COVID-19 patients undergo surgery at increased death risk: Lancet study

News Network
May 30, 2020

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.

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Agencies
March 14,2020

New Delhi, Mar 14: Excise duty on petrol and diesel was on Saturday hiked by ₹3 per litre as the government looked to mop up gains arising from fall in international oil prices.

Special excise duty on petrol was hiked by ₹2 to ₹8 per litre incase of petrol and to Rs 4 incase of diesel, an official notification said.

Additionally, road cess on petrol was raised by ₹1 per litre each on petrol and diesel to ₹10.

The increase in excise duty would in normal course result in a hike in petrol and diesel prices but most of it would be adjusted against the fall in rates that would have necessitated because of slump in international oil prices.

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News Network
June 18,2020

Beijing, Jun 18:  Besides washing hands and wearing masks, it is also important to close the toilet lid before flushing to contain the spread of COVID-19, as per a new study.

According to a new study cited by The Washington Post, scientists who simulated toilet water and airflows, have found that flushing a toilet can generate a plume of virus-containing aerosol particles that is widespread and can linger in the air long enough to be inhaled by others. The novel coronavirus has been found in the faeces of COVID-19 patients, but it remains unknown whether such clouds could contain enough virus to infect a person.

"Flushing will lift the virus up from the toilet bowl," co-author Ji-Xiang Wang, who researches fluids at Yangzhou University in Yangzhou, China, said in an email. Wang stressed that bathroom users "need to close the lid first and then trigger the flushing process" and wash hands properly if the closure is not possible. As one flushes the toilet with the lids open, bits of faecal matter swish around so violently that they can be propelled into the air, become aerosolised and then settle on the surroundings.

Experts call it the "toilet plume".Age-old studies have been made to understand the potential for airborne transmission of infectious disease via sewage, and the toilet plume's role. Scientists who have seeded toilet bowls with bacteria and viruses have found contamination of seats, flush handles, bathroom floors and nearby surfaces. This is one reason we are told to wash our hands after visiting the toilet. Public bathrooms are well known to contribute to the spread of viruses that transmit via ingestion, such as the noroviruses that haunt cruise ships. However, their role in the transmission of respiratory viruses has not been established, said Charles P Gerba, a microbiologist at the University of Arizona."The risk is not zero, but how great a risk it is, we do not know. The big unknown is how much virus is infectious in the toilet when you flush it ... and how much virus does it take to cause an infection," said Gerba, who has studied the intersection of toilets and infectious disease for 45 years.

A study published in March in the journal Gastroenterology found significant amounts of coronavirus in the stool of patients and determined that viral RNA lasted in faeces even after the virus cleared from the patients` respiratory tracts. While another study in the journal Lancet found coronavirus in faeces up to a month after the illness had passed.

Scientists around the world are now studying sewage to track the spread of the virus. According to the researchers, the presence of the virus in excrement and the gastrointestinal tract raises the prospect of transmission via toilets, because many COVID-19 patients experience diarrhoea or vomiting.

A study of air samples in two hospitals in Wuhan, China found that although coronavirus aerosols in isolation wards and ventilated patient rooms were very low, "it was higher in the toilet areas used by the patients".The Centers for Disease Control and Prevention (CDC) says it remains "unclear whether the virus found in faeces may be capable of causing COVID-19," and "there has not been any confirmed report of the virus spreading from faeces to a person".For now, the CDC characterises the risk as low based on observations from previous outbreaks of other coronaviruses such as severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). Wang decided to use computer models to simulate toilet plumes while isolating at home, as per Chinese government orders and thinking about how a fluids researcher "could contribute to the global fight against the virus".

Published in the journal Physics of Fluids, the study found that flushing of both single-inlet toilets, which push water into the bowl from one port, and annular-inlet toilets, which pour water into the bowl from the rim's surrounding edge with even greater energy, results in "massive upward transport of virus".

Particles can reach heights of more than three feet and float in the air for more than a minute, it found. The paper recommends not just lid-closing and hand-washing, it urges manufacturers to produce toilets that close and self-clean automatically. It also suggests that toilet-users should wipe down the seat. Gerba, however, said seats should not be a major concern.

Research has found that public and household toilet seats are typically the cleanest surfaces in restrooms, he said, probably because so many people already wipe them off before using them. Also, he said of SARS-CoV-2, the virus that causes COVID-19, "I don't think it's butt-borne, so I don`t think you have to worry."Gerba, who has been studying coronavirus transmission for two decades to investigate the role of a toilet flushing in a SARS outbreak stresses "flush and run" when using a public toilet without a lid. Gerba also said that people should wash hands well post-flushing and use hand sanitiser after leaving the restroom. "Choose well-ventilated bathrooms if possible and do not hang around the restroom in any case," added Gerba.

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News Network
February 5,2020

Feb 5: Tesla is making Elon Musk a lot richer without paying him a dime.

A blistering stock rally has bolstered the value of CEO Musk's 19% stake in the electric car maker by $16 billion since the start of 2020, to $30 billion.

Tuesday's steep climb in the share price could sweeten Musk's payday under his record-breaking compensation package, which is built on stock options that rely on market value targets. Two milestones have now been achieved that could see Musk unlock options worth $1.8 billion.

The controversial chief executive, who is also the majority owner and CEO of rocket maker SpaceX, recently testified that he did not have a lot of cash as he successfully defended himself in a defamation lawsuit. He previously has taken loans using his Tesla shares as collateral.

Musk does not take a salary, choosing instead a risky options package that envisions the stock market value of Tesla rising to $650 billion over 10 years, a prospect that was derided by some investors when the deal was announced in 2018.

That target now looks less crazy. Shares of Tesla have rallied over 50% since the company posted its second consecutive quarterly profit last Wednesday, which was viewed as a major accomplishment for a company competing against established automotive heavyweights including General Motors Co  and BMW.

Tesla shares have climbed about 400% since early June, helped by the company's better-than-expected financial results and ramped-up production at its new car factory in Shanghai.

On Tuesday, Tesla surged as much as 24% before falling back in the final minutes of the trading session to end the day up 13.7%. That put its market capitalization at $160 billion, almost twice the combined value of Ford Motor and General Motors.

The shares had also rallied on Monday, partly fueled by Panasonic Corp's 6752.T saying its automotive battery venture with Tesla was profitable for the first time.

The options Musk was awarded in 2018 vest incrementally based on targets for Tesla's stock market value and its financial performance. The market capitalization would have to sustainably rise by $50 billion increments over the agreement's 10-year period, with the full package payout reached if the market cap reaches $650 billion, as well as the company's meeting revenue and profit targets.

Musk is on his way to seeing his first two tranches of options vest. He achieved operational targets on revenue and adjusted earnings last year.

The rise in Tesla's market capitalization last month to a target of $100 billion opened the way for Musk's first tranche of options to vest. With Tuesday's surging share price, the market capitalization blew past the second target of $150 billion, opening the way for the second tranche to vest. Tesla's market capitalization must stay at or above each target level for one- and six-month averages for each set of options to vest.

Tesla was valued at about $52 billion when shareholders approved the pay package in March 2018, a time when the company faced a cash crunch, production delays and increasing competition from rivals.

A full payoff for Musk would surpass anything previously granted to U.S. executives, according to Institutional Shareholder Services, a proxy advisor that recommended investors reject the pay package deal at the time.

Musk currently owns about 34 million Tesla shares, and his compensation package would let him buy another 20.3 million shares if all his options tranches vest.

When Tesla unveiled Musk’s package, it said he could in theory reap as much as $55.8 billion if no new shares were issued. However, Tesla has since awarded stock to employees and last year sold $2.7 billion in shares and convertible bonds, diluting the value of the stock.

Musk has transformed Tesla from a niche car maker with production problems into the global leader in electric vehicles, with U.S. and Chinese factories. So far it has stayed ahead of more established rivals including BMW and Volkswagen.

Many investors remain skeptical that Tesla can consistently deliver profit, cash flow and growth. More Wall Street analysts rate Tesla "sell" than "buy," and the company's stock is the most shorted on Wall Street.

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