Milk teeth start erupting when the baby is around six months old. All the Deciduous teeth (milk teeth) erupts completely till 2 ½-3 years of age. Many people assume that cavities or hygiene of milk teeth is not of much importance as they will shed off eventually but milk teeth are really important for the overall health of the child.

These are some of the reasons behind the importance of milk teeth:

• Loss of milk teeth or painful carious teeth discourages the child to eat or chew food properly which leads to malnutrition in kids.

• A smiling face is a confidence booster. Kids with carious teeth or broken milk teeth sometimes don’t interact confidently.

• Milk teeth guide the eruption of permanent teeth. Permanent teeth may erupt in open space either outward or inward the arch if milk teeth are lost due to caries or trauma.

A common problem associated with milk teeth is nursing bottle caries. This is also called baby bottle tooth decay. It is caused when a child goes to bed with a bottle filled with milk or juice. It usually affects children between the ages of 1 to 2 years. Breastfed infants who fall asleep while breastfeeding are also at risk. Usually, upper and lower front teeth are involved. Light or brown colour spots leads to further decaying of teeth.

PRECAUTIONS AND TREATMENT

• Do not allow your child to take a bottle while sleeping or lying down.

• Take good care of gums and teeth.

• In case of light brown and brown spots, visit a dentist and get a filling done to restore the carious teeth. This will prevent the teeth from further damage.

• Dislocation of teeth due to trauma.

In many cases, a loose tooth will heal without treatment. Injured teeth that are very loose may need to be removed. The dentist will further guide about space maintainers, if necessary, for the proper positional eruption of permanent teeth.

• Fracture of teeth: Children with broken teeth should see a dentist promptly. The dentist will determine if the tooth’s nerves or blood vessels are damaged or not. Treatment may include smoothing the rough edges of the tooth, repairing it with a tooth-coloured resin material, leaving the tooth in place, or removing it.

• Thumb-sucking: If the child is still sucking their thumb even when their permanent teeth begin to come in, the habit can cause a wide range of other problems, affecting teeth alignment and the shape of the roof of the mouth. In that case, a dentist can provide habit-breaking appliances depending on the severity of the habit and its effects.

• Grinding of teeth (Bruxism): Teeth grinding is a common condition among school-aged children. It develops because their top teeth aren’t aligned with their bottom teeth. Another reason could be in response to pain — just as you rub a sore muscle like teething or an earache. It can also be a sign that a kid is experiencing stress or hyperactivity. Nightguards can help keep your child from grinding their teeth as they sleep.

• Over retained deciduous teeth: It may mean delaying in the shedding of milk teeth, delayed eruption of permanent teeth, or presence of both milk and permanent teeth at the same site. In these cases, visit your dentist to rule out the possible cause and treatment related to that.

When is the right time for orthodontic braces or wiring of teeth in cases of crowding or mal-aligned teeth in children?

The best age for an orthodontic assessment of children is around 8-10 year of age. It helps to avoid progressive dental issues, helps in keeping better oral hygiene, and accordingly, braces can be planned after one to five years. For adults, orthodontic treatment can be done at any age.

Some oral hygiene tips for children:

• Baby teeth start to break through the gums when a child is around 6 months but it is important to start good oral care for infants even before the first tooth comes in.

• Wipe baby’s gums with a soft washcloth after feeding. This helps remove the bacteria that can cause tooth decay.

• Once they begin to erupt, brush teeth twice a day for at least two minutes with fluoride toothpaste.

• Use a pea-sized amount of fluoride toothpaste and make sure your child spits it out after brushing.

• Use a small or medium-size brush, according to the kid’s age and change the brush after every three months.

• Help your child brush and floss, and remind him or her to pay attention to the back teeth.

• Visit the dentist every six months.

The writer is a Senior Dentist at AIIMS.

Dalbir Singh, who is co-president of the Global Coalition Against TB (GCAT), talked to this paper on TB and the challenges to tackle the disease. Excerpts:

Q: Could you elaborate on the reasons for the surge in TB in India and the role of policy to contain it?

A: India shares 27% of burden of incidence out of 10.5 million cases globally. TB continues to be a grave public health challenge since it claims more lives than any other infectious disease. Decades of unrestrained transmission, outmoded diagnostics till the recent past, an unregulated and fragmented private sector where nearly 68% Indians seek care for TB, coupled with undernourishment of significant population, rise of diabetes, smoking addictions and indoor pollution, have aggravated the growth of the disease. Other determinants like migration, poverty, proximal living spaces, stigma and social discrimination, lack of productive integration of private sector and limitations in healthcare outreach and emergence of Drug Resistant TB have also adversely affected the management of TB.

TB disproportionately affects the poor who lose nearly 35% household incomes. TB perpetuates poverty. India needs a focused national policy to handle this challenge. Since 2012, with strong advocacy by policymakers and eminent domain experts under the umbrella of the Global Coalition Against TB and other civil society groups, the government resolved to launch landmark initiatives at the policy level, including banning of outdated serological tests, making TB a notifiable disease, establishment of the National TB Research Consortium, introduction of Molecular Diagnostics (CBNAAT), integration of the private sector, enhancement of use of ICT tools, provision of social support and formulation of a dynamic National Strategic Plan (2017-25), with framework for Gender Responsive Approach. The RNTCP, which was a project, gave way to the National TB Elimination Programme which is now the apex institution with the mandate to implement plans to end TB by 2025.

Q: Is LTBI (Latent tuberculosis infection) a major concern for TB management in India?

A: 40% of India’s population is affected by latent TB. TB bacilli remain dormant and manifest as a TB disease with the weakening of the immune defences. It’s actually a binary condition of dynamic spectrum with asymptomatic LTBI non-transmissible state and symptomatic active TB that infects that can be transmitted. Though active TB treatment is cornerstone of WHO End TB strategy, the SDG deadlines can only be met by incorporating LTBI as a component our TB control policy, since it can be a huge reservoir of potentially becoming active TB. The policy must aim to screen high risk and vulnerable groups including alcohol, drug, smoking addicts, HIV, end state renal failure, transplant, silicosis and severely diabetic patients for preventive therapy.

Q: How can we involve and integrate community structures effectively into the TB prevention and care framework?

A: One third of patients are missed globally as well as in India as being undiagnosed or not reported because of lack of access to healthcare facilities. Since the government outreach has limitations, a collaborative effort with and through the communities can fill the gaps. Community engagement is imperative because it allows contextualization and adaptation of health interventions and policy needs of the community. It effectively addresses issues like stigma and social discrimination and increases psychological comfort for TB victims and survivors, strengthens patients’ support system, promotes awareness on various government schemes, innovation, and facilities, empowers local communities to lead TB response and adapt Community Centric and Gender Centric approach to improve quality services. WHO recognizes community engagement as one of the four principles of Global End TB Strategy. There are inspiring examples to emulate from Africa on reaching out to underserved nomadic and migrant communities and extending a healing touch to those who are socially isolated.

Q: How can we strengthen institutional ground-level structures to accelerate our fight against TB?

A: India has 2,50,000 local governments which are constitutionally mandated to make governance more participative by deeper engagement at the grassroots level. Public health is obligatory function of those institutions. Currently, these are being highly underutilized. Given the enormity of health challenge in TB, these can be integrated with the government structures. Local governments are closer to the people and understand ground realities better. We need to devolve more power and resources so that in collaboration with local communities, peripheral decision-making composite units can be formed under guidance of elected representatives at the block/village levels. They will enhance accountability, enable prioritization and improve facilities and delivery of services. We must promote capacities of community-based organisations of health workers like ASHA who performed commendably during the Covid crisis.

Q: What do you feel is the roadmap for India’s fight against TB, so that we are able to achieve a TB free status by 2025?

A: We must innovate to step up research and development, promote awareness and use of ICT and develop a Multi-Sectoral Approach with the comfort of all stakeholders. We can end TB by 2025 if we build synergy between the government apparatus, the public sector, governments, the civil society and with deeper engagement of local communities.

Top scientist Dr Rakesh Mishra, who is a director of CSIR-CCMB labs, talked to The Sunday Guardian on mutant variants. Excerpts:

Q: What exactly is the double mutant variant and how is it going to affect us in future?

A: Double mutant variant as the name suggests has two changes in its genome one L is converted into R at 452 position and in one E is converted Q at 484 position. So when these two mutations are together, we call it double mutant and in cases that we have sequence genomes, these two mutation are going together, so that way, its giving its signature to a new variant. Particularly in Maharashtra, about 20% of the cases are due to this new variant as of now, although in other states it’s not very prominent. It’s 1 or 2% or even less.

Q: How it is going to affect and who is responsible for this mutant variant?

A. Responsible! Virus mutate in natural ways and if we allow the virus to spread, then it will have more chance to mutate and only people are allowing it spread so people are responsible in that way but while this is natural process we should keep that also in mind, as far as problems are considered since even in Maharashtra, where it is seen in highest proportion which is only 20 %, that means 80% of the cases of Maharashtra are not because of this variant and in other states we don’t see this variant so much. So this means this variant is not responsible for the recent rise in the cases; something else is responsible. Also, we have not seen increased symptoms or mortality; in fact more and more people are asymptomatic; not more than 85% and mortality has decreased, which means we understand the disease better and proper care has been given by doctors and that’s why mortality is less. This also means that this variant, like other circulating variants, is not more dangerous. So it not a fast spreader, it is not clinically more dangerous, but whether it will be a problem for the vaccine or not that is something we have to confirm because there are only reports that both of these mutations can have immune escape behavior.

If it was actually happening at least in our case, we would have seen by now some re-infection cases which we have not seen so far. May be, there is less data, so we can’t conclude very much but early indications are that immunity acquired by prior infection and therefore by vaccination is protecting against this virus as of now; so more data will be required. There are experimental ways of figuring that out which is to culture the virus in laboratory and see if the anti-bodies of vaccinated people or recovered people can neutralise this virus and that’s what we are doing and I am sure many laboratories are doing in the country. We have started culturing this virus and in the coming weeks, we’ll know if any protection of vaccine is compromised in this case, but that will take a little time. Early indications are that we need not to worry in that context here.

Q: Does the government require more vaccines to control such mutant variants?

A: It is always good to have. Vaccine is a weapon against infection. The more weapons you have, the better you are. These vaccines have come as a emergency approval and within a year the vaccine is available which most of us thought will not be possible. That it has happened is a remarkable achievement of the industry, the scientists and also of our regulatory bodies who have gone so carefully and given these approvals and they have proven to be right because the vaccine is safe. Now more than 5 crore people have taken vaccines and they are doing well. Vaccination in UK is reducing the infection significantly, that observation has already been made, so it is a very good tool. More is better so because these vaccines are emergency approval, we don’t understand fully, particularly the long-term effects of these vaccines or age group and other medical conditions; how long they will protect, which variant which one will protect; all those data will emerge only after vaccination follow up which is happening in many countries, including in our country.

In the coming months, we will understand more about the utility of different vaccines. Whether one vaccine is better for younger people, and another is better for older people, we don’t know today, but we might understand it in the coming months; so therefore, it is very good idea to have more vaccines. We should have 6, 10 vaccines, so that we can ensure that the pandemic is controlled and we don’t get into more problems in the future. In fact, we should try and vaccinate at a very high rate the largest number of people possible before the virus recovers and makes more variants. We can eliminate the virus by vaccinating large number of people. So that is a good strategy to follow and while we do all this, whether vaccination or no vaccination, Covid appropriate behaviour is the most important point today. So even if  we are vaccinated, it will take month, to month-and-a-half to get the full effect of the vaccine. The vaccine does not mean that you will not get infected, it means that we will not get very sick; that you make not require to go to the hospital and lives will be saved. But the virus may still hang around, so the most important thing is to wear masks and avoid crowing and do hand hygiene.

Q: How does mutation takes place?

A: Mutation is a natural process of these viruses like is common flu we see every year. We get cough and cold; so is the same with the virus. Once it comes, our system fights it and within a week or 10 days, we get rid of it, but after a few months, it changes its coat and comes back and infects again. So it is the same thing happening with the coronavirus. The Covid-19 virus keeps changing, it is very natural. In fact, all of us are different because our ancestors had some mutants which we have inherited; that’s why we look different; all of us have genomic chances. They originated with mutation at some point or the other and mutation, if it is good for the species, it persists and if they are bad, we perish. Similarly, in virus, if the mutation is bad, that particular virus will die and if the mutation in advantageous for the virus, it will adopt better and spread more. So, it is a natural process for all living beings; that’s why we see variety in life.

Q: Do you think in future it can be deadly if people do not take care of themselves, and not follow the guidelines?

A: Absolutely. If lakhs and lakhs of people are infected and the virus is having a good time spreading all over, it will generate more variants and there is no doubt about that. Maybe we are lucky that the double mutant is not very dangerous at this moment, but in future, some other variant may emerge that may be more infectious and that may not respect vaccination. That may cause more mortality. All those things are possible; therefore, wearing masks and maintaining social distancing and hygiene is a must to defeat this virus.

NEW DELHI: The threat of the spread of mutant variants, its implications and the ‘second wave’ of Covid-19—which The Sunday Guardian’s ‘Medically Speaking’ section was among the first to report—is looming large in the country today. The Sunday Guardian discussed the matter with prominent medical experts Dr Harsh Mahajan, founder of Mahajan Imaging and chief radiologist, Dr Dhiren Gupta, Chairman-elect of the Indian Academy of Paediatrics (Intensive Care Chapter) and doctor at the Sir Ganga Ram Hospital, Dr Avinash Bhondve, former president of IMA Maharashtra, Dr Neeraj Nischal, Associate Professor of Medicine at the All India Institute of Medical Sciences and Dr J.A. Jayalal, National President, Indian Medical Association, to find out how the situation can be managed better.

Dr Neeraj NischalDr Harsh MahajanDr Dhiren GuptaDr Avinash Bhondve

Q: Are we seeing the second wave of Covid-19 or moving towards it?

Dr Nischal: This concept of a wave has been described by epidemiologists. Based on the experience of previous pandemics, it is certain that there will be multiple waves. The moment we lower down our guards, as long as we have vulnerable populations and do not vaccinate most of the population, these waves are going to come. That’s why we have to ensure that we follow the Covid-appropriate behaviours we have been talking about for the last one year. But it is easier said than done. Everyone is saturated and we all want to go out and enjoy the way we did in the past. But the pandemic has not gone away. We will be in big trouble if we lower our guards and that is why, second wave or not, things depend on us. If we allow it to propagate, we will definitely have the second wave, and if we control it right away, we might be safe from the situation which most European countries and the US faced recently.

Q: Maharashtra is going through a bad phase. There was a time when the number of cases was declining but if we see the latest data, the maximum cases have been reported from Maharashtra. What can be the reason behind it? Are people taking it for granted?

Dr Bhondve: Let us talk of some practical and theoretical things. First of all, as Dr Neeraj rightly said, the waves will keep on coming. In early February, new cases were around 2,000 a day, which have gone up to more than 23,000. Before that, in the month of December and January, the number of cases and daily cases and all other parameters came down, but never touched the zero line or went back to the base line. So, this is the rise in the number of cases. There are many reasons. We always blame the common people for not using masks or not observing social distancing, but these things were there even in December and January. The main reason behind the rise in new cases since early February is the government of Maharashtra giving instructions to district officers to increase testing and contact tracing. It was clearly advised that for every patient 280 contacts should be traced. When this number started increasing, it was quite obvious that 90% of the cases, which were asymptomatic or mildly symptomatic, were diagnosed.

Also, the rate at which patients are increasing is very fast. The patients are mostly in the age group of 20 to 45 years, and they are mostly asymptomatic or mildly symptomatic. There was a similar scenario in Britain, where they investigated this and did long sequencing on most of these patients. Like it was a variant in Britain, it could be a variant which has evolved in Maharashtra. These types of sequencing should be done on the patients from Maharashtra like it was done for the patients who came from Britain, South Africa and Brazil.

I think the sum total of all these things is the reason behind the rising cases in Maharashtra.

Q: So, how is Covid-19 striking back?

Dr Mahajan: We know this RNA virus tends to mutate very rapidly. If we see, there are over 100,000 mutations, and over 7,000 have happened in India itself. Out of that, the variants that concern the most have been the three—the UK, South Africa and Brazil variants—as Dr Bhondve also said. In India, about 7,000 patient samples have been genome sequenced, out of which about 200 are from Maharashtra. Out of these 200, in 20% of them they have found two mutations. This is at present. However, as time passes and we do more sequencing, we will know whether it is really the one causing this rapid surge because it is already known that it can be more contagious. The government has now said that 5% of all positive samples across the country will be sequenced. In December, the government also formed institutes for genomic surveillance. So, it’s only when we do more genomic sequencing, that we will know the kind of mutations happening, how they are spreading across the country, if they are similar to the strains found in other parts of the world, and if this is a new Maharashtra strain. But the important point is that if we protect ourselves and we follow Covid-appropriate behaviour, especially the use of masks and practising hygiene and social distancing, we can overcome any mutations and variants. However, we have seen of late, not only in Maharashtra or Punjab, where most of the new cases are happening, but also in Delhi and other parts of the country, that people have reached a level of fatigue. There is a release now, markets are full and weddings are happening, even indoors with hundreds of people. If we continue this, irrespective of what the variant may be, we will get more cases.

But Maharashtra does appear to be at the start of a second wave, as has been said. This may also be due to enhanced testing and very stringent contact tracing where we are picking up more of the asymptomatic variety. This is also the time when the vaccination drive in these pockets needs to be accelerated and the Central Government has to give permission to states to vaccinate those between 20 and 45 years as they are the ones who are getting maximally infected.

Q: What would you like to say about people forgetting to follow Covid-appropriate behaviour?

Dr Gupta: We know this is going to come, which means we cannot stop it. These viruses are going to be here with us. What we need to find out is how we can prevent infections and reduce the number of patients getting infected. Dr Harsh has beautifully defined it. I would like to define it on the levels of the individual, the government and the virus. On the virus level, we know it has marked each and every community. This virus knows much more than what the medical sciences know about this virus.

On the government and individual levels, what I have found is that people are scared of the side effects of the vaccine. So, as Dr Mahajan said, all the population should be vaccinated very quickly. This way we can prevent this virus from circulating quickly, prevent its mutations and suppress such waves, which are otherwise bound to happen. Secondly, there is the problem of ignoring Covid-related behaviours. The kisan andolan is still in full swing, cricket matches have begun, and even politicians are moving here and there without masks. With this type of attitude, whatever we do and whatever programs we start at whatever level, the public is going to behave like this. But what we can do is enhance our vaccination program. There is a lack not only on the government level; it is also the public that is responsible. They are so scared of the vaccine’s side-effects that they forget how bad this virus is. I have worked in the Covid ward and seen people who got infected. Young people think that they cannot get infected or if they do, it would be mild, but they forget that they are the people who are going to spread this virus to the elderly.

But these things are not very simple. I have seen many doctors getting fed up with masks and we have seen that continuously wearing them for 12 hours induces some hypoxia. So, it’s easier to preach. But at the individual level, Covid-appropriate behaviour is very important. We should get vaccinated and, as Dr Mahajan said, open up vaccinations for 20-40-year-olds too and also allow all sorts of vaccines available in the market. We have inoculated more than 2 crore people and no major side effects have happened. We have also got our indigenous vaccine, i.e. Covaxin. This should be promoted as well. We should ask other companies, which have been approved in the US, like Pfizer or Moderna, to export to India. It should be like a flea market: whosoever wants to get it and can pay should get whatever they think is medically suitable. Everyone has to pitch in, including the government, because this is going to rise. I look at the Covid wards, we get a daily warning from our medical director about them being full. So, this is the only way to stop it or slow it down.

Q: The IMA has already urged people and the government to not drop their guard against Covid-19.

Dr Jayalal: Yes, it is quite painful to know that even after very sustainable efforts by the government and healthcare professionals to control the virus, there has been a sudden spike in cases across the country. It is painful to note we have crossed even 36,000 cases in a day, which only denotes we are reaching the second wave. But it is nothing new and it is not in our hands because with any pandemic, multiple waves are inevitable. So, at this moment, we don’t need to panic. We need to sensitize our people. One of the most important things for hospitals and other places where people are accumulated is proper ventilation. Schools have opened and children are coming in, but in many school buildings, the infrastructure and ventilation systems are not adequate. The government should spend much more effort on this because this is not on the children, it is on administrators and management. When we were starting with the pandemic, one of the greatest tasks the Indian Medical Association undertook was to equip hospitals with Covid-appropriate infrastructure with one-way traffic to patients, restrictions on the number of people entering, masking and proper cleaning of the place, etc.

Also, with the elections now, we have seen videos where for every nomination, though there is a control measure, for example, only five to ten persons should go, thousands of people are crowding. The Election Commission has taken a very important step by making sure all officers at the election booths are vaccinated. Now we have also requested the government to make it mandatory for agents coming to the political booths to show vaccination certification. Moreover, as Dr Harsh Mahajan and others said, vaccination should be made more available. There is no point restricting vaccinations when India is able to export more than 5.8 crore vaccines. Vaccination should be provided at the doorstep level. We need to be on a war footing.

Common sense has to prevail among the public too. People believe that Covid is not going to do anything to them and that kind of mindset has settled in because political leaders are not leading by example. That should be punished. We would like to express on behalf of the IMA that in all the countries, the second wave has been more disastrous than the first. Though we have scientific knowledge and know the effects of disasters, we must aggressively fight it. Be assured that the Government of India and the medical fraternity will be on the front lines and we will control and treat people as much as possible. The only thing we want is that the government and our colleagues come together and follow Covid protocol.

Q: Do you think speeding up vaccinations can reduce Covid-19 cases in Maharashtra?

Dr Bhondve: Yes, definitely. As Dr Jayalal rightly said, vaccinations can be increased. I would like to inform all of you that when the two vaccines were allowed to be used on an emergency basis, it was only the IMA under Dr Jayalal that declared that the vaccines are safe. At the same time, neither the Government of India nor any state governments have come out with a statement saying the vaccines are safe and everybody has to take it. With previous vaccines like for polio and other things like the Swacchta Abhiyaan, there were a lot of advertisements. Celebrities were asked to talk about it on TV. But nothing has been done for the Covid vaccinations. This has had a very bad impact on the common people. Right now, even in the first phase, only 40%-50% of doctors and healthcare workers were vaccinated. In the stage where all people over 60 years are being vaccinated, if you observe the statistics, there are people who are not even aware that there is vaccination available and they should get vaccinated. As Dhiren sir rightly said, we have to educate such people. Then there are divyaang people or the handicapped. They are supposed to take the vaccination but none of them are getting it. Meanwhile, for people who are between 45 and 59 years of age, the numbers are not sufficient. 

Secondly, the Government of India said that all vaccination centres should run 24×7. But this is not being seen. All hospitals should be allowed to do vaccinations and take care of any side effects. In Pune, we have around 600 hospitals. So, if we allow even 500 hospitals, at a rate of 100 people, we can vaccinate 50,000 people more. So, the timing and number of hospitals should be increased. And as Dr Dhiren rightly said, more than 3 crore people have been vaccinated and there are no serious side effects. So why not open up the market and vaccines be given by hospitals without all these registrations? During the Covid situation, when the beds in government hospitals were full or restricted, the government allowed beds in all private hospitals, even ones with 5 and 10 beds. So, for accelerating the vaccination drive, all private hospitals should be given a freer hand. Even the VCI head has said this. But it is not being implemented practically. We hope this gets implemented and the vaccine campaign is accelerated so we can control it in 6-8 weeks.

RNA virus tends to mutate very rapidly. If we see, there are over 100,000 mutations, and over 7,000 have happened in India itself. Out of that, the variants that concern the most have been the three—the UK, South Africa and Brazil variants.

Top healthcare experts and doctors discuss why India is again witnessing a massive spike in Covid-19 cases. Dr Anjan Trikha, Chairman of Clinical Managerial Group, Covid Centre at AIIMS, Dr Neeraj Nischal, Associate Professor, Department of Medicine at AIIMS, Dr Dhiren Gupta, Senior Consultant and Paediatric Intensivist at Sir Ganga Ram Hospital, and Dr Rakesh Mishra, Director at CSIR-CCMB, share their views. Excerpts:

Q. Why so many cases are increasing, particularly in states like Karnataka, Kerala, Punjab, Gujarat, and Tamil Nadu, 86% of the Covid-19 cases have been reported from these states. Do you think there is some kind of mutation of the virus?

Dr Rakesh Mishra: There is certainly a reason otherwise things won’t happen without any reason. Mutation of the virus is the most dreadful reason which we were afraid of. Probably that is not the reason as so far whatever the sequence we have seen it doesn’t look like a new variant is common in the new cases. This means it is not a new variant unless it is that subtle that we are not able to pick. Also, we have seen that while we detect a lot of UK variant and some South Africa variant in travellers who come from international travel, we have not seen a lateral spread of this beyond primary contact in a few cases. Either we are able to control well or these are not infectious for the entire population. or whatever reason, these are not posing any major concern. That leads us to the most likely possibility that most of us think is correct, the spread was not happening as we were taking the correct steps of wearing a mask, social distancing, not going to crowded places and taking care of ourselves, what we call covid appropriate behaviour. We have stopped doing that and once you don’t do that anymore, the virus is always waiting, leading to a big spike in cases. There is correlation to recent past, it might have happened due to a local election, marriage function and people in trains travelling without masks. Luckily, it is not the variant that is causing this as it can ring new surprises and new troubles. But if we continue doing things this way, a lot of people get infected and the virus keeps spreading, any variant will emerge in this population. That is the biggest fear I have that a new variant can come and create new kinds of problems and compromise the vaccine program and other things that we have achieved so far.

Q. What kind of implications can there be from the P1 virus which is a Brazilian virus?

Dr Rakesh Mishra: One thing is that it is not spreading in our population and we must be practising the Covid safety rules so that we are safe. But some studies show that strains require more antibodies to get neutralised and there is a report that shows it might be less effective against this. But it is only a quantitative difference and vaccines largely are more likely, particularly that we are using in India, effective against these variants. These are surprises that cannot be predicted, there may be a situation that this variant has acquired some resistance. If one more mutation happens on top of this in that direction it might be a problem. To prevent the spread as sufficiently as possible, particularly when we detect new variants like P1 or UK, we should be extremely careful and implement strict rules so that we don’t end up with one more lockdown which will be worse than the disease itself.

Q. BBMP has to deploy Marshalls at temples to control the crowd. Do you think that people are not that serious now and have taken things for granted?

Dr. Anjan Trikha: Yes, people have lowered their guard, they are taking things for granted. We have had hesitations; we have had elections and we have seen a lot of people getting together for various rallies and marriages. Earlier there were no marriages, then marriages with 20 people, which increased to 50 people and then further to 200 people. I have at least five wedding cards with five functions for each wedding, the way a big fat Indian wedding used to take place. I can assure you that all the people there will be having masks but in their pockets. The guard has been lowered. The same is with temples, we have to realise that God can only take care of people who take care of themselves. Wherever God may be, it could be a temple, a gurdwara, or a mosque, any religion for that matter, people have lowered their guard. We have to suffer because of that.

Q. What kind of precautions need to be taken by those who have been vaccinated for the first dose? A lot of cases have been seen that people are getting infected after a single dose and are blaming the vaccine. What would you like to say about it?

Dr Neeraj Nischal: Most of us are not aware of or not willing to learn that it is biological vaccination along with social vaccination that is going to save us during this pandemic. If we take the vaccine, it will take some time for us to develop immunities. After taking the first dose we rectify to take the second dose. Once you take the second dose, then after two weeks we anticipate that the adequate immunity level will come. Even after you have immunity the chances of getting infected is still there. It’s just that this vaccine most probably is going to prevent you from getting a severe form of the disease. That’s why getting one shot of a vaccine and thinking that you have become immune to this infection is wrong. We have to ensure that even if we have taken both sets of doses, we have to practice social vaccination after that. Otherwise, we will start saying the vaccine is not working. The idea of vaccination is to prevent morbidity and mortality due to this infection but chances of cutting down transmission may not be 100% or even 70-80% as efficacy is just against the severe disease. We have to keep our guard up even after taking the vaccine.

Dr Dhiren Gupta: What Dr Nischal has said is right. I witnessed five cases who got an infection after the second dose and all these cases were symptomatic though they were young medical students. In young you can’t say they are not severe as otherwise also they are not that severe in the elderly population, probably nobody knows the authenticity of these vaccines. These vaccines have been approved by just a very small trial which has never happened in the past, nobody knows what is the effect of the new strain and the constant mutating viruses. We don’t need any virus to be imported from Brazil, the UK, and South Africa. Recently there was a paper which stated that over 7,000 mutations have happened in India but we are just doing 0.6% entries for the mutation and 5% of the samplings. So we don’t know what is happening but we can’t lower the guard unless the whole population gets vaccinated which means it can still spread despite some people being vaccinated.

Q. Do you think Covid-19 is mild among children?

Dr Dhiren Gupta: Yes, it used to be mild but the problem with the paediatric age group is they can spread it and spoil the game. They may not suffer from severe covid infections especially classical Covid not very much prevails in the paediatric age group which we have seen in the previous two academics in Delhi and India. But in the UK strain, they have found that the prevalence was a little bit more in the paediatric age group than any other mutation. The post-Covid multi-organ inflammatory syndrome is quite life-threatening in this age group. We can say that it is rare but it is not that rare that we should not worry. We follow the cases among adults once the academic is in the adult as the adult population carries the infection to the home. Still, we don’t have the schools open. The Covid-positive children can spread the virus to the elderly, they become very well variables for the infection as the paediatric age group is very attached to their grandparents. It can spread to the most vulnerable population is worrisome.

Q. What can be done as some children have started going to schools, other schools will open in future including for toddlers?

Dr Anjan Trikha: Yes, we can’t have another year of schools not opening. They could be closed for a couple of months, say four to five more months but that is also unreasonable. One thing which we are forgetting is by closing schools we are trying to hinder the development of a child. A child develops a lot mentally when he goes to school, some kind of vaccine behaviour has to be brought to the child. Maybe in the class, they’ll have to be seen that they don’t share food and water, and have to be masked. They have to be told not to touch here and there and put their fingers in the nose, eyes and mouth after every hour. I know it is a tough call but we tend to teach our children not to pick their nose, so we have to teach them not to put things in their mouth. This kind of behaviour has to be taught to them and as I have been pointed out that kids would likely to be bigger spreaders than to be getting affected. We have got our share of children who got Covid and landed in ICU. That behaviour would have to be taught to children and it’s going to be another eight months to a year if not more before some kind of vaccine can be available as a mass vaccination for children.

Dr Dhiren Gupta: First adults have to follow that behaviour then only they can teach their children.

Dr Anjan Trikha: Adults have to get it but the earlier we start the better it is. 

Dr Dhiren Gupta: I see that even the doctors are getting fed up with masks. The tolerance to have a mask for a whole day is not easy. We did a study if you wear a mask for a whole day, for a few hours without interruption, then it is leading to an actual problem in health and that we proved in our nurses. We know that recently it has been found that this virus doesn’t spread by touch but hand washing has to be there. Our vaccination is very slow which means it has almost been the third month of vaccination and we have got the best system in the world including the government and the private regarding vaccination and we couldn’t utilise that system very well to date. All we need to be is quick and fast or once a mutation arrives your existing vaccination would never be sufficient.

Q. What would you like to say about ramping up vaccination?

Dr Neeraj Nishal: Adults have to be role models for children. Once you are there in the home and following all the Covid appropriate behaviour, children are going to learn about that. Every parent has to make a conscious decision that if his/her child is not ok, they should not be sending them to school. Everyone has to pitch in not just children or adults, it has to be a combined effort including the school administration who can start telling this in online classes. They can guide the children and what is expected when they come to school for physical classes. As far as vaccination efficacy against strain is concerned, we should not be worried too much about this as the vaccine is there. We could have ramped up the vaccination on day one but are people going to come and take those vaccines so this vaccination program needed to be slowly implemented. People are taken into confidence so that there is no hesitancy whatsoever. When the time comes everybody will get a chance to take the vaccine, I’m sure they will come forward and take it. The support that the vaccine is getting is improving day by day. I feel the rate may be slow but it is effective and will be wrapped up in time. We should not be in a hurry to ramp up everything on day one and if something wrong would have happened then the whole program would have collapsed so it was a proper way.

Q. What can be the reason behind Maharashtra reporting more than 30,000 cases in a single day? 

Dr Rakesh Mishra: That is how we began. The reason is most likely that the people have stopped taking precautions. We should be aware that this virus spreads very efficiently. The good thing is that we know how it spreads so we can stop that, and like other coronaviruses, it has a tendency to mutate and we have seen out of 6,000 variants or 6,000 isolates in India we have documented 7500 mutations, luckily most of them are not of much consequence they are just academic records.

Mutation and transmission are not correlated, those are just recorded in those isolated. Either it is very transmissible otherwise itself normal mutation. 

Q. Do you think people are not following guidelines?

Dr Rakesh Mishra: Exactly, we are not behaving as we should and that is the best tool that we have, even if there are vaccines now maybe there will be many more but vaccines have limited benefits. 1000% people are not going to get 100% protection which means if we keep playing with the virus, allowing it to hang around in a larger number for a longer time we will certainly discover one day, which will trouble us heavily and the whole thing can become a big problem. The cause for the increase in the number of cases is most likely not a new variant although we have to keep monitoring everyday a large number of isolates by samples, at least 5% in particular where there is a large number of cases. Then very easily we can tell whether the new variant is happening or not. But since we haven’t seen something so far and there is a direct correlation to the people being careless it is very likely we are encouraging the virus and inviting trouble for ourselves. We have to go back to the social vaccine and trust in that and then only the full advantage of the real vaccine will be there otherwise all will go in vain and we will be back to the drive out.

Q. Do you believe the vaccine that is going to work is the social vaccine?

Dr Anjan Trikha: Yes, everything has been rightly said by Dr Gupta, Dr Nishal and Dr Mishra, I would like to add that injectable vaccines are a totally different ball game and a social vaccine is equally important. I also feel like Dr Nishal, the government has done a considerably good job in starting vaccination at a slow phase. If you realise that we people like to discuss a lot, everybody in the country is discussing which vaccine to take and not to take. Let us have faith in our government and they are doing a good job. There were a group of people who never took the vaccine in a state as somebody had told them they can’t have alcohol after taking the vaccination for 15 days. So the vaccination drives go for a dodge. These kinds of issues will be solved. We are one of those countries where lockdown and everything else was criticised but we did a good thing. The economy went for a toss and it has gone for a toss everywhere in the world. Even if you go to the USA it’s the same thing, my son who is 35 is not vaccinated in Cincinnati as only above 60 years are getting vaccinated. We are following the same thing and are on the right track. We have hiccups in India. There are going to be elections in West Bengal, Kerala, and Tamil Nadu, so this will go on.

Q. There are people who are thinking they should Covishield or Covaxin. What would you like to say about it?

Dr Neeraj Nischal:Theoretically there may be differences between these two vaccines but at the time of the pandemic, we cannot be choosing among these two. If you are eligible, go ahead and take the available vaccine. Don’t try to differentiate between these two vaccines and try to find out which vaccine you should take. Unless there are clear cut contraindications as far as one of the vaccines is concerned, say immune-compromised patients should avoid taking this vaccine, you should not be taking that vaccine but if this is not the case, go with whatever vaccine you are getting and don’t wait which is better and which is not. This is pandemic time and if we wait for the perfect solution then it might be too late. Everybody was worried about when the vaccine will come and now that the vaccine is here, we should know the vaccine is not going to end the pandemic, vaccination will. So, whenever the turn comes, irrespective of the vaccine you are getting, come forward, take it and help in ending this pandemic.

Q. What message would you like to give?

Dr Dhiren Gupta: I think what Dr Nischal said is true, we should not have any hesitations in getting vaccines, whatever type of vaccine is available you get it as soon as possible. Don’t go by the rumours. I would like to advise the media that there will be a reaction in adult vaccination and paediatrics patients as they do not react to vaccination much as compared to adults. But if you compare the disease severity, hardly any reactions are there. Get yourself vaccinated, practice social distancing, and wear a mask which we can’t forget even after vaccination.

New Delhi: Addressing the issue of unavailability of candidates who could fulfill the high standards demanded in the selection process in All India Institute of Medical Sciences (AIIMS), New Delhi and other AIIMS, the Parliamentary Committee has called for a “centralised recruitment process” that would yield “speedy and better outcome”.

Expressing concerns over the premier institutions, the committee called for urgent filling up the vacant faculty and non-faculty posts by expediting the recruitment process and framing of recruitment rules at the earliest. The department-related Parliamentary Standing Committee on Health and Family Welfare, headed by Prof Ram Gopal Yadav, submitted its 126th report on Demands for Grants 2021-22 on 8 March 2021.