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1.
Indian J Crit Care Med ; 26(5): 596-603, 2022 May.
Article in English | MEDLINE | ID: covidwho-1863138

ABSTRACT

Background: Coronavirus disease-2019 (COVID-19) is prone to acute hypoxemic respiratory failure (AHRF). Because tracheal intubation is associated with a higher risk of death in these patients, AHRF employs high-flow nasal oxygen therapy (HFNOT). The goal of this study was to assess the effect of HFNOT on oxygenation status as well as different predictors of HFNOT failure. Methods: A prospective observational cohort study was conducted in COVID-positive critically ill adult patients (age >18 years) with AHRF, who were unable to maintain SpO2 >90% on a non-rebreathing face mask at an oxygen flow ≥15 L/minute. Respiratory variables (PaO2/FiO2, SpO2, and RR) before HFNOT (baseline) and then at 1 hour, 6 hours, 7th day, and 14th day after HFNOT application were recorded. Borg CR10 scale and visual analogue scale were used to evaluate the subjective sensation of dyspnea and comfort level, respectively. As needed, Student's t, Mann-Whitney U, or Wilcoxon signed-rank tests were performed. To find parameters linked to HFNOT failure, multivariate logistic regression and receiver operating characteristic (ROC) analysis were employed. Results: A total of 114 patients were enrolled in the study, with an HFNOT failure rate of 29%. The median PaO2/FiO2 ratio at baseline (before the initiation of HFNOT) was 99.5 (80-110) which significantly increased at various time points (1 hour, 6 hours, 7th day, and 14th day) after HFNOT initiation in the successful group. Patients reported significant improvement in sensation of breathlessness [9 (8-10), 3 (2-4); p <0.001] as well as in comfort level [2 (1-2), 8 (4-9); p <0.001]. Multivariate logistic regression analysis, sequential organ failure assessment (SOFA) score >7, acute physiology and chronic health evaluation (APACHE) II score >20, admission P/F ratio <100, D-dimer >2 mg/L, IL-6 >40 pg/mL, random blood sugar (RBS) >250 mg/dL, and 6 hours ROX Index <3.5 were independent prognostic factors of HFNOT failure. Conclusion: The use of HFNOT significantly increased the oxygenation levels in COVID-19 patients with AHRF at various time periods after HFNOT beginning. Age, SOFA score, APACHE II score, ROX score, admission P/F ratio, IL-6, D-dimer, and RBS were independent prognostic factors of HFNOT failure in this cohort. How to cite this article: Khan MS, Prakash J, Banerjee S, Bhattacharya PK, Kumar R, Nirala DK. High-flow Nasal Oxygen Therapy in COVID-19 Critically Ill Patients with Acute Hypoxemic Respiratory Failure: A Prospective Observational Cohort Study. Indian J Crit Care Med 2022;26(5):596-603.

2.
J Family Med Prim Care ; 11(2): 415-417, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1776496

ABSTRACT

A small state in Northeast, Mizoram, with credentials in education sector similar to Kerala, like Kerala is attracting attention for the wrong reason; the high COVID-19 case load. So, what may be driving the high case load in these high literacy level states. Is the low mortality level (due to COVID-19) leading to a lack of emphasizing caution to prevent infection transmission behind this surge?

3.
J Family Med Prim Care ; 11(2): 744-750, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1776491

ABSTRACT

Background: The first wave of the COVID-19 pandemic affected health in all domains i.e., physical, mental, and social aspects. Liver transplant (LT) recipients faced a multitude of challenges during the first wave of lockdown. The aim was to identify the psychosocial difficulties and quality of life during the first year of the pandemic. Methods: A cross-sectional survey was conducted on LT recipients with a predefined structured questionnaire that included clinical, COVID-19 anxiety scale, and Post-Transplant Quality of life questionnaire (pLTQ). Results: A total of 109 patients were studied; with a mean age of 50.5 ± 11.1 years, with a median post-transplant follow-up of 52.4 months and a live donor transplant in the majority (79.8%). Almost all (99.1%) could come to the hospital for regular follow-up, prior to the pandemic. But during the first wave only 57% could maintain planned hospital visits and about 88% could not pursue their regular activities, and 39% missed their routine exercise because of imposed restrictions. Similarly, financial implications were responsible for 4% defaulting from treatment; while 7.3% managed by curtailing supportive drugs (on their own) leading to deranged liver tests in 4.6%; requiring immediate attention. The psychosocial difficulties raised the stress of pandemic (median score 18), and impacted quality of life (mean total pLTQ score 4.7 ± 0.9). Conclusions: For LT recipients, the first wave of COVID-19 pandemic affected their physical, mental, financial, and social wellbeing; in addition to the disease itself. Awareness, psychosocial support, and comprehensive care are some unmet needs for this special group; especially when it is expected that subsequent waves may continue to occur.

4.
J Family Med Prim Care ; 11(1): 1-4, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1753776

ABSTRACT

The outbreak of coronavirus disease (COVID-19) has triggered changes and reforms in the health sector in India. As the pandemic points to a gap in the industry, it has led to the creation of new opportunities to solve problems. To help the country repair the damage caused by the virus pandemic, the Government of India announced that in the health budget 2021, promotion of health and well-being will be one of the six pillars. Investment in health infrastructure in the 2021 budget has increased significantly to welcome the much-needed increase in budget allocations of Rs. 2.3 lakh crore. Three areas will also be strengthened, including preventive health care and therapeutic health care. Special emphasis is placed on prevention, treatment, and health care. To promote primary health care, the country will establish 17,000 rural and 11,000 urban health care centers. Provision of affordable quality medical insurance will be provided by the government. The integrated and collaborative model of the public and private sectors in the provision of health services has led to a rapid expansion of work. This is an attempt to demonstrate the planned reforms in the health budget, especially during the COVID-19 pandemic. The budget of 2022-23 is about to be announced soon. It is to be seen how the financial allocation for the health sector impacts the health of the Indian people.

5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-314049

ABSTRACT

Background: Acute hypoxemic respiratory failure (AHRF) is common in COVID-19. Tracheal intubation in such patients is fraught with higher mortality, therefore, high flow nasal oxygen therapy (HFNOT) is being used in AHRF. In this study, we aimed to determine the impact of HFNOT on oxygenation status and also various predictors of HFNOT failure. Methods: A prospective observational cohort study was conducted in COVID-positive critically ill adult patients (aged>18 years) with AHRF, who were unable to maintain SpO2>90% on a non-rebreathing face mask at an oxygen flow ≥15 litres/minute. Respiratory variables (PaO2/FiO2, SpO2, and RR) before HFNOT (baseline), then at 1-hour, 6-hour, 7-day, and 14-day after HFNOT application, were recorded. Borg CR10 scale and visual analog scale were used to evaluate the subjective sensation of dyspnoea and comfort level respectively. Student’s t, Mann–Whitney U or Wilcoxon signed-rank tests were used as applicable. Multivariate logistic regression and Receiver-Operating Characteristic (ROC) analyses were performed to determine factors associated with HFNOT failure. Results: 114 patients were included with HFNOT failure rate of 29%. The Median PaO2/FiO2 ratio at baseline (before initiation of HFNOT) was 99.5 (80-110) which significantly increased at various time points (1-hour, 6-hour, 7-days, and 14-day) after HFNOT initiation in the successful group. Patients reported significant improvement in sensation of breathlessness (9 [8-10], 3 [2-4];p<0.001) as well as in comfort level (2 [1-2], 8 [4-9];p<0.001). Multivariate logistic regression analysis, SOFA>7, APACHE II>20, admission P/F ratio<100, D-dimer>2mg/L, IL-6>40 pg/mL, Random Blood Sugar (RBS)>250 mg/dL, 6-hour ROX Index<3.5, were independent prognostic factors of HFNOT failure. Conclusion: In COVID-19 patients with AHRF, the use of HFNOT significantly improved oxygenation levels at various time points after HFNOT initiation. Age, SOFA, APACHE II, and ROX scores, admission P/F ratio, IL-6, D-dimer, and RBS were independent prognostic factors of HFNOT failure in this cohort.

6.
J Family Med Prim Care ; 10(10): 3531-3534, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1597232

ABSTRACT

Arguably the worst health crisis in recent memory, Covid19 has been a great masterclass, albeit at a cost which no individual or nation would have wanted to afford. Besides other, what are the lessons for the academic medicine in general and primary care, community medicine, family medicine and public health in particular? Perhaps, identifying the roles of each in the healthcare system and building a thought process around these roles is the way forward. Only then will we have a chance to fight a pandemic like the Covid-19.

7.
IOP Conference Series. Earth and Environmental Science ; 889(1), 2021.
Article in English | ProQuest Central | ID: covidwho-1556699

ABSTRACT

Covid-19 has improved the economy’s ESG plan. The ESG rating of an industry is crucial for stakeholders and will influence future business practices. ESG is commonly understood to refer to a set of criteria for making long-term investments in the areas of the environment, social welfare, and governance. Climate change is a systemic concern, and governments, companies, and society are increasingly determined to meet it. Climate change, according to the ESG, is the world’s most complicated challenge, posing collective risk and ambiguity to society. The impact of ESG elements and climate risk in the insurance business is investigated in this research. The research will also look into how insurers are responding to climate change. The research will also look into how insurers are pursuing climate-friendly activities such as creating green jobs, supporting socially responsible investing, and prioritizing environmental, social, and governance (ESG) and commercial sustainability in their operations. As a result, the study’s major recommendation is that potential clients and insurers increase their horizons of ESG risk awareness.

8.
J Family Med Prim Care ; 10(10): 3548-3552, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1534375

ABSTRACT

Virus infections can cause tissue damage in many ways. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a cause of the current COVID-19 pandemic, has been extensively studied so far to investigate its pathophysiology and evaluate its impact on the metabolic system of human cells. This has given a lead to study the role of 2-deoxy-D-glucose (2DG) against COVID-19 disease. We hereby would like to briefly discuss the concept and rationale behind the use of 2DG COVID-19.

9.
J Family Med Prim Care ; 10(10): 3540-3543, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1534368

ABSTRACT

The sudden upsurge in the newly emerging COVID-19 variants acted as a catalyst for India to scale up the viral Genomic surveillance in order to understand the nature and trends of the newer variants of concern and strengthen public health interventions across the country. The Government of India has proposed the Indian SARS-CoV-2 Genomics Consortium to expand the whole-genome sequencing (WGS) of this virus. However, in a vast country like India introduction and implementation of any new strategies amidst the already existing barriers due to COVID-19 will be a herculean task. This paper talks about how the primary care physicians can play a vital role in successful implementation of the above strategy in addition to the surveillance systems in India.

10.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-292583

ABSTRACT

Background: Global pandemic of COVID 19 has affected many countries. The initial epicenter was in China with gradual spread to various countries including India.For a developing country like India with limited resources and high population, it is worthwhile to know how these patients requiring intensive care admission were managed and the outcome of these patients. To address these issues, a prospective observational study was planned.Methods: A multicenter study was conducted from June 2020 to December 2020 including 4 centers across India. Patients > 18 years of age admitted in the intensive care unit (ICU), with the diagnosis of COVID 19 pneumonia confirmed by reverse transcriptase –polymerase chain reaction (RT-PCR) or rapid antigen test (RAT) as applicable were included. Factors associated with ICU mortality were examined using multivariable logistic regression analysis and Cox proportional hazard model.Results: Of 667 patients were included in the study. ICU mortality was 60 %. In multivariable analysis, history of cerebral vascular accident (CVA), day 1 acute physiology and chronic health evaluation (APACHE II) score, need for invasive ventilator support, minimum PO 2 , fluid balance and complications such as pneumothorax and arrhythmia during ICU admission were associated with mortality. Among these parameters, day 1 need for invasive ventilator support (odds ratio OR: 3.01(1.81, 5.00) and development of arrhythmia (OR 3.85 [1.56, 8.06]) had higher odds of mortality. Cox proportional hazard analysis showed, history of ischemic heart disease (IHD) (Hazard Ratio, HR 1.64, 95% CI:1.13, 2.38), day1 APACHE II (HR 1.03, 95% CI:1.00, 1.07), arterial blood gas (ABG) pH (HR 0.14, 95% CI:0.03, 0.56) and use of therapeutic anticoagulation (HR 0.42,95% CI:0.29, 0.61) as a predictor of 7 days ICU mortality. Daywise trend of ventilator parameters showed dynamic compliance was higher on day3 and 4 in survivors.Conclusion: In this cohort of ICU patients, ICU mortality was 60%. The reason for higher mortality could be the severity of illness as suggested by the day 1 PF ratio (109.31 [77.79-187.26]). Trial Registration -(IEC131/2020, CTRI/2020/06/025858).

11.
J Family Med Prim Care ; 10(8): 2729-2731, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1478279

ABSTRACT

Public Health has always been important for the general public, governments, and governance as it deals with the objective of improving population health through prevention, promotion, and health education. Public Health is defined as "the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society" (Acheson, 1988; WHO). The COVID 19 pandemic has brought a focus on the concept of public health more than ever. Independent departments of Public Health do not exist at medical colleges in India. Public health is a multidisciplinary domain. The body of knowledge is cross-cutting and multidimensional in nature. Public health education is optimal only with the contribution of the participating faculty from different educational and professional backgrounds. Lack of strong public health academics may adversely impact the capacity to formulate indigenous public health policy. In many parts of the developing world, public health policies are heavily influenced by the knowledge developed by the western universities within the domain of global health. Global health policies and goals become synonymous with national health goals. For the democratic republic of India, there is an urgent need to strengthen the public health education system so that the future challenges of health, safety, economy, security can be met The National Medical Commission (NMC) has invited comments on the draft postgraduate medical education regulations 2021. It is an apt opportunity to fundamentally reform public health education in India.

12.
Ann Pediatr Cardiol ; 14(3): 269-277, 2021.
Article in English | MEDLINE | ID: covidwho-1395103

ABSTRACT

BACKGROUND: Outcome data of children with heart disease who acquired COVID-19 infection are limited. AIMS: We sought to analyze outcome data and identify risk factors associated with mortality in children with heart disease and grown-ups with congenital heart disease (GUCH) who had a laboratory-confirmed COVID-19 infection. SETTINGS AND DESIGN: This is a retrospective, multicentric, observational study. MATERIALS AND METHODS: The study included children with heart disease and GUCH population, who presented with either symptomatic or asymptomatic COVID-19 infection to any of the participating centers. COVID-19-negative patients admitted to these centers constituted the control group. RESULTS: From 24 pediatric cardiac centers across India, we included 94 patients with a median age of 12.5 (interquartile range 3-96) months and 49 (52.1%) patients were males. Majority (83 patients, 88.3%) were children. One-third of the patients (n = 31, 33.0%) had acyanotic congenital heart disease, and 41.5% (n = 39) were cyanotic, with > 80% of the patients being unoperated. Only 30 (31.9%) patients were symptomatic for COVID-19 infection, while the rest were incidentally detected positive on screening. A total of 13 patients died (case fatality rate: 13.8%). The in-hospital mortality rate among hospitalized patients was significantly higher among COVID-19-positive cases (13 of 48; 27.1%) as compared to COVID-negative admissions (9.2%) during the study period (P < 0.001). On multivariate analysis, the independent predictors of mortality among COVID-19-positive cases were severity of illness at admission (odds ratio [OR]: 535.7, 95% confidence interval [CI]: 6.9-41,605, P = 0.005) and lower socioeconomic class (OR: 29.5, 95% CI: 1.1-814.7, P = 0.046). CONCLUSIONS: Children with heart disease are at a higher risk of death when they acquire COVID-19 infection. Systematic preventive measures and management strategies are needed for improving the outcomes.

13.
Ann Pediatr Cardiol ; 14(3): 260-268, 2021.
Article in English | MEDLINE | ID: covidwho-1395102

ABSTRACT

BACKGROUND: COVID-19 pandemic has disrupted pediatric cardiac services across the globe. Limited data are available on the impact of COVID.19 on pediatric cardiac care in India. AIMS: The aims are to study the impact of COVID-19 pandemic on the care of children with heart disease in India in terms of number of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries. SETTINGS AND DESIGN: This is a retrospective, multicentric, observational study. METHODS: We collected monthly data on the number and characteristics of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries and major hospital statistics, over a period of 5 months (April to August 2020), which coincided with the first wave of COVID-19 pandemic in India and compared it with data from the corresponding months in 2019. RESULTS: The outpatient visits across the 24 participating pediatric cardiac centers decreased by 74.5% in 2020 (n = 13,878) as compared to the corresponding period in 2019 (n = 54,213). The reduction in the number of hospitalizations, cardiac surgeries, and catheterization procedures was 66.8%, 73.0%, and 74.3%, respectively. The reduction in hospitalization was relatively less pronounced among neonates as compared to infants/children (47.6% vs. 70.1% reduction) and for emergency surgeries as compared to elective indications (27.8% vs. 79.2%). The overall in-hospital mortality was higher in 2020 (8.1%) as compared to 2019 (4.8%), with a higher postoperative mortality (9.1% vs. 4.3%). CONCLUSIONS: The current COVID-19 pandemic significantly impacted the delivery of pediatric cardiac care across India with two-third reduction in hospitalizations and cardiac surgeries. In an already resource-constrained environment, the impact of such a massive reduction in the number of surgeries could be significant over the coming years. These findings may prove useful in formulating strategy to manage subsequent waves of ongoing COVID-19 pandemic.

14.
Energies ; 14(16):4761, 2021.
Article in English | ProQuest Central | ID: covidwho-1376758

ABSTRACT

Increasing the energy efficiency of machining operations can contribute to more sustainable manufacturing. Therefore, there is a necessity to investigate, evaluate, and optimize the energy consumed during machining operations. The research highlights a method employed to prioritize the most energy-intensive machining operation and highlights the significance of electric parameters as predictors in power estimation of machining operations. Multi regression modeling with standardized regression weights was used to identify significant power quality predictors for active power evaluation for machining operations. The absolute error and the relative error both decreased when the active power was measured by the power analyzer for each of the identified machining operations, compared to the standard power equation and that obtained from the modeled regression equations. Furthermore, to determine energy-intensive machining operation, a hybrid decision-making technique based on TOPSIS (a technique for order preference by similarity to ideal solution) and DoM (degree of membership) was utilized. Allocation of weights to energy responses was carried out using three methods, i.e., equal importance, entropy weights, and the AHP (analytical hierarchy process). Results revealed that a drilling process carried out on material ST 52.3 is energy-intensive. This accentuates the significance of electric parameters in the assessment of active power during machining operations.

15.
J Proteins Proteom ; : 1-8, 2021 Aug 25.
Article in English | MEDLINE | ID: covidwho-1371412

ABSTRACT

Outbreak of COVID-19 by SARS-CoV-2 infection caused severe acute respiratory syndrome that has been declared a public health emergency of international concern. To control infections, there is urgent need to develop an effective therapeutic strategy. COVID-19 viral spike glycoprotein and proteases play major role in viral entry and mediating virus replication and spread and thus can serve as potential antiviral drug target. Being highly specific, efficacious and safe, peptides hold their place in therapeutics. In present study, molecular docking of 21 pharmacologically active non ribosomal peptides (NRPs) from marine microbes with SARS-CoV-2 spike glycoprotein and papain such as protease was done. Dactinomycin, Tyrocidine A and Gramicidin S showed highest binding interaction with target proteins. The binding affinity of Dactinomycin and Gramicidin S docked with SARS-CoV-2 spike glycoprotein was - 12.4 kcal/mol and - 11.4 kcal/mol, respectively. This suggested their potential to destabilize SARS spike protein binding with human host ACE2 receptor and thus hindering viral entry to the cells. Binding affinity of Tyrocidine A and Gramicidin S with SARS-CoV-2 papain-like protease was - 13.1 kcal/mol and - 11.4 kcal/mol, respectively which might be inhibited COVID-19 by acting on the protease. Gramicidin S showed same binding affinity for both target proteins and thus expected to be most potent. Based on the binding energy score, it was suggested that these pharmacologically active NRPs are potential molecules to be tested against SARS-CoV-2 and used to develop effective antiviral drugs.

16.
J Family Med Prim Care ; 10(7): 2436-2440, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1362669

ABSTRACT

Primary health care is a comprehensive care with a wide range of essential services for people living in the rural and hard-to-reach areas. However, the primary healthcare delivery system in India is still in its initial stages and lacks human resources. With the COVID-19 pandemic around the corner, there has been a diversion of resources for controlling corona pandemic leading to undermining availability and accessibility of health services. This article highlights a few case scenarios and the multidimensional impact of lockdown on primary healthcare services. The article suggests certain appropriate measures that can be implemented as the lockdown simply cannot stop the transmission with no definite treatment and vaccine. There should be a multipronged strategy for breaking the chain of transmission and for future preparedness in case of such situations and to strengthen our primary healthcare system.

17.
J Family Med Prim Care ; 10(7): 2433-2435, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1362664

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic continues to bring in its wake not only morbidity and mortality but also an unprecedented challenge to public health, food systems, human dignity, and work across the world. The availability and possible delivery of a safe and effective vaccine to populations across the world are not only being seen as a hope to surmount these challenges but also as a show of human resilience in the face of adversity. Nations need to galvanize their resources and make the availability of vaccines universal, without which the real benefits of its development cannot be realized. Despite its large domestic needs, our country is being looked upon with both hope and expectation to deliver at this crucial juncture in the evolution of human civilization, and India is more than willing to do its part.

18.
J Family Med Prim Care ; 10(5): 1801-1803, 2021 May.
Article in English | MEDLINE | ID: covidwho-1290885

ABSTRACT

The COVID virus and the pandemic are defying the general laws of epidemiology and virology. The pandemic shows how the economy can be crippled due to health care. Health is a key area which directly drives the economy. Incapacity in health policy leaves us vulnerable as a country. Global organizations and development partners have been too keen to lend technical help, policies, and procedures to India. Gone are the days when India used to receive any international funding in the health sector but at present most of the money is our own. We often take stewardship for implementation of these surrogate policies and procedures countrywide. The International donors and development partners pushed India on the path of selective primary care - disease based vertical programs. It was part of a geopolitical strategy. It is not resources but capacity. Capacity to make any innovation or change. There is a need for a new public health order in India. A massive change; a massive reform. Covid is an opportunity to think, push for institutional capacity building. As far as COVID pandemic is concerned, we need to strengthen the general health system in India, and not yet another vertical National Covid Control Program (NCCP) - Eliminate Covid by 2050; committing all national resources to one disease only. There is an urgent need for India to shift from selective primary health care to a comprehensive health care model. We have capacity and resources, we only need a national resolve! It is time to protect national interest. We cannot keep ourselves artificially vulnerable for ever.

19.
J Family Med Prim Care ; 10(1): 1-9, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1239062

ABSTRACT

In view of India unlocking, to secure a large population of this country, the healthcare facilities delivering primary care as well standalone health facilities need to be secured from impacts of COVID-19 pandemic. This document dwells on the broader guidelines for primary care practitioners/standalone private health facilities/frontline healthcare facilities to mitigate the impact of COVID-19 Pandemic. The authors understand that the situation is evolving, so the guidelines too will keep evolving.

20.
J Family Med Prim Care ; 10(4): 1515-1519, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1236870

ABSTRACT

The concept of Herd immunity is a key factor for epidemic control. According to it only a proportion of entire population needs to be immune either via natural infection or vaccination. The idea of herd immunity via natural infection rather than vaccination is a bit controversial, as it is not clear how long will the antibodies last, and whether re-infection or re-activation of the virus can occur after the antibodies starts weaning from the body. It has been suggested that coronavirus will likely become similar to a seasonal flu once the herd immunity is attained. Till then, it will continue causing outbreaks year-round and there could be multiple waves of virus transmission before achieving herd immunity. Therefore, the public needs to learn to live with it, and continue practising the best prevention measures, including wearing of masks, physical distancing, hand hygiene, and avoidance of gathering.

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