SARS-COV-2 | Virus| Flu | Bio-safety | COVID-19 | Chickenpox | Mumps | Influenza

Biosafety cabinet- What it is and different types and how it can be used effectively?

Basically a biosafety cabinet is a micro-biosafety cabinet that is also called a biological safety cabinet, where it is mostly enclosed with ventilated laboratory workspace for pathogens.

The main use is to protect the people working with laboratory pathogens.  All exhaust air has HEPA filters(high-efficiency particulate air) that remove harmful viruses and bacteria. HEPA filters were commercialized in the 1950s.

It is similar to that of the laminar flow chamber, but this blows unfiltered air towards the user and considered to be safe for working with pathogenic agents.

Types of BSLs:

The U.S  Centers for Disease Control and Prevention classified  into four  types

BSL-1	BSL-2	BSL-3	BSL-4
This type of cabinet provides environmental and personal protection but fails to provide product protection. This type is used in case of working with non-causative microbes to humans. Eg: E.coli	This is suitable to work with pathogens that cause moderate harm to the environment and personal. An example includes the HIV virus, hepatitis A, B, C virus.	This type is used in serious pathogens to the environment that includes Mycobacterium tuberculosis, SARS coronavirus. All laboratory workers will be under medical surveillance and must wear personal protective equipment while inside the cabinet.	This is the highest level of safety cabinet. In this highly transmitted pathogens such as Ebola, Nipah, flavivirus work will be taking place. High safety and precautions measures will be taken inside this type of cabinet.

Currently, India has  3 BSL-4 laboratories they are

1. High-Security Animal Disease Laboratory(HSADL), Bhopal
2. Centre for Cellular and Molecular Biology(CCMB), Hyderabad
3. National Institute of Virology, Pune

The COVID-19 is an airborne virus. Let us see what is an airborne virus and different types of it.

Airborne virus: This a type of virus that can be transmitted via aerosols and people get infected.

Different types include

1. Measles:  This virus can stay up to 2 hours in the air and infected people can exhale around 5000 viral particles into an hour. This virus kills around 2,00,000 every year

2. Influenza: This virus is very small and it can stay at least an hour in the air. It is Influenza A that is responsible for Flu in humans. Around 500,000 deaths are due to the influenza virus every year across the globe.

3. SARS-COV-2:   COVID-19 can stay up to 3 hours actively in the air. It varies with different surfaces.

4. Chicken Pox: A herpes virus called Varicella zoster causes chickenpox, it can stay up to several hours in the air. This virus causes a rash that turns into blisters. It takes up to 2-3 weeks for a pox to appear.

5. Swine Flu: This flu is caused by the H1N1 virus that causes a respiratory infection in humans. The droplets spread about 3 feet and remain in the air up to 2 to 8 hours.

6. Mumps: It is caused by the Rubula virus. This virus spread through sneeze and cough. It mostly affects the salivary gland, due to swelling as a result of infection.

7. Rubella Virus: This virus spreads through close contact with an infected person. It causes slight fever, mild rash and swollen glands. Humans are the only host for the rubella virus.

Gilead Sciences | COVID-19 | Remdesivir | Favipiravir | Japan | UK

Drugs enter into Phase III  trials on COVID-19 patients. Any guess on which drug entered into this segment. Yes, it is Favipiravir and Remdesivir that entered into phase 3 of human trials. As this phase is more important for the approval from healthcare authorities. Phase III clinical trials involving around 3000 participants. Selected participants have the condition that the new drug is to treat. This is a phase to evaluate how the new drug works when compared to the existing drugs in the same condition. The developers of Favipiravir(Avigan) have increased the production of antiviral drugs when they announced the phase iii clinical trial to test the safety and efficacy of the drug against COVID-19.

Avigan is approved to manufacture and sell in japan as an influenza antiviral drug. It is manufactured by Fujifilm Toyama Chemical Co.Ltd.

Mechanism of action: Favipiravir selectively inhibits the RNA polymerase of the influenza virus, this polymerase enzyme is necessary for viral replication, once the virus enters into the human host.

How this could be beneficial in COVID-19?

Yes, COVID-19 uses the same principle to replicate and categorized into the same single-stranded RNA virus like influenza. Therefore Researchers believe that Avigan may be effective in treating COVID-19.

Note: Avigan could be used only if the novel or remerging influenza outbreak occurs, and available antiviral drugs are not effective enough.

Avigan’s production and distribution are controlled by Japan's Health, Labor, and Welfare Ministry. It has been distributed in the market in Japan or overseas. Fujifilm is planning to co-operate with domestic and overseas partners to accelerate the production of their antiviral drugs.

Gilead Sciences also announced that it has initiated two phases of III studies to test the safety and efficacy measure of Remdesivir in patients with moderate to severe COVID-19.

Note: These two studies were given Urgent Public Health Research (UPHR) status by UK health authorities.

Researchers say that Remdesivir is an investigational nucleotide analog. It showed broad-spectrum antiviral activity both in vitro and in animal models against different types of emerging viral pathogens. These phase III clinical trials will help to generate crucial data on  safety and efficacy of the drug. The selected locations for phaseIII trials are mostly in the hospital of the UK.

Containers | Drugs | Vaccine | Infections | COVID-19

Risks faced by dead bodies after natural disasters

Most of the microbes do not survive after the human the body dies, but in certain cases, there is a risk to the healthy people after the dead too (Cholera and hemorrhagic).

Healthcare workers who routinely handle these things may have a risk of getting Tuberculosis, Bloodborne viruses( Hepatitis B and C, HIV) and gastrointestinal infections (eg., cholera, E.coli, typhoid/paratyphoid fevers. In the case of gastrointestinal infections, workers may be directly transmitted from feces leaked from dead bodies. In the case of COVID-19, there is no such incidence of transmission after death, since it is a new disease. The main transmission in COVID-19 is through droplets.

Note: The family of the patient can view the dead body at the time of removal with standard precautions.

DNA vaccine enters into human clinical Trials 

This is the second vaccine that enters into human trials for COVID-19.

The U.S based Inovio pharmaceuticals enter into phase 1 human trial after showing prominent results in preclinical studies.

Mechanism of action: INO-4800 DNA vaccine works by injecting a genetically engineered plasmid that enters into the patient cells, that could produce desired and targeted antibodies and fight the infection. The availability of this vaccine in the market would take at least a year.

Note: DNA vaccine has not yet been approved across the globe in human use.

 New Antiviral drug enters into clinical stage

Researchers hope that a new drug called EIDD 2801 could help COVID-19 patients. This drug has been found to reduce lung damage in in-vitro studies. This research is under study by The University of North California.

EIDD-2801 is an orally available form of antiviral compound EIDD-1931. This can be taken as a pill and get absorbed to travel to the lungs. As per in-vitro study data, when this drug was given as treatment  12 or 24 hrs. EIDD-2801 has found to reduce weight and lung damage in mice. If this drug is found to treat COVID-19 in human trials. In future cases, it can also be used to study other pandemic viruses.

Shipping containers to be turned into hospitals for COVID-19 treatment

Since there is a lot of demand for Intensive care units, ship containers are to be converted into two-bed intensive care units. One such earliest design is called RUAGField Hospital, it uses a combination of standard ISO Shipping containers and expandable or foldable containers to build field hospitals. 

Another type of design called Cura ( Connected units for Respiratory Ailments), In this type they use previously used shipping containers to build pop-up shops and co-working spaces. These containers can be shipped to any locations by means of transport. So, this could be ready to support treating patients. Their team got the first prototype to manufacture in Turin, Italy. Italy has 12.5 critical care beds per 100,000 people, while Germany has 29.2 beds per 100,000 people. Whereas researchers estimated that the UK will need 200 beds per million people. 

Some Countries repurposed convention centers and filled with as many as beds as possible. There is a problem in this type, as an intense concentration of contaminated air in these field hospitals, and the second solution is prefabricated hospitals. These prefabricated hospitals have full mechanical ventilation, in addition to negative pressure systems.

Pharmaceutical industry | Drugs | Malaria | Face masks

Drug repurposing, what it is and how it would be beneficial to people. Some of the already approved drugs could be used for treating new diseases. Scientists across the globe are working for the treatment of COVID-19. Drugs used for the treatment of HIV, Arthritis, Malaria are under study.

1. Chloroquine- this has been used for the treatment of malaria in nearly a century.

It is a synthetic version of quinine that exist as natural compounds in the bark of cinchona trees.

Mechanism of action: It slowdowns the entry of virus into the cells, that slows the rate of replication

2. Hydroxychloroquine- it is closely related to chloroquine, it is considered as less toxic for malaria treatment. In some other cases, it can also be used to treat autoimmune diseases(lumps and rheumatoid arthritis). It is available in the market since 1950s.

Mechanism of action:  This works by disrupting the communication between cells in the immune system.

3. Kaletra- it is a combination of two antiviral drugs. Lopinavir and ritonavir used for HIV. This drug is widely available and undergone clinical trials.

Lopinavir- it prevents  viral enzymes from cutting   important proteins(that are key to HIVs reproduction), whereas Ritonavir helps in boosting of lopinavir concentration in cells.

Some study claimed that, no benefits to COVID-19 patients.

4.Remdesivir- This drug was developed to fight against Ebola, But failed to prove effective. But this showed positive results against MERS and SARS. The working of this drug in COVID-19 patients are unclear yet. But some studies showed that it blocks RNA replication during the reproductive stage of coronaviruses.

5.Losartan- it is a hypertension drug that reduces blood pressure by preventing angiotensin(hormone) from binding receptors on blood vessels

6.Favipiravir- It is a flu drug developed in Japan. It showed prominent results in cases of COVID-19. This drug has been used for the treatment of influenza in Japan. In march 2020, this drug has been approved for experimental treatment for COVID-19 patients.

7.Actemra- It is an immunosuppressive drug  that is used to quiet cytokine storms. It has been approved for the treatment of rheumatoid arthritis and juvenile rheumatoid arthritis. It works by blocking cell receptors that bind to interleukin 6. IL-6 is a cytokine that can trigger dangerous inflammatory cascades.

How Bats are not affected by COVID-19

Warning: Do not take those drugs without doctor's prescription.

Ivermectin | CoroFlu | Social distancing | Nasal vaccine | COVID-19

CoroFlu is  COVID-19 nasal vaccine that has been shown safe and efficacy data in humans, during phase 1 and phase2 and clinical trials. Bharat biotech is involved in the development and testing of this vaccine. This is an international collaboration project between the University of Wisconsin-Madison along with Flugen and  Bharat Biotech. Coroflu will be built on the backbone of FluGen’s vaccine candidate known as M2SR. Based on an invention by UW-Madison virologists and FluGen Co-founders(Yoshihiro and Gabriele). This is a self-limiting version of the influenza virus that induces an immune response against the flu.

Is Social distancing is followed only in humans or other species too?

Yes, Animals to have their own strategies of social distancing, for example, infected ants spend most of the time outside their nest, in order to avoid infection to other ants.  

In honey bee hives, infected larvae emit certain chemicals called bee-pheromones. Older bees have the capability to smell these pheromones. So, the older bees will separate the diseased bees from the hives.

The infected bees will take up honey as self antibiotics, if this doesn’t work they self isolate from the group of bees. 

In 1966, a chimpanzee named McGregor had contracted polio. Other members of the group removed from their crew. Once they get cured, they will be welcomed back.

During an infection, sick mice remove themselves from the group. Female mice can smell parasitic infection in the male’s urine.

In aquatic species such as Caribbean spiny lobsters emit certain chemical signals, which can be smelled by fellow lobsters at an early stage of infection. When a virus infects lobsters it takes up o 8 weeks to get infected. Their fellow lobsters avoid them during the first 4 weeks of infection.

In the case of the cow, they self isolate themselves before giving birth to a calf in order to prevent the disease from their calf. Female fish generally prefer parasite-free partners. In this case, they use visual clues and chemical signals to identify infected individuals. This has been observed in Trinidad guppies.

Possible drug identified  by Australian scientists for coronavirus

Ivermectin, An FDA the approved antiparasitic drug has shown good results in vitro against broad range diseases such as Dengue, influenza and Zika virus. Based on the study, available antiparasitic drugs can kill the virus within 48 hours. Now, the next step is to determine the dosage calculation for preclinical and clinical testings. The above study was conducted between Monash University and Doherty institute of infection and immunity.

Ventilators | 3D-printers | FDA | Medical Research | Researchers | COVID-19

Engineers have developed a low cost fully functional ventilators. What is the advantage of this one? This one has adapters that allow 4 to 9 patients to benefit from a single ventilator. This can overcome the shortage of ventilators due to the COVID-19 pandemic. The cost of one ventilator could be less than $300, compared to big ventilators that cost much as $30,000.

When lungs of COVID-19 patients are damaged by a virus, they experience shortness of breath and require ventilators to continue breathing. Researchers from MIT developed an emergency ventilator called E-Vent. The design is an upgraded version of the bag-valve resuscitator. These are operated by hand to help patients with breathing difficulties during emergencies. Until an intervention such as a ventilator becomes available. The researchers devised a mechanical system to squeeze and release the Ambu bag.

A similar system was developed by researchers at Rice University and Metric Technologies. Their prototype was built primarily of 3D-printed and laser-cut parts. Their prototype allows adjusting the rate of air delivery to the lungs of COVID-19 patients.

Another low-cost version called VentilatorPAL was developed by a Dutch company. It comes with a mobile app that allows adjusting air pressure and airflow to the lungs.

Another low-cost open-source ventilator called VentilAid. Most parts can be made anywhere locally with the help of a 3D printer.

Engineers have also developed simple tools to save multiple lives using a single ventilator. Each ventilator is originally designed to be used by one patient at a time. But the new adapters adjust the ventilators to be used by 4-9 patients simultaneously. These adapters can be built using 3D printers.

One of them called VESper has already been approved by FDA for emergencies, These innovative things can save their lives.

The COVID-19 pandemic has led to worldwide shortages of Personal Protective Equipment (PPE), surgical masks, gloves, diagnostics kits, artificial respiratory apparatus like Ventilators, oxygen cylinders, and other appliances. India needs around 38 million masks and 6.2 million pieces of PPE, according to media reports.

This situation has led certain automobile manufacturers such as Tata Motors, Mahindra& Mahindra, Hyundai motor, Honda cars, and Maruti Suzuki to collaborate with the existing ventilators makers.

Maruti is collaborating with AgVA healthcare to rapidly scale-up production of 10,000 ventilators per month. Similarly, Mysuru based medical equipment maker Skanray Technologies is partnering with Bharat Electronics Ltd.

We need to invest more in science and technology-based companies. The Pune based Mylab discovery is one such example to show the scientific talent in a shorter duration. Even though if we want world-class science, a researcher in biotechnology sector earns  almost 40% less on average than data analytics based on publicly available data.

The COVID-19  crisis should reprioritize of medical research in the west. India needs strong public health infrastructure not only to COVID-19 but such as preventing chronic illness, controlling infectious diseases and increasing the frontline healthcare workers and affordability of medicine.

Recession | COVID-19 | Developing countries | Lung Disease | Atrial fibrillation | Diabetes | Asthma | BCG Vaccine

As per the UN trade report, the world economy will go into recession this year with a prediction of trillion dollars due to the Corona pandemic. Before that what is a recession, In terms of economics a recession is a business cycle contraction where there is a decline in economic activity. As a result of this, the consequences may be unemployment, social effects, and business failures. But the report expects the recession in developing countries like China and India will be less. The report does not give detailed information on how China and India will be expected from the economic crisis.

A health condition that may be a risk of death from the coronavirus.

According to the patient's report from Italy, 76.1% of patients had hypertension or blood pressure.

How this is related to COVID-19?

Researchers  assume  that people with heart issues may have weak immune system and this COVID-19 affects the lung that may indirectly affect the heart as well. This coronavirus could have a negative effect on those with a plaque in their arteries.

Diabetes was the second  most common condition, some viruses thrive on higher blood glucose levels and patients had a weak immune system too.

About one-quarter people had atrial Fibrillation. What is Atrial Fibrillation?, According to the American  Heart Association, it is defined as an irregular heartbeat that can lead to stroke, heart failure and blood clots.

Do Cancer patients do get affected?

Yes, About 20% of Italy patients had active cancer in the past five years are been infected with COVID-19. Cancer treatment can impair the respiratory system and reduces the immune levels.

Patients with Lung Diseases such as chronic emphysema and bronchitis are weaker. COVID-19 causes inflammation in the lungs lining and irritation in the nerve around them. It may also cause inflammation in the air sacs that can lead to pneumonia ( lungs filled with fluid). This pneumonia prevents the lungs from getting enough oxygen into the bloodstream.

What about Asthma patients?

People with moderate to severe conditions may have a high risk of getting sick. This COVID-19 affects the respiratory tract that causes an asthma attack and may lead to pneumonia and acute respiratory disease.

Is Cigarette smokers are more prone to  COVID-19 infection?

Yes, tobacco has a huge impact on respiratory health. It is also a factor of Chronic Obstructive Pulmonary Disease ( COPD). Smoking is considered to be a risk for any lower respiratory  tract infection.

Dementia, it doesn’t increase the risk of COVID-19, but the characteristics of the people are being changed. In this list of medical illnesses, chronic liver disease was the least common among the report. People with liver transplants will be undergoing immunosuppressing medications.

U.S  Scientists  expect that Bacillus Calmette – Guerin ( BCG) vaccine administered to millions of Indians children after birth to protect against tuberculosis. This has been found to be a game-changer against COVID-19. But it is too early to say anything, BCG vaccine is the live weakened form of Mycobacterium bovis(causative agent of TB) in cattle.  BCG vaccine has quite effective against SARS infection.

Ventilators | Vietnam | COVID-19 test | Polymerase Chain Reaction | Masks | Infectious Diseases

How do COVID-19 tests work?

There are two types of tests carried out. In the U.S, they use long Q-tip to swab the back of your throat. In developed countries such as china, an antibody test may be carried out from the blood sample. The throat swab is well suited for Polymerase Chain Reaction (PCR).

PCR test works by detecting specific genetic material within the virus. From the sample, nucleic acid will be extracted, which holds the viral genome. Amplification of certain regions of the genome will be done by a reverse transcription-polymerase chain reaction.  A large sample be obtained that is compared to SARS-Cov2. It has 30,000 nucleotides. PCR targets  approximately 100 nucleotides that are specific to SARS-Cov2. These 100 nucleotides include 2 genes in the SARS-Cov2 genome.

A sample is positive if it has both the genes, whereas if both the genes are absent, they are COVID-19 negative. In  Contrast, serological tests look for specific antibodies. If they detect particular antibodies, it is positive. This test has an advantage that it can detect antibodies even the patient gets recovered.

How Vietnam tackled COVID-19?

Vietnam is a densely populated neighbor country of China. It has a low budget for the treatment of coronavirus. In addition to that is has a weak health care system. But somehow they managed to keep the infection rate very low. Vietnam shares 897 miles border with china. But they had 207 cases since the break and no fatalities. During Tet new year, the Vietnam government declared war on the coronavirus. Vietnam does have the capability to fight the outbreak like south Korea.

Ho Chi Minh city’s hospitals have a total of 900 intensive care beds. Based on available resources, Vietnam applied strict quarantine policies. They also tracked different levels of contact with infected persons. These were implemented at an earlier stage. Since the beginning of February, Schools and Universities were closed. Around 3000 businesses have closed in the first two months of 2020.

Does masks really protect form COVID-19?

 Types of masks and respirators

	Face mask ( Cloth or paper masks)	Surgical mask	N95 respirator	Surgical  N95 respirator
Purpose	Prevents  large particles expelled by the wearer from reaching the environment.	To be used as a physical barrier to protect from large droplets of blood or body fluids,	Reduces exposure to very small airborne particles or contaminants. May not protect against sprays and direct liquid splashes.	To be used as a physical barrier from large droplets of blood or body fluids as well as small particles
Filtration efficiency	Not applicable	Bacterial filtration efficiency above 95%	Minimum  95% against  particulate aerosols	Minimum  95% against  particulate aerosols
Fluid resistance	Absent	Yes	Not applicable	yes

Coronavirus: How do ventilators work?

Since COVID-19 mainly affects the lower respiratory tract. Then the illness quickly becomes critical, and the most severe cases must be immediately connected to a ventilator in the intensive care unit.

Artificial respiration can save lives because if breathing stops, the organs are no longer supplied with oxygen. At the same time, the carbon dioxide produced during breathing is no longer exhaled via the lungs. But there is a worldwide lack of equipment.