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The Hindu
27-05-2025
- Health
- The Hindu
Health Matters Newsletter: How to stay ready for future pandemics
It's time to address the elephant in the room: for a few weeks now, that elephant has been COVID-19. For some time now, the number of confirmed COVID cases have been rising in certain parts of the world, particularly in South East Asia. Meanwhile, India which had very nearly stopped routine testing for suspected COVID infections also picked up the cue, and began testing for the condition. A slow, and gradual increase was noticed, over the weeks. Bindu Shajan Perappadan recorded that the Active Covid cases in India had climbed to 1009 this week. About 305 people had been treated, and there were seven deaths last week. What followed the news on rise in cases in South east asia was a great deal of panic reporting by sections of the media. Every case has been breathlessly reported, while forgetting that for a country with a 1.2 billion people, the current number of cases is hardly even a blip on the radar. Of course, the price of having gone through one ghastly pandemic is eternal vigilance, and we have learnt that the hard way. There is no doubt that testing has to be scaled up, vaccines and boosters should be made available again to all those who require it, and hospitals need to gear up in order to face a large scale crisis if one were to emerge in the future. Do read Saima Wazed's important piece, in this context: A medical oxygen access gap SE Asia must bridge . South Asia and East Asia and the Pacific have the highest unfulfilled demand for medical oxygen (the oxygen service coverage gap in these two regions is 78% and 74% respectively), and there is a clear and urgent need for action to rectify this. But, and this is key: there is not yet a COVID crisis in the country. Numbers still continue to be in the 100s range and most people seem to recover without major, notable complications. INSACOG has reported that most of the Sar-CoV-2 samples sequenced in India over the last couple of weeks were BA.2 and JN.1 variants, milder variants with home care sufficient for those who test positive. Officials in the Health Ministry also confirmed that there was no indication that the current variants cause more severe disease, but also that it was not more tranmissible than previously. However, as we learnt the last time, it is important to take care of people who are more vulnerable, have a robust surveillance network for picking up influenza like illnesses, and respiratory conditions. For an explainer on What's behind the recent Covid-19 spike in India? , hit the link. Amidst all this, that the WHO members adopted the 'pandemic agreement' born out of disjointed global COVID response came as good news. In short, the World Health Organization's member countries on approved an agreement to better prevent, prepare for and respond to future pandemics in the wake of the devastation wrought by the coronavirus. The treaty guarantees that countries which share virus samples will receive tests, medicines and vaccines. Up to 20 % of such products would be given to the WHO to ensure poorer countries have some access to them when the next pandemic hits. WHO Director-General Tedros Adhanom Ghebreyesus has touted the agreement as 'historic' and a sign of multilateralism at a time when many countries are putting national interests ahead of shared values and cooperation. While the effectiveness of the treaty is being undermined by the United States opting to sit this one out, it augurs well that other nations have come together to offer a broad swathe of protection to even people in nations who may not be able to afford the cost of newer vaccines or diagnostic facilities. Working on the principle, not of charity, but of the entrenched belief in public health that no one is safe until every one is safe, this pandemic agreement could make the difference between life and death for some people, in a crisis. Incidentally, India reaffirms commitment to global health at World Health Assembly . India addressed the plenary session of the 78th World Health Assembly on Wednesday, (May 21, 2025) reaffirming its commitment to global health equity under the theme 'One World for Health', while reaffirming its faith in working together with other nations. Staying on COVID, before we meander into the jungle of health news, FDA panel is split on updates to COVID shots as questions loom for fall vaccinations . Agencies reported that government advisors were split on whether drugmakers need to update their COVID-19 vaccines for next season, a decision overshadowed by confusion over a new Trump administration policy that may limit which Americans can get the shots. Earlier, the FDA said routine vaccine approvals will be limited to seniors and younger people with underlying medical risks, pending new research for healthy adults and children. In other news on the infectious diseases front, we hear from Tamil Nadu that the State government has decided to expand its vaccination coverage, after a study flagged a rise in Japanese encephalitis cases . There has been a noticeable increase in cases (more than five cases) in districts outside of endemic areas such as Chennai, Kanchipuram, Chengalpattu and Tenkasi, the study found, spurring the government to action. Soujanya Padikkal writes in the epaper on the newer antibiotics in the market and the emergent resistant strains too. As we continue to tackle the challenges of antimicrobial resistance, time to factor in newer, emergent issues , she says, while talking about the newer antibiotics molecules in the market and the pipeline. After nearly 30 years, new antibiotics are now available, and that does provide more tools in the armamentarium, but neither are our older microbial resistance issues in the part nor are our newer drugs immune to resistance. A tough task at hand for the government, which is being looked up to, to lead antibiotics stewardship. Last week, I wrote about the Second Lancet Commission on adolescent health . It has recorded some gains; particularly in survival, but indicates need for more investments, laws to ensure the wellbeing of the largest bulwark of adolescents we will every have. There are several areas of concern mentioned, including climate change, the poverty of data, the impact of social media, non communicable diseases creeping up early, all impinging on the physical and mental health of adolescents and youth. Relatedly, Dr. Pushkala M.S. examines why obesity in children is a growing concern in India . Two concerns present themselves - unhealthy diet choices, and lack of physical activity and will have to be addressed in a wholesome manner. Athira Elssa Johnson and Meghna M. write a detailed piece on why the CBSE's sugar board mandate is a starting point for integrating nutrition education into school curricula. The most effective interventions during childhood are eventually those that have been inculcated at the school. Dr. Maria Antony's article on how preferring Screentime over playtime will impact on children's mental health is an article every parent should read. Dr. V. Mohan writes an elaborate article on prevention of diabetes, much before it begins, here . He explains that there are four types of prevention. Primordial prevention refers to a reduction of risk factors for diabetes such as obesity or physical inactivity, thereby decreasing the risk of developing prediabetes or diabetes in the future. Primary is prevention (or postponement) of diabetes in those in a pre-diabetes stage, while secondary prevention refers to the prevention of complications of diabetes in those who have already developed diabetes. There is also tertiary prevention which is used to describe limiting physical disability and preventing progression to end-stage complications in those who have already developed some complications of diabetes. Fitness coach Raj Ganpath chimes in about what it is that prevents India from exercising enough and why this needs to change . He reasons that we come from a past of heavy physical labour and simple eating. While the concept of exercising did exist in a certain quarter, it was not essential to the culture or the society, because of the rather tough labour day most people had to endure. R. Sujatha, meanwhile, had a piece following up on the WHO's advisory on using low sodium salt substitutes: Apparently, these are yet to take off in Chennai . Keith Diaz, in a piece in The Conversation, also brings up the newer paradigm: Sitting is the new smoking! Too much sitting increases risk of future health problems in chest pain patients, as per new research. Adding to the stress and the causative factors for the onset of non communicable diseases is the lack of sleep - another plague of modernity. Here, Dr. N. Ramakrishnan explains Why poor sleep and sleep deprivation are under-recognised public health issues . Onto yet another kind of stress - this time, heat related. In a full-pager, Nandita Shivakumar and Apekshita Varshney ventured inside i nside Tamil Nadu's textile factories where they found women reel under harsh summer heat . There is certainly a major role for private factory managements and the government to ensure that effective cooling relief for their women workers, but it is also the responsibility of the global brands who contract work out to these units to ensure that the workers are in good health, they argue. It turns out not just the women in the factories, about 3/4th of India's population is at 'high' to 'very high' heat risk. A CEEW study identified Delhi, Maharashtra, Goa, Kerala, Gujarat, Rajasthan, Tamil Nadu, as among the top 10 regions at highest heat risk. This is not going away with the monsoon showers. It will keep coming back in greater power, possibly, year on year, so it is best to prepare ourselves against the onslaught of the weather. Have you heard of using oral sunscreens as sunblocks? Well, dermatologists say it is a myth . Dermatologists emphasise that supplements marketed as oral sunscreens are only supportive therapies and should never replace broad-spectrum topical sunscreen. In an interesting development, an ICMR-funded trial led by CMC Vellore found that CAR-T therapy can be safely manufactured at hospital ; and experts have called for Early medical care for pelvic organ prolapse symptoms in order to improve the quality of life of women. Tailpiece Cat stories and jumbo stories pick themselves as internet's favourites. And here, this jumbo story is part of our tailpiece as well. Did you read about how 400 pills a day have to be fed to elephants with TB in Pakistan . This involves administering the tablets — the same as those used to treat TB in humans — hidden inside food ranging from apples and bananas to Pakistani sweets. Explainers Dr. C. Aravinda tries to explain the biology behind sterilisation: Going beyond the blame game: understanding sterilisation and its limits Zubeda Hamid examines, on the lines of the U.S. Health Secretary RFK Jr.'s autism research push, what is actually needed for autism care? Geetha Srimathi in the All you need to know about series, writes about Normal Pressure Hydrocephalus while Meenakshy S. writes vitiligo P.S. Niranjana explains the history behind the iconic Caduceus symbol . Manjeera Gowravaram asks: Does neurodegeneration start when blood vessels are damaged? Also read: Abhinay Lakshman Union government to launch fresh round of a nationwide survey to examine patterns of substance use Dr. Monisha Madhumita Beyond fairness: marking International Skin Pigmentation Day with awareness and acceptance Afshan Yasmeen Dementia — the urgent need for India to invest in elder care Unregulated hair transplant practices in India: experts raise health and medical ethics concerns Science quiz: On digestive health Study validates India's first ICMR-SCD Stigma Scale for sickle cell diseas e India partners with WHO to mainstream Ayush globally through agreement on traditional medicine interventions For many more health stories, head to our health page and subscribe to the health newsletter here.
The Hindu
13-05-2025
- Health
- The Hindu
Health matters newsletter Growth and areas of concern: Reading India's health
On excess deaths in India in 2021, India's rise in the Human Development Index, improved infant and maternal mortality rates, climate changed-linked health issues, and more This past week has offered a glut of data as far as health statistics are concerned: specifically, India- related data has emerged, giving us an occasion to evaluate where we stand, on many health fronts. While we must certainly celebrate the successes, hard won, it is also incumbent upon us to mark out areas of concern, and push these sectors into the public realm to collectively urge action from the State. Firstly, the data of deaths during 2021, was finally unveiled, justifying many media accounts of excess deaths of COVID in India, at that time hotly contested by the Indian government. Now, official statistics say that India reported 21 lakh additional deaths in 2021 compared with 2020. After five years, the report on births and deaths released by the Registrar General of India, mentioned that the two lockdown years reported 5,74,198 COVID-19 deaths. The COVID-19 dashboard maintained by the Union Ministry of Health says that, as on May 5, the total number of deaths induced by the pandemic stood at 5,33,665. The report said that among the leading groups of causes, diseases of the circulatory system, including pulmonary ailments, constituted 29.8% of the total number of medically certified deaths, followed by deaths caused by COVID-19 at 17.3%; deaths caused by diseases of the respiratory system at 12.7%; and deaths caused by certain infectious and parasitic diseases at 6.1%. COVID-19 was the second-leading cause of death in 2021; it was the third-leading cause of death in 2020. Had there not been a war in the Indian subcontinent, this report would have elicited more debate and discussion. A World Health Organization (WHO) report had earlier estimated India's 'excess deaths' for the period at 47 lakh. Another report in a top journal had cited 41 lakh 'excess deaths' in this period. But then, the government's explanation flew in the face of some hardcore facts. A government official told Bindu Shajan Perappadan that 'Excess deaths in 2020 and 2021 were not equal to deaths by COVID-19, and the increase was attributable to several reasons'. His argument ran thus: the number of deaths documented in the CRS has been increasing over time, even in the years preceding the COVID-19 outbreak in 2020, and the preliminary analyses of the CRS data to assess cumulative deaths in 2020 and 2021 had been carried out. 'Based on the three-year (2016-19) annual rate of increase of 6.42%, the expected number of deaths would be 81,31,869 in 2020, and 86,54,185 in 2021. However, the observed deaths were 81,15,882 in 2020, and 1,02,24,506 in 2021. The 'excess deaths', defined as observed deaths deducted from expected deaths were minus [-]15,987 and 15,70,321 in 2020 and 2021, respectively. Thus, the total excess deaths over the two-year period amounted to 15,54,334 — this is 9.3% higher than the expected deaths. This translates into about 1,249 excess deaths per one million population,' the official said. He further argued that the increase in deaths registered in the CRS could be attributed to several reasons, including a larger population cohort, maturing reporting processes, and increased awareness of the need for registration leading to higher levels of registration. This trend has been further accentuated over the years by mandatory requirements for death certificates linked to pension schemes, social security benefits, and property issues. Moreover, the official said, compensation for death by COVID-19 required death certification, prompting registration under the CRS. The other report that was keenly watched, did not have the Indian government bristling in defence. That is because the media reported that India went up three spots to 130 among 193 nations in Human Development Index. India continued its steady rise on the Human Development Index (HDI), ranking 130 out of 193 countries in the 2025 Human Development Report (HDR) of the United Nations Development Programme (UNDP). With its HDI value increasing from 0.676 in 2022 to 0.685 in 2023, India remains in the medium human development category, moving closer to the threshold for high human development (HDI ≥ 0.700). Also, India's life expectancy is the highest since the inception of the index, indicating a strong recovery from the pandemic and its impact on life expectancy. Clearly the country's interventions to improve maternal and infant mortality and better the standards of living for the citizens of the country are showing some ameliorative effects. This was also indicated in the latest Sample Registration System data, also released last week. The Union Health Ministry claims that India outpaces global averages. Three States in India — Kerala, Maharashtra, and Tamil Nadu — have attained the U.N. Sustainable Development Goals (SDGs) targets in Maternal Mortality Rate or MMR; Under-Five Mortality Rate or U5MR; and Neonatal Mortality Rate or NMR. According to the report, eight States have already attained the MMR SDG target, including Kerala (20), Maharashtra (38), Telangana (45), Andhra Pradesh (46), Tamil Nadu (49), Jharkhand (51), Gujarat (53), and Karnataka (63). Twelve States/Union Territories have already attained the U5MR SDG target — Kerala (eight), Delhi (14), Tamil Nadu (14), Jammu & Kashmir (16), Maharashtra (16), West Bengal (20), Karnataka (21), Punjab (22), Telangana (22), Himachal Pradesh (23), Andhra Pradesh (24), and Gujarat (24). Vijaita Singh recorded that as per the SRS, the Total Fertility Rate remains constant at 2.0 in 2021, and here is a further update on India's latest Maternal Mortality Ratio. Afshan Yasmeen looks at the southern region's data and reasons Karnataka's MMR reduces to 63 per lakh live births, but is still highest among southern States. Siddharth Kumar Singh reports on public health expert K. Srinath Reddy's position that 'India's healthy life expectancy lags a decade behind total lifespan'. Serena Josephine M. further outlines the Tamil Nadu success story, and records better under 5 mortality rate: In T.N., comprehensive nutritional, immunisation services pay off with steadily decreasing deaths among under-fives. Moving from statistics-based progress to achievements in labs. A recent Study found migraine drug can reduce depressive symptoms in patients having both. In the study involving 540 patients, 'fremanezumab' was found to reduce days of migraine in a month and symptoms of depression, compared to a placebo (inactive substance producing no effects). The drug, administered as an injection beneath the skin (subcutaneous), is available in India. V. Geetanath reports that NIAB scientists perform CRISPR-based genetic manipulation to identify protein to halt zoonotic infection 'Toxoplasmosis'. Toxoplasmosis is a parasitic zoonotic infection that can be transmitted through contaminated food, especially undercooked meat. The parasitic infection caused by 'Toxoplasma gondii' can lead to abortion and neonatal mortality in both humans and animals, causing substantial economic losses in the livestock industry due to reproductive failure. Which makes this advance significant. In other news, an AI tool uses selfies to predict biological age and cancer survival; and a San Francisco based company says its at-home test kit for cervical cancer was approved by the FDA. Climate change is going nowhere, and we report on the many ramifications, this week too. Summer is in the subcontinent, and we cannot ignore the impact of a changing climate: it manifests in many forms, not the least sweat, urging our attention. Sharmila Vaidyanathan underlines the gut impact in this article Climate change is disrupting the human gut in a new path to illness. Apparently, climate-induced changes in the yield and nutritional quality of various foods could tip the balance of gut microbiota towards strains associated with malnutrition. Dr. Amrish Patel writes on the temperature-asthma link: increasing heat is worsening symptoms in asthma patients, causing new cases among the healthy, while Dr. Ankit Sharma Decodes the link between summer and kidney stones, yes, a link exists. Aravind Unni and Shalini Sinha make the case that It is time to protect India's workers from the heat. Last week we reported of a new subtype of monogenic diabetes discovered by the researchers of Madras Diabetes Research Foundation and Washington University School of Medicine in St. Louis. MODY is a rare, inherited form of diabetes caused by mutations in a single gene, typically appearing in adolescents and young adults. While 13 MODY subtypes have been recognised to date, the newly-identified variant challenges long-standing assumptions about the condition, doctors said. Drawing from climate change and staying on non communicable diseases, we talk about Manish Anand and Vidhu Gupta's article: Sprouting sustainable, nutrition-sensitive food systems here. Food insecurity is no longer just about hunger. It now encompasses all forms of malnutrition, including diet-related non-communicable diseases (NCDs). Millions, including food producers, struggle to afford a healthy diet. They advise that nutrition-sensitive agriculture is central, requiring agricultural policies that integrate nutrition objectives by promoting the cultivation of climate-resilient, biofortified crops, enhancing crop diversity, and improving post-harvest storage systems to bolster food security and dietary quality. Shrabana Chatterjee writes of increasing infertility and the need to stem stigma and misinformation, in context, in this article. The basic problem arises out of looking at it as a 'woman's problem', she says. In the infectious diseases bandwidth, today, we have R. Prasad reporting: Kerala reports seventh Nipah outbreak since 2018. The Hindu's edit on the subject Greater regularity: On the Nipah virus, calls for sharing genetic sequences in public databases without any delay, in order to conduct more research. Athira Elssa Johnson argues that India needs patient-centric care and trained counsellors to manage Inflammatory Bowel Diseases burden: experts, ahead of World IBD Day on May 19. And testing for HIV becomes an issue in parts of T.N. face as a shortage of HIV test kits hits the State. While India has a robust private health care system, it is clear that the biggest deliverer of health services in the country is the public health system and do read this important piece by Dr. C. Aravinda delineating its fault lines: Scattered public health services, fragmented governance. Dr. K. Ganapathy further talks about Medical accountability in the digital health era: the pros and the pitfalls. Not the least, remembering the war-like situation the country was forced into last week, Dr. Kinshuk Gupta, Prof Suneela Garg and Prof Mongjam Meghachandra Singh write a timely article on Health preparedness in situations of war. An article our health managers will do well to stick by. In the tailpiece segment of the week, the parley conversation between Dr. Meghna Singhal and Sannuthi Suresh should be highlighted for the depth of opinions it brought on. You can read, and listen to this conversation moderated by me, on the link: Is social media defining self-worth? What is clear is that snooping on your adolescent's social media use is not going to get you anywhere, as adults, the best thing parents can do is to ensure that the channels of communication remain open with their children. Our explainers section did overtime this week, but that leaves us with a wealth of information that you will have access to online. In the All you need to know series, we have Zubeda Hamid on cystic fibrosis; Geetha Srimathi on Lafora Disease, and others write on Lupus; and the Barker hypothesis about the impact of the intrauterine atmosphere on humans. Saurabh Khiste explains if intermittent fasting helps or harms kidney health? We also handle a range of subjects, beginning with Is climate change increasing the levels of toxic arsenic in our rice? to Why did T.N. ban mayonnaise made from raw eggs? and as basic as Why does our temperature go up when we are ill? There are explainers on How did India's national health programmes contributed to increased longevity? And a video you can watch on the subject: Can drugs like Ozempic solve the obesity problem in India? If you have a few extra moments, do read: Vidhya P. on Celebrating the compassion, commitment and courage of nurses on Nurses Day Elizabeth Hintz and Marlene D. Berke in The Conversation When doctors don't believe their patients' pain – experts explain the all-too-common experience of medical gaslighting Access to funds and affordable treatments remain key challenges in Duchenne Muscular Dystrophy care in India A silent burden: Thalassaemia patients in Karnataka battle disease with hope and hardship Science Quiz: On skin cancer For many more health stories, head to our health page and subscribe to the health newsletter here.
