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1.
J Med Virol ; 93(4): 2499-2504, 2021 04.
Article in English | MEDLINE | ID: covidwho-1217398

ABSTRACT

Various new clinical signs and symptoms, such as dysfunction of smell (anosmia) and taste (dysgeusia) have emerged ever since the coronavirus disease 2019 (COVID-19) pandemic begun. The objective of this study was to identify the clinical presentation and factors associated with 'new loss/change of smell (anosmia) or taste (dysgeusia)' at admission in patients positive by real time polymerase chain reaction for SARS-CoV-2 infection. All adult COVID-19 patients with new onset anosmia or dysgeusia at admission were included in study group. Equal number of age and gender matched COVID-19 patients without anosmia or dysgeusia at admission were included in the control group. A total of 261 COVID-19 patients were admitted during the study period of which 55 (21%) had anosmia and or dysgeusia. The mean (SD) age was 36 (13) years and majority were males (58%, n = 32). Comorbidity was present in 38% of cases (n = 21). Anosmia and dysgeusia were noted in more than 1/5th of the cases. Anosmia (96%, n = 53) was more common than dysgeusia (75%, n = 41). Presence of both ansomia and dysgeusia was noted in 71% of patients (n = 39). On comparing the cases with the controls, on univariate analysis, fever (higher in cases), rhinitis (lower in cases), thrombocytopenia, elevated creatinine and bilirubin (all higher in cases) were significantly associated with anosmia or dysgeusia. On multivariate analysis, only rhinitis (odds ratio [OR]: 0.28; 95% confidence interval [CI]: 0.09-0.83; p = .02) thrombocytopenia (OR: 0.99; 95% CI: 0.99-0.99; p = .01) and elevated creatinine (OR: 7.6; 95% CI: 1.5-37.6; p = .01) remained significant. In this retrospective study of COVID-19 patients, we found anosmia and dysgeusia in more than 1/5th of the cases. Absence of rhinitis, low platelet counts and elevated creatinine were associated with anosmia or dysgeusia in these patients.


Subject(s)
/epidemiology , Dysgeusia/epidemiology , Adult , /physiopathology , /blood , /physiopathology , Case-Control Studies , Dysgeusia/blood , Dysgeusia/physiopathology , Dysgeusia/virology , Female , Humans , India/epidemiology , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Pandemics , Platelet Count , Real-Time Polymerase Chain Reaction , Retrospective Studies , Rhinitis/epidemiology , Rhinitis/etiology , Thrombocytopenia/epidemiology , Thrombocytopenia/etiology
2.
J Med Virol ; 93(4): 2431-2438, 2021 04.
Article in English | MEDLINE | ID: covidwho-1217392

ABSTRACT

Healthcare workers (HCWs) are at higher risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Information regarding co-infection of SARS-CoV-2 with vector-borne diseases (malaria and dengue) is crucial especially for the countries wherein malaria and dengue are endemic. The objective was to study the prevalence, demographic, clinical presentations among HCWs with coronavirus disease 2019 (COVID-19) and to compare the viral clearance in HCWs with COVID-19 and co-infection of malaria and dengue. This retrospective study was conducted at a dedicated COVID-19 hospital, BYL Nair Charitable Hospital (NH), Mumbai, India April 6th-October 31st 2020. The SARS-CoV-2 infection in HCWs was confirmed by reverse transcription-plymerase chain reaction. Out of 491 HCWs infected with SARS-CoV-2, analysis of viral clearance was carried out in 467 HCWs over seven month periods, The prevalence of SARS-CoV-2 infection in HCWs was 13% (491 out of 3711). Out of the HCWs with COVID-19, prevalence of SARS-CoV-2 infection was higher among security guards (25%) with 1% mortality. The co-infection of malaria or dengue was reported in 31 HCWs (6.3%). The mean duration of virus clearance was longer (12 days) in symptomatic HCWs as compared to asymptomatic (8 days, p < .005). The recovery of SARS-CoV-2 infection in HCWs was faster (mean 8 days) with co-infection of malaria than without malaria (p < .005). We recommend universal testing of HCWs, to optimize staffing levels during the current pandemic as HCWs are the most precious resource. There is a need to effectively implement standard protocols for prevention of vector-borne diseases, especially in the hospital settings.


Subject(s)
/epidemiology , Coinfection/epidemiology , Malaria/epidemiology , Adolescent , Adult , Dengue/epidemiology , Female , Health Personnel/statistics & numerical data , Hospitals , Humans , India/epidemiology , Male , Middle Aged , Pandemics , Prevalence , Retrospective Studies , Young Adult
3.
J Med Virol ; 93(4): 2534-2537, 2021 04.
Article in English | MEDLINE | ID: covidwho-1217391

ABSTRACT

With the exponential spread of the coronavirus disease 2019 (COVID-19) pandemic across the world within the 12 months, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains are continuously trying to adapt themselves to the host environment by random mutations. When doing so, some variants with evolutionary advantages such as better human to human transmissibility potential might get naturally selected. This short communication demonstrates how the mutation frequency patterns are evolving in 2457 SAR-CoV-2 strains isolated from COVID-19 patients across diverse Indian states. We have identified 19 such variants showing contrasting mutational probabilities in the span of 7 months. Out of these, 14 variants are showing increasing mutational probabilities suggesting their propagation with time due to their unexplored evolutionary advantages. However, the mutational probabilities of five variants have significantly decreased in June onward as compared to March/April, suggesting their termination with time. Further in-depth investigation of these identified variants will provide valuable knowledge about the evolution, infection strategies, transmission rates, and epidemiology of SARS-CoV-2.


Subject(s)
/virology , Mutation , /genetics , /epidemiology , Evolution, Molecular , Genetic Variation , Genome, Viral , Humans , India/epidemiology , Pandemics
5.
BMJ Open ; 11(4): e047334, 2021 04 30.
Article in English | MEDLINE | ID: covidwho-1209692

ABSTRACT

OBJECTIVES: Responding to pandemics is challenging in pluralistic health systems. This study assesses COVID-19 knowledge and case management of informal providers (IPs), trained practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) and Bachelor of Medicine, Bachelor of Surgery (MBBS) medical doctors providing primary care services in rural Bihar, India. DESIGN: This was a cross-sectional study of primary care providers conducted via telephone between 1 and 15 July 2020. SETTING: Primary care providers from 224 villages in 34 districts across Bihar, India. PARTICIPANTS: 452 IPs, 57 AYUSH practitioners and 38 doctors (including 23 government doctors) were interviewed from a census of 1138 primary care providers used by community members that could be reached by telephone. PRIMARY OUTCOME MEASURES: Providers were interviewed using a structured questionnaire with choice-based answers to gather information on (1) change in patient care seeking, (2) source of COVID-19 information, (3) knowledge on COVID-19 spread, symptoms and methods for prevention and (4) clinical management of COVID-19. RESULTS: During the early days of the COVID-19 pandemic, 72% of providers reported a decrease in patient visits. Most IPs and other private primary care providers reported receiving no COVID-19 related engagement with government or civil society agencies. For them, the principal source of COVID-19 information was television and newspapers. IPs had reasonably good knowledge of typical COVID-19 symptoms and prevention, and at levels similar to doctors. However, there was low stated compliance among IPs (16%) and qualified primary care providers (15% of MBBS doctors and 12% of AYUSH practitioners) with all WHO recommended management practices for suspect COVID-19 cases. Nearly half of IPs and other providers intended to treat COVID-19 suspects without referral. CONCLUSIONS: Poor management practices of COVID-19 suspects by rural primary care providers weakens government pandemic control efforts. Government action of providing information to IPs, as well as engaging them in contact tracing or public health messaging can strengthen pandemic control efforts.


Subject(s)
Pandemics , Cross-Sectional Studies , Humans , India/epidemiology , Pandemics/prevention & control , Primary Health Care
7.
Lancet ; 397(10285): 1611-1612, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1209096
8.
Health Syst Reform ; 7(1): e1897323, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1207212

ABSTRACT

As countries all over the world grapple with containing the COVID-19 outbreak, Low- and Middle-Income Countries (LMICs) are particularly hard-pressed because on the one hand, the pandemic has created unforeseen high demand for health services which requires increased spending. On the other hand, the contagion and the public health measures taken to curb it have disrupted economies whilst creating additional spending pressures as well. This constrains the policy options available for LMICs to ensure an adequate and sustainable financing for the health sector's COVID-19 response whilst maintaining routine supply of essential health services. Despite this, as demonstrated by India, many LMICs are undertaking many reform efforts to address both the health and economic hardships caused by the pandemic. In this commentary, we describe the policy tools that one such LMIC, India, has used to enable financing for the outbreak.


Subject(s)
/economics , Family Characteristics , Health Expenditures/statistics & numerical data , Developing Countries , Female , Humans , India/epidemiology , Male , Pandemics
9.
Indian J Med Ethics ; VI(2): 1-2, 2021.
Article in English | MEDLINE | ID: covidwho-1206585

ABSTRACT

The government of India imposed a strict nationwide lockdown on March 24, 2020, to arrest the spread of Covid-19 (1). Abiding by the government regulations, several educational institutions including those in healthcare, postponed or cancelled several academic activities to curb the spread of the virus (2). Considering the high risk of infection transmission, several academic research projects involving human participants were paused. This has posed serious challenges in managing academic tasks such as teaching and learning activities related to research, participant examination and follow-up, field work for data collection, face-to-face discussion with colleagues, students and supervisors. Many academic healthcare research activities involve human subjects as research participants; but because of the lockdown, final year post-graduate students may not be able to complete their research projects within the stipulated time frame. Healthcare students are in a vulnerable situation because of the pressure to submit their research projects for the successful completion of the courses. Given this situation, it is probable that students may resort to unethical or fraudulent research activities such as data manipulation or fabrication to complete their research projects before the existing deadline. Such research, if published in the future, can damage the credibility and validity of the scientific evidence.

.


Subject(s)
Biomedical Research/statistics & numerical data , Biomedical Research/standards , Communicable Disease Control/standards , Guidelines as Topic , Pandemics/prevention & control , Quarantine/standards , Adult , Female , Humans , India/epidemiology , Male , Middle Aged , Young Adult
10.
Indian J Med Ethics ; VI(2): 1-24, 2021.
Article in English | MEDLINE | ID: covidwho-1206582

ABSTRACT

The Indian media's reportage of the Covid-19 pandemic has exposed the State's long-standing apathy towards low-income migrants and the structural neglect and violence faced by them in society. But how consistent were the country's print media in reporting on this population group before the crisis? This paper reports the findings of a study that examines the representation of migrants and refugees and their health in the Indian print media prior to the pandemic. A secondary objective was to examine any variations in their representation based on their social positions (for example, ethnicity, nationality, gender, religion). Using frame and content analyses, three English language newspapers were examined for the period January 1, 2017 to December 31, 2018. A total of 1,111 articles were retrieved. Analysis revealed that migrants were most frequently framed as "villains", posing a threat to the security, culture, health and economy in their destination states/cities, and less often as victims. On health coverage, the study found that the media frequently pathologised migrants and projected them as carriers of infection. Migrants' religion, ethnicity and class, and their proximity to the majoritarian population appeared most prominent in determining the frame imposed. The articles mostly relied on accounts of state officials and political leaders, whereas migrants' voices comprised less than a quarter of the sources of information. The media thus play a vital role in crystallising these disparities and, through acts of both omission and commission, end up vilifying migrants.


Subject(s)
Apathy , Health Status , Mass Media/statistics & numerical data , Pandemics/statistics & numerical data , Refugees/statistics & numerical data , Transients and Migrants/statistics & numerical data , Adult , Aged , Aged, 80 and over , Female , Humans , India/epidemiology , Male , Middle Aged , Socioeconomic Factors
11.
Indian J Med Res ; 153(3): 281-286, 2021 03.
Article in English | MEDLINE | ID: covidwho-1206395

ABSTRACT

Following the several episodes of zoonotic disease outbreaks and the more recent COVID-19 pandemic, the Indian policy initiatives are committed to institutionalize One Health (OH) approaches and promote intersectoral, transdisciplinary collaboration and cooperation. The OH principle needs to be visualized beyond the scope of zoonoses. While conservation, ecological and veterinary professions are getting increasingly engaged with OH, most of the medical/clinical and social sciences professions are only peripherally aware of its nuances. The OH initiatives, by their essentially multidisciplinary nature, entail working across ministries and navigating tacit institutional hierarchies and allocating leadership roles. The logical operational step will be the constitution of One Health Committees (OHC) at the State and district levels. Here, we outline the key foundational principles of OHC and hope that the framework for implementation shall be deliberated through wider consultations and piloted and adopted in a phased manner.


Subject(s)
One Health , Animals , Humans , India/epidemiology , Pandemics , Zoonoses/epidemiology
12.
Proc Natl Acad Sci U S A ; 118(18)2021 05 04.
Article in English | MEDLINE | ID: covidwho-1203482

ABSTRACT

Melting snow and ice supply water for nearly 2 billion people [J. S. Mankin, D. Viviroli, D. Singh, A. Y. Hoekstra, N. S. Diffenbaugh, Environ. Res. Lett. 10, 114016 (2015)]. The Indus River in South Asia alone supplies water for over 300 million people [S. I. Khan, T. E. Adams, "Introduction of Indus River Basin: Water security and sustainability" in Indus River Basin, pp. 3-16 (2019)]. When light-absorbing particles (LAP) darken the snow/ice surfaces, melt is accelerated, affecting the timing of runoff. In the Indus, dust and black carbon degrade the snow/ice albedos [S. M. Skiles, M. Flanner, J. M. Cook, M. Dumont, T. H. Painter, Nat. Clim. Chang. 8, 964-971 (2018)]. During the COVID-19 lockdowns of 2020, air quality visibly improved across cities worldwide, for example, Delhi, India, potentially reducing deposition of dark aerosols on snow and ice. Mean values from two remotely sensed approaches show 2020 as having one of the cleanest snow/ice surfaces on record in the past two decades. A 30% LAP reduction in the spring and summer of 2020 affected the timing of 6.6 km3 of melt water. It remains to be seen whether there will be significant reductions in pollution post-COVID-19, but these results offer a glimpse of the link between pollution and the timing of water supply for billions of people. By causing more solar radiation to be reflected, cleaner snow/ice could mitigate climate change effects by delaying melt onset and extending snow cover duration.


Subject(s)
/epidemiology , Environmental Pollution , Ice Cover , Quarantine , Snow , /virology , Climate Change , India/epidemiology , Water Supply
13.
PLoS One ; 16(4): e0250433, 2021.
Article in English | MEDLINE | ID: covidwho-1197393

ABSTRACT

The COVID-19 pandemic has unleashed multiple public health, socio-economic, and institutional crises. Measures taken to slow the spread of the virus have fostered significant strain between authorities and citizens, leading to waves of social unrest and anti-government demonstrations. We study the temporal nature of pandemic-related disorder events as tallied by the "COVID-19 Disorder Tracker" initiative by focusing on the three countries with the largest number of incidents, India, Israel, and Mexico. By fitting Poisson and Hawkes processes to the stream of data, we find that disorder events are inter-dependent and self-excite in all three countries. Geographic clustering confirms these features at the subnational level, indicating that nationwide disorders emerge as the convergence of meso-scale patterns of self-excitation. Considerable diversity is observed among countries when computing correlations of events between subnational clusters; these are discussed in the context of specific political, societal and geographic characteristics. Israel, the most territorially compact and where large scale protests were coordinated in response to government lockdowns, displays the largest reactivity and the shortest period of influence following an event, as well as the strongest nationwide synchrony. In Mexico, where complete lockdown orders were never mandated, reactivity and nationwide synchrony are lowest. Our work highlights the need for authorities to promote local information campaigns to ensure that livelihoods and virus containment policies are not perceived as mutually exclusive.


Subject(s)
/epidemiology , Civil Disorders , Cluster Analysis , Communicable Disease Control , Humans , India/epidemiology , Israel/epidemiology , Mexico/epidemiology , Pandemics , Public Health , /isolation & purification
16.
Neurosci Lett ; 749: 135692, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1196745

ABSTRACT

BACKGROUND: India has the second largest COVID-19 epidemic in the world as per current estimates. Central and peripheral nervous system involvement in COVID-19 (Neuro COVID-19) has been increasingly identified and reported. This letter is the first report of the spectrum of neurological disorders observed in patients with severe COVID-19 from a resource limited setting like India. Till October 30th 2020, Noble hospital and research center, Pune, India has admitted 2631 patients of COVID-19. Out of these, 423 patients had severe COVID-19. NEUROLOGIC COMPLICATIONS IN SEVERE COVID-19 IN PUNE, INDIA: Of the 423 patients with severe COVID-19, 20 (4.7%) had pre-existing neurologic co-morbidities, with cerebrovascular disease (8 patients) being the most common. Poliomyelitis (4 patients) was also an important co-morbidity associated with severe COVID-19. Bodyache or myalgia (207/423, 49 %) and headache (59/423, 13.9 %) were the most common neurologic symptoms observed in patients. Encephalopathy (22/423, 5.2 %) and new onset large vessel ischemic stroke secondary to cerebral artery thrombosis (5/423, 1.1%) were the most common secondary neurologic complications noted in our cohort. Two cases of COVID-19/central nervous system tuberculosis co-infection were also identified. CHALLENGES IN MANAGEMENT OF NEURO COVID-19 IN INDIA: Various challenges like an overwhelmed health care system, inadequate workforce, lack of exhaustive reporting of symptoms and poor availability of neuroimaging in ventilated COVID-19 patients leads to underestimation of Neuro COVID-19 in resource limited settings like India.


Subject(s)
/diagnostic imaging , Nervous System Diseases/diagnostic imaging , Severity of Illness Index , Tertiary Care Centers/trends , Tuberculosis, Central Nervous System/diagnostic imaging , /epidemiology , Humans , India/epidemiology , Nervous System Diseases/epidemiology , Tuberculosis, Central Nervous System/epidemiology , Tuberculosis, Central Nervous System/therapy
17.
BMJ Open ; 11(4): e049653, 2021 04 15.
Article in English | MEDLINE | ID: covidwho-1189893

ABSTRACT

OBJECTIVE: To provide evidence on the effect of the COVID-19 pandemic on the mental health of young people who grew up in poverty in low/middle-income countries (LMICs). DESIGN: A phone survey administered between August and October 2020 to participants of a population-based longitudinal cohort study established in 2002 comprising two cohorts born in 1994-1995 and 2001-2002 in Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam. We use logistic regressions to examine associations between mental health and pandemic-related stressors, structural factors (gender, age), and lifelong protective/risk factors (parent and peer relationship, wealth, long-term health problems, past emotional problems, subjective well-being) measured at younger ages. SETTING: A geographically diverse, poverty-focused sample, also reaching those without mobile phones or internet access. PARTICIPANTS: 10 496 individuals were approached; 9730 participated. Overall, 8988 individuals were included in this study; 4610 (51%) men and 4378 (49%) women. Non-inclusion was due to non-location or missing data. MAIN OUTCOME MEASURES: Symptoms consistent with at least mild anxiety or depression were measured by Generalized Anxiety Disorder-7 (≥5) or Patient Health Questionnaire-8 (≥5). RESULTS: Rates of symptoms of at least mild anxiety (depression) were highest in Peru at 41% (32%) (95% CI 38.63% to 43.12%; (29.49-33.74)), and lowest in Vietnam at 9% (9%) (95% CI 8.16% to 10.58%; (8.33-10.77)), mirroring COVID-19 mortality rates. Women were most affected in all countries except Ethiopia. Pandemic-related stressors such as health risks/expenses, economic adversity, food insecurity, and educational or employment disruption were risk factors for anxiety and depression, though showed varying levels of importance across countries. Prior parent/peer relationships were protective factors, while long-term health or emotional problems were risk factors. CONCLUSION: Pandemic-related health, economic and social stress present significant risks to the mental health of young people in LMICs where mental health support is limited, but urgently needed to prevent long-term consequences.


Subject(s)
Anxiety/epidemiology , Depression/epidemiology , Pandemics , Adult , Ethiopia/epidemiology , Female , Humans , India/epidemiology , Longitudinal Studies , Male , Mental Health , Peru/epidemiology , Vietnam/epidemiology , Young Adult
18.
J Nerv Ment Dis ; 209(4): 256-264, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1189531

ABSTRACT

ABSTRACT: There is an understandable concern that obsessive-compulsive disorder (OCD) may worsen during the COVID-19 pandemic, but there are little empirical data. We report the impact of COVID-19 pandemic on the short-term course of OCD. A cohort of patients with a primary diagnosis of OCD (n = 240) who were on regular follow-up at a tertiary care specialty OCD clinic in India were assessed telephonically, about 2 months after the declaration of the pandemic ("pandemic" cohort). Data from the medical records of an independent set of patients with OCD (n = 207) who were followed up during the same period, 1 year prior, was used for comparison (historical controls). The pandemic group and historical controls did not differ in the trajectories of the Yale-Brown Obsessive-Compulsive Scale scores (chi-square likelihood ratio test of the group × time interaction = 2.73, p = 0.255) and relapse rate (21% vs. 20%; adjusted odds ratio, 0.81; 95% confidence interval, 0.41-1.59; p = 0.535). Preexisting contamination symptoms and COVID-19-related health anxiety measured by the COVID-Threat Scale did not predict relapse. Only a small proportion of patients (6%) reported COVID-19-themed obsessive-compulsive symptoms. The COVID-19 pandemic, at least in the short run, did not influence the course of illness.


Subject(s)
/psychology , Obsessive-Compulsive Disorder/psychology , Adult , Case-Control Studies , Cohort Studies , Disease Progression , Female , Humans , India/epidemiology , Male , Obsessive-Compulsive Disorder/epidemiology , Obsessive-Compulsive Disorder/therapy , Pandemics , Recurrence , Severity of Illness Index , Tertiary Care Centers/statistics & numerical data
19.
Diabetes Metab Syndr ; 15(1): 205-211, 2021.
Article in English | MEDLINE | ID: covidwho-1188470

ABSTRACT

BACKGROUND AND AIMS: Potential role of health literacy in determining adherence to COVID-19 preventive behavior, pharmacological, and lifestyle management among diagnosed patients of chronic diseases during nationwide lockdown is inadequately investigated. METHODS: A cross-sectional study was conducted from May-August 2020 among diagnosed patients of chronic diseases residing in a COVID-19 hotspot of urban Jodhpur, Rajasthan, and availing health services from primary care facility. Telephonic interviews of participants were conducted to determine their health literacy using HLS-EU-Q47 questionnaire, adherence to COVID-19 preventive behaviour as per World Health Organization recommendations, and compliance to prescribed pharmacological and physical activity recommendations for chronic disease. RESULTS: All the 605 diagnosed patients of chronic diseases availing services from primary care facility were contacted for the study, yielding response rate of 68% with 412 agreeing to participate. Insufficient health literacy was observed for 65.8% participants. Only about half of participants had scored above median for COVID-19 awareness (55.1%) and preventive behavior (45.1%). Health literacy was observed to be significant predictor of COVID-19 awareness [aOR: 3.53 (95% CI: 1.81-6.88)]; COVID-19 preventive behavior [aOR: 2.06, 95%CI; 1.14-3.69] and compliance to pharmacological management [aOR: 3.05; 95% CI: 1.47-6.35] but not for physical activity. CONCLUSION: COVID-19 awareness, preventive behavior, and compliance to pharmacological management is associated with health literacy among patients of chronic disease availing services from primary health facility. Focusing on health literacy could thus be an essential strategic intervention yielding long term benefits.


Subject(s)
/epidemiology , Health Literacy/trends , Patient Compliance , Primary Health Care/trends , Quarantine/trends , Urban Population/trends , Adolescent , Adult , /psychology , Chronic Disease , Communicable Disease Control/trends , Cross-Sectional Studies , Female , Health Facilities/trends , Humans , India/epidemiology , Male , Middle Aged , Patient Compliance/psychology , Registries , Surveys and Questionnaires , Young Adult
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