Archive for category Biotech – Medical Device – Life Science – Healthcare

Entrepreneurship was his passion, leadership, his expertise


Entrepreneurship was his passion, leadership, his expertise. Google was a young company when Nikesh Arora chose to join @Google over founding his own company. Under his skilled leadership, the company’s operations grew rapidly and in 2011, Arora became Senior Vice President and Chief Business Officer of Google.  After working in Google for nearly a decade, Arora joined @SoftBank, a Japanese multinational company. Arora guided SoftBank investments in startups like Ola and Grofers and SoftBank grew rapidly. 

Palo Alto Network headquarters exterior under blue sky. Palo Alto Networks, Inc. is a network and enterprise security Palo Alto Network headquarters exterior under blue sky. Palo Alto Networks, Inc. is a network and enterprise security - Santa Clara, CA, USA - 2020 Building Exterior Stock Photo

In 2018, Arora joined Palo Alto Networks and currently serves as the CEO and Chairman of this leading #cybersecurity and cloud computing company. Cyber security experts have to constantly figure out innovative ways to keep up with cyber hackers, who got even more active during Covid 19 pandemic. According to Dzone research, almost 53% of SMB’s suffered from a data breach during 2020.

After Arora joined Palo Alto Networks, under his leadership, the company made the biggest acquisitions in its history with the acquisition of Demisto for $560 million followed by Twislock for $410 M and recently @Aporeto for $150M.  Given the company’s scale compared to smaller competitors in the segmented cybersecurity market, its double digit growth remains solid. PAN leadership has maintained that PAN is still on track to grow revenue by 20% annually until 2022 and its operating free cash flow margins are expected to exceed 22% and 30% respectively. 
Inviting entrepreneurs to take the exciting opportunity to hear Nikesh Arora, CEO of PAN speak at @TiEcon 2021on May 7 at the link  https://www.tiecon.org/register?utm_source=Darshana_Nadkarni&utm_medium=referral&utm_campaign=Volunteer_Contest . At TiEcon, there are exciting #entrepreneurship tracks and other tracks on #CloudComputing #Security #Healthcare and more.

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દ્રષ્ટિકોણ: દુર્લભ રોગ (rare diseases)


આજે “રેર ડીઝીસ” ડે ના દિવસે “દુર્લભ રોગ” વિષે વાત કરીએ.  એવા ઘણા દુર્લભ રોગ છે જેને અનાથ રોગ પણ કહેવાય છે, કેમ કે તેના નિવારણ ઉપર ઘણા લોકો કામ કરતા હોતા નથી. દુનિયા માં 6000 થી ઉપર એવા દુર્લભ રોગ છે. કદી જોયા ન હોય એવા વિચિત્ર રોગ ધારણ કરનાર રોગીઓ પણ ક્યારેક વિચિત્ર લાગે અને તાકી તાકીને જોવાની આપણે ભારતીયોને ક્યારેક એવી ટેવ હોય છે. તો આશા છે કે આ બાબત માં થોડું જ્ઞાન મેળવી આપણે આવા રોગ ને અને રોગીઓને ધિક્કાર કે કુતુહલ થી નિહાળવાની બદલે અનુકંપા ની દ્રષ્ટિ થી જોશું.

કઈ પ્રકારના દુર્લભ રોગ હોય છે તેના વિષે થોડી વાત કરીએ. 

* Proteus syndrome (પ્રોટિયસ સિન્ડ્રોમ): આ એવી પ્રકારનો રોગ છે કે તેમાં શરીરમાં રહેલી પેશીઓ (ટિશ્યૂઝ) વધ્યાજ કરે છે. દરેક ને તે જુદી રીતે અસર કરે છે. કોકના હાથ વધ્યા કરે, કોક નો એકજ હાથ વધ્યા કરે અને કોક ના પગ અથવા એકજ પગ વધ્યા કરે અને કોક નું માથું કે શરીર નું બીજું કોઈક અવ્યય વધ્યા કરે. 

* Fibrodysplasia ossificans progressiva (FOP): (ફાઇબરોડિસપ્લેસિયા ઓસિફિકાન્સ પ્રોગ્રેસીવા) ટૂંક માં (FOP) એવો જ એક ભયાનક રોગ છે જે આખી દુનિયામાં લગભગ 2 મિલિયન લોકોને જ છે. તેમાં વ્યક્તિ પોતાના હાડકા ના પિંજરા માં કેદી બની જાય છે. આ રોગ માં હાડકા વિકસતા જાય છે અને વ્યક્તિના હાડપિંજર જોડે જોડાતા જાય છે. ધીમે ધીમે વિકસતા જતા હાડકાની અંદર માણસ ભીંસાતો જાય છે અને ધીમે ધીમે તેની પ્રવૃત્તિ રૂંધાતી જાય છે અને ભીંસાતી વ્યક્તિ પોતાના હાડકામાં રૂંધાઈને મોત ને ભેટે છે.  અમેરિકા માં હેન્રી ઇસ્ટલેક નામના બાળક ને આ રોગ હતો. તે 39 વર્ષે મૃત્યુ પામ્યો ત્યારે તે માત્ર તેની જીભ હલાવી શકતો હતો બાકી બહારના કોઈ પણ અવ્યય ને તે હલાવી શકતો ન હતો. આ રોગ વિષે નીચેના વિડિઓ માં જોઈ શકશો.

* Severe combined immunodeficiency, SCID: (સિવિયર કમબાઇન્ડ ઈમ્યૂનોડેફિશિનઝિ અને ટૂંક માં સ્કીડ) T cells અને B cells ના genetic mutations ને લીધે થાય છે. આ રોગ હોય તે વ્યક્તિમાં કોઈ પણ જંતુઓનો સામનો કરવાની તાકાત હોતી નથી. આવા બાળકોને કોઈ પણ સહાય ન મળે તો તેઓ એક વર્ષ ની અંદર મૃત્યુ પામે છે. પરંતુ મેડિકલ પ્રગતિ ને લીધે હવે તેઓ બબલ ની અંદર રહીને ઉછરી શકે છે અને તેઓને બબલ બેબી તરીકે ઓળખાય છે. ડેવિડ વેટર નામનો છોકરો ઘણા વર્ષ આ રીતે જીવિત રહેલો. તે એવા બબલ ની અંદર જીવિત રહેલ કે તેને ક્યારેય કોઈ અડકી ન શકે અને તે બહારની વસ્તુઓને એકદમ સાફ કાર્ય વગર હાથ લગાવી ન શકે.

* Moebius Syndrome (મોબીયસ સિન્ડ્રોમ): આ રોગ હોય તે લોકો સ્મિત કરી શકતા નથી. તે લોકો ફ્રાઉન પણ નથી કરી શકતા અને આય બ્લિન્ક પણ નથી કરી શકતા. તેઓના ચહેરા ઉપર કોઈ પણ પ્રકારના હાવભાવ વર્તાઈ શકતા નથી. 

*  water allergy or “aquagenic urticaria” : પાણી ની એલર્જી જન્મ થી નથી હોતી પણ યુવાવસ્થામાં ઉત્પન્ન થાય છે. મૉટે ભાગે એક મા બાળક ને જન્મ આપે તે પછી તેને ક્યારેક આ રોગ થાય છે. આજ સુધી માં માત્ર 30 કિસ્સા નોંધાયા છે. તાજેતરમાં ઇંગ્લેન્ડ માં 21 વર્ષની યુવતીને તે રોગ થયો અને ત્યાર બાદ તે બિલકુલ પાણી પી સકતી નથી અને અઠવાડિયામાં એક વાર 10 સેકેન્ડ માં નાહી લ્યે છે નહિ તો તેને આખા શરીરે ખુબ બળતરા અને રાશ થાય છે. તે માત્ર ડાઈટ કોક પી શકે છે. 

* Guillain-Barre syndrome (ગીયાનબારે સિન્ડ્રોમ): આ રોગ અચાનક જ શરીરમાં આવે છે.  શરીર ની ઇમ્યુન સિસ્ટમ જે બહાર ના રોગી જંતુઓનો સામનો કરે છે તે સિસ્ટમ આ રોગ માં પોતાના શરીર નો સામનો કરવા માંડે છે. એકદમ જલ્દી ફેલાતા આ રોગ માં વ્યક્તિ પેરાલાઇસ પણ થઇ શકે છે. આ રોગ થી વ્યક્તિને બોલવા, ચાલવા, ખાવા, પીવા, બાથરૂમ જવામાં અડવડતા થાય છે. જેવી ઝડપ થી આ રોગ આવે છે અને ફેલાઈ છે તેવીજ ઝડપ થી ક્યારેક આ રોગ ચાલ્યો જાય છે અને ક્યા કારણ થી આ રોગ આવે છે તેની મેડિકલ વિભાગ માં પુરી જાણકારી નથી. મારા બે મિત્રોને આ રોગ થયેલો અને બંને હવે સારું સ્વાસ્થ્ય ધરાવે છે.  કોઈપણ વ્યક્તિને ક્યારે પણ આ રોગ થયો હોય તેમણે કોઈપણ વેક્સીન અને અત્યારે કોવીડ વેક્સીન  લેતા સમયે ડોક્ટર ના અવલોકન હેઠળ લેવાનું જરૂરી છે.

તો આ દુર્લભ રોગ દિવસ શા માટે છે અને આજે આપણે શા માટે તેના વિષે વાત કરી રહ્યા છીએ?

દુનિયા માં આવા 6000 જેટલા રોગ છે. અમેરિકામાં 2 લાખ થી ઓછા લોકોને આવા રોગ થાય છે. તેથી ભાગ્યેજ કોઈ કંપની કે વૈજ્ઞાનિક તેનું નિવારણ શોધવા માટે કામ કરતા. કેમ કે આવા રોગો આટલા દુર્લભ હોય તો તેઓ તેના નિવારણ ઉપર વર્ષો કામ કરે અને તેની કયોર શોધે તે પછી તેમાં તેમને શું વળતર મળે? અને તેવીજ રીતે આવા દુર્લભ રોગો નો સામનો કરનાર વ્યક્તિ પણ ખુબ એકલતા અનુભવે છે અને તેમને મિસ ડાયગ્નોસિસ અને લોકોના પૂર્વગ્રહ નો સામનો કરવો પડે છે. પણ હવે આવા દુર્લભ રોગોને સમજવા માં ઘણી પ્રગતિ થઇ રહી છે. દુર્લભ રોગ દિવસ નો હેતુ લોકોમાં, સમાજમાં, મેડિકલ વિભાગોમાં અને નીતિ વિભાગોમાં તેના વિષે જાણકારી અને સમજણ વધારવા માટે નો છે. તેમજ હવે જેમને આવા દુર્લભ રોગ હોય તેઓના જૂથ બન્યા છે અને તેઓ એકબીજા જોડે નવી શોધ થાય તેની આપ લે કરે છે. 

નવા માર્ગદર્શન અનુસાર FDA પણ દુર્લભ રોગો (જેના બે લાખ થી ઓછા કિસ્સા અમેરિકામાં નોંધાયા હોય), જેના ઉપર વૈજ્ઞાનિકો કામ કરી રહ્યા હોય તેઓના માર્ગ માંથી વિઘ્નો હટાવી અને તેમને દરેક રીતે અનુકૂળતા મળે તે માટે સહાય કરી રહ્યા છે. હવે આવા રોગ ના નિવારણ ઉપર ઘણા વૈજ્ઞાનિકો અને નાની નાની  કંપની હવે કામ કરી રહી છે. 

ભારત માં ઉછરતા મને ખ્યાલ આવ્યો નહિ કે જુદા દેખાતા લોકોને તાકી તાકી ને જોવાની કેવી આદત આપણા ભારતીઓમાં હોય છે. પણ દર વર્ષે હું મારી દીકરી ને લઈને ભારત જતી અને તે હંમેશ મને કહેતી કે — મમ્મી અહીં બધા હંમેશા આપણી સામે તાકી તાકીને કેમ  જોવે છે?  મારી દીકરી ના પહેરવેશ અને વાતો પરથી તુરંત બધા સમજી જતા કે આ વિદેશ થી આવેલ લાગે છે. અને એક થોડું પણ જુદું માણસ દેખાય તો લોકો ટગર ટગર જોવા લાગે. હવે તે બાબતમાં હું પણ સંવેદનશીલ થઇ ગઈ છું. બે વર્ષ પહેલા હું એકલી દિલ્લી થી અમૃતસર જવા નીકળી. ટ્રેન માં હું મારી ચોપડી વાંચતી હતી. અચાનક મેં ઉપર જોયું તો આજુ બાજુ બેઠેલા ચાર પુરુષો મારી સામે તાકી ને જોઈ રહ્યા હતા. આ રીતે વ્યક્તિને આપણે સંકોચ અનુભવતા કરી દઈએ છીએ.  તો આવી જાણકારી મેળવીને આશા છે કે આપણે કોઈને તાકી ને જોવા ની બદલે તેમની જોડે મૈત્રીભાવ કેળવી શકીએ.  

નીચેના વિડિઓ માં દસ બીજા દુર્લભ રોગ વિષે જાણકારી મેળવી શકશો. https://www.youtube.com/watch?v=SsGA_u1ihNs

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Coronavirus – Vaccines and Immunity


While 2020 will forever be defined by the coronavirus pandemic, 2021 is a year that will be etched in memory of humankind for how the world came together to beat the virus with the fastest and most effective vaccines. As coronavirus vaccines are starting to get rolled out, people have many questions. How soon a person receiving the vaccine may develop immunity, how long the immunity will last, what if one does not take the second dose, can one still be a carrier without exhibiting symptoms and so on. Let us try to address some of those concerns.

First, a shoutout to incredible scientists, engineers and healthcare professionals whose dedication, persistence, hard work and professionalism amidst a lot of noise, politics, fake information and conspiracies prevailed only because of their complete focus on finding solutions to the challenges represented by the covid crisis. 

Vaccines & Immunity

Covid 19 Vaccines: Covid 19, a disease caused by the novel strain of coronavirus has defined the year 2020. As we stand the on the verge of a brand new year, 2021 is likely to be defined by the vaccines to beat covid 19. 

Virus, Bacteria, Vaccine, Vaccination, Coronavirus

At no time in history, has there been such a rapid pace of innovation in developing vaccines to combat such a ferocious disease, as now. Currently, three vaccines authorized are Pfizer-BioNTech, J&J, and Moderna’s vaccines. Additionally three other vaccines  in phase 3 clinical trials are developed by AstraZeneca, Janssen and Novavax.  As far as I know, all of these are mRNA vaccines. mRNA stands for messenger ribonucleic acid and it can be described as messengers that carry instructions on how to make a protein. These messengers never enter the nucleus of the cell and therefore they can never alter or modify a person’s genetic makeup or DNA. These messengers only work with the body’s natural defenses to fortify them and help them develop immunity to the disease.

Sometimes any of these vaccines can cause some symptoms like fever, headache and so on. These symptoms are a sign that the body is building immunity. None of these vaccines will infect anyone with covid 19 and none of the vaccines can cause someone to test positive on Covid 19 tests. If a person develops immunity then it is possible that they may test positive on some antibody tests, but not on covid 19 diagnostic tests. If you got sick from covid 19, prior to taking the vaccine, very likely you may still benefit from getting the vaccine. So it is advisable for everyone to take the vaccine, including those who may have contracted the disease before. 

There are different kinds of immunities and at this point, researchers don’t have all the answers. While it is hard to say exactly how long most people will be protected from the disease after receiving the vaccine, it may also vary from person to person. But here is some general info.

  • Sterilizing immunity: In this  best case scenario of robust & durable immunity (like Measles), once a person develops immunity then the body is able to defend itself in all possible future infections.  In coronavirus, this may be unlikely for most of us. However, some people with strong natural immunity may develop it.
  • Functional immunity: This is the type of immunity that is most likely in case of novel coronavirus. Here the person may contract the virus but the immune system will recognize & fight off the virus with very mild symptoms.
  • Waning immunity: In this case, a person infected or vaccinated would lose immunity over a period of time. This is likely in case of coronavirus and we may need to take booster doses. But even in this situation, most people will likely not be very sick as reinfections will be much less severe.
  • Lost immunity: In this case, a person would lose all immunity in some time & reinfection may be like first infection, carrying the same risk. Experts feel this is not very likely as most people will be able to generate some immune response and then develop some long term immunity.

Covid 19 is a serious disease. While many people only have a mild illness, others get severe illness and many are dying from it, all over the world. Covid 19 vaccines will help protect you by creating an antibody response, without having to experience serious sickness and without long term serious and detrimental effects on your body.

Some indication seems to be that very likely the mutated strain coming from UK may be more contagious BUT less virulent. This may also be great news for vaccine efficacy. On the other hand, there isn’t much data on the mutated strain coming from South Africa but Dr. Fauci has said that vaccines may not be as effective on the South African virus. A thing to remember is that ultimately, viral load, duration of exposure AND your immune system will determine your risk of infection and also the impact of the vaccines on you. Any of these factors can change the outcome for you. For instance, even if you are young and have great immunity, if you are exposed to heavy viral load (mostly from someone in close proximity) and if that occurs for a long time then your risk of infection increases. So please continue to take all precautions.

Please sign up for some of the interesting health tracks and events and take the opportunity to listen to the incredible scientists from across the world as they share their journeys towards incredible breakthroughs in fighting covid 19.

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Covid updates – July, 2020


Virus, Covid, Science, Covid19

Here are some covid updates from last couple of weeks. I have gathered info from zoom sessions. For more details, accurate sources, and veracity, please research further.

  • CA expecting 19000+ deaths by Nov. 1
  • US covid deaths top 150,000
  • More than 6,300 covid cases in the US, are linked to colleges
  • After some decline in people dying, now daily death counts are rising in 21 states
  • 47% (that is, almost half the population) of US adults have some underlying condition that slightly increases the chance of severe covid illness
  • Blood glucose level of 7 or higher leads to 33% chance of dying 60% chance of contraction
  • Spain had 2,255 more cases in last 24 or so hours.  Britain imposed quarantine on travelers from Spain
  • WHO warns of new EBOLA outbreak in Congo
  • China reports biggest virus spike since end of Wuhan outbreak
  • India has the fastest growing coronavirus cases in the world
  • 23% of Delhi residents seem to have antibodies 
  • North Korea is reporting their first covid case
  • Plastic visors in place of masks are NOT effective
  • Israel & Japan experience huge spikes in covid cases
  • Chinese study found that people with type 2 diabetes had shorter telomere length
  • Study found that aerosoles in covid patients’ rooms, had live virus floating around even after 5-6 days
  • Research found no transmission of covid from infected moms to newborn babies, even after 2 weeks of breast feeding with proper cleaning protocols
  • In another study, pregnant women who had virus, their placenta also had virus
  • Study says mosquitoes cannot pass on covid from infected patients to non infected patients
  • From 3334 patients with covid in NY hospitalized, 16% had DVT, stroke or heart attacks
  • Presence of virus in the gut likely means that virus takes longer to leave the system and would lead to higher risk of liver injury
  • Spain study found that about 5% of those who contracted covid  in large cities had antibodies while only 3% of those of contracted covid near the coast, had antibodies
  • In one study, over 50% of people who contracted covid show some heart damage
  • 85 babies under age 1 tested positive in one county in Texas
  • Overwhelming fatigue, palpitations, muscle aches are symptoms that linger for 4-6 weeks after recovery from covid

On potential vaccines & treatments & safety products

  • There are 42 potential vaccines — Most in phase 1, 14 of them are in phase 2 and 4 are in phase 3 
  • Oxford/ AZ vaccine results look good in phase 1 / 2
  • China’s Sinopharm is in phase 3 trial for covid vaccine
  • Cage Bio developed sanitizers that offers protection for up to 4 hours
  • Steroid treatment slightly reduces the need for mechanical ventilation 
  • A client has very exciting and fascinating prevention strategy. If interested in investing then let me know & I’ll put you both in contact.
  • Boehringer Ingelheim identified 28 new antibodies to fight the virus

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Diversity on Boards


In 1995, when I began doing diversity training for employees at @IBM, there was often some resistance among corporations. Some felt that it was better to not “open a can of worms”. At IBM, a grand diversity initiative was started by Ted Childs Jr., who is widely recognized as the leading corporate diversity expert. 

Diverse People Stacking Hand Together - Royalty-free Adult Stock Photo

At the core of the diversity training, we focused on how workplaces that become inclusive where each and every employee can bring their best and contribute at the highest level of productivity, such teams enjoy high morale and the company enjoys high retention rate. In our trainings, we emphasized the importance of embracing diversity to uncover the competitive advantage it provides. 

All of that is still true. AND additionally, it seems, today the climate exists where we can also speak freely of how and why it is ethically and morally the right thing to do, to embrace the entire range of diversity, from diversity of gender, race, religion and sexual orientation to diversity of thought, functionalities and perspectives.

I am eagerly looking forward to the Road to @TiEcon panel on July, 22 at 9:40am on the roadmap to bring diversity on boards of corporations. It is widely understood that just having a diverse range of people on a team, is in itself not enough to create a high performing team. In order to leverage diversity and create a high performing team, a team needs to strategically and consciously create a culture that values diverse people, diverse range of behaviors, and creates a space for listening to diverse perspectives. 

I am eagerly looking forward to the views and best practices that this panel will share. The panelists are: Anjali Bansal, founder at Avaana Capital; Dipti Jaggi @clinakos; and Tina Shah Paikeday, Head of D&I @RRAonLeadership at Russell Reynolds Advisory. 

Sign up for this exciting panel and the entire event at the link below.
https://www.tiecon.org/?campaign=Referral&source=DaNa 

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Hardware enabling Artificial Intelligence Revolution – Panel at TiEcon


Artificial Intelligence, Brain, Think

From virtual doctors to hassle free data maintenance to driverless cars and robotic surgeries, artificial intelligence (AI) has been transforming the way we live, work, learn, and conduct business.  But it is only now, as powerful GPUs have become available to train networks, that the technology has become more practical and it’s use more strategic. 

At Road to TiEcon event on July 22, an exciting panel of senior leaders across a range of industries, will discuss how hardware is enabling the AI revolution. Panelists include Chris Rowen, CEO at @BabbleLabs & founder of #Tensilica; Gaurav Singh, Corporate VP at @XilinxInc; Gordon Wilson, CEO at Rain Neuromorphics @Rain_AI; and Sumit Gupta, VP of AI strategy & CTO, Data & AI at @IBMData @IBMcloud @IBM cognitive systems. This will be an exciting panel.

The algorithmic superiority of certain complex functions comes only with high computation and memory and this requirement poses significant challenges to the hardware platforms required to execute these functions. The AI teams under proven leaders, are in constant quest for new devices, architecture and algorithms that would lead to improved efficiency. 

Sign up for this exciting panel and entire event at the link below. https://www.tiecon.org/?campaign=Referral&source=DaNa  

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Changing Healthcare Landscape in the post-Covid world


In the post Covid world, one thing that is certain to change is health care and health technologies that impact the quality of care. There is already an enormous impact of digital technologies with remote monitoring, remote diagnosis, and telehealth platforms, and artificial intelligence powered apps and devices. Related to that is an explosion and access that providers have in the number of data points. 

In the immediate covid world, there is an urgency of some of these new technologies in contact tracing and monitoring the spread of the pandemic. There is also a necessity for protective gear that while protecting providers can make care more personalized and is easy to use. Providers are also trying to balance providing care for other health issues while dealing with continuing covid cases.

So what might be possible attributes that will make new technologies and devices stand out?

Medical Equipment on an Operation Room

For any tools that impact healthcare, accuracy, reliability, and safety are of prime importance. Also delivery of care is rapidly transforming and all devices need to seamlessly integrate into rapidly changing clinical flow. All devices that work with healthcare data must also be extremely secure. 

At Road to #TiEcon2020 @TiEcon @tiesv on June 24th, domain experts will discuss new technologies and how it is all poised to make an impact in the changing arena of healthcare.  Domain experts speaking at this event include, Dr. John Whyte @WebMD, Aashima Gupta @GoogleCloud, Dr. Suraj Kapa @MayoClinic, Ramesh Raskar @MediaLab, Dr. Meera Kanhouwa @Deloitte.

If you need more information than post your question with your email. Register for the event with the link here:
https://www.tiecon.org/?campaign=Referral&source=DaNa

 

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Coronavirus: Treatments and Vaccines


Recently a science teacher said that treatment for covid with remdesivir or hydroxychloroquine is better than a vaccine. I said, treatment like that is good but a vaccine is better. She said, “no. since many people get adverse reactions from vaccines, a treatment is better”. So I decided to write this blog post. First, let us consider what are drug treatments and how they are different from vaccines.

Drug treatments: Currently over 70 companies are working on various drug treatments for novel coronavirus. Although this virus is novel, not all drugs being considered are entirely novel. For instance, like the previously considered malaria drug, hydroxychloroquine, Gilead’s drug, Remdesivir, that is in the news, is not a novel drug. Remdesivir is a broad spectrum antiviral drug that has been found to successfully prevent MERS coronavirus in rhesus monkeys. Besides antiviral drugs, there are other anti-inflammatory drugs. Scientists believe that in the end, what might work may be a sort of a cocktail or some combination of antiviral and anti-inflammatory drugs.

Drug treatments do not prevent Covid-19. These drugs are offered to patients who are already suffering from coronavirus. On the other hand, vaccines prevent people from contracting the disease in the first place.  

Drug treatments are not cures. 1) there isn’t a 100% response rate among people treated with remdesivir or any other treatment. So despite many drugs showing promise, there are a few people who will respond to a drug; many still die. 2) many who suffer from the disease but go on to recover, they still utilize huge amounts of hospital resources during their illness phase. 3) during the illness phase, these sick people also spread the virus with the possibility of making others (including healthcare professionals) sick. 4) even people who may recover with the help of these drugs from covid, may have suffered substantial damage to their lungs and that may reduce their lifespan or affect them in other ways.

Vaccines:  Vaccines prevent people from getting sick. So when people don’t get sick, they don’t spread the virus, don’t utilize healthcare resources, don’t infect healthcare professionals or others in the community, and don’t get any kind of long lasting damage to their lungs. Clearly, vaccine is a far superior way to deal with coronavirus.

Why are vaccines taking much longer than drugs for covid?

Virus, Pathogen, Infection, Biology

As I mentioned above, many of the drugs considered currently for treatment of covid are already in existence for some other illnesses or diseases. So there are existing drugs considered for either preventing covid deaths or preventing people from becoming sicker and helping them recover faster and ending hospital stays earlier.

Vaccines on the other hand, have to be developed. There are considerable challenges at each stage of vaccine research, development and manufacturing. First of all, pharmaceutical companies have decreased vaccine research and development in the last several years, because vaccine development and manufacturing is expensive, time consuming and offers smaller payback in terms of revenues. For each new virus and for all mutations, the vaccine has to be developed and then when the virus is not active then the vaccine is not useful. Clinical studies take place during the research and development phase. Only if the studies show the vaccine to be safe and effective then the vaccine proceeds to the next phase where it has to be manufactured in large quantities required.

During a pandemic like this one, not only do we need a vaccine quickly but the world will also need  hundreds of millions of doses for the entire world population.  Fortunately, pharma companies, scientists from all over the world, billionaires like Bill Gates and Governments and countries have stepped up to tackle this challenge, with an unprecedented spirit of collaboration.  There are measured expectations for an effective vaccine to be available within 12 to 18 months. That is an unprecedented and highly aggressive timeline. Bill Gates has offered to support manufacturing of top 7 candidates during the research and development phase. That means, even without the proof of effectiveness of any of them, he will foot the bill for manufacturing all of them, in the hope that at least a couple of them will prove to be safe and effective and the world will get required doses speedily. Meanwhile, countries like India are getting ready for manufacturing of vaccines. India has proven capability and expertise to ramp up production of vaccines, while keeping costs down. Regulatory hurdles are likely to be less severe as US FDA and other regulatory bodies have promised EUA (emergency use authorization) for drugs and vaccines that may help contain covid.

If drugs like Remdesivir work then that will help some people recover and recover faster; so let us hope that any one of these drugs alone or in combination with other drugs will reduce mortality, shorten hospital stays, and help reduce spread of covid. But ultimately we need a vaccine for covid-19 and the way in which entire world is coming together, gives much hope for availability of a speedy vaccine.

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Herd Immunity for Covid-19?


Have you noticed only politicians and some lay people talk about #HerdImmunity? Scientists and business people seem to be talking about #testing, cure and vaccines. Amazon is planning its own tests just for their own workforce. Some of my clients are doing the same. Chemicals for covid-19 diagnostic tests are hard to find but businesses may tap into their global connections to acquire them.

So what is herd immunity?

A person is answering question relating to herd immunity.

Herd immunity is an epidemiological concept coming from an idea that ultimately if enough people in a population are immune to a disease then it stops spreading. For instance, if 80 people out of 100 can’t get the disease than the 20 people who can get it remain protected because they may be unlikely to actually get exposed.   

Herd immunity can be achieved in a community in one of the two primary ways.

1) Vaccine access and acceptance:

If a significant number of people get access to the vaccine, they accept it and avail of the opportunity and become non carriers of the virus then even if 5% may not have gotten the vaccine, they may not get the disease because there may not be enough people to get it from. But we don’t yet have a vaccine for coronavirus.

2) Virus has a free rein: 

This is how the politicians have been speaking of herd immunity. Herd immunity is also connected to the argument that the best way to end the social distancing is to allow the virus to run free or at least almost free and in the end the population will achieve herd immunity. This sounds like a creative new idea rather than something horrifying that we should try to avoid at all costs. But let us remember that this only happens after VAST numbers in a population, get infected. So that requires us to “sacrifice the vulnerable on the altar of the economy in vast numbers.”

What kind of vast numbers of fatality might we be speaking of? As per some estimates, herd immunity for Covid-19 can occur after at least 60 to 70 percent of the population develops immunity.  That means at least 60 to 70 percent of the people have to first get infected. Moreover, these have to be random infections. That means, several people would die with a highly contagious virus running free in a society, before herd immunity is achieved.  This would overwhelm our healthcare system and several healthcare professionals would die while working in a high virus load environment.

Even with all our social distancing measures in place, we have a high death count that has brought healthcare system on the brink of overwhelm, in many places. In New York, a dense state with high international travel, there was a death count of almost 15,000 in a population of less than 10M. Healthcare professionals from several other geographical regions traveled to New York to lend help. Can you imagine every state taxed that way beyond their maximum capacity to care for the patients? And that is the reason that scientists and business leaders are not advocating herd immunity as an ultimate preventive measure. We can be lay people and choose to remain ignorant and spread the forwards and myths about herd immunity OR we can listen to what science has to say over what the politicians may be advocating.

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Lessons from Shanghai, China: Strategy for containment & care during Covid-19 


Recently, CABS, the Chinese American Biopharmaceutical Society hosted a webinar on the topic,  “COVID-19 Clinical Treatment and Research Experiences from China”, with Dr. Wenhong Zhang. Dr. Zhang is Director of the Department of Infectious Diseases in Shanghai and leader of Anti-Covid-19 team. He is also on Chinese Society of Infectious Disease and with Chinese Association of Internal Medicine. During the fight against Covid-19, Dr. Zhang led the Shanghai team to formulate a clinical treatment and containment plan.

 

Night, City, Shanghai, Asia, East, Architecture, Urban

An article in scientific publication Lancet predicted in late January that after Wuhan, Shanghai can be the epicenter of the virus with as many as 800,000 cases. However, with very early focus on containment and reasonable social distancing (even without complete lockdown measures), Shanghai managed to restrict the spread to about 4,000 cases. The key was that the healthcare system went on full alert when they had their very first case of a person traveling from Wuhan.

 

Dr. Zhang shared many details of their process for containing the spread and answered questions sent by the audience members. I have captured a few of the nuggets from his talk and I am sharing them below.


Diagnosis: Immediately they optimized diagnostics and did all needed tests for suspected patients. Shanghai made separate fever clinics and all patients who met 1 epidemiology criteria plus one clinical criteria were encouraged to go to these clinics. Suspected Covid-19 patients were sent to separate quarantine wards for full testing, and while they awaited results.  If the results came back positive, they were sent to separate hospitals for quarantine stay and were tested again, before release.

 

Further, while in the US some hospitals first tested for flu and other viruses and if the patient tested positive for any of them then they were not tested for coronavirus, Shanghai tested all suspect cases for coronavirus. Dr. Zhang said that they have found that there are a lot of co-infections so a person can have regular flu virus plus coronavirus. Additionally, they found a high negative rate in PCR testing, while a positive rate was around 70%. Therefore, despite negative test results, if the patient was highly suspect than they did more testing. They did not rely on CT scans because they found that a chest CT cannot precisely confirm Covid and all cases needed molecular diagnosis.

 

Detailed process in place: Shanghai had a very detailed process in place for the steps to be taken for patients in the first screen, then first test, then when tested positive, if tested negative, and for followup.  Timely diagnosis and timely distancing and quarantine is very important, said Dr. Zhang. Immediate separation and early control of local transmission is the key to stop the Covid-19 disease spread, said Dr. Zhang.  This is something that did not happen in Italy. Almost all of their early cases were of foreigners. Eventually all of their cases and high death toll has been among the local population.

 

Treatment Options: Dr. Zhang shared that over 95% of the patients recovered and eventually were released. One patient died. There has been debate around anti-viral treatments. Dr. Zhang said, these treatments don’t seem to be effective. China also used hydroxychloroquine (widely touted malaria drug) to treat Covid patients and did not find it to be effective. However, it can have compassionate use since it shows little lasting side effects, said Dr. Zhang. Although he did not observe clinical evidence of anticoagulants, he said, it is possible that early anticoagulation may block clotting and eventually reduce the risk of major organ damage.

 

Respiratory Treatment: Dr. Zhang shared that the most fundamental treatment in keeping patients alive is respiratory treatment. We have a narrow window to stop progression from mild symptoms to severe symptoms, said Dr. Zhang. Low and short duration corticosteroids may stop progression and we need more studies to find that out. Life support for critically ill patients is crucial. Timely intervention with mask oxygen inhalation, nasal cannula oxygen therapy, mechanical ventilation etc. can prolong life until the body’s immune system gets critical time to fight off the virus.

 

Medical Personnel: In Shanghai, strict following of protocol, translated into not a single infection spreading into the healthcare professionals. Highly qualified and standardized process included appropriate PPE (personal protective equipment) with gowns, goggles, masks, double layer gloves and shoe covers. Healthcare professionals were asked to never share a meal with others at home, during the time this contagion was active. As far as possible, the patients were kept in negative pressure wards and surfaces were cleaned with disinfectants every 4 hours.

My Comments
Stay tuned for my next article on how China effectively used high tech, specifically big data and coupled it with public awareness and public participation to contain the virus. Please note: I am not a fan of, or in any way endorsing communism or authoritarianism. And yet, perhaps there are lessons even for Western democracies, to pay heed to early signs and implement containment strategies. And that is exactly what Bill Gates was referring in 2015, when he spoke at TedTalks and warned us about a virus pandemic that can possibly kill millions. That is what various scientists have been warning of, for years.

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