CoronaVirus Pandemic – XIII: The variants are coming!
Just when we thought the light at the end of this pandemic tunnel was getting brighter, comes another surge that has created a catastrophic situation in India. It is also here in California, Michigan and New York. The reason: new batches of mutated viruses called variants are arriving with the result that global coronavirus cases are surging, mostly driven by India and South America (Brazil). These mutants/variants are more infectious and often capable of causing severe disease.
As you know, the Covid-19 situation in India is exploding with daily infection rate topping over 400,000 cases/day and death almost 4,000/day! No one anticipated this sudden surge, which has placed an unexpected demand for hospital beds, ventilators, drugs and oxygen. This new corona variant apparently has been identified as B.1.617, a home-grown variant that may have been a combination of ones emerged from South Africa and California. The U.K. variant, B.1.1.7, now the dominant strain causing new infections in the U.K. and the U.S., is also spreading to other countries, including India. The Brazilian variant is (P.1) already in Florida and may be responsible for many of the cases here.
How do these variants occur and why do we worry about them? According to the experts, “The viral mutations evolve from the excessive replication of the virus when it enters a new host. With every new person the virus infects, it has a new opportunity to duplicate its genome and in that process changes occur in the virus itself that make it fitter and stronger. And a new variant evolves every time the virus infects a person that causes more severe, and even deadly disease.
According to Dr. Ravindra Gupta, professor of clinical microbiology at the University of Cambridge, and an expert in the SARS-CoV-2 virus and its variants, “The steep, rapid increase in cases in India is probably the result of relaxed social distancing and a lot of social meetings, including religious gatherings and political rallies – all combined with the presence of new variants.” Another possibility is that “people previously infected with SARS-CoV-2, but did not have a severe case of the infection, might get even sicker if they are re-infected.” It’s of significance that a lot of young people are getting infected in India and many are asymptomatic in the beginning and so can easily infect others. A lot of them go on to become severely ill and die later.
The upshot of all these is that the pandemic is not going to end soon because the variants may keep it going – in spite of all the new advances in the management of this disease, vaccinations, drugs and prevention protocols. And if we are not careful, these variants can create more surges in the U.S. also.
Are the current vaccines effective against the variants? According to Dr. Celine Gounder, a reputed infectious disease specialist from Bellevue, N.Y., “For now, the vaccines are quite effective, but there is a trend toward less effectiveness, especially against the variants.” As per CDC, the effectiveness of the current COVID vaccines is quite high although there is anecdotal evidence that people who have been vaccinated can also get sick with corona. But the disease tends to be milder in them.
In the hopes of taming the virus, India has now opened vaccinations to all adults but the pricing and economic disparities may limit the access. With increased vaccine production, help coming from countries along with strict lockdown and preventive measures, India will survive the crisis.
Fortunately, things are much better in the U.S. “Thanks to our accelerated vaccination program, we are far ahead of where anyone thought we would be in our war against the virus. Everyone 16 and over is eligible now,” says Dr. Anthony Fauci. And vaccinations are our only way to reach some degree of herd immunity and put an end to this pandemic. All the vaccinated people will need booster doses in future and the companies like Moderna have started manufacturing variant-targeting vaccines that incorporate key mutations of the virus so they will be protective against thee mutant strains.
Although CDC has relaxed rules on mask wearing for outdoors for fully vaccinated people, they are still necessary in crowded outdoor venues. We all are eager to put the pandemic behind us and resume normal life but we have to keep a close eye on the variants since we don’t want another surge from them and undo all the progress so far.
To be continued …
M.P. Ravindra Nathan, M.D., is a cardiologist and Emeritus Editor of AAPI Journal. For further reading, “Second Chance - A Sister’s Act of Love” by Dr. Nathan from Outskirts Press, can be found at www.amazon.com
Cataracts? Should you wait?
Let me change your mindset since June is cataract awareness month
If you are over 55 years of age, you most likely have grey hair and cataracts too!
Whaaaaaaat? Yes, you read that right with your cheesy “cheaters” (since to be at 55, you most likely crossed the age of 45 when you started wearing reading glasses).
First, let’s smash this myth and cave-man logic to smithereens – this concept of wait till your cataracts are “ripe” like it was some fruit with “vision nectar.”
Let me define cataract for you. Our natural lens in the eye is clear as a diamond and soft as jelly when we are born. Over time, as we mature (age), this lens becomes gray (like your hair) and harder in consistency to then take on an elaborate name: cataract!
So, it’s not a disease of any kind and in most cases is an age-related change, which impacts vision.
What I like to teach eye surgeons is not to look for maturing of that cataract or waiting for it to ripen. Instead, look for glasses or contact lens prescription with such eyes and then using that cataract, no matter how minimal it is as an excuse, to correct that patient’s vision to see without glasses and be done forever.
Thinking about the cataract as a “lens” with a prescription number (our natural lens has 15 diopters of power) is vital so patients or surgeons won’t look at it like a pathology but as an opportunity.
Also, remember what I have mentioned here, by the time you have cataracts, you most likely are also needing reading glasses and those too can be corrected.
Cataract surgery takes minutes but don’t fall for a cookie-cutter surgical practice where you are hurtled as a number. Instead, ask for a custom-designed surgery with new generation lens implants that can also help to see at most distances without glasses.
Though there are tremendous surgical and technological advances available, insist that your surgeon provides proof of their innovation and results with a long and consistent track record of success. Do also ask the surgeon if he or she can handle a side effect.
Do not fall for a menu card of three choices only. There are more than 30 lens implant options in the USA and over 80 lens options worldwide.
Also, if you have had previous Lasik or Radial Keratotomy surgery in the past, your cataract surgery requires a higher expertise and you must look for a surgeon with experience.
Custom cataract surgery and new Technology Lens Implants (IOLs)
Custom cataract surgery is performed as an outpatient procedure using the “no needles,” “no patch” and “no stitch” technique with computer programmed, high-speed ultrasound along with diamond instruments. The cataract is replaced with an artificial lens implant (IOL). Exciting advances in IOL designs give patients the option to choose between a Monofocal, Toric, Multifocal, Bifocal, Trifocal, Extended Depth of Focus and Accommodating, Presbyopia-Correcting IOLs (like progressive glasses)and even new generation lens implant that can be modified after it has been implanted into the eye (light adjustable lens) which provide a range of vision at near and distance. This allow a person to perform most of their daily activities with reduced or no dependence on glasses.
When designing a customized cataract surgery plan, your eye doctor needs to perform a wide range of state-of-the-art diagnostic tests to determine two major aspects of the plan:
I. Surgical Plan:
The surgical technique based on cataract densitometry analysis.
Incision (entry) site and size based on three-dimensional corneal topography.
- Calculations for lens implant power, sizing and orientation based on IOL Master V, A-Scan Analysis and Scheimpflug Virtual Imaging.
Type of lens implant: Monofocal/Multifocal/Toric/Accommodating/Dual
Type of incisional technology: femtosecond lasers
Advanced lasik laser vision surgery as staged combination
Diamond Astigmatic Keratotomy (AK) incisions.
Additionally, combined knowledge of the technologies as well as the optics of the eye will allow measurement of higher order aberrations along with secondary refractive errors and optical zones with corneal asphericity (factors that affect vision beyond the three common refractive errors, i.e.; nearsighted, farsighted and astigmatism).
So, do not fret about being diagnosed with cataracts. Smile and ask your eye doctor if you can now have the vision always desired to see at all distances and read without glasses – for the rest of your life.
Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at firstname.lastname@example.org or visit www.gulanivision.com