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Newsroom, June 5: The union health ministry has announced new rules for shopping malls which have been permitted to open from June 8, except those falling in containment zones.

The guidelines will come into effect from Monday and cinema halls, gaming arcades and children play areas in these establishments will remain closed.

Here is the complete list of standard operating procedures issued by the ministry to be followed in shopping malls to contain the spread of COVID-19.

•   Thermal screening of all visitors mandatory at entry point, along with compulsory hand hygiene. Only asymptomatic visitors will be allowed to enter the shopping mall .

•  It will be mandatory for all visitors as well as workers to wear face masks at all times inside the mall. 

•  Posters and audio-visual media on preventive measures about COVID-19 should be displayed prominently.

•  Visitor entry to shopping malls should be allowed in a staggered manner and adequate manpower be deployed by mall management for ensuring social distancing norms.

•  All employees who are at higher risk like elderly, pregnant women and those having underlying medical conditions should take extra precautions. They should preferably not be exposed to any front-line work requiring direct contact with the public.

•   Proper crowd management in the parking lots and outside the premises – duly following social distancing norms shall be ensured. Preferably, separate entry and exits for visitors, workers and goods/supplies shall be organised.

•   The staff for home deliveries should be screened thermally by the shopping mall authorities prior to allowing home deliveries and required precautions while handling supplies, inventories and goods in the shopping mall must be ensured.

•   Physical distancing of a minimum of 6 feet, when queuing up for entry and inside the shopping mall should be maintained as far as feasible while the number of customers inside the shop should be kept at a minimum, so as to maintain the physical distancing norms.

•   The number of people in the elevators should be restricted and use of escalators with one person on alternate steps should be encouraged.

•   Number of people in the elevators shall be restricted, duly maintaining social distancing norms. Use of escalators with one person on alternate steps may be encouraged.

•   Effective and frequent sanitation within the premises shall be maintained with particular focus on lavatories, drinking and hand washing stations/areas

•   Cleaning and regular disinfection of frequently touched surfaces  to be made mandatory in all malls in common areas as well as inside shops, elevators, escalators etc.

•   In the food-courts, adequate crowd and queue management is to be ensured and not more than 50 per cent of seating capacity should be permitted.

•   Food court staff should wear mask and hand gloves and take other required precautionary measures, the seating arrangement should ensure adequate social distancing between patrons as far as feasible and tables should be sanitized each time a customer leaves.

•   Gaming arcades, children play areas and cinema halls inside shopping malls shall remain closed.

•   Spitting should be strictly prohibited and installation and use of Aarogya Setu App shall be advised to all.

•   The ministry advised persons aged above 65, those having comorbidities, pregnant women and children below the age of 10  to stay at home, except for essential and health purposes.

Bengaluru, Mar 28: Sun Tsu, in 'The Art of War' speaks of a skilful general who can subdue his enemy without any fighting. This constitutes the ultimate triumph which is referred to as stratagem. Today, we would need one such when we are faced with the '21-day corona challenge' for India.
Nearly four weeks back, Dr Jyothsna Rao, Dr Gururaj Rao and I sat across the OPD in the afternoon at HCG Bengaluru discussing our ongoing cancer immunology research. While on this topic, we drifted into the discussion on the coronavirus. During this engaging discussion, we wondered the similarity of the enigma between the virus and cancer. I paused to ask Dr Jyothsna and Dr Guru - how we wish we could do something against this virus.
Dr Jyothsna is a PhD from NCBS and had worked under Dr Ralph Steinman, physician and researcher from Rockefeller University, who won the Nobel Prize for his discovery of the dendritic cell and its role in adaptive immunity in 2011. Dr Gururaj is a molecular and cell biologist who did his PhD at the Chapel Hill, University of North Carolina and is the Director of iCrest.
Jyothsna while hearing our perplexing conversation on the covid intervened, "Yes, surely. I think we should take a break from cancer and focus on the innate and adaptive immunity role in COVID-19."
Thus began this sincere attempt to relook the human immune system from the eyes of the COVID-19.
We have 10 types of immune cells at the least which are widely dispersed in millions across the body. When our body is invaded by a foreign organism (bacteria, fungi or virus), these cells work with each other to destroy the invader.
Now, the question is - how do the immune cells talk to each other? They use small-molecule substances called cytokines (cyto means cells; kine means movement). There are many cytokines that are involved in work on the immune system. The most relevant for viruses are interferons.
Interferons (IFN) as the name reflects have an ability to interfere with the viral activity and stop their multiplication. These specialised signal proteins are released by our cells in response to a viral attack to forewarn other cells. They help build the antiviral proteins within the cells to kill the virus as it tries to invade the new cells.
Historically, interferons are a group of cytokines known to be potent antiviral agents against viruses and a hallmark cytokine induced by the host upon viral infections. Interferons possess unique immunoregulatory activities and are signature cytokines released by (TH1) T immune cells, which are crucial in viral infections.
As the outbreak of COVID-19 grapples us, an urgent need for finding strategies to combat the virus is growing. Coronaviruses (CoVs) are a group of RNA viruses. In patients infected with coronavirus, it was indicated that the activation of the IFN does not occur until 48 hours post-infection. Thus the delayed IFN-related antiviral response by the healthy cells leads to coronavirus evade the immune response.
Numerous studies have presented the success in defeating CoVs by the direct administration of IFNs. In a combination as a concoction, it was shown to synergistically inhibit the virus replication in vitro.
Moreover, it is understood that the earlier induction of IFNs in children although they have a less developed immune system could be the reason behind the children being least affected.
The key to success in reducing the disease fatality might be the stimulation of the immune responses to trigger IFN production at the very early stages of the disease, which might be done through the administration of IFN. Despite the evidence for the efficacy of IFNs in treating CoV-induced infections, the proper dosing and ideal timing for such interventions needs to be verified in clinical trials.
For the later stages of the diseases in advance stages where patients are on ventilator and have developed respiratory distress, we propose to utilise the mesenchymal cells derived from donor bone marrow that have been known to treat acute respiratory syndrome. Mesenchymal cells are known to possess anti-inflammatory activity and thus used often in autoimmune diseases.
With this scientific background, we have activated T cells from healthy donors, in a cGMP facility at iCrest - HCG hospital with an enriched cocktail of cytokines rich in Interferons. Injections of this cocktail we believe will result in a surge of cytokines in the body of the infected person and will boost his ability to fight the virus in the early phases. We are in the initial phases of this study and hope to be ready in the coming weeks with meaningful data on its potential utility.
Currently, it awaits government approvals (Union and state) and we have applied to central drugs authority for their initial evaluation and further directions.
As my Guru often expounded the philosophy of 'Seva' - the goal of education is knowledge, the end goal of knowledge is service. In this attempt to serve our fellow humans at this brink of unprecedented crisis, medical fraternity stands with you and promises to do our best for your safety.
We assure to exhaust every bit of our spirit in this fight against coronavirus. We have lost the sight of shores and travelled thus far, but that is the mandatory first step to cross the ocean. Are we going to succeed in this battle, is something only time will answer. 

Bengaluru, Apr 8: A 65-year-old man from Kalaburagi district became the fifth COVID-19 fatality in Karnataka, where six new positive cases were confirmed, pushing the tally in the state to 181, the health department said on Wednesday.

The man with Severe Acute Respiratory Infection (SARI), died at a designated hospital in Kalaburagi on Tuesday, a day after being shifted from a private hospital where he was initially treated for two days.

"On April 4, he had got admitted to a private hospital, on April 6 he was shifted to ESI hospital, where he passed away," Primary and Secondary Education Minister Suresh Kumar told reporters here.

The private hospital had been locked and its entire medical team quarantined, he said, adding a notice had been served on it for act of "criminal negligence" (by not referring the patient to designated hospital) and will be followed with a police case.

"He was suffering from SARI, on collecting his sample, tests have revealed that he was positive....investigation is on to find how he got infected," the Minister said.

Noting that the hospital in this case did not refer the patient to the designated hospital and kept treating him for two days, he appealed to all private healthcare facilities to inform authorities if anyone showed any indications for COVID-19.

"As of 5 PM on April 8, cumulatively 181 COVID-19 positive cases have been confirmed in the state, it includes 5 deaths and 28 discharges," the health department said in a bulletin.

Out of the positive cases, 71 are those who had come back from foreign countries, while remaining 110 are contacts and those who had gone to Delhi, the Minister said.

Kumar also said an expert committee comprising Narayana Health founder-chairman Dr Devi Prasad Shetty and Jayadeva Institute of Cardiovascular Sciences director Dr C N Manjunath among others, constitutedto devise an exit strategy for the lockdown, has submitted its reports with various recommendations to Chief Minister B S Yediyurappa.

The chief minister and officials were examining it which was likely to come up before the cabinet meeting on Thursday after which the details will be shared, he added.

The health department said the six fresh cases reported on Wednesday included the elderly man from Kalaburagi who died.

Among the positive cases are a woman from Uttara Kannada with history of SARI and contact of a Dubai returnee, a 72- year-old woman from Kalaburagi, who is mother of a patient that tested positive for the disease; a man from Mandya with contact to two patients.

Others include a man from Chikkaballapura with travel history to Delhi and a woman from Bengaluru also with a travel history to the national capital.

Contact tracing is in progress for all the cases, the bulletin added.

The department said out of 148 active cases in the state, 146 COVID-19 positive patients (including 1 pregnant woman) are in isolation at designated hospitals are stable and two in ICU (one each on oxygen and ventilators).

It said out of total 181 cases in the state, six are transit passengers of Kerala.

Bengaluru accounted for the highest in the state with 63 cases, followed by Mysuru (35), Dakshina Kannada (12) Bidar (ten), Uttara Kannada and Kalaburagi (9 each), Chikkaballapur (8) Belagavi (7), Ballari (6), Bagalkote (5), Mandya (4) Davangere, Bengaluru Rural and Udupi (three each), and Kodagu, Tumakuru, Gadag and Dharwad one each.

Those discharged include 16 from Bengaluru, four from Dakshina Kannada, two each from Uttara Kannada, Kalaburagi and Davangere, and one from Bengaluru Rural; while among those dead are two from Kalaburgari and one each are reported from Bengaluru, Bagalkote and Tumakuru.