Coronavirus can pass from mother to foetus, says ICMR, floats guidelines

GS Paper III

Topic: science and technology

Mains: vertical transmission of coronavirus, types of antibodies

What’s the News?

  • It is possible for a pregnant woman who is positive for COVID-19 to pass on the virus to her child, the ICMR has said, laying down norms both for the care of the mother and the child in such instances.
  • The guidelines also call for the use of personal protective equipment for hospital staff, especially at the time of delivery.

Vertical transmission:

  • Vertical transmission is transmission from mother to baby antenatally [before birth] or intrapartum [during labour].
  • Pregnancy is a very special period in life where an infection which potentially could be severe could have significant adverse effects. Therefore, we must make all efforts to look after the mother and child optimally.

The Guidance for Management of Pregnant Women released by ICMR:

  • Emerging evidence now suggests that vertical transmission is probable, although the proportion of pregnancies affected and the significance to the neonate (new born) has yet to be determined.
  • While the science on whether a pregnant woman with COVID-19 can pass on the virus to her child, is still emerging, with only small studies done on a limited number of cases so far, there is evidence in COVID literature both of such transmission having taken place and of instances when an infected mother has given birth to a perfectly healthy child.
  • It is important that during pregnancy and during labour, health workers and the baby who come in contact with the mother’s body fluids take special precautions. Isolation of the baby too is important.

Immunoglobulin M

  • IgM is one of several forms of antibody that are produced by vertebrates. IgM is the largest antibody, and it is the first antibody to appear in the response to initial exposure to an antigen.
  • The elevated IgM antibody level suggests that the neonate was infected in utero. IgM antibodies are not transferred to the foetus via the placenta.
  • The infant potentially could have been exposed for 23 days from the time of the mother’s diagnosis of COVID-19 to delivery.
  • The laboratory results displaying inflammation and liver injury indirectly support the possibility of vertical transmission.

Antibodies are glycoproteins, termed as immunoglobulins (Igs), which are produced in response to an immune reaction and specifically bind to antigens responsible for initiating the reaction.

The antibody recognizes a unique molecule of the pathogen, called an antigen, via the fragment antigen-binding variable region.

Types of antibodies:

IgA

It accounts for 10–15% of all immunoglobulins and is prevalent in serum, nasal mucus, saliva, breast milk, and intestinal fluid. At mucosal surfaces, IgA provides the primary defense against inhaled and ingested pathogens.

IgG

It triggers phagocytosis to initiate opsonization reaction – a process used to destroy foreign particles (e.g. bacteria) through phagocytosis.

IgM

IgM is the largest antibody and the first one to be synthesized in response to an antigen or microbe, accounting for 5% of all immunoglobulins present in the blood.

IgE

IgE is the least prevalent one, with a serum concentration 10,000 times lower than IgG. However, the concentration of IgE increases significantly in allergic conditions, such as bronchopulmonary aspergillosis, and parasitic diseases, such as schistosomiasis.

IgD

IgD functions as a B cell antigen receptor and may participate in B cell maturation, maintenance, activation, and silencing. 

Mother-to-child transmission:

  • Mother-to-child transmission of coronavirus during pregnancy is unlikely, but after birth, a newborn is susceptible to person-to-person spread.
  • A very small number of babies have tested positive for the virus shortly after birth. However, it is unknown if these babies got the virus before or after birth.
  • The virus has not been detected in amniotic fluid, breastmilk, or other maternal samples.

Conclusion:

  • There are scientific guidance documents that prescribe separation of the mother and child in such cases immediately after birth.
  • Transmission after birth via contact with infectious respiratory secretions is a concern.
  • Facilities should consider temporarily separating (e.g. separate rooms) the mother who has confirmed COVID-19 or is a PUI (person under investigation) from her baby until the mother’s transmission-based precautions are discontinued.

How coronavirus attacks, step by step

GS Paper III

Topic: Science and Technology

Prelims: lines of treatment for coronavirus 

What’s the News?

In the search for a treatment for COVID-19 disease, researchers have been targeting specific behaviours of the novel coronavirus (SARS-CoV2) that causes the disease. While the virus itself is still being studied, the hunt for a treatment is based on what is known so far about the way it infects humans.

Coronavirus: Stages of a pandemic

  • First stage
  • Second stage: (locally) Local transmission
  • Third stage: full lockdown
  • Fourth stage: from pandemic to endemic coronavirus: Stages of a pandemic
  • First stage
  • Second stage: Local transmission
  • Third stage: full lockdown
  • Fourth stage: from pandemic to endemic

Coronavirus: Stages of a pandemic

  • First stage: In the first stage of a disease cases of an epidemic are imported into a country in which the infection did not originate and it eventually takes the form of a pandemic sweeping the globe.
  • Second stage: The second stage is when the virus starts being transmitted locally.

Local transmission means that the source of the infection is from within a particular area and the trajectory the virus has taken from one person to the next is clearly established.

  • Third stage: The third stage is that of community transmission which means that the virus is now circulating in the community, and can infect people with no history either of travel to affected areas or of contact with an infected person.
  • If and when community transmission happens, there might arise the need for a full lockdown because in that situation it is theoretically possible for every person, regardless of where they are from and who they have been in contact with, to spread the disease.
  • Fourth stage: from pandemic to endemic It is when the disease, COVID-19 in this case, becomes endemic in some countries.

Infection process:

  • It begins with the “spike” that gives coronaviruses their name. A coronavirus is surrounded by a fatty outer layer (“envelope”) and on the surface of this layer is the “corona” (crown) of spikes made of protein.
  • On the surface of human cells is an enzyme called ACE2, which acts as the receptor that enables SARS-CoV2 to launch its attack.
  • The virus’s spike protein binds to the receptor, then fuses with the cell surface, and releases its genetic material (RNA in the case of SARS-CoV2) into the cell. The coronavirus that causes SARS, called SARS-CoV, uses the same ACE2 receptor to invade a cell.
  • Once inside, the virus replicates itself by using the cell’s molecular mechanism. All these stages involve various interactions between virus proteins and human proteins.
  • Any treatment being developed or researched will look to inhibit these activities at one stage or the other.

Four lines of treatment:

The Solidarity experiments are trying to find out if virus activity can be inhibited:

At reception stage:

  • This is the target of trials with a combination of anti-malarial drugs chloroquine and hydroxychloroquine.
  • It found chloroquine prevented that virus’s ability to attach itself to the ACE2 receptors.
  • However, because chloroquine causes severe side effects, the current trials are being done with a combination with its less toxic derivative hydroxychloroquine.                         

At cell entry stage:

  • The chloroquine-hydroxychloroquine combination comes into play again. Many viruses enter a cell by acidifying compartments within the membrane at the cell surface, and then breaching the membrane itself.
  • When chloroquine and hydroxychloroquine enter the compartment, it loses part of its acidity; the aim of the trials is to hinder the virus at this stage.

At replication stage:

  • A number of trials are looking at obstructing replication at a key step during which the virus uses enzymes to break down proteins, leading to a chain of new viruses.
  • The drug lopinavir, for example, has been known to inhibit the enzyme used by HIV to split proteins, but because lopinavir itself tends to break down in the human body, it is used in combination with ritonavir, which allows it to last longer.

The Solidarity trials with the drug remdesivir, originally created to fight the Ebola virus, will seek to inhibit the novel coronavirus by targeting the action of a key enzyme that facilitates its replication.

Structure:

  • At the Max Planck Institute in Germany, researchers identified the spike protein as not only the sharpest weapon of the virus but also its Achilles’ heel.
  • Antibodies can recognise the spike protein, bind to it, and mark it as a target for immune cells. However, the virus also has a sugar coat that hides parts of its spike proteins from the immune cells.

Behaviour:

  • When the virus attacks, the body responds by activating certain proteins and deactivating others to hinder it.
  • At the same time, the body has other mechanisms that the virus exploits. These were what the researchers mapped, identifying specific proteins.

Conclusion:

  • Beyond the Solidarity trials, reports on other specific drugs are emerging from time to time.
  • In Nature last week, an international collaboration led by researchers at ShanghaiTech University reported six possible drug candidates, which they identified after testing more than 10,000 compounds.

Pharma units in limbo amid confusion over hydroxychloroquine exports

GS Paper III

Topic: Science and technology

Prelims: Hydroxychloroquine

What’s the News?

  • Despite the External Affairs Ministry’s nod, the Directorate General of Foreign Trade maintains that the drug hydroxychloroquine is still prohibited for export.
  • Some small exporters have tonnes of finished goods lying in their FG warehouses and some at ports which is not being exported because of lack of clarity on the procedure.
  • It is strange that despite being there a huge capacity in our industry (supply) and demand of the same in the United states, the medicine is still not exported.

Background:

  • India is the lead producer for HCQ, an anti-malarial drug, while Indian-made paracetamol is used as a fever medication worldwide.
  • With the Covid-19 outbreak creating additional demand for anti-malaria drug hydroxychloroquine, Gujarat Chief Minister Vijay Rupani said three companies from the state will export it to the United States.
  • “Gujarat is shining the world over. US President Trump has been vigorously demanding that drug from India. Now, when the Centre has given permission for its export, Gujarat is all set to send it to the United States,” said Rupani.

Contradictions:

  • Ministry of External Affairs (MEA) announced that it would “license” the malaria drug hydroxychloroquine (HCQ) and supply it to various countries on a “government to government basis”.
  • However the Directorate General of Foreign Trade (DGFT) maintains that the drug is still prohibited for export, causing some confusion in industry circles. Even though it had uploaded its previous two notifications of March 25 (54/2015-2020) and April 4(01/2015-2020) which banned the export of HCQ “without any exceptions”, and kept paracetamol on a restricted list.
  • Pharmaceutical Export Promotion Council of India: There is huge capacity in our industry for both HCQ and paracetamol production. But our manufacturers, especially the MSMEs and SMEs are confused about the process, given the DGFT’s notification banning exports.

Global market:

  • “The Indian pharmaceutical industry has been painstakingly built over 25 years with a market of $22 billion to 206 countries. It would be a tragedy if we are not allowed to use our strength at this time when the world needs these products, by placing orders and even paying in advance and still unable to get these spareable medicines with huge capacity in India,” Mr. Dua said.
  • He added that several industry groups plan to petition the Commerce Ministry and the Ministry of External Affairs to clarify the rules for export.

Aarogya Setu app can subsequently act as e-pass for travel

GS Paper III

Topic: Science and Technology

Mains: Concerns associated with Aarogya Setu App

What’s the News?

  • The Aarogya Setu app launched by the Centre earlier this month, which has clocked over 1.5 crore downloads within two weeks of going live, might soon be made into an e-pass for movement of citizens.
  • Government officials pointed out that a functionality for the app has been suggested wherein it can approve people, who are clear of any threat of contracting or spreading COVID-19 disease, for movement.

Background:

  • Based on the experiences of South Korea and Singapore, India has made its own effort through the app which will be an essential tool in India’s fight against the pandemic.
  • The app being an e-pass which could subsequently facilitate travel from one place to another.
  • PM said there seems to be a consensus amongst the states on extension of Lockdown by another two weeks.
  • He underlined that the motto of the government earlier was ‘jaan hai to jahaan hai’ but now is ‘jaan bhi jahaan bhi’

Aarogya Setu app:

  • Aarogya Setu app enables people to assess themselves the risk for their catching the Corona Virus infection. The app calculates this on the bases of user’s interaction with others, using cutting edge Bluetooth technology, algorithms and artificial intelligence.
  • After instalment in a smart phone, the app detects other devices with AarogyaSetu installed that come in the proximity of that phone. The app can then calculate the risk of infection based on sophisticated parameters if any of these contacts is tested positive.
  • Aarogya Setu app is expected to help the Government in taking necessary timely steps for assessing risk of spread of COVID-19 infection, and ensuring isolation where required.

The App’s Design:

  • The App’s design ensures privacy-first. The personal data collected by the App is encrypted using state-of-the-art technology and stays secure on the phone till it is needed for facilitating medical intervention.
  • Available in 11 languages, the App is ready for pan-India use from day-1 and has highly scalable architecture.
  • In the meeting today, PM Modi also talked about strengthening healthcare infrastructure and reaching out to patients through tele-medicine. He also suggested that direct marketing for farm produce can be incentivised to prevent crowding in mandis, for which model APMC laws should be reformed swiftly. Such steps will help farmers sell products at their doorstep.

App’s efficacy:

  • Cybersecurity experts have said that while there is little clarity on how the Centre will track these interactions, the app’s efficacy also depends on how many COVID-19 positive users had downloaded it.

For the app to work efficiently, three conditions are to be fulfilled-

  • The first one is that a good number of tests have been performed across the country.
  • And these patients ought to have a smartphone with the app, only then can a cluster be formed for bigger inter-mobile communication.

Concerns:

  • Another factor that might hinder the working of the app is that it requires Bluetooth and GPS to be always functional. “There is a technical concern too, called ‘signal interference’.
  • Bluetooth operates on the 2.4 GHz band. When you have too many Bluetooth enabled devices working in close proximity with devices such as WiFi routers, which also work on the same frequency, it might cause interference. This, in turn, will again hamper the efficiency.
  • Privacy concerns, which had led to as many as nine organisations and at least 11 individuals writing to the Centre flagging the usage of and processing of personal data of individuals.
  • Concerns of proportionality– A clause in the app’s privacy policy which allowed the government to share personal information uploaded to the cloud with such other necessary and relevant persons in order to carry out necessary medical and administrative interventions.
  • Lack of Law: India does not have a law dealing with personal data protection which should be limiting data collection and processing.
  • Limited liability clause of the app: It says that the government would not be responsible if inaccurate information was fed. While it exempts the government from being blamed if the information is not correct, it also means that no liability can be fixed on the government even if the personal information of the users so collected and stored is leaked in the future.

Conclusion:

Aarogya Setu is an important step in our battle against COVID-19. It offers useful knowledge through leveraging technology. As more and more people use it, it will increase its efficacy.