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editor’s note
November 2020 / Vol. 7 / Issue 7
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
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Executive Editor
Shah
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HarachandVangala
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editor’s note
editor’s note
Dear Doctor,
editor’s note
Dear The Doctor, unlocking process is almost complete now, though the pandemic
continues Dear Doctor,
rage. New positive cases reported among those with
compromised My daughter, like immunity every other or comorbidities urban, school-going are adding child, had to your hardly case any burden time to
Perhaps against most of our expectations, we still find ourselves in the middle of
by sit
a raging
the unengaged. minute. Besides
pandemic.
With
Like
no endless
everyone
specific academic
else,
treatment chores,
you too
protocol including
are exhausted place the
with
yet, hectic
all
you homework
the options
are left
looking
and soft
for disease helplessly
skill projects
management at
and
the laid deficient
presentations,
out before care
she
you. and
also
However, feeling
found
suffocated
time for her
the fact is that inside
painting
symptom the
and
PPE.
dancing classes. In between all these edu-arta-thons, she would also invariably
relievers
squeeze Dear and Doctor proven and unproven immunity boosters are the only options in front
of Since the infected, infection
in her favourite
and control
sports
that the seems
and
pandemic to
workouts
be remains a challenging
with school
as untamed task
and
as at
building
ever. this All juncture,
buddies,
hope now all
of whom she has many. But, COVID-19 has put a stop to all that. The lack of the
our rests hope on a is potential currently vaccine. pinned But on how achieving close are herd we to immunity, that panacea especially really? Not given
usual We opportunities know you are for busy. action, It is with always classes reassuring confined that to the trust internet and and, faith most
very,
of of all,
that to be the frank, prospect but not of very a safe far either. vaccine still appears quite distant. But with the
the hundreds relentless of confinement patients in at your home, healing often touch leaves keeps her moody you busy and in glum—a this noble typical
concept Indeed, of the natural latest herd WHO immunity survey has comes a list of the 165 billion-dollar SAR-CoV-2 vaccine question: candidates How
psychological profession. syndrome In the hectic that practice, affects the it’s ‘normal’ quite natural people that exposed you might to ‘abnormal’
close under are development we to such across a threshold the world. and At least what 23 does of them current are in data clinical have trials miss to tell and us
situations. out on This some pandemic
six are in final stages, of the including latest and developments the prolonged
phase-3 human in lockdown
studies. emerging is nothing
Eight medicine. less
vaccine candidates In than this era a very
in this regard?
‘abnormal
are in of various innovation,
situation’
stages medical
for not
of development science
just her,
is
but getting
millions
India too. redefined
of children
Of these, almost
and
two by
adults
are the already day.
across
in Old
the
Only a high-quality representative serosurvey could provide an accurate
world.
assessment phase-1 technologies human of the trials. are current being The Oxford-AstraZeneca replaced as well as by the evolving new vaccine, the immunity which blink is of presumably an status eye. in Robots the
The repercussions and manifestations of this prolonged abnormality in our
community, front-runner and artificial among intelligence the four global are taking candidates over a in good the part most of advanced the procedures, stages, has
now
social
while been
life vary
and
genomics allowed
from
that
to
person
too, only
and be tested
to person.
if the
molecular in India.
These
inherent
science The unveil Indian
include
challenges
the manufacturing
anxiety
of
and
conducting,
depression
mysteries of partner life further. of
as
analysing
the
well
We British
as biological
and interpreting
are vaccine
effects
fortunate project—Serum
like
them
disturbed
are successfully
to have such Institute
sleep,
breakthroughs of India
appetite
overcome.
— as will
disturbances
they conduct help specialists the
and
observerblind,
other
like
emotional Epidemiological
you
randomised
difficulties. studies
rise above
controlled
The severity have empirically
the expectations
study
may
to
of
determine
even extend proven
today’s informed
the safety
to that mental viral
patient.
and immunogenicity
illness transmission and even
does
of substance not slow
the vaccine misuse. down
candidate The until young in about and least
1600 the 60% old, of
healthy pregnant the population
human women, is
volunteers family infected.
in the members country. of
However,
However, the infected data
this and from
is only those the
the who most
second have recent
phase died of due nationwide
human to the trials, infection survey carried
and they and will even out
move the by
to lonely the
Indian
Phase-3 are Similarly, all vulnerable Council
only
it
when
is of also to Medical
the mental a
company
time Research health when
is successful issues India (ICMR) is caused witnessing show
in submitting by that the revolutionary pandemic only a fraction
safety data, and growth
evaluated society’s of the in
general
by reaction the healthcare population
Data to it. Safety industry, is seropositive
Monitoring especially Board in for
(DSMB), the the private SARS-CoV-2
to the sector, CDSCO—the wherein infection.
Indian increasing At 7%, the
drugs
figure
regulator. One number fell of the way of most doctors below crucial the are areas threshold taking we up must multiple needed focus roles for on reaching is of the clinician, psychological herd researcher immunity. impact and that
Therefore, this These entrepreneur. has on promising
the revelation first This advancements response requires that teams expansion a significant
by like the you scientific of and majority your your community focus colleagues. of to the a wider worldwide
1.3 billion-strong
The canvas. long are In hours
Indian certainly spent this working population context, commendable. in it potentially becomes is still But, susceptible important dangerous what we seem to how and the to a unpleasant infection busy be losing professional comes sight situations, as in like all a such you shock this as can are testing the
to very labs, those
keep real hospital challenges waiting
pace wards with
for these and redemption risks COVID latest involved ICUs, developments
from makes in vaccine the frontline pandemic development. a quick health through
and workers The easy
natural development
way. prone to such
herd of mental a safe immunity. health vaccine issues. Our typically cover In this story a edition, long, explores complex we wanted the process complexities to highlight and often the of lasts conducting
ground 10-15 realities years
serosurveys and on this
At involves Future
front in multiple and India.
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 Other public subjects and information private we participation. touch both upon the Therefore, in care-seeker this edition this rapid as include well race as potential and the the caregiver. shortened pathways
journalists, scientists and doctors, our aim is to help you do just that. We
for process Another vaccine is certainly highlight designs not of for the this emerging desirable edition is respiratory way a report go on forward, viruses a genetic but to confer study we do on need long-term the a NCD-hit solution
are equipped to bring you the latest from the science of care from across
resistance urgently. South Asian That, and population—uncovering however, prophylactic doesn’t therapy answer the trials the story question for behind COVID-19. of whether first-ever such Genome-wide
a rapidly
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
Dr
Wishing
deep V Ramprasad, of into views an insightful
the and high-wire CEO analyses reading,
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 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
a most care promising seamlessly. cardiovascular Come, let’s treatment join hands involving this information one-time gene journey. editing. Our
Wishing you an insightful reading,
guest on Straight Talk this month is Sameer Sheriff of iPC Health who explains why
we need CH Unnikrishnan
to get a grip on India’s high levels of medical error deaths urgently.
Wishing editor@futuremedicineindia.com
you an insightful reading,
C H Unnikrishnan
editor@futuremedicineindia.com
C H Unnikrishnan
editor@futuremedicineindia.com
C H Unnikrishnan
editor@futuremedicineindia.com
www.futuremedicineindia.com futuremedicineindia FutureMedIndia
AUGUST 2018/ FUTURE MEDICINE / 3

RESEARCH POLICY SPECIAL FEATURE FM COVID-19 UPDATES
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T-CELL DRIVEN
VACCINE STRATEGY
HErD ImmUNITY A DISTANT DrEAm FOr INDIA,
SUGGEST SErO-SUrVEYS
IMMUNE
NDHM: IMA
UP IN ARMS
@
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REGULAR FEATURES
06 Letters
08 News updates
38 Drug approvals
50 Research snippets
55 Hospital news
60 Devices&gadgets
64 Gynecology &
paediatrics
66 Research
74 Technology
77 Clinical trials
90 Guidelines
96 Calendar
98 Holy grail
Columns
25 TRIALOMICS
Dr Arun Bhatt
54 THE CELLVIEW
Dr Rajani Kanth Vangala
56
SPECIAL FEATURE
MOUNTING
HUMAN COST
FM examines the mounting human
cost of the COVID-19 pandemic at a
time when the toll from SARS-CoV-2
crosses the 1 million mark
12
POLICY
DIGITAL HEALTH
MISSION IN THE
CROSSHAIRS
Not enough safeguards
for medical records
in the policy blueprint, says IMA
46
STRAIGHT TALK
“PATIENT PRIVACY
AND DATA
PROTECTION ARE
OF PARAMOUNT
IMPORTANCE”
Seema Arora
National Marketing Head
ResMed India

16
FM COVID-19 UPDATES
FIRST ‘HUMAN
CHALLENGE’
TRIAL ON
COVID-19
TO BEGIN IN UK
80
SPECIAL FEATURE
KERALA TO TAP
MEDICAL
VALUE TOURISM
LEVERAGING
SKILLSETS
IN MODERN,
TRADITIONAL
MEDICINE
It is important
that the results
of serosurveys
to be interpreted
carefully, factoring
in their context
and limitations.
Dr Chandrakant
Lahariya
A leading public
policy and health
systems expert
26
COVER STORY
WHITHER
HERD
IMMUNITY?
India’s seroprevalence findings
suggest that the country is
nowhere close to achieving
herd immunity

IN FOCUS SPECIAL FEATURE GENOMICS FM COVID-19 UPDATES
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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
Epidemic curve: Stay
cautious!
Hi
Since its outbreak in late 2019
in China COVID-19 had spread
around the globe taking many
lives and creating a state of
delirium that everyone had
almost shared equally. In
case of India which now has
the second most number of
the COVID-19 cases around
the world after the U.S, the
situation has been a lot worse.
With the government scaling
up its testing capacity, the
positivity rate of the infection
appears to have started
falling since October.
However, now the cases have
begun to show an increasing
trend in Kerala which had
its infection under control
a few months ago until the
restrictions were lowered
during the festive season. This
implies that the assumption
that the country has reached
the peak of the epidemic
curve could be based on a
flawed estimation. Let us for
now not have an unrealistic
consolation based on any
partially-known epidemiology.
We still have a densely
populated group of
people across the country
where the virus might not
have reached yet. We may
not be able to predict when
the epidemic will reach the
curve and and explode. Hence
it is better to stay cautious
and maintain necessary
measures.
Mahesh Sawant
Pune
Ensure safety of
doctors
Dear Editor
India has always been keeping
up the fight against the virus
helping contain the infections
and cure the affected with
the continuous help from our
dedicated medical staff and
authorities. However, many
doctors among other people
did lose their lives fighting
the pandemic. As FM has
mentioned in one of your
recent articles- “India loses
more doctors to COVID-19” it
is revealed that the doctors
suffer four times the mortality
of ordinary citizens in this
country. With a population
so vast and the given
situation of the poor work
environment, high numbers
of casualties and lack of
standardisation of PPE kits
makes our doctors more
prone to the infections.
Every single doctor is of
utmost value as his/her
service could save several
lives. Meanwhile, during this
time there have also been
various cases of medical
negligences reported across
the country which resulted
in the death of COVID-19
patients.
Dr Gaurav Sharma
Lucknow
&
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news updates
NOBEL PRIZES 2020
HCV discoverers
honoured
The 2020 Nobel Prize in
Physiology or Medicine is
awarded to Harvey J Alter,
Michael Houghton and Charles
M Rice for the discovery of the
hepatitis C virus.
Alter studied the
transmission of hepatitis as a
result of blood transfusions
and showed the existence
of a third, blood-borne viral
pathogen —other than HAV
and HBV.
Houghton and his
colleagues identified the
new kind of RNA virus that
belonged to the Flavivirus
family on the basis of genetic
material from infected
chimpanzees and named it
the hepatitis C virus.
A team led by Rice
characterised a portion of
the hepatitis C genome
responsible for viral replication
using genetic-engineering
techniques demonstrating
its role in causing liver
disease.
This pioneering work
has paved the way for the
development of screening
methods that have
dramatically reduced the risk
of acquiring hepatitis from
contaminated blood and has
led to the development of
effective antiviral drugs. The
harsh and poorly effective
treatments of yesteryears
for the infection have been
replaced by drugs that directly
block the virus.
HCV induced hepatitis is
now almost a curable disease
and the lesions associated
with infection are often
reversible. Clinical studies
have shown that shortterm
anti-viral treatment
cures more than 95% of the
patients, including advanced
cases who failed to respond
to previous therapeutic
modalities.
71 million people
worldwide are chronically
infected with hepatitis C,
which causes nearly 400,000
deaths per year, mostly from
cirrhosis and liver cancer,
according to WHO.
In 2016, spurred by the
development of effective
treatments for hepatitis C and
expanding access to hepatitis
B vaccination, the 194
member states of the WHO
committed to eliminating viral
hepatitis as a public health
threat by 2030.
I am overwhelmed at the
moment, but so pleased that
this originally obscure virus has
proven to have such a large
global impact.
Harvey J. Alter, M.D
Senior Scholar
NIH Clinical Center’s Department of
Transfusion Medicine, USA
You cannot stop an epidemic
as large as [Hepatitis C] or
Covid[-19] just with good
therapy — you absolutely have
to have a vaccine to really curb
the transmission across the
world.
Michael Houghton
Professor, Department of Medical
Microbiology & Immunology
University of Alberta, Canada
It shows you what can be done
if people really mobilise and
work together.
Charles M Rice
Rockefeller University, New York City
8 / FUTURE MEDICINE / November 2020

CRISPR-Cas9 back in spotlight
Emmanuelle Charpentier and Jennifer
Doudna shared the Nobel Prize for
Chemistry for developing the precise
genome-editing technology.
Charpentier, now at the Max Planck
Unit for the Science of Pathogens in Berlin,
and Doudna, at the University of California,
Berkeley, have developed CRISPR–Cas9
gene-editing tools, a technology that allows
to make precise edits to the genome and
has swept through laboratories worldwide
since its inception in the 2010s.
Using these, researchers can change the
DNA of animals, plants and microorganisms
with extremely high precision. This
technology, which has had a revolutionary
impact on the life sciences, is contributing
to new cancer therapies and may make the
dream of curing inherited diseases come
true.
Using the CRISPR/Cas9 genetic scissors,
it is now possible to modify genes in cells
and change the code of life over the course
of a few weeks.
“There is enormous power in this genetic
tool, which affects us all. It has not only
revolutionised basic science, but also
resulted in innovative crops and will lead to
ground-breaking new medical treatments,”
said Claes Gustafsson, chair of the Nobel
Committee for Chemistry, announcing the
prize.
Clustered regularly interspaced short
palindromic repeats (CRISPR) is a microbial
‘immune system’ that prokaryotes use to
prevent infection by viruses called phages.
The CRISPR system gives these microbes
the ability to recognize precise genetic
sequences that match a phage or other
invaders and target these sequences for
destruction using specialized enzymes.
These enzymes, known as CRISPRassociated
proteins (Cas), including one
called Cas9, have been identified previously.
But Charpentier identified another key
component of the CRISPR system, an RNA
molecule that is involved in recognizing
phage sequences, in the bacterium
Streptococcus pyogenes, which can cause
disease in humans.
In a collaboration, the duo isolated the
components of the CRISPR–Cas9 system
and showed that the system could be
programmed to cut specific sites in isolated
DNA. Their programmable gene-editing
system continues to tweak and improve
CRISPR and to identify other gene-editing
tools.
This tool has contributed to many
important discoveries in basic research, and
plant researchers have been able to develop
crops that withstand mold, pests and
drought. In medicine, clinical trials of new
cancer therapies are underway.
Emmanuelle Charpentier
Jennifer A Doudna
Emergency
department
must in medical
colleges: NMC
The National Medical
Commission (NMC)
has made it clear that all
medical colleges offering
MBBS courses must have a
Department of Emergency
Medicine.
Releasing the latest
“minimum requirements
for MBBS admission
regulations 2020” for public
comments, the apex
regulator mandated that
the emergency department
should have at least
30 beds.
The regulations will be
applicable to medical
colleges being established
from the 2021-22 academic
session.
The draft guidance
stipulates the infrastructural
facilities requirements for
medical colleges offering 100,
250 and 500 admissions
annually. All the institutions
offering undergraduate
education are required to
have a college building,
laboratories, tutorial rooms,
library, hostels and bed
distributions.
For medical colleges
November 2020 / FUTURE MEDICINE / 9