'Modi can be finished only in the political arena'

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.

Beijing, Jun 18:  Besides washing hands and wearing masks, it is also important to close the toilet lid before flushing to contain the spread of COVID-19, as per a new study.

According to a new study cited by The Washington Post, scientists who simulated toilet water and airflows, have found that flushing a toilet can generate a plume of virus-containing aerosol particles that is widespread and can linger in the air long enough to be inhaled by others. The novel coronavirus has been found in the faeces of COVID-19 patients, but it remains unknown whether such clouds could contain enough virus to infect a person.

"Flushing will lift the virus up from the toilet bowl," co-author Ji-Xiang Wang, who researches fluids at Yangzhou University in Yangzhou, China, said in an email. Wang stressed that bathroom users "need to close the lid first and then trigger the flushing process" and wash hands properly if the closure is not possible. As one flushes the toilet with the lids open, bits of faecal matter swish around so violently that they can be propelled into the air, become aerosolised and then settle on the surroundings.

Experts call it the "toilet plume".Age-old studies have been made to understand the potential for airborne transmission of infectious disease via sewage, and the toilet plume's role. Scientists who have seeded toilet bowls with bacteria and viruses have found contamination of seats, flush handles, bathroom floors and nearby surfaces. This is one reason we are told to wash our hands after visiting the toilet. Public bathrooms are well known to contribute to the spread of viruses that transmit via ingestion, such as the noroviruses that haunt cruise ships. However, their role in the transmission of respiratory viruses has not been established, said Charles P Gerba, a microbiologist at the University of Arizona."The risk is not zero, but how great a risk it is, we do not know. The big unknown is how much virus is infectious in the toilet when you flush it ... and how much virus does it take to cause an infection," said Gerba, who has studied the intersection of toilets and infectious disease for 45 years.

A study published in March in the journal Gastroenterology found significant amounts of coronavirus in the stool of patients and determined that viral RNA lasted in faeces even after the virus cleared from the patients` respiratory tracts. While another study in the journal Lancet found coronavirus in faeces up to a month after the illness had passed.

Scientists around the world are now studying sewage to track the spread of the virus. According to the researchers, the presence of the virus in excrement and the gastrointestinal tract raises the prospect of transmission via toilets, because many COVID-19 patients experience diarrhoea or vomiting.

A study of air samples in two hospitals in Wuhan, China found that although coronavirus aerosols in isolation wards and ventilated patient rooms were very low, "it was higher in the toilet areas used by the patients".The Centers for Disease Control and Prevention (CDC) says it remains "unclear whether the virus found in faeces may be capable of causing COVID-19," and "there has not been any confirmed report of the virus spreading from faeces to a person".For now, the CDC characterises the risk as low based on observations from previous outbreaks of other coronaviruses such as severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). Wang decided to use computer models to simulate toilet plumes while isolating at home, as per Chinese government orders and thinking about how a fluids researcher "could contribute to the global fight against the virus".

Published in the journal Physics of Fluids, the study found that flushing of both single-inlet toilets, which push water into the bowl from one port, and annular-inlet toilets, which pour water into the bowl from the rim's surrounding edge with even greater energy, results in "massive upward transport of virus".

Particles can reach heights of more than three feet and float in the air for more than a minute, it found. The paper recommends not just lid-closing and hand-washing, it urges manufacturers to produce toilets that close and self-clean automatically. It also suggests that toilet-users should wipe down the seat. Gerba, however, said seats should not be a major concern.

Research has found that public and household toilet seats are typically the cleanest surfaces in restrooms, he said, probably because so many people already wipe them off before using them. Also, he said of SARS-CoV-2, the virus that causes COVID-19, "I don't think it's butt-borne, so I don`t think you have to worry."Gerba, who has been studying coronavirus transmission for two decades to investigate the role of a toilet flushing in a SARS outbreak stresses "flush and run" when using a public toilet without a lid. Gerba also said that people should wash hands well post-flushing and use hand sanitiser after leaving the restroom. "Choose well-ventilated bathrooms if possible and do not hang around the restroom in any case," added Gerba.

In an unprecedented crisis despite Prime Minister Narendra Modi assuring the continuation of essential services like food and groceries, online marketplaces like Flipkart and Amazon along with delivery platforms like Bigbasket, Grofers and FreshToHomes hit a major blockade on Wednesday as local authorities shut warehouses and sent delivery boys back, even harassed them.

Millions of people across cities were left helpless at homes as essential items like fruits and vegetables, dairy and milk, meat and fish etc did not reach their doors despite placing orders well in advance. Later, the orders went dry.

While Grofers' warehouse in Faridabad was closed by the local law enforcement agencies, Bigbasket complained that the police stopped its delivery partners and "some of them were even beaten up by for no fault of theirs".

"We are not operational due to restrictions imposed by local authorities on movement of goods in spite of clear guidelines provided by central authorities to enable essential services. We are working with the authorities to be back soon,' Bigbasket tweeted.

In a statement to IANS, Bigbasket said that it will help to have better coordination between the Centre and state, and between the state and local police to "ensure that our delivery vans and bikes don't get stopped by the police. Bigbasket and bb daily are not taking new orders".

Furious people stormed the social media platforms, writing their plight to NITI Aayog CEO Amitabh Kant on Twitter.

"Sir, all e-commerce are down. Believe me I tried everything (Grofers, Bigbasket, Flipkart, Amazon, Big Bazaar), no delivery till 31st March or Server Down or No Service. Need to think how we can enable them through digital India," tweeted one user.

Kant tweeted back to Bigbasket: "They should give me specifics - State & location. I will act on it by getting in touch with concerned authorities & sorting it out. Govt guidelines exempt them. We will ensure that citizens are not impacted".

Kant also responded to Grofers: "Cold storages & Warehouses as well as delivery of all essentials goods including food, pharma thru E-Commerce are exempted under MHA order. I have spoken to CS & DGP, Haryana . They have taken immediate action to ensure that supply chains efficiently function for the citizens".

The subscription-based hyperlocal delivery startup FreshToHome sent messages to its customers, saying that despite the government declaring food delivery as essential, "we are facing hardships in continuing our operations".

"Please bear with us as we are working hard to unblock local authority hurdles," said the FreshToHome team.

Reports later surfaced that the Department for Promotion of Industry and Internal Trade (DPIIT) has initiated talks with the state Chief Secretaries asking them not to restrict movement of people engaged in home delivery of essential items, mentioned in the list of exempted items circulated by the Home Ministry.

Meanwhile, Flipkart said it has temporarily suspended its operations and services - including grocery items. The marketplace has decided to halt all orders from March 25 for all three supply chains -- groceries, non-large goods and large items.

"Flipkart has temporarily suspended orders as we assess the possibilities of operating in the lockdown. We are prioritising the safety of our delivery executives and seeking the support of the local governments and police authorities to meet the needs of our customers as they stay home during this lockdown," Rajneesh Kumar, Chief Corporate Affairs Officer, Flipkart, said in a statement.

E-commerce giant Amazon said the company has to "temporarily stop taking orders and disable shipments for lower-priority products.

"For all pending customer orders on lower-priority products, we are reaching out to customers and giving them a choice to cancel their orders, and receive a refund for prepaid items," said the company.

Witnessing a surge in demand, supermarket chain Biz Bazaar entered the fray, with launching doorstep delivery services in major cities like Delhi, Mumbai, Bengaluru and Gurugram.

However, within no time, Big Bazaar was flooded with calls, forcing the company to issue a statement, saying that "In light of the recent announcement, we are receiving an unprecedented number of requests for doorstep delivery. There could be a delay due to the restrictions on movements".

Already battling massive surge in demand, the online delivery platforms faced other issues too, including zero access to several high-rises across the country which have gone under complete lockdown with all entry and exit gates locked.