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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.

The Covid-19 pandemic has made an unprecedented impact on the Indian businesses, particularly small and medium enterprises (SMEs) and startups. According to a joint survey by FICCI and Indian Angel Network (IAN), the pandemic has hit the businesses of around 70% startups.

With uncertainty in the business environment and an unexpected shift in priorities of the government as well as corporates, many startups are struggling to survive, it says.

In a nationwide survey on the 'Impact of Covid-19 on Indian Startups' involving 250 startups, 70% participants said their businesses had been impacted by Covid-19 and around 12% had shut operations.

The survey shows only 22% startups have cash reserves to meet the fixed cost expenses over the next 3-6 months, and 68% are reducing operational and administrative expenses.

Around 30% of the companies said they would retrench employees if the lockdown was extended too long. The 43% startups have already started 20-40% salary cuts over April-June.

Over 33% startups said investors had put the investment decision on hold and 10% said the deals had been scrapped. Only 8% startups had received funds as per the deals signed before Covid-19 outbreak, the survey revealed.

The reduced funding has forced startups to put a hold on business development and manufacturing activities, which has resulted in loss of projected orders.

The survey highlights the need of an urgent relief package for startups, including possible purchase orders from the government, tax relief and swifter tax refunds, and immediate fiscal support measures, including grants, soft loans and payroll grants.

Besides 250 startups, 61 incubators and investors also participated in the survey.

While 96% of investors accepted that their investments in startups had been impacted by Covid-19, 92% said their investments in startups would continue to be low over the next six months.

Around 59% investors said they would prefer to work with the existing portfolio firms in the coming months. Only 41% said they would consider new deals.

"A comparison of priority investment sectors before and during Covid-19 shows 35% investors are now looking at investments in healthcare startups, followed by EdTech, AI/Deep Tech, FinTech and Agri," said the survey.

Around 44% incubators surveyed said their day-to-day operations had been considerably hit by Covid-19. Most incubators are now supporting their portfolio firms by providing them virtual platforms to interact with mentors, investors and industries.

Dilip Chenoy, FICCI Secretary General, said, "The startup sector is stressed for survival at the moment. The investment sentiment is also subdued and is expected to remain so in the coming months. Lack of working capital and cash flows may lead to major layoffs over the next 3-6 months."

Indian startups needed an enabling ecosystem and flow of funds to continue operations, the survey said.

Padmaja Ruparel, President, Indian Angel Network & Co-Chair of FICCI Startup Committee, said, "In these uncertain times, as investors, we must play an important role to provide the Indian startups funding, mentoring and hand-holding support to stay afloat and come out at the other end of this crisis."

To that end, IAN recently announced a debt fund to help IAN portfolio companies raise working capital and ensure business continuity by partnering with debt providers.

This must be replicated on a wider scale, so a larger number of startups are provided the capital support to make it during these tough times, Ruparel said.

Mumbai, Jul 3: In yet another move to keep Chinese technologies companies at bay, the Centre has cancelled the 4G upgradation tender for BSNL as it has decided to come up with fresh specifications for the upgrade process, sources said.

The Department of Telecommunications (DoT) is likely to issue a fresh tender in the next two weeks.

People in the know said that the fresh tender may not allow Chinese companies to participate and that the new tenders that will be floated in the next two weeks will emphasise on Make in India.

As the border tussle with China escalated last month and around 20 soldiers lost their lives, the government had last month asked both BSNL and MTNL not to use equipment of Chinese makers in their upgrading process to 4G facilities.

Huawei and ZTE are the major Chinese telecom equipment makers working with Indian telecom companies and they would be the hardest hit by the decision.

The impact may be felt in terms of the much-awaited 5G trials in the country. After much deliberation, the Centre last December decided to allow Huawei to take part in the 5G trials.

The cancellation of tender for BSNL's 4G upgradation comes after the Centre on Monday banned 59 Chinese apps including TikTok, WeChat and UC Browser.

A statement by the Ministry of Electronics and IT said that the decision was taken since "there is credible information that these apps are engaged in activities which are prejudicial to sovereignty and integrity of India, defence of India, security of state and public order".