Can Pakistan's TB Vaccination Program Help Reduce Impact of Coronavirus?

Can Pakistan's 88% BCG vaccination rate against tuberculosis (TB) help reduce the impact of coronavirus? A New York Institute of Technology study using data from 178 countries has concluded that both the incidence and mortality of COVID-19  are significantly lower in countries with BCG vaccination programs against TB. Will this study help prove Dawn News' alarming forecast of over 2 million confirmed cases by June 1 and 20 million actual infections wrong?

Pakistan's Dawn News Coronavirus Forecast

The study has found that the coronavirus has hit US and Italy which do not have universal BCG vaccination programs much harder than countries like Japan which do.  Scientists say it will take several months to get results from ongoing trials testing the BCG vaccine against COVID-19.
TB Vaccine May Lower Death Rates From COVID-19. Source: NYIT College of Osteopathic Medicine  

Scientists have speculated that BCG vaccine may boost the innate immune system not just against TB but also against a variety of other pathogens from invading the body or from establishing an infection. Here are some of the key findings of the study summarized below:

1. Countries that do not have a BCG vaccination policy against TB have seen 10X greater incidence and deaths from Covid-19 than the countries that do, according to a study of  data from 178 countries by New York Institute of Technology researchers.

2. BCG, or Bacillus Calmette-Guérin, is a vaccine for tuberculosis (TB). It is administered at birth in many developing countries that have historically suffered from the disease, such as India and Pakistan. Most of the developed nations, including US, Italy and the Netherlands do not have universal TB vaccination programs. Japan is among the few developed OECD nations that still do. The East Asian nation had some of the earlier cases, but the mortality is low despite not having adopted some the more stringent social distancing rules.

3. The study looked at Covid-19 instances and mortality for 15 days between March 9 and 24 in 178 countries and concluded that incidence of Covid-19 was 38.4 per million in countries with BCG vaccination compared to 358.4 per million in the absence of such a program.

4. The death rate was 4.28 per million in countries with BCG programs compared to 40 per million in countries without such a program. Out of the 178 countries studied, 21 had no vaccination program, while the status was unclear in 26 countries. The latter group was treated as not having a policy for the purpose of this study.

Scientists do not have data yet on the effect of BCG vaccination on coronaviruses in general or SARS-CoV-2 in particular, according to Reuters. There are also many BCG vaccines, with different capacities to protect against various TB strains. Scientists need to determine which BCG vaccines might have the best ability to boost the innate immune system to fight COVID-19.  Scientists say it will take several months to get results from ongoing trials testing the BCG vaccine against COVID-19.

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Riaz Haq said…
Population over 65 years more vulnerable to #coronavirus. #Pakistan 4%, #India 6%, #China 11%, #US 16%, #Italy 23%, #Japan 28%
Riaz Haq said…
Pakistan with a score of 35.5 ranks 105/195 countries on global health security index.

It is rated as more prepared on a scale from most to least prepared.
Riaz Haq said…
#Pakistan reports death of 3rd doctor from #coronavirus. Dr. Abdul Qadir Soomro, 70, a veteran physician in #Karachi, managed a #charity #hospital for Jamaat-e-Islami's Al-khidmat Foundation -- among largest relief agencies in Pak. May his soul RIP. Amen.

Pakistan on Monday reported the demise of another doctor from coronavirus, raising safety concerns among health professionals who have been complaining about lack of proper safety gears.

Dr. Abdul Qadir Soomro, a veteran physician, breathed his last at a local hospital in southern port city of Karachi, becoming the third doctor in the country who succumbed to the virus.

Soomro, 70 was the administrator of a charity hospital, run by Al-khidmat Foundation -- the country's one of the largest relief agencies -- in the eastern outskirts of Karachi, where he had established an isolation ward for suspected coronavirus patients, the Health Ministry said in a statement.

His death brought the number of casualties from COVID-19 to 52 in the country.

The number of infection cases in the country has risen to 3,277, as 397 news cases were reported over the past 24 hours.

A total of 257 patients, of them 130 on Monday, have recovered, while 17 are in critical condition.

So far, the northeastern Punjab province reported 1,493 cases, Sindh 881, Khyber Pakhtunkhwa 405, southwestern Balochistan 191, northern region of Gilgit Baltistan 210, the capital Islamabad 82 and Azad Jammu and Kashmir confirmed 15 cases of the coronavirus.

Meanwhile, the virus also spread into the country's jails, with 49 cases confirmed in jails of Punjab province alone.

"We have 1,493 confirmed cases in Punjab, among them 49 are prisoners who are currently under quarantine," Usman Buzdar, chief minister of Punjab, said on Twitter.

Since appearing in Wuhan, China last December, the novel coronavirus has spread to at least 183 countries and regions, according to figures compiled by U.S.-based Johns Hopkins University.

The data shows more than 1.29 million cases have been reported worldwide, with the global death toll nearing 70,800, and more than 270,300 recoveries.
Riaz Haq said…
Pakistan: WHO and UNICEF estimates of immunization coverage: 2018 revision
Riaz Haq said…
Fragile health facilities may face corona catastrophe

In a little more than a month since patient zero, Pakistan has registered over 4,200 coronavirus cases – the government estimates that the case will exceed to 50,000 by the April end.

The crippling national healthcare system is expected to collapse if the outbreak continues to spread by leaps and bounds, as it is not capable enough to address the global pandemic, Bloomberg reported on Wednesday.

The World Health Organisation statistics show that Pakistan spends just 2.9% of the gross domestic product on health, a number significantly below neighbouring India and less than half the global average.
The country is one of only three with ongoing polio transmission, and it has reportedly struggled in recent years to contain AidsIDS and dengue outbreaks.

Health care in Pakistan “continues to suffer from coordination challenges and an acute shortage of resources,” says Arsalan Ali Faheem, a consultant at DAI, a Bethesda, Md.-based company that advises on development and health projects. “The country has been hard-pressed to find resources for health delivery.”

He said that health care in Pakistan “continues to suffer from coordination challenges and an acute shortage of resources”.

Most of the health services including ambulances, hospitals are mostly funded by charitable organisations whereas paramedics staff lack training to operate critical-care equipment, said Asad Sayeed, an economist at the Collective for Social Science Research in Karachi.

Commenting on Pakistan’s economic conditions, he added that finance is an issue, whereas it is also about priorities since budget for health is meager when it is compared to the country’s defense budget.

Sayeed also said that after the 18th Amendment of the Constitution, the federal government has a very limited role to play in the health care sector. Collectively, federal and provincial health spending in the last fiscal year was the lowest since 2016.

There has been a lot of debate over the mishandling of pilgrims that had entered from Iran to Pakistan via Taftan border in Balochistan and the airports, many believe that the country failed to screen most of the pilgrims that become of of the source for the pandemic to spread in the country.

Thousands of travellers without symptoms were waved through the border. Those who felt ill were sequestered in a makeshift tent city on the Pakistani side that, according to patients, had no soap or hand sanitizer. “If one is affected, everyone would get it,” says Mohammad Hussain, 42, who spent more than two weeks there. “The camp was a breeding ground for the virus,” he added.

The government is trying to curtail the numbers by banning public gatherings and restricting the movement of the citizens. After quite an effort, it reached a deal with religious scholars to close down mosques and shrink crowds at Friday prayer.

Officials are going door to door looking for possible cases, with assistance from military personnel, a daunting task in one of the world’s most populous countries. In Karachi, local authorities have converted a convention hall into a 1,200-bed field hospital in anticipation of a surge in patients.

On the other hand, the federal government had submitted a report in the Supreme Court stating that they estimate 50,000 patients of coronavirus in the country by 25 April 2020.
The number of tests for COVID-19 performed in Pakistan is less than 50,000 as of now.

The country has done a very limited number of tests, fewer than 50,000 whereas US has done about 2 million tests.
Riaz Haq said…
National Heath Chief Zafar Mirza: Fewer Covid-19 deaths in #Pakistan doesn't mean we stop being careful. 73% #COVID19 deaths among patients with pre-existing health issues, 85% of those who died from #coronavirus above age 50 while 78% of them were males.

Special Assistant to the Prime Minister on Health Dr Zafar Mirza on Thursday said low Covid-19 deaths in Pakistan does not mean people start becoming lax about preventive measures against the virus outbreak.

Speaking at a news briefing in Islamabad, Mirza said: "I am seeing reports on some media programmes that Pakistan's Covid-19 death rates are lower as compared to projections made through modelling. While it is true to some extent that Pakistan has lesser coronavirus cases and a lower death rate than projected by experts, it is not a reason for citizens to become lax."

He said the restrictions imposed by the government on large gatherings and social contact had an effect on the infection rate, "but if people think we don't need those preventive measures and we don't need social distancing, it would be a very big mistake".

Stressing the need for more prevention and responsibility, Mirza warned that the country could see a sharp rise in the number of cases and deaths if people were not careful and started going out.

Talking about Covid-19 deaths he said that 73 per cent of Covid-19 deaths in the country were of people who had pre-existing health conditions, adding that 85pc of those who died from Covid-19 were above the age of 50 while 78pc of them were males.

Mirza added that the government was creating a mechanism whereby personal protection equipment (PPE) would be provided to health professionals in hospitals in such a way that shortage was not observed.

He said the National Disaster and Management Authority (NDMA) after its calculations had provided PPEs, including N-95 masks, gowns and gloves to 152 hospitals for a week. These are the hospitals where most coronavirus patients would be brought, he added.

"We have a list of some 400 hospitals and all of them will be provided PPEs, and on a priority basis."

The PM's aide on health said the government would facilitate firms wishing to manufacture ventilators locally through a committee formed under the Drug Regulatory Authority of Pakistan (Drap).

Through the committee, the firms' applications would be processed as soon as possible so that production could be started in order to overcome shortage, he revealed.

'Burden on hospitals will increase by month's end'
Meanwhile, Prime Minister Imran Khan during an earlier media briefing said that he believed the burden on the country's healthcare system would increase by the end of this month, but Balochistan might not face a worsening situation due to sparse population.

He added that the government was analysing data of coronavirus cases not just in the country but also in the United Kingdom and United States as well.

He said that the government was also looking at the numbers in India and Bangladesh as their population trends were similar to Pakistan's.
Riaz Haq said…
After nearly 55,000 tests, #Coronavirus case curve in #Pakistan continues to flatten at lower levels relative to #India and #Asia.
Riaz Haq said…
More medical supplies from #China reach #Islamabad, including 59 #ventilators, 936kg of #masks, #protective #suits, safety lenses, thermometers & 1720 kg of unstitched cloth for surgical gowns. NDMA will distribute these to all provinces. #PPE #coronavirus

While talking to media, Chairman NDMA Lt General Mohammad Afzal stated that the consignment that arrived on Saturday was received by Minister of Climate Change Zartaj Gul at Islamabad International Airport.

He also said that Pakistan had the capacity to test virus patients across the country for another 75 days. "The supply of goods that arrived from China will be sent out to all small-scale hospitals in Khyber Pakhtunkhwa and other provinces," he said.

The chairman went on to say that all supplies were purchased on the finances allocated by the federal government, and no provincial funds were used for the procurement of the medical relief equipment. “Army chief has also ensured testing facility in 11 army laboratories," he informed reporters.

Another shipment of resources from China was received by NDMA on Friday. The consignment included medical equipment such as PCR testing kits, mobile X-ray machines, Chinese KN95 masks, disposable medical masks and water-impermeable surgical gowns.
Riaz Haq said…
The number of confirmed COVID-19 cases in Pakistan has risen to 5,038 as of 10 April. Increase of 250 new cases in the last 24 hours.
The most affected province due to COVID-19 virus is Punjab 2,425, followed by Sindh 1,318.
The National Disaster Management Authority is dispatching additional Personal Protection Equipment for doctors and health workers of 202 hospitals of Sindh.

More than 1.5 million families will get severely affected if the lockdown continues for two months in Balochistan.
The public sector hospitals of the Islamabad city are again considering extending the closure of Outdoor Patient Departments for one month due to possible high risk of novel coronavirus spread from the facilities, The Nation learnt on Saturday.
The district administration of Rawalpindi has established a 120-bed quarantine facility at Shahbaz Sharif Sports Complex located on Sixth Road.
Minister for Aviation Ghulam Sarwar Khan on Saturday said the government would bring back 4,000 Pakistanis stranded across the world following Covid-19outbreak through special flights.
Chairman National Disaster Management Authority (NDMA) Lieutenant General Muhammad Afzal said Pakistan has the testing facility available for 75-days to diagnose Coronavirus or COVID-19 pandemic disease.
Prime Minister Imran Khan on Saturday said the incentives announced by the central bank for the business community would prevent massive unemployment in the county because of the economic downturn caused by the coronavirus pandemic as the health minister warned against easing restrictions at the current stage of the outbreak.
Riaz Haq said…
#Pakistan Health Chief says #Coronavirus cases fatality rate ‘very low in Pakistan’. Actual #COVID19 cases by April 14 is 5,716 vs prediction of 18,000. Death rate 1.7% vs global avg of 6.2%. Sindh #lockdown very early stage but situation in Punjab better.

Special Assistant to Prime Minister on National Health Services Dr Zafar Mirza on Tuesday said the COVID-19 cases’ fatality rate reported in Pakistan was very low at 1.7% against the global figure of 6.2%.

In a briefing on COVID-19, he said the reason behind low number of deaths in Pakistan as compared to other countries was due to the immediate measures taken by the government to control the outbreak under the supervision of Prime Minister Imran Khan.

He said it was a sign of relief that despite the prediction of 18,000 COVID-19 positive cases in Pakistan by April 14, the reported cases were 5,716 so far, which were two-third lower than the expected trend.
Similarly, the figure of expected deaths was 191 in the country as of Tuesday while the actual deaths reported were 96 so far. He added the government has tried its best to control the disease.

He said although Sindh had taken measures at a very early stage, the situation in Punjab was better. He added the overall steps taken at the national level resulted in better control over the disease.

He, however, said all the countrymen have a role to play in controlling the disease as still there were threats and fluctuation in the figure of daily deaths’ number.

Dr Mirza said the first coronavirus case was reported very late in Pakistan as compared to other countries on February 26, while the first meeting of National Security Council (NSC) was held on March 13, to make major decisions over the situation.
Riaz Haq said…
#SouthAsia has 20% of world’s population but less than 2% of #COVID19 cases. Positive Test Rates Percent: #India (4.36), #Bangladesh (11.43), #Pakistan (8.26) much lower than #Italy (12.69), #US (19.55), #France (34.09). #Sunshine #Heat #Humidity #BCG

Despite being home to one-fifth of the world’s population, South Asia accounts for less than 35,000, or approximately 1.5 per cent, of the 24 lakh coronavirus cases worldwide.

The eight countries, which make up the Indian subcontinent and are part of the South Asian Association for Regional Cooperation (SAARC), include Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka.

While the number of cases in Europe and North America was 14 lakh and 8.8 lakh, respectively, as of 22 April, India had 20,178 cases, Pakistan 9,749, Bangladesh 3,382, Afghanistan 1,092, Sri Lanka 321, Maldives 108, Nepal 42 and Bhutan 6.

Even the positivity rate — the ratio of confirmed cases to total tests conducted — is lower in South Asia. The rates in India (4.36), Bangladesh (11.43), Pakistan (8.26) and Sri Lanka (4.19) are way lower than those for Italy (12.69), US (19.55), France (34.09) and Germany (8.59).

Experts have offered different reasons to explain this disparity — the warmer and more humid weather in the South Asian region tempered the spread of the disease, protection offered by the tuberculosis vaccine bacillus Calmette-Guérin (BCG), a potentially better immune response among those in the Indian subcontinent, and a weaker strain of the virus here.

Some say the explanation could be a lot simpler — South Asian countries have likely implemented efficient physical distancing thanks to a slower first wave of spread within the countries. The nations are also reportedly seeing far lower testing numbers as compared to the rest of the world.

The SAARC countries have the lowest testing rates in the world but that may not fully explain the fewer cases.

India, for instance, conducts just 335 tests per million population whereas the numbers for western are far higher — 7,103 in France, 20,629 in Germany, and 12,659 in the US.

But even in countries of South Asia that have higher testing, the positivity rate has remained low. Bhutan has conducted a total of over 8,700 tests, which translates to 11,000 tests per million people, but has only six confirmed cases. The Maldives is currently conducting 6,871 tests per million with 1.08 positivity.

“At this point in time, no one has an explanation for the low prevalence of cases in this region,” said Sumanth C. Raman, a healthcare domain consultant and a doctor specialising in child health. “Certainly the rate of testing is lower, and that is a very likely contribution to the explanation. But it doesn’t explain the full picture.”

The lockdown may have “shifted the peak from say April to June” but only time will tell if South Asian countries indeed have an advantage, said Shahid Jameel, a virologist who serves as the CEO of The Wellcome Trust/DBT India Alliance, an independent nonprofit that funds health and biomedical research in Indian institutions.

“It (the number of cases), however, has definitely proven the doomsday predictors wrong. They had predicted the number of infected as high as 1-2 crore,” he said.

A major reason for the observed pattern of spread could be the fact that older populations respond poorly to Covid-19, said Madhukar Pai, director of Global Health at McGill University, Canada, and a tuberculosis expert. “Countries with younger populations should have a different epidemic curve because of the age effect, especially for deaths due to Covid-19,” he said.

Younger people have mild or asymptomatic infection and, over time, they will protect others through herd immunity, Pai said.
Riaz Haq said…
One More Reason to Wear a Mask: You’ll Get Less Sick From COVID-19

As more and more states promote face masks as a way to control the spread of COVID-19, the top-line message has been: wear a mask to protect others. While it’s true that most face masks are more effective in preventing you from launching droplets into the air than breathing in already dispersed droplets – that doesn’t mean masks offer no protection to the wearer.

It’s likely that face masks, by blocking even some of the virus-carrying droplets you inhale, can reduce your risk of falling seriously ill from COVID-19, according to Monica Gandhi, MD, an infectious disease specialist at UC San Francisco.

“The more virus you get into your body, the more sick you are likely to get,” she said.

In the latest wave of infections in the U.S., the wider use of masks may be one factor for the lower death rates – along with more testing, younger patients and better treatments – said Gandhi. A greater proportion of these new cases have been mild or asymptomatic, though more data is needed to see if they track geographically with higher rates of mask-wearing.

Worldwide, epidemiological patterns seem to provide a clue. In countries where mask wearing was already commonplace, such as Japan, Taiwan, Thailand, South Korea, and Singapore, and in countries where mask wearing was quickly embraced, such as the Czech Republic, rates of severe illness and death have remained comparatively low.

These epidemiological observations are among the evidence that Gandhi and colleagues cite in a paper in the Journal of General Internal Medicine, in which they propose that masks can lead to milder or asymptomatic infections by cutting down on the dose of virus people take in.

“Masks can prevent many infections altogether, as was seen in health care workers when we moved to universal masking. We’re also saying that masks, which filter out a majority of viral particles, can lead to a less severe infection if you do get one,” said Gandhi. “If you get infected, but have no symptoms – that’s the best way you can ever get a virus.”

The idea that viral dose, also known as viral inoculum, determines the degree of illness is not new, said Gandhi. Descriptions of a dose-mortality curve – how much of a virus is needed to cause death in an animal – were first published in 1938. And after all, the earliest vaccines, which were documented in 16th century China, involved exposing someone to a small amount of smallpox virus to induce mild illness and subsequent immunity.

A small number viral particles is more likely to be quelled by the immune system before they can proliferate, said Gandhi.

Researchers have studied dose dependency experimentally with other viral infections, like the flu. In a study with healthy volunteers, those who received a higher dose of the influenza A virus developed more severe symptoms.

Because the new coronavirus, SARS-CoV-2, is potentially lethal, experiments on masking and disease severity have been necessarily limited to animals. In a hamster study, a surgical mask partition between the cages of infected and uninfected hamsters significantly cut COVID-19 transmission. Fewer hamsters caught the virus and those that did showed milder symptoms.

Tale of Two Cruise Ships
Gandhi believes the viral inoculum theory helps explain an unusual feature of the new coronavirus – what Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Disease, has called its “protean” manifestations.

Early in the year, as COVID-19 spread around the world, infectious disease experts began to notice this strange aspect of the new virus – the extreme variation in its symptoms and severity. Some who tested positive didn’t seem sick at all, some had symptoms of a cold, others lost their sense of taste or developed delirium, and still others suffered severe pneumonia that led to death.

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