Efficacy of Pranayama in Preventing COVID-19 in Exposed Healthcare Professionals: A Quasi-Randomized Clinical Trial.

Background: The global outbreak of COVID-19 has created a challenging situation, especially for the frontline Health Care Professionals (HCPs), who are routinely exposed and thus are at a higher risk of infection. Pranayama, a component of Yoga, is known to improve immune function and reduce infection. However, no clinical trial on the efficacy of Pranayama in preventing COVID-19 has yet been conducted. Aim & Objective: This quasi-randomized clinical trial assessed the efficacy of Pranayama in preventing COVID-19 infection in HCPs routinely exposed to COVID-19. Methodology: The study was conducted at 5 different COVID-19 hospitals, India in year 2020. The inclusion criteria were being an HCP exposed to COVID-19 patients and being negative on antibody tests. 280 HCPs were recruited sequential and assigned to intervention and control groups. Of these, 250 HCPs completed the study. The intervention was twice daily practice, for 28 days, of specially designed Pranayama modules under the online supervision of Yoga instructors. The HCPs in the control group were advised to continue their normal daily routine, but no pranayama sessions. Participants who developed symptoms suggestive of COVID-19 were subjected to Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) or Point of Care Rapid Antigen Test (RAT) for confirmation of the diagnosis. All the participants were tested for antibodies to COVID-19 on 28th day of the intervention to detect any asymptomatic infection. Results: The intervention (123) and control (127) groups had comparable demographics and baseline characteristics. At end of 28 days of intervention, nine participants in the control group and one in the intervention group developed COVID-19 (P-value: 0.01, Odds Ratio: 0.107, 95% CI: 0.86; Risk Ratio: 0.11, 95% CI: 0.89). Conclusion: The intervention of twice daily practice of the Pranayama module for 28 days in HCPs might have made a noteworthy contribution and may have helped in preventing COVID-19 infection. CTRI Number: CTRI/2020/07/026667.

COVID-19 vaccination in pregnancy: Need for global pharmaco-vigilance.

Coronavirus infectious disease has been around for more than 2 years as a pandemic, but now appears to have taken the form of an endemic. COVID-19 vaccination in pregnant women is presently being recommended and followed in most countries. However, robust scientific evidence on safety of the vaccine in the medium or long term, or regarding any adverse effects, is lacking. We searched the PubMed and gray literature for evidence on medium- or long-term effects of COVID-19 vaccination during pregnancy on the mother or her fetus/newborn and found limited data on this subject. Moreover, available evidence comes almost exclusively from the Western world. Any adverse effects of COVID-19 vaccination during or after pregnancy may take time to manifest. Therefore, there is a need to keep the cohort of vaccinated women and their children under scrutiny for any possible adverse effects. This is also needed to build confidence in the long term in the vaccines. A global pharmaco-vigilance or post-marketing surveillance network covering pregnant recipients of COVID-19 vaccines can identify and help to address any medium- or long-term adverse effects of the COVID-19 vaccines on pregnancy and the newborn.

Exit strategies from lockdowns due to COVID-19: a scoping review.

INTRODUCTION: In response to the ongoing COVID-19 pandemic, countries have adopted various degrees of restrictive measures on people to reduce COVID-19 transmission. These measures have had significant social and economic costs. In the absence of therapeutics, and low vaccination coverage, strategies for a safe exit plan from a lockdown are required to mitigate the transmission and simultaneously re-open societies. Most countries have outlined or have implemented lockdown exit plans. The objective of this scoping review is to (a) identify and map the different strategies for exit from lockdowns, (b) document the effects of these exit strategies, and (c) discuss features of successful exit strategies based on the evidence. METHODS: A five-step approach was used in this scoping review: (a) identifying the research question and inclusion/exclusion criteria; (b) searching the literature using keywords within PubMed and WHO databases; (c) study selection; (d) data extraction; (e) collating results and qualitative synthesis of findings. RESULTS: Of the 406 unique studies found, 107 were kept for full-text review. Studies suggest the post-peak period as optimal timing for an exit, supplemented by other triggers such as sufficient health system capacity, and increased testing rate. A controlled and step-wise exit plan which is flexible and guided by information from surveillance systems is optimal. Studies recommend continued use of non-pharmaceutical interventions such as physical distancing, use of facemasks, and hygiene measures, in different combinations when exiting from a lockdown, even after optimal vaccination coverage has been attained. CONCLUSION: Reviewed studies have suggested adopting a multi-pronged strategy consisting of different approaches depending on the context. Among the different exit strategies reviewed (phase-wise exit, hard exit, and constant cyclic patterns of lockdown), phase-wise exit appears to be the optimal exit strategy.

Prioritizing pregnant women for COVID-19 vaccination.

Despite emerging evidence on safety and efficacy, most countries do not offer COVID-19 vaccines to pregnant women even though they are at higher risk of complications from COVID-19. We performed a web search of COVID-19 vaccination policies for pregnant women under two categories: countries bearing a high burden of COVID-19 cases and countries with a high burden of maternal and under-five mortality. Of the top 20 countries affected by COVID-19, 11 allow vaccination of pregnant women, of which two have deemed it safe to vaccinate pregnant women as a high-risk group. In contrast, only five of the 20 countries with high under-five mortality and maternal mortality allow vaccination of pregnant women and none of these countries has included them as part of a high-risk group that should be vaccinated. India and Indonesia, with one-fifth of the world's population, fall under both categories but do not include pregnant women as a priority group for COVID-19 vaccination. To prevent COVID-19 from further aggravating the already heavy burden of maternal and under-five mortality, there is a strong case for including pregnant women as a high-priority group for COVID-19 vaccination. We recommend including COVID-19 vaccination in routine antenatal care in all countries, particularly India and Indonesia in view of their high dual burden.