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Variants, variants, but what does it mean?

Variants, variants, but what does it mean?

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When COVID19 hit Sri Lankan shores in March 2020, very few of us thought that this would be something that’d last months, let alone years. Even fewer anticipated that it could mutate and create variants that made a bad situation worse. However, the nature of pandemics is such that they last years (not months), and viruses use widespread infections to become a more potent version of themselves. 

This is why, fast forward 14 months, the world now has around eight variants of the Sars-CoV-2 pathogen. What does that even mean, though?

Short read: The more the virus is allowed to spread, the more mutations it will create to evade the immune response. The variants we have seen arising out of the UK, South Africa, and Brazil are more infectious and deadly. If these variants successfully bypass the vaccine response, we will be back to square one. As such, limiting the spread of infection remains an integral part of the pandemic response.

Want to know the why behind the what?


Let’s go back to the basics. COVID19 is a disease caused by the Sars-CoV-2 pathogen. The virus is a shell containing a strand of RNA. The strand of RNA has around 30,000 letters of genetic information. This RNA gets into our cells, replicates, creates more viral cells and causes havoc in our bodies.


But sometimes, during this replication process, the infected cell makes errors when copying the letters. These errors are referred to as mutations. Genetic sequencing of PCR tests helps scientists keep track of these mutations. The mutations are bucketed into groups called lineages, and if enough viruses have the same mutation, they are called a variant. If the mutations in these variants grow varied enough and change their function, you get a strain


So let’s put this into context. 


Sars-CoV-1 caused the 2001 SARS epidemic, a different strain from Sars-CoV-2, the cause of our pandemic. Unfortunately, Sars-CoV-2 has undergone sufficient mutations in various parts of the world to now have several variants running amok. 

When does this become a problem?

Mutations are normal. Even when our DNA is replicated by our cells, mutations occur. However, the effects of the mutation are what matters the most. The CDC/WHO classify variants into i) variants of interest, ii) variants of concern and iii) variants of high consequence. 

Although ca. 8 mutations have been discovered in Sars-CoV-2, 3 of these variants are currently classified as variants of concern. Variants of concern cause more severe disease, are more contagious and can evade the vaccine response. The remaining five are categorised as variants of interest: they can surge infections and be more infectious. However, they are not entirely understood as yet. 

What’s going on in India?

Within the span of a few weeks, India has become the global epicentre of the pandemic, with ca. 400,000 new cases reported per day. The speed of transmission and the high death toll has shocked a world that thought the worst of the pandemic might be behind it. 

Scientists have discovered a double mutation in the virus roaring through India – the B 1.617 is present in ca. 80% of sequenced PCRs. 

Studies are currently underway to determine whether these mutations allow the virus to evade the vaccine immune response and immunity generated from prior infection.

Image source: Hindustan Times

Will the vaccines work against the variants?

This is a crucial question scientists are constantly examining with each variant and mutation. Unfortunately, the answers so far have been varied depending on the vaccine and the variant. 

Pfizer remains overwhelmingly strong in the face of new variants. AstraZeneca remains viable against the UK variant but less so against the South African one. The Brazilian variant appears to be bypassing the immune response of people who had already had COVID19. 

 

So what does all this mean for us in Sri Lanka?

Viruses mutate when allowed to replicate. They are given more chances to replicate when they are allowed to spread rapidly through a population. Most of these mutations don’t cause further harm. Still, when vaccinations and increased immunity makes it harder for the virus to survive, the mutations can become more potent. It’s evolution, after all!

Image Source: BBC

Whilst the body’s immune system remains a formidable opponent to the virus – regardless of the mutations – reducing opportunities for the virus to mutate is a critical pandemic response. 

For us, it means adhering to public health guidelines:

  • Wearing masks when outside our homes
  • Washing hands
  • Disinfecting high touch surfaces and reducing movement

By doing these things, we remove the breeding ground for the virus, maintain vaccine effectiveness till everyone can get vaccinated and hopefully, reduce COVID19 to a simple seasonal cold or flu. 

Stay safe. Stay home. 

If you need medical advice, avoid the hospital or clinic and speak to one of our 1,000 experienced doctors via video call.

Download oDoc today.  

Sources
  1. Davies N.G. et al (2021), Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7, Nature
  2. Volz, E et al (2021) Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: Insights from linking epidemiological and genetic data., Preprint MedXRiv
  3. Dasgupta, B (2021) ‘Double mutant’ most common variant now: India’s genome data., Hindustan Times
  4. Coronavirus Variant Tracker, New York Times
  5. Xieping, X et al., (2021) Neutralization of SARS-CoV-2 spike 69/70 deletion, E484K, and N501Y variants by BNT162b2 vaccine-elicited sera, BioXRiv Preprint
  6. Emary, K et al., (2021), Efficacy of ChAdOx1 nCoV-19 (AZD1222) Vaccine Against SARS-CoV-2 VOC 202012/01 (B.1.1.7). The Lancet, Preprint
  7. Sabino E et al., (2021), Resurgence of COVID-19 in Manaus, Brazil, despite high seroprevalence, The Lancet, 397: 452-455.
  8. Roberts, M (2021) What are the Indian, Brazil, South Africa and UK Variants? BBC News
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COVID-19 is airborne

COVID-19 is airborne.

How can you protect yourself and your loved ones?

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We’ve already heard it so many times. Wear a mask. Sanitize or wash hands. Socially distance. Avoid crowds. So much so that sometimes we tune out health rules and regulations. But with the recent spike in COVID-19 patients, with more patients hospitalized and more young people at that, we need to realign and come back to what we’ve always known. COVID-19 is not going anywhere and a 3rd wave has already bulleted its way onto our shores, full throttle.

As always, oDoc is here to provide you with the latest information on COVID-19 and the best protocols for keeping you and your loved ones safe.

COVID-19 aerosols droplets

COVID-19 is airborne. What does that mean?

COVID-19 is spread through the air by respiratory droplets and aerosols. Aerosols play a significant role in increasing the infectiousness of the virus. They are tiny droplets that can remain suspended in the air for hours with poor ventilation. Bigger respiratory droplets fall to the ground in seconds and reduce the chance of getting inhaled by a non-infected person.

Let’s say you go to your gym. Maybe you’re going at non-peak hours, where there are not many people around. You may think that you could unmask and use whatever equipment you please. But if a COVID-19 infected person used the gym a few hours ago, their infected aerosols will still remain suspended in the air, especially if the space is poorly ventilated, i.e. with no open windows or fans to circulate air.

You can easily breathe in those aerosols and become infected yourself. So even if there is no one else around you in an indoor space at a specific moment in time, you can still get COVID-19 by infected people who were in that space just a few hours ago.

Things to keep strictly in mind, especially when visiting enclosed, indoor spaces:

Double mask! Make sure the fit is secure with no space for respiratory leakage. If you’re wearing a KN95 or N95, you don’t need to double mask.
mask enclosed
Wear your mask/masks whenever you’re out of your home and not only when you’re near another person as infected aerosols can still remain in the air
social distancing
If possible, meet others outdoors where any infectious particles will be rapidly diffused. Wash your hands with soap or use hand sanitizer frequently. Maintain 6 feet physical distancing

Avoid entering indoor spaces that include others who are not from your household. If you absolutely need to visit an indoors place, make sure the space is properly ventilated with multiple open windows for cross ventilation and minimize the time spent in this space. The longer time you spend indoors, the higher chance of infection!

no enclosed indoor spaces
ventilation

If you or a loved one is experiencing any COVID-19 symptoms, use our COVID-19 assessment tool on the oDoc app to understand your symptoms better. Alternatively, you can consult a GP on oDoc to understand next steps if you believe you might have COVID-19.

You can download the oDoc app here.

References:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00869-2/fulltext
https://www.bmj.com/content/373/bmj.n913
https://www.bmj.com/content/370/bmj.m3206
https://www.indiatoday.in/world/story/sri-lanka-new-covid-corona-variant-highly-transmissible-airborne-1794632-2021-04-24

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Is My Baby Drinking Enough Milk?

Is my baby drinking enough milk?

Milk supply myths debunked!

Nicole Parakrama | BSc Hons Molecular Cell Biology, UCL (UK) | 17th April 2021 | <5 minute read

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“Aney why is he crying so much?”…

…“Hungry-da?”…..

Mothers of infants might find this line of questioning familiar!

In our culture, we tend to cajole and bribe our children into eating more, with the goal of making them as chubby as possible. However, when we don’t allow our children to regulate their hunger for themselves, this can lead to unhealthy eating patterns (see this study here) with repercussions all the way into adulthood (some other great longitudinal studies here and here). We do our children a great disservice when we don’t take into account their varying body structures, feeding patterns, and metabolisms when considering when and how often we feed them.

“Aney why is he crying so much?”…

…“Hungry-da?”…..

Mothers of infants might find this line of questioning familiar!

In our culture, we tend to cajole and bribe our children into eating more, with the goal of making them as chubby as possible. 

 This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had

However, when we don’t allow our children to regulate their hunger for themselves, this can lead to unhealthy eating patterns (see this study here) with repercussions all the way into adulthood (some other great longitudinal studies here and here). We do our children a great disservice when we don’t take into account their varying body structures, feeding patterns, and metabolisms when considering when and how often we feed them. This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had the most

the most significant impact on Perceived Inadequacy of Milk (PIM)”.  In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?”  This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case.

This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had the most significant impact on Perceived Inadequacy of Milk (PIM)”.  In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?”  This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case.

significant impact on Perceived Inadequacy of Milk (PIM)”. In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?” 

This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case. 

A longitudinal study by Nielsen et al studied the milk intake of 50 healthy, exclusively breastfed babies over 6 months, and found the milk intake and fulfilment of energy values to be in excess of literature values.

Unfortunately, it is this fear of having a low supply which can become a roadblock in our breastfeeding journeys, far more often than it being an actual medical issue.

At a very high level, the rule of thumb is – if your baby comes off the breast looking relaxed, and if the number of heavy, wet diapers in 24 hours is more than or equal to the number of days old (for newborns up to one week), and 5-6 thereafter, your baby is very likely getting adequate milk (check out this comprehensive presentation by the Sri Lanka College of Pediatricians, particularly slides 41-46).

There are 9 common occurrences that may worry mothers, but which are not necessarily an indication of inadequate milk supply:

1. My baby wants to nurse very frequently

Breast milk is actually digested very efficiently (usually within 1.5-2 hours) and frequent feeding is common as a result.  Some babies are also more ‘sucky’ than others or require more skin contact.

2. My baby suddenly nurses more frequently, or for longer durations

This may be a growth spurt, which usually lasts a few days to a week. Since milk production is supply & demand-based, allowing your baby to feed extra will result in your breasts producing more milk to catch up.

3. My baby suddenly nurses less frequently, or for shorter durations

With age, as your baby gets more efficient at extracting milk, and the size of their little tummy increases, this will happen and is not an indicator of low supply.

4. My baby guzzles down a bottle of milk after nursing

Many babies will take a bottle of milk even after a full breastfeed, due to their suckling reflex, and then fall asleep due to exhaustion rather than satiation.

5. My breasts don’t leak milk, or only leak a little, or have stopped leaking

Leaky breasts have nothing to do with your milk supply adequacy. Leaking often stops once your milk supply has adjusted to your baby’s needs, and/or as the feeds become more predictable.

6. My breasts seem softer, or don’t get engorged anymore

Again this often happens once your milk supply has adjusted to your baby’s needs, and/or as the feeds become more predictable.

7. I don’t feel a let down sensation

Some women may never experience a let down sensation (tingling, pins & needles or a feeling of warmth), or find that it reduces over time. This is not connected to a reduction in supply.

8. I get very little milk when i pump

There are many reasons why this could be… pumping technique, pump type, flange size etc. At the best of times, your baby’s suck will always be more efficient at draining your breasts than the pump can mimic.  Pump output should not be used as a reliable indicator of production.

Hopefully you will find some reassurance if you are in this boat of questioning your supply.  However, if you have already found it in yours or your baby’s best interest to give formula, there is no guilt or shame in that. Breastmilk, while optimal, is not the only way to feed your baby. There are many circumstances where combination feeding (formula + breast milk) or only formula is necessary, and your child will be none the worse for it.  A well-fed baby combined with a happy mother really is the best end result.

How I became ‘The Milk Coach’

When my first child was born, I was quite unprepared for what lay ahead.  Particularly when it came to breastfeeding – I was naïvely expectant that I could just place him onto my chest, and let nature take its course.  What a surprise I was in for!  Cracked nipples from sub-optimal positioning, and my milk taking its own time to come in, led to terrible pain.  This pain became excruciating when my son developed oral thrush which travelled through to my milk ducts.  Fortunately, thanks to a lot of research and some wise mum friends, I was able to power through those awful first few months.  Most crucially, I was able to advocate for myself with health professionals (and I’m thankful for the ones who listened to me when I did!).

This birthed a passion to peer-to-peer counsel, share with and advocate for my fellow Sri Lankan mums, to support them to achieve their breastfeeding goals. To this end I am working to add to a science background (in Molecular Cell Biology) with an accreditation by La Leche League International (LLLI). 

Join the conversation, follow @themilkcoach on Instagram or Facebook.

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How to relieve menstrual cramps

How to relieve menstrual cramps

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Ladies, is it that time of the month? Are we feeling subtle cramps in our stomach, lower back pain, maybe some strange mood swings? Maybe we have to make a trip to the supermarket and buy our monthly stock of pads and tampons. We get it! Your period is here, which means those uncomfortable, painful cramps are here too. We’re here to help ease the burden by giving you some ways you can relieve the pain and discomfort.

What are menstrual cramps?

Period cramps, or dysmenorrhea, refers to the discomfort women feel in their abdomen, lower back and thighs during their menses. Cramping can vary in intensity from woman to woman. Some may feel a slight discomfort and others may feel more severe pains that can affect certain aspects of their life.

What are menstrual cramps?

Period cramps, or dysmenorrhea, refers to the discomfort women feel in their abdomen, lower back and thighs during their menses. Cramping can vary in intensity from woman to woman. Some may feel a slight discomfort and others may feel more severe pains that can affect certain aspects of their life.

Why do period cramps happen in the first place?

During your period, the uterus contracts to help shed its lining. Hormone-like substances (prostaglandins) trigger the contractions which causes pain and inflammation. Higher levels of prostaglandins can lead to more severe menstrual cramps.

Symptoms of menstrual cramps may include:

  • Cramping in the lower abdomen
  • Lower back pain
  • Pain radiating down the legs
  • Nausea
  • Vomiting
  • Diarrhea
  • Fatigue
  • Weakness
  • Fainting
  • Headaches

Symptoms of menstrual cramps may include:

  • Cramping in the lower abdomen
  • Lower back pain
  • Pain radiating down the legs
  • Nausea
  • Vomiting
  • Diarrhea
  • Fatigue
  • Weakness
  • Fainting
  • Headaches

What can you do to relieve the pain from cramps during your menses?

For mild and temporary cramps, some home remedies can provide comfort and relief.
Here are a few things for you to try:

Applying heat to your lower abdomen and lower back can relieve pain. If you don’t have a heating pad or hot water bottle, take a warm bath or use a hot towel.

Applying heat to your lower abdomen and lower back can relieve pain. If you don’t have a heating pad or hot water bottle, take a warm bath or use a hot towel.

Applying heat to your lower abdomen and lower back can relieve pain. If you don’t have a heating pad or hot water bottle, take a warm bath or use a hot towel.

Avoid foods that cause bloating such as fatty foods, alcohol, carbonated drinks, caffeine or salty foods. Instead have some tea with ginger or mint, hot water with lemon or strawberries

Avoid foods that cause bloating such as fatty foods, alcohol, carbonated drinks, caffeine or salty foods. Instead have some tea with ginger or mint, hot water with lemon or strawberries

Avoid foods that cause bloating such as fatty foods, alcohol, carbonated drinks, caffeine or salty foods. Instead have some tea with ginger or mint, hot water with lemon or strawberries

Maintain a consistent diet of minimally processed foods, fiber and plants. Try having more papaya, brown rice, walnuts, almonds, broccoli, fish, leafy green vegetables and flax seeds.

Maintain a consistent diet of minimally processed foods, fiber and plants. Try having more papaya, brown rice, walnuts, almonds, broccoli, fish, leafy green vegetables and flax seeds.

Maintain a consistent diet of minimally processed foods, fiber and plants. Try having more papaya, brown rice, walnuts, almonds, broccoli, fish, leafy green vegetables and flax seeds.

Drink more warm or hot water and eat water-based foods to increase your hydration such as cucumber, watermelon, lettuce and celery.

Drink more warm or hot water and eat water-based foods to increase your hydration such as cucumber, watermelon, lettuce and celery.

Drink more warm or hot water and eat water-based foods to increase your hydration such as cucumber, watermelon, lettuce and celery.

Exercise! Although the last thing we want to do during our menses is work out, exercise releases endorphins which relieves some menstrual cramp pain.

Exercise! Although the last thing we want to do during our menses is work out, exercise releases endorphins which relieves some menstrual cramp pain.

Exercise! Although the last thing we want to do during our menses is work out, exercise releases endorphins which relieves some menstrual cramp pain.

When to see a doctor:

  • If period cramps disrupt your life in some way every month
  • Your symptoms get progressively worse and you are in intense pain every month
  • If you started having severe menstrual cramps after the age of 25

You can speak to a VOG doctor by consulting an Obstetrician or Gynecologist on the oDoc app. GPs and Family Physicians are also available to consult.

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Confused over AstraZeneca news? We break it down in one minute!

Confused over AstraZeneca news? We break it down in one minute!

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AstraZeneca, long regarded as the problem child of the COVID vaccines, is plagued again by negative news. So what’s happened? What does it mean for you?

Short read:

The overall risk of blood clots is ca. 4 for every 1,000,000 people. The benefits of AstraZeneca vaccine outweighs the risks posed by COVID19 and the vaccine itself for over 40s. Anyone who didn’t suffer from clots should receive their second vaccine when offered.

However, as the risks posed by COVID19 to under 30s are lower, alternate vaccines are more prudent for use in this population. This is not out of safety concerns but utmost caution.

Want more details? We break it down into bite sized pieces below:

What’s happened?

In early March 2021, a slew of European countries paused administering the AstraZeneca vaccines after some reports of blood clots began to appear.

As per protocol, all severe adverse effects have to be investigated by the relevant medical authorities. When investigating, authorities look for signs of causation – did A cause B? Or did A and B happen to occur at the same time?

Most often, they do this by analysing the rates of occurrence of the event in the general population (or in the specific demographic) and then compare that to the rate of occurrence in the corresponding vaccinated population.

Here’s a simplified fictional example of what that means:

In the general population, say 1% of people over 50 suffer from heart attacks in a one month time period. In the vaccinated population, if this rate is the same or lower, then the event is deemed to not be caused by the vaccine. But if this rate is higher in the vaccinated population, then further investigations or ending of the vaccine trials or drives are required.

What did the investigations show?

On March 19th, EU & British regulators stated that the benefits of the AstraZeneca vaccine in preventing COVID19 outweighs any risks posed by it. They investigated ca. 30 cases of clots out of the 20,000,000 people who had received the vaccine in the EU & UK.

Following this, Germany, Italy and a number of other countries recommenced their vaccine drives with prudent processes in place.

So what’s the latest news about?

On April 7th, The UK’s major medical body, the MHRA held a press conference in collaboration with the EU’s major medical body, the EMA to discuss their findings.

There was confirmation that blood clots have been identified as a “potential side effect” in “an extremely small number of people” (emphasis added).

For example, in the 40-49 age group, 0.5 harms can be caused for every 100,000 people. This compares to 51.5 ICU entries with COVID19 in the same age group for every 100,000 people.

Most importantly, the benefits of AstraZeneca vaccine was found to far outweigh the risks for the majority of people.

What are the key things to remember about this event?

  1. The vaccine is still safe to administer to the vast majority of people over the age of 30. If you’ve had the first dose and haven’t had the below symptoms, you should take the second dose.
  2. If you have a known blood disorder, speak to your doctor before going for vaccination. 
  3. Anyone who has the below symptoms four days after vaccination should seek prompt medical advice.
  4. Symptoms to look out for include: 
    • new onset of a severe or persistent headache
    • Blurred vision
    • Shortness of breath
    • Chest pain
    • Leg swelling
    • Persistent abdominal pain
    • Unusual skin bruising or pinpoint spots beyond injection site

No medicine or vaccine is without risk. But knowing the destruction caused by COVID19 (even to those that present with no symptoms), it is always a matter of weighing the benefits against the risks. Agencies continue to monitor safety and will continue to act expeditiously when necessary. 

Concerned about clots or any of the above symptoms? Speak to an on demand GP on oDoc within 3 minutes.

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Source

  1. “MHRA issues new advice concluding a possible link between COVID19 vaccine Astrazeneca and extremely rare unlikely to occur blood clots”, MRHA website, April 2021
  2. Under 30s won’t be given Astrazeneca vaccine over “extremely rare” risk of blood clots, ITV, April 2021

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