Minority ethnic groups had a higher risk of testing positive for SARS-CoV-2 and of COVID-19-related hospitalisations, intensive care (ICU) admissions and death compared with white groups in England, according to an observational study published in The Lancet. The COVID-19 pandemic is understood to have had a disproportionate impact on minority ethnic communities in the UK and beyond. This study accounted for a large number of explanatory variables such as household size, social factors and health conditions across all ethnic groups and at different stages of COVID-19, from testing to mortality.

Understanding drivers of SARS-CoV-2 infection and COVID-19 in minority ethnic communities will be crucial to public policy efforts to overcome inequalities. “Minority ethnic groups in the UK are disproportionately affected by factors that also increase the risk for poor COVID-19 outcomes, such as living in deprived areas, working in front-line jobs, and having poorer access to healthcare. Our study indicates that even after accounting for many of these factors, the risk for testing positive, hospitalisation, ICU admission and death was still higher in minority ethnic groups compared with white people in England. To improve COVID-19 outcomes, we urgently need to tackle the wider disadvantage and structural racism faced by these communities, as well as improving access to care and reducing transmission,” says lead author, Dr Rohini Mathur of the London School of Hygiene and Tropical Medicine, UK.

On behalf of NHS England, the research team used the new secure OpenSAFELY data analytics platform to analyse partially anonymised electronic health data collected by GPs covering 40% of England. These GP records were linked to other national coronavirus-related data sets for the first and second waves of the pandemic – including testing, hospital data and mortality records. Ethnicity was self-reported by participants in GP records and grouped into five census categories (white, South Asian, Black, other, mixed) and then a further 16 sub-groups. Possible explanatory factors, including clinical characteristics, such as BMI, blood pressure, smoking status and conditions such as asthma and diabetes were included in the analyses alongside demographic information such as age, sex, deprivation and household size. Of 17,288,532 adults included in the study, 63 per cent (10,877,978) were white, 5.9 per cent (1,025,319) South Asian, 2 per cent (340,912) Black, 1.8 per cent (320,788) other, and 1 per cent (170,484) mixed.

Ethnicity was unknown for 26.3 per cent (4,553,051) people. During wave 1, nearly all minority ethnic groups had a higher relative risk for testing positive, hospitalisation, ICU admission, and death compared to white groups. The largest disparities were seen in ICU admissions, which were more than doubled for all minority ethnic groups compared with white groups, with Black people more than three times more likely to be admitted to ICU after accounting for other factors. The proportion of people testing positive for SARS-CoV-2 in wave 1 was higher in South Asian groups (0.9 per cent test positivity), Black (0.7 per cent) and mixed groups (0.5 per cent) and compared with white people (0.4 per cent). “Higher risks for testing positive and subsequent poor outcomes amongst minority ethnic groups suggest that people may delay seeking testing or accessing care for SARS-CoV-2. This may be due to a lack of access to testing sites or conflicting health messaging.

It may also suggest that some may be fearful of losing income or employment if required to quarantine after testing positive as minority ethnic groups are more likely to work in insecure jobs with poorer workplace protections. People who need to be tested as well as those who test positive must be supported better if we are to reduce disparities in COVID-19 outcomes,” says Dr Mathur. Compared with wave 1, the relative risk for testing positive, hospitalisation, ICU admission, and death were smaller in pandemic wave 2 for all minority ethnic communities compared to white people, with the exception of South Asian groups. South Asian groups remained at higher risk for testing positive, with relative risks for hospitalisation, ICU admission, and death greater in magnitude in wave 2 compared to wave 1. “Despite the improvements seen in most minority ethnic groups in the second wave compared to the first, it’s concerning to see that the disparity widened among South Asian groups. This highlights an urgent need to find effective prevention measures that fit with the needs of the UK’s ethnically diverse population,” says Dr Mathur. After accounting for age and sex, social deprivation was the biggest potential explanatory factor for disparities in all minority ethnic groups except South Asian. In South Asian groups, health factors played the biggest role in explaining excess risks for all outcomes.

As the country continues its battle against the second wave of COVID-19 infections, a new survey has shown that 48 per cent of people do not know the government helpline number 1075 in case of any visible symptoms of COVID-19.According to the survey conducted by Smile Foundation across 12 states covering a total of 27,216 respondents, almost one in four Indians is unable to protect himself completely from getting infected. The survey was conducted across Delhi, Haryana, Uttar Pradesh, Telangana, Tamil Nadu, Chhattisgarh, Gujarat, Maharashtra, Karnataka, West Bengal, Jharkhand, and Rajasthan via telephonic interviews in regional languages encompassing Smile’s beneficiaries in underserved areas. While 22.7 per cent of respondents said they visited a private hospital/clinic for primary healthcare services, the majority about 45 per cent, relied on PHCs/CHCs. Moreover, the survey further noted that about 25 per cent did not have total protection (person having a mask, wearing a mask, covering nose with a mask, social distancing of 1-2 metres required to prevent Covid-19, hand washing 5 times a day and min.20 seconds of handwashing).

Talking about the survey, Santanu Mishra, Co-Founder, and Executive Trustee, Smile Foundation said, “The survey outlined that most of the respondents are aware of coronavirus and COVID-19, which is very encouraging. India has shown commendable grit in fighting COVID-19 despite our challenges. We must continue with full vigor, efforts to curtail the spread of the viral infection. This is a time when all stakeholders including the government, civil society organizations, and corporates must work in unison to design and implement strategies that alleviate suffering and improve healthcare outputs for millions of our compatriots.” The survey identified five factors as key challenges in delivering healthcare to all Indians – lack of awareness of healthcare issues among the general public, lack of access to quality healthcare services, inadequate number of health workers in India, high cost of healthcare, and lack of accountability in the healthcare system.

To address these challenges, Smile Foundation has been running the Health Cannot Wait campaign. Initiatives under this campaign include Smile on Wheels mobile hospitals, Smile Health Camps that provide healthcare services to the larger community, BaatonBaaton Mein Sehat a tele-counselling service for the underprivileged aimed at providing emotional and psychological support in the time of COVID-19, and Health Online telemedicine service through e-clinics. Smile Foundation is a NGO in India directly benefitting over 15,00,000 children and their families every year, through more than 400 live welfare projects on education for poor children, healthcare, livelihood, and women empowerment, in over 2000 remote villages and slums across 25 states of India. Adopting a life cycle approach of development, Smile Foundation focuses its interventions on children, their families, and the community.

Okay, so you’ve just had a baby. Celebrations, cake and balloons should be in order. Only, you aren’t quite feeling the cheer. In fact, the nine months of joy, anticipation and excitement you felt during your pregnancy are now inverted into a sense of perennial gloom. Becoming a parent triggers an array of emotions, from joy and excitement to anxiety and fear. Baby blues are fairly common among new moms, but how do you cope with postpartum depression, a long-lasting and severe mood disorder?

Postpartum depression is a clinical condition that can affect new parents after childbirth. It can affect new mothers and fathers, and its symptoms generally include extreme sadness, exhaustion, tearfulness, changes in eating patterns, reduced libido and self-doubt. Although about 10% of women develop symptoms of postpartum depression, there’s a misperception that it becomes evident only after childbirth. Nope, not really. Expectant mothers can face symptoms of depression while they’re still pregnant, although they become more pronounced after childbirth. New parents fall privy to the condition because of exhaustion, lifestyle changes after childbirth, and lack of sleep. If you have a history of depression or anxiety, your chances of developing postpartum depression are higher. Speak to a doctor if you’re wary of developing postpartum depression. It’s always better to be prepared.

Many couples ask me if Postpartum depression can be alleviated with the right treatment. It really depends on the degree to which the condition has affected you. If your symptoms are mild, your doctor may suggest that you wait to see whether the condition ebbs on its own. If your life is severely affected by postpartum depression on the other hand, you may be prescribed antidepressant medication and counselling. Antidepressants can change the chemical composition in your brain, which in turn, can temper your emotional balance. Postpartum depression is a conquerable condition. When you rise above it, you’ll discover the joy in little things. Like the way your baby laughs. Or the first time he stands up. You’ll learn something new every day. And perhaps, to honour this beautiful new phase of life, you can call for another round of cake and celebrations.

Some handy tips:

• Focus on developing a bond with your baby before you plan and think of anything else. Always remember a women has undergone many changes before, during and post pregnancy and getting back to normal takes time

• Create time for yourself: Make sometime for exercises & pursuing your hobbies. Plan your time according to your babies schedule and you will be able to recover soon

• Continue to maintain a healthy lifestyle & clean eating habits: Just as during the time of pregnancy you maintained a good healthy lifestyle, continue to focus on nutritious, home cooked food that will help you feel better and give your body the nutrients you need.

• Focus on Breastfeeding your child exclusively for 6 months: Some women develop depression symptoms while breast-feeding. This condition is called Dysmorphic Milk Ejection Reflex or D-MER. With D-MER, you might experience sudden feelings of sadness, agitation, or anger that last several minutes after your milk lets down.

• Continue to spend time with family & your partner : Do not isolate yourself. Always remember Positive social contact relieves stress faster and more efficiently than any other means.

• Last but not the least Don’t Compare Yourself to Others: It’s natural to compare your story to others in order to try and make sense of your suffering. However, this can create unrealistic expectations and place more added pressure on yourself. Remember that your recovery process is different from others for any number of reasons and the timeline for PPD is different for everyone. If you have certain risk factors, you might find your PPD lasting longer even with treatment.

Women need to remember that Post-Partum Depression can be a result of many factors like a complicated pregnancy or delivery or simply a lack of support from your partner or family members and friends but always remember this golden period of child birth and celebration should not be missed.The sooner you can get help with managing your depression, the sooner you can begin to enjoy your baby and parenting journey.

The Author is the Director – Department of Gynecology and Obesetriction, Cloudnine Group of Hospitals, Noida

For the first time researchers demonstrate that intermittent fasting can reduce hypertension by reshaping the gut microbiota in an animal model. Nearly half of adults in the United States have hypertension, a condition that raises the risk for heart disease and stroke, which are leading causes of death in the U. S. At Baylor College of Medicine, Dr David J. Durgan and his colleagues are dedicated to better understand hypertension, in particular the emerging evidence suggesting that disruption of the gut microbiota, known as gut dysbiosis, can have adverse effects on blood pressure.“Previous studies from our lab have shown that the composition of the gut microbiota in animal models of hypertension, such as the SHRSP (spontaneously hypertensive stroke-prone rat) model, is different from that in animals with normal blood pressure,” said Durgan, assistant professor of anesthesiology at Baylor.The researchers also have shown that transplanting dysbiotic gut microbiota from a hypertensive animal into a normotensive (having a healthy blood pressure) one results in the recipient developing high blood pressure.“This result told us that gut dysbiosis is not just a consequence of hypertension, but is actually involved in causing it,” Durgan said. “This groundwork led to the current study in which we proposed to answer two questions. First, can we manipulate the dysbiotic microbiota to either prevent or relieve hypertension? Second, how are the gut microbes influencing the animal’s blood pressure?” added Durgan. Can manipulating the gut microbiota regulate blood pressure?To answer the first question, Durgan and his colleagues drew on previous research showing that fasting was both one of the major drivers of the composition of the gut microbiota and a promoter of beneficial cardiovascular effects. These studies, however, had not provided evidence connecting the microbiota and blood pressure.Working with the SHRSP model of spontaneous hypertension and normal rats, the researchers set up two groups. One group had SHRSP and normal rats that were fed every other day, while the other group, called control, had SHRSP and normal rats with unrestricted food availability. Nine weeks after the experiment began, the researchers observed that, as expected, the rats in the SHRSP control had higher blood pressure when compared to the normal control rats. Interestingly, in the group that fasted every other day, the SHRSP rats had significantly reduced blood pressure when compared with the SHRSP rats that had not fasted. “Next, we investigated whether the microbiota was involved in the reduction of blood pressure we observed in the SHRSP rats that had fasted,” Durgan said.The researchers transplanted the microbiota of the rats that had either fasted or fed without restrictions into germ-free rats, which have no microbiota of their own. Durgan and his colleagues were excited to see that the germ-free rats that received the microbiota of normally fed SHRSP rats had higher blood pressure than the germ-free rats receiving microbiota from normal control rats, just like their corresponding microbiota donors.“It was particularly interesting to see that the germ-free rats that received microbiota from the fasting SHRSP rats had significantly lowered the blood pressure than the rats that had received microbiota from SHRSP control rats,” Durgan said. “These results demonstrated that the alterations to the microbiota induced by fasting were sufficient to mediate the blood pressure-lowering effect of intermitting fasting.” How the microbiota regulates blood pressureThe team proceeded to investigate the second question of their project. How does the gut microbiota regulate blood pressure?“We applied whole-genome shotgun sequence analysis of the microbiota as well as untargeted metabolomics analysis of plasma and gastrointestinal luminal content. Among the changes we observed, alterations in products of bile acid metabolism stood out as potential mediators of blood pressure regulation,” Durgan said.The team discovered that the SHRSP hypertensive animals that were fed normally had lower bile acids in circulation than normotensive animals. On the other hand, SHRSP animals that followed an intermittent feeding schedule had more bile acids in the circulation. “Supporting this finding, we found that supplementing animals with cholic acid, a primary bile acid, also significantly reduced blood pressure in the SHRSP model of hypertension,” Durgan said.Taken together, the study shows for the first time that intermittent fasting can be beneficial in terms of reducing hypertension by reshaping the composition of gut microbiota in an animal model. The work also provides evidence that gut dysbiosis contributes to hypertension by altering bile acid signaling. “This study is important to understand that fasting can have its effects on the host through microbiota manipulation,” Durgan said. “This is an attractive idea because it can potentially have clinical applications. Many of the bacteria in the gut microbiota are involved in the production of compounds that have been shown to have beneficial effects as they make it into the circulation and contribute to the regulation of the host’s physiology. Fasting schedules could one day help regulate the activity of gut microbial populations to naturally provide health benefits,” added Durgan.

The Mayo Clinic data scientists who developed highly accurate computer modelling to predict trends for COVID-19 cases nationwide have new research that shows how important a high rate of vaccination is to reducing case numbers and controlling the pandemic. Vaccination is making a striking difference in Minnesota and keeping the current level of positive cases from becoming an emergency that overwhelms ICUs and leads to more illness and death, according to a study published in Mayo Clinic Proceedings. The study, entitled “Quantifying the Importance of COVID-19 Vaccination to Our Future Outlook,” outlines how Mayo’s COVID-19 predictive modelling can assess future trends based on the pace of vaccination, and how vaccination trends are crucial to the future course of the pandemic.The Mayo researchers estimate that a peak of more than 800 patients would be in hospital ICUs in Minnesota this spring if no vaccines had been developed. The projections take into account new variants of the SARS-CoV-2 virus as well as current public health measures and masking standards. The predicted ICU census levels would be more than double the number of Minnesota COVID-19 patients who were hospitalized in ICUs on Dec. 1, at the height of the most recent surge last year. “It is difficult to untangle how much of this elevated rate of spread right now is due to new variants as opposed to changes in social behaviour,” the authors say, but “regardless of the reason, the absence of vaccinations in the current environment would have been likely to result in by far the largest surge to date.”If Minnesota had achieved vaccination of 75 per cent of the population by early April, the study estimates that the 7-day average of cases per 100,000 residents, the number of COVID-19 patients hospitalized and the number in ICUs would plummet by early July. “According to the model, this level of vaccination would completely suppress the growth (even in the face of the recent elevated spread rate) and immediately drive cases and hospitalizations down to very low levels,” the authors say. The Mayo Clinic study was led by Curtis Storlie, PhD, and Sean Dowdy, M.D., whose team developed the computer model for forecasting COVID-19’s impact on hospital usage that has helped guide Mayo’s response to the pandemic.

Mayo Clinic’s predictive modelling also has been shared with Minnesota public health leadership to help inform critical decisions over the past year. Mayo Clinic’s forecasting of COVID-19 trends nationally is available online at the Mayo Clinic COVID-19 Resource Center. The Coronavirus Map tracking tool has county-by-county information on COVID-19 cases and trends nationwide. When the pandemic emerged last year, Mayo Clinic data scientists developed predictive modelling to assess when and where COVID-19 hot spots would occur. The model accurately predicted the timing and magnitude of COVID-19 case and hospitalization surges, which enabled Mayo Clinic to prepare and assure it could provide the best care while keeping patients and staff safe.

The Mayo Clinic data scientists who developed highly accurate computer modelling to predict trends for COVID-19 cases nationwide have new research that shows how important a high rate of vaccination is to reducing case numbers and controlling the pandemic. Vaccination is making a striking difference in Minnesota and keeping the current level of positive cases from becoming an emergency that overwhelms ICUs and leads to more illness and death, according to a study published in Mayo Clinic Proceedings. The study, entitled “Quantifying the Importance of COVID-19 Vaccination to Our Future Outlook,” outlines how Mayo’s COVID-19 predictive modelling can assess future trends based on the pace of vaccination, and how vaccination trends are crucial to the future course of the pandemic.The Mayo researchers estimate that a peak of more than 800 patients would be in hospital ICUs in Minnesota this spring if no vaccines had been developed. The projections take into account new variants of the SARS-CoV-2 virus as well as current public health measures and masking standards. The predicted ICU census levels would be more than double the number of Minnesota COVID-19 patients who were hospitalized in ICUs on Dec. 1, at the height of the most recent surge last year. “It is difficult to untangle how much of this elevated rate of spread right now is due to new variants as opposed to changes in social behaviour,” the authors say, but “regardless of the reason, the absence of vaccinations in the current environment would have been likely to result in by far the largest surge to date.”If Minnesota had achieved vaccination of 75 per cent of the population by early April, the study estimates that the 7-day average of cases per 100,000 residents, the number of COVID-19 patients hospitalized and the number in ICUs would plummet by early July. “According to the model, this level of vaccination would completely suppress the growth (even in the face of the recent elevated spread rate) and immediately drive cases and hospitalizations down to very low levels,” the authors say. The Mayo Clinic study was led by Curtis Storlie, PhD, and Sean Dowdy, M.D., whose team developed the computer model for forecasting COVID-19’s impact on hospital usage that has helped guide Mayo’s response to the pandemic.

Mayo Clinic’s predictive modelling also has been shared with Minnesota public health leadership to help inform critical decisions over the past year. Mayo Clinic’s forecasting of COVID-19 trends nationally is available online at the Mayo Clinic COVID-19 Resource Center. The Coronavirus Map tracking tool has county-by-county information on COVID-19 cases and trends nationwide. When the pandemic emerged last year, Mayo Clinic data scientists developed predictive modelling to assess when and where COVID-19 hot spots would occur. The model accurately predicted the timing and magnitude of COVID-19 case and hospitalization surges, which enabled Mayo Clinic to prepare and assure it could provide the best care while keeping patients and staff safe.