India may have undercounted COVID-19 cases

• The findings of a serological survey by the Indian Council of Medical Research (ICMR) from 69 districts across 21 States indicate that an estimated 7,00,000 people could have been infected by the SARS-CoV-2 virus in these districts even in early May.
• The number indicated by the survey is twenty times higher than the 35,000 confirmed cases of COVID-19 reported as of early May in the entire country, suggesting that the actual COVID-19 count overall could be underestimated by a factor of at least 20.
• Confirmed infections have since swelled to more than 3,08,000 as of Friday (June 12), with more than 8,900 people having died of the disease.

Tested for antibodies

• The research paper published in May in the ICMR's in-house Indian Journal of Medical Research describing the methodology of the survey, blood samples of 24,000 adults were examined for antibodies produced specifically for SARS-CoV-2 via an ELISA test .
• The survey revealed that 0.73% of the population showed evidence of IgG antibodies.
• The survey began around May 12 and given that it takes an average of two weeks for IgG antibodies to be detected.
• The adult population of these districts according to the 2011 census was 60% of the overall population (160 million) and this works out to around 96 million persons.
• If the results of the survey are applied to the adult population of these districts, the total number of people likely to have infected by the virus adds up to 7,00,000; the numbers could be even higher if the growth of the population in the last nine years is factored in.

Indirect evidence

• Antibodies produced in response to being infected by the virus confer immunity but are also evidence of being exposed to the infection.
• Because they rely on blood samples and are only an indirect evidence of the presence of the virus, they aren’t as accurate as PCR tests.
• Two values called sensitivity and specificity — that are a measure of the proportion of cases mis-identified or outright missed — determine the accuracy of the test.
• Academic literature has suggested that there is a higher chance of “false positives” being reflected in serological surveys if there is a low prevalence of the disease.
• The scientist that The Hindu spoke to said while the prevalence percentage accounted for the limitations of this test, 7,00,000 was an “accurate estimate” of the level of infection in these districts. The test has been developed and validated by the ICMR-National Institute of Virology and is said to be the most reliable so far.
• “Community transmission has been evident for long.

COVID-19 taking an emotional toll on children

Context

• The fear of losing loved ones to the coronavirus (COVID-19) infection is most apparent among children who dabble with immense anxiety and emotional stress brought by the ongoing pandemic and lockdown.
• Doctors say that the toll on the mental health of the young ones is way more than the physical symptoms of COVID-19.

Stress and anxiety rise amid coronavirus pandemic

• “Every age group is processing the events in a different way,” said Dr. Soonu Udani from SRCC Children’s Hospital, that has treated over 45 minors with COVID-19 over the past weeks.
• She said that children below 10 years don’t know much and are picking up tiny bits from the television and family conversations, while those above 10 years have more fear of death as they try to comprehend the severity of the infection.

Struggle to understand

• As most children are asymptomatic or display mild symptoms, they also struggle to reason why they have to be hospitalised.
• The hospital has started using play therapy, drawings and charts to tell children about the virus, and the importance of being in isolation or quarantine.

Parenting in a post-COVID world

• Two to three-year olds, separated from their parents, show signs of anxiety through extreme clinginess after their parents return from quarantine.
• “A mother told me that her child is not even letting her go to the bathroom. In slightly older children, three to six-year-olds, a common thought is ‘did I do something wrong that my parents went away’,” said Dr. Sengupta.
• Teenagers are also facing a hard time with lack of social circle and no privacy at home.
• It was important for parents and caregivers to not brush aside the queries of their children.

Psychosomatic symptoms

• In some cases, children whose family members had COVID-19, reported abdominal pain, twisting of neck, headaches and myalgia or muscle pain, but as soon as their report returned negative, they start feeling better.
• “We have seen four such cases of psychosomatic symptoms in children who were anxious due to a family member testing positive,” said Bengaluru-based child neurologist Dr. Minal Kekatpure.
• The interaction with doctors and nurses clad in alien-looking PPE suits fascinates children but also frightens some of them.

Hydroxychloroquine does not reduce mortality, RECOVERY trial finds

Recovery trial

• The RECOVERY trial, a large randomised controlled trial in the U.K. to test five drugs, including hydroxychloroquine, has found no clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19.
• The trial investigators found that there was no significant benefit in mortality reduction in the intervention group, which was the primary objective.
• The RECOVERY trial began in March.
• It is a dynamic trial assessing five candidate drugs and convalescent plasma therapy for treating COVID-19 in patients in U.K. hospitals. The trial has enrolled over 11,000 patients.
• On June 4, following the retraction of The Lancet paper on use of hydroxychloroquine, the U.K. Medicines and Healthcare Products Regulatory Agency wanted the independent Data Monitoring Committee of the RECOVERY trial to carry out an additional review.
• It also asked the investigators to look at the unblinded data in the hydroxychloroquine arm.

No beneficial effects

• It then came to light that the drug did not have the desired beneficial effects
• According to the release, a total of 1,542 patients were randomised to receive hydroxychloroquine for 10 days while 3,132 patients in the control arm received only standard care.
• The researchers found that there was “no significant difference in the primary endpoint of 28-day mortality”.
• While mortality was 25.7% in the intervention group (who were administered HCQ), the control group had 23.5% mortality, which is not statistically significant.

Outcomes measured

• The primary outcome tested was reduction in all-cause mortality within 28 days of randomisation.
• The secondary outcomes measured were to assess any reduction in duration of hospital stay and need for and duration of ventilator or ECMO within 28 days and up to six months after randomisation.

Huge speculation

• Deputy Chief Investigator Martin Landray from the University of Oxford says: “There has been huge speculation and uncertainty about the role of hydroxychloroquine as a treatment for COVID-19, but an absence of reliable information from large randomised trials.
• The preliminary results from the RECOVERY trial are quite clear — hydroxychloroquine does not reduce the risk of death among hospitalised patients with this new disease.”

Post-exposure prophylaxis

• Another trial found that hydroxychloroquine drug was not effective even as a post-exposure prophylaxis in asymptomatic participants who have had high-risk exposure with a confirmed COVID-19 case.
• Nearly 88% (719 of 821 participants) had such high-risk exposure.
• The results of the trial published in The New England Journal of Medicine found that the incidence of COVID-19 illness was not statistically significant in the group that received the drug compared with the control group.
• While 49 of 414 (11.8%) participants who received the drug developed illness, 58 of 407 (14.3%) participants who got the placebo fell ill.
• Side-effects were more in the intervention group but no serious adverse events were reported.

Persistent global transmission of chikungunya from India

Context

• Studying the geographic distribution and evolution of the chikungunya virus over the period from 2005-2018, a team from ICMR-National Institute of Virology, Pune, has noted India as an endemic reservoir for the virus with persistent global transmissions from the country.
• The paper published recently in Infection, Genetics and Evolution adds that “dispersal of the strains from India was noted to neighbouring and distant countries” such as Sri Lanka, Bangladesh and China.
• The team studied newly sequenced chikungunya viruses isolated during outbreaks that happened between 2014 and 2018. During these years, the virus showed activity in India. Karnataka, Maharashtra and New Delhi accounted for a majority of the cases.

Indian Ocean lineage

• The whole-genome sequencing study revealed that the isolates belonged to the Indian subcontinent sub-lineage of the Indian Ocean lineage.
• The Indian Ocean lineage is a subgroup within the East Central South African genotype.
• It was responsible for the resurgence in the epidemic on La Reunion island and other neighbouring islands in the Indian Ocean and in the Indian sub-continent during 2004-2005.
• This study helped understand the overall evolution and epidemiology of the Indian Ocean lineage.
• Analyses of about 207 whole genomes, including the eleven whole genomes of this study and 39 additional whole genomes from India, showed two separate clusters of Indian Ocean islands sub-lineage and Indian subcontinent sub-lineage.
• It is already known that Kenya was the most likely ancestral location for both the sub-lineages, and the study further confirmed this.

Spread from clusters

• Observations from the phylogeography study (Phylogeography is the study of the historical processes that may be responsible for the contemporary geographic distributions of individuals) based on the genome sequences over the period from 2005 to 2018, showed persistent global transmissions from India.
• The strains from these clusters were noted to have spread to China, Sri Lanka, Bangladesh, and Southeast Asian countries including Indonesia, Malaysia, Singapore and Papua New Guinea beyond mid-2006.
• Transmissions to Yemen, China, Japan, Hong Kong, Pakistan, Australia, Bangladesh and Italy were also noted later on.
• Further studies of the chikungunya sequences revealed indigenous evolution in India at least at three time points over the period 2005-2018, with specific mutations that conferred viral fitness in the Aedes vector species.
• There is a possibility of further diversification as this is an RNA virus and continues to acquire mutations.

Great Oxidation Event (GOE)

• The atmosphere of early Earth contained little molecular oxygen. A significant increase in oxygen occurred ca. 2.4–2.0 billion years ago in what is called the Great Oxidation Event (GOE).
• A large positive excursion in carbon isotopic composition in sedimentary carbonates is known to have occurred 2.2–2.0 billion years ago (the Lomagundi-Jatuli event), which provides evidence for an enhanced rate of organic carbon burial, i.e., enhanced net production of oxygen.
• The Proterozoic snowball Earth event (global glaciation) occurred 2.3–2.2 billion years ago, roughly coinciding with the GOE.
• Thus, a causal relationship between the GOE and the snowball Earth event has been suggested.
• The snowball Earth event could have been triggered by an increase in oxygen in the atmosphere because it would have resulted in a significant reduction of atmospheric methane level, thereby reducing the greenhouse effect of the atmosphere and causing global glaciation.
• On the other hand, the termination of the snowball Earth event may have triggered the production of a large amount of oxygen because the extremely hot climate (~60 °C) immediately after the termination of the snowball Earth event must have significantly increased the supply of phosphate to the oceans, resulting in large-scale blooms of cyanobacteria, which could have produced large amounts of oxygen.
• The postglacial transition of atmospheric oxygen levels may have promoted an ecological shift and biological innovations for oxygen-dependent life.

Baby Dragons

• 2 rare aquatic creatures officially called proteus or olms, also known as baby dragons, are going on display in the aquarium at Slovenia’s Postojna Cave.
• The Olms have pale pink skin, no eyesight, a long thin body and 4 legs.
• They live only in the waters of dark caves of the Southern European Karst region.