Covid-19 & Cytokine Storms
Accumulating evidence suggests that a subset of patients with severe Covid-19 might have a “Cytokine Storm Syndrome” (CSS).
CSS is an overly vigorous immune response to a triggering event, frequently certain viral infections.
Severe COVID-19 patients are defined by manifestations that include respiratory failure requiring mechanical ventilation and shock or organ failure that requires intensive care, and which may lead to death.
Cytokines are inflammatory immunological proteins that are there to fight off infections and ward off cancers.
The release of inflammatory mediators increases the blood flow to the area, which allows larger numbers of immune system cells to be carried to the injured tissue, thereby aiding the repairing process. Thus, inflammation has an important protective function.
However, if this inflammatory response is not regulated, very dangerous consequences can follow. This is when a ‘cytokine storm’ can be triggered.
CSS is characterised by the overproduction of immune cells and the cytokines themselves because of a dysregulation in the process.
Reasons: A cytokine storm can occur due to an infection, auto-immune condition (when the body’s immune system attacks healthy cells as in case of coeliac disease- an immune disorder that primarily affects the small intestine), or other diseases.
Signs and symptoms include high fever, inflammation (redness and swelling), severe fatigue, and nausea.
In the case of any flu infection, a cytokine storm is associated with a surge of activated immune cells into the lungs, which, instead of fighting off the antigen, leads to lung inflammation and fluid build-up, and respiratory distress.
Sequencing Novel Coronavirus
India has shared nine whole genome sequences of the novel coronavirus (SARS-CoV-2) with the Global Initiative on Sharing All Influenza Data (GISAID).
The Indian Council of Medical Research (ICMR) has allowed all national research laboratories to conduct testing for the novel coronavirus.
So far, 3,086 sequences of the virus isolated from humans have been shared by 57 countries.
With 621, the U.S. has shared the most number of sequences, followed by the U.K. (350), Belgium (253) and China (242).
It has been found that a spike protein of SARS-CoV-2 also known as 2019-nCoV, enables the virus to enter and infect human cells.
Sequencing the genome of SARS-CoV-2 will help understand
Genome sequencing is figuring out the order of Deoxyribonucleic acid (DNA) nucleotides, or bases, in a genome—the order of Adenine, Cytosine, Guanines, and Thymine that make up an organism’s DNA.
On April 2, 2020, the Indian Council of Medical Research (ICMR) allowed all national research laboratories including those under the Council of Scientific and Industrial Research (CSIR) to conduct testing for the novel coronavirus.
Global Initiative on Sharing All Influenza Data:
GISAID is a public platform started by the World Health Organization (WHO) in 2008 for countries to share genome sequences.
The GISAID Initiative promotes the international sharing of all influenza virus sequences, related clinical and epidemiological data associated with human viruses, and geographical as well as species-specific data associated with avian and other animal viruses.
India Revokes Ban on Export of Hydroxychloroquine
Recently, India revoked its earlier ban on the export of malaria drug hydroxychloroquine (HCQ), which is being used to treat Covid-19.
U.S. Pressure: The ban on HCQ was revoked by India after U.S. President said that India could invite “retaliation” if it withheld supplies of HCQ.
Earlier, the government of India placed HCQ on a restricted items list, and later put a blanket ban on any export of the drug.
India’s Stand: Revocation has been done in view of the humanitarian aspects of the pandemic.
Neighbouring Countries: India has decided to licence paracetamol and HCQ in appropriate quantities to all its neighbouring countries who are dependent on its capabilities.
It will also supply these essential drugs to some nations that have been particularly badly affected by the pandemic.
Pre-existing Orders: The government will fulfill the pre-existing orders, mainly to the U.S., Brazil and European countries, as they have made advance payments on their orders.
Domestic Demand: The orders will be fulfilled depending on the stock position and domestic demand for the drug, which would be continuously monitored.
The government said that currently it has sufficient stock of the HCQ drug.
Hydroxy-chloroquine is an oral drug used in the treatment of malaria and some autoimmune diseases such as rheumatoid arthritis.
Recent studies show that the HCQ drug alone or in combination with azithromycin appears to reduce the virus quickly.
Further, the study suggests that prophylaxis (treatment given to prevent disease) with hydroxy-chloroquine at approved doses could prevent SARS-CoV-2 infection.
Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP)
Pharmacists, popularly known as “Swasth ke Sipahi”, of Pradhan Mantri Jan Aushadhi Kendra, are delivering essential services and medicines at doorstep of patients and elderly under Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) of the Government of India.
Working as part of Pradhan Mantri Jan Aushadhi Kendras (PMJAK), they are extending essential services by making available quality generic medicines at affordable prices to the common People of the country and the elderly persons at their doorstep to fight Corona pandemic. This is supporting the government’s initiative of practicing social distancing.
‘Pradhan Mantri Bhartiya Janaushadhi Pariyojana’ is a campaign launched by the Department of Pharmaceuticals, Govt. Of India, to provide quality medicines at affordable prices to the masses through special kendra’s known as Pradhan Mantri Bhartiya Jan Aushadhi Kendra.
Bureau of Pharma PSUs of India (BPPI) is the implementing agency of PMBJP. BPPI (Bureau of Pharma Public Sector Undertakings of India) has been established under the Department of Pharmaceuticals, Govt. of India, with the support of all the CPSUs.
Salient Features Of The Scheme:
Ensure access to quality medicines.
Extend coverage of quality generic medicines so as to reduce the out of pocket expenditure on medicines and thereby redefine the unit cost of treatment per person.
Create awareness about generic medicines through education and publicity so that quality is not synonymous with only high price.
A public programme involving Government, PSUs, Private Sector, NGO, Societies, Co-operative Bodies and other Institutions.
Create demand for generic medicines by improving access to better healthcare through low treatment cost and easy availability wherever needed in all therapeutic categories.
What is a generic medicine?
There is no definition of generic or branded medicines under the Drugs & Cosmetics Act, 1940 and Rules, 1945 made thereunder. However, generic medicines are generally those which contain same amount of same active ingredient(s) in same dosage form and are intended to be administered by the same route of administration as that of branded medicine.
The price of an unbranded generic version of a medicine is generally lower than the price of a corresponding branded medicine because in case of generic version, the pharmaceutical company does not have to spend money on promotion of its brand.
How are they regulated in India?
Drugs manufactured in the country, irrespective of whether they are generic or branded, are required to comply with the same standards as prescribed in the Drugs and Cosmetics Act, 1940 and Rules, 1945 made thereunder for their quality.
The UN Women has urged member-states to include prevention of violence against women in their action plans on COVID-19. It has also called the rise in gender-based violence a “shadow pandemic”.
Other suggestions made by UN Women:
Member states should consider shelters and helplines essential services.
Helplines, psychosocial support and online counselling should be boosted, using technology-based solutions such as SMS, online tools and networks to expand social support, and to reach women with no access to phones or Internet.
Police and justice services must mobilise to ensure that incidents of violence against women and girls are given high priority with no impunity for perpetrators.
Why these measures are necessary?
Globally 243 million women and girls aged 15-49 have been subjected to sexual and/or physical violence perpetrated by an intimate partner in the previous 12 months. The number is likely to increase as security, health and money worries heighten tensions and strains are accentuated by cramped and confined living conditions.
How lockdown is worsening the situation?
According to emerging data, violence against women and girls, particularly domestic violence, has ‘intensified’.
As per data compiled by the U.N. body, France has seen a 30% increase in domestic violence since the lockdown on March 17.
In Argentina, emergency calls for domestic violence cases have increased by 25% since the lockdown on March 20 and Cyprus (30%), Singapore (33%) have also registered an increase in calls.
Canada, Germany, Spain, the U.K. and the U.S. have also registered an increase in cases of domestic violence and demand for emergency shelter.
About UN Women:
The United Nations Entity for Gender Equality and the Empowerment of Women:
UN Women is the UN entity dedicated to gender equality and the empowerment of women. It was established to accelerate progress on meeting their needs worldwide. In July 2010, the United Nations General Assembly created UN Women, the United Nations Entity for Gender Equality and the Empowerment of Women.
It merges and builds on the important work of four previously distinct parts of the UN system, which focused exclusively on gender equality and women’s empowerment:
The main roles of UN Women are:
To support inter-governmental bodies, such as the Commission on the Status of Women, in their formulation of policies, global standards and norms.
To help Member States to implement these standards, standing ready to provide suitable technical and financial support to those countries that request it, and to forge effective partnerships with civil society.
To hold the UN system accountable for its own commitments on gender equality, including regular monitoring of system-wide progress.