Mucormycosis: 2021 Epidemic ???

It would be unjustifiable for me to not chronicle this issue as a microbiologist.

                                           Image credits: Pathology Outlines - Zygomycetes

Mucormycosis (formerly known as zygomycosis) is a severe but uncommon fungal illness caused by mucormycetes, a kind of mould. Molds may be found in many kinds of places. Mucormycosis is a fungal infection that mostly affects persons who have health issues or who use medications that reduce the body's capacity to resist infections and illness. After breathing fungal spores from the air, it most often affects the sinuses and lungs. It can also happen after a cut, a burn, or any other form of skin damage.

While we work to defend ourselves against COVID-19 and live with it, there is another threat posed by a fungus that we must be aware of and respond to. During or after recovery, a few COVID-19 patients have been diagnosed with mucormycosis, a fungal illness. According to a statement issued by Maharashtra's Health Minister few days ago, the fungal infection has afflicted over 2000 people in the state, with ten people succumbing to it. Some of the patients even went blind. 

Mucormycosis is a fungal infection that affects people of all ages.

A consequence of fungal infection is mucormycosis or black fungus. Mucormycosis is contracted when a person comes into touch with fungus spores found in the environment. It can also appear on the skin if the fungus enters through a cut, scrape, burn, or another kind of skin damage.

Patients who are recuperating or have recovered from COVID-19 have been diagnosed with the illness. Furthermore, anyone with diabetes who has a weak immune system should be cautious.

The following factors enhance the likelihood of mucormycosis infection in COVID-19 patients, according to a warning published by the Indian Council of Medical Research:

Diabetes that is uncontrolled

Due to the usage of steroids, the immune system is weakened.

Intensive care unit (ICU) or hospitalization for an extended period of time

Co-morbidities, organ transplantation, and cancer

Voriconazole treatment (used to treat serious fungal infections)

What does it have to do with COVID-19?

The illness is caused by a group of microorganisms called mucormycetes, which are found in nature, mostly in soil and decaying organic waste such as leaves, compost, and heaps. 

In the usual order of things, our bodies immune systems effectively combat fungal infections. COVID-19, on the other hand, is known to have an impact on our immune system. Furthermore, COVID-19 patients are treated with medicines like dexamethasone, which inhibits our immune system's reaction. COVID-19 patients are at an increased risk of succumbing to assaults by organisms such mucormycetes as a result of these variables.

Furthermore, COVID patients receiving oxygen treatment in an ICU with a humidifier are vulnerable to fungal infection due to moisture exposure.

However, this does not guarantee that every COVID patient will develop Mucormycosis.

Although the condition is rare in those who do not have diabetes, it can be deadly if not treated quickly. Early identification and therapy are crucial to a person's recovery.

 What are some of the most prevalent signs and symptoms to look out for?

Mucormycosis starts as a skin infection in the air pockets behind our eyes, nose, cheeks, and between our teeth. The infection then spreads to the eyes, lungs, and ultimately the brain. It causes nasal discoloration, impaired or double vision, chest discomfort, breathing problems, and bloody coughing.

Not all cases of blocked nose should be considered cases of bacterial sinusitis, according to the Indian Council of Medical Research, especially during and after Covid-19 therapy. To recognize a fungal infection, you should get medical treatment.

What is the treatment for it?

Although the illness may start as a skin infection, it has the potential to spread to other regions of the body. Surgical removal of all dead and diseased tissue is required for treatment. This can lead to the loss of the upper jaw or possibly the eye in certain cases. A 4-6 week course of intravenous antifungal treatment may also be required to cure the infection. Treatment involves a team of microbiologists, internal medicine experts, intensivist neurologists, ENT experts, ophthalmologists, dentists, surgeons, and others since it affects many regions of the body.

One of the most important preventive measures proposed by the ICMR is diabetes control. As a result, diabetic COVID-19 patients must take care of.

ICMR in its guidelines has also advised COVID-19 patients to discontinue immunomodulating drugs, a substance that stimulates or suppresses the immune system. The National COVID-19 Task Force has revised the dosage of Tocilizumab to prevent any such adverse effects. Maintaining proper hygiene can also help keep the fungal infection away.

For patients on oxygen therapy, it should be ensured that the water in the humidifier is clean and is refilled regularly. Attention should be paid to ensure there is no leakage of water (to avoid wet surfaces where the fungus can breed). Patients should maintain proper hygiene by keeping their hands as well as a body clean.

COVID-19 medicines like Tocilizumob and Itolizumab suppress the immune system in addition to steroids. And when these medications aren't utilized properly, our immune system can't fight the fungal infection, which raises the risk.” Adds Dr. Paul.

Immunomodulating medications, which activate or inhibit the immune system, should be avoided by COVID-19 patients, according to the ICMR's guidelines. To avoid any such side effects, the National COVID-19 Task Force reduced Tocilizumab's dose. Maintaining good hygiene can also aid in the prevention of fungal illness.

It is important to keep the water in the humidifier clean and replenished on a regular basis for patients on oxygen treatment. Water leaking must be avoided (to avoid wet surfaces where the fungus can breed). Patients must keep their hands and bodies clean to ensure good hygiene.

After COVID Recovery, be extra cautious.

After healing from COVID-19, it's important to keep a careful eye on any of the warning signs and symptoms listed above, as the fungal infection might resurface weeks or months later. To reduce the danger of infection, one should use steroids only as directed by a doctor.

The treatment of the fungal infection might be made easier if the condition is detected early.

The treatment of mucormycosis necessitated a multi-disciplinary approach involving eye surgeons, ENT specialists, general surgeons, neurosurgeons, and dental maxilo facial surgeons, as well as the use of Amphotericin B as an anti-fungal medicine, according to Lav Agarwal, Joint Secretary, Health Ministry.

References:

Mucormycosis | Fungal Diseases | CDC

Press Information Bureau (pib.gov.in)

Declare mucormycosis an epidemic, Centre tells States - The Hindu

Pathology Outlines - Zygomycetes

 

NEP2020 highlights

On July 28th, 2020, the Union Cabinet of India approved India's National Education Policy (NEP). Over the course of more than 50 months of discussions and workshops, the Indian government gathered feedback from 2.5 lakh village-level stakeholders and presented it to two national parliamentary committees after a 34-year break. However, it is unclear to what extent the policy has taken into account recommendations.

In the midst of a slew of op-eds and commentaries on the NEP, this piece tries to look at the policy through the eyes of practitioners. 

1. Early Childhood Care and Education (ECCE): 

Extends the eligibility window for the Right to Education from 6 to 18 years old. The policy promotes universalization of ECCE with the goal of having 100 percent of children "school-ready" by 2030.

Investment in play equipment and child-friendly structures, as well as CPD for ECCE instructors and Anganwadi workers through a six-month certification program with some online components.

Maintaining the status quo of having a curriculum under one ministry and implementation under three different ministries is a missed opportunity. This technique has resulted in poor integration of ECCE and primary education to date. The NEP's proposal for a "joint task force" does not appear to be a sufficient solution to this well-known problem. 

There is uncertainty over whether every Anganwadi or pre-primary learning center will have a qualified teacher and helper (sevika).

India's National Education Policy Cannot Be Afforded (NEP)

2. Literacy and Numeracy Foundations

To attain 100 percent foundational level (up to Grade 3) learning by 2025, a three-month preparatory course for pupils, access to digital content through electrified textbooks (ETB-DIKSHA), student-led peer learning, and community tutoring are all advocated.

Teacher vacancies should be filled as soon as possible, with priority given to underserved areas and groups.

There is no definition of what a fundamental text is, which will be used to assess literacy.

It is said that there is a National Book Promotion Policy. More than a book policy, however, it is critical to prioritize pupils' access to relevant, age-appropriate reading materials in a variety of languages, which is currently a priority of government programs like Samagra Shiksha.

Students' ability to grasp grade-level learning goals may suffer as a result of an exclusive concentration on core learning. As a result, children who are perceived to be "gifted" and/or "high achievers" may have their opportunities limited.

Overall, though the policy does not bind the government to any specific action, it clearly demonstrates the administration's desire to bring about significant improvements in the education system.

3. At all stages of education, everyone should have equal access.

A promise to attain a Gross Enrolment Ratio (GER) of 100 percent at all levels by 2030.

Investment in facilities and teachers for children up to Grade 12; as well as ensuring that social workers and counsellors are available to pupils to address problems that contribute to dropout rates.

To guarantee that no kid is left behind, a technology-based platform is used to track each and every one of them.

To reduce the number of dropouts and out-of-school children, alternative public-private partnership school models are being encouraged.

 There is no information on the number of social workers or counselors assigned to each kid, at what level they will be appointed (for example, at the school or cluster level), or whether they would be drawn from current ministry professionals.

There is no mention of legal infractions that lead to school dropouts, such as child marriage and child labor.

There is no agreement on the social and economic benefits of online learning courses for children who are unable to attend school.

4. Educational curricula and pedagogy

The policy emphasises bi-lingual education and textbooks for learning, as well as various languages at the middle and secondary levels, and supports local languages to be the medium of teaching until at least Grade 5.

The proposed 5+3+3+4 class system focuses on identifying learning levels at each important juncture, employing a multidisciplinary approach, and lowering material by focusing on fundamental learning capabilities.

At the middle school level, new age courses like coding and computational thinking (among others) are introduced.

Secondary school students can now select their own topic courses (primarily in arts, physical, and vocational education).

When it comes to teaching language, there is no clear decision or rule. For example, the policy states that local languages should be used "whenever possible," which gives a lot of opportunity for the status quo—that is, the present three-language formula—to remain, particularly in government-run school systems like Kendriya Vidyalayas (KVs).

The policy offers what appears to be an endless list of pedagogies, values, abilities, and methodologies that are all deemed to be "nice to have." Many of these are already included in the 2005 National Curriculum Framework, although there have been observed difficulties in translating them into teacher practices or student behavior.

The issue of children's "mother tongues" and home languages differing from the local language utilized for school instruction has not been addressed, particularly in the case of migrant and Adivasi households.

The guideline instructs teachers to include in their curricula ‘Indian knowledge systems,' which include yoga, Indian philosophy, and Adivasi/indigenous learning methods. Upskilling educators, who are now struggling to teach the basic curriculum, to incorporate these complicated ideas in a secular and inclusive manner is, nevertheless, a significant problem.

National textbooks, which have been proposed, might be regarded as an attempt to over-centralize education, with unintended implications.

Due to the extensive range of ways that have been presented, teachers may feel perplexed regarding recommended classroom activities. This may result in a lack of focus as well as limited success with any particular strategy.

5. Evaluations and testing

Hits: A focus on quantifiable learning results at all levels of the newly planned educational system, including testing in the third, fifth, and eighth grades.

To monitor the children's continuous academic achievement, promote formative assessments (those that are done on an ongoing basis and cover smaller chunks of the curriculum), peer evaluation, and holistic progress reports.

Board examinations for 10th and 12th grades will include student choice. The policy proposes doing so by enabling students to choose their subject and difficulty level (standard and higher level).

Misses: The strategy recommends the creation of two new agencies: PARAKH (Performance Assessment Review Analysis of Knowledge for Holistic Development) and NTA (National Testing Agency). These new organizations may result in over-centralization and, as a result, over-testing of children at the national and state levels.

There is some overlap in the emphasis assigned to board exams in the 12th grade and common university admission examinations after that.

Funding based on state performance may result in low-income and low-performing states being unable to access federal funds in the future, further stratifying the economy.

The strategy proposes the creation of a comprehensive progress report card for kids and parents, which can be accessible via AI-based software and used to track their progress on a regular basis. However, it is unclear how the massive digital gap that now exists will be bridged.

The policy statement emphasizes the need of boosting Olympiads and another competitive testing to enhance admission to IITs and NITs. 

Unintended consequences: A high-stakes testing culture (with schools mandated to publicly display student scores) on several state and national tests will put pressure on students to perform, countering the policy's intended impact of lowering coaching culture.

Teachers and schools will begin teaching for the exam, fully ignoring the curriculum section's holistic learning objectives.

6. Education and training for teachers

Hits: By 2030, the policy recommends changing the minimum teacher education degree requirement from a two-year D.El.Ed/B.Ed to a four-year B.Ed undergraduate program.

In theory, excessive teacher transfers should be avoided, resulting in improved continuity with pupils and the availability of local housing.

Promotion should be based on merit rather than seniority or teaching level (elementary/primary/secondary), according to the policy. There are also opportunities for vertical teacher mobility when high-performing teachers can be promoted to the district or state-level positions.

Promotion of blended learning teacher training programs (MOOCs) for CPD of teachers and school administrators, with a minimum of 50 hours of CPD per year required.

A chance to increase the efficacy of in-service teacher training by tying it to seniority-based credits was missed. (A global best practice is to assign "credits" for successful completion of each teacher training program; the accumulation of credits over a 10-year period can be used to qualify for increments and/or form the foundation of some weightage for promotions.)

There is no clear commitment to increasing special education support. The policy mentions a step-up course for current special educators, but this is insufficient unless the number of special educators is expanded in a proportionately reasonable relation to the number of children.

Unintended consequences: Graduate teachers with four years of university education may find the INR 4,000 average salary in low-cost private schools (which account for more than 70% of the private school sector) unsustainable, causing a ruckus in the sector or raising the overall cost of operations of those schools, making it less ‘low-cost' in the long run.

There is uncertainty about how to raise present teachers' professional qualifications to that of prospective four-year trained teachers. It's also possible that distinct groups may emerge within teacher unions and professional communities. Alternatively, an extremely resource-intensive and difficult, or perhaps controversial, the upskilling procedure will be required.

The policy mentions comprehensive criteria, including peer reviews, and makes references to performance-based pay/incentives for instructors. However, when the performance-based incentive system is not done cooperatively, worldwide problems have been highlighted.

7. An educational system that is both equitable and inclusive.

The ‘Gender Inclusion Fund,' which assists female and transgender students by pushing state-level inclusion efforts, providing enough infrastructure for safety, and targeted boarding, is a big hit.

In aspirational districts, Special Education Zones (SEZs) and Kasturba Gandhi Balika Vidyalayas (KGBVs)/KVs would be established with an emphasis on increasing the quantity and quality of learning.

There are no concrete steps or deadlines for closing the gap between socioeconomic groups or for children with special needs; merely a "verbal recognition" that injustices exist.

There is mention of a ‘culture of inclusiveness at the school level, but no specifics on how one may go about creating one.

Given the poor educational performance of certain religious minorities, particularly Muslims, the policy should have been more explicit in its acceptance and assistance.

The issue of female student safety and sexual assault is not addressed in the Gender Inclusion Fund or at the boarding school level.

The position, appointment, budgets, ratios, and other aspects of the social workers, special educators, and counselors who are needed to bridge different developmental and social inclusion gaps remain unclear.

8. School complexes

Reorganizing smaller schools with low enrolment into the school complex' structure, which connects 10-15 such small schools into one administrative unit, will help reduce school isolation, efficiently use teaching-learning resources, and increase governance and accountability, especially in rural/Adivasi areas of India.

In principle, giving local leaders power to develop and implement the project is a wonderful concept. At the school complex level, a School Complex Management Committee (SCMC) and public participation will support decentralized implementation and increased parental participation.

Misses: Students and parents are anticipated to have safe and cheap mobility, particularly while using common resources like as libraries, Balbhavans, labs, Samajik kendras, and so on. This mobility is now lacking, which is why tiny schools within a one-kilometer radius were necessary, to begin with.

Unintended consequences: School consolidation might be perceived as a catalyst for closing schools, resulting in a reduction in the size of the government's educational footprint. This might be used as justification for expanding the number of private schools in the future.

9. Accreditation of schools and the establishment of standards

 A concerted effort to increase transparency and accountability in schools by establishing standards through a specialized organization (the State Schools Standards Authority, or SSSA), which includes learning-related metrics and student input into school ratings.

Development, performance, and accountability will be three essential pillars of the system's support for officers and instructors, fostering more alignment and clarity in job tasks, periodic performance assessment procedures, and timely feedback methods.

Misses: Supervision frameworks such as the School Quality Assessment and Accreditation Framework (SQAAF), SSSA standards, department of education monitoring, and SSC Board frequent testing give the perception that there is too much oversight on how schools operate.

Public schools should become the most appealing alternative for parents, according to the strategy, while the conditions for establishing private schools should be loosened. 

Unanticipated outcomes:

Multiple monitoring and oversight frameworks by various entities may result in over bureaucratization and duplication in the education system's regulation.

While public disclosure of learning outcomes on school websites or the SSSA website is appealing in principle, it will put pressure on students and teachers to perform well, leading to a high-stakes testing culture, negating the earlier point about testing being used more for development and support than anything else.

Low-cost private schools will primarily follow looser criteria for establishing private schools, leading to segregation of students' educational experiences and a mentality that "low-cost is good enough for the poor."

Overall, though the policy does not bind the government to any specific action, it clearly demonstrates the administration's desire to bring about significant improvements in the education system. Much will depend on transparent and timely execution, just as it will with any other policy.

COVID-19 effect on globalisation.

1. BUSINESS:

Without a question, the pandemic has had a significant impact on business, as well as buying and selling as a means of making money.

Many corporations and their stockholders are involved in unsuccessful business ventures and are in debt. The manufacturing business, as well as limited corporations, limited liability firms, and general partnerships, are bankrupt.

Due to the implementation of lockdown in several nations, just a few department stores are open, and alternatives are restricted.

According to research by the International Labour organisation, the covid -19 pandemic has resulted in the loss of work for as many as 41 lakh Indian youngsters (ILO) and 255 million full-time jobs will be destroyed, resulting in a $3.7 trillion loss in labour revenue.

Half of the individuals who lost their employment owing to the coronavirus pandemic are still jobless.

In 2020, there will be a reduction in working hours, resulting in unemployment and a decrease in labour income.

Between March 28 and April 4, 2020, a study of more than 5,800 small firms found that layoffs and closures had already happened.

Business affected due to pandemic:

Construction: Many builders have stopped their project due to insufficient material, no labours, lack of payment and implemented hour of work. 

Real estate business: The market is facing a downfall. Buying, selling or investing in properties is becoming a Huge risk for buyers and dealers. 

Restaurants: are facing loss as there is no more option of dine-in. Now the restaurant is only open for takeaway.

 Gym and fitness:are temporarily closed due to the rise in cases. Work out from home has become new normal, attending through online digital platforms. owners finding difficulty to pay bank loans, rents, electricity bills, and salaries to employees. Professional trainers and supporting staff are unemployed. 

Public and Private transportation: People are finding it hard to travel in public transport due to the high chances of transmission. One is opting for private transport through Ola and Uber. Private auto driver and buses are losing jobs many are committing suicide and Facing the loss of a breadwinner. 

 Malls: According to a crisil rating study, India's shopping malls have lost 80-86 per cent of their pre-pandemic income recovery in the current fiscal year.

Tele corporations, IT firms, private firms, software firms, and MNC firms.They are experiencing massive unemployment, payment delays, and no raises, and they are finding it difficult to pay bank losses and leasing rent.

Multiplexes: The covid-19 epidemic has had a significant influence on the cinema industry as well as all other creative forms. Across the globe, procedures, filmmakers, and directors have invested billions of dollars. There are around 200,000 theatres in the globe, all of which are currently shuttered. Only a few countries have entered the arena with specific measures in mind. Due to the ongoing pandemic problem, it is projected that the box office would suffer further losses. Attendance is also lower in the lower locations. 

2. EDUCATION:

The covid-19 epidemic has had a significant impact on schooling. The government has made the decision to shut down the institutions. Many youngsters are having difficulties at school. The shutdown of schools and universities has caused more than a billion pupils to fall behind in their studies.

Digital learning has become the new norm in children's education, with hours spent in online classrooms having an impact on their mental and physical health.

Due to school closures, youngsters are unable to participate in physical exercises. Learning on mobile phones, tablets, iPads, and laptops is damaging their vision.

In a pandemic, it is difficult for parents to control the educational learning process.

Before the pandemic, there was a lot of growth and development in educational technology, and many institutions were using the notion of online education, where students could learn at their own pace.

All of this had now become the new educational standard. Virtual learning is being introduced by the government as well as the majority of schools.

  Advantages of online education:

The easy and quick learning process 

Affordable learning, and can be accessed from anywhere.

Improved attendance. 

Digital and virtual learning process. 

Gaining Knowledge of gadgets and apps.

The disadvantage of online education: 

Lack of socialising 

Lack of Confidence 

Network or technological issues 

Inability to focus on the screen 

Limited learning options 

No physical activities 

Monitoring issues for parents 

Manage screen timing 

Falling behind in academic 

Distraction by home members

3.Tourism:

 People's travel patterns have altered dramatically as a result of the covid -19 pandemic, whether for pleasure or work.

The tourist infrastructure has had a significant impact on many nations, resulting in economic losses.

Tourism is one of the most heavily impacted sectors by the pandemic, both in terms of livelihood and economics. Import and export restrictions are also in place, which is having a negative impact on several nations' economic sectors. Having an impact on the lives of billions of jobless people. based on (UNWTO) 

More than 100 million direct tourist jobs are under threat, according to the United Nations World Tourism Organization. The informal economy's youth and employees are among those at greatest risk. The covid-19 has had an impact on both foreign exchange earnings and work possibilities, resulting in unemployment.

To prevent the spread of the coronavirus, numerous nations are closing their borders owing to the epidemic.

India is a thriving country known for its history, tradition, culture, and hospitality, however, the Covid-19 outbreak has caused a significant decline in the tourism industry in the country.

India has one of the largest covid-19 instances in the world, resulting in a drop in tourism. India's borders are open, but people all across the world are wary of taking dangers since India is anticipating three waves of covid-19.

Covid-19 instances are quite rare in European nations, which is why they have implemented a conditional quarantine strategy.

Switzerland, Australia, New Zealand, Iceland, Thailand, Japan, Singapore, Malaysia, Germany, the United States of America, the United Kingdom, maturities, Russia, Morocco, Hong Kong, Bhutan, Spain, Oman, Bahrain, Mexico, South Korea, Kyrgyzstan, Portugal, Rome, and China.

Many countries have already blocked their borders, like the Maldives, which was once one of the most popular vacation destinations on the planet, but has now closed its gate owing to an increase in covid -19 cases. In times of crisis, several well-known celebrities have visited the island.

 Many tourists are waiting for the gates to reopen in Bali, which is now closed for entry.

The borders between Dubai and the rest of the world are open.

The limitations on travel have been eased.

Certain precautions must be taken.

Saudi Arabia has withdrawn its travel restriction for 11 countries: the United Arab Emirates, the United States, Germany, Italy, Ireland, Sweden, Portugal, Japan, Switzerland, and France.

People from India, Bangladesh, and Sri Lanka are now prohibited from entering Italy.

As a result, a number of nations have imposed travel restrictions.

Tourists from all over the world eagerly await the chance to travel for pleasure.

Measure to be followed by the passengers:

For domestic flights: 

Health screening shall be done for all passengers 

 the covid-19 negative test report is needed to travel

All passengers must download the Aarogya Setu app. 

For international flights: 

Thermal screening,

One must be vaccinated, 

Carry RT-PCR report -covid 19 negative test,

Home Quarantine of 14 days, 

one must be holding a valid visa issued by the country. 

Vaccinated report of both doses

Pre and post-departure RTPCR test conducted by authorities.

To expect tourists travelling for business must hold a ‘work permit’.

Confirm reservation at hotel and resort. 

Passengers must hold a valid return ticket.

Tourist travelling from one island to another must-have permit.