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.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
Agencies
June 18,2020

New Delhi, Jun 18: Vodafone Idea on Thursday told the Supreme Court that it has incurred Rs 1 lakh crore losses as it insisted it is not in a position to furnish bank guarantees.

A bench comprising Justices Arun Mishra, S. Abdul Nazeer, and M.R. Shah, taking up the adjusted gross revenue (AGR) matter through video conferencing, directed the telecom companies to submit their financial documents and books for the last 10 years.

Asking Vodafone if it was a foreign company, the bench said that how can the company say it would not furnish any bank guarantee.

"What if you fly away overnight in future without paying anything?" it asked.

Senior advocate Mukul Rohatgi, representing Vodafone Idea, denied his client is a completely foreign firm and cited before the bench its tie-ups and investments.

Vodafone owes over Rs 58,000 crore as AGR dues and so far, has paid close to Rs 7,000 crore.

Rohatgi contended before the court that the telecom company is in a tough situation, and cannot furnish any fresh bank guarantee, as profits have eluded the company in past many quarters. He submitted before the bench that Rs 15,000 crore bank guarantees are lying with the government, and his client's losses are over Rs 1 lakh crore.

"I cannot offer any more surety," he informed the bench.

Justice Mishra noted that this is public money and these dues should be recovered. "Do not tell us that you will pay if you were to make profits... the money must come," he noted.

Justice Shah observed that the telecom industry is the only industry which earned during the Covid-19 pandemic. "After all, this money will be used for public welfare", he said.

Rohatgi argued that his client would have to fold up if orders were issued to clear dues tomorrow. "11,000 employees will have to go without notice, as we cannot pay them," he added.

Senior advocate Abhishek Manu Singhvi, appearing for Bharti Airtel, contended before the court that out of Rs 21,000 crore AGR dues, the company has already deposited a sum of Rs 18,000 crore.

He argued that his client has given a bank guarantee, in excess of demand, to DoT, and supported the proposal for phased repayment of remaining AGR dues. He insisted that the company needs to sit down with the government and calculate the dues. Airtel owes Rs 25,976 crore after paying Rs 18,000 crore, as per the government.

Senior advocate Arvind Datar, representing Tata Telecom, informed the bench that his client has paid Rs 6,504 crore in AGR dues so far, and furnishing a bank guarantee may adversely impact investments in the sector.

The total AGR dues are close to Rs 1.5 lakh crore.

The top court will now take up the matter in the third week of July.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
Agencies
March 15,2020

Cybercriminals continue to exploit public fear of rising coronavirus cases through malware and phishing emails in the guise of content coming from the Centers for Disease Control and Prevention (CDC) in the US and World Health Organisation (WHO), says cybersecurity firm Kaspersky.

In the APAC region, Kaspersky has detected 93 coronavirus-related malware in Bangladesh, 53 in the Philippines, 40 in China, 23 in Vietnam, 22 in India and 20 in Malaysia. 

Single-digit detections were monitored in Singapore, Japan, Indonesia, Hong Kong, Myanmar, and Thailand. 

Along with the consistent increase of 2019 coronavirus cases comes the incessant techniques cybercriminals are using to prey on public panic amidst the global epidemic, the company said in a statement. 

Kaspersky also detected emails offering products such as masks, and then the topic became more commonly used in Nigerian spam emails. Researchers also found scam emails with phishing links and malicious attachments.

One of the latest spam campaigns mimics the World Health Organisation (WHO), showing how cybercriminals recognise and are capitalising on the important role WHO has in providing trustworthy information about the coronavirus.

"We would encourage companies to be particularly vigilant at this time, and ensure employees who are working at home exercise caution. 

"Businesses should communicate clearly with workers to ensure they are aware of the risks, and do everything they can to secure remote access for those self-isolating or working from home," commented David Emm, principal security researcher.

Some malicious files are spread via email. 

For example, an Excel file distributed via email under the guise of a list of coronavirus victims allegedly sent from the World Health Organisation (WHO) was, in fact, a Trojan-Downloader, which secretly downloads and installs another malicious file. 

This second file was a Trojan-Spy designed to gather various data, including passwords, from the infected device and send it to the attacker.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.
Agencies
May 30,2020

The GST Council is unlikely to make major changes in the indirect tax structure at its next meeting slated mid June.

A top government source said that the Centre is not in favour of increasing tax rates on any goods or service as it could further impact consumption and demand that is already suppressed due the COVID-19 pandemic and lockdown.

It was widely expected that the GST Council could consider raising tax rates and cess on certain non-essential items to boost revenue for states and the Centre. Several states have reportedly taken an over 80-90 per cent hit in GST collections in April, the official data for which has not yet been released by the Centre.

"The need of the hour is to boost consumption and improve demand. By categorising items into essential and non-essential and then raising taxes on non-essential is not what Centre favours. But, the issue on rates and relief will be decided by the GST Council that is meeting next month," the finance ministry official source quoted above said.

The GST Council is chaired by the Union finance minister and thus the views of the Centre play out strongly in the council meetings.

However, the Council will also have to balance the expectations of the states whose revenues have nosedived after the coronavirus outbreak and wide scale disruption to businesses while they have still not been paid GST compensation since the December-January period.

To the question of wider scale job losses in the period of lockdown as businesses get widely impacted, the official said that the Finance Ministry has asked the labour ministry to collect data on job losses during Covid-19 and is constantly engaging with the ministry to oversee job losses and salary cuts.

On restrictions put on Chinese investment in India, the official clarified that no decision had yet been taken to restrict China through the Foreign Portfolio Investment (FPI) route.

Asked about monetising government debt, the official said that the issue would be looked at when we reach a stage. It has not come to that stage yet.

In the government's over Rs 20 lakh crore economic package, the official defended its structure while suggesting that comparisons with the economic packages of other countries should not be drawn as India's needs were different from others.

"We have gone in more reforms that is needed to give strength to the economy. This is required more in our country," the official source said.

Comments

Add new comment

  • Coastaldigest.com reserves the right to delete or block any comments.
  • Coastaldigset.com is not responsible for its readers’ comments.
  • Comments that are abusive, incendiary or irrelevant are strictly prohibited.
  • Please use a genuine email ID and provide your name to avoid reject.