Monday, July 13, 2020

The Coronavirus Disease

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Hardi Talwani

Article Title

The Coronavirus Disease

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Global Views 360

Publication Date

July 13, 2020

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Computer generated representation of COVID-19 virions (SARS-CoV-2) under electron microscope

Computer generated representation of COVID-19 virions (SARS-CoV-2) under electron microscope | Source Felipe Esquivel Reed via Wikimedia

Severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) is a novel virus from the family of coronaviruses which causes COVID-19 i.e. Coronavirus Disease-2019. It is the successor of the SARS-CoV-1 which caused the SARS outbreak in the year 2003-2004. This is a positive-sense single-stranded RNA virus which has rapid mutation properties.

The etymology of the name suggests that 'Corona' comes from the Latin word corōna meaning crown, garland, or a wreath. When seen under an Electron Microscope, the virion which has a diameter of 50-200 nanometres looks like the solar corona hence named Coronavirus.

When the virus enters the body; it attaches itself to the binding site or the ACE 2 receptors of healthy lung cells through its spike protein. Then it enters the cell via this attachment and causes apoptosis or cell death. The virus also affects organs other than lungs such as the brain, heart and kidneys. The multiple impact points make it problematic for the researchers to create a vaccine in addition to its rapid mutation properties.

The disease might have a zoonotic origin i.e. the transmission occurs from animals to humans. On comparing the genomic sequences the Human Coronavirus strain is found to be 96% identical to Bat Coronavirus samples and 92% similar to the Pangolins samples. Human transmission of the disease takes place via air droplets when the infected person is coughing, sneezing or talking.

The first cases of this respiratory illness were reported to the World Health Organization (WHO) from Wuhan City, Hubei Province, China, on 31 December 2019. It is the first severe outbreak since the 2009 H1N1 Influenza Pandemic. Initially, it was supposed that the site of origination is Huanan Seafood Wholesale Market but, in May 2020 the negative samples tested, by  Chinese Center for Disease Control and Prevention, from the livestock market suggested that it was the site of the super spreading of the virus.

SARS-CoV-2 is known to have an average reproduction number of 2.2-2.6 which means that, on an average, one infected person can spread the infection to 2-3 people. Although if measures like social distancing are put into use, to reduce the exposure of the infected population, it leads to a significant reduction in transmission rates. The infection fatality rate (IFR) of COVID-19 in various studies till 16th June 2020 was projected to range 0.60% to 1% of infected people . However few studies suggested the IFR as high as 3.6%.

The testing of an individual takes place through a method known as real-time Reverse transcription Polymerization Chain reaction (rRT-PCR). The process of obtaining strains and testing the patients usually involves nasal swabs or sputum swabs; the results come in within a span of a few hours to a couple of days.

Currently, there are no known vaccines available for the virus or any specific antiviral treatments, but there are numerous vaccines in works all over the world to tackle COVID-19. Experts believe that the minimum time required to test a vaccine is 12 to 18 months.

Trials are also going on for the repurposed drugs or the drugs which are useful for treating other diseases and might be capable against COVID-19: Some of these drugs are Hydroxychloroquine, chloroquine, Remdesivir, Dexamethasone, Lopinavir-ritonavir, and Convalescent plasma.

The only current solutions for tackling the pandemic are social distancing, hand wash, hygiene and face masks.

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February 4, 2021 4:52 PM

Randomised Control Trials and the Alleviation of Poverty in India

Abhijit Banerjee and Esther Duflo won the 2019 Nobel Prize in Economics for their “experimental approach in alleviating global poverty”. Their experimental approach encompassed a variety of novel methods to understand and analyse interventions and Randomised Control Trials (RCTs). Their research has been used by policy makers to make informed policy decisions to best help the marginalised.

What are RCTs?

To understand the effect of a policy, intervention, or medicine, decision makers try to measure the efficacy of the treatment. Do deworming pills given to children improve test scores? Does providing chlorinated water improve the health and economic outcomes of villages? These are some causal (read causal, i.e. caused by, not casual) questions researchers are interested in. The best way to analyse causal effects is to randomise the selection of people in the treatment and the control group (for example: children who are given deworming pills versus children who are not given the pills). This random selection of the two groups removes many statistical biases that might affect the results.

RCTs in India:

Many of the RCTs performed by Banerjee and Duflo were in India. They involved short- and long-term impact assessments of various interventions, policies, models, and treatments. We look at a few RCTs implemented in India:

Teacher absenteeism rates:

Troubled by the low attendance rates (or high absence rates) of public-school teachers in India, Duflo assessed the impact of financial incentives on the absence rates of teachers in Rajasthan. The study monitored teacher attendance by cameras, which was tied to a financial incentive if the attendance was high. From a baseline absence rate of 44%, teacher absenteeism in the treatment group fell by 21%, relative to the control group. High teacher attendance caused child test scores to improve too.

COVID-19 and health-seeking behaviour:

In the context of COVID-19, Banerjee tested the effect of sending messages via SMS that promoted health preserving behaviour. The results were very positive. By sending a short, 2.5-minute clip to 25 million randomly selected individuals in West Bengal, the intervention i) found a two-fold increase in symptom reporting to village health workers, ii) increased hand washing rates by 7%, and iii) increased mask-wearing by 2%. While mask-wearing rates increased only marginally, the spillover effects (wearing a mask stops the virus from infecting more people) were moderately high and positive.

Asset Transfers and the Notion of Poverty:

An RCT by Banerjee in West Bengal involving a productive asset transfer accompanied with training found large and persistent effects on monthly consumption and other variables. The treatment group reported 25% higher consumption levels relative to the control group, who did not receive the asset transfer and training. Implications of such RCTs are huge. The notion that the poor are lazy and unwilling to perform strenuous labour is falsified by this RCT. Often, what the poor lack are opportunities that are hard to come by, given their financial status. A small nudge, like the asset transfer, can cause large and positive effects on their well-being.  

Salt fortification to reduce anaemia:

RCTs also help rule out less cost-effective interventions. Duflo and Banerjee evaluated an RCT which distributed fortified salt in 400 villages of Bihar, to reduce the prevalence of anaemia. However, this intervention found no statistically significant impact on health outcomes like anaemia, hemoglobin, etc.  Thus, while RCTs help introduce novel methods of impacting the lives of the poor, they also help in ruling out in-effective measures. A policy maker might try other alternatives to reduce the prevalence of anaemia.

Are RCTs the gold standard?

Maybe. Extrapolating results from a regional RCT to national policies could present problems. Contextuality matters. A study that indicates positive gains for one region might present different, and rather adverse effects for another region. Nation wide effects might not be as prominent as regional results of a single RCT. The good part is that Banerjee and Duflo have a solution. Just perform more RCTs!

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