COVID 19: Asymptomatic cases 'carry same amount of viruS

People with symptomless Covid-19 can carry as much of the virus as those with symptoms, a South Korean study has suggested.

South Korea was able to identify and isolate asymptomatic cases through mass testing as early as the start of March.

There is mounting evidence these cases represent a considerable proportion of coronavirus infections.

But the researchers weren't able to say how much these people actually passed the virus on.

People with a positive coronavirus test were monitored in a community treatment centre, allowing scientists to look at how much of the virus was detectable in their nose and throat swabs.

They were given regular tests, and only released once they were negative.

Results of 1,886 tests suggest people with no symptoms at the time of the test, including those who never go on to develop symptoms, have the same amount of viral material in their nose and throat as people with symptoms.

The study also showed the virus could be detected in asymptomatic people for significant periods of time - although they appeared to clear it from their systems slightly faster than people with symptoms.

The median time (the number where half of cases were higher and half were lower) from being diagnosed to receiving a negative test was 17 days in asymptomatic patients and 19.5 days in symptomatic patients.

Because of the nature of the isolation centre, the study didn't include people with severe cases of the disease. They were also younger and healthier than average.

Most coronavirus testing, including in the UK, focuses on people with symptoms, so there is little data on asymptomatic cases.

This study gives us some more information about what they look like in the body.

The researchers acknowledge their study could not "determine the role" that the presence of the virus in asymptomatic patients played in transmission, however.

In theory, having the same amount of virus in your nose and throat means you have just as much to pass on.

But people without symptoms are less likely to have a hacking cough that will send infected droplets further into the air.

There is "as much virus in their respiratory mucus as someone who has the disease", says Dr Simon Clarke, a cellular microbiologist at the University of Reading.

But, he added, "that doesn't mean they're spraying as much into the environment".

While there was still a risk from people without symptoms, someone with symptoms who was "coughing and spraying out the virus" was likely to be a higher risk, he said.

The risks of catching coronavirus from anyone depended on a number of factors, said infection biologist Dr Andrew Preston from the University of Bath.

That included how deeply and quickly the infected person was breathing, how close you were to them for how long, and whether or not you were in a closed environment, he added.

 Vaping is linked to a significant increase in Covid-19 risk among teenagers and young adults, according to a new study.

Since March, experts have been speculating that vaping might be the reason more young people are getting ill than health experts predicted, however, this new study, published the Journal of Adolescent Health, is the first to examine the connection between youth vaping and Covid-19.

Among the young people who were tested for Covid-19, researchers from Stanford University found that those who used e-cigarettes were five to seven times more likely to be infected than those who didn’t vape.

"Teens and young adults need to know that if you use e-cigarettes, you are likely at immediate risk of Covid-19 because you are damaging your lungs," said University of Stanford Professor of Pediatrics and study author, Bonnie Halpern-Felsher.

 Previous research has also shown that smokers and vapers are at higher risk of a more severe Covid-19 infection and are more likely to die from the virus.

Evidence shows vaping can weaken the lungs normal functions as well as causes airway and lung inflammation, which make it easier for pathogens to enter the body. Further, some ingredients in vape cartridges can slow the body’s ability to fight off infections.

"Young people may believe their age protects them from contracting the virus or that they will not experience symptoms of Covid-19, but the data show this isn't true among those who vape," said lead author, Shivani Mathur Gaiha.

"This study tells us pretty clearly that youth who are using vapes or are dual-using [e-cigarettes and cigarettes] are at elevated risk, and it's not just a small increase in risk; it's a big one."

More than 4,000 people in the U.S. between the ages of 13 to 24 were surveyed in May for the study, answering questions about whether they had ever smoked vapes or cigarettes and if they had vaped or smoked in the past 30 days. They were also asked if they had experienced Covid-19 symptoms, been tested for Covid-19 or or tested positive for Covid-19.

The study’s results – which were adjusted for confounding factors like age, sex, compliance with shelter-in-place orders, rate of Covid-19 diagnosis in the states the participants live etc. – showed that young people who had used both e-cigarettes and cigarettes in the previous 30 days were almost seven times more likely to be diagnosed with the disease.

The Stanford University study also found that young people who smoked or vaped were almost five times as likely to experience Covid-19 symptoms – coughing, fever, tiredness and difficulty breathing –than those who never smoked or vaped.

However, it’s worth noting that health officials have also warned that vaping injuries are on the rise again.

E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) have similar symptoms to the coronavirus, making diagnosis more difficult.

“Because EVALI and Covid-19 signs and symptoms can be similar (e.g., cough, fever, and diarrhea), health care providers should maintain clinical suspicion for EVALI during the COVID-19 pandemic,” wrote researchers in the Morbidity and Mortality Weekly Report via CDC.

This may explain why they were also more likely to receive COVID-19 testing, said Halpern-Felsher, especially given that in May, many regions limited COVID-19 testing to people with symptoms. 

The study results showed that depending on which nicotine products the young adults used and how recently they’d used them, young people who vaped or smoked, or both, were 2.6 to nine times more likely to receive Covid-19 tests than non-users.

In addition, the study found that lower socioeconomic status and Hispanic or multiracial ethnicity were also linked to a higher risk of being diagnosed with the disease.

The researchers hope their findings will prompt the Food and Drug Administration (FDA) to create stricter regulations for how vape products are sold to young people.

"Now is the time," Halpern-Felsher said. "We need the FDA to hurry up and regulate these products. And we need to tell everyone: If you are a vaper, you are putting yourself at risk for Covid-19 and other lung disease."

 Development of new Covid-19 vaccines is proceeding at a furious pace, which is good news for the world. We already have two vaccines in phase 3 trials in the US and Europe; each of these trials which will vaccinate many thousands of people, and then wait to see how many get infected. If the vaccines work, then in a few months’ time we’ll be able to start large-scale production.

But we don’t have to wait. Both of these vaccines (from Moderna and Oxford University/Astra Zeneca) have already been shown, in phase 1 trials, to be safe and probably effective. That’s why the companies are moving ahead and giving each vaccine to 30,000 more people: they are fairly confident that the vaccines are safe. The NY Times reports that 3 other Covid-19 vaccines are also in phase 3 trials: one from BioNTech and Pfizer, and two from Chinese companies, Sinopharm and Sinova Biotech. So why not start administering millions of doses right now? We should at least consider the possible benefits–and the costs.

In fact, an Indian vaccine manufacturer is already moving ahead with large-scale production. The Serum Institute, run by Indian billionaire Adar Poonawalla, is manufacturing hundreds of millions of doses of the Oxford vaccine, before it gets final approval, investing its own money and taking a chance that the vaccine will work. 

 Why aren’t we doing the same thing in the U.S. and Europe? As I see it, there are two things holding us back:

1. Money. Making hundreds of millions of doses of a vaccine is expensive, and if the vaccine doesn’t succeed in phase 3 trials, that money will have been wasted. I can see why the private companies running these trials might not be able to proceed with large-scale production. This is where the government can step in: just buy the vaccines in advance! We’re already doing this on a fairly large scale anyway: the US recently announced that it was paying Novavax $1.6 billion to cover all stages of its clinical trials plus the manufacture of 100 million doses, long before the vaccine has been approved. Given that the U.S. alone has already spent well over $3 trillion (that’s 3000 times a billion, for those who are counting) to bail out the economy, with at least another $1 trillion to come, a few billion dollars more to manufacture vaccines–even if the vaccines don’t work–seems like a great investment.

2. Caution. The normal process for vaccine testing and approval requires 3 phases. In phases 1 and 2, we carefully test for safety and try to determine the best dose. Even though a vaccine might seem effective after these phases, the number of people being tested is small, and we need larger numbers to be confident that the vaccine works. That’s what phase 3 tells us. So the current phase 3 plans for these vaccines work like this: identify a large number of people (30,000 in at least one of the trials) and give half of them the vaccine, and give the other half a placebo. Then wait for a few months and see how many people get Covid-19. If the vaccine is working, then we’ll see that significantly fewer people in the vaccinated group get sick.

Great. We should definitely do this, and we are.

But we’re in the midst of the worst pandemic since 1918. The careful, step-by-step vaccine approval regimen wasn’t designed for a global emergency, in which every day of delay means that thousands of people die.

We already know that the vaccines in phase 3 trials are safe–otherwise it would be unethical to give the vaccine to 30,000 people, as these trials are doing. (Note: phase 3 trials sometimes uncover safety issues that affect only a small percentage of people–issues that might not appear in smaller phase 1/2 trials. So phase 3 also assesses safety, on a larger scale.) Weighing the risks versus the benefits, I think we should immediately ramp up production, using government funds rather than private money, and then offer these vaccines for free to anyone who wants them.

Of course we’ll have to educate anyone who wants the vaccine that we don’t know for sure if it works. No one will be forced to take it, but I’m guessing that millions of people will be eager to try. And yes, there’s a chance that the vaccines won’t work very well, and maybe this will create greater distrust when we eventually do get a good vaccine. But that’s a risk we ought to take, given the greater harm caused by delays. The evidence for these trial vaccines is already better than for most of the actual treatments we’re giving people–and most importantly, we know they are safe.

So let’s start vaccinating millions of people now, as soon as we can ramp up production. I’ll be first in line to try either the Moderna or the Oxford vaccine, as soon as it’s ready.

 It was a catchy idea: Your blood type might affect your risk of contracting Covid-19 or of developing a serious case of the disease.

Numerous news outlets reported the story a few weeks ago, including CNN and NBC News. NBC's website summarized the results as follows: "Overall, the findings indicate that people with Type O blood seem to be more protected and that those with Type A appear more vulnerable." NBC was also careful to note this was only an "association," not causation. And in the original paper published in the New England Journal of Medicine, the authors noted several limitations to their study, including the fact that "adjustments for all potential sources of bias (e.g., underlying cardiovascular and metabolic factors relevant to Covid-19) could not be performed."

But the idea spread around the world, reported by health and science journalists.

More recently, further studies have shown that these associations may not be as strong as initially reported.

 A major multi-institutional study published by researchers based at the Massachusetts General Hospital showed "there is no reason to believe being a certain ABO blood type will lead to increased disease severity, which we defined as requiring intubation or leading to death."

Another paper from Columbia Presbyterian Hospital in New York found that having type A blood did not increase a person's risk of becoming infected, and that having type O blood might slightly decrease one's risk. But lead author Nicholas Tatonetti noted, "[T]he effect is so small that people shouldn't count on it."

 This is not the first time that an initial intriguing scientific result has been modified or overturned by further research. This has happened repeatedly in nutrition science or drug trials. Spurious correlations based on small data sets are a well-known phenomena, as nicely illustrated by this classic xkcd cartoon.

Good scientists know this can happen, which is why they welcome further research that either confirms or disproves their initial reports. Our best understanding of the truth is always subject to further refinement (or occasional upheaval) based on new evidence and better methods of analysis. But when we're dealing with emotionally charged issues such as the Covid-19 pandemic, it's easy to forget this.

So when we read stories about various drugs or vaccines that might (or might not) work, it's probably wise to temper our initial exuberance (or disappointment) at early results. And be careful when reading mainstream news reports that might not capture all the nuances of the original scientific papers. The truth is out there. We just need to exercise patience and good judgment.

India reported 62,170 new Covid-19 infections in the last 24 hours and with that it became only the third country to cross the two million mark.

It has added one million cases in just 20 days, faster than the US or Brazil, both of which have a higher caseload. Given India's dense population, the numbers are unsurprising. But experts say the virus could have been slowed. They blame a hasty lockdown, patchy test and trace and ineffective safety protocols.

Even as active cases appear to wane in what used to be hotspot areas - Delhi, Tamil Nadu and Maharashtra - they are surging elsewhere.

"We have seen a fair amount of travel between rural and urban areas, and we are seeing the virus now entering rural areas and spreading there," says Dr Srinath Reddy, president of the Public Health Foundation of India and an advisor to the federal and state governments on tackling Covid-19.

One of the states where cases have been rising fast is Bihar - millions of people from this poor northern state move to cities in search of better jobs and it's their return that is believed to have set off case numbers here. India's swift lockdown in March left millions of urban workers jobless and most of them returned to their villages in April and May.

Other states that also send migrant workers out in large numbers - such as Uttar Pradesh and Orissa - have also been seeing high rates of increase. It's hard to trace the virus' path clearly because data is scarce and uneven, but anecdotal evidence shows that many of these states, some of the poorest in the country, struggled to effectively quarantine those coming from hotspot cities such as Delhi or Mumbai.

"This is a virus that came to India on international flights - it landed in cities like Delhi and Mumbai," says virologist Shahid Jameel. But "because of the hasty lockdown", he adds, migrants took the virus from cities to villages.

And numbers started to grow as India began reopening in June - unable to afford the lockdown any longer - and testing increased. People began travelling across states, and even within states more, possibly ferrying the virus along the way. Dr Reddy says the spread in rural areas is relatively slower because there are "more open spaces, you travel over longer distances".

But the virus has certainly arrived in rural India as can be seen from the fact that cases are rising the fastest in the southern state of Andhra Pradesh which is not home to any sprawling cities - such as Delhi, Mumbai and Chennai - that fuelled the pandemic in India initially. Eight of the 20 districts reporting the highest active cases in India now are from Andhra Pradesh - and all except one are rural. The state has shot to third place in the national tally. In the past week, its case numbers have gone up by an average of 7.8% - nearly double that of the national average 3.4%.

District officials told BBC Telugu that the reason for the spike was migrant workers returning home from cities as well as fishermen arriving from the neighbouring state of Tamil Nadu. And although India is yet to restart international flights, repatriation flights from abroad have brought home hundreds of thousands of people. Andhra Pradesh saw many of its overseas workers returning from Gulf countries - this too, officials say, led to more positive cases. But Andhra Pradesh was also testing a lot - at 44,000 tests per million, it has one of the highest testing rates per capita in India. So why did it fail to contain the virus?

"If only tests were the acid test, the US should be flying high," says Dr Reddy. The US has high testing rates, but has also struggled to curb the virus or keep the death toll low. "When you are uncovering a lot of cases and death rates remain low, there is this feeling that there isn't as much to be feared from the virus," he adds.

The death rate from the virus is relatively low across India, although the government has been accused of undercounting Covid-19 deaths. In Andhra Pradesh, Dr Reddy says, the state did a good job in testing, tracing and even isolating suspected patients. District officials did widespread fever surveillance and recruited community volunteers to enforce quarantine rules and safety measures. But none of this proved enough as economic activities resumed and the authorities struggled to continue with the efforts.

 "After the lockdown was relaxed, people gathered for parties, weddings, birthday celebrations. The rules are not being followed. How can the authorities stop them? How many people can be prosecuted for neglecting their responsibility?" Dr M Mallik, East Godavari District Medical and Health Officer, told BBC Telugu. Dr Reddy says this is happening in many other states as well, but case numbers are not rising due to lower testing rates. Bihar, for instance, is doing as few as 6,000-7,000 tests per million, compared to Andhra Pradesh's 44,000.

But India's testing data comes with caveats as the country is increasing its use of antigen tests, which are faster but less reliable than the RT-PCR test. India's guidelines require that anyone who gets a negative antigen test result must be retested with an RT-PCR kit, but it's unclear how often that is actually happening. And antigen tests account for 30% of India's tests, according to the Indian Council of Medical Research.

"There is a chink in our strategy," Dr Jameel says. "Testing is below par and variable across the country. Tracing is patchy and isolation is not being followed effectively." "But there's also the whole attitude towards the outbreak - that life can go on as usual."

 He says this cavalier attitude is leading to more gatherings and lesser use of masks - people have even taken to wearing them below the nose. And the political leadership, he adds, is behaving in a way that runs counter to the message. He points to Prime Minister Narendra Modi's appearance this week at a ceremony to lay the foundation stone for a temple.

At the event too, some 300 guests sat side-by-side, dutifully masked, to watch Mr Modi perform rituals. And outside, people gathered in close groups in the streets and on rooftops to watch the televised event or catch a glimpse of it in real time.

"All this is telling the country that everything is fine but the numbers don't say that," Dr Jameel says.

Nutraceuticals refer to products that are derived from herbal products, minerals, vitamins and dietary substances which are consumed for their physiological benefits or to boost immunity against diseases. The etymology of the term can be traced back to 1989, when Dr. Stephen De Felice, a medical practitioner introduced this segment to mainstream medicine and hence, invented ‘nutraceuticals’, a term derived from the confluence of ‘nutrients’ and ‘pharmaceutical’.  

Despite the foreign origins to the word ‘Nutraceuticals’, what it entails is indigenous to India. India has had a rich heritage of herbal medicines and supplements, which have found resonance in our mythology and folklore. The nutraceuticals market in India is expected to grow from $ 4 billion in 2017 to $ 18 billion in 2025 in the backdrop of rising demand for dietary supplements from upper and middle class. 

The nutraceuticals market in India can be further divided into functional food, beverages and dietary supplements. While functional food includes items such as breakfast cereals, and fortified flour, functional beverages include commodities like sports drinks, fortified juices, and glucose. Dietary supplements, which constitute over 65 percent of the Indian nutraceuticals market, include commodities such as macronutrients, herbal and non-herbal extracts. It is this segment that draws major competition and is the home ground to firms like Amway, Himalaya, Dabur and Emami. This segment is growing at a rate of 17 percent, and hence, will drive the growth of the market.  

Propelling the demand for nutraceuticals in India, among other factors, is the fact that 15 percent of the population is undernourished in the country, and the government has taken several measures to reduce the same through various initiatives such as Integrated Child Development Services (ICDS), National Health Mission (NHM) and the mid-day meal scheme. As per a World Bank report on ‘Nutrition in India’, India loses nearly US$12 billion in Gross Domestic Product (GDP) to malnourishment.   However, interventions to alleviate the loss would cost just about US$ 524 million annually, thus, rendering a benefit-to-cost ratio of almost 23 times. This focus towards preventive care has also been accentuated due to the increasing costs of healthcare: 62 percent of the healthcare costs incurred in India are out-of-pocket expenditures. ; 60 percent of medical prescriptions by doctors in India include supplements.

Furthermore, India has also seen an increase in wealth as a result of which, its middle income and high income households will drive nearly US$ 4 trillion of the country’s incremental consumption by 2030. 

The strength of the Indian nutraceuticals market also emanates from certain supply drivers, which place it amongst the strongest markets in the world. Many of the supply drivers associated with the market are: 
•    Better GDP growth rate among the trillion-dollar economies; 
•    A large coastline spanning over 7,500 kms, with over 12 major and 200 minor ports make it an ideal manufacturing hub for the global value chain; 
•    India is home to largest number of US FDA approved plants located outside the US, a strong testament to its ability to line itself against global competitors; 
•    India has the lowest labour costs among South Asia and South East Asian Nations ; 
•    India has ample availability of ingredients – India is the world’s second largest producer of fruits and vegetables, largest producer of milk and as of 2016, was the third largest market for active pharmaceutical ingredients; 
•    A significant increase in internet penetration has helped increase the availability and visibility of nutraceuticals in the market, due to which, by 2020, nearly 40 percent of the total spend on FMCG in India will be influenced by digital media, a market opportunity of over US $45 billion.   

As nutraceuticals offer opportunities for pharmaceuticals companies to make their products more consumer-oriented, and for food producers to create brands with a medical image, this convergence of medicine, food and technology is further likely to provide impetus to the food processing industry and retail sector in India, which are slated to rise to over US$958 billion by 2025 and US$1.7 trillion by 2026, respectively. Further, the nutraceuticals sector has also been opened up significantly to attract foreign investments: 100 percent FDI is permitted in the manufacturing sector under automatic route, and such entities are allowed to sell their products through wholesale, retail or e-commerce; 100 percent investment is also allowed under automatic route for pharmaceutical entities under greenfield investments, while it is 74 percent for brownfield investments, with government approval required beyond 74 percent.   Similarly, 100 percent FDI through government approval is allowed in food retailing with respect to food products manufactured in India. 

The growing demand for nutraceuticals has also helped give rise to ventures such as HealthKart, Patanjali, apart from creating room for further consolidation by global brands such as Cargill, Nestle, and Amway in the Indian market. Patanjali’s stupendous performance of clocking over a billion dollars in revenue within a decade of its launch and the UK wellness giant, Holland & Barrett entering the Indian market are further testament to the huge potential of the Indian nutraceuticals market.  India’s unique advantage of rich heritage and knowledge, availability of raw materials, growth in herbal extract manufacturers and a strong presence as a preferred supplier in many export markets make it a formidable contender in the global nutraceuticals market.