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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.

Thiruvananthapuram, Mar 12: In the wake of COVID-19 outbreak, Internet service providers in Kerala have agreed to step up the network capacity by 30 to 40 per cent of the present capacity to meet the demand, especially in view of the spurt in work-at-home mode.

"The decision was made at a meeting of representatives of various telecom service providers in Kerala circle and officials of the Telecommunication Department convened by the Secretary, Electronics and IT, following a direction by Chief Minister Pinarayi Vijayan to look into the issue," said a press release by the IT Department.

The decision will be beneficial for those working in IT institutions. The government has come out with a set of suggestions to avoid social gatherings at public places in view of coronavirus spread. Telecom service providers have assured the government that they are well equipped to face the current situation.

The major part of Internet consumption in Kerala is made available through local servers. Moreover, global Internet traffic is very low as compared to the overall consumption. So, increasing the capacity won't be difficult, service providers informed.

"Complaints regarding the low availability of the Internet due to the spurt in consumption of the Internet can be made to the service providers to their complaint redressal number or inform state government call centre (155300). But complaints regarding the insufficiency in the current network infrastructure should be strictly avoided," said the release.

The IT Department will also demand daily reports from various telecom service providers. By analysing these reports, steps for remedies will be taken after bringing the sudden increase in consumption to the service providers.

Kochi, May 22: During the nationwide COVID-19 lockdown, Kerala recorded the highest number of cyber attacks followed by Punjab and Tamil Nadu, a study by anti-virus software firm K7 Computing said on Thursday.

In a statement issued in Chennai, the company said its K7 Computing's Cyber Threat Report, a comprehensive analysis of cyber attacks during the lockdown has found that Kerala recorded the highest number of cyber attacks during this period. The report analyses various cyber attacks within India during the pandemic and reveals that threat actors targeted the state with COVID-themed attacks aimed at exploiting user trust.

In Kerala, regions like Kottayam, Kannur, Kollam, and Kochi saw the highest hits with 462, 374, 236, and 147 attacks respectively, while the state as a whole saw around 2,000 attacks during the period - the highest thus far in the country.

This was followed by Punjab with 207 attacks and Tamil Nadu with 184 attacks, the company said.

The sudden surge in the frequency of attacks witnessed from February 2020 to mid-April 2020 indicates that scamsters across the world were exploiting the widespread panic around coronavirus at both the individual and corporate level.

These attacks aimed to compromise computers and mobile devices to gain access to users' confidential data, banking details, and cryptocurrency accounts.

The key threats seen during this period ranged from phishing attacks to rogue apps disguised as COVID-19 information apps that targeted users' sensitive data. Phishing attacks were noticed more in Tier-II and Tier-III cities while the metros fared better. Smaller cities saw over 250 attacks being blocked per 10,000 users.

Users from Ghaziabad and Lucknow seem to have faced almost 6 and 4 times the number of attacks as Bengaluru users.

According to the statement, a majority of the recorded attacks were phishing attacks with sophisticated campaigns that could easily snare even the most educated users. These attacks were aimed at heightening users' fears and creating a sense of urgency to take action.

K7 Labs noticed phishing attacks where scamsters posed as representatives of the United States Department of Treasury, the World Health Organization (WHO), and the Centres for Disease Control and Prevention (CDC), the company said.

Users were encouraged to visit links that would automatically download malware on the host computer such as the Agent Tesla keylogger or Lokibot information-stealing malware, infamous banking Trojans such as Trickbot or Zeus Sphinx, and even disastrous ransomware.

Other attacks included infected COVID-19 Android apps like CoronaSafetyMask that scam users with promises of masks for an upfront payment; the spyware app Project Spy; and seemingly genuine apps that are infected with dangerous malware like banking Trojans such as Ginp, Anubis and Cerberus.

"Covid-19 has created an ideal situation for various threat actors to target individuals and enterprises alike. The panic caused by the stringent lockdown measures and rapid spread of this virus has left many people looking for more information on the situation," J. Kesavardhanan, Founder and CEO of K7 Computing was quoted as saying in the statement.

"Threat actors exploit this fear to their advantage and scam users into downloading malicious software and divulging sensitive information like banking codes. The need to be cyber cautious has never been greater. This is more so in the case of corporates who have adopted a work from home policy hurriedly without adequate cyber hygiene. We have seen an increase in attacks on enterprises and SME employees as well," he added.

Such attacks are expected to continue till normalcy returns. Social engineering attacks targeted at winning users' trust will gain momentum.

Healthcare institutions, well-known government offices, and international organisations will continue to be a prime target throughout the pandemic, the statement said.