its medicines, and claims they are clinically proven. A day after the Supreme Court warned Baba Ramdev-owned Patanjali Ayurved of imposing hefty fines if they do not withdraw misleading advertisements, the company said in a press release on November 23 that its products have helped thousands of people free from several diseases like blood pressure, sugar, thyroid, asthma, arthritis, obesity, liver and kidney failures, and cancer. The company claimed that it has a database of more than one crore people, with real-world evidence, preclinical and clinical evidence to prove the efficacy of their products.
Meanwhile, Kallol Bhattacherjee reports that Ayurvedic products will not be a part of the India-U.K. FTA dialogue. The U.K.’s policy towards Ayurveda products is not part of negotiations on the India-UK Free Trade Agreement (FTA). The U.K. grants Traditional Herbal Registration for herbal or homoeopathic medicines that are used to treat minor health conditions. However, the use of Ayurveda for serious health issues will require stringent tests. To be authorised for treatment of a major health condition, an ayurvedic product would need to provide robust clinical trial data proving safety, quality and efficacy that meets the requirements for full marketing authorisation, he writes, quoting sources.
While you are here, do read C. Maya’s story on life after a stroke. There is life after a stroke, with proper rehabilitative therapy, she says, but indicates the multiple aspects that this might involve, including medical care, social support, age and co-morbidities and financial capacity. In a newsletter about learning from the past, the following is an important story: Lessons learnt from the polio eradication programme can help improve retinopathy of prematurity services in India. Afshan Yasmeen quotes researchers writing in Lancet Regional Health - Southeast Asia Lancet paper who advocate that drawing on the success of the GPEI, a similar comprehensive approach be framed to address the challenges of Retinopathy of Prematurity in India.
Here’s an example of lessons we did not learn from the past, or court judgements either. Mohammed Imranullah S. reports that concerning the two-finger test, the Madras High Court recently warned doctors of being guilty of misconduct if they continue to perform it on victims of sexual assault. Expressing their shock at the incident, a Division Bench led by Justice Sundar said: “We notice regrettably that a two-finger test had been conducted in the instant case, though the Supreme Court and this court, in several cases, have repeatedly held that such a test is neither acceptable nor desirable to ascertain whether the victim was subjected to sexual intercourse.” The Supreme Court in Lillu alias Rajesh versus State of Haryana (2013) held that medical procedures should not be carried out in a manner that constitutes cruel, inhuman, or degrading treatment and that health should be of paramount consideration while dealing with gender-based violence. If concerns of sensitivity are not enough to convince doctors, perhaps fear of the law and courts will.
While Geetha Srimathi talks of how outmoded extraction systems, and modern requirements might put the Irula tribespeople, who have a unique skill, out of work, this is also an interesting take on how the entire industry works to churn out anti-snake venom for the country: Slip sliding away: venom extraction in Tamil Nadu.
Sometimes, the smallest of innovations make the best impact on outcomes. In order to ensure that clean linen is being used in all government hospitals in the State, Tamil Nadu has decided to have specific-coloured linens on each day. Simple enough and an effective quality control mechanism. Of course one assumes that the linen is washed hygienically before being replaced.
So many decades after independence, it is incomprehensible that we are still writing and reading stories like this: a tribal woman being taken to hospital in an ambulance gave birth on the muddy pathway in the wilderness of Tamil Nadu’s Nayakaneri hillock. And this is in Tamil Nadu, which has a relatively progressive and well branched out health system network in place.
From the Health pages
Since you are here already, do also spend a few moments on the following stories:
Sunalini Mathews writes on the now popular, evolving non-medical concept of dopamine: Dopamine on the brain.
D. Balasubramaniyan explains: How does our brain learn to read?
The National Medical Commission clarifies on norms for foreign medical graduates to register, work and study in India.
Ayushman Bharat Health and Wellness Centres (AB-HWCs) to be called ‘Ayushman Arogya Mandir’.
For a smattering of regional content, stop by here:
Substance use disorders: NIMHANS conducts workshop for nursing personnel from Namma Clinics.
Health Department sets goal to make Karnataka anaemia-free by 2025.
Virtual screening of the international dementia documentary at NIMHANS fosters a deeper understanding of the neurodegenerative disease.
No decision yet on training teachers for Type 1 diabetes management in Kerala.
Family Health Centre in Kozhikode is first antibiotic-smart healthcare centre in the country.
Residents advised to mask up as Coimbatore witnesses surge in viral flu cases.
Serena Josephine M. writes: Madras Medical College’s Institute of Cardiology to lead a multicentric study on pregnancy and cardiac diseases.
Families of 30 deceased persons agreed for organ donation in two months in Tamil Nadu.
Doctors at the Institute of Obstetrics and Gynaecology manage a case of alloimmune thrombocytopenia.
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