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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.

Feb 27: With the window to submit comments on India's proposed personal data protection law closing on Tuesday, a period of anxious wait for final version of the Bill started for social media firms.

This comes even as global Internet companies have called on the government for improved transparency related to intermediary Guidelines (Amendment) Rules and allay fears about the prospect of increased surveillance and prompting a fragmentation of the Internet in India that would harm users.

As per the proposed amendments, an intermediary having over 50 lakh users in the country will have to be incorporated in India with a permanent registered office and address.

When required by lawful order, the intermediary shall, within 72 hours of communication, provide such information or assistance as asked for by any government agency or assistance concerning security of the state or cybersecurity.

This means that the government could pull down information provided by platforms such as Wikipedia, potentially hampering its functioning in India.

In the open letter to IT Minister Ravi Shankar Prasad, leading browser and software development platform like Mozilla, Microsoft-owned GitHub and Cloudflare earlier called for improved transparency by allowing the public an opportunity to see a final version of these amendments prior to their enactment.

According to a Business Insider report, Indian users may lose access to Wikipedia if the new intermediary rules for internet and social media companies are approved.

Since the rules would require the website to take down content deemed illegal by the government, it would require Wikipedia to show different content for different countries.

Anusha Alikhan, senior communications director for Wikimedia told Business Insider that the platform is built though languages and not geographies. Therefore, removing content from one country, while it is still visible to other country users may not work for the company’s model.

India is one of Wikipedia’s largest markets. Over 771 million Indian users accessed the site in just November 2019.

Also read: Explained: What is the Personal Data Protection Bill and why you should care

The Personal Data Protection Bill, 2019, which was introduced in Lok Sabha in the winter session last year, was referred to a Joint Parliamentary Committee (JPC) of both the Houses.

The government last month decided to seek views and suggestions on the Bill from individuals and associations and bodies concerned and the last date for submitting the comments was on Tuesday.

Prasad, while introducing the Personal Data Protection Bill, 2019, in the Lok Sabha on December 11, announced that the draft Bill empowers the government to ask companies including Facebook, Google and others for anonymised personal data and non-personal data.

There was a buzz when the Bill's latest version was introduced in the Lok Sabha, especially the provision seeking to allow the use of personal and non-personal data of users in some cases, especially when national security is involved.

Several legal experts red-flagged the issue and said the provision will give the government unaccounted access to personal data of users in the country.

In their submission to the JPC, several organisations also flagged that the power to collect non-personal and anonymised data by the government without notice and consent should not form part of the Bill because of issues regarding effective anonymisation and potential abuse.

"Clauses 35 and 36 of the Bill provide unbridled access to personal data to the Central Government by giving it powers to exempt its agencies from the application of the Bill on the basis of various broad worded grounds," SFLC.in, a New Delhi-based not-for-profit legal services organisation, commented.

The Software Alliance, also known as BSA, a trade group which includes tech giants such as Microsoft, IBM and Adobe, among others said that the current version of the privacy bill pose substantial challenges, including the sweeping new powers for the government to acquire non-personal data, restrictions on data transfers, and local storage requirements.

"We urge the Joint Parliamentary Committee, as it considers revisions to the Bill, to eliminate provisions concerning non-personal data from the Personal Data Protection Bill and to remove the data localisation requirements and restrictions on international data flows," said Venkatesh Krishnamoorthy, Country Manager-India, BSA.

The Personal Data Protection (PDP) Bill, 2019 draws its origins from the Justice B.N. Srikrishna Committee on data privacy, which produced a draft of legislation that was made public in 2018 ("the Srikrishna Bill").

The mandatory requirement for storing a mirror copy of all personal data in India as per Section 40 of the Srikrishna Bill has been done away with in the PDP Bill, 2019, meaning that companies like Facebook and Twitter would be able to store data of Indian users abroad if they so wish.

But the bill prohibits processing of sensitive personal data and critical personal data outside India.

What is more, what constitutes critical data has not been clearly defined.

As per the proposals, social media companies will have to modify their application as they are required to have a system in place by which a user can verify themselves.

So legal experts believe that some system to upload identification documents should be there and something like the Twitter blue tick mark should be there to identify verified accounts.

"The 2019 Bill introduces a new category of data fiduciaries called social media intermediaries ('SMIs'). SMIs are a subcategory of significant data fiduciaries ('SDFs') and will be notified by the Central government after due consultation with the DPA, or the Data Protection Authority. Clause 26(4) of the Bill defines SMIs as intermediaries who primarily or solely enable online interaction between two or more users," SFLC.in said.

"On a plain reading of the definition, online platforms like Facebook, Twitter, YouTube, TikTok, ShareChat and WhatsApp are likely to be notified as SMIs under the Bill," it added.

Mumbai, Jun 27: The Bombay High Court observed that COVID-19 patients from poor and indigent sections cannot be expected to produce documentary proof to avail subsidised or free treatment while getting admitted to hospitals.

The court on Friday was hearing a plea filed by seven residents of a slum rehabilitation building in Bandra, who had been charged ₹ 12.5 lakh by K J Somaiya Hospital for COVID-19 treatment between April 11 and April 28.

The bench of Justices Ramesh Dhanuka and Madhav Jamdar directed the hospital to deposit ₹10 lakh in the court.

The petitioners had borrowed money and managed to pay ₹10 lakh out of ₹12.5 lakh that the hospital had demanded, after threatening to halt their discharge if they failed to clear the bill, counsel Vivek Shukla informed the court.

According to the plea, the petitioners were also overcharged for PPE kits and unused services.

On June 13, the court had directed the state charity commissioner to probe if the hospital had reserved 20% beds for poor and indigent patients and provided free or subsidised treatment to them.

Last week, the joint charity commissioner had informed the court that although the hospital had reserved such beds, it had treated only three poor or indigent persons since the lockdown.

It was unfathomable that the hospital that claimed to have reserved 90 beds for poor and indigent patients had treated only three such persons during the pandemic, advocate Shukla said.

He further argued that COVID-19 patients, who are in distress, cannot be expected to produce income certificate and such documents as proof.

However, senior advocate Janak Dwarkadas, who represented the hospital, said the petitioners did not belong to economically weak or indigent categories and had not produced documents to prove the same.

A person who is suffering from a disease like COVID-19 cannot be expected to produce certificates from a tehsildar or social welfare officer before seeking admission in the hospital, the bench noted and asked the hospital to deposit ₹10 lakh in court within two weeks.