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VOL 7 | ISSUE 6
PAGES 100
OCTOBER 2020
FUTUREMEDICINEINDIA.COM
COSTLY
STRATEGY?
ALLOWING THE PANDEMIC TO RUN ITS COURSE
UNTIL MUCH OF THE POPULATION GETS EXPOSED COULD PROVE DISASTROUS
IN FOCUS SPECIAL FEATURE GENOMICS FM COVID-19 UPDATES
FALLING
FRONTLINE
COVID-19
REINFECTION
VACCINE FOR
GALLBLADDER
CANCER?
BLOOD THINNERS ON
COVID19 PATIENTS

editor’s note
October 2020 / Vol. 7 / Issue 6
Founder & Managing Editor
CH Unnikrishnan
Executive September Editor 2020 / Vol. 7 / Issue 5
S Harachand
Founder & Managing Editor
Science CH August Unnikrishnan
Editor 2020 / Vol. 7 / Issue 4
Dr
Executive
Rajanikant
Founder
AUGUST
&
Editor
Vangala
2018
Managing / Vol:
Editor
Consulting S 5 / Issue: 4
CH
Harachand Editors
Unnikrishnan
Dr
Science
Shivanee
Executive Editor
Shah
Prapti Editor
Dr S Rajanikant Shah
HarachandVangala
Copy Consulting Editor
Science Editor Editors
Sreejiraj Dr Dr Shivanee Eluvangal
Rajanikant Shah Vangala
Design Jeetha Editor D’Silva
Consulting Editors
Gopakumar Prapti Shah K
Dr Founder Shivanee & Editor Shah
Curator-cum-Correspondent
Copy Jeetha Editor D’Silva
Divya Sreejiraj
CH Unnikrishnan
Prapti Choyikutty Shah Eluvangal
Photo Design Copy Executive Editor
Editor Editor
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Advisory Curator-cum-Correspondent
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editor’s note
Dear Doctor,
editor’s As we speak note now, you are still engaged on the frontlines of the fight against
COVID
editor’s
19, 276
note
days after the virus first made its presence known in India. The fight
hasn’t Dear Doctor, got any easier, rather it is getting more intense by the day. But the worst
that Dear has Doctor, happened to you so far has probably got less to do with the rage of the
My daughter, like every other urban, school-going child, had hardly any time to
pandemic Perhaps and against more most to do of our with expectations, the retraction we by still the find protector. ourselves Every in the tribute middle —
sit unengaged. Besides endless academic chores, including the hectic homework of
the a raging flowers, pandemic. the lights Like and everyone the tintinnabulation else, you too are — exhausted that you were with bestowed all the options with
and soft skill projects and presentations, she also found time for her painting and
suddenly for disease seem management to have lost laid its out meaning before you. when However, the government the fact is that disowned symptom your loss.
dancing classes. In between all these edu-arta-thons, she would also invariably
The relievers pain
Dear and
Doctor proven the protest and unproven of the Indian immunity Medical boosters Association are the after only a options shocking front denial
squeeze in her favourite sports and workouts with school and building buddies,
by of the infected, country’s and health that ministry the pandemic that it remains has data as on untamed deaths as in ever. the frontline All hope force,
of whom she has many. But, COVID-19 has put a stop to all that. The lack of
now
the
has rests
usual
no on
We opportunities
match, a potential and is vaccine.
know you are for
fully
busy. action,
justified. But
It is with
how While
always classes
close we are
reassuring confined
pay we to our that
that to
humble the
panacea
trust internet
tributes really?
and and,
to Not
faith most
all very, the
of of all,
450 to be frank, but not very far either.
the hundreds relentless
doctors and
of confinement
many more
patients in at
supporting
your home, healing often
healthcare
touch leaves keeps her
professionals
moody
Indeed, the latest WHO survey has a list of 165 SAR-CoV-2
you busy and
vaccine
in glum—a
who lost
this
candidates
noble typical
their
lives
psychological
mainly due
under profession. syndrome
to government
development In the across hectic that
the practice, affects
negligence
the
world. At it’s ‘normal’
in providing
least quite 23 natural people
of them that exposed
care and
are you in clinical might to
safety
‘abnormal’
during
trials miss
COVID and
situations. duty,
six are out on This let’s
final some pandemic also take
stages, of the including latest and this
developments the opportunity prolonged to
phase-3 human in lockdown remind ourselves
studies. emerging is nothing that
Eight medicine. less such
vaccine candidates In than political
this era a very
inconsistencies ‘abnormal
are in of various innovation,
situation’ can never
stages medical
for not be
of development science
just allowed her,
is
but to getting
millions affect our
India too. redefined
of children morale and
Of these, almost
and dedication
two by
adults
are the already day.
across to
in Old
the this
noble world. service.
phase-1 Now, technologies human trials. are being The Oxford-AstraZeneca replaced by the new vaccine, the which blink is of presumably an eye. Robots the
The repercussions even as there and is no manifestations clear direction of on this the prolonged stability of abnormality the virus or in signs our of
any
front-runner and artificial among intelligence four global are taking candidates over a good the part most of advanced the procedures, stages, has
now
social new
while been
life treatment vary
genomics allowed
from other
to
person than
and be tested
to person. the half-informed
molecular in India.
These
science The unveil Indian
include media
the manufacturing
anxiety chatter and about depression “free
mysteries of partner life further. of
as and
faster”
the
well
We British
as vaccines, biological we
are vaccine
effects must
fortunate project—Serum
like focus disturbed on the
to have such Institute
sleep, next step
breakthroughs of India
appetite forward.
— as will
disturbances We believe
they conduct help specialists the
and that
observerblind,
other it is
time like
emotional to talk
you
randomised
difficulties. about the
rise above
controlled
The scientific severity aspects
the expectations
study
may
to
of
determine
even of herd extend immunity
today’s informed
the safety
to mental — our
patient.
and immunogenicity
illness next and big even hope.
With
of substance the expedited
the vaccine misuse. candidate The development young in about and of
1600 the a old, vaccine
healthy pregnant seeming
human women, ever
volunteers family more like
in the members a distant
country. of
dream,
However, the infected community
this and is only those level
the who second
immunity have phase died — the
of due human
natural to the trials,
consequence infection and they and will
of even the
move the majority
to lonely of
the
Phase-3 are people Similarly, all vulnerable only
getting it
when
is also to infected
the mental a
company
time — health when seems
is successful issues India like is caused the witnessing
in
natural
submitting by the way revolutionary pandemic forward.
safety data, and But growth
evaluated society’s the problem in
is by reaction that the healthcare we Data to still it. Safety do industry, not Monitoring have especially much Board clarity in (DSMB), the on private the to the critical sector, CDSCO—the size wherein of the Indian population increasing drugs that
needs regulator. One number of the of infected, most doctors crucial and are recover, areas taking we up in must multiple order focus for roles herd on is of immunity the clinician, psychological to researcher be a reality. impact and that
Seroprevalence this These entrepreneur. has on promising the first studies, This advancements response requires meanwhile, teams expansion by give like the you scientific a of peek and your into your community focus the colleagues. to actual a wider worldwide extent The canvas. long of are infection In hours
spread certainly spent this working context, commendable. the general in it potentially becomes population. But, important dangerous what we But seem I how and doubt to a unpleasant busy be the losing country professional sight situations, has a in like systematic all such you this as can are testing the
approach very labs, keep real hospital challenges pace even wards with on that these and front risks COVID latest involved as ICUs, of developments now. makes in vaccine Our frontline cover development. a story quick health this and workers time The easy development
tries way. prone to find to such
out of mental a what safe health vaccine is store issues. typically for In us, this at a edition, long, least complex as we far wanted as process reaching to highlight and the often herd the lasts immunity ground 10-15 realities years goal is
concerned. and this
At involves Future
front multiple and
Medicine,
the elements paramount
which is of conceived
importance research and and
of development providing
crafted by
additional
a and team various of
mental
senior levels health
of support Separately, public and information private participation. to both the Therefore, care-seeker this rapid as well race as and the the caregiver. shortened
journalists, a scientists landmark and cancer doctors, genetics our aim study is by to help a group you of do scientists just that. to We identify
a process potential Another is certainly highlight not of the this desirable edition is way a report to go on forward, a genetic but study we do on need the a NCD-hit solution
are equipped
treatment
to bring
or vaccines
you the
for
latest
gallbladder
from the
cancers,
science of
which
care
have
from
no
across
known
treatments urgently. South Asian That, so population—uncovering however, far in the doesn’t world, is answer also the in the focus story question behind for us of in whether this first-ever edition. such Genome-wide
We a rapidly also bring
developed Polygenic
the world
Risk solution
in
Score
an
will
interesting
for be coronary 100%
and
safe artery
convenient
and disease efficacious.
way,
on the
supplemented
In this South edition, Asian we
by
population. delve
the best
you a discussion with Dr G. Richard Olds, a world authority med-schooling and Dr
deep V Ramprasad, of into views the and high-wire CEO analyses of MedGenome, acrobatics from the that masters which is COVID-19 initiated each vaccine the field. CAD We development.
PRS present study, you also this
President of St. George’s University, on the advantages of a truly international talks
about Also specialised the in this greater edition knowledge impact is a special that vehicle it feature can that make plugs on the in India, you latest into scientific Straight the emerging advancements Talk of world this edition. of
medical education system in the current world context and India’s persisting
a most care promising seamlessly. cardiovascular Come, let’s treatment join hands involving this information one-time gene journey.
challenges
editing. Our
Wishing you in an the insightful area of medical reading, education.
guest on Straight Talk this month is Sameer Sheriff of iPC Health who explains why
Wishing we need CH Unnikrishnan
to get insightful a grip on reading, India’s high levels of medical error deaths urgently.
Wishing editor@futuremedicineindia.com
you an insightful reading,
C H Unnikrishnan
C editor@futuremedicineindia.com
H Unnikrishnan
editor@futuremedicineindia.com
C H Unnikrishnan
editor@futuremedicineindia.com
www.futuremedicineindia.com futuremedicineindia FutureMedIndia
AUGUST 2018/ FUTURE MEDICINE / 3

IN FOCUS SPECIAL FEATURE GENOMICS FM COVID-19 UPDATES
Vol 7 Issue 6
October 2020
₹ 250.00
VOL 7 | ISSUE 6
PAGES 100
OCTOBER 2020
FUTUREMEDICINEINDIA.COM
ALLOWING THE PANDEMIC TO RUN ITS COURSE
UNTIL MUCH OF THE POPULATION GETS EXPOSED COULD PROVE DISASTROUS
FALLING
FRONTLINE
COSTLY
STRATEGY?
COVID-19
REINFECTION
VACCINE FOR
GALLBLADDER
CANCER?
BLOOD THINNERS ON
COVID19 PATIENTS
14
IN FOCUS
INDIA LOSES
MORE DOCTORS
TO COVID-19
Doctors in India suffer four times the
mortality of ordinary citizens
REGULAR FEATURES
06 Letters
08 News updates
16 Controversy
30 Research
44 Drug approvals
54 Research snippets
59 Hospital news
60 Special feature
66 Devices&gadgets
72 Gynecology &
paediatrics
74 Nutrition
78 Policy
82 Guidelines
96 Calendar
98 Holy grail
Columns
33 TRIALOMICS
Dr Arun Bhatt
58 THE CELLVIEW
Dr Rajani Kanth Vangala
64
DISEASE
MOLECULAR
TESTING REDEFINES
SEPSIS DIAGNOSIS
Newer techniques ensure higher
accuracy and speed in detecting
sepsis as well as the microbe
50
STRAIGHT TALK
“INDIAN DOCTORS
ARE BRILLIANT,
BUT THE PROBLEM
IS TO ENSURE
THEM RIGHT
EDUCATION AND
TRAINING”
Dr G Richard Olds
President, St. George’s University

20
FM COVID-19 UPDATES
INDIA REPORTS
SPORADIC
CASES OF
SARS-COV-2
REINFECTION
34
COVER STORY
HOW FAR TO
HERD IMMUNITY
Embracing natural herd immunity
as a strategy to stop the pandemic
could prove a recipe for disaster
28
GENOMICS
GENETIC STUDY
FLAGS
GALLBLADDER
CANCER THERAPY,
VACCINE
CANDIDATES
MedGenome-led research, which
analysed samples of gallbladder
cancers from patients in Korea,
India and Chile, identified several
targetable genomic alterations
The reason why
herd immunity
thresholds are
lower when
immunity is
induced by natural
infection than by
vaccination is
individual variation
in susceptibility or
exposure.
Gabriela Gomes
Professor of
Mathematics and
Statistics at the
University of
Strathclyde, Scotland

POLICY GENOMICS RESEARCH FM COVID-19 UPDATES
letters to the editor
DON'T MIX AYUSH
WITH MODERN
MEDICINE: ALLOPATHS
Peptide prevention
₹ 250.00
VOL 7 | ISSUE 5
PAGES 100
SEPTEMBER 2020
FUTUREMEDICINEINDIA.COM
STRESSED OUT
COVID 19 UNLEASHES A DELUGE OF MENTAL HEALTH PROBLEMS
POLYGENIC RISK
SCORES FOR CAD
IN SOUTH ASIANS
PROMISE OF
PEPTIDES
IN COVID-19
ASYMPTOMATIC
SPREAD OF
SARS-COV-2
Hi
The article ‘PROMISE OF
PEPTIDES’ in recent issue
is an interesting subject.
These peptides with its
easy cell-penetrating ability
and modifiable nature may
be promising by bringing
more than just a reduction
of viral load. New peptides
are being developed and
repurposed as therapeutics
for the treatment of COVID-19
recently. Therefore, peptidebased
drug development
focusing more than the
prevention of viral infection
and focusing on alleviating
symptoms that increase the
fatality of the disease such as
reducing alveolar oedema and
thrombosis formation in the
lungs becomes important. The
role of peptides provides a new
option for the treatment of
infectious COVID-19 disease.
Ramakrishnan Pillai
Chennai
Natural viricides
Dear Editor
The article TRYPTANTHRIN
-UNEXPLORED PROMISE?”
by Arunkumar discussed the
potential role of Strobilanthes
cusia in the treatment of
COVID-19. Exploring traditional
medicinal herbs is a beneficial
step to fight off many
infections especially like those
caused by coronaviruses.
As discussed, the study by
a team lead by Tsai, Yu-Chi
identified tryptanthrin as the
key active component in the
methanolic extract of the
leaf. However, the study only
investigated the extract’s
activity towards anti-human
coronavirus NL63 (HCoV-
NL63) which showed great
inhibition through cytopathic
effect (CPE) and reducing virus
yield in the infected cells. Both
tryptanthrin and indigodole
B showed strong virucidal
activity although former
tryptanthrin was showed to
prevent the early and late
stages of viral replication via
blocking viral RNA genome
synthesis and protease
activity. Finally, the risk lies in
the time these studies shall
consume to further analyse
and realise their actual effect
against such viruses like SARS-
CoV-2 and finally generate
a large-scale production
of this molecule which is
only in experimental stages.
However, it is fascinating to
always know more about the
potentiality of such compounds
present in nature which
need to be explored further
in a large scale where the
side-effects associated with
such compounds would also
be negligible unlike certain
vaccines or drugs whose
long term actions may be
unpredictable especially when
given to large population.
Mathew K
Pathanamthitta
&
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Parliament (Rajya Sabha)
passed the Epidemic Diseases
Amendment Bill, 2020,
legislation that provides for
up to five years in jail for
those who attack doctors and
health care personnel.
The bill seeks to replace
the Epidemic Diseases
(Amendment) Ordinance
2020 to amend the Epidemic
Diseases Act, 1897 issued by
the government to provide
protection to health care
service personnel, their
living premises as well as
their workplaces against any
violence during the course of
a pandemic.
Introducing the bill,
the Union health minister
informed the house about
the growing incidents of
violence on healthcare
professionals.
Many healthcare workers,
including doctors, paramedics,
were insulted in some form or
the other, due to the stigma
attached to COVID-19. The
central government acted
on this situation and found
that there was a need for a
law, a prohibitory mechanism
against such incidents, he
said.
The service
personnel
who will be
protected
under
the new
legislation
includes “public and clinical
healthcare service providers
such as doctors, nurses,
paramedical workers
and community health
workers; any other persons
empowered under the act
to take measures to prevent
the outbreak of the disease
or spread thereof; and any
persons declared as such
by the state government,
by notification in the official
gazette.”
The punishments can
be invoked in instances of
damage to property including
a clinical establishment,
any facility identified for
quarantine and isolation of
patients, mobile medical units
and any other property in
which the healthcare service
personnel have a direct
interest in relation to the
epidemic.
According to the
provisions of the bill,
complaints of offences will be
investigated by an officer of
the rank of inspector within
a period of 30 days, and the
trial has to be completed in
one year unless extended by
the court for reasons to be
recorded in writing, the bill
proposes.
The commission or
abetment of such acts of
violence will be punishable
with imprisonment for a term
of three months to five years,
and with a fine of Rs 50,000
to Rs 2,00,000.
8 / FUTURE MEDICINE / October 2020

PGIMER’s dept
of community
medicine
becomes centre
of excellence
Ministry of Health
and Family Welfare
(MoHFW) has recognised the
Department of Community
Medicine and School of Public
Health of the Postgraduate
Institute of Medical Education
& Research, Chandigarh
(PGIMER) as a “Centre of
Excellence on Air Pollution
and Health” under the
National Programme on
Climate Change and Human
Health (NPCCHH).
Dr Ravindra Khaiwal,
Additional Professor of at
Department of Community
Medicine and School of Public
Health, will be assigned as
nodal faculty for the centre of
excellence on air pollution and
health.
The centre will be
responsible for analysing the
impact of air pollution and
climate change on public
health. It will also spearhead
several programmes to
decrease the impact of air
pollution on human health.
The centre will educate
people regarding the aspect
of climate change and
air pollution through selfexplanatory
training modules
and awareness materials
released by the authorities.
Health ministry
recommends
COVID-19
screening for all
TB patients
The Union health ministry
has issued guidelines
recommending COVID-19
screening for all tuberculosis
(TB) patients and TB
screening for all COVID-19
positive patients.
According to the ministry,
tuberculosis is associated with
a two-fold increase in the risk
of severe COVID-19 disease.
In addition, tuberculosis
patients tend to have
comorbid conditions including
malnutrition, diabetes,
smoking, HIV etc, that
increase their vulnerability.
The prevalence of
COVID-19 vaccines need to show 50% efficacy in trials for approval: DCGI
COVID-19 vaccines developed
in India need to demonstrate
at least 50% efficacy in providing
immunity against SARS-CoV-2
infection in phase 3 trials to get
an approval, according to the
new draft guidance document,
released by the Central Drugs
Standard Control Organisation
(CDSCO).
The Drugs Controller General
of India, under the Central Drugs
Standard Control Organization,
is responsible for the approval
of licences of pharmaceutical
products, devices and vaccines.
The new guidelines are issued
to streamline the manufacturing
and distribution of potential
vaccines. Currently, over a dozen
pharma companies in India are in
a race to develop Indian vaccines
against the coronavirus.
“To ensure that a widely
deployed COVID-19 vaccine is
effective, the primary efficacy
endpoint estimate for a placebocontrolled
efficacy trial should
be at least 50 percent and the
statistical success criterion should
be that the lower bound of the
appropriately alpha-adjusted
confidence interval around
the primary efficacy endpoint
estimate is (greater than) 30
percent,” the draft states.
For vaccines developed
outside India, the marketing
approval will be provided on the
basis of clinical trial data once
they pass the evaluation for the
overall safety and effectiveness of
the vaccine.
“However, an additional
clinical trial may be required in
the local population to confirm
the safety and effectiveness of
the Indian population. The extent
of local clinical trial requirements
will be decided on a case by case
basis,” the the draft guidelines
state.
October 2020 / FUTURE MEDICINE / 9