The cyclical ebb and flow of infections

This week in health: WHO’s verdict on e-cigarettes, rising mental health concerns and how the winter season affects human behaviour.

Updated - December 20, 2023 10:30 am IST

Published - December 19, 2023 02:36 pm IST

Image for representational purpose only. File

Image for representational purpose only. File | Photo Credit: Reuters

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As 2023 comes to its final port of call this December, headlines are once again dominated by whispers, facts and questions about COVID-19. We knew that COVID-19 was not leaving anytime soon, but we are close enough to the pandemic at this stage for COVID-19 whispers to cause a sense of alarm and panic in the society. How serious is the situation now?

Globally, the number of cases of COVID-19 has started increasing. Some countries have urged their residents to mask up once again, at least in public places, and while travelling on airplanes, particularly Singapore, media reported (Singaporeans strongly encouraged to wear face masks following a spike in cases). The WHO acknowledged the surge, the emergence of the JN.1 variant and said it would continue to assess the situation. WHO’s Maria Van Kerkhove said the number of respiratory infections across the world has been increasing, not just COVID-19 this holiday season where people are travelling more. JN.1 a sublineage of the BA.2.86 series, has the full spectrum, from asymptomatic disease to severe disease to death, similar to Omicron variants. She said as it is possible to track the virus, so member states have been asked to mount strong surveillance, do good sequencing and share the sequencing, so that the WHO could modify its advice as per evolving parameters. The good news is that all approved COVID vaccines provide protection against severe disease and death, for all variants, including JN.1.

Kerala which has produced the index patients in COVID waves in the past, also threw up the first detected case of JN.1 in the country last week. JN.1 was detected in the sample of a 79-year-old woman in Kerala that was drawn on December 8. The senior citizen’s sample had returned a positive result in an RT-PCR test taken on November 18, doctors said, adding that she had mild symptoms of influenza-like illnesses (ILI) and had recovered from COVID-19. Two COVID-19 deaths reported in north Kerala further prompted the health department to issue an alert. Earlier, an Indian traveller was also detected with JN.1 sub-variant in Singapore. The person was a native of Tamil Nadu’s Tiruchi district and had travelled to Singapore on October 25. However, no increase in cases was observed in Tiruchi district or any other location in Tamil Nadu since then. “No other case of JN.1 variant has been detected in India,” the source said. It was also confirmed that while cases were increasing across the country, 90% of them were in the mild category. 

Nevertheless, this led to some guarded concern amongst health authorities in Stated neighbouring Kerala — Tamil Nadu and Karnataka. Since States have porous borders and it is impossible to effectively monitor the movement of people across, so to be on the safe side, State Governments have increased surveillance and put in place mechanisms to handle patients in case the new sub-variant is to be detected within their borders. Tamil Nadu (as cases rise in Kerala, Tamil Nadu to keep a close watch on COVID-19 situation) and Karnataka (Karnataka’s Kodagu on alert and Karnataka on high alert; TAC to meet on December 19) are gearing up. 

Meanwhile, it is the season also for all kinds of infections, and outbreaks, winter as it is in half the world. Siddharth Kumar Singh writes about how mumps is on the rise in Hyderabad, with doctors advising MMR vaccinationrespiratory infections and influenza cases on the rise in Kerala and the State’s plans to monitor rising cases of respiratory illnesses closely.        

On the subject of influenza, Bani Jolly and Vinod Scaria write on the significance of an influenza A (H1N2)v case in the U.K. On 27 November 2023, the United Kingdom Health Security Agency (UKHSA) reported the first known human case of influenza A (H1N2)v in the U.K., a variant of the influenza virus previously not known to cause infections in humans. Following detection, public health agencies in the U.K. are now working rapidly towards characterising the pathogen and assessing the risk it may present to human health. Instances of human-to-human transmission of the virus have also not yet been detected, however, the detection of the virus in a case with no contact with animals could possibly mean that a limited and undetected human-to-human transmission may have occurred. “But there is no definitive evidence,” says the WHO.

Five countries in East and Southern Africa also have anthrax outbreaks, WHO says, with 20 deaths reported  

Also, an important story: Scientists see the risk of lost opportunity for long COVID research in China. With more than a full year past since China eased restrictions and let COVID-19 sweep its households, scientists are worried a unique opportunity may be slipping away to study long COVID from possibly hundreds of millions of infections in that country. Global disease experts say little is known about China’s experience with long-term COVID effects, which in Britain, Canada, the U.S. and elsewhere are thought to have afflicted millions with debilitating fatigue, brain fog and other symptoms that persist for months or even years. China’s rare circumstances - relying on home-grown vaccines and mostly avoiding COVID until late in the pandemic - could, these experts say, provide particularly valuable data and insights on long COVID.  

Saloni Puri meanwhile quoted from a freewheeling chat with global wellness experts at the Soul Festival at Soneva Fushi in the Maldives a couple of months ago. They shared their collective thoughts on the new paradigms for society — from nurturing a sense of community to gut health to deconstructing stress, in the wellness futurecast of 2024.

This time around, we will do well to pay attention to the health care needs of a population, for whom the COVID-19 pandemic exacerbated loneliness. write on the Global State of Social Connections survey. The survey shows a third of the global population reported interacting daily with friends and family who live far away, suggesting that many people likely use some form of technology to foster connectedness. Meta and Gallup collaborated on two research studies, the first in 2022, revealed important variations in people’s sense of connectedness and loneliness across the seven countries studied. The 2023 report builds on that research by presenting data on connections and loneliness among people from 142 nations. While it showed better connections in 2023, than in the past, it is significant that nearly a quarter (24%) of the global population felt “very” or “fairly” lonely.

Here’s a key detailed story on what impact COVID-19 vaccinations had on the mental health of people, by Rajeev Jayadevan. A recent U.K. study by Walker et al. revealed an increased incidence of mental health problems following COVID-19. However, this was less common among vaccinated individuals, when compared to unvaccinated people. During the period following the vaccine rollout, the researchers found a clear difference in mental health outcomes among vaccinated individuals. They suffered less depression, anxiety and serious mental illness following COVID-19, compared to their unvaccinated peers. The effect was independent of whether they had a prior history of mental illness. This is inferred to be due to the decreased severity of COVID-19 among vaccinated people, which could have had an indirect impact on mental health outcomes.

On to the subject of mental health among medical professionals, it is reassuring that The Federation of All India Medical Association (FAIMA) has set up a national mental health task force in response to the alarming rising in mental health issues and deaths by suicide among doctors. Bindu Shajan Perappadan records that the round-the-clock voluntary facility comprises psychologists, psychiatrists, and resident doctors to provide support in managing stress and mental health issues, the association said in its letter to the Union Health Minister Mansukh Mandaviya. Further, the association has requested all medical students to contact its representatives if they were enduring mental issues, including anxiety and depression. FAIMA has also suggested that the Central government fix and ensure strict compliance with the duty hours of postgraduate medical students; provide a mental wellness centre in every medical institution; and have a dedicated helpline number for staff members, so that students could reach out without hesitation.

And then the impact of technology on assisting and exacerbating mental health challenges is an area we can no longer ignore. Technology brings with it new mental health challenges, says Sowmya Swaminathan speaking at a recent meeting in Chennai organised by SCARF to award journalists for writing on mental health issues. There are concerns about the acceptable limit on screen time for children, the do’s and don’ts, addiction and cyberbullying; it is not limited to children and that remains difficult to decipher even for adults, she said. She also suggested setting up and training a special cadre to care for persons with mental illness as it can make a big difference to their quality of life.    

Meanwhile, a five-member committee headed by Vinod K. Paul upon reviewing the Uniform Code for Pharmaceutical Marketing Practices (UCPMP), recommends curbs on freebies doled out by pharma companies. The 100-page report submitted to the Department of Pharmaceuticals (DoP) says the value of “brand reminders”, including books, calendars, diaries, journals (including e-journals, dummy device models of body organs, medical books, and clinical treatment guidelines) should not exceed ₹1,000 per item. In the case of free drug samples, tax should be deducted at source for the company under the Income Tax (I-T) Act if their value exceeds ₹20,000 per year.

The evidence is finally out. Long pushed as an alternative to tobacco use, e- cigarettes, the WHO concluded were not effective for quitting tobacco use. Instead, alarming evidence has emerged on adverse population health effects, said the World Health Organisation last week. It added there is an urgent need to control e-cigarettes to protect children, as well as non-smokers and minimise health harm to the population. “Kids are being recruited and trapped at an early age to use e-cigarettes and may get hooked to nicotine,” said WHO Director-General Tedros Adhanom Ghebreyesus in a statement issued by the organisation, while urging countries to implement strict measures to prevent uptake to protect their citizens, especially their children and young people.

K.S. Parthasarathy writes on a crucial piece of research that discourages putting young children (and adults) through unnecessary CT scans: CT scans associated with increased risk of blood cancers. Radiation doses at moderate (over 100 mGy) to high (over 1 Gy) values are known to cause haematological malignancies (blood cancers) in both children and adults and other cancers. However, there has been uncertainty about risk at low doses (less than 100 mGy) that are typically associated with diagnostic CT examinations. A recent study (Nature Medicine, 9 November 2023) suggests that even low doses of radiation have a small probability of causing blood cancer. Researchers from the International Agency for Research on Cancer (IARC) and its partners followed up a multinational cohort of 9,48,174 individuals who underwent CT examinations before age 22 years in 276 hospitals from nine European countries. The final study covered about 1.3 million CT scans in nearly 9,00,000 patients. They estimated the radiation doses to the active bone marrow of each subject based on the body part scanned, patient characteristics, period and inferred CT technical parameters. About 51% of the cases were younger than 20 years at diagnosis, whereas 88.5% were younger than 30 years.     

Tailpiece

This week’s tailpiece is a hands-down winner by Michael Varnum and Ian Hohm who write on how the winter season affects human minds and behaviour. What comes to mind when you think about winter? Snowflakes? Mittens? Reindeer? In much of the Northern Hemisphere, winter means colder temperatures, shorter days and year-end holidays. Along with these changes, a growing body of research in psychology and related fields suggests that winter also brings some profound changes in how people think, feel and behave.

While it’s one thing to identify seasonal tendencies in the population, it’s much trickier to try to untangle why they exist. Some of winter’s effects have been tied to cultural norms and practices, while others likely reflect our bodies’ innate biological responses to changing meteorological and ecological conditions. The natural and cultural changes that come with winter often occur simultaneously, making it challenging to tease apart the causes underlying these seasonal swings.

From the Health page

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The country aims at having 1 ambulance per a lakh population, says Union Minister.

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For the key stories from our regions, stop by here:

Andhra Pradesh

Sambasiva Rao M. reports that the ‘enhanced’ Aarogyasri scheme will be launched in Andhra Pradesh on December 18.

ASHA workers stage protest for hike in salary, pension.

ASHA workers launch 36-hour ‘Maha Dharna’ in Visakhapatnam.

Harish Gilai writes: tribals of Andhra Pradesh district in fear grip after six infants die of unknown causes in four months.

Children in Andhra Pradesh combat HIV stigma in Tirupati event.  

Puducherry

Centre non-committal on Puducherry’s demand to establish medical college at Karaikal.

Karnataka

‘Smart ambulance’ emergency care rolled out in Mysuru.

Only 316 staff working against 868 sanctioned posts in Karnataka’s Gulbarga Institute of Medical Sciences.

Karnataka Government announced a slew of measures to end female foeticide and also to set up task force to prevent female foeticide.

Afshan Yasmeen writes on how nearly 1,500 ‘fake’ doctors were identified by the Health Department since 2007.

Provide additional grants to KIMS Hospital, Mahesh Tenginakai urges government.

NIMHANS to roll out NAMAN rural mental health programme in two taluks of Karnataka and Uttarakhand.

Conduct pregnancy tests in all rape cases and sexual offences on minor children, says Karnataka High Court.

Karnataka Health Minister flags off “Wellness on Wheels”– an advanced mobile clinic.

Karnataka Health department closes down unauthorised clinics, laboratories in Udupi district.

Kerala

Hospital to offer free surgery to differently abled children.

Drains spilling over to Kozhikode beach pose health risk.

Tamil Nadu

Chennai hospital launches device to treat foot ulcers.

Devala residents demand closure of tar mixing factory in the  Nilgiris over health concerns.

Fever clinics, a boon to rural population of Tamil Nadu’s Tirunelveli district.

Committee to finalise and submit a report on the Chief Minister’s health insurance scheme CHIS by end of January 2024.

From 38 last year, Tamil Nadu’s RGGGH treats 61 overseas patients in 2023.

Health Minister launches initiative to distribute medicines by autorickshaws in flood-hit areas.

Telangana

Siddharth Kumar Singh reports on the trans person who underwent a hysterectomy at Hyderabad’s Osmania General Hospital.

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.

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