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Society of Environment and Occupational Health

Protecting Environment and Promoting Occupational Health, Safety and Wellness
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Society of Environment and Occupational Health

Protecting Environment and Promoting Occupational Health, Safety and Wellness

Covid-19 Pandemic

It still remains a grim and complex situation. The fast- emerging mutant variant strains are presenting new challenges apart from the already existing ones like that of a far from satisfactory medical management, and the persisting physical and psychological impacts.

Guidelines for COVID-19 vaccination of children between 15-18 years and precaution dose to HCWs, FLWs & 60+ population with comorbidities

India’s National COVID Vaccination Program is built on scientific and epidemiological evidence, WHO guidelines and global best practices. Anchored in systematic end-toend planning, it is implemented through effective and efficient participation of States/UTs and the people at large.

Government of India’s commitment to the vaccination program has been unwavering and proactive from the beginning, from strengthening Research and Development capacity, to encouraging and enabling manufacturing and vaccinating each and every adult Indian safely, as fast as possible.

As a consequence of reliance on scientific & epidemiological evidence and pro-active implementation, India’s COVID-19 vaccination programme has achieved historical milestone of administering more than 141 crore doses so far. 90% of the adult population of the country has been covered with at least one dose and 62% of the adult population has been covered with both the doses.

For the COVID vaccination program, Government of India initiated early and proactive steps as far back as April 2020:

  • Task Force for Focused Research on Corona Vaccine” (constituted in April 2020), to encourage domestic R&D of Drugs, Diagnostics and Vaccines, headed by Principal Scientific Advisor to the Government of India.
  • “National Expert Group on Vaccine Administration for COVID-19” (NEGVAC), (constituted in August 2020), to formulate a comprehensive action plan for vaccine administration, co-chaired by Member (Health) NITI Aayog and Union Health Secretary.
  • “Empowered Group on Vaccine Administration for COVID-19” (constituted in January 2021), to facilitate optimal utilization of technology to make COVID vaccination all inclusive, transparent, simple and scalable, headed by CEO, National Health Authority

India’s COVID vaccination program incorporates recommendations of the foremost experts in the field of immunization, public health, disease control and information technology. Based on scientific and epidemiological evidence, the programme gives priority to strengthening the country’s healthcare system by protecting the professionals, health and frontline workers, manning it, as well as protecting the most vulnerable population groups.

COVID vaccination in the country commenced with vaccination to all Health Care Workers. The program was expanded with time to include vaccination of Front Line Workers, citizens more than 60 years of age, citizens more than 45 years of age, and eventually citizens more than 18 years of age.

Under the National COVID Vaccination Program, from 16th January to 30th April 2021, 100% of vaccine doses were procured by Government of India and provided free of cost to State Governments. State Governments were in turn to administer vaccination free of cost to defined priority groups. To increase the pace of vaccination, participation of private hospitals was also enlisted where individuals could also choose to get vaccinated at a prescribed rate

In response to the suggestions of many State Governments to be permitted the flexibility to procure vaccine directly and administer them as per their own prioritization based on local requirements, Government of India revised the Guidelines. Under the revised Guidelines effective from 1st May, 2021, Government of India was procuring 50% of the vaccine produced and was continuing to provide them to States free of cost for administering to priority groups. The State Government and private hospitals were also empowered to directly procure from the remaining 50% vaccine pool.

Many States subsequently communicated that they were facing difficulties in managing the funding, procurement and logistics of vaccines, impacting the pace of the National COVID Vaccination Program. It was also noted that smaller and remoter private hospitals also faced constraints.

Keeping in view the aforesaid aspects, the experiences gained from 1st May 2021 and the repeated requests received from States, the Guidelines for National COVID Vaccination Program were reviewed and revised. These Revised Guidelines became effective from 21st June 2021.

Under the Revised Guidelines, Government of India procured 75% of the vaccines being produced by the manufacturers in the country and provided it free of cost to States/UTs as has been the case from the commencement of the National Vaccination Programme. These doses were administered by the States/UTs free of cost to all citizens as per priority through Government Vaccination Centres.

Vaccine doses provided free of cost by Government of India have been allocated to States/UTs based on criteria such as population, disease burden and the progress of vaccination. Wastage of vaccine has affected the allocation negatively.

Government of India has also provided States/UTs advance information of vaccine doses to be supplied to them. States/UTs were expected similarly, to further allocate doses well in advance to districts and vaccination centers. They were also expected to put in the public domain the information about the above availability at district and vaccination center level, and widely disseminate it among the local population, maximizing the visibility and convenience of citizens.

In order to incentivize production by vaccine manufacturers and encourage new vaccines, domestic vaccine manufacturers were given the option to also provide vaccines directly to private hospitals. This was restricted to 25% of their monthly production. Later on, it emerged that the off take of private hospitals was much below the aforesaid 25%. Therefore, the Govt. of India procured more than 75% of vaccines being produced by the manufacturers in the country. These vaccines were provided free of cost to the States/UTs.

All citizens irrespective of their income status have all along been entitled to free vaccination. Those who have the ability to pay are encouraged to use private hospital’s vaccination centres.

The CoWIN platform provides every citizen the facility of conveniently and safely prebooking vaccination appointments. All government and private vaccination centers also provide onsite registration facility, available both for individuals as well as groups of individuals, for which detailed procedure have been finalized and published by States/UTs, in order to minimize any inconvenience to citizens.

Keeping in view the recent global surge of COVID-19 cases, detection of Omicron variant which has been categorized as a Variant of Concern (VOC), scientific evidence, global practices and the inputs/suggestions of ‘COVID-19 Working Group of National Technical Advisory Group on Immunization (NTAGI)’ as well as of ‘Standing Technical Scientific Committee (STSC)’ of NTAGI it has now been decided to further refine the scientific prioritization & coverage of COVID-19 vaccination as follows:

  1. COVID-19 Vaccination of children in the age-group of 15-18 years to be started from 3rd January 2022. For such beneficiaries, vaccination option would be “Covaxin” only.
  2. As a matter of abundant precaution, for those Health Care Workers (HCWs) & Front Line Workers (FLWs) who have received two doses, another dose of COVID-19 vaccine would be provided from 10th January 2022. The prioritization and sequencing of this precaution dose would be based on the completion of 9 months i.e. 39 weeks from the date of administration of 2nd dose.
  3. All persons aged 60 years and above with comorbidities who have received two doses of COVID-19 vaccine, will on Doctor’s advice be provided with a precaution dose from 10th January 2022. The prioritization and sequencing of this precaution dose would be based on the completion of 9 months i.e. 39 weeks from the date of administration of second dose.

All citizens irrespective of their income status are entitled to free COVID-19 vaccination at Govt. Vaccination Centres. Those who have the ability to pay are encouraged to use Private Hospitals’ Vaccination Centres.

Co-WIN features and provisions:

  • HCWs, FLWs and Citizens 60+ with co-morbidities:
    1. All HCWs, FLWs and citizens aged 60 years or above with comorbidities will be able to access the vaccination for precaution dose through their existing Co-WIN account.
    2. Eligibility of such beneficiaries for the precaution dose will be based on the date of administration of 2nd dose as recorded in the Co-WIN system.
    3. Co-WIN system will send SMS to such beneficiaries for availing the precaution dose when the dose becomes due.
    4. Registration and appointment services can be accessed through both, the online and the onsite modes.
    5. The details of administration of the precaution dose will be suitably reflected in the vaccination certificates.
  • New beneficiaries aged 15-18 years:
    1. All those aged 15 years or more will be able to register on Co-WIN. In other worlds, all those whose birth year is 2007 or before, shall be eligible.
    2. Beneficiaries can self-register, online through an existing account on Co-WIN or can also register by creating a new account through a unique mobile number, this facility is available for all eligible citizens presently
    3. Such beneficiaries can also be registered onsite by the verifier/vaccinator in facilitated registration mode.
    4. Appointments can be booked online or onsite (walk-in).
    5. For such beneficiaries, option for vaccination would only be available for Covaxin as this is the only vaccine with EUL for the age-group 15-17.

These Guidelines will come into effect from 3rd January 2022 & will be reviewed from time to time.

How to avoid ‘Corona Fatigue’

In the interest of public health, Dr Kishore Madhwani offers tips on how to stay safe and calm.

Worldwide reports assert that ‘Corona Fatigue’ has set in. The inadvertent phenomenon has also been described as ‘Caution Fatigue’.

After nearly three months of lockdown followed by the phase of ‘opening up’, people have started taking it easy, so to speak – you may find that you’re no longer disinfecting your hands as frequently as you used to and even venturing out to public places. CNN World News has quoted professor Jacqueline Gollan, expert in psychiatry and behavioral sciences, as well as obstetrics and gynecology, as saying, “When we become impatient with warnings, or we don’t believe the warning to be real or relevant, or we de-emphasize the actual risk – we then bend rules or stop safety behaviors like washing hands, wearing masks and social distancing.”

The importance of the professor’s statement is significantly relevant. During the lockdown, most had sought to stay indoors. The fact, however, is that we have to be more careful during the ‘opening-up’. We were protected during the lockdown—as we all stayed indoors. 

However, we will now be more vulnerable to COVID-19 infection, as we step out into the world. We have to be more self-disciplined about social distancing because if an asymptomatic person sneezes or coughs near us we’re more likely to be infected. It has to be remembered that the Coronavirus hasn’t lost its severity.

We still cannot host people at home. Moreover restaurants are best avoided: a spoon, fork or glass, which had not been well cleaned, could be the route to Covid-19.

We have to request Uber and drivers or your own care to switch off the air-conditioner and keep the windows open. In case the driver coughs or has been mildly infected, then you could be in trouble.

It is a time to be grateful that we have survived the first phase, and avoid being trapped by the next.

There is no reason to be alarmed or to get overwrought. Here are 10 tips, from the point of view of an occupational therapist.

  1. Wear a cloth mask when venturing out of home, either to the office or to a public space. Venture out only if necessary and take the minimum time possible to complete the task.
  2. Switch on your cell phone Bluetooth when going out of the house. Download the Arogya Setu App and 1.5 App (United Nations–Social Distancing App). Take care of elderly family members, pregnant women and children for whom maintaining hygiene and social distance is a special challenge.
  3. Wash hands more often/clean with sanitizer (take at least 20 seconds) every two to three hours – before and after eating meals, before touching eyes, mouth, nose and mask and after use of restroom. Keep surfaces – floors, tables, walls, and objects – doorknobs and handles, virus free by using soap water or disinfectant.
  4. Avoid eyes, nose and mouth, touch less handrails, doorknobs and lift buttons. Vis-à-vis, grocery shopping (vegetable and packaging’s) should be disinfected by 1 per cent sodium hypochlorite with contact time of 10 minutes or bleaching powder (20 ml of bleach in a liter of water), with contact time of 10 minutes.
  5. Maintain social distancing – keep at least 6 feet away and no shaking of hands. Try to walk 10,000 steps in your house daily.
  6. Use the crook of your elbow for catching your sneeze or cough. Alternately use a disposable tissue and dispose immediately. Spitting outside your home is prohibited and punishable.
  7. Stay away from the ailing (better to avoid hospitals) and drink warm liquids – like milk with ginger, tea with tulsi, mulethi and cardamom. Inform the family that you are arriving home, leave the door open on reaching home, keep your footwear outside, remove your watch, cellphone, spectacles and wallet and keep them in a secluded area. Immediately have a bath with soap and water. Then sanitize your belongings and wash your hands. Alternatively, your personal belongings could be sanitized in UV-C chamber boxes for 10 minutes.
  8. Eat thoroughly cooked hot food 80%, minimize junk food to 20%. Eat greens, sprouts, protein like soya, rajma, chholay, egg whites, chicken breast and vitamin supplements containing zinc, vitamins C and D. Take flu and typhoid shots; the elderly could take pneumonia shots if asthmatic or have chronic bronchitis.
  9. The monsoons may be responsible for outbreaks of malaria, dengue, leptospirosis, typhoid, diarrhea, vomiting, flu – all of which may be accompanied by fever, body aches, Immediately contact your personal physician to determine the next steps.
  10. Maintain calm and a cool attitude. Perform body stretches and do yoga. & SPIRITUALITY. If anxious, contact the counseling line: 080 4611 0007.

How to keep the virus at bay, now

Dr. Kishore Madhwani writes on the essentials to keep safe at this juncture of the COVID-19 virus pandemic.

Post-Diwali, the New Year has begun with positive vibes of early recovery, opening of public sector offices, relaxation of lockdown in worshipping  places, shopping malls and restaurants.

Plus, there’s news of a potential vaccine for transforming tomorrow to the new normal. One feels optimistic – perhaps we will celebrate our next Eid, Baisakhi, Durga Puja and Diwali with the traditional fervour – as we may be vaccinated by then. 

As this dreadful virus is now unleashing a second wave in Delhi and globally (USA and Europe) with a record number of cases and deaths,  please remember the mantra SMS V3 on your fingertips for protection from COVID-19.

The mandatory execution of SMS V3  as opposed to a total lockdown has been successful in South Korea, New Zealand and Singapore in controlling transmission effectively.

SMS is where most protection is achieved by S – Sanitisation, M – Mask Wearing and S – Social Distance

In a social message, Amitabh Bachchan mentions the above three mandates.  It may be pertinent, also to stress the importance of V3, which is extremely important for your safety to achieve substantial protection from the virus.   

V: Ventilation, V: Vigilance and V: Visiting Out

Let me elaborate on each component of the essential mantra, beginning with Sanitisation.

Surface Sanitisation is very conveniently, cost-effectively achieved by a) 1 percent hypochlorite solution for walls, table surfaces, door knobs etc., and b) a contactless UV-C radiation chamber in a span of two to eight minutes depending on the size and quantum of items to be disinfected, ranging from currency notes, stationery, keys, mobile phones, spectacles and laptops to  farm fresh vegetables, tetra-packs and home-delivered food. It is worth investing in this chamber because the radiation destroys the virus DNA, thereby terminating virus replication.

Self-Sanitisation: Religiously washing hands for 20 seconds every three hours with soap and warm water. If water is not available, 70 percent alcohol-based sanitizers should be rubbed for 20 seconds before donning a mask, eating, rubbing your eyes, the nose and after taking off the mask, disposing of the mask, completing eating, toilet use and touching potentially contaminated surfaces.

Mask Wearing: Disposable N95, triple-layered or reusable cloth masks (in descending order of efficacy) now advocated by WHO for protecting others and recently confirmed for self- protection too (CDC, USA), reduces virus transmission by 70 per cent and has the potential of reducing countless cases and deaths globally; if snugly fitting and fully covering the nose and mouth.

Additionally, a face shield is strongly recommended while interacting  and spending long duration indoors with others.. 

Social Distancing: Maintaining 6 feet distance at all times (Do Gaz Ki Doori Jo Aaj Hai Zaroori) is challenging but very easily achieved by downloading the magical UNTIL APP (use link in attachment below) on your Android Mobile Phone (keeping  the Bluetooth on). This automatically alarms you with a beep if you violate the 6 feet distance. If it is windy, then the minimal social distancing maintenance will be beyond 6 to 10 feet.

Ventilation: Avoid visiting enclosed small spaces like bars and restaurants since uni-directional drafts of air from split air conditioners could transmit the virus from asymptomatic virus carriers to a long distance in the same room. Aerosol transmission of viruses increases exponentially indoors from breathing to speaking, shouting, singing, coughing and sneezing.

Staying indoors for lengthy periods should be avoided in totally confined (nil ventilation) work areas, non-exhaust ventilated small office spaces where outside air cannot enter and exit.  

In workspaces and showrooms or malls, the central HVAC unit should be installed with UV-C radiation lights for deactivating virus, must have a minimum 12 air exchanges per hour, maintain temperature at  24 degrees and a relative humidity at 40 per cent to 70 per cent (making it  a bit warm & uncomfortable).

When travelling, use a self-driven vehicle. But if you’re using public transport, then social distancing, mask-wearing, switching off the air conditioners and keeping windows open (if feasible) minimises the risk of transmission. New generation split air conditioners with nano E technology inactivate the COVID-19 virus as do room air purifiers (with HEPA filters) for small enclosed rooms. These innovations may transform tomorrow’s workplace for adapting to the new normal. 

Vigilance: Earliest detection by Rapid Antigen Test/RT PCR Swab Test, isolate, treat fast, track and trace fast all the close contacts for their home quarantine.

Monitor the vital parameters of all the affected for hospitalisation if health deteriorates and protect from post COVID-19 complications/syndrome.

Visiting: Avoid elevators as well as large gatherings of five people or more, limit visiting time (five minutes if possible) and frequency, avoid or limit interaction with people if possible. When travelling, it is recommended to invest in a FITNESS TRACKER (an excellent medical wearable used as a screening device), which alerts you by recording your temperature, oxygen saturation, pulse rate, blood pressure, heart rhythm with precision for the  timely action of contacting your personal family physician.  

Mission Possible

Dr. Kishore Madhwani writes on the largest vaccination programme in the world, which kickstarts in India on this Saturday. 

Come Saturday, the country embarks on its ambitious mission to vaccinate 30 crore (300 million) population by July 2021. 

The Largest Global Vaccination Drive by a democracy will be virtually rolling out on Saturday 16 January, 2O21 by Prime Minister Narendra Modi. 

He will officially launch the much-awaited COVID-19 Vaccine Intelligence Network Application of the Ministry of Health & Family Welfare – popularly known as the Co-WIN App – a digital platform for real-time monitoring of the COVID-19 vaccine roll-out and delivery in the country – wherein users will be able to self-register to get vaccinated.  

Two Covid-19 vaccines have been approved by the Drug Controller General of India (DCGI) for restricted emergency use. The Pune-based Serum Institute of India’s COVISHEILD and the Hyderabad-based Bharat Biotech’s COVAXIN will be given in the first phase of the vaccination drive, which will include frontline workers (first in priority) followed by people above 50 years. No choice will be offered by the government for vaccine selection. 

The Pune-based Serum Institute of India has released 1.1 crore (11 million) doses and Bharat Biotech has released 55 lakh (5.5 million) doses, totalling to 1.65 crore (16.5 million) doses. These have reached 13 cities from the factories in TATA motors refrigerated trucks to Mumbai by road and to other destinations by air. 

The Indian Air force along with Spice jet, Air India and other domestic carriers, transported the vaccines to airports of 13 cities. From the destination airports, again by refrigerated trucks with walk-in coolers, amidst security of police protection as well as temperature monitoring of the cold chain, the convoy reached the destination government centres/hospitals for storage in cold rooms specially  constructed and armed with CCTV cameras for safety from theft and adulteration. 

On Thursday 14 January, a dry-run (mock administration and monitoring drill) of the vaccination drive will be carried out to ensure safety and a smooth execution process for the final big event slated for Saturday. 

Data on frontline healthcare workers, who would get the vaccine on a priority basis, has already been collected from government and private health facilities and has been fed into the Co-WIN App. The National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) has recommended that the COVID-19 vaccine needs to be provided on priority to government and private sector healthcare workers, which are around one crore. 

Beneficiaries/Target Audience: After the frontline Health Officials are covered, for further vaccine roll out in the country, the  Co-WIN app digital platform will have to be used by all the citizens, vaccine eager and vaccine hesitant groups, citizens of 50 years and above and citizens of 50 years and above with underlying comorbidities. 

Once the app is up and running, citizens can login and register themselves, be informed of vaccine administration date and of the site near their residence. 

CO-WIN App will have 5 following modules: 

  1. Administration Module 
  2. Beneficiary Registration Module 
  3. Vaccination Module 
  4. Beneficiary Acknowledgment Module 
  5. Status Updation and Report Module
  1. On the spot registration for vaccines will not be permitted. 

Here’s how the entire vaccination process will be monitored with the Co-WIN App: 

  • The administrator module is for the administrators who will be conducting these vaccination sessions. 
  • Through these modules, they can create sessions and the respective vaccinators and managers will be notified. 
  • The registration module is for people to get registered for vaccination. It will upload bulk data on comorbidity provided by local authorities or by surveyors. 
  • The vaccination module will verify beneficiary details and update vaccination status while the beneficiary acknowledgement module will send SMS to beneficiaries and also generate QR-based certificates after one gets vaccinated. 
  • The report module will prepare reports of how many vaccine sessions have been conducted, how many people have attended those, how many people have dropped out, etc. 
  • The mobile application will also send real-time data of temperature of the cold-storage facilities to the main server. 

Following online registration, the beneficiary will receive SMS on their registered mobile number on the due date, place and time of vaccination. On getting the due dose of vaccine, the beneficiary will receive SMS on their registered mobile number, documents needed and cost. 

In order to register, citizens will need to upload a photo identity, which can be an Aadhar Card, Driving License, PAN Card and others. Union Health Minister Dr. Harshvardhan has announced that the vaccination will be free for frontline workers. The cost to the general public has not been announced yet (probably free). He has also shared a design of the vaccination centre sites on twitter (link shared above), as shown here: 

After all doses of vaccine are administered, a QR code based certificate will also be sent to the registered mobile number of the beneficiary, said the ministry. 

On preventive measures and precautions, the ministry has advised that all beneficiaries should rest in the observation room at the vaccination centre for at least half an hour after taking the COVID-19 vaccine. 

hey should Inform the nearest government health authorities, in case they feel any discomfort or uneasiness subsequently. Remember to continue following key COVID appropriate behaviour, until receiving  the second dose & subsequently as well. These can be easily remembered by the mnemonic: SMS- V3, Sanitization hands and surfaces, Mask Wearing, Social Distancing of 6 feet, Vigilance (if symptomatic- test early + isolate fast), Ventilation in 4-wheelers (keep all 4 windows 3- 4 inches open) and in public transport, ensure 6 feet distancing with mask wearing and keep windows open, if feasible, Visiting out of home, ensure wearing mask & avoiding the 3 Cs: Closed gatherings – 50 individuals without physical distancing  (could be superspreading events), Closed confined indoor spaces with poor/nil ventilation for long durations and Close conversations for more than 5 to 10 minutes (please wear face shields).  

Currently 10 vaccines are undergoing clinical trials in India.  

It is expected that India will be a major vaccine producing and supplier hub for the world. ALL current vaccines used GLOBALLY will be made in India in NEXT 6-12 months. We are not expected to have any vaccine shortage.

INDIA HAS ALSO SECURED THE MAXIMUM DOSES OF COVID- 19 VACCINE 

In the next 3 to 4 months, 2 more vaccines will be available for roll out and subsequently all 4 vaccines may be available in private hospitals and clinics, subject to government approvals.   

India flattens curve, but precautions are a must

Dr. Kishore Madhwani writes on the flattening of the COVID-19 graph in India, and emphasises that COVID Appropriate Behaviour is still extremely essential in our daily lifestyles to beat the virus.

The news has been heartening since the last month. India has flattened its COVID-19 graph; 146 districts had no new cases for seven days, Health minister Dr Harsh Vardhan had stated on January 28 in a press release.   

All across the nation newly diagnosed COVID-19 cases stood at a total of 12431 (Rapid Antigen & RTPCR Test based). The overall numbers have reduced gradually over the last few months. The positive news is that the pandemic is probably receding ;except in the states of Kerala with 6102 fresh cases and Maharashtra with 2736 cases.

Hence, a high-level team of experts from the Centre’s Ministry of Health and Family Welfare has reached the states to control the situation by auditing and reviewing the surveillance, containment measures and a strict enforcement for COVID Appropriate Behaviour.

The curve (daily new cases) plateaued in September 2020; after which it has  been receding gradually towards hopefully becoming totally flat in the due course of time.

With nearly 2.48 million cases of Coronavirus around the world, countries across the globe have been grappling with ways to stall the spread of the  pandemic. The number of cases across the world have continued the exponential growth since last month, mainly due to emergence of mutant virus strains.

However, there are a few countries like India which have been able to limit the rate of growth and ‘flatten the curve’. This involves reducing the number of new COVID-19 cases from one day to the next. When a country has fewer new COVID-19 cases emerging  than it did on the previous day, that’s a sign that the country is flattening the curve.

The first case in India was detected on January 30, 2020. The country took 109 days to record 1 lakh cases and subsequently on June 13, 2020 recorded over 11,000 cases for the first time. The seven day moving average of the cases on February 4, 2021 fell to 11,818 cases (below 12,000) for the first time in last eight months, since June 2020. This is encouraging news indeed.

The good news for India is that the pandemic, which had spiked with maximum cases in the month of September 2020, has been successfully tamed, after which there has been a steady decline in the number of reported active cases.

On February 1 2020, there were 11,427 new cases recorded across pan-India (12 per cent lower than previous day) and 118 new deaths have been recorded. The five days moving average has reduced for a) India from 19772 cases on 1 January 2021  to 13,617 on 1 February, and b) Mumbai from 630 cases on 1 January to 447 cases on 31 January 2021. Hence, it is evident that the curve is receding and gradually moving towards flattening.

With the initiation of the largest vaccination drive across India on 16 January 2021, we are gradually moving towards further flattening of the curve. Keeping these developments on the radar, the Union Home Ministry on 27 January, issued an order to open up the lockdown measures very gradually with strict guidelines enforced for surveillance, containment and caution against COVID-19 from February 1 to 28. This is being executed with abundant precaution to ensure that the number of cases do not increase.

The State Government and Union territories have been asked to mandatorily enforce containment measures as well as Standard Operating Procedures (SOPs) on various activities along with COVID Appropriate Behaviour. These activities are movement by metro and local trains, air travel, reopening of schools, colleges, swimming pools, gyms, yoga centres, hotels, restaurants, multiplexes, shopping malls and entertainment parks.

No restrictions have been imposed on inter-state and intra-state on persons and movement of goods. Subsequently, the home ministry allowed swimming pools to open for everyone and 100 per cent seating capacity in cinema halls in most states and Union Territories.

Treading on the side of caution correctly, the Maharashtra State government has enforced strict measures in cinema halls, airports and local trains in Mumbai. It has permitted only 50 per cent seating capacity with strict enforcement of the SOPs.

Municipal authorities in plainclothes also visit the cinema halls to ensure sanitisation of the premises with disinfectants (in empty halls), staggered entry-exit of viewers, social distance maintenance during intermissions and a prolonged interval time – as no eatables are permitted inside auditorium, a temperature maintenance of 24-30 degrees ensuring 70 per cent relative humidity and outside air exchanges (with internal exhaust ventilation) approximately every 30 minutes are complied with in major multiplex chains like the PVR cinemas. This may instill confidence in resuming filmgoing as even ticketing and snack purchases have no-touch digital payment facility.

To arrest the spread of the mutant virus strains at international airports in Maharashtra, passengers arriving from Denmark, U.K., UAE, Brazil, South Africa and a few European cities are compulsorily quarantined at their own expense in hotels for seven days, during which they are tested by RTPCR for COVID-19 on Day 5 . If negative; they are then sent home on Day 7 and are advised to remain in home quarantine for another 7 days.

Health Minister Harsh Vardhan has stated that 165 cases of a new UK variant of the virus have so far been reported in the country. The patients are being  kept under supervised quarantine and surveillance. If any foreign national tests positive for COVID 19, they are transferred to COVID-19 designated hospitals; until they turn negative, a necessary procedure.

Mumbaikars can travel by local train (Western Railway) early mornings from 4.15 a.m. up to 7 a.m., then 12 p.m. to 4 p.m. and after 9 p.m. until the last train at 12.50 a.m. (up to Virar). The essential service staff can utilise trains from 7 a.m. to 12 noon and from 4 p.m to 9 p.m. Shops are open until 11p.m. and restaurants until 1 a.m. 

Severe precautions are being taken to halt the transmission of the mutant virus strain. Because, if we let our guard down now, when the cases are gradually receding, and if the mutant virus strains spread in India, we will be in the same state of emergency as the above-mentioned countries where health authorities are overwhelmed with numbers of hospital admissions, ICU beds, shortages in the supply of PPEs for healthcare workers and medication.

Hopefully we will be able to succeed in halting the transmission of mutant virus strains and simultaneously upscale the Prime Minister’s ambitious programme of vaccinating 30 crore Indian population by July 2021. To ensure that you are protected from COVID-19 including the mutant virus strains, kindly watch my video on YouTube titled MISSION POSSIBLE: A  SAFE NEW NORMAL 2021 with SMS V3 (Covid Appropriate Behaviour) & Vaccinations.

The guidelines issued by the ministry mention that citizens above 65 years of age, those with comorbidities, pregnant women and children below the age of 10 years are now advised to be careful and take necessary precautions. All the district magistrates have been asked to strictly enforce measures for enforcement of social distancing. “State governments may, as far as possible, use the provisions of Section 144 of the Criminal Procedure Code,” the guidelines have stated firmly. Meanwhile, the government has asked the Civil Aviation Ministry to further open up international air travel but only in consultation with the Home Ministry.

In conclusion, the coming months and the year 2021 will be extremely crucial for India. We all need to implement SMS V3 (COVID Appropriate Behaviour), get vaccinated early and disseminate this information to our families, colleagues and places frequented by us like gyms, parks, malls, swimming pools, markets, restaurants, cinema halls and entertainment parks to practise SMS V3 in our daily lifestyles.

How to combat the coronavirus right now

Dr. Kishore Madhwani writes on everything you must know today with the nation’s ongoing tireless vaccine drive and how we need to take more precautions than ever before.

As I write this, the experts’ viewpoint is: How to navigate hard scientific evidence to overcome the surge (temporary spike) of 16,838 new cases across India, with Maharashtra recording 12,316 new cases (Mumbai – 1173) followed in terms of numbers by Kerala, Punjab, Karnataka, Tamil Nadu and Gujarat. These six states account for 86 percent of fresh cases.

Although we are partially opening up at the directives of the government, we all need to ensure that strict protective measures are implemented to prevent transmission of the virus. If we let our guard down, allowing the globally emerged mutant virus strains to spread in India, we will be in a state of emergency. The health authorities will be overwhelmed with the  number of hospital admissions and the availability of ICU beds – a reality experienced in Mumbai, since the last couple of weeks.

It is but natural to expect that new mutations of the virus will come to the fore every day. While some of us are living in fear, many are living under denial. This battle between these two attitudes is getting even more complex since there is an increasing amount of ‘information fatigue’ among people.

This article will essentially focus on factual information to provide you simple solutions  to cope with current situations and a realistic prediction of the outcomes, based on our current interventions and adaptability of the virus to survive. These interventions have the potential of becoming game-changers to ultimately topple the coronavirus.

It is interesting to note how our interventions have changed from 2020 to date: from ‘no mask’ (advocated by WHO) to ‘yes mask’ (advocated by CDC, USA and finally agreed by WHO) to the current ‘please double mask for 95% protection’ (CDC, USA). U.S. President Joe Biden and his team of office-bearers are double masking today, as seen on CNN.

Why have these recommendations evolved and changed ?

Very simple – we are updating recommendations because the virus is becoming smarter (as it is mutating); hence we need to outsmart the virus by wearing a shield on our face (double mask) and also by creating an additional shield around the population by speeding up vaccinating everyone (starting with most vulnerable group above 60 years and 45 years with co-morbidities in India, initiated in 1 March 2021) locally, nationally and globally.

According to Oxford University’s Our World in Data website, 268.57 million vaccine doses have been administered across the world. In India, 14 lakh people were given the vaccine till 7 pm on March 5. The Health Ministry data showed a total 17.14 lakh people have been vaccinated in the last five days and 1.9 crore beneficiaries since January 16 – as confidence and vaccine eagerness increases across the nation.

It is reassuring to know that we are one of the few countries globally, where citizens have access to getting vaccinated 24×7 at hospitals in their vicinity  with monitoring for adverse effects under close supervision.

In the U.S., vaccines are being given inside self-driven cars with subsequent 15 to 20 minutes waiting inside the car. Of course, any one would prefer close monitoring inside hospital premises, rather than inside a car. Credit is due to our Health Ministry for releasing a 542-page list of hospitals across India under the Prime Minister’s Jan Arogya Yojana scheme, the Central Government Health Scheme and local private hospitals, to realistically progress towards achieving the goal of vaccinating 30 crore population by the end of July 2021.

Very recently in India, the coronavirus positivity rate (based on a seven day moving average) has increased from 1.7% (one month ago) to 1.9% (one week ago) to the current 2.1% today.

Why has there been a surge in cases recently?

Indians are fed up, fatigued and have become complacent in Covid  Appropriate Behaviours (SMS V3) when the curve has flattened. Some are not wearing masks during travel by public transport, in public places, in gyms; where going maskless is a key factor in COVID-19 transmission, and also not following social distancing norms.

Even some nurses and healthcare workers have been hesitant to get themselves vaccinated. The same scenario is witnessed in countries where cases are receding. In  the U.S. the Governor of Texas, in an announcement, sweepingly rollbacked the ‘TEXAS MASKING MANDATE’ in the state. To this horrifying revelation, the Infectious Disease Specialist Dr Peter Chin Hong, Professor at University of California, commented on NDTV, “It is going to be dangerous, as lives are going to be lost”. The coverage reported that Michigan, Louisiana, Mississippi would follow suit based on a political directive.

The COVID-19 virus is a sneaky, stubborn and persistent virus, which needs to be tackled with extreme patience, without any fear or panic, very cautiously (throughout 2021) because if we become complacent and let our guard down now, the virus will get the upper hand and create a scenario mimicking bombing of the virus in the community; as is currently being witnessed globally and in India, too, where a resultant second wave could be inevitable. 

Permit me to explain: If your enemy is becoming smarter by changing in structure and virulence, which can bring about a change in symptoms and immune escape [rendering currently available vaccines ineffective against variants (mutant strains), you need to understand the new symptoms. You have to be more vigilant in early detection and isolation to block the virus transmission.

The newer symptomatology for the variants is fever, skin rash (ranging from hives, blisters to maculo-papular lesions), conjunctivitis, sore throat, loss of sense of taste and smell, persistent cough, headaches, muscle aches and tiredness – in short profound influenza like illness features, as shown in diagram]. Any patient having a sore throat, cold and  bodyache should be immediately tested by RTPCR test for COVID-19.

Which variants are causing the above symptoms?

The UK (B.1.1.7), South Africa (B.1.351) and Brazil (P1) variants of SARS-CoV-2 are probably causing the above symptoms in the country. As on date, 242 cases of these variants have been reported by the Ministry.

Analysis from the National Institute of Virology indicates that Bharat Biotech’s COVAXIN has 81% efficacy & antibodies generated by it can neutralise the UK variant B.1.1.7 strains and other heterologous strains. This is our Ah-moment and hopefully becomes our Ah-moment and game-changer.

Cases caused by the B.1.351 variant were reported in the U.S, at the end of January 2021. Vaccine-makers Moderna and Pfizer-BioNTech (mrna vaccines) have already announced that they are working to modify their vaccines to better protect against the South African B.1.351 variant – and possibly to create booster shots. The mrna vaccine production technology – it is based on genetic coding just by altering the genetic code – against the variants can be genetically engineered and manufactured in minimal time. This is a definite gamechanger in the fight against COVID-19. The good news is that mrna vaccines will be produced in Hyderabad, India by year-end.

The P1 Variant has been reported from Brazil. It is among the factors, which epidemiologists believe is contributing to a rise in cases and deaths, and there has been concern in the scientific community about the variant’s resistance to vaccines. This P1 variant contains a set of additional mutations that may affect its ability to be recognised by antibodies resulting in immune escape, which may render the current vaccines ineffective against it.

But a WOW moment here is the breaking news released that an Oxford University study shows that Covisheild (Serum Institute of India) shot works against the Brazil P1 Strain, implying that the Indian vaccine will not have to be modified in order to protect against the variant. Another game-changer in the fight against COVID-19.

Another breakthrough is the single dose Johnson and Johnson vaccine, which is effective against the South African and Brazil strains, protection starting  two weeks after vaccination and by four weeks after the shot, it prevents severe disease, hospitalisations & death. Efficacy is 72 percent and storage temperature is 2 to 8 degrees centigrade.

One more breakthrough announcement is the initiation of human phase 1& 2 trials in India by Bharat Biotech  on nasal vaccines, which if successful will be a great milestone in  our battle against COVID-19. A couple of intranasal puffs in nostrils intercepts virus present in mucosal membranes (not achieved by injectable vaccine) stimulating the immune system to make proteins in the nose and blood to combat the virus and prevent it from growing.

Administered in all age groups with fewer side-effects, provides easy immunity by directly interacting with T cells present in the nose and throat, targeting the immune cells present in the mucosal membranes. Self-administered, it is immediately absorbed by the blood vessels without needles and cold chain maintenance in remote areas, having  an infinite outreach globally; if successful could eradicate COVID-19.  

What should be our approach to curb the sudden surge in cases?

Vaccinate as many citizens as soon as possible to achieve maximal local coverage of populations/herds to gradually move towards achieving herd immunity. The limited data available suggests the vaccines will at least partly reduce transmission, and the studies to determine this with more clarity are underway.

There should be more data within the next couple of months. Until then, precautionary measures like double masking, 2 metres social distancing in the presence of unvaccinated people will remain top priority  with repeated emphasis on V3. The first V is vigilance for early disease detection and isolation — to prioritise micro containment in order to control the virus transmission and tackle the recent surge. The second V is ensuring ventilation during travel, at workplaces and public spaces. The third V is when visiting out, please ensure to avoid the 3 Cs

  • Limit closed conversations to 5 minutes
  • Closed gatherings 50 people has the potential of becoming a superspreader  events
  • Closed confined spaces with minimal or nil ventilation

To ensure that you are protected from COVID-19 including the mutant virus strains, kindly watch my video on YouTube explaining V3; which is part of the acronym SMS V3 (for covid appropriate behaviour)

Yesterday evening my cousin sister’s eight-year-old daughter diligently wearing a mask visited a mall to shop essentials and came across another eight- year old and asked, “Where is your mask? Why are you not wearing one?” The parents of the eight-year-old were so embarrassed that they apologised to my cousin and made the child wear a mask immediately. Moral of the story: Children can significantly influence adults to adopt V3  along with SMS without offending anyone.

“It is easier for us to make children wear masks than adults,” Jake Tapper has stated on CNN and he is so correct.

To conclude: To eliminate COVID-19, scientific wisdom should prevail for easing lockdown restrictions. Children could effectively inspire the implementation of COVID Appropriate Behaviour (CAB) along with celebrities and politicians who could spread this message:

YOU NEED TO FIRST SHIELD YOURSELF WITH A DOUBLE MASK AND  SHIELD ALL PEOPLE AROUND YOU WITH VACCINATION; AS THESE ARE PRECIOUS INTERVENTIONS SPEARHEADING THE ATTACK ON COVID-19.