ICMR says COVID-19 testing should be widely available to all symptomatic individuals

Agencies
June 24, 2020

New Delhi, Jun 24: Expanding the testing criterion for coronavirus, the Indian Council of Medical Research has said it should be made widely available to all symptomatic individuals across the country.

"Since test, track and treat' is the only way to prevent spread of infection and save lives, it is imperative that testing should be made widely available to all symptomatic individuals in every part of the country and contact tracing mechanisms for containment of infection are further strengthened," it said in an advisory on 'Newer Additional Strategies for COVID-19 Testing' on Tuesday.

In its revised testing strategy for COVID-19 issued on May 18, the Indian Council of Medical Research (ICMR) had advised testing for all symptomatic Influenza-like illness (ILI) among returnees and migrants within seven days of illness.

All hospitalised patients who develop ILI symptoms, symptomatic individuals living within hotspots or containment zones and healthcare and frontline workers involved in containment and mitigation of coronavirus were also advised testing.

The apex health research body has also advised authorities to enable all government and private hospitals, offices and public sector units to perform antibody-based COVID-19 testing for surveillance to help allay fears and anxiety of healthcare workers and office employees.

The earlier advisories on rapid antibody testing advisories had focused on areas reporting clusters (containment zones), large migration gatherings/evacuees centers and testing of symptomatic ILI individuals at facility level.

Besides, the ICMR on Tuesday also recommended deployment of rapid antigen detection tests for COVID-19 in combination with RT-PCR tests in all containment zones, all central and state government medical colleges and government hospitals, all private hospitals approved by the National Accreditation Board for Hospitals and Healthcare (NABH), all NABL-accredited and ICMR approved private labs, for COVID-19 testing.

All hospitals, laboratories and state governments intending to perform the point-of-care antigen tests need to register with ICMR to obtain the login credentials for data entry.

"ICMR advises all state governments, public and private institutions concerned to take required steps to scale up testing for COVID-19 by deploying combination of various tests as advised," the advisory added.

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Agencies
June 14,2021

The highly transmissible Delta variant of SARS-CoV-2 has mutated further to form the ‘Delta plus’ or ‘AY.1’ variant but there is no immediate cause for concern in India as its incidence in the country is still low, scientists said.

The new Delta plus variant has been formed due to a mutation in the Delta or B.1.617.2 variant, first identified in India and one of the drivers of the deadly second wave. Though there is no indication yet of the severity of the disease due to the new variant, Delta plus is resistant to the monoclonal antibody cocktail treatment for Covid-19 recently authorised in India.

“One of the emerging variants is B.1.617.2.1 also known as AY.1 characterized by the acquisition of K417N mutation,” Vinod Scaria, clinician and scientist at Delhi’s CSIR-Institute of Genomics and Integrative Biology (IGIB), tweeted on Sunday.  

The mutation, he said, is in the spike protein of SARS-COV-2, which helps the virus enter and infect the human cells.  

According to Public Health England, 63 genomes of Delta (B.1.617.2) with the new K417N mutation have been identified so far on the global science initiative GISAID.  

In its latest report on coronavirus variants, updated till last Friday, the health agency said Delta plus was present in six genomes from India as of June 7.  

“The variant frequency for K417N is not much in India at this point in time. The sequences are mostly from Europe, Asia and America,” Scaria wrote on Twitter.  

The earliest sequence of this genome was found in Europe in late March this year.  

Noting that the travel histories for the variant are not readily available to make assumptions, Scaria said an important point to consider regarding K417N is the “evidence suggesting resistance to monoclonal antibodies Casirivimab and Imdevimab”.

This cocktail recently received emergency-use authorization in the country from the Central Drugs Standard Control Organisation. Drug majors Roche India and Ciplas have priced the antibody cocktail at a steep Rs 59,750 per dose.  

Similar to antibodies which are proteins that the body naturally produces to defend itself against the disease, monoclonal antibodies are artificially created in a lab and tailor-made to fight the disease they treat.  

Casirivimab and Imdevimab are monoclonal antibodies that are specifically directed against the spike protein of SARS-CoV-2, and designed to block the virus' attachment and entry into human cells.  

Scaria also indicated the mutation may be associated with the ability to escape the immune response against the virus.

Allaying fears, immunologist Vineeta Bal noted that while there may be some setback in the use of commercial antibody cocktail due to the new variant, resistance to the therapy is not an indication of higher virulence or severity of a disease.  

“How transmissible this new variant is will be a crucial factor to determine its rapid spread or otherwise,” Bal, guest faculty at the Indian Institute of Science Education and Research, Pune, told PTI.  

She also noted that the quality and quantity of neutralising antibodies, responsible for defending cells from pathogens, generated in the individual infected with the new variant is unlikely to be affected because of the mutation.  

“Thus in individuals catching infection with the new variant, it may not be a matter worth worrying,” she added. 

Pulmonologist and medical researcher Anurag Agrawal concurred.  

“There is no cause of concern due to the new variant in India as of now,” Agrawal, the director of CSIR-IGIB, told PTI.

The scientist said the blood plasma from many fully vaccinated individuals will have to be tested against this variant to determine whether it shows any significant immune escape.  As the Delta variant continues to evolve and acquire new mutations, there is a lot of interest in understanding its evolution. He said SARS-CoV-2 has a nearly constant rate of acquiring genetic variants, and each variant has acquired additional variants in a stepwise fashion.

“Understanding this continued evolution is of great importance in mapping the evolutionary landscape of emerging variants. Largely the virus has tried to optimise for transmission and immune escape by step-wise acquisition of new mutations,” he added 

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News Network
June 24,2021

At least seven cases of Guillain-Barre syndrome – a rare neurological disorder – have been detected by the doctors in Kerala within a month among 12 lakh people who received the Covishield vaccine, prompting them to alert others to watch out for GBS among the vaccine recipients.

“Overall, our experience should prompt all physicians to be vigilant in recognising GBS in patients who have received the ChAdOx1-S vaccine (Covishield in India). While the risk per patient (5.8 per million) may be relatively low, our observations suggest that this clinically distinct GBS variant is more severe than usual and may require mechanical ventilation,” they reported in the Annals of Neurology.

GBS is a rare condition in which the immune system attacks the nerves. The symptoms start as weakness and tingling in the feet and legs. The sensations can quickly spread to the upper body, leading to paralysis in the worst cases.

While the condition may be triggered by an acute bacterial or viral infection, there are treatments available to deal with such medical emergencies.

Out of the seven patients detected by the Kerala doctors, six are women and all of them are 50-70 years of age. They are from Ernakulam, Kottayam and Kannur districts of Kerala where approximately 1.2 million individuals had received the Covishield vaccine as of April 22.

“GBS following vaccination is a rare adverse effect that is likely to be causal. All the seven patients are alive and getting better with treatment,” Boby V Maramattom, the corresponding author of the study and a senior doctor at the department of neurology, Aster Medcity at Kochi said.

The incidence of GBS in India is approximately 6–40 cases per million per year, with a seasonal variation, peaking in the rainy season.

With a denominator of 1.2 million people, the expected cases of GBS per year are approximately seven to 48 annually or between 0.58 to four cases in every four weeks. The reporting of seven GBS cases in 1.2 million people within four weeks (mid March to mid April) marks a 1.4-to-10 fold rise in the incidence of GBS.

“Although the (causative) factors are not completely established, molecular mimicry between viral proteins and human nerve proteins are likely to be a reason,” he said. “It is not completely unexpected with a vaccination but the risk is approximately less than five per million doses.”

A separate team of researchers also reported four such cases from Nottingham in England, an area in which approximately 7,00,000 people received the same vaccine. The frequency of GBS in both the areas was estimated to be up to 10 times greater than expected.

"If the link is causal it could be due to a cross-reactive immune response to the SARS-CoV-2 spike protein and components of the peripheral immune system. The clinicians should be vigilant in looking for this rare neurological syndrome following the administration of Covid-19 vaccines," wrote the authors of the UK report.

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