ANSWERS TO DIFFICULT QUESTIONS

there are many concerns about certain triple mutant strains and therapies available for Covid infections. The role of Plasma, Favipiravir, Hydroxychloroquine, Ivermectin, needs to be reassessed. The confusion about the vaccination schedule particularly after the Covid infection needs to be dwelled with.

Why triple mutation strain is dangerous?

The coronavirus keeps changing as it passes from one individual to another. These genetic mutations are known as variants. Some variants trigger changes in spike protein that the viruses use to latch on to and enter human cells. Multiple SARS- CoV-2 variants are circulating globally and a triple mutant strain is a huge challenge for India. The ferocious second wave of Covid is associated with a triple mutation in this 8.1.617 strain and has been found in Maharashtra, Delhi, Chhattisgarh, and West Bengal. The triple mutant virus may not be destroyed by the body’s immune response.

Why these variants of the virus are a matter of grave concern?

These mutated viruses particularly D614 G variants multiply more quickly in human respiratory cells. These mutants particularly B.1.1.7 variant is associated with an increased risk of death. These mutants may have the ability to evade detection by specific viral diagnostic tests. These triple mutants may have a potential impact on vaccination. They may also have decreased susceptibility to therapeutic agents such as monoclonal antibodies.

What should be done on an urgent basis?

There should be faster genome sequencing studies to fully understand the recent triple mutations in the virus. Genome sequencing helps us to understand the origin of the virus, the geographic distribution, the severity of infection, the ability of the vaccine to protect us, and notably the medications to be used. A focused study and having many more individuals tested for genome sequencing is an urgent need, particularly in Maharashtra and Delhi.

Will triple mutant variant impact Covid -19 vaccine?

Experts fear that the new variant may have an impact on vaccine efficacy
because the new variant has a major mutation called E484K, which helps to evade the immune system. This can evade the vaccine efficacy. The E484 K was also found in the Brazilian and South African variants of the virus. Scientists believe that there is a need to keep modifying our vaccines. We need genomic sequencing on a very major scale urgently. Immune response and triple mutation virus infection? India has three authorized vaccines so fat The Covaxin, Covishield and Russia’s Sputnik V vaccine approved recently. Certain foreign vaccines have been fast-tracked recently. All these efforts are likely to be affected if the vaccines turn out to be less effective against the double or triple mutation variant.

What is the role of convalescent plasma in coronavirus infection?

Plasma donated by individuals who have suffered from coronavirus infection has adequate antibodies against coronavirus. These antibodies if donated to a patient of coronavirus may benefit. However large-scale studies have not proved the utility of this therapy. Plasma therapy at best needs to be given in the first 3 to 4 days of in few lions. Plasma therapy does not prevent death or the need for ventilator therapy. It has no role in seriously ill patients.

What is the role of Hydroxychloroquine?

The current view is that there is no evidence of its utility in either preventing or in the treatment of coronavirus infection. It was used in 2020 with great expectations. However many investigators worldwide have not agreed to earlier claims.

What is the role of Favipiravir?

One of the key factors that distinguish a virus is the genetic material it is made of There are either DNA-based or RNA-based viruses. Favipiravir works exclusively on RNA viruses. It targets the RNA polymerase and prevents the virus from making copies of itself once the virus gets insides the host cell. The severity of illness has been found to be much reduced and the CT scan findings have also been observed to improve. It needs to be introduced early in treatment and is not suggested in pregnancy and in those with severe liver disorders. It is approved in few countries including India.

What is the role of Ivermectin?

The drug ivermectin is commonly used in the developing world for parasitic infections and has been found to be safe. The drug is affordable. In a small study from Bangladesh, Ivennectin given for 5 days reduced the CRP and LDH values indicating a reduction of inflammation. The drug does not find any mention in the protocol of coronavirus treatment in most developed countries.

When should I take the second dose of vaccination if I get infected from the community after the first vaccine dose?

The Covid infection will trigger an immune response that may protect you for the next 40 days. It is suggested to have the second dose of vaccine 40 days following the positive RTPCR or Antigen test. There have been serious concerns about the recent impact of the second Covid wave. More people are affected, the infection is more serious and the spread is very rapid. The need for oxygen, ventilatory support and Remdesivit Tocizulimab, and related medications is on the rise. The death rate also is on the rise. The double and triple mutations of viruses are causing a serious impact on the health system. Rapid genomic sequencing for a large population is an urgent need. Please continue to have two masks at maximum periods of time, even though you are indoors as this is an air-borne infection as reported in Lancet’s medical journal recently.

Categories : COVID-19
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Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.

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