Suresh Neramballi - an unsung Mangalurean hero in Kuwait

New Delhi, Jul 3: Accredited Social Health Activists (ASHAs) in Karnataka have emerged as a "crucial pillar in the state's success" in combating Covid-19, the Union Health Ministry said on Friday.

Acknowledging and praising their work, the ministry said they have been actively participating in household surveys in the state, screening inter-state passengers, migrant workers and others in the community for symptoms of the infection,

“Around 42,000 ASHAs have emerged as a crucial pillar in the state's success” in combating Covid-19, the ministry said.

"Recognizing the increased vulnerability of certain population groups to Covid-19, in a one-time survey to identify households with the elderly, persons with co-morbidities, and immune-compromised individuals, about 1.59 crore households were covered," the ministry said in a statement.

ASHAs regularly monitor such high-risk groups in their area with a periodicity of follow-up visits varying from once a day in the containment zones to once every 15 days in other areas, it said.

They also visit the houses of persons complaining influenza-like-illness (ILI) symptoms and severe acute respiratory infections (SARI), besides high-risk individuals who have called the state health department helpline numbers, the ministry said.

ASHAs are a part of the Rural Task Force, headed by Panchayat Development Officer (PDO) at the Gram Panchayat level, for addressing public grievances on both Covid-19 and non-Covid-19 related services.

ASHAs are trained female community health activists selected from the village itself and accountable to it. They are trained to work as an interface between the community and the public health system.

In the urban areas too, they have been at the forefront of dissemination of various awareness activities in fever clinics and swab collection centres in urban areas.

They have also actively screened cases of ILI and SARI in urban areas. They are also part of the screening teams at international and interstate check-posts.

Karnataka has reported 272 Covid-19 deaths and 18,016 cases, according to the health ministry data updated at 8 AM.

Bengaluru, Jun 15: A total of over 4,000 COVID patients have been discharged in Karnataka so far, as the state on Monday reported 213 new cases of coronavirus and two related fatalities, taking the total number of infections to 7,213 and the death toll to 88.

On Monday alone 180 patients were discharged in the state after recovery. As of June 15 evening, cumulatively 7,213 COVID-19 positive cases have been confirmed in the state, which includes 88 deaths and 4,135 discharges, the health department said in its bulletin.

Out of the 2,987 active cases, 2,931 patients are in isolation at designated hospitals and are stable, while 56 are in Intensive Care Units. Among the two deaths were a 65-year-old man from Dharwad, who was the contact of another patient already tested positive.

He was admitted on June 14 at a designated hospital and died the same day. The other was a 75-year-old woman from Bengaluru, diagnosed with ILI (Influenza Like Illness) A known case of Diabetes mellitus and Hypertension , she was admitted on June 13 at a designated hospital and died on June 15.

Out of 213 new cases 103 are returnees from other states, a majority of them from neighbouring Maharashtra, while 23 are those who returned from other countries.

Among the districts where the new cases were reported, Kalaburagi accounted for 48, followed by Bengaluru urban 35, Dharwad 34, Dakshina Kannada 23, Raichur 18, Yadgir 13, Bidar 11, Ballari 10, Koppal 4, three each from Vijayapura, Bagalkote and Shivamogga, two each from Udupi, Haveri and Ramanagara, and one each from Hassan and Davangere.

Udupi district tops the list of positive cases with a total of 1,028 infections, followed by Kalaburagi 944 and Yadgir 822.

Among discharges also Udupi is on top with total of 736 discharges, followed by Kalaburagi 459 and Bengaluru urban 329. A total of 4,49,331 samples have been tested so far, out of which 5,362 were tested on Monday alone.

So far 4,32,346 samples have been reported as negative, out of which 4,738 reported negative today, the bulletin said.

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.