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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.

In a bid to help tackle rise in domestic violence during the social distancing times in India, Twitter on Wednesday launched a dedicated search prompt to serve information and updates from authoritative sources around domestic violence.

Twitter has partnered with the Ministry of Women and Child Development the National Commission for Women in India to expand its efforts towards women.

The search prompt will be available on iOS, Android and on mobile.twitter.com in India, in both English and Hindi languages, the company said in a statement.

Data shows that since the outbreak of Covid-19, violence against women and girls has intensified in India and across the globe.

"We recognise collaboration with the public, government and NGOs is key to combating the complex issue of domestic violence. Accessing reliable information through this search prompt could be a survivor's first step towards seeking help against abuse and violence," said Mahima Kaul, Director, Public Policy, India and South Asia, Twitter.

Every time someone searches for certain keywords associated with the issue of domestic violence, a prompt will direct them to the relevant information and sources of help available on Twitter.

This is an expansion of Twitter's #ThereIsHelp prompt, which was specifically put in place for the public to find clear, credible information on critical issues.

The feature will be reviewed at regular intervals by the Twitter team to ensure that all related keywords generate the proactive search prompt, said the company.

Violence against women and girls across Asia Pacific is pervasive but at the same time widely under reported.

"In fact, in many countries in our region, the number is even greater, with as many as 2 out of 3 women in some countries reporting experiences of violence," added Melissa Alvarado, UN Women Asia Pacific Regional Manager on Ending Violence against Women.

Rekha Sharma, Chairperson, the NCW, said: "With social distancing norms in place, several women are unable to contact their regular support systems. This initiative by Twitter will provide big support to the survivors, who would otherwise be easily isolated without access to relevant information and help".

In a bid to help struggling small businesses in Covid-19 times, Facebook has introduced Shops to help set up a single online store for customers to access on both Facebook and Instagram.

While Facebook Shops is being rolled out from Wednesday, the company will introduce Instagram Shop, a new way to discover and buy products in Instagram Explore, this summer, starting in the US.

The social networking giant also announced that it will invest in features across its family of apps to inspire people to shop and make buying and selling online easier.

"Creating a Facebook Shop is free and simple. Businesses can choose the products they want to feature from their catalogue and then customise the look and feel of their shop with a cover image and accent colours that showcase their brand," Facebook said in a statement late Tuesday.

Any seller, no matter their size or budget, can bring their business online and connect with customers wherever and whenever it's convenient for them.

People can find Facebook Shops on a business' Facebook Page or Instagram profile, or discover them through stories or ads.

"From there, you can browse the full collection, save products you're interested in and place an order — either on the business' website or without leaving the app if the business has enabled checkout in the US," informed the company.

Last month, Facebook announced $40 million in grants for 10,000 small businesses in the US to help them get through these challenging time.

The grants will go to small businesses in 34 locations where Facebook employees live and work.

The company said that in Facebook Shops, users will be able to message a business through WhatsApp, Messenger or Instagram Direct to ask questions, get support, track deliveries and more.

In the future, they will be able to view a business' shop and make purchases right within a chat in WhatsApp, Messenger or Instagram Direct.

Later this year, Facebook will add a new shop tab in the navigation bar, so people can get to Instagram Shop in just one tap.

Facebook said it is making it easier to shop for products in real time.

Soon, sellers, brands and creators will be able to tag products from their Facebook Shop or catalogue before going live and those products will be shown at the bottom of the video so people can easily tap to learn more and purchase.

"We're starting to test this with businesses on Facebook and Instagram, and we'll roll it out more broadly in the coming months," said the company.

Facebook is also working with partners like Shopify, BigCommerce, WooCommerce, ChannelAdvisor, CedCommerce, Cafe24, Tienda Nube and Feedonomics to support small businesses.