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May 30: Patients undergoing surgery after contracting the novel coronavirus are at an increased risk of postoperative death, according to a new study published in The Lancet journal which may lead to better treatment guidelines for COVID-19.

In the study, the scientists, including those from the University of Birmingham in the UK, examined data from 1,128 patients from 235 hospitals from a total of 24 countries.

Among COVID-19 patients who underwent surgery, they said the death rates approach those of the sickest patients admitted to intensive care after contracting the virus.

The scientists noted that SARS-CoV-2 infected patients who undergo surgery, experience substantially worse postoperative outcomes than would be expected for similar patients who do not have the infection.

According to the study, the 30-day mortality among these patients was nearly 24 per cent.

The researchers noted that mortality was disproportionately high across all subgroups, including those who underwent elective surgery (18.9 per cent), and emergency surgery (25.6 per cent).

Those who underwent minor surgery, such as appendicectomy or hernia repair (16.3 per cent), and major surgery such as hip surgery or for colon cancer also had higher mortality rates (26.9 per cent), the study said.

According to the study, the mortality rates were higher in men versus women, and in patients aged 70 years or over versus those aged under 70 years.

The scientists said in addition to age and sex, risk factors for postoperative death also included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.

"We would normally expect mortality for patients having minor or elective surgery to be under 1 per cent, but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3%) and elective surgery (18.9%)," said study co-author Aneel Bhangu from the University of Birmingham.

Bhangu said these mortality rates are greater than those reported for even the highest-risk patients before the pandemic.

Citing an example from the 2019 UK National Emergency Laparotomy Audit report, he said the 30-day mortality was 16.9 per cent in the highest-risk patients.

Based on an earlier study across 58 countries, Bhangu said the 30-day mortality was 14.9 per cent in patients undergoing high-risk emergency surgery.

"We recommend that thresholds for surgery during the SARS-CoV-2 pandemic should be raised compared to normal practice," he said.

"For example, men aged 70 years and over undergoing emergency surgery are at particularly high risk of mortality, so these patients may benefit from their procedures being postponed," Bhangu added.

The study also noted that patients undergoing surgery are a vulnerable group at risk of SARS-CoV-2 exposure in hospital.

It noted that the patients may also be particularly susceptible to subsequent pulmonary complications, due to inflammatory and immunosuppressive responses to surgery and mechanical ventilation.

The scientists found that overall in the 30 days following surgery 51 per cent of patients developed a pneumonia, acute respiratory distress syndrome, or required unexpected ventilation.

Nearly 82 per cent of the patients who died had experienced pulmonary complications, the researchers said.

"Worldwide an estimated 28.4 million elective operations were cancelled due to disruption caused by COVID-19," said co-author Dmitri Nepogodiev from the University of Birmingham.

"Our data suggests that it was the right decision to postpone operations at a time when patients were at risk of being infected with SARS-CoV-2 in hospital," Nepogodiev said.

According to the researchers, there's now an urgent need for investment by governments and health providers in to measures which ensure that as surgery restarts patient safety is prioritised.

They said this includes the provision of adequate personal protective equipment (PPE), establishment of pathways for rapid preoperative SARS-CoV-2 testing, and consideration of the role of dedicated 'cold' surgical centres.

Toronto, May 7: Scientists have uncovered how bats can carry the MERS coronavirus without getting sick, shedding light on what triggers coronaviruses, including the one behind the COVID-19 pandemic, to jump to humans.

According to the study, published in the journal Scientific Reports, coronaviruses like the Middle East respiratory syndrome (MERS) virus, and the COVID19-causing SARS-CoV-2 virus, are thought to have originated in bats.

While these viruses can cause serious, and often fatal disease in people, bats seem unharmed, the researchers, including those from the University of Saskatchewan (USask) in Canada, said.

"The bats don't get rid of the virus and yet don't get sick. We wanted to understand why the MERS virus doesn't shut down the bat immune responses as it does in humans," said USask microbiologist Vikram Misra.

In the study, the scientists demonstrated that cells from an insect-eating brown bat can be persistently infected with MERS coronavirus for months, due to important adaptations from both the bat and the virus working together.

"Instead of killing bat cells as the virus does with human cells, the MERS coronavirus enters a long-term relationship with the host, maintained by the bat's unique 'super' immune system," said Misra, one of the study's co-authors.

"SARS-CoV-2 is thought to operate in the same way," he added.

Stresses on bats, such as wet markets, other diseases, and habitat loss, may have a role in coronavirus spilling over to other species, the study noted.

"When a bat experiences stress to their immune system, it disrupts this immune system-virus balance and allows the virus to multiply," Misra said.

The scientists, involved in the study, had earlier developed a potential treatment for MERS-CoV, and are currently working towards a vaccine against COVID-19.

While camels are the known intermediate hosts of MERS-CoV, they said bats are suspected to be the ancestral host.

There is no vaccine for either SARS-CoV-2 or MERS, the researchers noted.

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"We see that the MERS coronavirus can very quickly adapt itself to a particular niche, and although we do not completely understand what is going on, this demonstrates how coronaviruses are able to jump from species to species so effortlessly," said USask scientist Darryl Falzarano, who co-led the study.

According to Misra, coronaviruses rapidly adapt to the species they infect, but little is known on the molecular interactions of these viruses with their natural bat hosts.

An earlier study had shown that bat coronaviruses can persist in their natural bat host for at least four months of hibernation.

When exposed to the MERS virus, the researchers said, bat cells adapt, not by producing inflammation-causing proteins that are hallmarks of getting sick, but instead by maintaining a natural antiviral response.

On the contrary, they said this function shuts down in other species, including humans.

The MERS virus, the researchers said, also adapts to the bat host cells by very rapidly mutating one specific gene.

These adaptations, according to the study, result in the virus remaining long-term in the bat, but being rendered harmless until something like a disease, or other stressors, upsets this balance.

In future experiments, the scientists hope to understand how the bat-borne MERS virus adapts to infection and replication in human cells.

"This information may be critical for predicting the next bat virus that will cause a pandemic," Misra said.

Thiruvananthapuram, Mar 12: In the wake of COVID-19 outbreak, Internet service providers in Kerala have agreed to step up the network capacity by 30 to 40 per cent of the present capacity to meet the demand, especially in view of the spurt in work-at-home mode.

"The decision was made at a meeting of representatives of various telecom service providers in Kerala circle and officials of the Telecommunication Department convened by the Secretary, Electronics and IT, following a direction by Chief Minister Pinarayi Vijayan to look into the issue," said a press release by the IT Department.

The decision will be beneficial for those working in IT institutions. The government has come out with a set of suggestions to avoid social gatherings at public places in view of coronavirus spread. Telecom service providers have assured the government that they are well equipped to face the current situation.

The major part of Internet consumption in Kerala is made available through local servers. Moreover, global Internet traffic is very low as compared to the overall consumption. So, increasing the capacity won't be difficult, service providers informed.

"Complaints regarding the low availability of the Internet due to the spurt in consumption of the Internet can be made to the service providers to their complaint redressal number or inform state government call centre (155300). But complaints regarding the insufficiency in the current network infrastructure should be strictly avoided," said the release.

The IT Department will also demand daily reports from various telecom service providers. By analysing these reports, steps for remedies will be taken after bringing the sudden increase in consumption to the service providers.