Nov 2, 2020

A New Study Finds Out COVID-19 Antibodies Fall Rapidly After The Infection

A study conducted by the Imperial College, London found that the antibody response to SARS CoV-2 disappears over time, indicating that there is a risk for reinfection. The study which tested about 3,65,000 adults in England noted that the number of people testing positive for antibodies has reduced by 26% between June and September.

About 60 in 1000 people had antibodies In the first round of testing, which was conducted at the end of June and the beginning of July. But in the latest tests, conducted in September, only 44 per 1000 people were positive. This data shows that the number of people with antibodies declined by more than a quarter between June and September. The decline in the antibodies was greater in elderly people (people above 65 years of age), and in people with suspected infection, which indicated that the antibody response varies by age and the severity of illness. However, the declining trend was not seen in healthcare workers which the authors suggest that it could indicate repeated or higher initial exposure to the virus.

The study suggests the possibility of decreasing population immunity and increased risk of reinfection as detectable antibodies decline in the population. However, experts say that this data does not lead to any conclusion and believe more work is still needed on long-term immunity, and also how the SARS CoV-2 would react to a viable vaccine that clears clinical trials to be rolled out against COVID-19. Some people who are at high risk may require additional follow-up booster doses to boost their levels of immunity.

Source: BBC, Firstpost

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Oct 27, 2020

The Most Widely Used Drugs And Therapies For COVID-19 Treatment; And The Surprising Non-Drug That Everyone Agrees On

Worldwide, more than 43 million people have been infected by SARS CoV-2 and more than 1.1 million people have lost their lives in the battle against COVID-19. There are no drugs or vaccines approved for the prevention or treatment of COVID-19 yet, except Remdesivir which was approved very recently by the FDA. The urgent need for treatment during the pandemic has led to the widespread use of unproven treatments, supported largely by observational studies.

Here, we discuss the most commonly used investigational drugs and other therapies to treat COVID-19.

Antiviral Therapies

Remdesivir

Remdesivir (GS-5734; Gilead Sciences, Inc) is the first approved drug for COVID-19 treatment by the FDA. This antiviral drug is approved for use in hospitalized adult and pediatric patients 12 years of age and older and weighing at least 40 kilograms (about 88 pounds). The drug has been shown to inhibit replication of other human coronaviruses which include SARS-CoV and MERS-CoV. An in vitro study showed that the drug prevented human cells from being infected with SARS CoV-2. Phase-3 clinical trials of Remdesivir for COVID-19 treatment are undergoing in the U.S., China, and South Korea. This antiviral is also being studied in combination with other medications.

Not all Remdesivir studies have been promising and recently, a study by the World Health Organization called the “Solidarity Therapeutics Trial” found that Remdesivir has little or no effect in hospitalized COVID-19 patients. The results of the study stated that the drug did not reduce mortality, chances for the need of medical ventilation, or the duration of hospital stay as compared with patients without the drug treatment.

Other investigational antivirals:

Favipiravir, also known as Avigan is an oral antiviral medication approved for the treatment of flu in China and Japan. It is approved in Russia for COVID-19 treatment. In Vitro studies have shown that high doses of this antiviral prevent human cells from being infected with SARS CoV-2. Some studies conducted in China for this drug have shown promising results and the first U.S. clinical trials for Favirpiravir were approved to start in Boston.

Tamiflu, also known as Oseltamivir is an antiviral medication used to treat and prevent influenza A and B virus. Several clinical trials are currently undergoing for Tamiflu in combination with other drugs to treat COVID-19.

Galidesivir is a new antiviral drug that is currently being developed and clinical trials for this drug are starting in Brazil soon.

The NIH currently recommends against using these antiviral drugs – Azithromycin, Hydroxychloroquine, chloroquine, Kaletra (lopinavir/ritonavir), and Ivermectin for COVID-19 which were earlier used for COVID-19 treatment.

Oct 19, 2020

Early Trials of Sputnik V Vaccine Found Safe & Showed 100% Immune Response

The Gamelaya Research Institute, part of Russia’s Health Ministry launched clinical trials of the vaccine, Gam-Covid-Vac (later renamed – Sputnik V) at two hospitals in Russia in June. There was a significant concern in the safety and efficacy of the vaccine when the Russian President announced that the vaccine was approved and claimed it to be the first registered COVID-19 vaccine, even before the phase-3 trials.

According to the preliminary results published in the Lancet, the vaccine has been shown to produce an antibody response in all 76 participants in the early-stage trials.

Sputnik V is a viral vector type of vaccine, where weakened forms of human adenoviruses (viruses that cause the common cold) are genetically modified to carry the gene for SARS CoV-2 spike glycoprotein to trigger an immune response in the body. It uses two different strains of human adenoviruses, a recombinant adenovirus type 26 (rAd26) vector and a recombinant adenovirus type 5 (rAd5) vector for the first and second vaccination dose, to boost the effectiveness of the vaccine.

The vaccine was designed in two formulations, frozen (Gam-COVID-Vac) and lyophilized or freeze-dried (Gam-COVID-Vac-Lyo). The lyophilized form was developed for vaccine delivery to hard-to-reach regions as it can be stored at 2-8 degrees celsius and the frozen form (can be stored at -18 degree celsius) was developed for large-scale use.

Phase 1 and 2 trials for this vaccine which took place in two hospitals in Russia involved healthy adults aged 18-60 years. In phase 1 of each trial, participants were administered intramuscularly with one component of the two-part vaccine – four groups of nine participants were given the frozen or lyophilized rAd26-S or rAd5-S component. The safety of the vaccine was assessed for 28 days.

In phase 2, which began no earlier than five days after the phase 1 trial began, 20 participants each in the frozen and lyophilized vaccine groups were administered intramuscularly with the full two-part vaccine – they received a prime vaccination with the rAd26-S component on day 0, followed by a booster vaccination with rAd5-S component on day 21.

According to the study, both vaccine formulations were safe over the 42-day study period and well-tolerated. The study also mentioned that antibody levels against the spike protein in those who received vaccination were comparable to SARS-CoV-2 antibodies in Russian patients who had been naturally infected with COVID-19 and recovered. The most common adverse events were pain at the injection site, hyperthermia, headache, asthenia (weakness or lack of energy), and muscle and joint pain. The study noted that these adverse effects are also seen with other vaccines, particularly viral-vector-based ones, and no serious adverse events were reported during the study.

However, the study also noted that further investigation is needed to establish the effectiveness of the vaccine to prevent COVID-19 infection. Phase 3 trials of the vaccine are currently underway in Russia and UAE. In India, the DCGI has finally approved Dr. Reddy’s to conduct phase 2/3 trials for the vaccine.

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Oct 12, 2020

The Bradykinin Hypothesis – One of the Most Compelling Explanations of COVID-19 Yet

The SARS CoV-2 virus that causes COVID-19, has infected more than 37 million people and caused over 1 million deaths worldwide. Currently, neither the disease mechanism is known nor are there any treatments available. However, an emerging hypothesis on the possible Mechanism of Severe Disease — which we’re calling the Bradykinin Hypothesis — is one of the most compelling explanations of COVID-19 to date and could help evolve more therapeutic interventions to offset the severe effects of COVID-19.

An analysis was done on more than 40,000 genes from 17,000 genetic samples to better understand the disease. The results of the analysis revealed a new theory on how COVID-19 impacts the body – “the bradykinin hypothesis”. This hypothesis proposes that SARS-CoV-2 interferes in the regulation of bradykinin, a peptide that promotes inflammation and is responsible for vasodilation in the human body, which can explain many symptoms of COVID-19, including its less common ones.

COVID-19 infection generally begins when the virus enters cells in the body through ACE2 receptors in the nose or respiratory tract; then the virus proceeds throughout the body, entering cells in other places where ACE2 receptors are present. ACE2 (Angiotensin-converting enzyme 2) lowers blood pressure in the body by breaking down angiotensin II, a vasoconstrictor peptide into angiotensin(1-7), a vasodilator. It counters the activity of another related enzyme ACE, which does the opposite work. So, the body has to balance the levels of ACE and ACE2 to maintain normal blood pressure. According to researchers, the virus doesn’t simply infect cells that already express lots of ACE2 receptors, instead it hijacks the body’s ACE2 regulatory mechanism and pushes the body to produce receptors where they’re less common, including the lungs.

Oct 7, 2020

How Trump’s Case Reveals The World’s Missed Opportunity with Remdesivir

We at CIO believe that when the dust settles after COVID, it will be proven that the Remdesivir is an effective treatment when taken in the early stage of infection, just like any other anti-viral drugs such as Tamiflu, Favipiravir, etc. Many months ago when Remdesivir had a setback in its severe stage clinical trials we wrote how the trial was not designed to succeed precisely because it was administered in severe late-stages of the disease (See the article).  

US President Donald Trump’s case has once again highlighted the failure of the world to recognize and work together to scale a usable treatment.  Mr. Trump has received Remdesivir even though he was at the early stage of infection showing only mild symptoms (according to White House physicians) and where the hospitalization was not required. As per the FDA, Remdesivir therapy could be given only to patients who are hospitalized. But, unlike Mr. Trump, an average citizen won’t get hospitalized unless the symptoms worsen, or the infection gets severe. And treating Mr. Trump with Remdesivir at an early stage shows that many in the scientific community believe it to be more effective early on.

This raises the question of why the government is not recommending Remdesivir as prophylaxis in the early stage of infection when it comes to the general public. One of the major factors for this could be a shortage of supply. Though Gilead Sciences, the company that found Remdesivir has signed non-exclusive licensing agreements with generic makers, the problem lies with the scarce raw materials. While the governments across the world are in their own race to find a cure or vaccine for COVID-19, they have clearly failed to come together and solve the problem of a supply shortage of Remdesivir which has shown that it inhibits virus replication. 

By working together, they could have not only solved the problem of shortage of supply but also could have figured out a way to manufacture it in the form of pills, or a more efficient delivery system. Currently, Remdesivir therapy is intravenous and requires hospitalization. This means that all the COVID patients would have to be hospitalized to be administered by Remdesivir, whereas hospital loads worldwide have struggled to treat only severe COVID patients. So problem-solving scaling and distribution is where global cooperation was needed, and lacking.

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Sep 29, 2020

India Has Finally Seen Its First Major Peak

In mid-August, there were a number of reports claiming that India may have peaked. At that time, CIO cautioned not to read too much into 3 days of declining cases, especially around the independence day weekend since potential anomalies in data reporting, would be possible then.

However, now, official data is indicating that active cases have reduced fairly consistently for the last 10 to 11 days. In addition, active cases are 5% below the peak level of cases seen on September 17th. At CIO, we believe in an exponential environment, 10 data points and a 5% decline both show signs that the exponential curve is burning out. Therefore we believe that India has seen a peak and we expect active cases to reduce fast to about the 50,000 level in the next 7 to 14 days.

Whether the trend continued beyond that will depend on how well we as a nation can comply with the basic rules of containment (mask-wearing, etc.) and whether the virus globally becomes more dangerous and spreads faster as the northern hemisphere cools down for winter.

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Sep 25, 2020

India Will Need 170 Million Lesser Doses If It Conducts Antibody Testing Before Vaccine Inoculation

At CIO, we strongly believe that at least 2 or 3 of the vaccines that are currently under late-stage trials will be approved and rolled out by the end of 2020 (see the top vaccines under phase-3 trials). The next question that arises after vaccine approval is who will be vaccinated first and how many doses of vaccine will India need initially? We did an analysis to estimate this:

Assumptions:

  • At least one vaccine will be approved and rolled out by the end of November 2020.
  • People above 50 years of age will be vaccinated first. (keeping in mind that the severity rate is higher in this age group)
  • Healthcare workers will also receive the vaccine first.
  • Those who have already had COVID-19 will not be vaccinated. (because there isn’t much reliable data on the possibility of reinfection, or how the immune system will react when a vaccine is administered to a previously infected person).
  • India has not peaked and does not peak before December as the weather turns colder and the virus gains strength.

Need 524M doses if you go by official stats

On Sep 21, India recorded a total of 5,562,711 cases. We estimated that the official confirmed COVID-19 cases by the end of November would be 32 million cases, with a nation’s doubling rate of 28 days. 

According to the age-wise distribution of cases in Karnataka and Maharashtra, 33% of COVID infections are seen in people above 50 years of age. Considering the same for India, by the end of November, with a total of 32 million confirmed COVID cases, we estimated that 10.5 million infected people (33% of 32 million) will be above 50 years.

According to the ICMR, 1073 healthcare workers were infected with COVID as of early May. We estimated that the number of healthcare workers infected with COVID by the end of November would be around 2.75 lakh (5% of total HCWs) with the same nation’s doubling rate.

India’s population of people above 50 years of age is 267,742,000. The total number of healthcare workers in India as of 2017 is estimated at 5.49 million. With 10.5 million people above 50 years and 2.75 lakh healthcare workers infected already, India would need 524 million (2 doses per individual = 2×262 million) doses of vaccine initially to vaccinate health care workers and people above 50 years of age who haven’t been infected.

Sep 21, 2020

Active Cases In India Decline For 3 Consecutive Days

With almost 5.5 million cases, India remains one of the worst-affected countries. India has reported a total of 4,395,331 recoveries, 88,316 deaths, and 1,003,334 active cases till Sep 20. The daily spike of new cases stands at around 90k for the past few days, while the active cases see a negative growth for 3 days in a row. But, this is not the first time. India has also seen a negative growth of active cases earlier in August but only for two consecutive days (on Aug 16 and Aug 17). After a month of increasing active cases, it turned negative again on September 18. The main reason for the negative growth in active cases can be attributed to the strong increase in the recoveries with the daily growth of recoveries at around 90k to 95k.

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Sep 20, 2020

Vaccines Are Just Around The Corner… But When Will They Come To The Indian Pop ?

With the surge in COVID cases worldwide, vaccines may be the only long term solution to control the pandemic. There are a number of vaccines being developed for COVID-19, however, only some of them are in the most crucial phase 3 clinical trials, where the vaccines are tested on thousands of people for safety and efficacy. 

The top vaccine candidates that are in phase-3 trials are discussed here. At CIO, we believe that at least 2 or 3 among them will be approved and rolled out by the end of 2020, With 1 possibly ready for deployment as early as October.  Technically, a couple have already been deployed, but each country has to decide to “accept” which vaccine is a real vaccine, is ready for scale up and which one they wish to back.  

Moderna

Moderna in collaboration with the National Institutes of Health began developing the COVID-19 vaccine in January, entered into human trials in March, and progressed into phase-3 trials on July 27. The company enrolled 30,000 people as part of the phase-3 trial which is expected to complete by the end of this month and if the trial shows promising results, it may launch the vaccine by the year-end. The company also said that it is on track to deliver at least 500 million doses per year beginning in 2021.  Typically, vaccines testing requires two doses, with twenty eight days in between.  That means, the first set of results would be available around mid-September. In this case, we believe no news is good news.  We expect Moderna’s vaccine to be a home-run.

AstraZeneca

AstraZeneca’s vaccine developed by the Oxford University entered phase-1 clinical trials in the third week of April and showed promising results. The vaccine entered phase-3 clinical trials at the end of August and the trials were paused on September 6, after a volunteer in the U.K. developed an unexplained illness. However, after an independent committee safety review, the trials resumed on September 12. The company has said that, if the phase-3 trials yield positive results, they might be able to start delivering the vaccine for emergency use as early as October. It also indicated that the manufacturing capacity of the vaccine, if approved, stands at 2 billion doses.

Sputnik V

The Gamelaya Research Institute, part of Russia’s Health Ministry launched clinical trials of the vaccine, Gam-Covid-Vac (later renamed – Sputnik V) in June. On Aug 11, the Russian President announced that the Russian health care regulator had approved the vaccine and claimed it the first registered COVID-19 vaccine even before the phase-3 trials. The phase-3 trials of the vaccine began on Aug 12. Very recently, Russia has signed a strategic deal with Indian drug company Dr. Reddy’s and agreed to supply 100 million doses of its vaccine.  Technically, this vaccine is already deployed; so by October if the vaccine gains enough acceptance, it will already have scaled partially.

CoronaVac

CoronaVac vaccine developed by Sinovac Biotech showed promising results in its early trials and entered phase 3 trials in July. The Chinese government approved the vaccine for limited emergency use in July.  Once accepted, China has deals to deploy in Brazil and the middle east, aside from domestically.  The UAE has already approved this for emergency use.

CanSino Bio

CanSino Biologics in collaboration with the Chinese Academy of Military Medical Sciences is developing a COVID vaccine and they published promising phase-I trial results in May followed by phase-II trial results in July. The Chinese government approved this vaccine for military use. The vaccine entered phase 3 trials in August.

Source: NDTV, NYTimes

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Sep 16, 2020

India Surpassed 5 Million COVID-19 Cases

On Sept 15, India reported 91,209 new cases taking the country’s total to 5020625 cases. With a daily spike of over 90k cases, India records the highest number of daily new cases in the world. COVID cases in India are growing at a rapid pace, and almost all the hotspot regions of the country are still seeing a rising curve with no drop in the number of daily cases reported.

At current growth rates, India is growing about 55,000 cases per day more than the US, and would take only a month to overtake the United States to become the worst-hit nation by this pandemic.

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Sep 15, 2020

India Has The Lowest Cases Per Million Versus Countries With Over 1M Cases

With ⅙ of the almost 30 million cases worldwide, India remains one of the worst-affected countries. India has recorded over 4.9 million cases with a daily spike of around 90k new cases after Unlock 4.0. CIO did an analysis of total cases per million population for all the countries with over 1M cases. This analysis showed that India has 3565 cases per million population which is the lowest among the other three countries (United States, Brazil, and Russia) having more than a million cases. Potential reasons for this could include lower testing; For example, the United States has tested approximately seven times the number of people that India has per million of population. Another reason could be a milder virus or a milder expression of the virus due to India’s younger population; India’s case fatality rates are also lower suggesting more mild cases that are less likely to be reported. A third reason could be because of lockdown; cases in India have still not peaked, and testing capacity has come online slowly as cases have grown, some massive testing capacity was not created in the beginning to identify possible cases. Lastly, the ICMR has insisted on claiming that community transmission did not exist in the first few months of the epidemic, thereby, creating an environment where testing of mild cases that were not directly linked to confirmed cases or known sources of exposure were not sought out or tested.

Data source: Worldometers

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Sep 14, 2020

AstraZeneca Resumes Its COVID-19 Vaccine Trials

The Medicines Health Regulatory Authority (MHRA) in the UK has said that the clinical trials of the AstraZeneca COVID-19 vaccine are safe to resume. AstraZeneca, one of the frontrunners of the COVID-19 vaccine race, developed by Oxford University paused its clinical trial last week after one of the volunteers in the UK developed an unexplained illness. The company noted that the pause was to enable a review of safety data by an independent committee. After the review, the committee recommended to the MHRA that the trails are safe to restart.

AstraZeneca vaccine is under phase-3 trials in many countries including India. The Serum Institute of India which is manufacturing this vaccine also paused its trials as per the instructions of DCGI. According to the Times of India report, the Serum Institute is awaiting further direction from DCGI to restart the trials in India.

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Sep 10, 2020

AstraZeneca Vaccine Trial Paused After A Trial Volunteer Developed An Illness

AstraZeneca, one of the frontrunners of the COVID-19 vaccine race, developed by Oxford University paused its clinical trial after one of the volunteers in the UK developed an unexplained illness. Hopes for this vaccine has been high as it generated strong immune responses previously, and was in the final stage of the vaccine approval. According to a New York Times report, the volunteer had been diagnosed with an inflammatory syndrome – transverse myelitis, which affects the spinal cord and can be caused by viral infections. The company paused the trials of this vaccine voluntarily, and an independent committee will review the safety data of the virus. Meanwhile, the Serum Institute of India which is manufacturing this vaccine also paused its trials as per the instructions of DCGI.

However, there are other promising vaccine candidates that are currently under phase-3 trials. Let’s be optimistic that one among them will be approved and rolled out soon.

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Aug 31, 2020

India Becomes The First Country to Record Over 78k New COVID Cases

With a total of over 36 million cases, India recorded its highest single-day spike with 78,701 cases on Aug 29. The spike is also the highest daily cases of any country in the world since the pandemic outbreak.  The dubious title was previously held by the US which recorded  77,638 cases on July 17.  In fact, on Aug 29, cases in India were more than the cases in any other continent, and were over 30% of the 2,57,000 new cases recorded globally. 

In the face of India reporting over 75k  daily new cases for the last 5 consecutive days, the central gov’t has released Unlock 4.0. With the opening up of more activities from September 1, India is set to remain at the top of world rankings.  Already, international newspapers are highlighting India’s spiraling numbers (The New York Times, The Guardian, etc). Now with unlock 4.0, 1,00,000 cases per day seems a real possibility.

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Aug 29, 2020

Documented Reinfections – Another Reason To Call For A Worldwide Genome Study

With confirmed, documented cases of reinfection, new questions arise about immunity after infection, the potential effectiveness of a vaccine and the risk posed upon reinfection.

Reinfection is not a new concept. Milder Coronaviruses that affect the upper respiratory tract (HCoV-229E and HCoV-OC43) are known to cause reinfection. This is because antibody levels drop fast after presumably mild infections. In viruses that have multiple strains, like dengue, immunity to one strain does not confer immunity to all strains. The Nevada case of reinfection was shown to be from two different strains.

However, reinfection can be potentially serious. In Dengue, reinfection leads to a greater chance of severe disease where a low level of antibodies from the first infection has been shown to potentially enhance the disease pathology. The world must move to immediately understand the nature of reinfection.

This is another reason why countries should commission wide-spread genome studies. Every swab that reports a positive Coronavirus case has 2 sets of genomes, the one of the virus, and of the patient. Add to that patient histories of mild moderate and severe illness and opportunities open up to get answers to the three fundamental questions: 1) why does SARS-CoV-2 present so differently in people 2) who is at risk of severe disease, or of reinfection 3) why are different geographies seemingly experiencing different epidemics.

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Aug 25, 2020

After a Temporary Reprieve, Cases Jump

Have we given up? For a few days after independence day, there was a steady, accelerating decline in active cases. At the time CIO cautioned against assuming that India had peaked (see: While the Pandemic in India Shows Promising Signs of Having Peaked, the Media Infodemic Rages On) especially with new cases hovering at a world-leading 60k cases. Since then new cases have continued to grow steadily, and as a result, active cases have once again spiked. However, newspapers are not reporting states stepping up containment.  Rather, the opposite – see: Karnataka scrapping restrictions. While India may very well be in a peaking process, a sustained rate of decline on the other side will require the same diligence that prevented an uncontrolled peak from occurring in April; both by the government and the public.

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Aug 23, 2020

Bharat Biotech Gets Approval for COVAXIN IntraDermal Trial

India’s first COVID-19 vaccine COVAXIN developed by Bharat Biotech in collaboration with ICMR’s National Institute of Virology is currently under phase 2 trials for the intramuscular vaccine delivery(vaccine injected into the muscles). The company also got approval from the DCGI for administering COVAXIN experimental vaccine via skin (intradermal vaccine delivery). The intradermal vaccine delivery will be studied separately alongside the ongoing trials. Bharat Biotech has now become the first Indian company to experiment a vaccine in both intramuscular and intradermal routes.

Intradermal vaccine delivery

Intradermal vaccine delivery is administering the vaccine by injecting it into one of the layers of the skin called dermis. This route is widely used for the administration of BCG and rabies vaccines while other vaccines are delivered by intramuscular or subcutaneous routes. According to WHO, the intradermal vaccine delivery should be more efficient, driven by the fact that the dermis and epidermis of human skin are rich in antigen-presenting cells, suggesting that delivery of vaccines to these layers, rather than to muscle or subcutaneous tissue induce protective immune responses with smaller amounts of vaccine antigen.

However, the clinical trials are required to determine if the intradermal delivery generates an immune response comparable to the intramuscular delivery.

Source: Newsbytes

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Aug 20, 2020

An Analysis Suggests That At Least 1 in 4 People Either Have/Had COVID

An analysis of 2,70,000 antibody tests conducted across 600 cities by a leading private laboratory, Thyrocare showed that an average of 26% of the people had developed antibodies to COVID infection, indicating their exposure to coronavirus. The head of the laboratory added that if the current trend continues, the percentage of India’s population developing antibodies to coronavirus might reach 40% before the end of December.

Meanwhile, the serological survey conducted in Delhi between Aug 1 and Aug 7 also showed that 29% of the sampled people have developed antibodies against COVID-19 infection. This was the second survey conducted in Delhi while the first one conducted in the last month showed that 23.48% of the sampled people were exposed to the virus.

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Aug 18, 2020

While the Pandemic in India Shows Promising Signs of Having Peaked, the Media Infodemic Rages On

Green shoots: A second day of active cases declining. Could India have peaked? 2 days is a good sign but it would be irresponsible to make the call that India has peaked, especially when new cases are still around the 60K level. But we at CIO are cautiously optimistic. Looking around the media over the last 24 hours, you might have thought the sky was falling. Numerous reports of Malaysian scientists finding a “10 times more infectious” virus with some claiming the worst is yet to come and that the virus is “10 times more deadly.” While the pandemic may be showing signs of recession, the infodemic rages on. 

Let’s understand this new D614G mutation that supposedly is a new super deadly threat, the harbinger of what would be equivalent to the second deadly wave that the 1918 influenza faced in October of that year where mortality rates were 10 times higher. Are media claims justified? 

First of all, the media claims it to be a new mutation. The D614G mutation is referred to here. This is a preprint of a paper from Apr 30. An article in Times now reveals that this mutation was established in the public media no later than May 8. 

Another claim is that the virus is 10 times more infectious. This is possibly true, the strain has quickly become dominant. One explanation for this is Darwinian, greater transmissibility, better survivability. Another, especially in a world full of lockdowns, is … coincidence. For a more balanced perspective, read this.  

The most controversial claim is that the virus is 10 times deadlier. Even if the virus is 10 times more infectious, to imply a correlation to 10 times deadlier is just unscientific, and therefore, scaremongering. One of the best outcomes the world could hope for is a mutation to a far more transmissible and benign upper respiratory tract infection like a common cold coronavirus rather than a SARS coronavirus. Infectiousness does not have to equal deadliness. If this were the case, then when on May 8, Times Now reported that the D614G was already spotted in 50% of cases in a study. we would have expected spiking mortality in India, which we have not seen.  

We live in a pandemic; question everything.

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Aug 17, 2020

Active Cases In India Decline For The First Time

On Aug 16, India reported 57,847 new COVID cases, 57,612 recoveries, and 962 deaths, with a decline in the active cases by 727. With the growing COVID-19 cases in the country, this is the first time India has seen a negative growth in the active cases. The negative growth of active cases is mainly due to the increase in the recoveries. This seems to be like a good news as the fall in the growth of active cases mean that India is in the right direction to eliminate the outbreak. However, this is true only if the declining trend continues.

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Aug 15, 2020

India’s Covaxin Convincingly Passes Phase 1

India’s first COVID-19 vaccine called the Covaxin has shown convincing results in its phase 1 trials which are to be concluded by the end of August 2020. The Phase 1 trials are currently underway on 375 volunteers and 12 medical institutes across the Nation. The vaccine(Covaxin) jointly developed by Hyderabad based Bharat Biotech in collaboration Indian Council of Medical Research (ICMR) and the National Institute of Virology (NIV) is said to have no adverse side effects and is safe to use.

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Aug 11, 2020

Welcome The First Registered COVID-19 Vaccine “Sputnik V”

In the battle of bringing a COVID-19 vaccine, Russian President Putin launched a coronavirus vaccine and claimed it to be the first one to get registered. The “Sputnik V” vaccine will enter its phase 3 testing on 12th August, 2020, and already 20 countries had pre-ordered over more than a billion doses of the vaccine. The vaccine was registered in Russia and has passed all needed checks as said by Putin during a televised video conference.

Currently, WHO and Russian health authorities are discussing the process for possible WHO prequalification for its newly approved COVID-19 vaccine, as mentioned by a WHO spokesperson.

Source: Livemint

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Aug 10, 2020

A Mouth Spray Can Destroy SARS CoV-2?

At a time when pharma firms are fighting tooth and nail to find a cure to COVID-19, a Swedish life science company, Enzymatica, has announced that its mouth spray ColdZyme can deactivate SARS-CoV-2 virus that caused the COVID-19 pandemic. The preliminary results of an in vitro study show that ColdZyme acts as a protective barrier against COVID-19 and can make SARS-Cov-2 inactive by 98.3 percent in 20 minutes.

The study reveals that ColdZyme is also applicable to the virus that causes the common cold. It is to note that the barrier solution of the device is mainly composed of glycerol and Atlantic cod trypsin. The main objective behind the execution of the present study was to determine the ability of ColdZyme to deactivate SARS-CoV-2 known to cause the COVID-19 pandemic.

Similar studies have been carried out that showed ColdZyme’s effectiveness against another coronavirus that is HCoV-229E. But more than 200 countries are still battling the pandemic with various kinds of treatments and vaccine development.

To provide some relief to the countries, the Swedish firm, also said that SARS-CoV-2 actively replicates in the throat and shows high viral shedding also at a time of mild symptoms. Therefore, ColdZyme sprayed onto the mouth and throat could lower the risk of infection, and decrease the viral load locally. The low value of viral load may reduce viral shedding and thus minimize the spread of SARS-CoV-2. Furthermore, the results of this barrier solution give us hope for the future for ridding various countries of this virus that is the prime cause of the deadly pandemic.

Source: CNBCTV18

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Aug 9, 2020

Vaccine Around The Corner​

Moderna

CIO Rating: Very strong CIO opinion on first level of availability: September

Moderna’s vaccine, developed with researchers at the National Institute of Allergy and Infectious Diseases, is the first US coronavirus vaccine to be tested in humans. Moderna uses genetic material –messenger RNA — to make vaccines and the company has 9 others in various stages of development. The science behind the Moderna vaccine is to inject the mRNA four part of the spike protein and have it slip into the cells of a healthy person, which then proceeds to replicate the viral protein, triggering an immune response. The company is in phase 3 trials since July 27 2020, involving 30,000 people. In Phase one the vaccine developed an immune response in 100% of trial participants. 45 people, in three of 15 volunteers aged 18-55 who got two shots, 28 days apart.

Astra Zeneca/Oxford Vaccine

CIO Rating: Strong CIO opinion on first level of availability: August

The vaccine developed by Oxford University is a viral vector type that uses a harmless virus to deliver the genetic material of a pathogen into cells, which then hopefully causes an immune response to the original pathogen. The company will commence phase 3 clinical trials in Maharashtra. 4000 to 5000 people will be injected with the vaccine in the trial sites. The Serum Institute of India intends to create over 2 to 3 million doses of the vaccine by the end of August 2020 and over 300 million doses by the end of the year.

Aug 7, 2020

Andhra Pradesh Is Out Of Control

We analyzed the worst affected districts, those with more than 5000 confirmed cases and having a doubling rate of 15 days or less. The analysis reveals that Andhra Pradesh is out of control with the rapid growth of cases in a state with already 2 lakh cases. Out of 22 national districts, which fit our criteria, all 13 districts of Andhra Pradesh are included. With a doubling rate between 7 and 15 days, AP is far exceeding the national rate of over 23 days. At this rate, AP can expect another 200,000 cases by Aug 19.

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Aug 5, 2020

A Safe Shot In The First Run By ZyCov-D, The Plasmid DNA Vaccine

ZyCov-D, a plasmid DNA vaccine to prevent COVID-19 was found to be safe in the phase 1 clinical trial as said by Zydus Cadila on 5th August 2020. The trial had begun on 15th July 2020 and the vaccine was found to be safe, immunogenic and well-tolerated in the preclinical toxicity studies.

The phase II trial is scheduled from the 6th of August 2020 by the company. This trial is said to evaluate the humoral and cellular immune response for the vaccine candidate. The durability of the humoral response up to six months post last dose will also be evaluated. Over 100 vaccine candidates are in development globally.

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Aug 3, 2020

India Brings Its Canon Called The Shycocan To The Battlefield Of COVID-19

A Bengaluru based organization has invented a device named Shycocan (Scalene Hypercharge Corona Canon) that neutralizes the spike protein present in Novel Coronavirus, thus cutting off its transmission from one person to another completely. The small drum-like device is proven 99.9% effective and can be installed in any closed area for disinfecting surfaces. Lab tests have shown that one device can cover up to 10000 cubic meters of area.

The device floods any indoor space with hundreds of electrons which neutralizes the potency of the virus caused by sneezing and coughing. Even if an infected person comes into such space, the device drastically reduces virus transmission via surface or airborne transmission. However, the device does not cure an infected person but efficiently contains the spread of the virus. It can be fixed in offices, schools, malls, hotels, airports, especially in any indoor space. The device has received approval from the US food and drug administration and the European Union. The Corona Canon will be launched at 12 am on 15th August 2020. 

Such a device shall prove itself as an asset for the mass, especially for the working class and students. The Corona Canon can become a safety charm that the workspaces can be equipped with, since it would keep them safe from the deadly virus thus, making them completely operational and fit for use. This can help bring some relaxation for the common public and may prove as a relief in these lockdown days.

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July 31, 2020

Russia Plans Another Sputnik Moment In The COVID-19 Vaccine Race

Russia is planning to register the first covid-19 vaccine by August 12, 2020. While Astrazeneca PLC, Moderna Inc. and Pfizer Inc, have begun last stage testing for covid-19 vaccines and some of the human trials expected as early as October, the developers of the Gamaleya vaccine claim it to be safe and potentially the first one to reach the public. The drug is developed by Moscow’s Gamaleya Institute and the Russian direct investment fund and may be approved for civilian use within 3 to 7 days of registration by regulators. The phase 3 trial of Gamaleya vaccine is scheduled to begin by next week in Russia, Saudi Arabia and United Arab Emirates.

Source: Bloomberg

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July 30, 2020

Test Positivity Rate

As we know countries that have fared well in the pandemic are the ones with low test positivity rates. As testing infrastructure is being ramped up rapidly worldwide let’s take a look at the top ten most affected countries to find out what their cumulative test positivity rate is. The cumulative test positivity rate is the percentage of total tests that have turned out to be positive so far. As we can see from the graph Mexico has the highest cumulative test positivity rate at over forty percent. That means two out of five people tested turned out positive. This is alarming in a country which has so far conducted the lowest number of tests out of all the top ten most affected countries. We can see that India and USA share almost a similar cumulative test positivity rate at about eight percent which is lower than almost all of the top ten countries in the world but we still have a long way to go before catching up to Russia or Spain at three and almost five percent respectively. With an overnight test positivity rate of 11.75, we can see that India is moving away from the cumulative test positivity rate of 8.74 since the pandemic started. As India embarks on unlock 3.0, the cumulative test positivity rate looks concerning compared to the top ten most affected countries but the overnight test positivity rate seems to be larger indicating that we may be worse off than before as case numbers in India continue to soar upwards.

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July 28, 2020

Are The Gains Of The Lockdown Reversing?

India’s coronavirus epidemic is now growing at the fastest in the world . From the graph it’s evident that before and during the lockdown the doubling rate had been increasing at a considerable rate but has begun to consolidate now and it looks to be correcting itself back to lower values of doubling rate. Starting out slightly above 10, the 14 days moving average has trended towards 20 but now looks stalled. This comes in the backdrop of number of new cases falling in countries like Russia , brazil and south africa as India continues to surge in number of new cases per day primarily led by states like Maharashtra, Tamil Nadu, Andhra Pradesh and Karnataka. India still has one of the world’s lowest testing rates among developing economies at 11.8 tests per 1000 people even as large parts of the country are showing doubling rates greater than the national average.

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July 26, 2020

Top States Have Very Different Approaches, And Very Different Outcomes

MAHARASHTRA – even as more police personnel from Maharashtra test positive for coronavirus disease , state Home Minister Anil Deshmukh said experts were being consulted to formulate a response to the rising number of positive cases and deaths in the force.State Home Minister Anil Deshmukh told, “On almost every front in the battle against Covid-19, the police force is playing a key role, be it guarding boundaries of districts or containment zones, or deployment at high-risk isolation wards, quarantine facilities and hospitals.Now, there is additional responsibility of managing large number of migrant workers returning to the state. This is in addition to all the routine police work.”Asked about the rising number of cases in the police force and if further measures were being taken in addition to existing ones, Deshmukh said, “We are consulting experts on the subject and their inputs will soon be brought into action. The strategy to tackle the infection among cops is being revised. We are considering different ways to bring changes in the daily functioning of the police force to ensure the risk is minimised.”

TAMIL NADU – The number of new infections has seen a dip in Chennai in the last few days. As it continued to stay at the 1,200-mark for the second consecutive day, a public health expert said there was a need to wait and watch the trend for the next 10 days. “The unlock may cause a surge in the number of people failing to wear masks and comply with physical distancing norms. We need to watch for the next 10 days,” the expert said.

J. Radhakrishnan, Health Secretary, said that the work must continue with the same intensity. “We appeal to the people to strictly follow standard operating procedures (SOP) for each activity, and the common factors for all SOPs are 100% herd masking, physical distancing, handwashing and stepping out of houses only if necessary. The vulnerable need to be protected,” he said.

July 24, 2020

Underneath Record Cases Some Of The Worst Hit States Showing Stabilization

As coronavirus cases in India are showing record spikes with each passing day and cases in most states are also demonstrating a rising trend, administrations are faced with the dilemma of either opening up activities further with the advent of varying degrees of lockdown in an attempt to arrest the tide of cases. We drilled down to show the spectrum of how the hardest hit states are coping.

West Bengal – Chief minister Mamata Banerjee had extended the lockdown in the state till July 31 in an announcement. In another decision, she decided to impose a total lockdown twice a week to further slow down community transmission of the virus in a state where the total new cases per day has shot up from 500s to over 2000 over the course of the last few weeks.

Tamil Nadu – Tamil Nadu has continually reported the single day spikes of over 6000 new Covid 19 cases taking the state’s total to 192,964 cases including 88 deaths reported over the last 24 hours. With no signs of abatement we are left wondering if the virus is finally peaking in Tamil Nadu with the number of active cases plateauing for the last several days.

July 23, 2020

Sleuth Signs of WFH Stickiness

Is WFH a temporary or permanent phenomenon ? Yesterday’s poll revealed a desire for half of respondents to shift . This could be a natural correlation to WFH , or rather work from anywhere. But to corroborate the stickiness of the WFH concept we looked back at recent polls. Last week, a poll on internet connections revealed that 45% of respondents have upgraded their internet connect with a quarter having upgraded both mobile and internet connections. In China, where gdp data is sometimes questioned, hedge funds and investors look for correlation in electricity usage . Similarly , internet upgrades provide insight into the potential stickiness of work from home.

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July 22, 2020

After COVID – The Great Indian Shift

Reverse Urbanization? WFH ? of just fed up with the Rat Race? Whatever the reasons, Indians are ready to make a change. A July 20 poll on CIO revealed that almost half of Indians are thinking of shifting because of COVID. The most popular destination, as many tech houses know already, is back to hometowns, perhaps to save cost, or stay closer to friends and family. Work from home, and COVID have made this option plausible and survey respondents confirmed their intent to take advantage of a new option. Other reasons to move, better healthcare and better lifestyle. 20% of movers even indicated they would like to quit India. Businesses should get ready for shifting attitudes and shifting locations for their employees.

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July 20, 2020

In opening up of temporary ‘air bubbles’, the civil aviation ministry’s decision may seem relatively unimportant. It is anything but

Announcing the opening of some international air travel in India at the same time as India crosses 1 million cases and keeps breaking daily records for new cases is controversial to say the least. In the past, CIO polls have showed on multiple occasions that Government policy during the pandemic does not reflect public opinion. Once again, our latest poll reveals this to be the case. 78% of respondents (n>2700) think it is too early to open up international travel. Opening up international travel is fraught with risk, in obvious and non-obvious ways. Obviously, international travel affects the chances of virus spread. Non-obviously, importing virus means potentially importing different strains, that could be more virulent, or that the Indian health system has not experienced.

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July 15, 2020

The Final Run of Moderna’s COVID-19 Vaccine

Moderna’s vaccine comes to the final showdown with COVID-19 and enters its phase 3. Moderna’s vaccine, developed with researchers at the National Institute of Allergy and Infectious Diseases, is the first US coronavirus vaccine to be tested in humans. The company announced that the Phase 3 trials of it would begin on July 27, involving 30,000 people.

The unique idea behind the Moderna’s vaccine is to inject the mRNA, genetic material from the virus to induce the immune system to fight the virus. mRNA-1273 uses ribonucleic acid (RNA) — a chemical messenger that contains instructions for making spike proteins. When injected into healthy people, the vaccine instructs the cells to make copies of the spike proteins that imitate the outer surface of the coronavirus as if they had been infected with the coronavirus. Other immune cells are then able to learn about the spike proteins and develop ways to protect the person if they ever come in contact with the actual coronavirus. 

Let’s hope for the best to come from this phase 3 trials and may this turn out to be the final run.

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July 13, 2020

COVID-19 Vaccine – A New Ray Of Hope

Russia has become the first nation to have completed clinical trials of the COVID-19 vaccine on humans after Sechenov University declared that the results have proven the medication’s effectiveness.

The Russian Health Ministry had sanctioned the trial on June 16. The first group of 18 volunteers received the vaccine on June 18 while the second group of 20 volunteers received the vaccine on June 23. Head and Chief Researcher Elena has stated that the research has been completed and it proved that the vaccine is safe. The first group of volunteers would be discharged on July 15 and the second group on July 20.  

The trial participants will be monitored on an outpatient basis after being discharged because, during the human trials, participants are deliberately exposed to the infection (in this case it is SARS-CoV-2 virus) to study the disease and test the vaccines.

According to the WHO, there are at least 21 vaccine candidates under key trials. Among which Gilead Sciences, Oxford University’s researchers (AstraZeneca), and American biotech company Moderna are at the cutting edge of developing the COVID-19 vaccine. Also, BioNTech SE and Pfizer Inc’s Covid-19 vaccine candidate is expected to be ready by the end of 2020.With these developments, we may hope that we would be able to get a vaccine soon in the near future.

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July 12, 2020

A New Breathalyzer Test May Be The Key To ‘Living’ With The Virus

While the countries are facing a severe shortage of medical supplies and an abundance of coronavirus infected patients at the same time, a team led by an Israeli professor has managed to design a COVID-19 breathalyzer. This device promises to detect the coronavirus within a minute. If it gets installed at a large number of global entry points and in public places such as airports, railway stations, and malls, the invention will prove to be a significant breakthrough in the fight against the dreadful contagion. It will help identify a virus carrier instantly with each device processing breath from about 4,000 people every day.

In addition to its benefits for providing an immediate result and avoiding any laboratory processing, the test also have various other advantages like eliminating the need for skilled individuals to obtain the samples. Most importantly, the breath technology will help identify patients even before symptoms are present, thus helping to halt the spread of the virus.

If the validation process is concluded and the FDA approves, we can hope to see the one-minute breath tests in public as soon as September.

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June 15, 2020

Gov’ts of Hardest Hit TN & Maha Still Perceived As Most In Control

A recent CIO poll revealed India believes that States, not the central gov’t or ICMR, are giving the clearest guidelines. This didn’t surprise us, as we have pointed out in the past how Central Gov’t guidelines are so ambiguous, that they are a virtual hand-off to the States. What is unexpected is that some of the hardest-hit states enjoyed a relatively more positive perception amongst their denizens. We mapped the states of the user who selected “My state gives the clearest guidelines” and subtracting the percentage of users on our site from that state. Positive readings show states that have a relatively positive perception amongst our users. The top three states included Maharashtra and Tamil Nadu even though they have been two of the hardest hit. On the other end of the spectrum, Bihar and UP have the worst relative perception.

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May 07, 2020

A New SARS-CoV-2? 

A study has found that a new highly potent, ‘more contagious’ strain of Covid-19, named A2a, has become dominant world over.

Why is this worrisome? Not only does this version spread faster, but unlike many other viruses, this one could make you more susceptible to a second infection as the mutation allows the coronavirus to enter human respiratory cells more effectively.

Most scientists developing vaccines against Covid-19 are working on the assumption that the virus is stable and less likely to mutate as rapidly as the seasonal influenza virus. This discovery could change that. Vaccines developed must be effective against this particular strain as it is the most prevalent and can take us closer to reaching herd immunity. However, if mutations in the virus continue, effectiveness of such vaccines would be limited.

We don’t know if this new strain is more dangerous than the original, but it has a much higher rate of transmission, making social distancing all the more important.

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May 06, 2020

This Is Why The World Is Wondering About Heat And Immunity

A COVIDIndia.org analysis reveals that there is a zone of lower COVID density in hotter Africa, Southern Asia, Oceania region. Multiple reasons for why this might be have been proposed.  

One hypothesis is that countries with existing BCG vaccination programs have higher conferred immunity. Another points to lower transmission due to heat. A third is that widescale testing does not exist in some areas. Countries with widespread malaria have also been offered as a hypothesis. There is even a theory that widespread use of the flu vaccine may reduce the immunity of people in some of the developed countries. None of the theories have been proven, but many believe there’s something different going on in this region.

 

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May 06, 2020

Will We Ever Get A COVID-19 Vaccine?

Vaccines, a long term innoculation against infection, normally take more than years, if not decades, to develop. Some viral diseases, such as dengue and HIV, still don’t have one. Currently, there are over 100 vaccine candidates in preclinical trials for Covid-19 and around 5 have progressed to the clinical evaluation stage. The first human trials began in Seattle, USA and Oxford, UK last month. Scientists have fast-tracked the process by not conducting animal trials (preclinical evaluation) to test its safety. Even with human trials, optimistically, we could have a successful vaccine only by mid-2021. Assuming that there will be a limited supply initially, only risk groups will be vaccinated first, including healthcare workers, children and older adults. So, it’s better that we get accustomed sooner rather than later to this new normal because no magic drug is going to revamp the situation anytime soon.

 

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May 04, 2020

Global Curve Signalling End Of Phase One?

Global COVID-19 cases have risen to about 3.5 million on day 156 since the day of the first case. However, the good news is that the rate of increase is not increasing and the doubling time has doubled as well. This is taking us closer to the flattening of the global curve, which is a situation in which each day sees a reduced number of new cases.

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May 03, 2020

Neutrophils – Fighters Of Infections, Aggravators Of COVID-19?

Neutrophils are white blood cells that protect us from infections. Amongst their functions, they sometimes form Neutrophil Extracellular Traps (NETs) to destroy microbes outside the cell. When NETs are not well-regulated they can cause an abnormal inflammatory response and blood clotting. Researchers have found that severe COVID-19 patients have increased NET blood levels. It is believed that blood clots and respiratory failure in COVID-19 patients could, in fact, be promoted by excess NET formation.

It is well understood that the cause of death by COVID-19 is often a result of the massive, immune response in some patients. Now, NETs are believed to be part of this response both directly, and indirectly by promoting the infamous ‘cytokine storms’, a massive inflammatory reaction in the body.

If true, treatment that inhibits development of NETs could dampen the body’s response and prevent it from losing control. The good news is that many drug candidates for this already exist and are in various stages of clinical trials for use in COVID patients.

Source: NCBI

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May 2, 2020

Bemcentinib, Cancer Drug – A Cure For COVID 19?

Bemcentinib, traditionally a cancer drug given along with chemotherapy, has been fast-tracked into human coronavirus trials in the UK. The medication, which comes as a once-a-day pill, has previously prevented immune invasion, drug resistance, and growth of cancers. The hope is to see it boost an immune response in COVID 19 patients and keep the virus from entering and multiplying in the lung cells by turning off the AXL receptors.

If the testing is successful, we can hope to see suitable treatment for COVID 19 soon.

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April 30, 2020

COULD The Cure To COVID Be COVID itself? – A Radical Idea And A Call For Data

At this point there are over 3600 genomes of the SARS-COV-2 virus. This in itself is not more newsworthy than saying people have different eye colors. At some point though, it calls for a thorough understanding: Is there one strain or more? What’s driving the pandemic? And more importantly, are there strains that are not driving the pandemic, and why not?

According to Indian scientists, there are up to 11 strains and only one driving the pandemic in India, which is the original strain from Wuhan. However, why are the other strains not driving the pandemic. This could be a lower transmitability, a lower infectivity, or much higher levels of asymptomatic infection. The last two, bring forth a radical notion. Is it possible to vaccinate an individual using a milder strain of the active infection – analogous to what we used to do with kids and chicken pox, knowing that childhood infection is much milder than adult infection.

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April 29, 2020

PCR Vs Antibody – What Is What And What Is Better?

Two different types of COVID tests are being referred to in media, the PCR and the antibody. But what are they and how are they different, and why do we even need two?

One is the PCR test (polymerase chain reaction test), in which an oral or nasal swab is taken. This tells us whether a patient is currently infected by looking for genetic material of the virus.

The antibody test, however, looks for the the antibodies that the human body forms in response to the infection. If the antibodies are there, that means we are currently or have previously been infected. If not , it means we have never been infected, or it is too early in the disease and our immune system reactions have not kicked in.

So really, PCR test for infection, while antibodies test for immunity, or more accurately, immune response.

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April 28, 2020

What is R0 And Why Should We Care About It?

Basic Reproductive Number or R0 (pronounced R-Naught) is essentially the average number of people who will contract a disease from someone who already has the disease. Covid 19’s R0 is estimated to be between 2-4, implying that every sick person will spread the disease to another 2 to 4 people. This cycle of reproduction will continue until there is some sort of intervention. If R0 is less than 1, the infection will eventually peter out. But if R0 is greater than 1, it will keep spreading exponentially and cause an epidemic. Thus, only when the R0 will go below 1 can we hope to see the eradication of the virus.
Read more about this here!

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April 27, 2020

Modeling Projections Based On Initial 21-day Lockdown: Is This How It Will Unravel In India?

On 25th March 2020, India announced a nationwide 21-day lockdown till 14th April 2020. A study, conducted by researchers at the Center For Disease Dynamics, Economics & Policy (CDDEP), Johns Hopkins University, and Princeton University, has modeled the impact of the 21-day lockdown on the spread of COVID-19 in India before, during, and after the lockdown is lifted. See the full study.

Source: CDDEP

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April 26, 2020

Remdesivir Flops, But Was It Ever Designed To Succeed?

The best hope for a near term vaccine apparently showed in clinical trials that “it did not improve patients’ condition or reduce the pathogen’s presence in the bloodstream” causing an 8+ billion dollar drop in the market cap of its maker Gilead Sciences. But was it ever designed to succeed. Remdesivir is an antiviral designed to stop the virus from replicating (see our 3D animation). But the first set of trials were all late stage trials in very severe cases. In severe cases it is the massive immune response that kills the patient not the virus itself. Therefore, reducing the viral load at that point is most likely the proverbial ‘too little too late’. Stopping the pathogenesis, or progression, of the disease with antivirals usually requires intervention in the early stages when the viral load is building. Indeed, Oseltamivir, or tamiflu, used as a prophylactic against swine flu is required to be taken within 48 hours of symptoms.

Thus by requiring that trials be conducted on severe patients first, remdesivir was potentially due to the fail from the beginning. However, the possibility that remdesivir still can be used as a prevention or early stage treatment can not be ruled out.

Source: BBC

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April 25, 2020

Modi’s Lockdown Strategy Dates Back Nearly 700 Years

Recently , a loyal visitor asked CIO for a map of quarantine centers. Our first thought was every house in the country is a QC. We didn’t know how right we were until we came across the origin of the word quarantine. During the mega pandemic of the bubonic plague in the middle ages, one city in the then Venetian empire (now Dubrovnik) instituted an embargo on arriving ships for thirty, and subsequently 40 days (in Latin quarantino). Similar to what happened with the Diamond Princess in Japan. Modi’s lockdown from March 25 to May 3rd is similarly a 40 day period. In effect, the whole country is a quarantine center. A strategy that was invented in the 1300s and still used today.

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April 23, 2020

Projections Show That Pandemic Could Peak In India By Mid-May

A study has predicted that the pandemic could peak in India by the middle of May, after which there will be a gradual decline. The report estimates that India could see the number of coronavirus cases crossing 75,000 around May 22 and gives an indication of when it might be safe to lift the lockdown. See the full study.

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April 22, 2020

Can The Curve Be Flattening Even Though Cases Are Spiking?

India has reported over 20,000 confirmed cases. Today, Maharashtra, Rajasthan, and West Bengal reported their largest single-day rise in cases. However, the doubling rate tells a different story. At CIO, we have tracked the doubling rate in real-time since mid-march. The doubling rate has slowed to over 7 days in the last week compared to 3 days before the lockdown. At present, we calculate a doubling rate of approx 8 days, indicating a progressive slowing. The recent spike in daily cases per day, means that the curve flattening could also be a lower but constant exponential growth rate after lockdown rather than a progressive decrease in the rate.

* 3 initial cases in Kerala recovered; This chart shows from the resumption of cases on March 2nd.

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April 21, 2020

Widespread Asymptomatic Data Means Testing Needs Ramping Up?

As testing is being scaled globally, asymptomatic positive cases are emerging in significant numbers. In some Indian states, including Maharashtra, UP, Punjab, Odisha, and Assam, asymptomatic infections are higher than symptomatic infections. In Jharkhand, 35 out of 36 cases (see the chart) were asymptomatic at the time of testing. The section of the population showing mild to no symptoms are in the 20-45 age group. Concerns are increasing of asymptomatic transmission. However, the ICMR has stated that the testing strategy has adequate provisions for suspected asymptomatic people, with travel or contact history, and those with influenza-like illness, and severe acute respiratory illness in high-risk areas. In a previous key insight, CIO showed that successful countries have early Mega Scale Testing.

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April 13, 2020

Convalescent therapy – does it in fact work?

Kerala is set to become the first state in the country to commence clinical trials of convalescent plasma therapy. This therapy uses antibodies from the blood of cured patients, to treat critically ill COVID-19 cases. Convalescent plasma has been around for over a hundred years. If it works, why didn’t countries start using it immediately? Why do we need clinical trials for a century old procedure? Read more about the muddied history of this technique.

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April 10, 2020

Why India Should Mega-Scale its testing program

Countries that test more, catch infections early and can mobilize contact tracing faster; thereby managing the outbreak better. The hardest hit countries, like the US and Italy have not tested enough and so have a high percentage of positive tests. Germany, however, has fared better and its vigilance is reflected in widespread testing. South Korea has lead the way with massive testing without a prescription, and has been a success story in managing the COVID outbreak so far. Indian positive test percentages started low, but are now rising. India needs to step up its testing program to stay ahead of the pandemic.

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April 9, 2020

Rajasthan strong in testing

A low number of test with a low number of infections sometimes indicates that the state is not testing enough. A high number of tests with high infections also can indicate that more testing needs to be done. But Rajasthan has a high number of tests with a low case positive rate, indicating that it is strong in tracking the spread of COVID.

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Data indicates Rajasthan treatment protocol effective

Studies show that the average time to death for a fatal COVID case is approximately two weeks. But Rajasthan has 430+ COVID infections, with some of the oldest cases. and still has a very low number of deaths. How is Rajasthan treating patients? To know more see treatment section.

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April 8, 2020

76% Of Positive Cases In Maharashtra Have No Symptoms

Two days ago, covidindia.org concluded that only severe cases worldwide were being tested. Now, Maharashtra released data shows that most (76%) cases are asymptomatic. It stands to reason that many more asymptomatic people would never have been tested. This would indicate a far lower mortality rate than can be calculated from confirmed cases.

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Maharashtra Data Confirms Community Transmission

An analysis of travelers vs. non-travelers shows that no growth in travelers in the past 11 days vs more than 5x growth in non-travelers.

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April 7, 2020

India is not immune to COVID-19

While we suspect there are many mild unreported cases in India (see only severe cases reported) as has been the claim for other countries. the data of the first 4067 cases released by MoHFW shows very similar patterns to the WHO joint study in China of the first 72,314 patients. The severity of cases with age and even the Case Fatality Rate reported thus far are similar. Though the sample size is low, Indian’s show no sign of immunity to COVID-19

Source: PIB

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April 6, 2020

Worldwide, only very severe cases are being reported

CONTEXT: Numerous studies have described the pathogenesis of the disease. As a result, we know that the time to death for mortality cases mostly ranges between 9-20 days, with 14-15 days from detection as a reasonable average.

METHOD: We looked at the number of deaths in countries with over 1000 cases on April 3rd. We then compared them to the number of reported cases two weeks prior, as these cases would on average be part of the reported cases at that time.

CONCLUSION: The number of deaths as of April 3rd was a very high percent of the cases reported on March 19, with the world average at 27% ! Since we know by all accounts that the mortality is anywhere from <1 to 4% , this indicates that in most countries in the world only very severe cases that are much more likely to be fatal are currently being reported.

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April 3, 2020

Join Us! Help Us Combat COVID-19

The COVIDIndia.org project is not just a website.  It is a movement, supported by 250+ volunteers.  Besides the timely, actionable, credibly sourced, and verified content on the site, we are engaged in numerous offline activities.  

If you want to help, please fill this form.  This is your chance to be part of the human response. No one will forget 2020 !

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