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VOLUME 5 ISSUE 3 JULY - SEPTEMBER 2020 INR 100/-

Shakespeare, COVID, and the Plague By Dr. Deepak Chopra Celebrity Author

The Key Strategies to Control the Pandemic by CSIR By Dr. Shekhar C. Mande DG, CSIR

Minding Our Minds During COVID-19: Taking Mental Health “HEAD ON” By Preeti Sudan Secretary, Health and Family Welfare, Govt. of India and The Challenges and Kavita Narayan Possible Solutions of COVID-19

By Dr. Kanuparthi Prasanna Laxmi Readers Feedback A Brief Review on InnoHEALTH Most liked article of the last Issue....

Feedback and Testimonials

Fight Corona IDEAthon & Mega Online To Forge and IC - You guys pulled it off! A first- The session was very informative.we got different Challenge SAMADHAN “ of-its-kind 100% Digital Ideathon. Hats off to options & suggestions by panelists to handle the the whole team. You brought so many Indians COVID19 pandemic. Thanks to the support of It is a huge crowd and immense responses ...u together to synergize on a country-wide problem. the organiser. Debashree Dash guys are managing it well The commitment, the program structure, crisis Nurse Educator Sujith R management was commendable! Cheers to Sri Sathya Sai institute of SRM Medical College Hospital and everyone from your team who worked behind higher medical sciences Research Center the scenes too! India Arjun Ramakrishnan SRM IDT, India Asst. Manager - Innovation Solving Diabetic Retinopathy diagnosis Congratulations to all the teams, mentors and National Life and General Insurance Company through Artificial Intelligence webinar SAOG, Oman not to forget - the organizing teams; you pulled out a great initiative and took it to the logical Thank you for giving me this opportunity to join conclusion - Great! Supporting Nurses & Midwives webinar such an informative webinar like this. I enjoyed a lot and learned a lot hoping for more webinars A loud shout to the Organizing Team - Its not Panel Discussion on Supporting Nurses and in future on different topics. easy to get all this planned, coordinated and Midwives in Pandemic COVID-19 was very executed flawlessly - Hats off! interesting and informative. Yashwant Technohand Atul Bengeri Sheetal Kothare Sales & service Engineer Assistant Professor Director Technovision India Pvt Ltd, India L. T. College of Nursing, AcumenToday, India SNDT Women’s University, India Diabetic Retinopathy webinar was very useful. Thank you all of you. This journey was amazing Working with you all was a good experience, I Speakers presentation was very excellent and found new friends. This is a memorable really appreciate the efforts and the coordination event. by your team. Hemapriya Prabakarane Atul Bengeri Manju Chhugani Professor & Dean Assistant Professor Director Vinayaka Missions College of Nursing, India AcumenToday, India Jamia Hamdard, India

2 Volume 5 | Issue 3 | July-September 2020 EXECUTIVE OPINION COVID-19: Challenges and Opportunities

OVID-19 has thrown a big challenge to mankind but it has also unmasked equally good opportunities. The weaknesses of our system have been unrevealed for us to transform and make it into an efficient system. It has woken up people from slumber and has made Cthem realize their vast potential.

The man made calamities like war bring out many developments and economic opportunities. Japan and Germany flourished after the Second World War, which has brought many newer management principles and development of industries during and after the war. Similarly, Dr. V K Singh challenges due to COVID-19 like importing personal protection equipment (PPE) had led to many textile industries to produce PPE in 60 days and we now produce 4.5 lakh PPE per day and Editor-in-Chief & MD, would be a 60 billion US dollar industry by 2025.We are now second largest producers of PPE InnovatioCuris and have augmented from importer to exporter in just 60 days.

[email protected] The tribals brewing Mahua flowers in central India has been taken as an innovative step to initiate production of alcohol for making sanitisers. The government also realises that there is scope of

tremendous growth in many ideas and these potential prospects must be explored by various economic incentives and schemes.

India now produce 4.5 lakh PPE The gigantic problem of migrant labourers was never perceived until now but their predicament per day and would be a 60 billion “ in the dire situations of nationwide lockdown has forced them to sought solace by traversing US dollar industry by 2025.We the treacherous journey of returning to their hometown in the most inhuman conditions. The “are now second largest producers unemployment and famished folklore’s situation has drawn the attention of the government and of PPE and have the pledge to uplift the livelihood of the labourers has opened the corridors for various schemes augmented from importer to in industrial development and create a platform for their sustainability in their native. This exporter in just 60 days. development would have not been possible if not exposed by pandemic. But do we have to face catastrophe to improve our systems, many things not happened for decades are happening now.

Research and innovations have taken quantum jump to produce healthcare devices by industries, manufacturing of drugs, testing kits and ventilators. It is a big boost to ‘Make in India’ projects. The health system was always neglected but it has now drawn the attention of policy makers to impart integral, qualitative, and affordable healthcare to every individual. It implies improved quality of life, public health and preventive health systems that should be in every one’s mind and is dealt with utmost priority. There’s also positive behaviour change that people are following like hand washing due to awareness created for COVID-19.

We have not taken environment issues, pollution and climatic changes seriously for causing epidemiological hotspots. Our knowledge about COVID-19 is very limited, as there was no treatment and vaccines made available to us for this pandemic. Many conjectures are being analysed. As per WHO, the worst situation is yet to come, are we really prepared though we have done better than many developed countries.

Amidst this unprecedented time, it gives an immense sense of pride for our medical fraternity who took the frontline charge against the novel coronavirus or COVID-19 and treated the infected patients without giving a second thought about the risk assigned to such efforts. We commemorate their efforts and hope that the revolutionary phase of medicine will bring us out from our present precarious situation.

Ideathon and Hackathon have been organised online for the first time in India to resolve problems and provide solutions to handle the COVID-19 pandemic. Many issues that did not attract attention for many years had become reality overnight like Telemedicine guidelines. According to a report by a research company, the e-health sector is expected to become a 16 billion dollar industry by 2020. It also brings side by side issues of Cybersecurity in the health sector whose unpretentious repercussions are still unknown to the healthcare fraternity. GUEST COLUMN Shakespeare, COVID, and the Plague

Written by Dr. Deepak Chopra

ocial isolation gives us time to conditions surrounding him persisted of a higher ideals. examine our lives in a new light, more or less unchanged until the middle suddenly faced with economic of the 19th century. The causes of plague Homo sapiens is the only species that Scollapse, empty streets, current panic and syphilis, and deaths in childbirth started liberated itself from natural evolution, future uncertainty, and death appearing to emerge, and more mundane but and this unprecedented achievement out of nowhere—in other words, the equally life-saving advances occurred in involved one thing only: going beyond. conditions that confronted every person public health, like the first sewer system Not our higher brain but human nature on a daily basis during the lifetime in America, which was built in Chicago in envisioned life independent of physical of Shakespeare. What feels horribly the late 1850s. circumstances. Miraculously, if you peer abnormal to us was routinely normal for at the oldest cave paintings in Europe, him and every member of the human race If humans were simply higher primates such as those in Chauvet-Pont d’Arc, in the 16th century. with very big brains, survival would be France, you don’t see primitive scratching the beginning and end of our story. The from 30,000 years ago. In statistical terms, Shakespeare is just Darwinian model for survival requires another survivor. Unlike his son, Hamnet, only getting enough food and finding You see art. The animals depicted are done who died at 11, Shakespeare didn’t die as a a willing mate so that you didn’t starve with confident, artistic lines that are also child, nor did his mother die giving birth before you were able to pass on your genes scientifically accurate, depicting a wide to him. He also escaped the plague. Ever to the next generation. Nothing much range of Paleolithic creatures precisely since the Black Death swept across the mattered after that momentous event. enough that they can be identified by globe in the 14th century, bubonic plague species. No one knows why sophisticated remained a threat, killing on average one Evolutionists persist in seeing Homo cave paintings suddenly appeared. The to three people in every house where it sapiens through the lens of basic survival, Chauvet depictions lie deep in the darkest struck. In Shakespeare’s lifetime, there but we do all kinds of things to deliberately heart of the caves. No sunlight penetrated, were four plague years, 1582, 1592, 1603, imperil our survival, from taking care of so the painters worked by the quavering and 1607, when London, including its our weak and sick instead of abandoning light of torches. In addition, since the theaters, shut down because of the disease. them, to stockpiling nuclear warheads, animals were not right before them, they Syphilis had arrived in Europe from the just to make sure that total war can erupt worked from memory of how each one New World in 1495, first appearing in a if we feel like it. War, crime, and violence looked. French garrison outside Naples, and it do nothing to improve human genes and quickly infected every level of society. But in fact work against simple survival. This act of going beyond exemplifies a Shakespeare didn’t die of it, either, or of trait that belongs to the human condition, smallpox. He wasn’t murdered in the street But if you put Shakespeare and the plague the trait of creativity for its own sake. In even though there was no London police together, something mysterious emerges. fact, even though the modern world owes force. He couldn’t have been executed as Despite every threat of disease and death, everything to discoveries that improved a witch, not being a woman, although crime, poverty, political oppression, life, the rise of technology and all the the practice was not only current but and religious fanaticism (the Puritans practical benefits it has brought, going growing. Finally, unlike his father, John in Shakespeare’s day railed against the beyond has always happened “in here” Shakespeare, Will’s life and reputation London theaters as ungodly, but luckily before anything could happen “out there.” weren’t ruined overnight due to charges they didn’t shut them down until 1642, Before the first primitive flint blades could brought against him by Queen Elizabeth’s 26 years after his death), not to mention be hacked out, the concept of “tool” and huge network of internal spies. widespread illiteracy, no public sanitation, “weapon” had to come first. And before and no police force, these horrendous a concept can be born, there has to be a As a survivor, Shakespeare stands out circumstances didn’t wipe out creativity, mind capable of concepts. because of his genius, but the horrible discovery, love, compassion, and a vision

4 Volume 5 | Issue 3 | July-September 2020 My point is that you and I, like our for their children, even die for them, in peril for countless people, but it has ancestors, are the product not of because they go beyond their own selfish actually risen the level of self-sacrifice, genetic evolution but the evolution of needs. Any creative hobby is meta, because service, sharing, cooperating for the consciousness. We were liberated from it has nothing to do with surviving. common good, laying down political the Darwinian scheme by self-awareness. antagonisms, seeking a global solution, In other words, we said to ourselves, “I just The higher your vision, the more meta and reflecting upon what really matters. thought of what I’d like to do,” and with you are. Buddha was extraordinarily Those are all meta qualities; they are the combination of awareness, vision, meta, but his followers, seeing the worth perfect examples of going beyond. The and desire, we evolved into the human of his vision, had to be meta or Buddha fact that we can see a future past the condition. The Greek word for beyond is would have preached in the wilderness. devastation of the pandemic is a meta meta, and we should apply it to ourselves Likewise, without metahumans among trait of huge importance. We aren’t human more often. To be human is an expression Jesus’s disciples, Christianity would have without being metahuman. For me, this is of the metahuman. Shakespeare was a perished on the cross. the lasting lesson and the deeper meaning meta-genius, but everyday people are just to be taken away from a terrible time. as meta in their own way. Parents sacrifice The COVID virus has put everyday life

Dr. Deepak Chopra, MD, FACP, founder of The Chopra Foundation, a non- profit entity for research on well-being and humanitarianism, and Chopra Global, a modern-day health company at the intersection of science and spirituality, is a world-renowned pioneer in integrative medicine and personal transformation. Chopra is a Clinical Professor of Family Medicine and Public Health at the University of California, San Diego and serves as a senior scientist with Gallup Organization. He is the author of over 89 books translated into over forty-three languages, including numerous New York Times bestsellers. His 90th book, Metahuman: Unleashing Your Infinite Potential, unlocks the secrets to moving beyond our present limitations to access a field of infinite possibilities. TIME magazine has described Dr. Chopra as “one of the top 100 heroes and icons of the century.”

Evolution of pandemic from Elizabeth era to the Gregorian era and lastly the present era

Volume 5 | Issue 3 | July-September 2020 5 CONTENTS PERSONA The Key Strategies to Control the Pandemic by CSIR 08

Minding Our Minds During COVID-19: Taking Mental Health “HEAD ON” 10 THEME The International Nurses Day Praising, Thanking and Protecting Nurses amid COVID-19 14 TRENDS WELL-BEING Health 2.0: Sustainable healthcare in Latest Innovations 16 COVID-19 pandemic 32

The Challenges and Possible My lockdown days due to Solutions of COVID-19 19 pandemic 35 CSIR lab to Reach OutNorth-East Villages through Entrepreneurship Drive 22 ISSUES Awareness, Usage of mHealth Apps and Consequent Health-Seeking Behaviour Counterfeiting in the times of Corona: How bad Changes Amongst Smartphone faith actors are exploiting the pandemic to boost fraudulent activities 36 Users in India 24 Racial and Ethnic Disparities in Patients with Telemedicine COVID-19 38 Practice Guidelines 28 RESEARCH IIT Delhi develops PPE coverall to avoid COVID-19 infection 46

Scientists develop mobile indoor disinfection sprayer 48

NEWSCOPE Latest News in Healthcare 50 To be a nurse/ nursing is not for everyone/ Beyond the call of duty 55

The New Normal: Analysis of challenges posed by COVID-19 on Indian Healthcare Industry 58

Looking at India’s role at containing COVID-19 outbreak and surge in new infection among denizens 62

6 Volume 5 | Issue 3 | July-September 2020 Subscribe to InnoHEALTH Get easy and early access to magazine innovations in healthcare

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Global Editorial Board Editor-in-Chief Dr. V K Singh Dr. Shailja Dixit, Chief Medical Officer, Scientific Commercialization, Fellow of Health Innovation & Technology Lab, USA Executive Editor Sachin Gaur Dr. Chandy Abraham, CEO, Healthcare Project, ITC Limited, India Editors Alok Chaudhary Dr. Sharon Vasuthevan, Group Nursing & Quality Executive Dr. Brijender Singh Dhillon at Life Healthcare Group, South Africa Dr. Avantika Batish Dr. Sarita Jaiswal, Chief Scientific Officer at Carpere, Nimisha Singh Verma University of Saskatchewan, Saskatoon, Canada Parthvee Jain Printed and Published by Sachin Gaur Associate Editor on behalf of InnovatioCuris Private Limited Dr. Debleena Bhattacharya Printed at InnovatioCuris Private Limited Editor: Sachin Gaur Sr. Designer Neha Prakash DCP Licensing number: F.2.(I-10) Press/2016 RNI: DELENG/2016/69964 Advisors © InnovatioCuris Private Limited Thumbay Moideen, Founder President, THUMBAY Group, UAE All rights reserved. Neither this publication nor any part of it may be Tanya Spisbah, Director reproduced, stored in a retrieval system, or transmitted in any form or by any Australia India Institute, Delhi means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission from InnovatioCuris Private Limited.

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Readers are requested to verify and make appropriate enquires to satisfy themselves about the veracity of the advertisements before responding to any published in this magazine. Sachin Gaur, the Publisher, Printer and Editor of this magazine, does not vouch for the authenticity of any advertisement or advertiser or for any the advertiser’s products and/or services. In no event can the Publisher, Printer and Editor of this magazine/ company be held responsible/liable in any manner whatsoever for any claims and / or damage for advertisements in this magazine. Authors will be solely responsible for any issues arising due to copyright infringements and authenticity of the facts and figures mentioned in their articles. InnoHEALTH magazine is not liable for any damages/copyright infringements.

Volume 5 | Issue 3 | July-September 2020 7 PERSONA PERSONA The Key Strategies to Control the Pandemic by CSIR THEME

Dr. Debleena Bhattacharya, interviewed Dr. Shekhar C. Mande for his valuable insights on the recent pandemic situations and the innovative resolving steps taken by CSIR institutes for COVID-19. TRENDS Q. With a background in life sciences, tracing and monitoring surveillance are what was your first reaction to the the key strategies to control the disease. COVID-19 pandemic? Did you see it In the meanwhile, if some therapies can coming? Do you foresee a second wave be brought to the market, it will be an like they are having in China now? What added advantage. should we do, once we are done with the first wave? Q. How do you see the COVID-19 impact on day to day research at CSIR WELL-BEING Dr. Shekhar C. Mande, currently A. Even before WHO declared Covid-19 labs? Has it given a sense of urgency and the Director General of Council for as a global pandemic, we had initiated mission to your office? Please share any Scientific and Industrial Research discussions in CSIR on the possible relevant projects or interventions in (CSIR) and Secretary, Department mitigation strategies. In fact, we were mitigating the crisis? of Scientific and Industrial Research alarmed as early as February first week, (DSIR), Govt. of India. He holds when I mentioned in a talk given at A. Like all other human endeavors,

ISSUES Doctor of philosophy in Molecular the Firodia Award acceptance, that we research has been affected by the Biophysics, from the Indian Institute live in the SARS-CoV-2 era. We were lockdowns. However, CSIR has attempted of Science, Bangalore. Following his therefore prepared for the pandemic- its best to maintain the laboratories PhD, he joined as Post-Doctoral like situation in early March. Based on with the campus-residing staff regularly Fellow at University of Groningen, the known facts of SARS viruses, we working in the laboratories, within the Groningen, The Netherlands jointly evolved a strategy to deal with constraints of regulatory norms. This and thereafter as Senior Fellow, the situation. The strategy included five alone has given all the sense of urgency University of Washington, Seattle, main pillars: Surveillance, Diagnostics, and mission.

RESEARCH USA. Apart from his vast academic Interventions; Hospital assistive devices experience, he holds a number of and Supply Chain models. CSIR therefore Among the many projects and prestigious fellowships and awards. undertook work on all these five pillars achievements until now, the following The Shanti Swarup Bhatnagar Prize simultaneously. Since the last week of deserve special mention: for Science and Technology, the March, the strategy group of CSIR has • Development of two novel diagnostics highest science award in India, in met every single evening online to discuss kits- CRISPR/Cas based FELUDA kit the Biological sciences category was the day’s developments, and to monitor and RT LAMP kit conferred on him in the year 2005. work on all different fronts. • Many recommendations on NEWSCOPE improving efficiency of diagnostics We do indeed see the disease coming back to ICMR and their subsequent in different waves, and therefore we are implementation against any complacency in the matter. • Initiating clinical trials on Mw, Favipiravir, Arbidol, ACQH- which It is our considered opinion that contact is the first phytopharmaceutical

8 Volume 5 | Issue 3 | July-September 2020 to go into clinical trial in India, and students will also undergo live projects biomedical instrumentation, petroleum four AYUSH formulation mentored by CSIR scientists. etc. CSIR labs can evolve contemporary • Development of PPE’s and bringing technologies which can be implemented their manufacturing capability to a Q. Will the polio/BCG vaccine provide towards this goal. substantial number immunity against pandemic virus? PERSONA • Development of BiPAP ventilator Q. What is your advice to the younger • Development of emergency buildings A. That’s the hypothesis that needs to generation of the country in regard to etc. be tested. Both these are being tested Innovation and Research in the health in clinical trials in the world at different sector? If any assistance is given to them Q. What are innovative pedagogies locations. in this direction. taken by CSIR for Covid 19? Q. The recent clarion call by the PM on A. Health sector will remain a dominant THEME A. Several training programs were “Atma Nirbhar Bharat.” How do you sector as long as humanity survives. It undertaken. More than 200 people were foresee that CSIR labs can contribute in will also continue to evolve in many trained in RT PCR diagnostics. Moreover, this direction for a self-reliant India? different directions. Therefore the recently CSIR has coordinated a large number of opportunities that lie in the summer research training program, where A. CSIR has a major role to play in health sector are innumerable. For the more than 16000 students have enrolled making India import-independent. In younger generation, these opportunities for online training. Some of the selected the many sectors- steel, pharmaceuticals, are there to grab. TRENDS WELL-BEING ISSUES RESEARCH NEWSCOPE

CSIR building in New Delhi, India

Volume 5 | Issue 3 | July-September 2020 9 Minding Our Minds During COVID-19: Taking Mental PERSONA Health “HEAD ON” Written by Preeti Sudan and Kavita Narayan THEME TRENDS WELL-BEING

SETTING THE CONTEXT We are after all a nation of events; paving the path to collective stress, anxiety

ISSUES everyone is connected to everything! No and a rapidly-decelerating state of mental ever in the history of the civilised, other country took to social media as fast health! modern world of the 21st century as India did, not necessarily to reduce the has mankind experienced number or need for physical meetings, The gentle touch of a supportive friend Nsuch a collective sense of vulnerability, celebrations, and gatherings but to or neighbour, a friendly embrace or a forcing us to deal with a dual threat; that provide us with the sources of connections pat on the back for a job well done, the of body and mind. While the effects of for our steady state of cognitive strength wiping of tears from grieving eyes, these COVID-19 on our physical health are by people and their stories that in many are all strict no-no’s in the COVID world!

RESEARCH increasingly documented including risk ways helped us to replenish our collective Little wonder then that we are reminded rates, treatment options, survival rates mental energies! of Mark Twain’s ironic quip, “Out of all and strategies and tips for self-care, the the things I have lost, I miss my mind the unprecedented psychosocial health effects With physical aspect, the implied social m o s t ”. presented by COVID-19 still remains a distancing which has been being enforced step-siblings for the attention it commands globally acted as one of the most effective INDIA’S MENTAL HEALTH of all the concerned stakeholders. ways to deal with the physiological aspect LANDSCAPE As Indians, for centuries, we have prided of the pandemic, the social networking NEWSCOPE ourselves on our ability to deal with almost sauce to mental well-being seems to It is important to understand the equivalent invisible, intangible issues have been forcibly taken away overnight! prevailing context for psychiatric and such as “mental health” by our various Instead, the majority of information psychological issues present in India indigenous ways, the most prevalent and consumed by the people and communities even before the pandemic was upon us powerful tool of them all being our strong has been infused mostly with fear and and to fully acknowledge and deeply social networks. dread of an uncertain future in all aspects, internalise the situation. It’s indeed

10 Volume 5 | Issue 3 | July-September 2020 anxiety disorders being the most common disorders affecting 45.7 million and 44.9 million people respectively. The estimate of the global burden of disease (GBD 2017) also predicts that depression would be the second-leading cause of disability worldwide by 2020. Further, the findings PERSONA of a countrywide National Mental Health Survey 2015-16 by NIMHANS revealed that nearly 150 million Indians needed active mental healthcare intervention while fewer than 30 million were seeking it.

THEME COVID-19 has inadvertently fast-tracked our attention to the ever ticking mental health time bomb. Healthcare workers and COVID-19 suspects have truly borne the brunt of this more than others. The stigma associated with COVID-19 patients is indeed a hapless reflection of the un-informed judgments their family TRENDS The National Institute of Mental Health and are subjected to, every day! Neuro-Sciences (NIMHANS) launched a national The doctors and caregivers, working round the clock and staying away from helpline (080)-46110007) on March 30, 2020 their families, risking their very lives for others are being ostracised from their own to provide counselling on mental health and communities. This instance is sufficient psychosocial issues related to the pandemic enough to discourage and cause stress WELL-BEING even to the most resilient minds. and lockdown, available in several vernacular The role played by collective religious languages, with a dedicated helpline for and spiritual awareness, particularly in COVID-19 healthcare warriors on the frontline. times of adversity cannot be overstated. A study conducted in March 2020, in the Journal of American Medical Association time we spoke about Mental Health, or several major mental health disorders. indicated that absence from weekly ISSUES the lack thereof, as a society; just as we Sadly, even the large majority of qualified, religious service participation could result would empathetically exchange stories well-read Indians, have mostly had a hard in almost a five-fold increase in suicidal of diabetes or hypertension or cardiac time accepting that they/their loved ones attempts. In the initial days of the current disease with friends and loved ones! We may need professional clinical help. pandemic, temples, churches, mosques do not need any more stories of celebrity and other places of solace or worship suicides or other horrific tales of self- The connotation of the word “mental” is remained closed to ensure physical destruction as a result of poor mental often used derogatorily in parlance for distancing. Many of the avenues that we RESEARCH health to motivate us into speaking openly generations has most definitely not helped as a society, young or old, have had at our about this issue and taking positive action. the cause. Somehow, even uttering words disposal to deal with the pressures of the like “depression” or “schizophrenia” feel external world, seem to be less accessible The #1 reason why, unlike physical like anathema to most, as if it’s a deep during this pandemic period. health disorders, there continues to be character flaw. It is scoffed at by loved ones utter denial and iron-clad resistance to as being “weak in mind”, often leading to The weeks, months and possibly years acceptance of a less-than-perfect-state-of finger pointing at negligent parents for ahead, are going to test our resilience, grit, NEWSCOPE mental-health is an appended judgment failing to raise their kids with resilience or adaptability, leadership, compassion and and stigma received from society for such worse still, attribute this to bad karma or generosity of spirit as humankind, all in cases. ancestral unatoned sins. equally high measures. In the hindsight into the future linked to the “new normal” In most western societies, chemical/ A state level report by Indian Council of there is a fear of increasing mental health neural imbalances, genetics, endocrine Medical Research (ICMR), published in issues where issues will be reluctant system functioning and external stress 2017, noted that about one in seven persons adaption to “COVID appropriate” social factors that trigger such responses are in India suffers from mental disorders behaviours, and adjusting to the unlocking well-understood to be the root-cause of of varying severity, with depression and of economic activities may weigh people

Volume 5 | Issue 3 | July-September 2020 11 down more than ever before and possibly weaken already-fragile minds.

WHAT CAN WE DO TOGETHER AS A SOCIETY

As a society, we have come up with many PERSONA creative ways to deal with the inevitability of loneliness and its sequel. The extensive use of digital technologies from places of worship, gym, yoga studios to conducting online activities through virtual workspaces and classrooms have majorly helped in maintaining the THEME physical distance without being socially isolated. Social media networks have ensured check-ins with millions of individuals across the globe, including COVID-19 patients who are recovering alone in hospital beds or in confined home quarantine.

TRENDS and are being uploaded and updated It’s a call to stop viewing ourselves and From a system standpoint, we as a regularly by NIMHANS and the All India everyone else from a prejudiced lens and country have been able to successfully Institute of Medical Sciences (AIIMS) stand together as a nation, as a humanity complete several lakh training of health on the Ministry of Health website www. to help us all recover and move forward. workers across the country by using mohfw.gov.in accessible at “Behavioural Most importantly, it’s a call to quieten the boons of digital learning. Training Health-Psychosocial resources”. the chatter, turn inwards and look within and capacity building resources on rather than externally or at others, for the COVID-19 appropriate behaviours, While the system is committed to doing source of our happiness. anti-stigma and psychosocial health is

WELL-BEING all it can to strengthen the facilities, create a mandatory module on the Integrated manpower and improve the accessibility Government Online Training platform to quality clinical services, this call is to (iGOT), where special response groups the society at large: If judgment is indeed such as police, defence personnel, at the core of this issue, we need to stop Preeti Sudan is a civil servant and an volunteers and students are learning the never-ending performance-reviews of officer of the Indian Administrative via online training content, alongside people for less-than-perfect lives. We need Service who has served federal and healthcare workers. Coordination of state governments at various levels. ISSUES to break the myth that everyone has to be psychosocial professionals and volunteers positive all the time! It is perfectly okay has made it accessible to all districts all to feel sad, angry, annoyed, frustrated, At present, Ms Sudan holds the office of over the nation. The National Institute scared and anxious. Having or expressing Secretary in the Department of Health of Mental Health and Neuro-Sciences feelings doesn’t make anyone a negative and Family Welfare in India’s Ministry (NIMHANS) launched a national person; it simply makes us human. We of Health and has been instrumental in helpline (080)-46110007) on March 30, need to learn to give ourselves and others planning and implementing some of 2020 to provide counselling on mental a break, forgive our follies and be kind to the biggest health initiatives in India. health and psychosocial issues related to RESEARCH ourselves. the pandemic and lockdown, available She has also served as a consultant to in several vernacular languages, with Stop beating yourself up! Everyone makes the World Bank in Washington DC. a dedicated helpline for COVID-19 mistakes, has setbacks and failures. You healthcare warriors on the frontline. don’t come with a book on how to get it A separate online platform https:// right all the time. You will fail sometimes, psychcare-nimhans.in/ has also been set not because you planned to, but simply up for mental health support professionals because you’re human. Failure is a part of

NEWSCOPE Kavita Narayan is a Technical providing counselling services. Several creating a great life”, quotes Les Brown, a Advisor to the Ministry of Health and webinars and videos including stress famous motivational speaker. Family Welfare, Government of India management, social stigma during and state Governments, on Health COVID-19, addressing psychosocial This is a clarion call to open up our hearts human resource strengthening and concerns of healthcare workers and for our minds, and speak up without policy reform. dealing with issues of children and senior fear or shame for ourselves and for one citizens, among others, have been created another about the issues of the mind.

12 Volume 5 | Issue 3 | July-September 2020 ACTION TO

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THEME Praising, Thanking and Protecting Nurses amid COVID-19 TRENDS

Written by Neha Lal

very year on May 12, the International Council of Nurses International Nurses day is the perfect

WELL-BEING (ICN) celebrates the International opportunity to give due recognition to the ENurses Day in remembrance of birth anniversary of Florence Nightingale’s. frontline healthcare official we profoundly The celebration conveys the significant role that nurses play in the society by address as nurses. bestowing their benevolent contributions and health management. with an empathetic disposition and The International Nurses day is also important for nurses as it is based on ISSUES sincere commitment upon the patients in On this International Nurses Day, GCS surge of best health care services. a yearly theme on various dimensions of how to achieve the development Medical College, Hospital & Research Centre, Ahmedabad in association Nurses are the frontline workers against goals. The goal serves as a time-bound with AHPI (Association of Healthcare the pandemic COVID-19. Their earnest achievable blueprint for reducing poverty Providers, India) organized a unique efforts to safeguard the health of the and improving lives. In addition, it program to celebrate the fighting spirit patients amidst medical insurgency provides a once in a year/generational of Nurses & to thank the hard work and deserves due recognition. Around the chance to define what needs to be done to deliver more efficient healthcare contributions of our nurses by exploring RESEARCH world, the nurses are working incessantly some of their daily challenges and to extend the healthcare services to the services. Furthermore, this day provides especially in the decisive circumstances of pandemic patients. an important role in making nurses well informed, advised, encouraged, and COVID-19. International Nurses day is the perfect supported to deliver better works. A unique online panel discussion was opportunity to give due recognition to the arranged on where Nursing Heads from frontline healthcare official we profoundly The theme for International Nurses Day leading Hospitals of Ahmedabad joined address as nurses. This day emphasizes 2020, Nurses: A Voice to Lead – Nursing

NEWSCOPE and interacted with each other and shared the importance of learning, sharing of the World to Health, demonstrates the their views in the view of Nursing Day expertise, and best practice of nursing pivotal role of the nurses in addressing a on various topics such as Challenges care to the ailing patient as it is the care wide range of health challenges which will faced by Nurses – Short-staffing in a that cures the disease apart from the inspire fellow nurses and make the aware hospital setting is a top concern for prescribed medicine. public of their contribution to healthcare

14 Volume 5 | Issue 3 | July-September 2020 PERSONA THEME TRENDS nurses, untrained staff, mental trauma, no Short-staffing in a hospital setting is a top family support to treat the patients during concern for nurses, untrained staff, mental present pandemic scenario, residential societies are imposing restrictions, trauma, no family support to treat the patients bereft of psychological support from family and friends. Academic changes during present pandemic scenario, residential WELL-BEING in nursing profession – Proper training/ societies are imposing restrictions, bereft of examinations/ online courses required, occupational health hazard, workplace psychological support from family and friends. violence like bullying, harassment, odd hours along with double duty, less awareness of infection control practices, skirmishing and combating strength of We take the privilege to salute our nurses facing problems to meet the expectations nurses with a notion of belief that with for all their hard work and dedication of patient, proper coordination between change in the continuing professional especially at the juncture of unprecedented ISSUES personal and professional life, the development program offered totime due to prominence of corona virus. measures taken by the government and practicing nurses many of the key hospitals to support nurses, provide challenges currently faced could be conducive environment with necessary addressed. This, however, would require Neha Lal is a dynamic professional precaution measure, maintaining work- influencing and negotiating skills at with 19 years of experience in managing life balance, preparedness to fight practice, area, and national levels with Hospital operations with a focus on

COVID-19, etc. need to be inculcated in a desire from practice nurses to engage RESEARCH quality healthcare delivery, expertise in the due course of time for the nurses. in leadership and communication skills determining the organization’s mission development. With these inputs, a real & strategic direction as conveyed Eminent Panelists - Sharmistha Nayi change could be achieved which would through policies & objectives.Awarded (Nursing Superintendent, KD Hospital), improve the medical practitioner and with “Mother Teressa Sadbhavna Arti Pandya (Nursing Superintendent, patient satisfaction. It creates an avenue Award” from International Business Shalby Hospital), Sonal Prajapati (Nursing for nurses from different part of the Council, New Delhi for outstanding Superintendent, GCS Hospital), Bhaskar world to unite, use the opportunity to achievements in Healthcare. Have NEWSCOPE Shirahatti (Sr. Manager, HCG Hospital), make contact with front line staff and received many accolades for her Surya Darji (Nursing Superintendent, keeping the aspect of this year’s theme,” dedication towards her work, the latest CIMS Hospital) along with Moderator nurses a force for change – a vital source was received on October 6,2018 for Neha Lal (Sr. GM Ops & HR - GCS for health” augments that nurses are the outstanding achievement as “Certificate Hospital, Secretary – AHPI, Gujarat principle force for the change provided for of Excellence” from International Chapter) participated in this discussion. the nursing care and they are responsible, Institute of Education & Management. In conclusion, Ms. Neha Lal (Moderator) well versed healthcare professionals that is congratulated as well as applauded the every country around the globe needs.

Volume 5 | Issue 3 | July-September 2020 15 TRENDS PERSONA LATEST INNOVATIONS! IIT ROPAR’S INNOVATION TO SANITISE PAPER CURRENCY, GROCERY ITEMS AND DELIVERY PACKAGES THEME

mid the coronavirus situation, a be sanitised by them thereby assuring medium to safeguard ourselves from team of engineers at IIT Ropar safety from COVID-19. The customers COVID-19 infection as the virus has have developed a common are advised not to look directly towards the capability to sustain itself on various Asanitising solution for all purpose work the light as it can be harmful to the eyes. surfaces for few hours after initial contact. i.e. from washing vegetables with warm water to currency notes or wallets. As per the developers, one can put all items SOURCE: www.sciencealert.com

TRENDS To tackle this situation, IITians have like notes, vegetables, wrist watch, wallets, made a trunk-shaped device fitted mobile phones, any paper/document or with ultraviolet germicidal irradiation any delivery package/courier in the trunk technology which works on the same before further use. principle as water purifiers. The device will take 30 minutes to sanitise The team recommends people to place this the items followed by a cooling off period device at their doorsteps or somewhere of 10 minutes before using them.

WELL-BEING close to the entry gate so that all items After the commercialisation of the device, brought from outside including currency it will be available for less than INR 500 per notes, grocery and delivery packages will piece. This device will be an indispensible

HUMAN TEXTILE- THE GAME CHANGER ISSUES

team of researchers at the French crocheting. To create the human textile, sheep’s artery and stop it from leaking. National Institute of Health and researchers cut sheets of human skin cells The same team of researchers had earlier Medical Research have grown into long strips and then wove them into a produced sheets of biomaterial and rolled Ayarn named “human textile” from human yarn-like material which can be fabricated them into artificial blood vessels. skin cells that can be used by surgeons to into a variety of shapes. So far, this yarn The paper was published in the Journal stitch up wounds or assemble implantable has been used by the researchers to stitch Acta Biomaterialis skin grafts. The main advantage of the a rat’s wounds and the wound healed in RESEARCH human textile is that unlike already in use two weeks. They also created a skin graft SOURCE: www.endgadget.com synthetic surgical materials, this does not by using a custom-made loom to seal a trigger an immune response which can complicate the process of healing. These yarns represent a whole new generation of completely biological tissue-engineered products and thus offer a unique level of

NEWSCOPE biocompatibility with the human tissues.

The researchers claim to use these human yarns to sew pouches, create tubes, valves and perforated membranes. The yarn can be used in various textile approaches like braiding, knitting, weaving and also

16 Volume 5 | Issue 3 | July-September 2020 WORLD’S FIRST TRANSPLANT OF LAB-GROWN HEART MUSCLES

t Osaka University, Japan, a team regeneration, eventually promoting As of now many patients lose their lives of scientists have carried out cardiac function. To grow the heart due to non-availability of transplants and

World’s first transplant using lab- muscle in the lab, researchers began with if this research becomes successful and PERSONA Agrown heart muscle cells. In the end of induced pluripotent stem cells (iPS) which proves to be safe for the recipients, this January this first-of-its kind of surgery was are made from an adult’s cells either from approach could be used to ultimately carried out as the first stage of a clinical skin or blood and then reprogrammed eliminate the need for some heart trial, which proved to be successful. back to their embryonic pluripotent state transplants. The pilot surgery was done on a patient which implies that they have the potential suffering from ischemic cardiomyopathy to become many different types of cells. The study appeared in BioNews 1033. which is a resultant condition by the The iPS cells were then encouraged to damage to the heart caused by coronary become the heart muscle cells that were SOURCE: www.inshorts.com THEME heart disease or heart attack. As a result required by the research team. These not enough blood can reach the heart due differentiated heart muscle cells were to narrowed arteries. then placed on small sheets which were a little over 0.1mm thick and ready for In the surgery, the team transplanted a transplantation. man-made sheet of heart muscle tissues

on the damaged areas of the heart. The clinical trial will be conducted over TRENDS It is hoped that the heart cells on the the next three years with ten operations degradable sheet will grow and secrete slated to be done on patients suffering a protein that promotes blood vessel from heart conditions. WELL-BEING ROBOT FINGERS THAT COOL OFF BY SWEATING

n today’s world of Artificial Intelligence Walter R Read professor of engineering. is perforated with extremely small sized and Robotics, who doesn’t want a A 3D printing technique which uses light pores that release the water. The actuators robot which can operate for long hours to cure resins into shapes was used by were able to cool off almost six times

Iwithout reheating? In order to make this the team to create fingers. Then the team faster than fan. Therefore it helps the ISSUES dream a reality a group of researchers led created finger like actuators which were robot fingers to cool off by sweating. The by Rob Shepherd, Professor of Mechanical made from two hydrosol materials that ability to perspire is the Unique Selling and Aerospace Engineering at Cornell retain water and react to temperature. Point of these robot fingers and they will University, USA have taken the first The base layer shrinks when it is exposed revolutionise the change in which robots step in creating robots that can work for to temperatures above 86 Fahrenheit serve human beings. extended durations without overheating. squeezing water into the top layer which

The research team has developed a 3D SOURCE: www.thebetterindia.com RESEARCH printed soft robot muscle which is similar to fingers that can sweat to regulate its temperature.

Overheating of robots is caused due to the inability to control the internal temperature and it has been a challenge NEWSCOPE since the time robots have been invented and used. To overcome this challenge the research team at Cornell University was inspired by sweating mechanism of mammals and ventured the idea with the Lab of Emmanuel Giannelis, to create nanopolymer materials for sweating by

Volume 5 | Issue 3 | July-September 2020 17 ‘MAMAROO SLEEP SELF-CLEANING SMART TOILETS – BASSINET’ – MIMICS THE KIND OF SANITATION INDIA NEEDS PARENTS’ MOVEMENTS TO anitation sector in India needs community customised for the differently-abled to have participation at a very committed level. ramps and handrails and have low operating PUT BABIES TO SLEEP Taking a note of this and extending the costs. One cannot overlook the excellent waste arm of Swachh Bharat Mission, Mayank Midha management done in these toilets. Each toilet

PERSONA S S-based company ‘4moms’ is and Megha Midha started a social enterprise has a bio-digester unit which treats pathogen dedicated for the innovative, easy to named ‘Garv Toilets’, which is an endeavour in sludge and sewer, after disposal the waste use baby products that make life easier to address the growing issues related to public can be used as organic fertilisers by farmers. Ufor parents. With this aim in mind 4moms toilet maintenance in the country. recently exhibited their smart cradle at CES By far Garv has installed 798 toilets across the 2020. The cradle can mimic parents’ cuddles These intelligent toilets are powered by IOT contry which are being used at least 1.4 lakh to lullaby babies to sleep. This technology- and Artificial Intelligence. Manufacturing of times a day. Garv via their vast network and enabled sleep bassinet named “mamaROO”

THEME these toilets is being done in such a way that associations with various NGOs, CSR projects is a smart sleep solution which integrates the the capital expenditure in constructing and and foundations has been able to install their same proven motions of infant seat which aids maintaining them over the years is minimal. toilets in schools, rural areas and cities making the baby to sleep in a safe, secured sleeping These toilets are made from metal enclosures, nearly 18,000 children use these toilets daily. environment. The bassinet moves on the making them essentially indestructible and are The price of these smart toilets ranges between commands of parents as the base stays still equipped with Radio Frequency Identification 2.5 to 4.2 lacs depending on the required and the basket glides up and down and also System (RFID) and IOT Technology. They features by the users. sideways to help babies sleep. The developers are self-sustainable in terms of energy claim that this innovative product will help consumption and waste disposal. All toilet SOURCE: www.cnet.com

TRENDS babies sleep faster and for a longer duration. units work on solar energy which ensures the availability of electricity at all times enabling The cradle comes in five patterns like kangaroo, the automatic features in the toilet running. car ride, rock-a-bye, tree swing and wave These intelligent toilets can self-flush if any of wherein each of the five movements has five the user has skipped to do so and also the jets speeds. The bassinet offers a total of 25 settings. are triggered to clean the floors after detecting The movements have been programmed on the number of people who have used these the basis of natural movements or motions toilets. that parents make when they are trying to

WELL-BEING comfort their babies. There are four voice Each unit has an LED light, an exhaust fan for options including ocean, rain, fan and shush ventilation and sanitary pad vending machine. and vibration settings alongwith a timer. The USP of these prefabricated toilets is that 4moms application can be connected to this they give real-time updates on the use of these smart baby gear. This bassinet was launched in toilets, hygiene behaviour of users, can be the market in the month of February 2020 at a price of $330.

ISSUES BATH MAT TO MEASURE YOUR WEIGHT, POSTURE AND EVEN YOUR SHOE SIZE t Consumer Electronics Show (CES) pressure mapping to help the users find out the detect body composition, body fat percentage 2020 an innovative bath mat has been users posture score and even suggest corrective and much more at a price of $ 179 per piece. unveiled by the name of “MATEO”. The exercises based on expertise from a podiatric The simpler models will be priced lesser than Abathroom mat is a smart one as it captures and medicine panel. The company also claims that $ 179. tracks health data of its user including weight, the mat can detect certain medical problems SOURCE: www.endgadget.com posture and body composition. Mateo has like diabetic foot. RESEARCH been named a CES 2020 Innovation Awards Honouree in the Health and Wellness category. The bathroom will capture the above data every time the user stands on it and it can analyse the The bathroom mat has two parts, the first, is readings immediately. The Mateo companion a machine washable cloth covers which looks application comes along with the mat and it like a garden-variety bath mat and the second, will alert the user when he/she reaches any and is a slim mat that includes the technology meaningful numbers regarding weight gain or Compiled by: to detect the metrics of the user. The mat has loss or improved posture. Dr. Avantika Batish, working as the NEWSCOPE medical grade 7000-dot pressure mapping. The Director Strategy and Healthcare at unique feature it holds includes its ability to The demonstrative mats exhibited at CES were International Health Emergency Learning identify its users by their footprint and create early prototypes and the company intends and Preparedness. She imparts her a heat map that studies the contact of the foot to launch a crowdfunding campaign in the knowledge as a guest faculty for MBA with the ground. coming months along with the launch of (HR) and MBA Healthcare Management The developers have expressed that their several iterations by the end of 2020 including B-Schools along with training in soft skills. patent-pending technology can utilise the a high-end mat with conductive thread to

18 Volume 5 | Issue 3 | July-September 2020 The Challenges and Possible

Solutions of COVID-19 PERSONA Written by Dr. Kanuparthi Prasanna Laxmi

OVID-19 cases in India have seen a World Health Organization and UNAIDS (SII), which is the world’s largest maker of dramatic surge in the past 2 weeks has estimated that in sub-Saharan Africa, vaccines by volume, has partnered with following Lockdown 3.0 which has disruption of antiretroviral therapy for Oxford University to produce up to 60

Ceased restrictions in many zones. In his AIDS-related illnesses could lead to million doses of a potential vaccine. At the THEME address to the nation on May 12, 2020, more than 500,000 extra deaths in 2020– same time, the challenges, hard work that the Prime Minister of India, Mr. Narendra 2021 if efforts are not made to relieve need to be promptly developed, assessed Modi announced an overall economic the disturbances in health services and and produced are at present scale are package worth Rs. 20 lakh crores apart supplies during the pandemic. In 2018, an enormous. The evaluation of wide range from highlighting the realization of self- estimated 470 000 people died of AIDS- of vaccines will bring a breakthrough in sufficiency for the country at a time when related deaths in the region. viability. The case-by-case evaluation of the pandemic has brought the economy COVID-19 vaccines, pre-clinical data, TRENDS to a standstill. As of May 13, 2020; 3,604 According to the categorization of safety profile and immunogenicity of new cases and 87 deaths were recorded COVID-19 strategic preparedness and a vaccine along with data on its shelf- and number of cases rose to 74,281 response plan by WHO for various life, stability, parenteral administration while the death toll hit 3,225, according countries as updated on May 7, 2020, India dosages that would be required along with to Worldometer. India at present is the stands at level-3 where, the operational the availability are the key factors that 11th most affected among 187 countries readiness index (levels 1-5) was aligned would be considered. Also, five hospitals, with coronavirus cases. Though blistering with the WHO SPAR benchmarks the B. J. Medical College and Civil hospital WELL-BEING number of cases are being registered on capacity levels: Level 1 ≤20%, Level 2 from Ahmedabad and Apollo Hospital in daily basis, union health minister Dr. ≤40%, Level 3 ≤60%, Level 4 ≤80%, and Chennai, AIIMS in Jodhpur and Bhopal, Harsha Vardhan claimed our recovery Level 5 >80%. This data will be updated rate is at 31.7% while our Nation’s periodically through capacity and risk mortality rate is at 3.2%, the lowest in the assessments based on the evolving world when global fatality rate is around COVID-19 situation. The categorization 7-7.5%, the minister says. itself takes into consideration additional factors relevant for managing the risk of Globally over 43 lakh cases have been COVID-19. Henceforth, it is important for ISSUES tested positive for this pandemic in as us to focus on containment efforts, ensure many as 213 countries and in current we don’t reach community transmission situation, many countries have taken stage, says health ministry. stringent measures to slow down the spread of SARS-CoV-2, virus responsible The accessibility of a safe and effective for COVID-19. In the Superpower nation, vaccine for COVID-19 is an inevitable United States of America, the virus has tool to contribute to the control of the RESEARCH forced significant shut downs across the pandemic. ICMR has teamed up with economy with stock markets plunging Bharat Biotech International Limited and share prices dropping. On March 25, (BBIL) for developing COVID-19 vaccine 2020, nine European countries—Italy, and the vaccine will use the virus strain France, Belgium, Greece, Portugal, Spain, isolated at the National Institute of Virology Ireland, Slovenia and Luxembourg— (NIV), in Pune. The strain has been called for “corona bonds” in order to effectively transferred from NIV to BBIL. NEWSCOPE support their countries to recuperate from Furthermore, the Serum Institute of India the epidemic. According to UNICEF over 19 million children living in displacement within their own countries due to violence The accessibility of a safe and effective vaccine and conflict in 2019 which had severely affected due to limited availability of water for COVID-19 is an inevitable tool to contribute and food resources amidst the COVID-19 to the control of the pandemic. crisis. A modelling group convened by the

Volume 5 | Issue 3 | July-September 2020 19 PERSONA THEME TRENDS WELL-BEING

have so far been approved to conduct Equipment”. Besides the facility based past 14 days stands at 10.9 days, while randomized controlled clinical trials on surveillance, Indian Council for Medical over the past three days, the doubling rate four treatment protocols — remdesivir, Research and National Centre for Disease has further increased to 12.2 days. combination of lopinavir and ritonavir, Control (ICMR &NCDC) in collaboration hydroxychloroquine and lopinavir and with significant participants and state Further, if lockdown is relaxed in ISSUES ritonavir with Interferon beta-1a under health departments have introduced a India, places of religious gathering WHO’s solidarity Trial to find an effective population based sero-survey in selected such as temples, mosques and churches treatment for COVID-19. Over 100 districts representing the case detection can emerge as potential clusters for countries are working together to find across the country. India has successfully coronavirus transmission as community effective therapeutics as soon as possible, strengthened its daily capacity to test gatherings for celebrating festivals and via the Trial, according to the WHO COVID-19 samples to over a lakh tests a marriages are widely acceptable norms. website. day. The development was made public by Coronavirus is expected to present the Union Minister of Health and Family both opportunities and challenges to RESEARCH In fight against the COVID-19 various Welfare Dr Harsh Vardhan. He also shared Indian pharmaceutical manufacturers. steps taken were already successful. that the total number of government-run Nation’s overdependence on China Aarogya Setu app which is currently being laboratories conducting testing activity for Active Pharmaceutical Ingredients used by over 9.85 crore Indians will alert across the nation has reached over 347, (APIs) disclosures it to raw material the person using it to recognize potential while another 137 private laboratories are supply disruption and price volatility COVID-19 positive cases once in close also carrying out the testing. The number according to a report from the Ministry of proximity along with alerts complemented of Covid-19 tests in India is close to the 20 Commerce and Industry (MCI). Further

NEWSCOPE by instructions on how to self-isolate and lakh mark, with the total number of tests medical challenges include matching to-do list in case the person develop the already performed having surpassed 17, Personal Protection Equipment demand symptoms. Also guidelines are updated 62,840. Whereas, the national doubling and supply, production of reusable anti- on rational use of “Personal Protective rate of the total COVID-19 cases in the viral masks; predicting and identification

20 Volume 5 | Issue 3 | July-September 2020 ICMR has teamed up with Bharat Biotech Dr. Kanuparthi Prasanna Laxmi, Ph.D International Limited (BBIL) for developing in Biotechnology from CSIR- Indian Institute of Chemical Technology. She PERSONA COVID-19 vaccine and the vaccine will use the has an extensive laboratory research experience in peasts management in virus strain isolated at the National Institute of plants, plant- insect interactions and Virology (NIV), in Pune. their defense strategies, biological control and the impact of bio- nanoparticles on the plant, soil and of potential hotspots; bed availability and retested if they have tested negative prior, pest insects. Her effective verbal and

COVID case management solutions for including community cases with upper THEME written communication skills are well hospitals. respiratory tract infections along with documented in her peer reviewed patients exhibiting influenza symptoms publications and presentations at India should further expand the to identify suspected cases and keep various conferences. She is proficient surveillance based on trends of the performing treatment in isolation wards. in statistical techniques, editing and epidemic besides should extend its proofreading of manuscripts. laboratory testing capacity. People Source: The tribune, WHO, UNICEF, belonging to higher risk groups should be India.com TRENDS WELL-BEING ISSUES RESEARCH NEWSCOPE

Volume 5 | Issue 3 | July-September 2020 21 CSIR lab to Reach Out North-East Villages through PERSONA Entrepreneurship Drive

Written by Umashankar Mishra THEME orth-East Institute of Science and He was addressing the CSIR-NEIST missions of the institute to facilitate Technology (NEIST) will make fraternity on the occasion of the National innovation and entrepreneurship in all possible efforts to reach out Technology Day through e-mode. the region. NEIST, based out of Jorhat, Nto about 500 villages of north-east India Assam, and a constituent laboratory of through its various entrepreneurship Some of these programmes include the Council of Scientific and Industrial and skill development programmes in CSIR-AROMA Mission, Rural Women Research (CSIR), has taken up this the aftermath of COVID-19 pandemic. Technology Park, Science and Technology initiative in concurrence with institute’s TRENDS This information has been given by Dr. G Interventions in the North-East Region theme “Year of Revitalizing NEIST for Narahari Sastry, Director of the institute. (STINER) and other similar societal Strengthening North East” for the year 2020.

‘Rebooting the Economy through Science, Keeping in tune with the national theme for the day that is ‘Rebooting the Technology and Research Translations Economy through Science, Technology acronymed as ‘RESTART’, the institute had and Research Translations acronymed WELL-BEING as ‘RESTART’, the institute had lined- lined-up its various activities for the National up its various activities for the National Technology Day. Notable among these Technology Day. was the entrepreneurship development programme for rural women under ISSUES RESEARCH NEWSCOPE

22 Volume 5 | Issue 3 | July-September 2020 the STINER project. The programme and assured that NEATEHUB (AIC- “The optimal use of technology depends was attended by 10 aspiring women AAU) is ready to provide all necessary on what use we put it in and accordingly it entrepreneurs from CSIR-NEIST colony support in CSIR-NEIST endeavor on can be a boon or a bane. Our aim should apart from online participation of other societal entrepreneurship. Dr. Mantu be to serve the society by positive and entrepreneurs from all over the state Bhuyan, Principal Scientist and Principal constructive intervention of science and PERSONA of Assam along with CSIR-NEIST staff Investigator of the STINER project, technology. In the wake of COVID-19 members. elucidated on the scope and opportunities pandemic, people are looking forward available under the project for budding to the scientific community with high “Social entrepreneurship oriented towards entrepreneurs and underscored the expectations and we need to uphold by the social, cultural and environmental technical facilities such as incubation living up to their expectations”, said Dr. needs of the society will be in great and training facilities that would be made Sastry. demand in the aftermath of COVID-19 accessible to the needy. Credit: India Science Wire pandemic in the nation”, said Dr Danish THEME Tamuly, Director on Board of North-East Agriculture Technology Entrepreneurs “Social entrepreneurship oriented towards Hub (NEATEHUB), Atal Incubator Centre (AIC) of Assam Agriculture the social, cultural and environmental needs University (AAU). He exemplified the importance of innovative ideas in of the society will be in great demand in churning out a profitable venture. the aftermath of COVID-19 pandemic in the TRENDS CEO, NEATEHUB of AIC-AAU, Dr. nation”, said Dr Danish Tamuly Karthikeyan emphasized on the changing scenario in the business ecosystem WELL-BEING ISSUES RESEARCH NEWSCOPE

Volume 5 | Issue 3 | July-September 2020 23 Awareness, Usage of mHealth Apps and Consequent PERSONA Health-Seeking Behaviour Changes Amongst Smartphone THEME Users in India Written by Dr. Sanjiv Kumar Dixit and Shikha Gill TRENDS WELL-BEING ISSUES

RESEARCH obile health (mHealth) solutions of apps has allowed significant growth the term ‘mHealth’ refers to public health have become an integral of smartphone applications that can and clinical activities involving mobile component of the healthcare be used for change in health seeking devices like smartphones. Mlandscape. mHealth apps offer health behaviour. The use of mobile computing related information and services which has exploded and reached the commercial mHealth has attracted researchers from are accessible to patients both at home industry and mainstream consumers via various fields, and the number of research and on-the-go. Increasing smartphone smartphones, mobile phones and tablets. publications has increased. However, access has catalysed the development According to Gartner Inc., worldwide to the best of my knowledge, very few NEWSCOPE and use of smartphone applications mobile connections will grow up to literatures have reported on trends, (apps). Mobile health interventions have 20.4 billion by 2020 in India. In a recent opportunities and challenges of mHealth previously relied on voice or text-based example, Apple launched new mobile apps in India. This study investigates short message services (SMS), however, features on the Apple watch 4 that can the use of mobile health applications on the increasing availability and ease of use track the ECG of the person. In this study, tablets or smartphones for change in

24 Volume 5 | Issue 3 | July-September 2020 PERSONA THEME TRENDS

and multiple choice answers and likert- The use of mobile computing has exploded scale-styled questions. The researcher

and reached the commercial industry and conducted an online population-based WELL-BEING survey of 250 people aged 18 or older mainstream consumers via smartphones, by using a virtual snowball sampling technique. The survey measured socio mobile phones and tablets. demographic information, chronic condition presence, health behaviors, quality of life, awareness of mhealth health-seeking behavior among Indian The following are the outlines for the apps and their usage. Questionnaire is at Appendix 1. Basic demographic-related adults. The number of mHealth Apps study ISSUES has also exploded and most of these questions were included, to compare Apps have not been evaluated. There is Primary Objectives: health seeking behaviour as per education, a need to have a repository of mHealth • To study the awareness and usage of income, gender and so on. Apps which have been evaluated by an mHealth apps amongst Indians. independent organization and found • To study whether the usage of The 250 responses were recorded in google useful and effective. mhealth apps is changing the health form. 247 responded and 3 people did not give consent to be a part of the study and seeking behaviour of people. RESEARCH Recently, due to the outbreak of covid-19 hence were excluded. Coronavirus, the government of India Secondary Objectives: launched a mobile app to monitor to help • To identify the reason people use The inclusion criterion was taken from its citizens identify the risk of contracting mHealth apps, who encouraged them the smartphone users, those who gave COVID-19. Aarogya Setu app is also and their continued usage rates. voluntary informed consent and are crafted to keep a user informed if in case he • To check whether the doctors are citizen of India. The exclusion criteria or she crosses a path with a positive tested encouraging the usage of mHealth were taken as those who were not Indians, NEWSCOPE patient. The app tracks the interaction of apps to patients. do not own/ use a smartphone, did not people with positive cases with the use of • To find out which services people consent to the study and were below the a social graph which is location generated would be interested in a mhealth app. age of 18. and the use of bluetooth technology. It is a self-testing tool which gives the result The study tool for the aforementioned The study conducted gave a total of 247 based on a simple questionnaire with objective was an online questionnaire individuals who have completed the the help of algorithms and Artificial for the general public. The questionnaire online population-based nationwide intelligence. consisted of open, closed, both single survey and 40.08% (99/247) were women

Volume 5 | Issue 3 | July-September 2020 25 undergoing. Health app users are younger mHealth Applications, identify new Apps and the male respondents are greater for that need to be developed to address using these apps. The study clearly brings out that awareness of mobile health apps the burden of diseases, improve health is more among the males than the females. Nowadays doctors are not recommending outcomes, oversee independent evaluation people for using mHealth apps to PERSONA and facilitate scale up of the Apps found monitor and plan their health effectively. Arogyasetu app may be the game changer successful for recommendation and awareness as the government of India is promoting this app. Although the usage of mhealth apps denotes increasing awareness of health and 59.92% were men. It was found that others. 30.3% (75/247) of people feel that seeking behaviour however the same is THEME 96% (237/247) were graduates and above. usage of mHealth has helped them lead not reflective of a corresponding change Most participants were working full-time a less stressful life.Males between the in health parameters. 83.4% (206/247), 14.2% (35/ 247) were not ages of 31 to 45 spend most of their time working and 2.4% (6/247) were retired. approximately 1 to 3 hrs daily on mobile Regarding mobile Health app use 44.9% of people reported to have spent followed by 46 to 59 years old (how much literature review was done by various between 1 to 3 hours everyday. 66.8% time?). 40% of people who spend 1 to 3 researchers. Lancet Innovations, self-assessed their health conditions as fit. hrs per day on mobile open the mHealth recognised the importance of mHealth app once in a day. These people spend apps for healthcare and medicine. All TRENDS 72% consulted doctors whereas 20.6% is on self-medication. 44% are doing regular more time in social media followed by these studies focused on disease self- exercise/ yoga. 70.4% are using social education and news followed by Health management and remote monitoring media and music apps. and Lifestyle. Overall males use more of patients. We found that the usage of mHealth apps than females. health app, person undergoing treatment, Among all those surveyed, 56.3% and health mindset in our survey was in (139/247) are aware of mhealth apps, Out of the persons who believed that consonance with these studies. There is a however only 31.6% (78/247) are using mHealth apps improved their health need for awareness for mobile solutions seeking behaviour (36.8% (91/247)) are for disease management. Our findings

WELL-BEING mHealth apps. 40.9% (101/247) are not using mHealth apps because of lack of not sure if they really improved their indicate that people undergoing treatment awareness. Of the people using mHealth health or not [47% (43/91)] remaining were not using health apps. We found apps, 49% (38/78) and 30%(23/78) use 42.9% (39/91) observed that it actually this relationship not only when we were apps for fitness and food / nutrition helped their health. It is interesting to looking at mhealth users but also when purposes respectively. Only 6.1%(15/247) know from this survey that those who we were investigating people undergoing are using for mental health. Only 13.8 % never used any mHealth apps still want to treatment.In another study from England:

ISSUES (34/247) are using for women’s health. recommend people to use mHealth apps Awareness and Use of mHealth Apps by 92.7% (229/247) of people say that they 24.8% (31/125). 67.2% of people (84/125) Reem Kayyali and his team, identified a will download mHealth apps if it is useful who have used the mHealth apps before lack of awareness and use of health apps for them. However, only 32.2% (81/247) will recommend people to use mHealth by the public. Our findings are consistent will download if it is paid. 22.2% (55/247) apps. Out of all the participants 1 out 3 with this study, they are unaware about of people use apps to track their activity is using mHealth apps and more than 40 these app’s benefits. This is exacerbated by / exercise and 26.7% (66/247) are using percent are not aware of mHealth apps doctors failing to recommend such apps for diet control. 20.2% (50/247) of people therefore a considerable number in not to their clients and patients, despite the

RESEARCH logging into mHealth apps daily. Only in the technological era. Mental health is benefits. 37.2% (92/247) trust that their mHealth a very essential part of a human life but app records data accurately. 17.41% today people are not giving too much A Survey on “Trend, Opportunities and (43/247) feel that usage of mHealth apps importance to this aspect that is the Challenges of mHealth Apps” was done has definitely improved their health reason behind only 6.1 percent of people by Shaidah Jusoh of Northern Border whereas 25.51% (63/247) feel that maybe are using mHealth apps for betterment University, Rafha, Saudi Arabia.The it has improved health. 36.8% (91/247) of their mental health. Users of mhealth findings showed the critical factor in feel usage of mHealth has improved apps differ in their demographic profile as the success of mHealth apps due to the NEWSCOPE their health seeking behavior. Only compared to non-users. The users belong involvement of all healthcare stakeholders. 5.3% (13/247) people told that doctors to the higher economic status, are more Another study conducted in four counties recommended them to use mHealth apps. health aware and tend to be younger. (U.S., Brazil, China and India) in 2012, Only 50.6% (125/247) of users are likely to There is no difference in the users and aimed to identify the views of healthcare recommend mHealth apps to non-users depending upon the treatment professionals, patients and customers

26 Volume 5 | Issue 3 | July-September 2020 regarding mHealth. Through our study we available, the users get confused about positive benefits of the usage of mHealth are confirming the usability and its benefit their usefulness and authenticity. There apps. The study though suffered from for the public. It can help the policy is a need to use a framework (Fig. 1) in the limitation of firstly being conducted makers to make decisions for increasing developing, evaluating and scaling up online and secondly being conducted awareness about mHealth and its benefits. the mobile Applications to address the only for persons holding a smartphone.

The study also confirms that with the right burden of disease. It is also important The sample size ideally should have PERSONA motivation from the doctors to patients for public health authorities or health IT been much higher to be representative for the use of mHealth apps will surely industry professional bodies to establish a of a country as vast and varied as India. increase awareness among the population. platform where authentic mHealth Apps Another issue is that the survey questions can be identified, tested and approved by constrained the findings that could be Exploring the review of literature, a independent institutions such as health deduced from the results. However, it systematic review by Dale and team was ministry. Such platforms can suggest gaps highlights the importance of the role found where mHealth is an important to software developers as to where mobile mHealth plays and the need to enhance

contributor to behaviour change Apps are needed to address the burden its use to educate the public for improving THEME intervention and disease management. of disease and interventions. There is a their health behavior. “Use of Mobile Health Applications for need to establish platforms preferably Health-Seeking Behavior Among US driven by a government institution such Adults” a study by Bhuyan SS explores the as InnoHealth which brings together Dr. Sanjiv Kumar Dixit is currently use of mHealth apps on smartphones or mHealth App developers, academicians, Professor, Leadership, Global Health & tablets for health-seeking behavior among public health programme managers and Strategic Management at INCLEN Institute US adults. “Evaluating mobile phone government policy makers to oversee of Global Health, Chair of Indian Alliance applications for health behaviour change: the whole process to help review the of Patients Group, Indian Academy of TRENDS Public Health, Chair Institutional Ethics A systematic review’’ study by Fiona H available mHealth Applications, identify Committee of Gautam Budh University McKay and team stated the better way to new Apps that need to be developed to and member Governing Board of NIHFW. process the effectiveness and the quality address the burden of diseases, improve He has a vast experience of 44 years and of apps by studying the behaviour changes health outcomes, oversee independent was earlier the Director IIHMR Delhi and caused due to mobile health apps. In an evaluation and facilitate scale up of the Executive Director, NHSRC, MoHFW.He article published in June 2018 entitled Apps found successful. has been conferred with many national and “Health as a Means Towards Profitable international accolades and fellowships. WELL-BEING Ends: mHealth Apps, User Autonomy, and This study was an attempt to ascertain Unfair Commercial Practices”, discussed the level of awareness and consequent mHealth apps and their potential benefits of a positive change in health to change the behaviour of the user. seeking behaviour amongst 247 Indians. Shikha Gill is an experienced Business Consultant and a certified physiotherapist “Behavior Change Techniques in mHealth It was heartening to note that the level of with a demonstrated history of working in Apps for the Mental and Physical Health awareness was pretty high (x%) however the information technology and services of Employees: Systematic Assessment” is the usage of mHealth apps (y%) needed a industry. Her areas of interest are: Health ISSUES an article by Elsbeth de Korte published in lot of improvement. The study paves the Informatics, Business Analytics, ERP, global October 2018. Research on Health apps is way to research on various innovative and health, Innovative health IT solutions to very limited. Interventions will be useful novel ways to educate the people on the bring changes in the health of societies. if they ensure change in health seeking behavior.

Our study is in accordance with the various studies mentioned above as far RESEARCH as change in health seeking behaviour of individuals in India is concerned. While the usage of mHealth apps is very popular among young people; older people are also increasingly becoming aware of the benefits of mhealth apps. Role of age in usage of mhealth apps underscores the NEWSCOPE importance of new ways of helping in health topics, and is increasing in future. In our study, we found weight loss, healthy diet and smoking cessation were the most common behaviour change targeted by the apps.Since there are a very large number of mHealth Apps Fig. 1: Steps in development and use of mobile Health Apps

Volume 5 | Issue 3 | July-September 2020 27 Telemedicine Practice Guidelines

PERSONA Timely clarity by the Govt which helps in Covid THEME TRENDS WELL-BEING Introduction cleared the air on the legality of tele- But perhaps, these might be included in medicine in India. draft bill for Digital Information Security he Indian Government has in Healthcare Act (DISHA). We had issued the Telemedicine Practice The Guideline are detailed and cover earlier written about DISHA , the future Guidelines (“Guidelines”) various modes of communication that can direction of digital health information Tfor enabling the Registered Medical be used by the RMPs to provide health care in India and about the Data Ownership, ISSUES Practitioners (“RMPs”) to provide services to the patients, such that the RMP Security, Consent for health data. health care services using the various shall uphold the same standard of care Doctor consultations outside India telecommunication and digital as in an in-person consultation. While jurisdiction: communication technologies. RMP is there are advantages of each mode of defined to mean a person who is enrolled communication, there are disadvantages The Guidelines do not permit for in the state register or the national register as well. The Guidelines require obtaining consultation outside India. Practically, under The Indian Medical Council Act, consent from the patients, the manner in those consultations will be through the 1956 (“IMC Act”). Under IMC Act, an which a prescription is to be issued by the medium of audio, video, text based and RESEARCH RMP has to be an individual, who has RMP, medicines which can be prescribed hence the aim of the Guidelines is to completed the “Recognized Medical by an RMP based on the different modes exclude such consultations. IMC Act, Qualification”. of communication and the nature of clause 12 also details “Recognition of consultation (i.e. first consultation or medical qualifications granted by medical In India there was no legislation or follow-up consultation or emergencies). institutions in countries with which there guidelines on the practice of telemedicine is a scheme of reciprocity”. through video, phone, internet-based The Guidelines specifically excludes

NEWSCOPE platforms like web / chat / apps etc. and amongst other things the use of digital Tools for Telemedicine the issuance of the Guidelines is a major technology to conduct surgical or step forward in the healthcare domain in invasive procedures remotely. It would The Guidelines has identified the modes India, especially during Covid situation. have been good if the Guidelines did for telemedicine consultation and the Publishing the Guidelines has certainly provide for data management systems etc. primary modes are video, audio and text.

28 Volume 5 | Issue 3 | July-September 2020 any prevailing law are not permissible. The Guideline are detailed and cover various Such activities can be in the nature of modes of communication that can be used by the RMP misusing the patient images and data (especially private and sensitive the RMPs to provide health care services to data) by uploading any explicit picture of

the patient on social media. Further, the PERSONA the patients, such that the RMP shall uphold RMPs are not permitted to solicit patients the same standard of care as in an in-person for telemedicine consultations through any advertisement or inducements. The consultation. penalties for any misconduct by the RMP will be as per the IMC Act and other The modes can include telephones, video of telemedicine interaction (e.g. phone prevailing laws. devices, chat platforms (like WhatsApp, logs, email records, chat/ text record, THEME Facebook messenger) or email, fax video interaction logs etc.). The RMP is Medicines that can be prescribed in or special apps developed for tele- also required to retain patient records, telemedicine consultation. The RMP should use her reports, documents, images, diagnostics, best judgement whether tele-consultation data (Digital or non-Digital) etc. utilized The Guidelines prescribe norms and or in-person consulting is suitable in a in the telemedicine consultation. The rules for the issuance of prescriptions given situation. Specific guidelines have time period for which such records have by RMPs. If an RMP has prescribed been set out for Technology Platform to be maintained are not specified in the medicines pursuant to telemedicine enabling telemedicine consultations. Guidelines and it is only mentioned that consultation then the RMP is required TRENDS the records are required to be maintained to issue a prescription as per the Indian Responsibilities of the RMP for the period as prescribed from time to Medical Council (Professional Conduct, time. Etiquette and Ethics) Regulation (“IMC Apart from the many responsibilities Regulations”). The IMC Regulations under the IMC Act and these Guidelines, Misconduct by the RMPs prescribe that a physician shall write the RMP should be reasonably comfortable his name and designation in full along that telemedicine consultation is in the The general requirements under the with the registration particulars on his WELL-BEING patient’s interest. The RMP can also decide IMC Act relating to professional prescription letter head and the same on the mode of technology (video, audio, misconduct, ethics will be applicable in rules also apply to prescriptions issued chat) to diagnose and treat a patient. case of a telemedicine consultation. The pursuant to a telemedicine consultation. Guidelines further provide that all actions The RMP is authorised to provide a photo, By way of maintenance of records, the RMP that wilfully compromise patient care scan, digital copy of a signed prescription is required to maintain the log or record or privacy and confidentiality or violate or e-prescription to the patient via email ISSUES RESEARCH NEWSCOPE

Volume 5 | Issue 3 | July-September 2020 29 or through any messaging platform. The consulting with the RMP for the first the patient’s identity by name, age, address, Guidelines also allow the RMP to transmit time or if more than 6 (six) months have email address, phone number, registered the prescription directly to a pharmacy elapsed since the previous consultation or ID or any other identification as deemed but in such cases the RMP is required to if a patient has consulted with the RMP appropriate. The RMP is also required ensure the explicit consent of the patient earlier but for a different health condition. to ensure that there is a mechanism for that entitle the RMP to get the medicines Follow-up Consult means the when the a patient to verify the credential and the dispensed from a pharmacy of the choice patient is consulting with the same RMP contact details of the RMP.

PERSONA of the RMP. within 6 months of his previous in-person consultation and the consultation is for For the purposes of identification, the However, it is clarified that the RMP may the continuation of care of the same RMP is required to begin the consultation prescribe medicines via telemedicine health condition. A consultation will not by informing the patient about his name only when the RMP is satisfied that be considered as a follow-up consult if and qualifications. The RMP is required adequate and relevant information there are new symptoms and / or the RMP to display the registration number has been gathered about the patient’s does not recall the context of the previous accorded by the State Medical Council

THEME medical condition and that the prescribed treatment and advice. The process of on prescriptions, website, electronic medicines are in the best interest of the consultation and the nature of drugs that communication (WhatsApp/ email etc.) patient. For issuing a prescription, the can be prescribed by an RMP depends on and receipts etc. issued by the RMP to the RMP is required to explicitly ask the age of if the consultation is a first consult or a patients. the patient and in case of doubt the RMP follow-up consult. should require an age proof of the patient. Consent from a patient is mandatory As in the case of in-person consultations, Identity and Consent for any telemedicine consultation and the RMP is required to maintain a record the consent may be implied or explicit.

TRENDS of the prescriptions issued pursuant to a The RMP is required to verify and confirm If a patient initiates a telemedicine telemedicine consultation.

A sample format in which the prescription The IMC Regulations prescribe that a physician is to be issued is provided as an Annexure shall write his name and designation in full to the Guidelines. along with the registration particulars on his First Consult and Follow-up Consult

WELL-BEING prescription letter head and the same rules The Guidelines draw a distinction also apply to prescriptions issued pursuant to a between a first consultation and a follow-up consultation with an RMP. telemedicine consultation. First Consult means that the patient is ISSUES RESEARCH NEWSCOPE

30 Volume 5 | Issue 3 | July-September 2020 The Guidelines also prescribe the process for The Guidelines provide that an online consultation by a Health Worker with an RMP course will be developed and made available by the Board of Governors so seeking consultation from a patient in a public as to enable all the RMPs intending to practice telemedicine to be familiar with PERSONA or private health facility. the Guidelines and that the RMP will be required to complete the course within a consultation, then consent is implied and patient and in the absence of the patient. period of 3 (three) years from the date of an explicit consent if needed if a health A Caregiver can consult with the RMP in notification of these Guidelines. However, worker or an RMP or a caregiver initiates absence of the patient if the patient is a the FAQs issued on the Guidelines a telemedicine consultation. An explicit minor (16 year or less) or if the Caregiver indicate that all RMPs can tele-consult consent from a patient can be recorded in has a formal authorisation or verified provided they follow the Guidelines. any form either by way of an email, text document establishing his relationship

Thus, the Guidelines create an uncertainty THEME or audio/video message and the patient with the patient and / or has been verified in relation to the online course and can state his/her intent on phone/video by the patient in a previous in-person further notification in this regard will help to the RMP (e.g. “Yes, I consent to avail consultation. introduce clarity on the subject. consultation via telemedicine” or any such communication in simple words). The The Guidelines also prescribe the process COVID-19 and Tele-medicine RMP must record such consent granted for consultation by a Health Worker by a patient in his patient records. with an RMP seeking consultation from With the Covid situation, the Guidelines a patient in a public or private health are published timely and provides an TRENDS Emergency Situation facility. A Health Worker can be a nurse, impetus for healthcare industry. The an allied health professional, mid-level Guidelines may evolve over a period of The Guidelines provide for specific rules in health practitioner, or any health worker time based on the actual experiences case of an emergency situation. In all cases designated by an appropriate authority. of RMPs and the patients pursuant to of an emergency, the RMP is required telemedicine communications. to advice the patient for an in-person Privacy in telemedicine consultation interaction with a Registered Medical WELL-BEING Practitioner at the earliest. However, in The RMP as part of telemedicine case of an emergency situation, the RMP consultation are required to abide by For further queries for Telemedicine may, based on his professional discretion, the principles of medical ethics. Thus, in Practice Guidelines kindly refer the advice first aid, counselling or facilitate keeping with the provisions of the Ethics link given below:- referral for an in-person consultation. Regulations, RMPs shall not publish www.mciindia.org/MCIRest/open/ The FAQ on the Guidelines clarify that photographs or case reports of the getDocument?path=/Documents/ in case of an emergency if the RMP asks patients without their permission, in any Public/Portal/LatestNews/Final_ for immediate referral for in-person medical or other journal in a manner by ISSUES FAQ-TELEMEDICINE%20%206-4- consultation but if a patient insists for which their identity could be made out. 2020..pdf tele-management, then the RMP should The Guidelines makes a reference that the record his statement regarding the advice Information Technology Act, 2000, the given regarding referral for an in-person data protection and privacy laws regarding consultation. The FAQ also clarify that in the handling and transfer of information case of an emergency the patient may call regarding the patients or any other an RPM for medical advice but a patient applicable rules in relation to protecting RESEARCH cannot insist for an advice if the RMP patient privacy as notified from time to chooses not to reply or to give any specific time will have to be complied with by Compiled by: advice. the RMPs. It is to be seen if the proposed Sharda Balaji, Managing partner, DISHA and the proposed Personal NovoJuris Legal. She is a Lawyer and Tele-consultation Through a Health Data Protection Bill, will all provide for a Company Secretary, along with Worker or a Care Giver a cohesive compliance structure. It is degree from Institute of Chartered Secretaries, UK. She has a Diploma

clarified that the RMPs will not be held NEWSCOPE Under the Guidelines, the consultations responsible for breach of confidentiality, if in Intellectual Property Rights with an RMP may be facilitated by a there is reasonable evidence to prove that from National Law School of India, Caregiver. A Caregiver could be a family the patient privacy and confidentiality Bangalore and an advanced certificate member or any person authorised by the has been compromised by a technology course in Copyrights from World patient to represent him. The Caregiver breach or by a person other than the RMP. Intellectual Property Organisation. may either be present with the patient during consolation or the Caregiver Online Course on Practice of may consult the RMP on behalf of the Telemedicine

Volume 5 | Issue 3 | July-September 2020 31 WELL-BEING PERSONA Health 2.0

THEME Sustainable healthcare in COVID-19 pandemic

Written by Dr. Kulsaurabh Kaushik and Dr. Yachika TRENDS

he detrimental effect of the Several reports have shown the sectors were greatly affected e.g an official outbreak of COVID-19[the disease predicamemt of patients having chronic data from a 350 bedded hospital in NCR caused by Severe Acute Respiratory diseases and those require proper medical reports more than 50 % reduction in TSyndrome coronavirus 2 (SARS-COV-2)] maneuveringother than COVID-19 bed occupancy rate and more than 60 % was evident not only on global healthcare infected patients.The overall revenue reduction in routine elective procedures systems but also on other aspects of generation for hospitals and healthcare thus making the system very fragile .

WELL-BEING human life.

The World Health Organisation (WHO) declared the COVID-19 outbreak as a global emergency on 30th January 2020. According to various scientific literatures, and a response to ‘flatten

ISSUES the curve’ governments have enforced border shutdowns, travel restrictions and quarantine in countries which constitute the world’s largest economies.All these factors have anticipated the fears of an impending economic crisis and recession.

The COVID-19 pandemic has caused an

RESEARCH unprecedented challenge for healthcare systems worldwide with healthcare workers as the frontline warriors .

In upcoming times there may be a higher surge in cases reporting critical situations or may be even fatalities due to previously existing illnesses like Chronic NEWSCOPE Heart Failure , Chronic Renal Failure , COPD etc. getting complicated because of improper or not adequately managed .

32 Volume 5 | Issue 3 | July-September 2020 Maharashtra Govt. has undertaken 80 percent of private hospital beds with For enabling life towards getting near to capping of treatment costs Another such step has been taken by the Delhi Govt normal, first thing that has to be made which has directed the private hospitals

sustainable is the healthcare system PERSONA with capacity of 50 beds or more to provide 20 % of its total capacity for Covid patients . SUSTAINABLE HEALTHCARE IN RED Zone COVID-19 PANDEMIC- HEALTH 2.0 With the prevalence of such regulations, • Every HCW working in Red Zone adequate measures are taken to safeguard OBJECTIVES works with all precautions including the workforce of the organization. With PPEs. (LEVEL 4 ) such regulations, it becomes foremost • Combat ongoing crisis in best • Patient treated as per his condition THEME important to take adequate measures to possible and efficient mannerto with all necessary monitoring and protect our workforce amid this health minimise the incidence of Covid -19 investigations thereby making things crisis as they are the only weapons all infection among HCWs more clear through this fight . For enabling life • First Covid 19 testing done at Red towards getting near to normal , first • Proper redressal of Patients suffering zone thing that has to be made sustainable is from chronic illnesses and impending • If patient is tested positive for Covid the healthcare system. life threatening emergencies related 19 then patient is shifted to Covid to such illnesses. centre and if report comes out TRENDS THE PROBLEM STATEMENT • Anticipate upcoming seasonal illness negative then patient is transferred to like Dengue and Malaria and take Yellow zone • Patients with similar symptoms optimum measures to reduce chances (influenza like symptoms) with of further crisis with these upcoming YELLOW/ ORANGE Zone pre-existing conditions like cardiac health threats. ailments and respiratory issues, are • Only patient once tested negative for

facing lot of trouble in getting routine • Develop a sustainable system where Covid Negative gets entry to Yellow / WELL-BEING management as well as emergency both the public health sector and Orange zone management because of projected private sector collaborate to fight this • Health care workers use atleast level 2 COVID-19 stigma. Pandemic crisis. PPE adjunct with an antiviral kit • Upcoming conditions with similar • Develop a system where the presentation like Dengue, Malaria in corporate health system reaches • Patient are treated as per the South East Asian countries will make their maximum capacity in terms of symptoms with all necessary situation more complicated thus services and also the revenue. monitoring .

pose further challenges in healthcare ISSUES • Clinical follow up of patient done system . POLICY SUGGESTIONS with investigations like CBC to look • Healthcare workers (HCWs) has to for lymphopenia , coagulation profile embrace the the Quarantine in masses • Every center starts functioning in to look for any derangement, LDH because of accidental exposure from a ZONED MANNER i.e they get levels and serial Chest X-rays to look a patient tested positive after routine divided into zones viz. Red, Yellow for radiological evidences . admission. and Green • Collapse of health system in terms of • Functioning of Non-Covid Zoned • Also any suspected patient to be kept RESEARCH providing adequate health services Hospital (may have reserved bed for in isolation or cabin with Negative and revenue to sustain hospitals covid 19) pressure if available . viability. • Second Covid-19 testing done at INTRAHOSPITAL ZONING In short our health system includes both Orange/ Yellow zone in case of public sector and corporate sector are any suspect either clinically or Non Covid ZONED HOSPITAL gets derangement in any of the significant

facing issue at every step whether it is: NEWSCOPE divided in the following : investigations .

1. Containment of disease • RED zone : consists of Emergency • If patient is unfortunately tested 2. Proper handling to emergencies due Room , RED ICU and RED Ward Positive , patient is referred to Covid to non Covid chronic illnesses • ORANGE or YELLOW zone : Unit . 3. Protection of HCWS (almost 321 Consists of another ORANGE ICU HCWs has been tested positive across and an ORANGE WARD . • If Second report also comes out DELHI ) • GREEN zone : consists of GREEN Negative , then patient is transferred 4. Sustainability ICU and GREEN Ward to Green zone

Volume 5 | Issue 3 | July-September 2020 33 services as well such zoning can be formulated and adopted. For e.g. an elective surgery can be performed by performing a pre admission COVID-19 test and then admitting patient in ORANGE zone ward isolation rooms and then performing another test if required. PERSONA Recently there has been guidelines by Delhi govt suggesting division of NonCovid hospitals into Risk Zones ( i.e mild , moderate and severe ) addressing the issue of infection among HCWs and thereby suggesting use of different level of

THEME PPEs in different zones depending upon risk associated . Also the advisory states formation of Holding area (corresponds to Red zone) for patients with influenza like illness (ILI ) in Non Covid hospitals .

We appreciate the authorities for addressing the problem and taking such TRENDS suggestions into consideration while forming the advisories and formulating the guidelines . Though there can be much more that can be done to achieve a more sustainable system which helps us fight the current pandemic in much more efficient manner as in our consideration achieving a SUSTAINABLE HEALTH

WELL-BEING GREEN Zone • Additional cost of the PPE kits and additional COVID-19 test , this can SYSTEM ( HEALTH 2.0 ) is the only • Patient that has been tested as sum up to around 8k- 10k per patient weapon amidst this crisis that can help us COVID-19 negative twice is admitted • Adjunct Formulations reach a safe bank . in Green Zone . • HCWs use N95 and Gloves only ANTICIPATED ADVANTAGES

ISSUES • Patients are treated as per his • Protection of healthcare workers - Dr. Kulsaurabh Kaushik, working condition including all necessary with double testing and proper zoning as Intensivist at Fortis Escorts , New monitoring and investigations. of hospitals depending upon the risk Delhi . Has done his MBBS and MD • Patients gets discharged from Green associated, can achieve a system from PGIMS , Rohtak . Loves to be a zone where minimise of the infection part of an ecosystem working for any among HCWs by using proper PPEs sought of development to overcome ANTICIPATED CHALLENGES depending upon the zones . ongoing challenges. Presently • We will be able to cater life saving holding a position as Joint Secretary,

RESEARCH • ZONING of the hospital itself may emergencies in an efficient manner Federation of Resident Doctor be a challenge as common AHUs . , also the routine services can be association , FORDA . But this can be managed with little escalated with such kind of strategies extra efforts and adequate planning • The hospitals can achieve a system and therefore allowing areas into a where they are able to provide their particular zone so that areas sharing services near to normal (precovid common AHU comprise of either times ) there by reaching a sustainable RED zone or Orange zone only . system both in terms of services and Dr. Yachika, completed MBBS from NEWSCOPE • Reallocation of healthcare workers in revenue generation . PGIMS Rohtak . Has secured a respective areas . respectable rank at NEET PG , soon • Rotational duty rosters and Post duty Current article mentions zoning of will be joining a PG course at some of Quarantine followed by Covid testing hospital for handling the emergency the good institute . before rejoining . admissions, likewise for routine health

34 Volume 5 | Issue 3 | July-September 2020 My lockdown days due to

pandemic PERSONA

Written by Dr. Debleena Bhattacharya

‘ hen the going gets tough, improvised as I get to make different raise the hopes when life is surrounded by the tough gets going’ cuisines with limited resources available. barricades of unprecedented situations. the inspirational quote The photos of dishes I made are The lockdown gave me the opportunity

Wreverberates in mind when tough displayed in end to show that I could do to introspect and understand the life in a THEME situation abruptly encircle you. The same it, beyond my imagination. The do-it- whole new dimension. The constant siren happened with me when the sudden yourself mantra has also made me more from the ambulance in the vicinity of my lockdown was announced in the nation responsible to figure out solutions from dwelling made me think that the life of due to coronavirus invasion. I was the resources available at hand one such human is so delicate yet so precious. We perplexed whether to stay in my cocoon example is the making of embroidery are the creators of our surroundings and or go to my relative house. Unaware of the frame from packaged food boxes. The also the destroyer. The unseen, unknown situation I stayed back, decided to face the nature with every passing day was novel virus taught a very meaningful TRENDS consequences and be responsible for my becoming more green and serene with lesson to the human that we are perishable actions. life as due to nationwide lockdown the as for Mother Nature we are just few industries, roads and all the pollution atoms joined. We talk about God’s particle When the nationwide lockdown was contributors has halted their work. and in the era of 2020, we are in surge of announced there was chaotic situation shielding ourselves from an unforeseen yet to stock up the essential needs before the During this lockdown period, a pending dangerous virus. Amidst this pessimistic shops closed. Have ordered my essentials dream has carved its path in my life; situation, rays of hope always help the WELL-BEING and was waiting to be delivered. The I got the opportunity to write a book. mankind and regain its former self. The sanitation process to be incorporated into The dream though was there but the lockdown has made a positive impact in our daily routine was now the new norm. motivation to go ahead was the one that my life as I get to believe in the notion that Initially it was difficult to get accustomed Prof (Dr.) V.K Singh, my co-author for the the insignificant change in your habit will with the frequent handwashing but good book gave me. His vast experience (he has have a huge impact in your habitat. habits eventually inculcates. already written two books on Healthcare Innovations) and the consent to be under The lockdown for the initial days were his tutelage instilled in me the hope to laden with online classes for the whole forge ahead with the book project entitled ISSUES day and the course completion along with ‘Climate Change and Epidemiological exam duties of the University. The end of Hotspots’. The book would be divided March 2020 and whole of April was hectic into two aspects: concern and sustainable from the normal routine days. In the approach. Understanding these aspects earlier days it was difficult to customise along with the other relevant issues help your biological clock to the new schedule the readers for an insightful journey for the where there are no schedule timings influences of the disease and provide an RESEARCH for meetings along with online lectures, indispensable guidance to policymakers course completion responsibility followed in designing preventive health measures by online exams. All these made the life go that are viable for reducing the disease haywire from normal routine. and the costs for the health-care system. 1) Besan ladoo, 2) Pav Bhaji, 3) Mixed vegetable Appe, 4) Mixed veg pizza, 5) Aloo paratha 6) Idli With the lockdown days I resolved to open sambhar and coconut chutney, 7) Vegetable Maggi, Amidst this got the opportunity to mentor myself through my mind and innovative 8) Parwal ka mithai, 9) Gujarati pudla and bhaaji

three-four teams of the innovative minds thoughts. The lockdown days gave the NEWSCOPE from our nation for the online forty-eight opportunity to make my dream as writer Dr. Debleena Bhattacharya, Assistant Professor in Department of Environmental Science and hours hackathon conducted by Ministry of come true and to explore my innovative Engineering in Marwadi Educational Foundation Human Resource and Development along inner self which has lost its way amidst the Group of Institutes (MEFGI), Gujarat, India. She with the abled hands of Innovatiocuris. daily routine. is the associate editor for InnoHEALTH magazine. There were many scientific projects that She holds a doctoral degree in Environmental Science and Engineering from IIT(ISM) Dhanbad came for expert review to be selected for The constant fear of death from virus has (India). Her research interest mainly focuses on BIRAC SITARE 2020 awards. made me more resilient towards life and two aspects they are environmental biotechnology these days of my confinement gave me the and wastewater treatment implemented with Apart from these, my culinary skills time for introspection and conviction to advanced technology.

Volume 5 | Issue 3 | July-September 2020 35 PERSONA ISSUES Counterfeiting in the times of

THEME Corona: How bad faith actors are exploiting the pandemic to

TRENDS boost fraudulent activities

Written by Sanjay Kaushik

he adage “Imitation is the huge. their nefarious ends continues to emerge sincerest form of flattery” can be almost every single day. Recently, the WELL-BEING interpreted in many ways in so The counterfeiting industry has historically Interpol orchestrated a crackdown on Tfar as one considers this truncated form been one of the major problems within the the illegal online sale of medical supplies of the original quote. From a pragmatic global business ecosystem. From brand and medication including “substandard viewpoint, however, it doesn’t hold as counterfeiting to fake news and currency hand sanitizers, unauthorised antiviral well. In legal terms, unlawful imitation duplication to the piracy of multimedia, medication and counterfeit face masks”. or forgery or counterfeiting can render the selling of unauthorised products The operation resulted in the arrest of the defaulter liable to being penalized continues to deal significant damages 121 bad-faith actors and the seizure of ISSUES and even land them in jail. Why? Because to legitimate business operations. Last fake products worth more than USD 14 counterfeiting or the illegal duplication of year, industry body of Authentication million. a thing to generate profits by deceiving the Solution Provider’s association (ASPA) public is regarded as a criminal offence asserted that India incurs losses over How counterfeiters are exploiting the nearly everywhere and India is certainly INR 1 lakh crore annually on account of lockdown in India no exception. counterfeiting activities across various sectors. In India, too, many counterfeit activities The criminal aspect of counterfeiting have surfaced since the onset of the RESEARCH stems from the fact that unauthorised Distasteful as it is, counterfeiting has pandemic and the mandated nationwide duplication of a thing amounts to IP theft. reared its ugly head even amidst the lockdown. Various legislations enshrined within COVID-19 crisis. The news of fraudulent the Indian law protect the IP rights of an activities seizing on the pandemic to meet According to OECD officials, nearly half entity, be it a person or an organisation. These include the Trademarks Act, 1999 The criminal aspect of counterfeiting stems with TM rules 2017; Patents Act, 1970;

NEWSCOPE Copyright Act, 1957, etc. Apart from the from the fact that unauthorised duplication of a ethical, moral, and legal repercussions of violating any of these laws, the economic thing amounts to IP theft. toll of such mala fide activities can be

36 Volume 5 | Issue 3 | July-September 2020 PERSONA THEME TRENDS

of the counterfeit pharmaceuticals trade, unable to evaluate and award insurance in humanity’s struggle against the gravest WELL-BEING which is on the rise amid the current claims. crisis of this generation. situation, originated in India in recent years. In the current scheme of things, Against this backdrop, the Association Sanjay Kaushik, ARVP ASIS when law enforcers are overwhelmed with of Private Detectives in India (APDI) International Region 13 A, Former priority tasks of managing the lockdown recently wrote to the Prime Minister Chairman ASIS International, and companies are endeavouring to apprising him of this situation and Chapter 207, India and Managing sustain business continuity, counterfeiters seeking regulatory support in allowing Director, Netrika Consulting India are exploiting the situation to the the continuation of investigative activities Pvt Ltd, is a recognised expert in ISSUES best of their advantage. Therefore, amid the lockdown. It will not only result Fraud Risk Management, Corporate counterfeiters currently have neither the in the curbing of unlawful, counterfeiting Security Consulting, Risk Assessment, fear of law enforcement – because it is as well as fraudulent activities that seek to Investigations, Anti Counterfeit overburdened and cannot execute raids exploit the pandemic for petty monetary Strategies, with over 26 years of at an adequate efficiency and scale – nor gains but also comprise a critical step experience including working as private investigators and agencies because forward in humanity’s struggle against the Chief Operating Officer of one of the they are not allowed to move amid the gravest crisis of this generation. largest Risk Consulting Firm. He was RESEARCH lockdown. A step in the right direction can translate the recipient of “Fraud investigator of into strengthened law enforcement across the year 2017” by Wealth & Finance On account of the lockdown, on-ground the country. It will not only result in the International, U K. He is the proud physical investigation has ground to a curbing of unlawful, counterfeiting as well Recipient of Prestigious “Investigation complete halt. Moreover, the disruption of as fraudulent activities that seek to exploit Professional of the year 2012” Award the background assessment activities also the pandemic for petty monetary gains in the 7th Security Leadership Summit. means that insurance companies, too, are but also comprise a critical step forward

Netrika, under the leadership of Sanjay NEWSCOPE has also won the “Security Design of The counterfeiting industry has historically the Year” award by Secutech in 2015. been one of the major problems within the Apart from being an authorised trainer for Certified Fraud Examiner, he is the global business ecosystem. honorary member various prestigious organisations.

Volume 5 | Issue 3 | July-September 2020 37 Racial and Ethnic Disparities in Patients with PERSONA COVID-19

Written by Prathayini Paramanathan, Muhammad Abbas, Winifred Iklaki, Priscilla Itua, Mehran Mortazavi, Parastoo Taravati, Ayobamidele Ayisat Tiamiyu. THEME TRENDS WELL-BEING

ISSUES Background have been affected with over 3,000,000 18% were African Americans (AA), positive cases and over 200,000 deaths. and 14% was Hispanic and Latino oronavirus Disease 2019 As of April 29, 2020, The United States of Americans (HLA); however, amongst the (COVID-19) is the new public America (USA) reported 983, 457 positive hospitalized patients, 45% was AA, 33% health crisis threatening the cases and 50, 492 deaths made it the was AA, and 8% was HLA. This clearly Cglobe. It is postulated to have erupted most affected country in the world. The indicates a disproportionate burden of from Wuhan, Hubei, China in December COVID-19 Associated Hospitalization the disease amongst racial and ethnic 2019, and to have been transmitted from Surveillance Network (COVID-NET) minority groups, specifically AA, possibly

RESEARCH bats to an intermediate host to humans. conducts population-based surveillance due to the genetic, environmental, and The World Health Organization (WHO) for COVID-19 positive patients who are socioeconomic variabilities that exist. announced COVID-19 as a pandemic admitted into the hospital across USA. It Currently, healthcare sectors worldwide on January 30th, 2020. It rapidly spread has been revealed that during the month are facing challenges in the diagnosis, across the entire world, and as of April of March 2020, 59% of the surveillance treatment, and prevention of COVID-19. 29, 2020, 210 countries and territories population was White Americans (WA), Healthcare professionals including Physicians, Scientists, and Professors are fighting to put an end to this disease. As NEWSCOPE Ultimately, racial and ethnic disparities that an effort to aid in this fight, we have put arise during public health emergencies like together this review article discussing some of the racial and ethnic disparities COVID-19 are related to socioeconomic status and key epidemiological variables that deprivation and affluence. exist in relation to COVID-19.

38 Volume 5 | Issue 3 | July-September 2020 PERSONA THEME

Introduction TRENDS

The first human coronavirus was identified According to CDC, members of racial and in the 1960s; since then, some of them have ethnic minority groups are more likely to led to major human outbreaks such as severe acute respiratory syndrome (SARS) live in densely populated areas due to racial and Middle East respiratory syndrome (MERS). Severe acute respiratory and ethnic residential segregation, which WELL-BEING syndrome coronavirus 2 (SARS-CoV-2) is a fundamental factor leading to health is the virus strain that causes COVID-19, and it is mainly transmitted through disparities. respiratory droplets via infected humans or surfaces. The estimated incubation infects individuals of all ages; however, investigated by the National Institute period of the disease is 2 to 14 days from the two most vulnerable groups are the of Allergy and Infectious Diseases the time of exposure, and symptoms range elderly (over the age of 60) and immune- is Remdesivir. This drug is a broad from asymptomatic infection to death. compromised. spectrum antiviral agent that blocks viral The most common presenting symptoms replication by interrupting the nascent ISSUES include fever, dry cough, and shortness Currently, COVID-19 positive patients viral ribonucleic acid chains leading to of breath (SOB); other symptoms are managed through supportive therapy, premature termination; it was earlier used include headache, dizziness, confusion, and the degree to this therapy is used to treat Ebola virus disease and Marburg conjunctivitis, rhinorrhea, nasal depends on the severity of the symptoms. virus disease. Another drug also showing congestion, anosmia, sore throat, sputum promising results is Chloroquine, which production, dysgeusia, anorexia, nausea, According to the WHO, COVID-19 is an anti-malarial agent that increases vomiting, abdominal pain, diarrhea, positive neonates and young children late endosomal and lysosomal pH above RESEARCH rashes, hives, lesions, myalgia, body chills, must be admitted into an isolation unit the level that is required for the virus body ache, and fatigue. In patients with with constant heart rate, respiration, and and cell fusion while interrupting the underlying comorbidities, the disease blood oxygenation monitoring; adults glycosylation of cellular receptors; it was may progress to pneumonia, respiratory showing mild symptoms must isolate used to treat SARS. Cancer drugs such as failure, kidney failure, septic shock, and for self-quarantine, intaking sufficient Baricitinib, Ruxolitinib, and Fedratinib death. Mild symptoms, from which a fluids, and using symptom relieving are also being investigated. They may patient can easily recover, constitute 80% medications. Adults showing severe to work in COVID-19 by inhibiting the NEWSCOPE of the disease; severe symptoms such critical symptoms must be admitted into Janus kinases, and signal transducers as shortness of breath and pneumonia an isolation unit with intravenous fluids and activators of transcription proteins constitute 14%; critical symptoms such as and corticosteroids, and oxygen therapy. reducing viral infectivity, viral replication, organ failure and septic shock constitute In terms of medical management of and the associated host inflammatory 5%; and fatal symptoms resulting in death COVID-19, there are some medications response. constitute 2%. According to the World that deserve recognition. Currently, Health Organization (WHO), COVID-19 one of the most promising drugs being Due to pressure from civil rights groups

Volume 5 | Issue 3 | July-September 2020 39 PERSONA THEME TRENDS and public health advocates, many of the AA, may be due to genetic difference such enzyme 2 (ACE2) and transmembrane states across USA have started reporting as genetic variations and pre-existing serine protease 2 (TMPRSS2). ACE2 demographic data for COVID-19. comorbidities, environmental distinction is an enzyme found on the host cells’ According to Ronald J Daniels, the such as habitats, socioeconomic surfaces, and is currently postulated to President of John Hopkins University, and prominence such as occupations, living be the primary receptor to which the Marc H Morial, the President and CEO of conditions, and access to healthcare. virus attaches; TMPRSS2 is a protein that the National Urban League, COIVD-19 Ultimately, racial and ethnic disparities facilitates viral fusion through the cell

WELL-BEING showed prominence in individuals that arise during public health membrane. Researchers at the University belonging to racial and ethnic minority emergencies like COVID-19 are related of Pittsburgh conducted a study in groups, especially AA, at a dramatically to socioeconomic status deprivation April 2020 to learn about how genetic disproportionate rate. and affluence. In this review article, we variations play a role in COVID-19’s discussed some of the disparities to better epidemiological variability. They assessed COVID-NET has revealed that during understand COVID-19 and aid in the the effects of ACE2 and TMPRSS2’s genetic the month of March 2020, 59% of the fight against it, as well as to inform the expressions in over 2000 individuals from

ISSUES surveillance population was WA amongst general public about skewed population varying populations, and concluded that which 45% was hospitalized due to outbreaks and prevent it in the future. AA have lower expressions of both. This COVID-19, 18% was AA amongst which suggests that genetic variations may lead 45% was hospitalized, and 14% was HLA Genetic Variabilities Leading to to lower susceptibility for COVID-19 amongst which 8% was hospitalized. COVID-19 Disparities infection amongst AA, and host genetics Furthermore, the New York City Health may explain the infection rate, severity of Department has revealed that till April 19, Genetic variations impact certain symptoms, and death rate on a personal 2020, the COVID-19 death rate amongst individuals’ predisposition to COVID-19 - level.

RESEARCH AA was 92.3 per 100,000 people and in genetic polymorphism plays an important HLA was 74.3 per 100, 000 people; this role in the likelihood of being infected Certain health conditions such as obesity, was significantly higher than the death by the disease, severity of symptoms, hypertension (HTN), diabetes mellitus rate of WA, which was 45.2 per 100, 000 and immunological response towards (DM), and cardiovascular disease (CVD) people. The disproportionate infection the disease. COVID-19’s transmission are common amongst AA due to their rate and death rate amongst racial and and dissemination into host cells is genetic variations, and such predisposing ethnic minority groups, especially mediated by angiotensin-converting factors put them at an increased risk for COVID-19. NEWSCOPE Another barrier to healthcare access faced by The Journal of American Medical AA and HLA is the lack of health insurance. Association published a study analyzing 5700 COVID-19 positive patients

40 Volume 5 | Issue 3 | July-September 2020 hospitalized in various hospitals across as increased alpha receptor sensitivity, medications such as angiotensin- New York City during March 2020; this decreased beta receptor sensitivity, converting enzyme inhibitors (ACEI) or study showed that the most common increased sympathetic nervous system angiotensin II receptor blockers (ARBs) comorbidities amongst these patients were activity due to stress, increased endothelin, in COVID-19 is limited. As stated earlier, HTN at 56.5%, obesity at 41.7%, and DM increased transforming growth factor beta, SARS-CoV-2 binds to ACE2 receptors

at 33.8%. While information is still limited decreased prostaglandin E2, decreased as the initial step in viral infection, and PERSONA at this time, recent studies conducted in urinary dopamine after salt loading, and these antihypertensive medications China point towards a positive correlation decreased atrial natriuretic peptide after may potentially increase ACE2 receptor between existing comorbidities and salt loading. The American Journal of expression increasing the risk for COVID-19 mortalities. For example, the Hypertension published a study in April COVID-19. However, abrupt withdrawal European Respiratory Journal published 2020 stating that the prevalence of obesity of these medications may result in adverse a study that analyzed 1590 COVID-19 is 51% higher in AA and 21% higher in outcomes; as a result, they should be positive patients,who were hospitalized HLA than WA, and AA have the highest continued in patients who are at risk or across China from December 11, 2019 to correlation between body mass index and positive for COVID-19. THEME January 31, 2020. They stated that 25.1% salt retention than any other race. Obesity of them had at-least one comorbidity may lead to sodium and fluid retention In March 2020, the Louisiana State with HTN, DM, and CVD being the most as well as vascular damage, which in turn University Health Sciences Center stated common. Other health conditions such as may lead to the exacerbation of HTN. that patients with HTN taking ACEI hepatitis B, immunodeficiencies, chronic The Cleveland Clinic Journal of Medicine or ARBs may be at a greater risk for kidney disease (CKD), and malignancies published a study in 2013 stating that AA COVID-19. On the other hand, the New

were also presents, but at a lower rate. have a higher rate and an earlier onset England Journal of Medicine published TRENDS These patients presented with shortness of HTN and DM as well as increased a report in April 2020 analyzing ACE2 of breath, loss of consciousness, and chest complications associated with CKD receptor expression in 617 COVID-19 abnormal x-ray results. and CVD. The higher rate of HTN and positive patients, taking antihypertensive associated lower rate of blood pressure medications in Japan. According to the Centers for Disease control contributed to a higher rate of Control and Prevention (CDC) in 2016, DM; the higher rates of HTN and DM It concluded that ACE2 receptor the prevalence of HTN in USA was 29% in contributed to a higher rate of CKD. Such expression has increased in patients WELL-BEING which AA contributed to 40.3% and HLA increased rates in AA were due genetic taking Olmesartan, but not in patients contributed to 27.8%. AA has a T594M variations, exposure to air pollution, taking other ARBs such as Losartan, variant polymorphism on the beta- limited food resources, and limited access Candesartan, Valsartan, or Telmisartan, subunit of the sodium epithelial channel, to healthcare. or ACEI. which may increase their prevalence to HTN. The increased rate may also be Currently, information regarding Another study published by the Journal of due to various physiological factors such the risks of taking antihypertensive American Heart Association in April 2020 ISSUES RESEARCH NEWSCOPE

Volume 5 | Issue 3 | July-September 2020 41 PERSONA THEME

once again stated differing information positive patients, elevated levels of plasma racial and ethnic residential segregation,

TRENDS where COVID-19 positive patients taking angiotensin II induced some degree which is a fundamental factor leading antihypertensive medications when of lung injury. In all of these studies, to health disparities. As a result, they hospitalized had a lower risk of all-cause the up-regulation of ACE2 receptor may find it hard to practice the social mortality compared to patients who were expression, restoration of angiotensin II, distancing measures required for the not taking these medications. and RAAS blockade were reversed with prevention of COVID-19. Many of them antihypertensive medications thereby live in multi-generational households Although the information above is preventing acute respiratory failure and where it is difficult to protect the elderly or conflicting, it indicates a potential benefit CVD. immunocompromised individuals from

WELL-BEING of taking antihypertensive medications in COVID-19 transmission in confined COVID-19. SARS-CoV-2 not only binds Environmental Variabilities Leading to spaces. In addition, grocery stores and to ACE2 receptors initiating the viral COVID-19 Disparities medical facilities tend to be placed far infection, but it also down-regulates ACE2 away from these areas making it tough receptor expression therefore preventing According to the Max Planck Institute for the members to stock up on products it from exerting its protective effects in for Chemistry and Mainz University in order to prevent going out often and various organs which may potentially Medical Center in 2015, air pollution receive treatment for COVID-19 if needed

ISSUES lead to acute respiratory failure and CVD. was responsible for 8.8 million premature respectively. Also, members of racial Furthermore, the down-regulation of deaths worldwide. In USA, air pollution is and ethnic minority groups are over- ACE2 receptor expression leads to the considered the largest environmental risk represented in detention centres, jails, and accumulation of angiotensin II, a peptide factor for disease. Currently, air pollution prisons where congregate living increases hormone in the renin-angiotensin- has decreased across the country as the risk of exposure to COVID-19. These aldosterone-system (RAAS) causing vehicle emissions have reduced due to racial and ethnic disparities are evident vasoconstriction and increasing blood social distancing and lockdown orders in in Michigan where AA represents 12% pressure, and RAAS activation; it has been place. However, decades of air pollution of the state population, yet 40% of the

RESEARCH postulated that angiotensin II may also such as particulate matter, ozone, nitrogen state’s COVID-19 deaths as of April 2020 play a role in organ injury in COVID-19 dioxide, and sulphur dioxide have had according to Metro Times. positive patients. A report published by negative impacts on people’s health. the New England Journal of Medicine Millions of Americans are currently In Wisconsin, where AA represent 6% of in April 2020 discussed the results of diagnosed with asthma and HTN due the population, yet 50% of the deaths as of various studies: 1) In experimental mouse to air pollution, and these conditions April 2020 according to The Washington models, exposure to SARS-CoV-1 spike increase their risk for COVID-19. The Post; and in Louisiana where AA protein resulted in the down-regulation Harvard TH Chan School of Public Health represent 32% of the population, yet 70% NEWSCOPE of ACE2 receptor expression, and acute released a study in April 2020 stating that of the deaths as of April 2020 according to lung injury or acute respiratory distress long-term air pollutions directly linked to Newsweek. syndrome (ARDS); 2) In experimental an increased COVID-19 death rate. mouse models, exposure to SARS- Socioeconomic Variabilities Leading to CoV-1 spike protein induced acute lung According to CDC, members of racial and COVID-19 Disparities injury or ARDS, which was limited ethnic minority groups are more likely by RAAS blockade; 3) In COVID-19 to live in densely populated areas due to As COVID-19 positive cases continue to

42 Volume 5 | Issue 3 | July-September 2020 increase across USA, AA and HLA have to be part of the COVID-19 essential Another barrier to healthcare access been affected at a disproportionate rate. workforce. For example, they represented faced by AA and HLA is the lack of According to the Brookings Institute, AA 20% of the nation’s food service workers, health insurance. According to a study represent 15% of Michigan’s population, stockers, cashiers, and janitors according published by Health Affairs in 2005, AA yet 35% of its COVID-19 positive cases to McKinsey & Company in October and HLA are less likely to be insured as of April 2020; this shows that they are 2019, and 30% of the nation’s bus drivers than WA based on their mortality gaps, PERSONA 133% more likely to be infected by the according to DATA USA in 2017. During which were analyzed from 1960 to 2000. virus. In addition, the COVID-19 death a pandemic like COVID-19, AA and HLA This disparity was largely evident before rate in Michigan is currently 4% in which workers, and consequently their families, the advent of Medicaid and Medicare; AA is once again over-represented at 40%. are at increased risk of exposure to the for example, in the 1960s, AA infant In contrast, WA represents 75% of the disease. mortality rate was 44.3 per 1000 children population, and only 25% of its positive and WA was 29.2 per 1000 children. Over cases and 26% of deaths. According to the Furthermore, many AA lack access the years, the overall American infant

New York Times, AA have COVID-19 to healthcare due to racial and ethnic mortality rate including the AA rate has THEME death rate of 20 per 100, 000 people and residential segregation as mentioned in decreased; however, the gap between the HLA of 22 per 100, 000 people in New our Environmental Variabilities Leading AA infant mortality rate and WA rate has York as of April 2020. According to the to COVID-19 Disparities section. As increased. A study published by Cancer WBEZ radio station, AA represent 16% stated above, they live in areas with low Detection and Prevention in 2002 stated of Illinois’ population, yet 30% of its socioeconomic statuses where adequate that AA women are 2 times more likely COVID-19 positive cases. North Carolina healthcare resources are not available to be diagnosed with uterine cancer than and South Carolina show similar patterns leading to poor health. The Journal of WA women, and 2.5 times more likely to with a slightly smaller gap. American Medical Association published die from it; it also stated that AA women TRENDS a study in 2017 analyzing the blood are less likely to be diagnosed with breast As COVID-19 continues to spread across pressure of 2280 AA; it concluded that cancer than WA women, but 36% more the nation, it will continue to exacerbate living in racially and ethnically segregated likely to die from it. The death rate is socioeconomic inequalities along the areas is associated with increased systolic higher amongst AA women because they racial and ethnic lines. Firstly, according blood pressure. Living in these areas lack health insurance, and as a result to the Brookings Institute in April 2020, during a pandemic like COVID-19 get screened for and diagnosed with AA and HLA are more likely to live in prevents the residents from being able cancer at later stages compared to WA WELL-BEING areas of with socioeconomic statuses to protect themselves efficiently from the women. According to a study published lacking green space, healthy food options, disease. For example, on April 9, 2020, by Urologic Oncology in 2014, having recreational facilities, and safety; these La Shawn K Ford, a Democratic member health insurance was associated with inefficient neighbourhoods are rooted of the Illinois House of Representatives, decreased racial and ethnic disparities in the historical legacy of redlining. stated that 10 million face masks were in disease treatment. The study analyzed Secondly, according to McKinsey & retrieved from the federal government, 70, 006 men, and concluded that uninsured Company in October 2019, AA and but none of them were provided to AA men with prostate cancer were 62% HLA are less likely to work in business Chicago’s West side neighbourhoods, less likely to receive treatment compared ISSUES and professional sectors, and more likely which are predominated by AA. to WA men while insured AA men were RESEARCH NEWSCOPE

Volume 5 | Issue 3 | July-September 2020 43 38% less likely. In 2018, the Affordable exist in medical treatments. This report and ethnic minority groups, specifically Care Act stated that 41.2% of AA was discusses a study that analyzed 60 million AA, are disproportionately affected. The enrolled in public health insurances such patients who were admitted to the underlying environmental, structural, and as Medicaid or Medicare, which have emergency room across USA from 2007 to socioeconomic variabilities have existed limited coverages and additional costs; as 2011, and concluded that AA patients had for years, and become exacerbated in this a result, these individuals’ finances were half the odds of being prescribed opioid pandemic. As COVID-19 continues to affected, as they had to spend a portion of medications compared to WA patients. spread across USA, the understanding

PERSONA their income for out of pocket expenses In addition, PubMed Central published of the disease has increased and more and premiums. a study in 2017 analyzing 39 primary information is now available. We must care physicians and 227 AA and WA use this information to manage and During this COVID-19 pandemic, patients with HTN. The study concluded eventually end this pandemic. And in uninsured or publicly insured individuals that AA patients’ interactions with their the meantime, we must strike a balance are less likely to be tested and therefore Physicians involved greater Physician between protecting public health and treated for the disease due to the perceived verbal dominance, less patient-centred safety, and respecting human rights,

THEME costs. Although the Federal government care, and shorter visits compared to WA equality, and dignity. announced that COVID-19 testing and patients; this was because Physicians treatment will be free for all American strongly believed that AA patients will residents regardless of insurance status not comply with recommendations. and type in April 2020, there are gaps in Furthermore, an article published by BBC these mandates, which may potentially News in April 2020 stated that Dr Jean- Prathayini Paramanathan, based in lead to unexpected medical expenses. As Paul Mira, the Intensive Care Unit Head Illinois, USA, is a final year medical a result, many individuals, specifically at Cochin Hospital in France, and Dr student currently sub-interning in TRENDS members of racial and ethnic minority Camille Lochthave, the Head of Research cardiology, and a Clinical Research groups who lack health insurance, may at Inserm Health Research Group in Assistant working in numerous unknowingly be infected by COVID-19 France, suggested that COVID-19 cardiovascular studies. In addition disease, and eventually succumb to is vaccines should be tested in Africa. Such to medicine and research, she has complications or transmit it to other incidents have occurred due to existing completed certifications in Public individuals. stereotypes that AA lack education Health at Harvard University in achievement and medical knowledge. Massachusetts, USA. She also Moreover, micro-level factors also contributes her time to numerous WELL-BEING enhance COVID-19’s racial and ethnic This review article clearly illustrates that humanitarian organizations such as disparities. According to the Brookings COVID-19 involves varying degrees of the American Red Cross and World Institute in April 2020, racial and ethnic infection rate, severity, and mortality rate Vision. empathy gaps exist in perceived pain amongst individuals due to racial and tolerance, and racial and ethnic biases ethnic disparities, and members of racial ISSUES RESEARCH NEWSCOPE

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+91 9643799179 CONTACT [email protected] RESEARCH PERSONA IIT Delhi develops Personal Protective Equipment (PPE) THEME coverall to avoid COVID-19 infection TRENDS WELL-BEING ISSUES

IT Delhi’s Department of Textile RESEARCH and Fibre Engineering has the The presence of anti-bacterial properties gives developed the technology for an extra edge to the coverall as it safeguards IPersonal Protective Equipment (PPE) Coverall (Integrated Body Suit and against the penetration of coronavirus which Shoe Cover) for the protection of doctors, nurses, paramedical staff and is the need of the hour due to unprecedented others from COVID-19. Researchers at situation apart from the lightweight material

NEWSCOPE IIT Delhi has been actively involved in the development of highly-functional that escalates the chances from the other and innovative textile materials which has gained the market prominence due available PPE in the market. to the texture and quality. Emeritus, Department of Textile and his student, Dr. Biswa Ranjan Das, Dr. S.M. Ishtiaque, Professor Fibre Engineering, IIT Delhi, and Scientist ‘D’ and Assistant Director,

46 Volume 5 | Issue 3 | July-September 2020 Defence Material and Stores Research and Development Establishment “The advanced version of PPE coverall that (DMSRDE), Defence Research and we have developed is set to emerge as an Development Organisation (DRDO), Kanpur, has developed an advanced improvised product in the national and

version of PPE coverall, which meets PERSONA the criteria specified by the Ministry international markets, bestowing several of Health and Family Welfare, special functional features along with meeting Government of India. An innovative coating was applied over the compact the requirements for added comfort.” - polyester woven fabric to maintain the lightweight of PPE. Dr. S. M. Ishtiaque, Professor Emeritus,

The presence of anti-bacterial THEME properties gives an extra edge to the Department of Textile and FibreEngineering, coverall as it safeguards against the IIT Delhi. penetration of coronavirus which is the need of the hour due to unprecedented situation apart from the lightweight In this unprecedented scenario, where far, while many infected with the virus are material that escalates the chances COVID-19 the ongoing pandemic, is undergoing treatment. This PPE coverall from the other available PPE in the spreading across the globe and has resulted is like a boon that will safeguard the TRENDS market. in the death of over three lakh people, so mankind from the indiscernible threat. The use of special-grade polyurethane Credit: India Science Wire coating of the coverall augments a smooth texture and the breathable fabric provides comfort to the user. The impermeable membrane on the WELL-BEING outer portion of the coveralls acts as a barrier for both oil and water. The PPE suit will be available in four varieties of size ranging from both Body Suit - S, M, L and XL alongwith shoe cover in various sizes from 1-4. The PPE suit can be reused for three consecutive times therefore it reduces the cost aspect also compared to other available ISSUES PPE suits in market.

For manufacture of the coverall the researchers have collaborated with G. D International company to produce 1,20,000 coveralls per month. RESEARCH

“The advanced version of PPE coverall that we have developed is set to emerge as an improvised product in the national and international markets, bestowing several special functional features along with meeting the requirements for added comfort. NEWSCOPE Breathability and the comfort of the coverall has been a major challenge and we have ensured that to reach an adequate levels of breathability and a softer feel, to support extended wearability,” said Dr. S. M. Ishtiaque, Professor Emeritus, Department of Textile and Fibre Engineering, IIT Delhi.

Volume 5 | Issue 3 | July-September 2020 47 Scientists developed a

PERSONA mobile indoor disinfection sprayer

cientists at CSIR-Central Mechanical THEME Engineering Research Institute (CSIR-CMERI), Durgapur, have Sdeveloped two mobile indoor Disinfection Sprayer units. These units can be used for cleaning and disinfecting the pathogenic micro-organism effectively, especially in hospitals and diagnostic centres. TRENDS Entitled as Battery Powered Disinfectant Sprayer (BPDS) and Pneumatically Operated Mobile Indoor Disinfection (POMID), these units can be used to clean and disinfect frequently touched surfaces such as tables, doorknobs, light switches, countertops, handles, desks,

WELL-BEING phones, keyboards, toilets, faucets, sinks, and cardboards. Intermittent usage of these disinfecting units can minimize the risk of coronavirus transmission for the people who inadvertently come in contact with those surfaces.

ISSUES The sprayer systems in both BPDS and POMID are designed with two-stage spraying units with a separate storage tank for each to manoeuvre a hygienic environment in the enclosed areas and they are monitored with fixed numbers of flexible nozzles set in the lower and upper tiers of the unit. There is also an industrial

RESEARCH variant of the Disinfectant Sprayer for large scale implementation.

POMID mobile indoor disinfectant unit assembled over a steel frame mounted on four wheels with a system enabled POMID mobile indoor disinfectant unit with compressors, pipe-fittings and spray assembled over a steel frame mounted on nozzles. The hand-held spray arm has the NEWSCOPE flexibility to move in any direction as per four wheels with a system enabled with requirement. Each unit of POMID has two storage tank of capacity 10 litres for compressors, pipe-fittings and spray nozzles. smoother operation.

48 Volume 5 | Issue 3 | July-September 2020 The other unit entitled BPDS has a cordless interface with two-nozzle spray system and The technology will have relevance even beyond an extended arm spray unit. The storage the current COVID-19 crisis, since viruses have capacity of 20 litres with a battery back-up time of 4 hours in a single charge is vital been existent throughout and a substantial

feature in the system. The gross weight of PERSONA the system is 25 kg (with an empty tank). number of cases of influenza have been spreading throughout the globe every year. “Most of the disinfectant sprayers prevalent in the market are based either on cleaning or disinfecting using a single the effectiveness of the disinfectant number of cases of influenza have been chamber storage for the liquid and are sprayer. CSIR-CMERI is consistently spreading throughout the globe every pump-based. The droplets produced by a focussed upon developing an efficient year. Hence, Dr. Hirani has urged the pump sprayer are much larger in size and and effective technology to administer MSMEs of the nation to come forward THEME the effective coverage of surface is lesser. the spread of COVID-19. The next stage and invest in this technology, keeping in However, the CSIR-CMERI developed of development for the devices would be mind the future orientation of hygiene indoor sprayer systems consists of dual- to incorporate 360-degree coverage for and healthcare devices. The technology chamber storage for disinfectants and disinfectants and cleaning spray as well as for BPDS is transferred to Power Tech cleaning and have better nozzle design, to make it compact and autonomous for Mining Pvt. Ltd. on the same day for better arrangement of nozzles and lesser usage in schools and homes”, added Prof. commercialization. droplet sizes. The sprayed disinfectantcan Hirani. TRENDS thus cover a greater surface area for the These sprayers are also equipped with Credit: India Science Wire specified volume of liquid”, said Prof. mopping features and extendable Harish Hirani, Director, CSIR-CMERI. arms to reach hidden area and clean comprehensively. The technology will “The particle size and the number of have relevance even beyond the current particles of disinfectant disposed are the COVID-19 crisis, since viruses have been two important parameters for determining existent throughout and a substantial WELL-BEING ISSUES RESEARCH NEWSCOPE

Volume 5 | Issue 3 | July-September 2020 49 NEWSCOPE PERSONA LATEST NEWS IN HEALTHCARE! DR HARSH VARDHAN LAUNCHES MOBILE APP TO ENABLE PEOPLE THEME EASY ACCESS TO BLOOD

he country has recorded over Developed by the E-Raktkosh, a team be requisitioned at a time and the blood 14,000 coronavirus cases for the of Centre for Development of Advanced bank will wait for 12 hours for the person 6th consecutive day since June 20, Computing (CDAC) under the Digital to collect it.” Twhen 14,516 cases were reported. From India scheme, the application will bring June 21-24, there was a hike of cases from transparency and will facilitate single- The Health Ministry informed that from

TRENDS 15,413 to 15,968. In total, 92,573 cases window access to blood services of the limited COVID-19 tests in January, a have been reported since June 20 and over Indian Red Cross Society. cumulative total of 75,60,782 samples have 2.82 lakh this month since June 1. been tested up to June 24 with 2,07,871 Dr Vardhan said, “In the last few months, samples being tested on Wednesday (June A mobile application that would enable I received several complaints from people 24,2020). The ministry also said that there people to access “safe blood” easily, facing difficulties in accessing safe blood. are in total 1,007 diagnostic labs, of which especially during the COVID-19 Many people require blood-related 734 are in the government sector and 273 pandemic, was launched by Union Health services regularly because of certain in private.

WELL-BEING Minister Harsh Vardhan on Thursday, medical conditions in their families. June 25, 2020. Through this app, four units of blood can Source:www.indianexpress.com

SOUTH AFRICA BEGINS FIRST TRIALS FOR COVID-19 VACCINE

ISSUES he first clinical trial of COVID-19 of its antiviral drug Remdesivir used for Biotechnology and pharmaceutical vaccine developed by Oxford the treatment of Covid-19. Remdesivir firms comprising Moderna Inc, and University has begun in South has made great strides in its role in the AstraZeneca, have been accelerating TAfrica. formulation of a vaccine against the the pace of their production, promising contagion. millions of supplies of their experimental The global fight against COVID-19 vaccines before the year-end. Last month, pandemic is intensifying with medical According to the World Health global drug firm Pfizer said that a vaccine experts and drug makers from across the Organisation (WHO), presently there are to treat COVID-19 patients could be RESEARCH world ramping up the efforts to arrive at 13 experimental drugs which are being ready by October-end. the potential treatment for coronavirus tested on humans, while over 120 others vaccine. are in the earlier stages of development. Some of the latest development on Covid-19 vaccine and treatment: With nearly 10 million COVID-19 patients Meanwhile, according to Soumya across the globe and over 4.8 coronavirus Swaminathan, Chief Scientist at WHO, • The University of Oxford and fatalities, the virus has encaptured almost around 2 billion doses of COVID-19 AstraZeneca Plc.’s experimental the entire planet under its grip and the vaccine would be ready by the end of 2021. vaccine, ChAdOx1 nCoV-19, is NEWSCOPE need for a Covid-19 antidote had becomes the first to enter the final stages of more urgent. However, many scientists still anticipate clinical trials. If the trial is successful, that a safe and effective vaccine to treat the Oxford Vaccine Group expects to American biopharmaceutical company coronavirus patients may take 12-18 launch the Covid-19 vaccine by the Gilead Sciences will soon initiate its months to develop. end of this year. clinical trials for an inhaled formulation

50 Volume 5 | Issue 3 | July-September 2020 • The first clinical trial of COVID- Ltd’s claim of a breakthrough cure for • The Coalition for Epidemic 19vaccine is being developed by the coronavirus disease (COVID-19) Preparedness Innovation (CEPI) - Oxford University will be initiated termed as ‘Coronil’ will be marketed an influential foundation focused in South Africa. as immunity booster rather than on preparation and response to ultimate cure for coronavirus. epidemics - has been identified • A Chinese military research institute by manufacturers with capacity PERSONA has been approved to test its second • The UK has started immunisation to produce four billion doses of experimental coronavirus vaccine of about 300 people with a new Covid-19 a year. The CEPI is backing in humans, the eighth Chinese coronavirus vaccine as part of a trial nine potential coronavirus vaccines. candidate in clinical trials. led by experts at Imperial College Source: www.hindustantimes.com, London. www.businesstoday.in • Experts believe that Patanjali Ayurved THEME INDIA TO HAVE SAY IN COVID VACCINE DISTRIBUTION

ndia’s Covid diplomacy has moved and regular conversation with his US Johnson & Johnson and Merck and others. beyond Hydroxychloroquine (HCQ) counterpart Mr.Steve Biegun, as well as A Chinese one also going into phase 3. and paracetamol to ensure that the officials from Japan, Australia and South There is an Australian one, also going into Icountry can leverage its position as the Korea, while Shri Jaishankar has added phase 3, by Murdoch Children’s Research TRENDS world’s largest vaccine manufacturer to be political heft to converse with US, Israel, Institute in Australia. That’s not really a part of the search and distribution of the the Quad countries, Brazil and South vaccine for COVID-19, but it is new kind Covid vaccine. Korea. India, officials said that it would of BCG vaccine,” Prof. Vijayaraghavan work with “like-minded countries” not confirmed After sustained conversations with only for vaccine development, but its their counterparts in key countries, the production and distribution. Interestingly, while India has a presence government has zeroed in on the Indo- in most of the international vaccine WELL-BEING Pacific group to cooperate for the vaccine. Prof. Vijayaraghavan says, “Globally there development programmes, it has no The key players have been foreign minister are more than 125 vaccine development presence in the two Chinese vaccine Shri S Jaishankar and foreign secretary programmes today, of these, 10 are in the programmes. Shri Harsh Shringla as well as the Prime first stage, eight in phase two (animal and Minister’s principal scientific adviser Prof. limited human trials) and two in phase 3 Prof.Vijayaraghavan gave his observation K Vijayaraghavan and the government’s (larger-scale human trials).We will know that “The size and extraordinary capability department of biotechnology. the results of the phase 3 trials in a few of the Indian vaccine manufacturing effort

months’ time” in bulk are enormous and well appreciated. ISSUES In an exclusive interview, Prof. Apart from the big multinationals, Vijayaraghavan said, “India will have a Apart from the Oxford University Brazil, Indonesia, China and India have voice- even if there is no “Indian” vaccine- programme where India has a large enormous capabilities. India has the in terms of distribution because India’s presence and which is currently the most largest. So India will not be ignored no role in providing vaccine to others will be advanced, getting into phase 3, “There is a matter who makes the vaccine.” very important” programme in the US called Warp Speed Source: www.timesofindia.india times.com which combines phase 1 and 2. Vaccines RESEARCH Shri Shringla has continued a sustained in these programmes include those by

CORONAVIRUS VACCINE UPDATE: MODERNA, ASTRAZENECA,

SANOFI MAKE HEADWAY NEWSCOPE

hile there are multiple been in the news for making headway in has identified manufacturers that can pharmaceutical companies the trials. Johnson and Johnson, Sanofi, produce up to 4 billion doses of vaccine across the world that are Inovio, Sinovac, CanSino are some of the in a year. The Coalition for Epidemic Wworking towards a coronavirus vaccine, other companies to have made significant Preparedness Innovation (CEPI) has there are only a handful that have reached progress. identified two or three manufacturing advanced stages of trials. Moderna, and plants for each vaccine. They currently AstraZeneca that is developing the corona Additionally, a vaccine alliance that produce two billion doses by 2021. The vaccine with Oxford University have is backing at least nine candidates group is planning for eight to 10 regional

Volume 5 | Issue 3 | July-September 2020 51 distribution sites in order to avoid making Johnson and Johnson: J&J has expedited human trials in Canada. everything centrally and trying to ship it its trials for the COVID vaccine. The around the world. final stage of the trial is expected to Pfizer: The company aims to make the begin in September and has been further COVID-19 vaccine candidate ready Moderna: The US-based pharma company scheduled for second half of the July. Like by October 2020. The CEO of the is all set for Phase III trial in July. The AstraZeneca, J&J believes this to be a race pharmaceutical company Albert Bourla third phase of the trial will include 30,000 against time. The company expects to get said, “If things go well, and the stars are

PERSONA participants in the US. It will be conducted approval for its candidate by early 2021. aligned, we will have enough evidence of alongside the National Institute of Allergy Johnson and Johnson have also received safety and efficacy so that we can... have a and Infectious Diseases (NIAID). CEO funds from US government’s Biomedical vaccine around the end of October.” The Stephane Bancel said that the vaccine Advanced Research and Development company is working with German firm candidate has an 80-90 percent chance of (BARDA) to speed up its vaccine BioNTech for possible vaccines. receiving FDA approval. He further said development programme. The company is that “We know our platform. It works on also in talks with European Commission Sanofi Pasteur: French drugmaker Sanofi

THEME MERS, Zika and CMV and so on. When to supply its candidate if it succeeds. expects to get approval for the corona you have the right sequence... you will get vaccine that it is developing alongwith neutralising antibodies. Inovio: Inovio began human trials for its GlaxoSmithKline Plc by the first half of coronavirus vaccine candidate in April. It the next year. If successful, it would be AstraZeneca: The company has started expects to report interim results from the available by April 2021. “We are being trials in South Africa and Brazil. trial later this month, and added that it guided by our dialogue with regulatory University of Witwatersrand in South would begin mid-stage trials this summer. authorities,” said Sanofi research Chief Africa is working with Oxford University The pharmaceutical company said that John Reed.

TRENDS to evaluate the candidate. Meanwhile the it has received $71 million from the US Brazil trials are sponsored by the Lemann Department of Defence (DoD) to scale up Sinovac: Chinese vaccine-maker Sinovac Foundation. Moreover, AstraZeneca production of the company’s devices that has said that its candidate CoronaVac has has signed its 10th deal for supply and are used to administer its experimental witnessed immune response in Phases I manufacturing of its vaccine candidate. COVID-19 vaccine into the skin. and II of the trials. It said that the vaccine Symbiosis Pharmaceutical said on has not caused severe side effects and Wednesday it agreed to make and supply CanSino: The company is developing its more than 90 per cent of the volunteers an unspecified number of units of the corona vaccine with Academy of Military have induced neutralising antibodies.

WELL-BEING vaccine, AZD1222, for AstraZeneca to use Science (AMS) and People’s Liberation in clinical trials. Army. The candidate is under Phase II of trials in China and has been approved for Source: www.businesstoday.in

ISSUES FIRST ICMR-APPROVED COVID-19 ANTIBODY TESTS LAUNCHED IN INDIA

hennai-headquartered CPC EEA that have been manufactured to EEA specific assays. Our priority now is to Diagnostics (CPC), a portfolio standards. work closely with all stakeholders such as company of Everstone-backed the government, the private sector as well

RESEARCH Chealthcare platform Everlife Holdings, The Clinical Laboratory Improvement as the medical research fraternity to make has launched Covid-19 antibody tests Amendments (CLIA)-based tests are these tests available to them.” — SARS COV-2 IgM and SARS COV-2 developed by Shenzhen-based YHLO IgG in India. Both CE-approved tests are Biotech, and run on the fully automated The IgM assay is capable of detecting the the first of their kinds to be approved by analysers iFlash 1800/3000, offering disease as early as the seventh day after the Indian Council of Medical Research sensitivity of 97.3% and 86.1% for IgG infection. The iFlash system minimises (ICMR). and IgM, respectively, with specificity of the human error while being able to 96.3% and 99.2%, respectively. handle large volumes. Depending on NEWSCOPE CE marking is a certification mark that the analyser model, a lab can report up indicates conformity with health, safety, R Kailasnath, MD, CPC Diagnostics, said: to 1,000 to 2,000 results per day on a and environmental protection standards “Our government recognises the need for single instrument, with the flexibility for for products sold within the European more and better testing, and we are happy facilities to add further modules to ramp Economic Area (EEA). The CE marking to be contributing to India’s fight against up output substantially, as stated on behalf is also found on products sold outside the Covid-19 with these highly sensitive and of Everstone Group.

52 Volume 5 | Issue 3 | July-September 2020 CPC is also planning to launch another in-vitro diagnostic products, has three “Everlife is committed to support its antibody ELISA-based testing solution, decades of experience in the industry. portfolio companies to fight COVID-19 which is under the process of ICMR It operates in India, Sri Lanka and in all the countries where it operates, approval. The ELISA tests developed Bangladesh. by providing safe and accurate testing. by EUROIMMUN AG in Germany Quantitative serological antibody testing can be programmed on any automated According to the company statement, is uniquely suited in the current Covid PERSONA ELISA processor or ELISA reader in the antibody tests are very valuable in environment, where countries are not addition to the dedicated EUROIMMUN community screening and surveillance only looking at detecting and controlling analysers. These tests offer high sensitivity and they eminently complement the RT- the spread but also preparing to re-open of 93.8% and 100% for IgG and IgA, PCR tests. their economies.” respectively, with specificity of 99.3% and 90.5% respectively. An enzyme-linked Unlike qualitative rapid tests, CPC’s CLIA immunosorbent assay, also called ELISA and ELISA tests provide semi-quantitative or EIA, is a test that detects and measures values. This feature is useful to assess the THEME antibodies in the blood. suitability of plasma (from individuals Source: www.financialexpress.com who have recovered) for therapy. CPC, a manufacturer and marketer of Raman Gandotra, CEO, Everlife, said:

GOVT TO ALLOW PPE, VENTILATOR EXPORTS AS INDIAN COMPANIES TRENDS ARE MASS-PRODUCING THEM NOW

he government is likely to According to two sources, the government the officer added. soon allow exports of personal is now working on the proposal to protective equipment (PPE) kits allow manufacturers to export surplus Empowered Group III is one of the high- and ventilators, two crucial components equipment after the domestic demand has level panels set up by the government to T WELL-BEING in the battle against coronavirus. been taken into account. bolster its response against the pandemic.

Over the past few months, since “The PPE kit-makers have informed us Launched by an order of the Ministry COVID-19 was first identified as a that they are getting demand orders from of Home Affairs, the group holds the strengthening threat, the present ruling several nations, including the US, the mandate of ensuring the availability of government has ramped up India’s UK, Nigeria, Germany, Spain, Russia and essential medical equipment such as capacities to manufacture PPE kits and Uganda,” a senior health ministry officer PPE, masks, gloves and ventilators, and ventilators in collaboration with private said. oversees each aspect in this regard, from ISSUES players. According to government production and procurement to import data, India is currently churning out “Several ministries, including those and distribution. an estimated 6 lakh personal protective of commerce and health, and the equipment (PPE) kits and around 1,000 Empowered Group III are involved in ventilators daily. drafting the proposal to allow exports,” Source: www.theprint.in RESEARCH AYUSHMAN BHARAT’S ROLE DURING COVID-19 OUTBREAK IN INDIA

eople covered under Ayushman The source told that the packages have flagship scheme of the central government Bharat Scheme would be eligible for been finalized for the regions that require to provide health coverage for the poor free treatment of COVID-19 as per multiple tests, and if a person needs segment of the population. Also, it’s the Preport. isolation it will be covered under the same world’s largest health coverage scheme scheme. covering more than 10 crore families. NEWSCOPE Ayushman Bharat is the flagship health insurance scheme by the Central NHA might have also created additional A cover of Rs 5 lakh is provided per family Government for the poor people. As packages in cases where patients are going over 1400 predefined packages across 23 per National Health Authority’s (NHA) through respiratory distress and need specialties. The source added, approvals direction, the treatment and testing of intensive care in some serious cases. for the packages have been sought within COVID-19 will be done for free of cost two days, once the packages are in place in any of the private hospitals empanelled The Ayushman Bharat Scheme or the and want to be prepared if there are for the scheme. Pradhan Mantri Jan Aarogya Yojana is the possibilities of community transmission

Volume 5 | Issue 3 | July-September 2020 53 being reported. who report having COVID-19 like The pandemic has derailed the whole symptoms and are in categories of having world. So, it would be unrealistic to expect Managing the call centre for the 1075 been in direct contact with a COVID-19 that all programmes will continue as they helpline of the health ministry, fielding patient were initial tested for symptoms to were. We have prepared packages and about 30,000 to 40,000 calls every day ensure the confirmation of the contagion. most of the states have started providing in terms of providing information. Connect them with doctors and offer testing and treatment under PM-JAY. So

PERSONA Preparation of a big database of citizens telemedicine to ensure follow-up actions. far, the caseload was not that much and showed high-risk people, the elderly who therefore the response was centered on have co-morbid conditions, etc. He also said that “We have also expanded public health facilities. But as the surge our empanelment (of private hospitals) is taking place, we’ll need more and more 700,000 calls were done to such high- because we know that we need more private sector participation. risk people to gather data for follow hospitals, not only for COVID-19 but up with anyone who have COVID-19 also for non-coronavirus cases. As many

THEME like symptoms. Consulting doctors to hospitals have converted themselves ensure they get the right information and into dedicated COVID-19 hospitals, a Source: www.bfsi.economictimes. treatment. If they need testing, treatment, lot of critical activities like dialysis and indiatimes.com, www.qz.com or isolation, all is being managed under chemotherapy still need to be done and Ayushman Bharat, shares Dr. Indu we need more hospitals. Bhusan, CEO of the National Health Authority (the agency that presides over So in the past month-and-a-half, we have Compiled by: the scheme). actually impanelled more than 1,000 new Parthvee Jain, Editor, InnoHEALTH TRENDS hospitals to take care of such people.” Magazine Then, with Aarogya Setu, all the people WELL-BEING ISSUES RESEARCH NEWSCOPE

54 Volume 5 | Issue 3 | July-September 2020 To be a Nurse/ Nursing is not for everyone/ Beyond PERSONA the Call of Duty

Written by Dr. Elsa Lycias Joel THEME

rom time immemorial women is derived from the fifth-century post- many people have faced the adversity have been considered to be better classical Latin nūtrīce, a wet-nurse hired and embraced the death but the utmost caretakers.History has provided us to provide an infant with breast milk when resilience and calm professionalism Fwith many examples of women as nurses the infant’s mother would not or could not displayed by nurses make them an and their contributions to the societies. do so. Etymologically it is related to our essential part of the societies. Be it ‘The lady with the lamp’ or ‘The modern word nourish. TRENDS angel of the battlefield’ or sojourner truth With a long history, they are everywhere or the first black woman general of USA As Britain prepares to celebrate Florence as members of the largest health care or the first lady of nursing, there is no Nightingale’s 200th birthday on May 12, profession in diverse settings and fields. dearth of inspiration. All of us, at least the whole world believes nurses as their Stories of army nurses have reinforced the when pandemics hit us came to know saviours and would not let go of them. fact that they do their best withstanding what the word ‘nurse’ stands for. The word In today’s scenario, despite intensive care hardships at the front and have been WELL-BEING ISSUES RESEARCH NEWSCOPE

Volume 5 | Issue 3 | July-September 2020 55 Be it ‘The lady with the lamp’ or ‘The angel of think, nurses report for work in the most challenging of circumstances, not just for the battlefield’ or sojourner truth or the first the sake of duty but their inner conscience that believes in safeguarding the human black woman general of USA or the first lady of lives is a fundamental principle of their profession. PERSONA nursing, there is no dearth of inspiration. Severe shortages of proper protection gear awardees of The Purple Heart. We all lethargy and unpreparedness for the for nurses in the current and post pandemic know how vulnerable they are under current pandemic. Uneven battle with periods is a result of governments’ the present circumstances as a vital link the deadly virus in turn threatens the lethargy and unpreparedness for the between the patient and the rest of the smooth rendering of health services to current pandemic. Uneven battle with healthcare system. Raincoats and helmets the public. Though nursing’s image take the deadly virus in turn threatens the THEME in lieu of coveralls and masks, claps and on an heroic cast during pandemics and smooth rendering of health services to clanging pots instead of PPEs and a pay wars, the reality for most nurses is that the public. Though nursing’s image take raise, it’s a struggle day in and day out. the work is incredibly demanding with on an heroic cast during pandemics and Relentless working around critically ill few financial rewards and poor working wars, the reality for most nurses is that patients even when the surge has affected conditions. Nursing fails to keep up the work is incredibly demanding with so many lives is itself an act of self denial. economically with other occupations. few financial rewards and poor working A listening ear and a calming touch even For the sake of four words -Humanity, conditions. Nursing fails to keep up

TRENDS as they keep their senses alert for one Fortitude, Devotion and Sacrifice which economically with other occupations. small subtle change to determine what describe this profession the best and for For the sake of four words -Humanity, or who needs to be called reflects their these words to ring true, the cracks in the Fortitude, Devotion and Sacrifice which flexibility, innovativeness, patience and current edifice of healthcare safety should describe this profession the best and for adaptability. not continually grow. For those thousands these words to ring true, the cracks in the who died on duty leaving their colleagues current edifice of healthcare safety should Severe shortages of proper protection gear and families shaken, their contributions not continually grow. For those thousands for nurses in the current and post pandemic are acknowledged as essential to victory who died on duty leaving their colleagues

WELL-BEING periods is a result of governments’ against this evil called COVID-19. If we and should not continually grow. For ISSUES RESEARCH NEWSCOPE

56 Volume 5 | Issue 3 | July-September 2020 Nursing fails to keep up economically with responsibility makes them an important part of the healthcare society. other occupations. For the sake of four words PERSONA -Humanity, Fortitude, Devotion and Sacrifice Forget COVID-19 for a moment. In normal circumstances, to smoothen which describe this profession the best and the often turbulent path of interaction between patient and an over worked for these words to ring true, the cracks in the health specialist, nurses are well able current edifice of healthcare safety should not to tolerate differences, willing to keep aside potential perceptions and whole

continually grow. heartedly contribute to shared care plans THEME even when multiple patient handoffs play foul in establishing a trusting and those thousands who died on duty leaving “rainbow rooms” that offer peace and collegial relationship. Nurses must re- their colleagues and families shaken, serenity alongwith a space to have a safe define stressful situations, carry on their contributions are acknowledged conversation. Above all, nurses need not and do their job in any situation with as essential to victory against this evil go home thinking, ‘I could have been the or without resources. There seems called COVID-19. If we think, nurses kindest to so and so’. to be no recognition anymore of the TRENDS report for work in the most challenging of collective goodwill involved in providing circumstances, not just for the sake of duty The rendering of a nurse is beyond the a service, many a time selfless one. A but their inner conscience that believes words as they are the mediums that bad job is definitely not excusable, but in safeguarding the human lives is a extend the support to the patients and others involved with nurses ought to fundamental principle of their profession. their families. With underpayment, understand and appreciate the struggles under-resourced and overworked, they or shortcomings. At the end of the day, Due to their long working hours and are barely holding it together in the they don’t feel like heroes but rush back WELL-BEING undulating efforts to keep their patients recent COVID-19 pandemic. Patients home as a daughter, wife, mother, lover or healthy also concerns about their personal who arrive in severe shock, others very a friend to feel belonged, to care and be psychosocial well-being. At these times, sick demanding a high level of nursing cared for. even behind a mask the nurses are care and many others on the verge of not wholly successful in altering their death needing a kind look or words of outward demeanour and the presentation comfort, surrender themselves with ‘that’ of what they see as their `detached’ look in their eyes. ‘Stoicism’ is the ruling Dr. Elsa Lycias Joel holds a doctorate face does not serve to mask feelings of word in times of profound upheaval, degree in biotechnology.Has worked exhaustion, demoralisation, anger or risk, and strain. Is there anything more with the new Indian express as sub ISSUES sorrow”. Recently, with too many failings traumatic than seeing the one you cared editor for a year. She is a prominent and deaths to handle, however, nurses for in the previous shift with lot of hopes writer for a number of children’s find themselves having to perform a and prayers, in a body bag hours later? magazines since 2004. She has also different kind of emotion management These soldiers who display courage in the contributed to The Delhi Press, I than that prescribed by their profession. face of duty are more than deserving of Quote, Women Exclusive (WE), They have to present the detached face of a ‘Maidstone Medal’ or “The Christiane infinithoughts, couples magazine the professional career, as fear of losing Reimann Prize”. What’s more, they put alongwith other national and regional RESEARCH grips them. Next moment, they also the wellness of others before their own, dailies. She has authored a children’s have to handle intense joy on liberating and many accept their fate with incredible book named “Perfect Endings’, the someone from a ventilator, when another dignity. Bold voices with clearly author’s copy of which was signed by one stabilises and could breathe on her/ articulate ethical positions and an astute the former President of India Dr. Abdul his own again. `Smiling happiest faces’ understanding of human rights, careful Kalam. also means they have to work hard on discernment of human rights violations their emotions especially with families of with a bold acceptance of professional NEWSCOPE patients whose expectations of a quality service have been raised beyond anything There seems to be no recognition anymore of better than the best. An impending doom or an existing gloom, the overall the collective goodwill involved in providing a effect is physically and psychologically service, many a time selfless one. palpable. ‘’Wobble rooms” are indeed

Volume 5 | Issue 3 | July-September 2020 57 The New Normal: Analysis of challenges posed PERSONA by COVID-19 on Indian Healthcare Industry THEME First virtual IC InnovatorCLUB Report

Written by Parthvee Jain

erceiving the current The lockdown has given us the opportunity After welcoming all the experts on board unprecedented times, I vehemently to refurbish our thought and adapt Dr V K Singh, MD of InnovatioCuris (IC),

TRENDS make an audacious statement ourselves to accept the “new normal”. enlightened about the idea behind this Pthat COVID-19 pandemic is the most Amidst the current situations, healthcare virtual platform and the vital role played clamorous, catastrophic and redefining sector faced the challenges pertaining to by IC to fight against the pandemic. aeon of our lifetime. the novel corona virus or COVID-19 and Dr Hem Chandra Pandey, Vice chancellor to respite itself from this situation it was of Uttarakhand Medical Education The situation that our generation in dire need of sustainable innovations to University initiated the opening of the has faced till date is more disastrous cater to the ever increasing demands of session and shared his views regarding compared to the Spanish flu 1918. The the COVID-19 patients. the public health issues addressed by

WELL-BEING rate of contraction of COVID-19 around the government hospitals prior to the the world has expedited from the first To address this situation, we as pandemic to safeguard the health of the cases reported in China in the end of InnovatioCuris Foundation of Healthcare humans. Given the ordeal of the present December 2019 till starting of the month & Excellence (ICFHE) took the initiative situation the government and private May 2020 irrespective of the fact that an to bring some industrial experts on a hospitals have come together to deal with approximate of one-third of the world’s single platform to synergize the need of this situation where the public health population is locked inside their homes. healthcare system and develop solutions activities are jointly being carried out by

ISSUES towards it. As the world is being digitally both. The current unprecedented situation is collaborated in the present time, we bereft of following any norms and has organised a first of its kind virtual Dr Hem Chandra also discussed the perplexed the whole world regarding ICInnovatorCLUB meeting on May 2,2020. diversified role undertaken by the private the economic crisis, lockdown protocols and strategies to come out safe from this virus. The virus has made alteration in its genetic expressions in order to acclimatize

RESEARCH itself in diverse geographical regions of Earth. The virus has originated from cross-species transmission (CST), also called interspecies transmission is now an undeniable fact as per the scientific literature any ecological modifications made by microorganisms take nearly 800 years to carve a niche for itself. The spread NEWSCOPE of this virus is pernicious as it seems to find new ways to hide itself; and now that we can be asymptomatic and yet be a carrier of infection is really deadly and devastating.

58 Volume 5 | Issue 3 | July-September 2020 hospitals in the state of Uttrakhand to collaborate with the state research The current unprecedented situation is bereft institutes and government hospitals of following any norms and has perplexed the for better treatment to be imparted to COVID-19 patients. whole world regarding the economic crisis, PERSONA Highlighting the issues of diagnostic lockdown protocols and strategies to come out challenges the COO of Oncquest Laboratories, Dr Ravi Gaur enlightened • Availability of ICMR approved testing a combined effort can and will definitely about the depth of the distressful situation kits make a huge difference. with an impactful verdict that “the • Logistic and supply chain disruption smallest, tiniest strand of RNA (virus) • Manpower needed for strong According to Dr Nagendra has brought the species humankind to motivation and assurance Swamy,(Principal Coordinator of

its knees. But we humans have pulled • Health being a state subject there Federation of Healthcare Associations, THEME through the crisis earlier, and will pull is some communication gap in Karnataka) there are approximately through this.” expressing the goals between the 16,00,000 beds in India out of which centre and the states quality validation 8,00,000 are with the public health sector He further emphasized that in the past, • Catering to India’s 1.3 billion including government hospitals, armed humans have faced two major infectious population is a huge task and calls for forces etc. Another 8,00,000 are organised diseases i.e TB and HIV and the present a smoother operational mechanism with private sector, the corporate hospitals scenario of COVID-19 also show higher for the success of this collaborative have 62,000 published beds only and impact on all the organs of the body approach. 1,00,000 beds available with large and TRENDS therefore leading to a multiple organ • State governments need to step up tertiary care hospitals and moving to failure in the human body. RT-PCR is the measures and ensure a hurdle-free private medical colleges we have around molecular diagnosis used for the detection. procedure and a safe environment for 2,00,000 beds in this segment. The balance The serology and antibody assay using the medical and testing workforce. 4,00,000 beds in private healthcare that is ELISA and rapid test cards play a vital role virtually handling the common class and in epidemiological growth. Appreciating the level of surveillance that serving as the backbone of the Indian countries like India are able to achieve healthcare. He further emphasised the WELL-BEING Some of the biggest challenges in testing/ at this time, Dr Gaur also highlighted unimportance given to the small and diagnosing the current situation are: the importance and appreciated the medium sized hospitals that can play a • Identification of suspected cases and support, alertness being extended by the major role in safeguarding the health of faster diagnosis government towards the capacity building. humungous population of India in the • Continuous revision of testing The steps being taken to overcome many current pandemic interventions. strategies of these challenges ensure that the testing • Augmenting the testing capacity is available to the last man out there on the Since the better healthcare facilities are Limited post with an affordable cost. only available in the metropolitan cities ISSUES • Availability of infrastructure (like there is an immediate surge for upliftment Biosafety Level 2 and 3 standards etc.) Dr Gaur, added that COVID-19 virus has needed for the small and medium sized • Limited NABL accredited diagnostic exposed the fragile existence of the human healthcare centres as this will cater to labs – Need to fast track accreditation race. the sustainable source for tackling the • Limited skilled workforce unprecedented situations caused by • Safety of manpower The accuracy of the detection and pandemic and the epidemics. • Limited resources like PPEs - generation of test report in a short span RESEARCH innovators stepped up and helped of time (4-6 hours) will impart a major He further complemented the efforts with some innovative models and impact on the eradication of COVID-19 and guidelines rolled out by MOHFW was made available with the help of and ICMR to segregate the hospitals into government interventions, but costs There is a strong need to have a near COVID and non-COVID hospitals so that are high patient and rapid but very accurate test. all the other healthcare facilities are also • Type of sample for swab collection As COVID-19, has become pandemic, available to the patients without any risks

(nasopharyngeal / oropharyngeal / there is an urgent need to invest more of cross contamination with coronavirus. NEWSCOPE buccal) in developing state -of-art-laboratories Dr Swamy, also shared his concern • When to collect samples - time equipped with latest technologies and about the financial and disease burden of sample collection (affects the qualified skilled force. Indian Government challenges that such hospitals are facing accuracy of the diagnosis) has done a very commendable work but to today, and highlighted the role of small • Storage and transportation of the foster development a strong collaboration and mid-sized hospitals to fight the samples ( special Viral transport is needed between government managed difficult situation by serving people with media required and cold chain needs labs and private labs. Both public and non-covid health issues keeping in mind to be maintained ) private entities have their limitations, but the safety of all.

Volume 5 | Issue 3 | July-September 2020 59 Good sleep, healthy diet and meditation are important practices to be taken into consideration. Three dimensional healthy lifestyle can do wonders and everyone should try to follow it, irrespective of one being at home, in a hospital or anywhere else. PERSONA Another interesting picture of challenges being faced by the private hospitals was emphasised by Dr Param Hans Mishra,CEO of Kailash hospital.

It is really sad that we all are struggling with such a paradoxical setting today, THEME where doctors who are the front line protectors/fighters have their own protection at highest risks, the healthcare We all are struggling with such a paradoxical staff who are saving millions of lives and families have their own lives and families setting today, where doctors who are the in the most vulnerable zone. And to front line protectors/fighters have their own top all this, is the shortage of resources TRENDS and finances to serve these healthcare protection at highest risks, the healthcare staff workers, organisations and ecosystems. It is a real challenge for the private sector who are saving millions of lives and families as the reduction in the number of non- covid treatments/surgeries (due to fear have their own lives and families in the most of catching cross infection) leads to vulnerable zone. reduction in cash flow and high number of covid treatments demands more and

WELL-BEING more per patient inputs (financial as well In alignment of the aforementioned Whether we talk about insomnia, strange as human resource). thoughts and further highlighting the dreams, or even too much sleep, all are challenges being faced by any mid-sized types of sleep disturbances that are a part Trying to find solutions to some of the hospitals today, Ms Upasana Arora,the of our body’s response to trauma and above challenges, ICFHE under the Director of Yashoda Hospital, Kaushambi anxiety. umbrella of Ministry of Human Resource and the chairperson of Services Export & Development (MHRD) organised two ISSUES Promotion Council (SEPC) requested the “Healthy self” and “self awareness” are virtual national level hackathon on Fight industrial expert to make amendments the key to good health that we all need to Corona IDEAthon and MHRD Mega in the policies for healthcare sector to take care of. Mindfulness and relaxation Online Challenge - SAMADHAN in the combat the pandemic situations in a better techniques are proven to improve mood month of March and April, to call upon way. She also emphasised on how all the and sleep quality by enhancing the the young innovators. safety measures like wearing masks, PPE control over the body’s focus and arousal etc should be considered as a universal system as well as in managing anxiety and Fight Corona IDEAthon was organised precaution. concerns. from March 27-29, 2020 by ICFHE

RESEARCH under the aegis of the Ministry of Human Moving ahead on the path of analysing Stress, in such a situation is quite normal Resource Development Innovation Cell, the challenges that the healthcare industry and can be healthy (as it motivates All India Council for Technical Education is facing, Dr S K Gupta, Director of one to take necessary actions), but too (AICTE) and FORGE Accelerator. It was Cardiology & Medicine, JWM Global much sustained stress is not. High and a national level 48 hour virtual/online Hospital & Research Centre India, talked unregulated levels of stress can have ideation hackathon that extended to 72 about one of the most important and least various negative consequences on the hours due to overwhelming response, brain, immunity and also on the vascular to discover ideas from thousands of

NEWSCOPE talked aspects to this dreadful situation that is trauma and anxiety that the health system of the body, leading to blood innovators, researchers, scientists, and workers and people are facing today. sugar imbalances, high blood pressure, educators from across India. More than impaired immunity and inflammatory 5400 teams and 300 mentors joined Putting it together, Dr Gupta told that responses – the very precise opposite of hands as a true community during these there are three dimensional aspects to what we need to fight the potential impact uncertain and challenging times to one’s well being, that is Spirit, Body and Mind. from this COVID-19 exposure. discover solutions that can help the nation

60 Volume 5 | Issue 3 | July-September 2020 PERSONA THEME

rise and combat COVID-19. Mr.Muthu Vangaliappan from Katomaran to help the community in this time of TRENDS Technologies and Business Solutions crisis. There were nine IDEAthon winners, three and Dr Sachin Sharma from AI joined in each track of Students, Educators & and shared their personal experiences Trying to fast forward this implementation Researchers and Professionals & Startups. and innovative solutions that they have process, ICFHE has taken a step towards The winners were awarded the cash prizes developed to fight the crisis. creating a Hospital Innovation Screening and also incubation grants upto 40 lakhs. Committee (HSIC) to get the innovations There were also nine motivational cash Working on their innovative solutions evaluated and tested on ground to expedite WELL-BEING prizes (three in each category) given out like: the validation process. A platform was to motivate some of the best ideas from 1) disposable/ reusable lung and heart extended to the innovators to demonstrate around the country. monitors that can be worn at home and their inventions that is evaluated by the only require a smartphone which will help eminent leaders of the industry. Standing tall on a highly impactful to reduce the burden for hospital based Fight Corona IDEAthon, the Ministry monitoring and the bottleneck of available As it’s said, every crisis is an opportunity of Human Resources & Development, hospital beds. As most of the death are in disguise. So let’s try to grab this in collaboration with AICTE and occurring due to comorbidity. The AI opportunity and stand together to fight ISSUES InnovatioCuris Foundation of Healthcare Algorithm developed by Abhayatech can against this and any such pandemic in & Excellence (ICFHE), again hosted act as a temporary doctor and constantly future. a nation-wide mega online challenge help in monitoring the patients therefore SAMADHAN under two tracks- Track ease the burden on doctors. 1:Ideate-Simulate-Win and Track 2: Validate-Pitch-Deploy.Under the 2) Autonomous mobile UV-C robot. It’s Parthvee Jain, Editor, InnoHEALTH, SAMADHAN challenge there were three a AI enabled robot that can be used to is an engineer with specialization and RESEARCH categories namely: student innovators, sanitize hospitals, offices, campuses etc. It interests in fields like Biotechnology, researchers & educators and startups to could be useful in hospital settings where Healthcare, Food Processing and share their ideas to solve the challenges the room has to be sanitized after each Nutraceuticals. Connecting European posed by COVID-19 pandemic. The and every patient like MRI room or CT Healthcare innovation leaders with SAMADHAN challenge was a 14 days scan room etc. the Indian healthcare system and long hackathon from April 14-25, 2020, pioneers, she heads the market that witnessed more than 3200 team 3) Early detection of COVID-19 using access program and partnerships NEWSCOPE participation from all over India. CT scan images and machine learning at InnovatioCuris: impacting techniques. organizational performance With the initiative of these hackathons, through expert research, analysis our healthcare ecosystem got some We hope that our Indian healthcare and evaluating market competitive bright solutions catering to some of the ecosystem will soon be able to implement conditions, current and emerging challenges posed by this pandemic. such innovative solutions to cater some of trends, and industry-specific the challenges mentioned by the experts solutions. Through an interactive discussion,and also there will be more and more Mr.Tarak Nagarajan from Abhaytech, young innovators out there who are eager

Volume 5 | Issue 3 | July-September 2020 61 Looking at India’s role at containing COVID-19 outbreak PERSONA and surge in new infection among denizens THEME

Written by Dr. Gautam Kr Ghosh

hough India has made progress National AIDS Control Organization and this seasonal flu, spread rapidly but it’s for preparing and migitating executing preventive intervention. These deceased impact is less. the impacts of pandemics still measures were internationally acclaimed TRENDS Tthere is an uneven distribution towards as they demonstrated numerous good In the initial stage, these diseases like International Health Regulations (IHR). practices through community-led H1N1, SARS-Cov-2 or COVID-19 is The Global Health Security (GHS) Index efforts.Similarly the outbreak of Nipah undetected. Unlike the other diseases, 2019 assessment reported the fate of India virus(2001), the Chikunguya (2002), COVID19 or Coronavirus is extremely which is shown below- severe acute respiratory syndrome (SARS contagious leading to death in maximum in early 2003), the pandemic H1N1(2009) cases. The people who are in their India over the last three decades has and Crimean-Congo Haemorrhagic fever advanced age i.e. above 60 years and those faced many novel diseases in epidemic (2011) were contained without significant whose immunity is compromised due to WELL-BEING proportion. For example, in 1984 Human morbidity and mortality for the country. certain health ailments are more prone to Immunodeficiency Virus (HIV) that the fatal consequences of this virus. caused Acquired ImmunodeficiencyIn the case of COVID-19, this has striking Syndrome (AIDS) arrived in India resemblance with pandemic H1N1 that Confronted with the current summons unnoticed. Nation’s health administrators persisted as seasonal flu and SARS that rising out of COVID-19 outbreak, it upheld control measures by setting up the caused severe bronchitis. Although is fascinating to take note of India’s ISSUES RESEARCH NEWSCOPE

62 Volume 5 | Issue 3 | July-September 2020 projection in the World Bank Group In the initial stage, these diseases like The states embraced ‘Custer Approach’ Pandemic Preparedness Funding Status H1N1, SARS-Cov-2 or COVID-19 is with distinguishing proof to trace the Report of September 2019. India scores as undetected. Unlike the other diseases, individuals who have interacted with IDA nations on readiness, research facility, COVID-19 or Coronavirus is extremely COVID-19 infected individual as a reconnaissance and workforce which is contagious leading to death in maximum group and afterward focusing on specific PERSONA anticipated in the figure underneath- cases. The people who are in their hotspots, door to door screening of people advanced age i.e. above 60 years and those infected and those potential age group India over the last three decades has whose immunity is compromised due to people likely to get infected. Certain areas faced many novel diseases in epidemic certain health ailments are more prone to were demarcated as “Containment Zones”. proportion. For example, in 1984 Human the fatal consequences of this virus. With the concurrence of the rapid Immunodeficiency Virus (HIV) that testing facility for COVID-19 there were caused Acquired ImmunodeficiencyConfronted with the current summons considerable increases in number of

Syndrome (AIDS) arrived in India rising out of COVID-19 outbreak, it symptomatic as well as asymptomatic THEME

Joint External Evaluation (JEE) Scores - 76 countries TRENDS

unnoticed. Nation’s health administrators is fascinating to take note of India’s cases. The migrant labourer from different WELL-BEING upheld control measures by setting up the projection in the World Bank Group states in the dire consequences has to take National AIDS Control Organization and Pandemic Preparedness Funding Status the ultimate judgemental step of returning executing preventive intervention. These Report of September 2019. India scores as back to their native states has spiked the measures were internationally acclaimed IDA nations on readiness, research facility, spread of the disease. Majority of the as they demonstrated numerous good reconnaissance and workforce which is migrant workers travelled from high risk practices through community-led anticipated in the figure underneath- areas to the rural native place, increasing efforts.Similarly the outbreak of Nipah the spread of the disease in rural areas virus(2001), the Chikunguya (2002), The Government is well aware of its which were earlier not exposed to the ISSUES severe acute respiratory syndrome (SARS role and anticipation for widespread pandemic. in early 2003), the pandemic H1N1(2009) transmission,therefore the outbreak was and Crimean-Congo Haemorrhagic fever declared in India as an epidemic and In response to the biggest economic crisis (2011) were contained without significant provisions of the Epidemic Diseases Act, triggered by the Covid-19 pandemic after morbidity and mortality for the country. 1897 were invoked. India’s reaction to the 1979 with a subsequent lockdown has led COVID-19 pandemic has been described to the Nation Central government’s fiscal

In the case of COVID-19, this has striking as being the most stringent as per the relief to just about 1.1% of GDP. It has, RESEARCH resemblance with pandemic H1N1 that Oxford COVID-19 Government Response however, allowed states to increase their persisted as seasonal flu and SARS that Tracker. The nation faced prolonged borrowing limit unconditionally by 0.5% caused severe bronchitis. Although lockdown since March 24. Given India’s of their Gross State Domestic Product this seasonal flu, spread rapidly but it’s deficient health infrastructure, a severe (GSDP) or Rs. 1.07 lakh crore. A definite deceased impact is less. reaction had to be embraced on emergent portion of the Centre’s fiscal relief i.e Rs basis to restrict the spread of the infection. 40,000 crore or 0.2 per cent of GDP with

an additional allocation to MGNREGA NEWSCOPE has led to a budget estimate of Rs. 61,500 In the case of Covid-19, this has striking crore for the fifth and final tranche of the resemblance with pandemic H1N1 that packages announced by Finance Minister.

persisted as seasonal flu and SARS that caused Amidst the lockdown, the Prime Minister of India addressed the nation on May12, severe bronchitis. 2020 where he allocated Rs. 20 lakh crore

Volume 5 | Issue 3 | July-September 2020 63 PERSONA THEME TRENDS The nation faced prolonged lockdown since states likewise have higher number of beds accessible for elderly population — March 24. Given India’s deficient health for instance, Kerala (7.4), Tamil Nadu (7.8), Karnataka (8.6) — while northern infrastructure, a severe reaction had to be and central states have moderately low embraced on emergent basis to restrict the accessibility of government beds for senior citizen category of people. It is certain spread of the infection. that availability of government beds is WELL-BEING wretchedly low in India, and a scourge like coronavirus can rapidly convolute the for “Atmanirbhar” package, stating it to be variations in the number of beds accessible issue much further. An expected 5-10% of liquidity driven with little burden on the per patient, isolation beds, intensive care all patients require critical care in form of exchequer. The government reinforced units and ventilator facility availability. ventilator support. new revenue options from different It very well seen that numerous states i.e sector such as agriculture, public sector Bihar, Jharkhand, Gujarat, Uttar Pradesh, Presently, Indian Council of Medical ISSUES enterprises. Andhra Pradesh, Chhattisgarh, Madhya Research (ICMR), the apex body, Pradesh, Haryana, Maharashtra, Odisha, has endorsed private clinics to treat In the area of healthcare, 17 states Assam and Manipur lie below the national COVID-19 patients. Thus with the reportedly have hospitals dedicated level figure (0.55 beds per 1000 populace). inclusion of private hospital in the drive, for the treatment of Covid-19 patients These 12 states together recorded for the bed capacity for COVID-19 patient with separate areas for suspected and nearly 70% of total population in India. might see improvement but the situation confirmed cases, but these facilities in Bihar has an intense lack of government can be inadequate if there is a surge in all likelyhood are to be overwhelmed hospital beds, with simply 0.11 beds patients requiring indoor-based care RESEARCH with the current surge in new infection. accessible per 1000 populace. A few states facility. The infrastructure stress will be Utilizing the available information improve on this metric, for example, West especially acute in few high-burden states from National Health Profile–2019, Bengal (2.25 government beds per 1000) like Gujarat, Maharashtra and Delhi. it is noticeable that there are 7,13,986 and Sikkim (2.34 government beds per Already, as per media reports, two of the government hospital beds available in 1000). The capital city of Delhi has 1.05 highest prevalent states for Covid-19 are India. This adds up to 0.55 beds per 1000 beds per 1000 populace and the southern Delhi and Tamil Nadu. Due to increasing populace. The older populace (matured 60 conditions of Kerala (1.05 beds per 1000) contagion rate there is an alarm for the or more) is particularly vulnerable for the and Tamil Nadu (1.1 beds per 1000) NEWSCOPE requirement of government hospital beds. disease. The accessibility of beds for older likewise have better accessibility of beds. The Union government instructed health populace in India is 5.18 beds per 1000 The situation is quite comparable when the authorities of all major states to reserve populace. examination is accomplished for simply at least 20 per cent bed for COVID-19 the older populace: North-eastern states patients in this scenario. Once more, there are between-the-states show improvement over others; southern

64 Volume 5 | Issue 3 | July-September 2020 Scientists ascribed the phenomenon as In response to the biggest economic crisis ‘Nature’s own way of immunization’ that triggered by the Covid-19 pandemic after 1979 may lead to reaching herd immunity.

with a subsequent lockdown has led to the Notwithstanding, simultaneously efforts PERSONA at this stage required is to generate the Nation Central government’s fiscal relief to just state and district-wise tally to conclude the about 1.1% of GDP. number of patients treated, their analysed test reports and data about their segment, socioeconomic and health status, with the Despite the COVID-19 trackers updates, stunting, non-communicable diseases goal that state administration can find there is still less transparency in the and respiratory diseases, as will be the a way to adjust lives and livelihood. The amount of cases reported and treated. demography a more youthful populace. declaration that generally safe patients THEME Health experts augmented that the non- As observed, most local jurisdictions do can self-confine at home will give some availability of detailed information, not collect data on the age groups and reprieve, yet this may pose potential precluding the scientific, clinical and disease profile of hospitalized patients, danger of transmission in the community, public health community from making the length of stay of hospital admissions, as health experts opined stressing that any definite estimation about the viral the numbers transferred from one level given the conditions, nation’s health spread. Testing criteria has changed of care to another, all of which hospital systems need to bend over endeavours to with testing of certain symptomatic administrators would need to plan bed

contain case growth and enlarge health TRENDS patients and their contacts along with capacity. infrastructure as much possible. asymptomatic patients, migrants workers, and some healthcare workers. The reports Notably, Indian Council of Medical varied from district to district in every Research (ICMR) recently undertook state. Any robust calculation would the first population-based serosurvey in Dr. Gautam Kr Ghosh, the require information on the qualities of the India, to assess the extent of exposure writer is Ph.D (sociology) and testing denominator to make reasonable to SARS Cov-2 – the pathogen behind presently working as a research WELL-BEING extrapolations for the remainder of the COVID-19. The preliminary findings scientist in ICMR National populace. Health specialists additionally shared revealed that several containment Institute of Cholera and Enteric express that the vulnerability profile of areas has high caseload districts, 15-30 per Diseases,Kolkata,India. at-risk populace in India will be one of cent of the population has been exposed a kind, with its blend of malnutrition, to the infection and quietly recovered. ISSUES RESEARCH NEWSCOPE

Volume 5 | Issue 3 | July-September 2020 65 BOOK REVIEW Atomic Habits by James Clear By Sachin Gaur, Executive Editor, InnoHEALTH Magazine

his book for many people might incident and his own motivation for This has saved a considerable amount be a turn off if they detest self-help building powerful habits over the years, of my time. I would recommend this books, as they normally come in a which have yielded results for him. The book for those who are looking for small Tcondescending tone with a promise that good news is that the book is not lengthy conquests in their daily life or are already most fail to realize. And for some who are and it provides some practical tips on in the process but lacking a more clear interested in self-improvement it might acquiring new (desired) habits and helps understanding along with a vocabulary be invaluable. While writing this review in breaking old ones. upliftment! let me divulge out my initial motivation for selecting this book. For pasteighteen Reflecting on my own life, I realize, months and more, I have been doing a readingbook is something which I cherish literature review for the topic of better as much as doing my daily habit which eating and a healthy lifestyle. combines with my daily walks, listening to audio books through a mobile app. Even Those who are acquainted with my the journey of this book is covered during lifestyle will find relevance to the crucial one of my daily walks! This small hack was modification I have to take pertaining giving me time for two hours of listening to my lifestyle. To achieve success over every day and an efficiency of completing my old habits and improve my health one book a week. I didn’t know this is goals has been a detrimental decision. what we call as habit stacking! This book gave me an insightful journey for the conceptual understanding of my Similarly, when I realized that social media behavioral framework. was taking lot of my time I uninstalled the application from my mobile phone. I need The author begins with a traffic personal arises I check my network in the laptop.

66 Volume 5 | Issue 3 | July-September 2020 IC InnovatorCLUB A not-for-profit initiative

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