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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.

Social media platform WhatsApp assured the Supreme Court on Wednesday that it will not roll out its payment services without complying with all payment regulations and norms in the country.

A bench headed by Chief Justice S.A. Bobde and comprising Justices Indu Malhotra and Hrishikesh Roy took up the matter through video conferencing. Senior advocate Kapil Sibal, representing the social media platform, said "WhatsApp Inc makes a statement on behalf of his client that they will not go ahead with the payments' scheme without complying with all the regulations in force."

The statement was made during the hearing of a petition seeking a ban on payment through WhatsApp, as it does not conform to the data localization norms. The top court took the assurance made by WhatsApp on record.

WhatsApp made the statement during the hearing of a plea seeking a ban on its payment service, for not being in line with data localization norms.

In 2018, WhatsApp was granted a beta licence to launch its payment service, but a dedicated and separate app is yet to be launched. A petition was moved in the apex court that WhatsApp's existing model for its payments service should be declared inconsistent with the Unified Payment Interface (UPI) Scheme, as a separate dedicated app has not been offered by the company.

The petitioner NGO, Good Governance Chambers, argued that the National Payments Corporation of India (NPCI) and the Reserve Bank of India (RBI) must change its model on the lines of the UPI payment scheme, and its operations may be suspended until these conditions are met.

The apex court today asked the Centre, Facebook and WhatsApp to file their replies within three weeks and it will take up the matter thereafter. The court noted that the government may process the applications filed by WhatsApp in accordance with the law and there is no stay on the same. Facebook was represented by senior advocate Arvind Datar.

The petitioner argued that lapses have been found in relation to WhatsApp's claims of having a secure and safe technological interface for securing sensitive user data.

In the wake of the gas leak at a factory in Visakhapatnam, the National Disaster Management Authority (NDMA) has issued detailed guidelines for restarting industries after the lockdown and the precautions to be taken for the safety of the plants as well as the workers.

In a communication to all states and union territories, the NDMA said due to several weeks of lockdown and the closure of industrial units, it is possible that some of the operators might not have followed the established standard operating procedures.

As a result, some of the manufacturing facilities, pipelines, valves may have residual chemicals, which may pose risk. The same is true for the storage facilities with hazardous chemicals and flammable materials, it said.

The NDMA guidelines said while restarting a unit, the first week should be considered as the trial or test run period after ensuring all safety protocols.

Companies should not try to achieve high production targets. There should be 24-hour sanitisation of the factory premises, it said.

The factories need to maintain a sanitisation routine every two-three hours especially in the common areas that include lunch rooms and common tables which will have to be wiped clean with disinfectants after every single use, it added.

For accommodation, the NDMA said, sanitisation needs to be performed regularly to ensure worker safety and reduce the spread of contamination.

To minimise the risk, it is important that employees who work on specific equipment are sensitised and made aware of the need to identify abnormalities like strange sounds or smell, exposed wires, vibrations, leaks, smoke, abnormal wobbling, irregular grinding or other potentially hazardous signs which indicate the need for immediate maintenance or if required shutdown, it said.

At least 11 people lost their lives and about 1,000 others were exposed to a gas leak at a factory in Andhra Pradesh''s Visakhapatnam on May 7.

The incident took place after it restarted operations when the government allowed industrial activities in certain sectors following several weeks of lockdown.

The lockdown was first announced by Prime Minister Narendra Modi on March 24 for 21 days in a bid to combat the coronavirus threat. The lockdown was then extended till May 3 and again till May 17.