As per a new report, studies show that maintaining good oral hygiene can help you overcome Covid-19, implying that there is a direct connection between oral hygiene and the deadly infection. This report was published in the US’s leading organisation of periodontists, the American Academy of Periodontology (AAP). Dr James G. Wilson, President of the AAP, mentioned in the report, “It is well-established that systemic inflammation is not only linked with periodontal disease but to several other respiratory diseases as well.

Therefore, maintaining healthy teeth and gums in an effort to avoid developing or worsening periodontal disease is absolutely crucial in the midst of a global pandemic like Covid-19, which is also known to trigger an inflammatory response.” Furthermore, a report by McGill University in Montreal, Canada, found a direct link between gums with inflammation and infection and even connected how oral hygiene can play a role in aggravating Covid-19 complications and even lead to deaths. According to this study, people that have gum issues or periodontitis are 8.8 times more likely to die of Covid-19. Not just this, such people are 3.5 times more likely to require hospitalisation for Covid-19 and 4.5 times more likely to require a ventilator. It has also come to light that oral health plays a pivotal role even in the Covid post-recovery period. Shedding more light on this, Dr Mohendar Narula, Founder and Chairman of MyDentalPlan Healthcare Pvt. Ltd. said, “Taking care of your gums and oral hygiene was always vital but it has become even more significant during this pandemic.

In this second wave of Covid-19, oral symptoms are on the rise.” Talking about maintaining gum health, he continued, “However, maintaining optimum gum health with simple steps such as brushing twice a day, tongue cleaning, flossing and gargles can help people combat these life-threatening diseases even better. Furthermore, professional dental cleanings twice a year and regular dental check-ups are known to minimize the severity of Covid-19 and the associated complications.” Adding to it Dr Narula said, “The second wave of Covid-19 is also witnessing Mucormycosis, a deadly fungal infection affecting the gums, teeth and the peri-oral area, developing as a post-Covid complication among immunocompromised individuals with poor gum and oral health status. It has now come to light that taking care of oral hygiene can also help people safeguard themselves even from this post-Covid-19 complication.” Oral care should be a part of health recommendations for every individual and its importance has increased significantly during this pandemic.

Can cancer patients take Covid-19 vaccines?    

A. The Covid-19 pandemic, caused by the SARS-CoV-2 virus, continues to have a serious impact on many people, including cancer patients, their families, and caregivers. Due to frequent hospital visits and increased exposure, vaccination for cancer patients has become imperative now. Individuals with cancer sadly have a higher risk of severe Covid infection because of their age, the disease, cancer treatment and medical comorbidities.

Currently, vaccination for cancer patients has been recommended for all people with cancer and blood malignancies. These vaccines can be taken as long as the components of the vaccine suit the patient even while their immunity is down. However, the following points to be noted –

· These vaccines should not be taken if they do not suit one’s body (like known allergic reaction, which is a contraindication) 

· There could be an unknown safety situation which can rarely cause a problem

· Effectiveness may not be as much as in the general population due to a less immune reaction. Here the vaccine is given to give whatever benefit possible and with the intent to reduce the severity of Covid-19 infection if it happens.

Q. When to start and which are the most preferred vaccines for cancer patients? Can the vaccination lead to a change of plans in the cancer treatment of the patients? 

A. While starting your programme of vaccination, It is important to discuss with your oncologists and plan strategies for taking vaccines between the cycles of chemotherapy, targeted therapy and immunotherapy. It is recommended to take any of the available vaccines as long as the blood counts are acceptable.

Cancer patients who are undergoing major surgery should ideally wait for a few days before going for vaccination. The best time for such patients to get vaccinated is before treatment, optimally 2 weeks before the start of chemotherapy. Furthermore, patients who have opted for radiotherapy can start their vaccination program anytime. Patients undergoing immunotherapy should opt. for vaccination at the earliest as toxicities and reaction can be severe if the Covid infection happens along with chemotherapy/immunotherapy.

Other than the appropriateness and timing of the vaccination, there are no changes that the vaccination causes in the plan for cancer therapy. Vaccination can be recommended one week from the start of the chemotherapy cycle.

Q. How long does immunity last?

A. The expected immunity usually develops in 2-3 weeks after the second dose of the vaccine and is effective beyond six months. As the vaccines and vaccination programmes are relatively new. We are still awaiting further data on whether or not the immunity lasts beyond six months. However, considering the current scenario, where comorbid patients are at an increased risk of contracting the Covid virus, vaccination is strongly recommended for all such patients. Cancer patients who have also recovered from Covid-19 can also undergo vaccination without the fear of any complications.

Q. What are the concerns of vaccination with regards to cancer patients?

A. A major concern is an uncertainty in the level of effectiveness of vaccination when immunity comes down during treatment. However, any level of effectiveness is better than status without Covid-19 vaccination. Lymphoma patients can have lower vaccine responses as we do not know precisely the efficacy of the Covid vaccine for lymphoma when on active treatment. For cancer patients, despite the vaccination, it is essential to continue the practice of wearing a mask, social distancing, and maintaining hand hygiene as they are already immune-compromised and chances of re-infection are also high among them.

Q. Is the Covid-19 vaccine safe in bone marrow transplants?

A. Covid-19 vaccination is recommended at least two to four weeks before the planned transplant. We recommend most of the transplant patients to delay all vaccines for at least three months following a stem cell or bone marrow transplant.

Q. What are the vaccine’s side effects?

A. Currently, serious side effects are rare and compared to the benefit of protection, it would be negligible. However, common side effects of vaccines are pain at the injection site, tiredness, headache, muscle pain, and fever. Chills, joint pain, nausea, injection site redness and swelling, swollen lymph nodes.

Q. Can one get ill with Covid-19 after vaccination?

A. It is possible that one can get sick post receiving a vaccine, but the good news is that it is likely to be less severe and people may not require hospitalisation in such cases.

The writer is Lead & Sr Consultant—Medical Oncology & Haematology, Aster CMI Hospital.

In a conversation with NewsX on Friday, Maharashtra Health Minister Rajesh Tope said that thehealthcare experts are actively studying real medication for black fungus and they will hopefully be able to cope with it. There are close to 1,500 cases of black fungus in Maharashtra and thus the state task force is actively monitoring the situation.

Q. Positivity rates in Maharashtra are declining but not the death rates. What do you think is the reason behind it? 

Our recovery rate has improved and so has the positivity rate. Some people are still not taking any precautions, I would urge them not to repeat such mistakes. Everyone must take all the required precautions.  

Q. How is the state is ensuring the stop of spread in rural areas?  

We are vaccinating people in full strength. If the Government of India will provide us with a sufficient amount we will do it better. We didn’t get vaccines as per our population due to which we are lacking behind. I would urge the Centre to provide us with the required amount of vaccines.  

Q. Has Maharashtra issued global tenders for vaccines? 

We have done that but didn’t get any response. It has happened maybe because of the complexity of norms implemented and if it’s eased in future then only foreign companies will approach us to sell their vaccines. There should be one uniform tender at a national level for smooth coordination and to lure foreign companies.  

Q. How is the state dealing with the cases of Black Fungus?  

People who fail in controlling their blood sugar and take steroids are prone to this disease. Our healthcare experts are actively studying real medication for this fungus and we will hopefully be able to cope with it. We have close to 1500 cases of Black Fungus due to which our state task force is actively monitoring the situation. Hospitals are being specifically designated for the same and I would urge the public to follow the guidelines to avoid the spread of Black Fungus.   

Q. How are you preparing for the third wave which is more dangerous for kids?  

We are discussing with doctors, analysts and researchers in different ways so that we can easily handle the third wave. Various experiments are being done to ensure immunity for kids and children. We are also educating parents to stay positive if their kids face symptoms and immediately approach the doctors.

Punjab Health and Family Welfare Minister Balbir Singh Sidhu joined NewsX on Friday for a conversation and informed that the state does not have many cases of black fungus but they have already started preparations on a war-footing manner to stop the spread before things go beyond control.  

Excerpts:

Q. Why do you think that in every state the positive rate is declining but not the death rates? People are alleging that states are hiding real facts. How Punjab is doing on this front?  

There is no such discrepancy happening in Punjab, we have ensured fair testing and recoveries. The second wave has been tough for us all due to which a lot of people are having a hard time. We have ensured testing on the ground level and followed up well to make sure that people don’t have side effects. Even in rural areas, people are asked to get involved in the process of vaccination and testing.  

Q. How is the state dealing with Black Fungus?  

Punjab does not have many cases of Black Fungus. We have already started preparations on a war footing manner to stop the spread before things go beyond control.  

Q. Are you considering announcing Balck Fungus as an epidemic? 

Yes, we have done that.  

Q. What do you think is the reason behind the shortage of vaccines? Do you think the coordination between the Centre and states is the real issue?  

We had to shut down so many vaccine centres because of the same reason. And to tackle the issue we have released global tenders so that private and international players can directly approach us.  

Q. How is the state ensuring to decrease the spread of the virus in villages? 

We are doing door-to-door vaccination in rural areas and educating them about the same. We have asked communities to come forward and cooperate with the state government. 

Q. How are you preparing for the third wave of Covid-19 which is expected to be more harmful to children? 

We have already informed our healthcare experts to prepare and convey the guidelines for the same. Our teams are working on the ground so that we can cope up with the third wave.

In a conversation with NewsX on Friday, Madhya Pradesh Health Minister Prabhuram Choudhary spoke about tackling Covid-19 cases, the status of vaccines, black fungus cases posing as a healthcare challenge and more. 

Excerpts:

Q. How is the state ensuring lesser deaths and positive rates?

We have prepared on a war footing level and ensured better medical facilities for every walk of society. We have put stringent control on corruption cases regarding Covid-19 drugs. Beds, oxygen tanks, injections, and other essential health care equipment were provided to the hospitals at the correct time due to which we could control the situation.  

Q. Was Covid curfew the most effective way to control coronavirus cases? 

Yes, it helps in breaking the Covid chain and ensures lesser positivity rates. We have seen this earlier too and credible studies have indicated towards Covid curfew to be one of the most substantial ways of stopping Covid-19 spread.

Q. What’s the status of vaccines in your state? 

We are using vaccines which we are getting from the Centre. Primarily, we vaccinated healthcare workers and since 5 May, we started vaccinated adults and this is being done on a war footing zone. We are educating civilians also to come forward and get vaccinated.  

Q. Another healthcare challenge we are facing is White and Black Fungus? What are your views on it? 

We have constituted important units consisting of healthcare experts to study and present the analysis on Black and White Fungus. We have also urged all those who are researching on the subject must come forward and share their insights too if they have something credible.  

Q. We observed a massive deficiency of oxygen tanks, beds, injections etc. Now, how is the state ensuring that such chaos will not be repeated while tackling White and Black Fungus? 

In the leadership of our Chief Minister Shivraj Singh Chauhan, we are ensuring these basic needs to every government and private hospital. While coping with Black Fungus it is being observed that M4 Teresina B is an effective medicine and the state leadership is ensuring to have sufficient supply of the same. 

Q. We are witnessing that Covid-19 cases are on the rise in rural areas. What is your leadership doing to cope with it? 

We are doing several activities to tackle the Covid-19 spread in rural areas. We have educated people in rural areas and conveyed the right information to them. We also urged community representatives in rural areas like “Sarpanchs” and others to come forward and identify people who are having symptoms for their timely treatment.  

Q. How are you preparing for the third wave which is more dangerous for kids? 

We are discussing with doctors, analysts and researchers in different ways so that we can properly manage the third wave. Various experiments are being done to ensure immunity for kids and children. We are also educating parents to stay positive in case their kids have symptoms and immediately consult doctors.  

Q. How is the state dealing with corruption cases around healthcare facilities which were on a massive high during the second wave? 

We have taken stringent action against accused people and have directed the investigating agencies to ensure no such activity takes place. I am again urging people not to get involved in such acts and cooperate with the state machinery.  

Q. Do you think the situation won’t arrive where you will have to implement lockdown again in the state? 

We are working rigorously to ensure such a time don’t come again. We wish everyone good health.

Karnataka Deputy Chief Minister Dr Ashwathnarayan C.N. joined NewsX on Friday for a conversation around combating black fungus, the ongoing vaccination programme, managing Covid-19 cases, and other issues. 

Excerpts:

Q. What is the current status of Black Fungus in Karnataka? Is the state prepared to deal with it?

We have first-line treatment for Black Fungus which includes Liposomal and Amphotericin B injections. Alternatives are also available and are being used to treat patients. Only one lakh vials of Liposomal and Amphotericin B injections are available in our country which is insufficient. However, the Government of India is effectively addressing the demand by importing, and the production of these injections will soon begin in the country.

Q. Why hasn’t Karnataka declared Black Fungus an epidemic yet, when seven other states have?

The Karnataka government declared Black Fungus a notified disease five days ago. In this regard, a notice and a circular have been issued. We want the reporting to be done regardless of where it is. The incidents must be reported.

Q. Is there enough stock in Karnataka to inoculate the vaccination programme for people aged 18 to 45 yrs?

For people between the ages of 18 and 45, we are attempting to prioritise frontline workers and priority sectors. Once that is completed, we intend to begin registration for people aged 18 to 45 on 1 June. As the time between the first and second doses has been increased, we will be able to administer the first doses to a greater number of people. According to the new Government of India guidelines, infected people do not need to take a vaccine for three months. Leading doctors have also advocated that infected people should not receive the vaccine for six to nine months.

Q. Covid case management is still an issue, and people are having difficulty finding beds and oxygen. Where does the state fall short?

We are attempting to make the best use of the vaccines that are available by reaching out to people who are not infected so that they can be protected. Keeping the third wave in mind, we want to keep people away from getting infected with the virus. As the supply of vaccinations increases, we will be able to expand to all sections.

Q. The Centre has already stated that the demand for using the entire supply of oxygen manufactured in Karnataka is more or less agreed upon. What is the current status of oxygen in the state?

According to the most recent updates, the demand and supply situation was extremely difficult. To address the challenge, we must implement a variety of measures. Unnecessarily, many people who did not require hospitalisation were admitted. We began the triage process, in which those who truly needed assistance were admitted and those who did not were not admitted. We attempted to make the most of the available beds. Everything was done including the streamlining process, availability of beds, and the strengthening of the system. We faced a lot of problems with the oxygen supply at first but were eventually able to manage the supply, oxygen, and beds. Every short or long distance, wherever the oxygen was supplied, was maintained and we ensured that it was available for everyone.

Q. There is a discussion about establishing a triage centre. What is the situation in Karnataka?

Yes, the number of SOS calls have decreased, and so has the demand for beds. As a result, we can now maintain supply and demand. However, there is still a need for ICU and ventilator beds. In the future, we will most likely need to ensure that there is a system in place for people to access services and that they are used effectively.

Q. What is the strategy for containing Covid-19’s rural spread in Karnataka?

In this direction, the basic foundation is to test early, detect early, treat early, and triage. Home isolation is not an option in rural areas so we have decided that all infected people should be admitted to CCCs (Covid Care Centres), and then to hospitals, if necessary. We will be able to stop the spread if this is done properly.

Q. Karnataka’s Home minister stated that the lockdown will be tightened so how long do you think the lockdown will last?

We must examine the outcome of the lockdown as well as the situation in terms of the number of Covid-19 cases. We will decide how long we need to extend it and how effective it should be based on the situation and our assessment. We will make a decision and announce it on the 23 May, based on the suggestions from all sectors and the technical committee.

Q. In the second wave, 40k children tested positive, and the numbers are expected to rise in the third wave. What kind of steps is the state taking to prepare for the third wave of Covid-19?

We are preparing and putting the infrastructure in place. We are attempting to scale up the existing facility by adding 25% more ICU beds and ventilators, required manpower, oxygen generators, and infrastructure. Within three to four months, the infrastructure should be in place to ensure that future requirements are effectively managed to deal with the third wave.